# Presentation: 522115

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Surveillance Overview**

**Graphics subject to change.**
**This material is in the public domain.**

## Program Objectives

**Identify 3 main levels of the national surveillance system for vaccine-preventable diseases**
**Locate the case definitions for nationally notifiable diseases**
**List the critical information to collect for each reported case of the disease**
**Describe the concept of surveillance indicators**

## Course Text and Reference Material

**Surveillance of Vaccine-Preventable Diseases**
**3****rd**** edition (2002)**
**Available online at**
**http://www.cdc.gov/vaccines/pubs/surv-manual/default.htm**

**Revised edition expected to be available in early 2008**

## Uses of Surveillance Data

**Disease control activities**

**Local**

## CDC Compendium of Case Definitions for Public Health Surveillance

**http://www.cdc.gov/epo/dphsi/casedef/index.htm**

## Critical Data Elements

**Demographic data**
**Clinical data**
**Vaccination history**
**Laboratory test results**

## Chain of Transmission

**Index**
**Case**

**Source**

**Secondary**

## Uses of Surveillance Data

**Evaluate the effectiveness of disease control programs**
**Formulate and evaluate immunization policy**

**State**

## Disease in an UnvaccinatedPerson

**Whether the person was vaccinated**
**If not, why not?**
**Missed opportunities to vaccinate?**
**Is there a more widespread problem?**

## Uses of Surveillance Data

**Formulate national immunization policy**
**Evaluate the effectiveness of immunization programs**
**Evaluate the effectiveness of vaccines**
**Document the impact of national immunization efforts**

**National**

## Surveillance Requirements

**Baseline of reported disease**
**Complete reporting is not essential**
**Year-to-year consistency**
**Aggregate reporting**

**Prevaccine Era**

## Surveillance Requirements

**Enhanced surveillance**
**Document vaccine impact**
**Evaluate effectiveness**
**Monitor progress toward disease elimination**

**Disease Control**

## Enhanced Surveillance

**Individual case investigations**
**Vaccination status**
**Laboratory confirmation**
**Highly specific case definitions**

## Critical Data Elements To Collect

**Demographic information**
**Clinical data**
**Laboratory data**
**Vaccination status**

## Surveillance Indicators

**Developed to assess the quality of national surveillance**
**The ability of our surveillance system to identify all cases**
**Assess investigative effort and the completeness of epidemiologically important surveillance data **

## Surveillance Indicators for Measles and Rubella

**Completeness of data**
**Timeliness of reporting**
**Proportion of cases that are laboratory confirmed**
**Proportion of cases that have an imported source**

## Surveillance Indicators for Haemophilus influenzae

**Timeliness and completeness of case information for children younger than 5 years of age**
**vaccination history**
**serotype**
**Incidence of non-type b disease among children younger than 5 years of age**

## Surveillance Indicators for Pertussis

**Timliness and completeness of epidemiologic, especially vaccination history**
**Proportion of clinically compatible cases that have laboratory testing**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Pertussis**

**Graphics subject to change.**
**This material is in the public domain.**

## Pertussis, 1980-2006

**Pertussis, 1980-2006**

**Year**

## Pertussis-Containing Vaccines

**DTaP**
**3 vaccines licensed for use in infants and children (6 weeks through 6 years)**
**2 combination vaccines that contain pertussis antigens**
**Tdap**
**2 vaccines licensed for use in adolescents and adults (10 years through 64 years)**

## Differences Among AcellularPertussis Vaccines

**Contain different components**
**Different amounts of these components**
**Components are made by different processes**
**Adolescent and adult versions have reduced quantities of many of the components**

## Pertussis Vaccination Recommendations

**Children**
**DTaP series for all children 6 weeks through 6 years of age**
**Adolescents**
**Single dose of Tdap is recommended  for all adolescents 11 and 12 years  of age and for older adolescents **
**Single dose of Tdap is recommended  for older adolescents (13 through 18 years) who have not yet received a dose of Tdap**
**Adults**
**Single dose of Tdap vaccine (Adacel only) to replace the next dose of adult Td vaccine**

