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1 Arizona Vaccine News Karen Lewis, M.D. Medical Director Arizona Vaccine News Karen Lewis, M.D. Medical Director Arizona Immunization Program Office April 12, 2021 Douglas A. Ducey | Governor Cara M. Christ | MD, MS, Director _____________________________________________________________________________________________ 150 North 18th Avenue, Suite 120, Phoenix, AZ 85007-3247 P | 602-364-3630 F | 602-364-3285 W | azdhs.gov Health and Wellness for all Arizonans Newsletter Topics COVID-19 VACCINATIONS • Vaccine Effectiveness of mRNA COVID-19 Vaccines in Healthcare Personnel • How Well Do COVID-19 Vaccines Protect Against Variants? • Delayed Local Reactions to mRNA COVID-19 Vaccine • Overcoming (COVID-19) Vaccine Hesitancy Through Understanding and Trust • Can Colleges and Universities Require Student COVID-19 Vaccination? • Insights for Future Pediatric COVID-19 Vaccine Campaigns • World Health Organization COVID-19 Vaccine Global Clinical Trials Tracker VACCINES AND VACCINE-PREVENTABLE DISEASES • Decrease in Childhood Vaccinations Amid COVID-19 Pandemic • Parental Hesitancy About Routine Childhood and Influenza Vaccinations • Influenza Vaccine Effective Against Pediatric Hospitalizations and Emergency Visits • No Increased Risk of Stillbirth in Pregnant Women who Received Influenza or Tdap Vaccines • Recent History of Measles Outbreaks in Arizona • Cost of a Large Measles Outbreak in the U.S. • Updated CDC Compilation of Meningococcal Vaccination Recommendations • Declines in 4vHPV Vaccine Type Infections Among Females after Introduction of HPV Vaccine • More Provider Recommendations for HPV Vaccine Yet Parents More HPV-Vaccine Hesitant • Additional Evidence that HPV Vaccination Decreases Cervical Cancer • 9vHPV Vaccine Is Now FDA-Approved for Prevention of Oropharyngeal Cancer 1 VACCINES AND VACCINE-PREVENTABLE DISEASES (cont.) • Map of Cases of Wild Polio and Circulating Vaccine-Derived Polioviruses • Increases in Paralytic Polio in Afghanistan, 2019-2020 • Oral Cholera Vaccine Is Now FDA-approved to Include Pediatric Ages • Recommendations on Ebola Vaccine Use for Pre-exposure Vaccination VACCINE HISTORY • The Journey from Cowpox Vaccine to mRNA vaccines RESOURCES • Recent Immunization Action Coalition Vaccine Handouts • Updated CDC Infographic: HPV is the Best Protection Against 6 Types of Cancer • CDC COVID-19 Vaccine Resources • Arizona Department of Health Services COVID-19 Vaccine Resources • Translations of the FDA COVID-19 Vaccine Fact Sheets for Recipients and Caregivers • CDC Adult Vaccine Assessment Tool COVID-19 VACCINATIONS Real-world Vaccine Effectiveness of mRNA COVID-19 Vaccines in Healthcare Personnel • mRNA vaccine effectiveness in fully immunized people (≥14 days after the second dose) was 90% against SARS-CoV-2 infections. • Vaccine effectiveness of partially immunized people (≥14 days after first dose but before the second dose) was 80%. See Morbidity and Mortality Weekly Report (MMWR), April 2, 2021 for more details. How Well Do COVID-19 Vaccines Protect Against Variants? • One reason SARS-CoV-2 is developing variants and will continue to do so is because relatively few people globally have been vaccinated. • The more transmissible or deadlier “variants of concern” contain mutations in the spike protein, creating vaccine efficacy concerns. • The South African trials of several vaccine manufacturers found lower vaccine efficacy compared with trials in countries where the B.1.351 variant was not dominant. • Although neutralization titers against the B.1.351 variant are lower than against other SARS-CoV-2 viruses, the antibody levels still may be adequate for protection. • Manufacturers are developing vaccines to deal with variants that escape coverage by first-generation COVID-19 vaccines. • CDC advises that even after being fully vaccinated, people should continue to use masks and socially distance in public places—in part because they could still unknowingly become infected and, although asymptomatic, transmit SARS-CoV-2 to people who have not yet received their shots. See JAMA, March 17, 2021. 2 Delayed Local Reactions to mRNA COVID-19 Vaccine • Delayed-onset local reactions have been reported after mRNA vaccination in some individuals beginning a few days after through the second week after the first dose. These reactions are sometimes quite large. • People with only a delayed-onset local reaction (e.g., erythema, induration, pruritus) around the injection site area after the first vaccine dose do not have a contraindication or precaution to the second dose. • These individuals should receive the second dose using the same vaccine product as the first dose at the recommended interval, preferably in the opposite arm. The above guidance is from “Interim Clinical Considerations for COVID-19 Vaccines Currently Authorized for Use in the United States.