what’s new with flu?(cdc) recommends a yearly flu vaccine as the first and most important step in...

The NJDOH CommunicableDisease Service includes:Infectious and Zoonotic Disease Program (IZDP): 609-826-5964

Vaccine Preventable Disease Program (VPDP): 609-826-4860

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Past issues of the New Jersey Com-muni-CABLE are available online at:http://nj.gov/health/cd/pub.shtml.

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In the United States, millions ofpeople are sickened, hundredsof thousands are hospitalized,

and thousands to tens of thousandsof people die from influenza (flu)every year. Although it is oftenminimized as a minor illness, muchof the U.S. population is at highrisk of serious flu complications,either because of their age orbecause they have a medicalcondition like asthma, diabetes(type 1 and 2), or heart conditions;or because they are pregnant. Forthese reasons, the Centers forDisease Control and Prevention(CDC) recommends a yearly fluvaccine as the first and mostimportant step in protectingagainst flu viruses. Everyone sixmonths of age and older shouldreceive a flu vaccine by the end ofOctober, if possible. However, aslong as flu viruses are circulating,vaccination should continuethroughout the flu season, even inJanuary or later.

There are several flu vaccineoptions available for the2016–2017 flu season including anew vaccine for people 65 yearsand older, FLUAD™, and aquadrivalent flu shot licensed forpeople four years and older,FLUCELVAX®. The flu vaccinesrecommended for use during the2016–2017 season are all injectable

vaccines. The 2016–2017 trivalentvaccines are recommended tocontain: • an A/California/7/2009(H1N1)pdm09-like virus

• an A/Hong Kong/4801/2014(H3N2)-like virus

• a B/Brisbane/60/2008-like virus(B/Victoria lineage)

The 2016-2017 quadrivalentvaccines will contain the abovethree viruses as well as aB/Phuket/3073/2013-like virus(B/Yamagata lineage).

While promoting flu vaccination topatients, please be aware that theCDC has made some changes inrecommendations and provided

Fall 2016

Communicable DiseaseService Mission StatementOur mission is to prevent communicable disease amongall citizens of New Jersey, andto promote the knowledge anduse of healthy lifestyles to maximize the health and well-being of New Jerseyans.

We will accomplish our mission through our leadership,collaborative partnerships, andadvocacy for communicable disease surveillance, research,education, treatment, prevention and control.

Chris Christie, Governor

Kim Guadagno, Lt. Governor

Cathleen D. BennettCommissioner

COMMUNICABLE DISEASE SERVICEChristina Tan, MD, MPHState Epidemiologist/Assistant Commissioner

Gary Ludwig, MS, Director

Suzanne Miro, MPH, MCHESEditor, Research Scientist

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What’s New with Flu?

Fall 2016

The Association of HealthFacility Survey Agenciesrecognized the

Department’s cross divisioncollaboration to ensure goodinfection control in New Jersey’shealth care facilities as a promisingpractice. The Division of HealthFacilities Survey and FieldOperations partnered withCommunicable Disease Service toprovide a Safe InjectionAmbassador training program toall 100 members of the survey staff.The program provided surveyorswith a basic foundation forrecognizing safe injection practicesand increased participants’ abilityto identify potential infectioncontrol breaches.

Surveyors included nurses,pharmacists, dietitians, and buildinginspectors. These surveyors inspectall licensed and/or certified healthcare facilities including hospitals,ambulatory surgery centers, hospiceand long-term care.

This is the second infection controleducation program that wasdeveloped in conjunction with theCommunicable Disease Service. Thefirst program was an educationsession that included training onprotocols to refer infection controlbreaches identified during surveyactivity to the NJDOH health careassociated infection coordinatorand/or the state epidemiologist.