## Pertussis Laboratory Confirmation

**Isolation of Bordetella pertussis from a clinical specimen**
**Positive polymerase chain reaction  assay (PCR)**
**Direct fluorescent antibody (DFA) testing should NOT be used (low sensitivity and variable specificity)**

## Bordetella pertussis Culture

**Cultures most often positive if the nasopharyngeal swab is obtained within the first week of cough onset**
**Beyond the first 3 weeks of illness  the organism is recovered less often**
**Demonstration video of NP swab technique available on the broadcast updates and resources webpage**
**   ****www.cdc.gov/vaccines/ed/surv07/surv07-resources.htm**

## PCR Testing

**Widely available**
**Rapid, sensitive, and specific**
**Some PCR assays have not been completely reliable**
**Cultures should continue to be performed even if PCR tests are used**

## Critical Data for Pertussis Case Investigation

**Demographic information**
**Clinical data**
**Complications**
**Vaccination history**
**Date**
**Vaccine type**
**Manufacturer**
**Lot number  **

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

***Haemophilus influenzae***

**Graphics subject to change.**
**This material is in the public domain.**

## Haemophilus influenzae

**Encapsulated or unencapsulated**
**Capsule composed of polysaccharide**
**Six antigenically distinct types designated by the letters a through f**

## Haemophilus influenzae type b (Hib)

**Estimated 20,000 cases of invasive Hib disease annually among children younger than 5 years of age**
**Leading cause of bacterial meningitis**
**~2/3 of cases among children younger than 18 months of age**

**Prevaccine era - U.S.**

## Invasive Haemophilus influenzae Disease 
Among Children <5 Years* - U.S., 1990-2005

**Invasive Haemophilus influenzae Disease **
**Among Children <5 Years* - U.S., 1990-2005**

**Year**

***Calculated from nine active laboratory-based surveillance areas**

## Haemophilus influenzae Serotyping

**Should be performed on EVERY isolate  of *****Haemophilus influenzae***** from a normally sterile site**
**Only way to determine if an isolate is type b (only serotype preventable by vaccination)**

## Critical Data for Haemophilus influenzae Case Investigation

**Demographic information**
**Clinical data**
**clinical syndrome**
**dates of hospitalization**
**date of first positive culture**
**outcome of the illness**
**Results of laboratory testing**
**serotype**
**body fluid source**
**antibiotic susceptibility **

## Critical Data for Haemophilus influenzae Case Investigation

**Vaccination status**
**date**
**manufacturer**
**lot number**
**Risk factors for Hib disease**
**child care**
**prematurity**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Pneumococcal Disease**

**Graphics subject to change.**
**This material is in the public domain.**

## Streptococcus pneumoniae

**Gram-positive bacteria**
**More than 90 known serotypes**
**Polysaccharide capsule is an important virulence factor**
**Capsular type-specific antibody is protective**

## Invasive PneumococcalDisease

**Bacteremia most common clinical presentation among children younger than 2 years**
**Most common cause of bacterial meningitis in the U.S.**
**Highest rate of meningitis among children younger than 2 years**

## Pneumococcal DiseaseIncidence by Age Group - 1998

## Children at Increased Risk of Invasive Pneumococcal Disease

**Functional or anatomic asplenia **
**Sickle cell disease**
**HIV infection**
**Out-of-home group child care**
**Certain racial and ethnic groups**

## Active Bacterial Core Surveillance (ABCs)

**Core component of the Emerging Infections Program Network (EIP)**
**Conducted at 10 EIP sites**
**Represent a population of over 38 million**
**Managed by staff in the National Center for Infectious Diseases**

## Surveillance Objectives: Streptococcus pneumoniae

**Measure the burden of invasive pneumococcal disease among persons of all ages**
**Track emerging antibiotic resistance**
**Study the impact of pneumococcal vaccines**