“ • Also see NEJM, April 1, 2021 for pictures of delayed skin reactions to Moderna vaccine. Overcoming (COVID-19) Vaccine Hesitancy Through Understanding and Trust • Just scientific vaccine messaging is not enough to overcome vaccine hesitancy. • Before attempting to persuade, try to understand the reasons for hesitancy. • Empathy is an essential tool in dealing with people’s fears about vaccines. See New England Journal of Medicine (NEJM), April 8, 2021. Can Colleges and Universities Require Student COVID-19 Vaccination? • There is no federal guidance on whether colleges and universities can require COVID-19 vaccination. • However, there is a well-established practice of universities mandating that students receive specified vaccines for other diseases as a condition of attendance, and vaccine exemptions are often hard to obtain. See the Harvard Law Review Blog, March 15, 2021. Past Vaccine Campaigns Give Insights for Future Pediatric COVID-19 Vaccine Campaigns • Past public health campaigns to support pediatric vaccinations have promoted polio, measles, mumps, and rubella vaccines. • Trust, access, and equity will be needed in addition to careful scientific data. • Even with safe and effective vaccines, targeted disinformation about a safe and effective vaccine can endanger public health. See NEJM, February 18, 2021. World Health Organization (WHO) COVID-19 Vaccine Global Clinical Trials Tracker • Eighty-five COVID-19 vaccines are in clinical trials and 184 are in pre-clinical trials. • The WHO tracks information about these vaccines and updates data twice weekly. See the data at WHO’s Draft landscape and tracker of COVID-19 candidate vaccines 3 VACCINES AND VACCINE-PREVENTABLE DISEASES Decrease in Childhood Vaccinations Amid COVID-19 Pandemic • CDC’s public sector vaccine ordering shows a 14% drop in 2020-2021 compared to 2019, and measles vaccine ordering is down by more than 20%. • CDC is asking healthcare providers to get children caught up on recommended vaccines. • Once COVID-19 vaccine use is approved for use in children, catching up on missed vaccines will become more challenging since current CDC recommendations are that there should be a 14-day period between COVID-19 vaccines and other vaccines. Parental Hesitancy About Routine Childhood and Influenza Vaccinations • Almost 1 in 15 US parents are hesitant about routine childhood vaccines. • Over one in 4 are hesitant about influenza vaccine. o Only 1 in 4 believe that influenza vaccine is effective. • One in 8 parents are concerned about vaccine safety for both routine childhood and influenza vaccines. See Pediatrics, July 2020 Influenza Vaccine Effective Against Pediatric Hospitalizations and Emergency Visits • Vaccine effectiveness was estimated for the 2018-2019 U.S. influenza season that had both influenza A(H1N1)pdm09 and antigenically drifted influenza A(H3N2) viruses. • Influenza vaccine reduced pediatric influenza A-associated hospitalizations and emergency department visits by 40%-60% despite a drifted A(H3N2) strain. See Pediatrics, November 2020. No Increased Risk of Stillbirth in Pregnant Women who Received Influenza or Tdap Vaccines • Using the Vaccine Safety Datalink, a case-control study looked at the risk between influenza or Tdap vaccination and stillbirths. • There was no significant association between influenza vaccination during pregnancy and stillbirths (adjusted odds ratio=0.95) and no significant association between Tdap vaccination during pregnancy and stillbirths (aOR=0.96). See the abstract in Obstetrics and Gynecology, December 2021. Updated CDC Compilation of Meningococcal Vaccination Recommendations • Replaces all previously published CDC reports and policies on meningococcal vaccines. • Guidelines for routine adolescent meningococcal vaccines. • Guidance on when to give meningococcal booster doses, including new recommendations for administration of booster doses of serogroup B meningococcal (MenB) vaccine for persons at increased risk for serogroup B meningococcal disease. • For people who are at high risk for invasive meningococcal disease, quadrivalent (ACWY) meningococcal vaccination is needed for people ages > 2 months, and also MenB vaccination for people ages > 10 years old. See MMWR (RR-9), September 25, 2020. 4 Recent History of Measles Outbreaks in Arizona • Fourteen measles cases were linked to a traveler from Europe in 2008. o The calculated cost just in two hospitals (excluding state and local health department costs, healthcare provider costs, and family loss of revenue due to quarantining) was almost $800,000. Journal of Infectious Diseases, June 1, 2011. • Five cases were linked to a Disneyland-related outbreak in 2015, four of these in unvaccinated people from the same family. ADHS Director’s Blog, January
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