Vaccines and Global Health: The Week in Review 6 February 2016

Vaccines and Global Health: The Week in Review is a weekly digest  summarizing news, events, announcements, peer-reviewed articles and research in the global vaccine ethics and policy space. Content is aggregated from key governmental, NGO, international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics & Policy in its work: it is not intended to be exhaustive in its coverage. You are viewing the blog version of our weekly digest, typically comprised of between 30 and 40 posts below all dated with the current issue date

.Request an Email Summary: Vaccines and Global Health : The Week in Review is published as a single email summary, scheduled for release each Saturday evening before midnight (EDT in the U.S.). If you would like to receive the email version, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.

pdf version A pdf of the current issue is available here:  Vaccines and Global Health_The Week in Review_6 February 2016

blog edition: comprised of the approx. 35+ entries posted below on 7 February 2016.

Twitter:  Readers can also follow developments on twitter: @vaxethicspolicy.
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Links:  We endeavor to test each link as we incorporate it into any post, but recognize that some links may become “stale” as publications and websites reorganize content over time. We apologize in advance for any links that may not be operative. We believe the contextual information in a given post should allow retrieval, but please contact us as above for assistance if necessary.

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David R. Curry, MS
Executive Director
Center for Vaccine Ethics and Policy
a program of the
– Division of Medical Ethics, NYU Medical School
– Children’s Hospital of Philadelphia Vaccine Education Center
Associate Faculty, Division of Medical Ethics, NYU Medical School

Zika virus [to 6 February 2016]

Zika virus [to 6 February 2016]
Public Health Emergency of International Concern (PHEIC)

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WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
WHO statement
1 February 2016
[Excerpt; Full statement distributed earlier and available here]
Based on the advice of the International Health Regulations (2005) Emergency Committee on Zika virus the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005).

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WHO: Zika situation report – 5 February 2016
Neurological syndrome and congenital anomalies
Read the full situation report :: 6 pages
Summary
:: An Emergency Committee was convened by the Director-General under the International Health Regulations (2005) on 1 February 2016. Following the advice of the Committee, the Director-General announced the recent cluster of microcephaly and other neurologic disorders reported in Brazil to be a Public Health Emergency of International Concern.
:: The Emergency Committee agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All experts agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better.
:: Between January 2014 and 5 February 2016, a total of 33 countries have reported autochthonous circulation of Zika virus. There is also indirect evidence of local transmission in 6 additional countries.
:: The geographical distribution of Zika virus has been steadily increasing since it was first detected in the Americas in 2015. Further spread to countries within the geographical range of competent disease vectors — Aedes mosquitoes — is considered likely.
:: Seven countries have reported an increase in the incidence of cases of microcephaly and/or Guillain-Barré syndrome concomitantly with a Zika virus outbreak.
:: The global prevention and control strategy launched by WHO is based on surveillance, response activities, and research.

WHO: Zika: Research in emergencies
February 2016 — To improve timely access to data in the context of a public health emergency, the WHO Bulletin is implementing a new data-sharing and reporting protocol. All research manuscripts relevant to the Zika epidemic will be posted online in the “Zika Open” collection within 24 hours.

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CDC issues Interim Guidelines for Preventing Sexual Transmission of Zika Virus and Updated Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure
Friday, February 5, 2016,
CDC has issued new interim guidance on preventing sexual transmission of Zika virus after confirming through laboratory testing, in collaboration with Dallas County Health and Human Services, the first case of Zika virus infection in a non-traveler in the continental United States during this outbreak.

Although sexual transmission of Zika virus infection is possible, mosquito bites remain the primary way that Zika virus is transmitted. Because there currently is no vaccine or treatment for Zika virus, the best way to avoid Zika virus infection is to prevent mosquito bites.

Based on what we know now, CDC is issuing interim recommendations to prevent sexual transmission of Zika virus. To date, there have been no reports of sexual transmission of Zika virus from infected women to their sex partners. CDC expects to update its interim guidance as new information becomes available….

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CDC adds 2 destinations to interim travel guidance related to Zika virus – Media Statement
WEDNESDAY, FEBRUARY 3, 2016
CDC is working with other public health officials to monitor for ongoing Zika virus‎ transmission. Today, CDC added the following destinations to the Zika virus travel alerts: Jamaica and Tonga. CDC has issued a travel alert (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing. For a full list of affected countries/regions: http://www.cdc.gov/zika/geo/index.html. Specific areas where Zika virus transmission is ongoing are often difficult to determine and are likely to continue to change over time..