## Surveillance Objectives: Neisseria meningitidis

**Provide baseline data related to the meningococcal conjugate vaccine**
**Evaluate vaccine impact on disease burden, herd immunity, and molecular epidemiology**
**Determine appropriate verification and validation criteria for current and potential serogrouping methods **

## Invasive Pneumococcal Disease(IPD) in the United States

## Reporting IPD Among ChildrenYounger Than 5 Years

**Isolates causing IPD from children younger than 5 years of age that are drug resistant should be reported ONLY as DRSP**
**Isolates susceptible to antibiotics, or with unknown susceptibility, should be reported ONLY as IPD (not drug resistant)**

## Critical Data for Streptococcuspneumoniae Case Investigation

**Core data**
**demographic**
**clinical**
**risk factors**
**vaccination history**

## Serotying no longer routinely available through CDC
States should consider developing serotyping capability
PCR serotyping protocol available at
 www.cdc.gov/ncidod/biotech/strep/prc.htm

**States should consider developing serotyping capability**
**PCR serotyping protocol available at**
** ****www.cdc.gov/ncidod/biotech/strep/prc.htm**

***Streptococcus pneumoniae***** Laboratory Investigation**

## Focus of State-Based Surveillancefor Streptococcus pneumoniae

**Compare state rates to rates elsewhere**
**Compare among populations within the state **
**If rates of invasive disease are elevated an epidemiologic investigation should be considered**

## Support for State PneumococcalDisease Surveillance

**State health departments should contact  the Respiratory Diseases Branch of NCIRD to discuss their specific situation**
**Contact information is on the broadcast updates and  resources webpage**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Meningococcal Disease**

**Graphics subject to change.**
**This material is in the public domain.**

## Meningococcal ConjugateVaccine (MCV4)

**Licensed in 2005**
**Approved for use among persons 2 through 55 years of age**
**Provides protection for serogroups A, C, Y, and W-135**

## Meningococcal ConjugateVaccine (MCV4)

**Routine vaccination of persons 11 through 18  years of age**
**College freshmen living in a dormitory**
**Other populations at increased risk**

**Recommended for:**

## Neisseria meningitidis

**Transmitted through direct contact with respiratory secretions from a person with invasive disease or an asymptomatic carrier**
**Clinical forms**
**meningitis**
**blood infection**
**pneumonia**
**purpura fulminans**

## Meningococcal Disease in the United States

**~1,400-2,800 cases each year**
**Case-fatality ratio 10%-14%**
**Serious sequelae in 11%-19%**
**Highest rate of disease among children younger than 2 years of age**
**62% of cases among persons 11 years of age or older**

## Meningococcal Disease Incidenceby Age Group-1998*

**Meningococcal Disease Incidence****by Age Group-1998***

***Source: ABCs/Emerging Infections Program Network**

## Meningococcal Disease Reporting

**National Notifiable Diseases Surveillance System (NNDSS)**
**Active Bacterial Core surveillance (ABCs)**

## Meningococcal Disease

**Clinically compatible, and**
**Evidence of *****N. meningitidis***** DNA**
**polymerase chain reaction (PCR)**
**immunohistochemistry on fixed   tissue**
**latex agglutination testing of CSF**

**Recommended for:**

## Critical Data for MeningococcalDisease Case Investigation

**Core data**
**demographic**
**clinical**
**risk factors**
**vaccination history**
**laboratory**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Varicella**

## Varicella Active Surveillance Sites

**Vaccination coverage**
**40% in 1997**
**Greater than 90% in 2006**
**Reduction in varicella incidence has been observed in all age groups**
**The number of outbreaks and the number and rates of hospitalization have also fallen**

## Changes in the Epidemiology of Varicella 

**Proportion of cases among vaccinated persons has increased**
**Median age of patients has shifted towards adolescence**

## Varicella Vaccination Recommendations

**Routine two dose schedule for children**
**first dose at 12-15 months of age**
**second dose at 4-6 years of age**
**Second dose recommended for all other persons without evidence of immunity to varicella, and all persons who have received only one dose**

## Varicella Outbreaks

**Definition**
**5 or more epidemiologically linked cases in one location (such as a school or child care center)**
**Outbreak control**
**exclusion of persons with varicella and unvaccinated children from the  outbreak setting**
**persons who have received 1 dose of varicella vaccine should receive a second dose during an outbreak**

## Sentinel Site Surveillance

**Sites can be located throughout the state or in select jurisdictions**
**Could include schools, child care centers, physicians' offices, hospitals, colleges, and other institutions**

## Key Information for Varicella Case Investigation

**Age**
**allows states to monitor the impact of vaccination on disease reduction in specific age groups**
**Identify shift in disease to older persons**
**Vaccination history**
**allows determination of the proportion of all cases that are vaccinated**
**allows assessment of crude vaccine effectiveness**
**Disease severity**
**allows assessment of the severity of  varicella in vaccinated cases**
**monitor vaccine effectiveness against all disease and against severe disease**

## Varicella Case Definitions

**Varicella**
**an illness with acute onset of diffuse, generalized maculopapulovesicular rash without other apparent cause**
**Breakthrough varicella**
**Varicella that occurs in a vaccinated person more than 42 days after vaccination**

## Laboratory Confirmation of Varicella

**Virologic**
**polymerase chain reaction (PCR)**
**direct fluorescent antibody (DFA)**
**viral culture **
**Serologic**
**varicella IgM antibody positive**
**seroconversion for IgG**
**significant rise in IgG antibody**

## Laboratory Confirmation of Varicella

**Virologic methods are preferred **
**PCR is the best choice because it   is the most sensitive and specific**
**DFA can be used if PCR is   unavailable**
**For PCR material from skin lesions and scabs are the preferred specimen**

## Herpes Zoster (Shingles)

**Incidence increases with increasing age, especially after age 50 years**
**More common among **
**immunocompromised persons **
**children with a history of    intrauterine varicella or varicella    occurring within the first year of life **

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Measles**

**Graphics subject to change.**
**This material is in the public domain.**

## Images of people with vaccine-preventable diseases can be found atwww.vaccineinformation.org/photos/

## Vaccine Licensed

**Vaccine Licensed**

**Measles—United States, 1950-2006**

## Measles—United States, 1980-2006

**Measles—United States, 1980-2006**

**Measles resurgence**

## Imported Measles, 2007 

**12 year old Japanese baseball player attending the Little League World Series (index case)**
**Outbreak control measures**
**follow-up on hundreds of exposures**
**administration of more than 1,000   doses of vaccine**
**airline passenger notification**
**health alerts**

## Imported Measles, 2007 

**7 total cases**
**2 boys from Japan**
**53 year old American airplane   contact**
**25 year old U.S. worker at the   airport when the index case arrived**
**40 year old corporate sponsor**
**two vaccinated college students in Texas **

## Measles Case Definition

**Generalized rash for 3 days or more,  and**
**Temperature of 101****o**** F (38.3****o**** C) or  higher, and**
**Cough, or coryza, or conjunctivitis**

## Measles Antibody Response

**Measles Antibody Response**

## Measles Confirmation

**The best  way to confirm measles is isolation of measles virus from the person**
**Viral isolation should be attempted for every suspected case of measles **

## Measles Serologic Confirmation

**IgG testing**
**requires demonstration of a   significant rise or seroconversion  in measles antibody between acute and convalescent specimens**
**first specimen should be drawn as   soon as possible after rash onset**
**second specimen 10 to 30 days   after the first **

## Measles Confirmation

**IgM tests and viral isolation are preferred**
**Negative IgM  does not rule out measles in a previously vaccinated person**
**Acute and convalescent IgG testing  or virologic testing will be necessary**

## Measles Virus Isolation

**Obtain specimens for viral isolation from all sporadic cases, or from at least some cases in each outbreak**
**Specimens should be obtained at the time of the initial investigation**
**Essential for tracking the molecular epidemiology of measles**