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Sanofi Pasteur to leverage its strong vaccine legacy in hunt for Zika vaccine
February 2, 2016
– Building on the company’s successful history in developing vaccines against similar viruses, most recently the introduction of Dengvaxia® against dengue, Sanofi Pasteur is launching a Zika vaccine project –

Lyon, France – February 2, 2016 -Sanofi Pasteur, the vaccines division of Sanofi, announced today that it has launched a vaccine research and development project targeting the prevention of Zika virus infection and disease.

Sanofi Pasteur leads the vaccine field for viruses in the same family as Zika virus (ZIKV), with licensed vaccines against Yellow Fever, Japanese Encephalitis and, most recently, Dengue. Importantly, Sanofi Pasteur’s expertise and established R&D and industrial infrastructure for the newly licensed vaccine for dengue, Dengvaxia®, can be rapidly leveraged to help understand the spread of ZIKV and potentially speed identification of a vaccine candidate for further clinical development.

“Our invaluable collaborations with scientific and public health experts, both globally and in the regions affected by the outbreaks of ZIKV, together with the mobilization of our best experts will expedite efforts to research and develop a vaccine for this disease,” said Dr. John Shiver, Global Head of R&D, Sanofi Pasteur.

The ZIKV is closely related to Dengue; it belongs to the same Flavivirus genus, is spread by the same species of mosquito and has a similar acute clinical presentation. Common symptoms caused by a Zika infection include fever, rash, joint swelling, conjunctivitis and headaches. However, there is a growing body of evidence linking Zika infection in pregnant women with an increased risk of a severe congenital complication at birth called microcephaly. Normally a rare condition, microcephaly results in an abnormally small head impairing brain development.

“Sanofi Pasteur is responding to the global call to action to develop a Zika vaccine given the disease’s rapid spread and possible medical complications,” says Dr. Nicholas Jackson, Global Head of Research for Sanofi Pasteur who will be driving the new ZIKV vaccine project. “In addition to the serious possibility of congenital complications associated with Zika, investigations are also underway to assess another reported connection between Zika and a dangerous neurological disorder”.

Until recently, ZIKV was considered a rare and seemingly benign virus. However in May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed ZIKV infection in Brazil, and since then it has spread across the Americas. In the United States, authorities have reported a locally transmitted case of Zika in Puerto Rico, with reports of cases in continental United States in returning travelers.

At a briefing session during the 138th Executive Board of the World Health Organization (WHO), the WHO Director General, Dr. Margaret Chan, stated that the WHO is deeply concerned about ZIKV for four main reasons:

:: the possible association of infection with birth malformations and neurological syndromes;
:: the potential for further international spread given the wide geographical distribution of the mosquito vector;
:: the lack of population immunity in newly affected areas;
:: absence of vaccines, specific treatments, and rapid diagnostic tests.

In addition, the Centers for Disease Control and Prevention (CDC) have issued travel recommendations for pregnant women to post-pone travel to countries in Latin America and the Caribbean where ZIKV transmission is ongoing.

Presently there is no vaccine or specific treatment for Zika. Vector control remains an important means of potentially controlling the mosquitoes responsible for spreading Zika.

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Pfizer, J&J, Merck evaluating technologies for Zika vaccine
Reuters Wed Feb 3, 2016

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Bharat Biotech says working on two possible Zika vaccines
Reuters Wed Feb 3, 2016

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Takeda Assembles Team to Evaluate Zika Vaccine Possibilities
Bloomberg Business February 2, 2016

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NIH [to 6 February 2016]
http://www.nih.gov/news/releases.htm
February 5, 2016
NIH seeks research applications to study Zika in pregnancy, developing fetus
New effort seeks to understand virus’ effect on reproduction, child development.

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IOM / International Organization for Migration [to 6 February 2016]
http://www.iom.int/press-room/press-releases
02/05/16
IOM: Migrants Must Be Included in Zika Virus Response Plans
Switzerland – IOM DG William Lacy Swing has called on governments to include migrants and mobile populations in Zika Virus preparedness and response plans.

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UN OHCHR Office of the United Nations High Commissioner for Human Rights [to 6 February 2016]
http://www.ohchr.org/EN/NewsEvents/Pages/media.aspx?IsMediaPage=true

5 February 2016
Upholding women’s human rights essential to Zika response – Zeid
GENEVA – Upholding women’s human rights is essential if the response to the Zika health emergency is to be effective, UN High Commissioner for Human Rights Zeid Ra’ad Al Hussein said Friday, adding that laws and policies that restrict access to sexual and reproductive health services in contravention of international standards, must be repealed and concrete steps must be taken so that women have the information, support and services they require to exercise their rights to determine whether and when they become pregnant.