## Critical Data for Measles CaseInvestigation

**Demographic and clinical data**
**Laboratory confirmation**
**Complete immunization history**
**Source of infection**
**Potential for transmission **

## Settings for Measles Exposure

**Schools**
**Contact with international visitors**
**Tourist locations**
**Air travel**
**Healthcare settings**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Graphics subject to change.**
**This material is in the public domain.**

**Rubella**

## Congenital Rubella Syndrome (CRS)

**Rubella virus infection during early pregnancy, especially during the first trimester**
**Serious, and sometimes fatal, illness**
**spontaneous abortion**
**stillbirth**
**birth defects**

## Rubella - United States, 1966-2006

**Rubella - United States, 1966-2006**

**Year**

## Rubella Laboratory Confirmation

**Isolation of rubella virus**
**Detection of rubella virus DNA by polymerase chain reaction (PCR) **
**Significant rise in serum rubella IgG antibody or seroconversion from acute to convalescent specimens **
**Presence of serum rubella IgM antibody**

## CRS Laboratory Confirmation

**Isolation of rubella virus from the infant**
**Detection of rubella virus by polymerase chain reaction (PCR)**
**Serologic confirmation**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Graphics subject to change.**
**This material is in the public domain.**

**Mumps**

## Mumps - United States, 2006

**Largest mumps outbreak in 20 years**
**6,584 cases reported from 45 states and Washington D.C. **
**Eight states accounted for 85% of the cases reported**
**28% were 18 to 24 years of age**
**84% were non-Hispanic white**
**63% were female**
**19% were laboratory confirmed**

## Changes to the Mumps Case Definition

**A clinical description was added to include cases that may present with only complications**
**Definition of a probably case requires epidemiological linkage to a clinically compatible case **

## Changes to the MumpsLaboratory Criteria

**Addition of detection of mumps nucleic acid with polymerase chain  reaction testing (PCR)**
**More specific guidance for IgG and IgM testing was added**

## Change in Mumps CaseClassification

**A suspect case classification was added**
**Provides a category to use for cases that may not meet the probable or confirmed definition but that may meet the definition once the case investigation is complete **

## Changes in Mumps VaccineRecommendations

**2 doses of live mumps virus vaccine are now recommended for:**
**school-aged children (kindergarten   through high school)**
**adults at high risk**
**international travelers**
**students at post-high school   educational institutions**

## Changes in Mumps VaccineRecommendations

**Healthcare personnel without other evidence of mumps immunity:**
**born during or after 1957:   documentation of having received   2 doses**
**born before 1957: 1 dose should be considered as evidence of immunity**

## Changes in Mumps VaccineRecommendations

**In outbreak settings:**
**second dose should be considered   for children 1-4 years of age and   for adults not classified as high risk**
**second dose should be strongly   considered for healthcare personnel born before 1957 without other evidence of immunity**

## Mumps Laboratory Confirmation

**Isolation of mumps virus**
**Detection of mumps virus by PCR**
**Significant rise in serum mumps IgG antibody or seroconversion**
**Presence of serum mumps IgM antibody**

## Critical Data for Mumps CaseInvestigation

**Demographic and clinical data**
**Complete immunization history**
**Source of infection**
**Opportunities for exposure to unknown cases**
**Potential for further transmission should be assessed**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Graphics subject to change.**
**This material is in the public domain.**

**Human Papillomavirus**

## Human Papillomavirus and Anogenital Cancer

**High-risk HPV types are detected in 99% of cervical cancers**
**70% of cervical cancers worldwide  are due to HPV types 16 and 18**
**The vast majority of women with high risk HPV infection do not develop cancer**

## Human Papillomavirus and Anogenital Cancer

**High risk HPV infection is also associated with cancer of the vulva, vagina, penis and anus**
**Not all cases of these less common anogenital cancers are related to HPV infection**

## HPV Vaccine Recommendations

**Routine immunization of 11 and 12  year old females**
**Vaccination can be started as young  as 9 years of age**
**Catch up immunization of females 13 through 26 years of age**
**Not currently approved for women older than 26 years or for males**