“Clearly, managing the spread of Zika is a major challenge to the governments in Latin America,” Zeid said. “However, the advice of some governments to women to delay getting pregnant, ignores the reality that many women and girls simply cannot exercise control over whether or when or under what circumstances they become pregnant, especially in an environment where sexual violence is so common.”

“In Zika-affected countries that have restrictive laws governing women’s reproductive rights, the situation facing women and girls is particularly stark on a number of levels,” the UN Human Rights Chief said. “In situations where sexual violence is rampant, and sexual and reproductive health services are criminalized, or simply unavailable, efforts to halt this crisis will not be enhanced by placing the focus on advising women and girls not to become pregnant. Many of the key issues revolve around men’s failure to uphold the rights of women and girls, and a range of strong measures need to be taken to tackle these underlying problems.”

The World Health Organization has declared a Public Health Emergency of International Concern amid concerns of a possible association between upsurges in reported cases of Zika virus disease and of microcephaly in Latin America. A causative link between Zika and microcephaly (babies born with abnormally small heads), and Zika and Guillain-Barré Syndrome (a neurological condition), is still under investigation.

Amid the continuing spread of the Zika virus, authorities must ensure that their public health response is pursued in conformity with their human rights obligations, in particular relating to health and health-related rights.

“Upholding human rights is essential to an effective public health response and this requires that governments ensure women, men and adolescents have access to comprehensive and affordable quality sexual and reproductive health services and information, without discrimination,” Zeid said, noting that comprehensive sexual and reproductive health services include contraception — including emergency contraception — maternal healthcare and safe abortion services to the full extent of the law.

“Health services must be delivered in a way that ensures a woman’s fully informed consent, respects her dignity, guarantees her privacy, and is responsive to her needs and perspectives,” he added….

EBOLA/EVD [to 6 February 2016]

EBOLA/EVD [to 6 February 2016]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

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Ebola Situation Report – 3 February 2016
No new confirmed cases reported.
[Excerpt from Summary]
:: With guidance from WHO and other partners, ministries of health in Guinea, Liberia, and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors of EVD, and enable those individuals to take any necessary precautions to prevent infection of their close contacts. Over 300 male survivors in Liberia have accessed semen screening and counselling services.

:: To achieve the second key objective of the phase 3 response framework of managing residual Ebola risks, WHO has supported the implementation of enhanced surveillance systems in Guinea, Liberia, and Sierra Leone to enable health workers and members of the public to report any case of febrile illness or death that they suspect may be related to EVD.

In the week to 31 January, 1063 alerts were reported in Guinea from all of the country’s 34 prefectures, with the vast majority of alerts (1060) reports of community deaths. Over the same period 9 operational laboratories in Guinea tested a total of 346 new and repeat samples (14 samples from live patients and 332 from community deaths) from 17 of the country’s 34 prefectures.

In Liberia, 1062 alerts were reported from all of the country’s 15 counties, most of which (925) were for live patients. The country’s 5 operational laboratories tested 1003 new and repeat samples (807 from live patients and 196 from community deaths) for Ebola virus over the same period.

In Sierra Leone 1287 alerts were reported from the country’s 14 districts. The vast majority of alerts (1071) were for community deaths. 1059 new and repeat samples (76 from live patients and 983 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period…

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IOM / International Organization for Migration [to 6 February 2016]
http://www.iom.int/press-room/press-releases
02/05/16
IOM Guinea Supports Psychosocial, Socio-economic Recovery of Ebola Survivors
Guinea – IOM has launched a programme to distribute cash grants to Ebola survivors as part of community-led projects in Boke in the northwestern part of the country.

POLIO [to 6 February 2016]

POLIO [to 6 February 2016]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 3 February 2016
:: There are ten weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more here.
:: The WHO Executive Board met last week, recognising progress made in 2015 and renewing their commitment to polio eradication. Read more here.
:: For the first time in history, Africa has had 4-months without any wild or circulating vaccine-derived poliovirus cases, nor any environmental positive sample.

Selected content from country-level reports
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, with onset of paralysis on 31 December in Peshawar, Khyber Pakhtunkhwa. The total number of WPV1 cases for 2015 is now 54, compared to 305 reported for 2014 by this time last year. A total of 306 cases reported onset in Pakistan in 2014.
:: Four new WPV1 environmental positive samples were detected in the past week. Two were in Sindh province, in Hyderabad and Karachi Gulshan-e-Iqbal with collection dates of 5 January and 18 January respectively. The other two were isolated from Peshawar, Khyber Pakhtunkhwa and in Kabdullah, Balochistan, with collection dates of 11 January and 15 January respectively.
:: Sub-National Immunization Days (SNIDs) are planned in February using tOPV. National Immunization Days (NIDs) are planned in March using tOPV.

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WHO: Inactivated polio vaccine introduced in Iraq
Baghdad, 3 February 2016 – Immunization is one of the most important preventive health actions in children’s lives as it provides protection against the most dangerous childhood diseases.

Iraqi children are set to receive protection from 6 major childhood diseases after the country’s introduction of the inactivated polio vaccine (IPV) as part of its national immunization programme. It is given to children at the age of 2 months, 4 months and 6 months. The IPV is introduced as a combination vaccine that contains antigens against polio, diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae type B (the bacteria that causes meningitis, pneumonia and otitis). Introduction of IPV is one of the key pillars in the global polio eradication effort, which seeks to completely eliminate this terrible disease. To date, the polio virus has been eliminated from every country except for some small areas of Afghanistan and Pakistan…

…”WHO acknowledges the Government of Iraq’s commitment to childhood vaccination and supports the introduction of IPV-containing vaccine as part of the Endgame Strategic Plan for the Global Polio Eradication Initiative,” said acting WHO Representative Altaf Musani.

“Polio eradication activities have pioneered multiple innovations and demonstrated that health service can, and must reach every child. The introduction of IPV into the Iraq public health structure is one step forward to ensure that Iraqi children are protected from polio, and also that they have equitable access to all health services,” added Peter Hawkins, UNICEF Country Representative in Iraq.

In May 2015, Iraq was removed from the list of infected countries, a landmark achieved through the continued support of WHO, UNICEF and multiple partners in Global Polio Eradication Initiative.

MERS-CoV [to 6 February 2016]

MERS-CoV [to 6 February 2016]

Middle East respiratory syndrome coronavirus (MERS-CoV) – Saudi Arabia
2 February 2016
Between 22 and 27 January 2016, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 5 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection…

…WHO remains vigilant and is monitoring the situation. Given the lack of evidence of sustained human-to-human transmission in the community, WHO does not recommend travel or trade restrictions with regard to this event. Raising awareness about MERS-CoV among travellers to and from affected countries is good public health practice.

WHO & Regionals [to 6 February 2016]

WHO & Regionals [to 6 February 2016]

Zero tolerance for female genital mutilation
February 2016 — More than 125 million girls and women alive today have undergone some form of female genital mutilation. WHO opposes all forms of female genital mutilation, which can cause a wide range of both short- and long-term health risks, and which is a grave violation of the human rights of women and girls.

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Weekly Epidemiological Record (WER) 5 February 2016, vol. 91, 5 (pp. 53–60) – Contents
53 Schistosomiasis: number of people treated worldwide in 2014

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Disease Outbreak News (DONs)
No new reports posted.

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:: WHO Regional Offices
WHO African Region AFRO
:: Dr Moeti urges vigilance amid spread of Zika virus
Brazzaville, 4 February 2016 – Countries from the WHO African Region have been urged to be watchful and prepare to tackle any signs of the Zika virus disease. The call was made by Dr Matshidiso Moeti, the WHO Regional Director for Africa. “The most effective forms of prevention are reducing mosquito populations by eliminating their potential breeding sites, and using personal protection measures to prevent mosquito bites. I call upon countries in the Region to strengthen vector control, surveillance and laboratory detection of Zika virus disease and neurological complications, as well as public awareness”, said Dr Moeti..