## State Cancer Registries

**Monitor cancer trends over time**
**Determine cancer patterns in various populations**
**Guide planning and evaluation of cancer control programs**
**Help allocate health resources**
**Advance clinical, epidemiologic, and health services research**
**Provide information for a national database of cancer incidence**

## National Program of Cancer Registries

**Supports cancer registries in 45 states, the District of Columbia, Puerto Rico, and the U.S. Affiliated Pacific Island Nations**
**With the National Cancer Institute collect data for the entire U.S. population**

## Pap Test

**Used to look for HPV related changes in cervical cells**
**Woman with high grade abnormalities is referred for cervical biopsy **

## Approaches To Monitor HPVVaccine Impact

**Population-based statewide data on cervical cancer precursors**
**Sentinel surveillance sites in 4 states to provide population-based assessment of cervical cancer precursors, HPV vaccination status and HPV type**
**Monitoring HPV types and cervical cancer precursors among patients in managed care organizations**

## Approaches To Monitor HPVVaccine Impact

**Monitoring the volume of patient visits for anogenital warts through a sentinel network of sexually transmitted disease clinics**
**Monitoring abnormal Pap tests through a sentinel network of family planning clinics**
**Administrative datasets**
**Vaccine safety datasets **

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Graphics subject to change.**
**This material is in the public domain.**

**Hepatitis B**

## Hepatitis B Virus (HBV) Infection

**Transmission of hepatitis B virus occurs as a result of percutaneous or permucosal exposure to blood of a person acutely or chronically infected with HBV**

## Hepatitis B Virus (HBV) Infection

**Infants**
**perinatal transmission from   mother to child can occur as a   result of   blood exposures during birth**
**Children**
**horizontal transmission from   infected family and household   members**

## Hepatitis B Virus (HBV) Infection

**Adolescents and adults**
**sex with multiple partners**
**injection drug use**
**men who have sex with men**
**occupational exposure to human blood**
**medical interventions (e.g., surgery, blood transfusion, organ transplant)**

## Hepatitis B Virus (HBV) Infection

**Incubation period averages 90 days (range 60 to 150 days)**
**Infants, children younger than 10 years of age, and immunosuppressed adults with newly acquired infection are usually asymptomatic**
**30% to 50% of older children and adults are symptomatic**
**Symptoms and signs include nausea, vomiting, abdominal pain, jaundice**
**Fatality rate 0.5%-1%**

## Chronic HBV Infection

**Chronic liver disease develops in two-thirds of persons with chronic HBV infection**
**15% to 25% will die prematurely from cirrhosis or liver cancer**
**In infants, young children, and immunosuppressed persons, most newly acquired HBV infections result in chronic infection**
**90% of infants with perinatal infection develop chronic infection**

## Hepatitis B Case Definition

**Clinically compatible symptoms**
**Jaundice or an elevation in liver enzymes **
**Laboratory confirmation**

**Acute**

## Laboratory Confirmation ofHBV Infection

**Positive IgM antibody to hepatitis B core antigen, or**
**Positive test for hepatitis B surface antigen (HBsAg) with a negative test for acute hepatitis A virus infection**

**Acute**

## Priorities in HBV CaseInvestigation

**Identify whether there are contacts of the case at risk of becoming infected**
**Determine, if possible, the source of infection for the index case**

## Critical Data for HBV CaseInvestigation

**Demographic and clinical data**
**Laboratory data including serologic testing and liver enzyme levels**
**Risk factor information**
**Vaccination status**
**Pregnancy status of women**

## Indications for HBV Postexposure Prophylaxis

**Sexual contacts**
**Infant younger than 12 months for whom the case is a primary caregiver**
**Persons who have had identifiable percutaneous or perimucosal exposure to the blood of the case**

## Identification of the Source ofHBV Infection

**Exposure during the previous 6 weeks to 6 months to:**
**another person with acute or   chronic HBV infection**
**injection drug use**
**exposure to human blood**
**medical interventions**
**use of blood products**
**sexual history**

## Criteria For Diagnosis Of Chronic HBV Infection

**Hepatitis B core IgM antibody negative and a positive result on one of the following tests:**
**hepatitis B surface antigen, or**
**hepatitis B e antigen, or**
**hepatitis B virus DNA**
**HBsAg positive, or HBV DNA positive, or HBeAg positive two times at least 6 months apart**
**Positive for any combination of these tests performed 6 months apart**

## Management of Persons With Chronic HBV Infection

**Should be referred for clinical follow-up**
**monitored for the development of chronic liver disease**
**should be evaluated for treatment**

## Perinatal HBV Infection

**Presence of HBsAg in an infant 1 to 24 months of age**
**Born in the U.S. or U.S. Territories**
**Born to a HBsAg-positive woman**

## Management of Infants Exposed to HBV

**Exposed infants should be tested for HBsAg 3 months after receiving the third dose of vaccine**
**Case should be reviewed and verified with the local perinatal hepatitis B coordinator**
**Reported through the NNDSS**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Graphics subject to change.**
**This material is in the public domain.**

**Poliovirus**

## Vaccine-Derived Poliovirus(VDPV) Infections-MN, 2005

**Type 1 VDPV identified in a stool specimen from a 7-month-old Amish infant**
**Hospital investigations did not find a healthcare-associated source for the infection or evidence of nosocomial transmission from the infant**
**4 other children in 2 other households infected with the VDPV**
**3 of the infant's siblings had likely been recently infected with a type 1 poliovirus**

## Vaccine-Derived Poliovirus(VDPV) Infections-MN, 2005

**First documented occurrence of VDPV community transmission in a developed country**
**Source of the virus was not identified but likely was a person who received OPV in another country  **

## Confirmed Poliovirus Infection

**A poliovirus isolate identified in an appropriate clinical specimen, with confirmatory typing and sequencing performed by the CDC Poliovirus Laboratory**

## Surveillance of Vaccine-Preventable Diseases
Satellite Broadcast and Webcast
December 13, 2007

**Satellite Broadcast and Webcast**
**December 13, 2007**

**Graphics subject to change.**
**This material is in the public domain.**

**Rotavirus**

## Rotavirus

**Incubation period 1 to 3 days**
**Vomiting often precedes the onset of diarrhea**
**Severe, dehydrating infection occurs primarily among children 3 to 35 months of age**
**Gastrointestinal symptoms **
**generally resolve in 3 to 7 days**

## Rotavirus

**Shed in high concentrations in the stool**
**Transmitted primarily by the fecal-oral route and probably by other modes, such as fecally-contaminated food and water, and respiratory droplets**
**Highly communicable **

## Rotavirus Vaccine

**Live, oral, human-bovine reassortant rotavirus vaccine licensed in the U.S. in 2006**
**Recommended for routine vaccination of infants at 2, 4, and 6 months of age**

## Rotavirus Surveillance

**Monitor the impact of vaccination**
**Evaluate vaccine effectiveness in field use**
**Identify and determine the causes of vaccine failure**
**Identify groups in which vaccination  coverage may be inadequate**

**Needed to:**

## Rotavirus Surveillance

**New Vaccine Surveillance Network **
**three medical centers in Tennessee, New York, and Ohio**
**conduct active, population-based   surveillance for rotavirus-associated medical encounters among children younger than 3 years of age**
**Laboratory-based sentinel surveillance systems National Respiratory and Enteric Virus Surveillance System**
**National Rotavirus Strain Surveillance System**
**National healthcare utilization datasets **

## National Center for Immunization and Respiratory DiseasesContact Information

**Email****	****	****nipinfo@cdc.gov**
**Website****	****www.cdc.gov/vaccines/**
**Broadcast Updates and Resources **
**   ****Web Page**
**   ****www.cdc.gov/vaccines/ed/broadcasts.htm**