:: Delegates adopted recommendations on Exchange of Best Practices to Reaching Every District/Community, equity and integration of child survival interventions in ESA –
Cape Town, 29 January 2016 – The first ever workshop on Exchange of Best Practices to Reaching Every District/Community (RED/REC), equity and integration of child survival interventions in East and Southern African (ESA) jointly organized by WHO, UNICEF and JSI, MCSP/USAID, ended with delegates agreeing on recommendations to address inequities in coverage of child survival interventions and make progress towards achieving Universal Health Coverage.
One hundred forty six (146) delegates drawn from the Ministries of Health child health and immunization programmes, partner organizations namely, WHO, UNICEF, JSI/MCSP, CDC, Bill and Melinda Gates Foundation, Sabin Vaccine Institute, the Gavi Alliance and PATH agreed for WHO and partners to develop a framework for integration of child survival interventions to address inequities and make progress towards achieving Universal Health Coverage. Additionally EPI managers were called upon to use findings and recommendations from the workshop to brief their respective ministers in preparation for the impending Ministerial Conference on Immunization in Africa scheduled to take place from February 24-25 in Addis Ababa, Ethiopia…
…The meeting agreed on the following recommendations:
…Countries to further review the best practices identified, adapt and plan for use in the national context, and develop an operation framework based on the integrated RED/REC strategic approach
…The African Region and partners to adapt the current RED strategic approach guidelines to include the expansion of RED components with equity and integration
…EPI managers to brief their respective ministers on the need to capitalize on the gains and expand RED approach to address inequities before the ministerial meeting
…WHO and partners should develop a regional framework for equitable and integrated delivery of child survival interventions in order to address inequities and make progress towards achieving Universal Health Coverage…

WHO Region of the Americas PAHO
:: PAHO Director calls for political commitment and more resources to fight Zika in the Americas (02/03/2016)
:: PAHO Director to brief ministers of health on microcephaly/Zika in the Americas (02/03/2016)
:: Films with smoking scenes should be rated “R” to protect children from tobacco addiction (02/01/2016)

WHO South-East Asia Region SEARO
:: WHO calls for preventive measures against Zika virus disease
New Delhi, 02 February 2016: WHO South-East Asia Regional Director Dr Poonam Khetrapal Singh is urging countries in the Region to strengthen surveillance and take preventive measures against the Zika Virus disease which is strongly suspected to have a causal relation with clusters of microcephaly and other neurological abnormalities.
WHO has declared the recent clusters of microcephaly and other neurological abnormalities reported in the Americas region as a Public Health Emergency of International Concern.
The Zika virus is of concern in the WHO South-East Asia Region as the Aedes aegyptii mosquito, responsible for its spread, is found in many areas and there is no evidence of immunity to the Zika virus in many populations of the Region.
In the past sporadic Zika virus cases were reported from Thailand and Maldives…

WHO European Region EURO
:: Preventing cancer – The European code against cancer 04-02-2016
:: Statement – WHO urges European countries to prevent Zika virus disease spread now 03-02-2016

WHO Eastern Mediterranean Region EMRO
:: WHO calls on countries of the Region to take steps to prevent Zika virus
Cairo, 31 January 2016 — As the Zika virus outbreak continues to spread reaching 24 countries in the Americas (as of 27 January), WHO’s Regional Director for the Eastern Mediterranean Dr Ala Alwan is calling on governments to work together to keep the Region protected.

WHO Western Pacific Region
No new digest content identified.

CDC/ACIP [to 6 February 2016]

CDC/ACIP [to 6 February 2016]
http://www.cdc.gov/media/index.html
http://www.cdc.gov/vaccines/acip/

[see Zika coverage above which includes CDC briefing content]

ACIP Meeting – February 24, 2016 (Wednesday only)
Meeting Webcast Instructions
Registration is NOT required to watch the live meeting webcast or to listen via telephone.
DRAFT AGENDA[2 pages] (as of January 25)
Deadline for registration:
Non-US Citizens: February 3, 2016
US Citizens: February 10, 2016

More than 3 million US women at risk for alcohol-exposed pregnancy- Press Release
Tuesday, February 2, 2016

MMWR Weekly – February 5, 2016 / Vol. 65 / No. 4
http://www.cdc.gov/mmwr/index2015.html
:: National Black HIV/AIDS Awareness Day — February 7, 2016
:: Disparities in Consistent Retention in HIV Care — 11 States and the District of Columbia, 2011–2013
:: HIV Testing and Service Delivery Among Black Females — 61 Health Department Jurisdictions, United States, 2012–2014
:: Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years — United States, 2016
:: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2016

Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014
FEBRUARY 5, 2016
Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low. Data for 2014 for adult vaccination coverage in the United States indicate that aside from a few minor improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013. This report represents the first comprehensive release of adult vaccination coverage data to include assessment of associations with expanded data on demographic characteristics of respondents including access to health care. These findings can be used by public health practitioners, adult vaccination providers, and the general public to better understand factors that contribute to low vaccination and modify strategies and interventions to improve vaccination coverage.