Survey staff indicated that thetraining has provided consistencybetween survey teams. Increasededucation will ultimately increase thequality of care provided to thepatients and residents of New Jersey.The Division’s effective use ofinfection control educationalopportunities and collaborativerelationship with the CommunicableDisease Service promotes the goalsand objectives of the Survey andCertification program by ensuringstaff have the most current infectioncontrol information and resourcesaccessible for their use.

New Jersey Department of Health CrossCollaboration a Promising Practice


Regional Epidemiology Program (REP): 609-826-5964



Past issues of the New JerseyCommuni-CABLE are available online at:http://nj.gov/health/cd/pub.shtml.

http://nj.gov/health/cd/pub.shtml

www.nj.gov/health/cd

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A Note from the Editor Thank you to those who took a few moments to respond to the NJ Communi-CABLE readershipsurvey. I am pleased that a vast majority of our readers rated the NJ Communi-CABLE veryhighly for subject matter and quality. We will continue to provide this publication on a quarterlybasis and will contribute articles based on the areas of interest indicated in the survey. Onesuggestion was to add an “interesting fact” feature and you will see on page 6 that I agree andmade it a part of the newsletter. Thank you once again for supporting the newsletter and pleasebe sure to share the link each quarter with your partner agencies.

Suzanne Miro, MPH, MCHES, Editor, NJ Communi-CABLE

Fall 2016






(ICAR) work being done in states andhow partnering with licensing andsurvey agencies could benefit bothparties. NJDOH and Texas DSHSwere given the chance to highlightsome recent successes with their re-spective programs. Mr. Mehr high-lighted the NJDOH award winninginfection control breach reporting al-gorithm, as well as the injection safetysurveyor training. Mr. Mehr alsourged survey agencies to collaboratewith their HAI coordinators, a pointthat was not taken lightly, as multiplesurveyor and licensing staff actuallyinitiated contact with their epidemiol-ogy programs shortly after the con-ference. Later in the conference, themid-west consortium of state regula-tory agencies invited CDC, NJDOH,and Texas DSHS to further the dis-cussion between HAI programs andregulatory bodies with CMS. Thissmaller session gave individual statesa chance to ask questions about theroles and responsibilities of the HAIprograms in Texas and New Jersey.Feedback was very positive overall,and AHFSA looks forward to contin-uing collaboration to prevent HAIs inlicensed facilities.

The Association of HealthFacility Survey Agencies(AHFSA) held its annual

conference in Austin, Texas this pastAugust. Representation included statelicensing and survey agencies andparticipants from the Centers forMedicare and Medicaid Services(CMS). The opening plenaryhighlighted the relationship thatinfection control and epidemiologyhave with licensing and survey. Mary Beth White-Comstock, aninfection preventionist from theCenters for Disease Control andPrevention (CDC), was invited to leadthe panel. For the state perspective,Jason Mehr and Shawn Tupy,healthcare-associated infection (HAI)coordinators from the New JerseyDepartment of Health and the TexasDepartment of State Health Services(Texas DSHS) respectively, presentedthe work they had done with theirstate licensing and survey agencies.The emphasis on the plenary was thepositive effects of collaborationbetween regulating agencies and HAIprograms.

CDC highlighted the recent InfectionControl Assessment and Response

CDS Employee Shares Keynote Address atAHFSA Conference



Fall 2016






updates regarding the 2016–2017flu season. The following is a quickreview of what you need to know tokeep your patients on track.

Interim Recommendation Against Useof LAIVAs advised by the AdvisoryCommittee on ImmunizationPractices (ACIP), CDCrecommends: • Injectable flu vaccines —inactivated influenza vaccine(IIV) or recombinant influenzavaccine (RIV) — should be usedduring 2016–2017.

• The intranasal live attenuatedinfluenza vaccine (LAIV) soldunder the trade name FluMist®Quadrivalent, should not be usedduring the 2016–2017 flu season.

This is an interim recommendationthat applies to the 2016–2017season only.

The recommendation against theuse of LAIV is based on concernsabout effectiveness. There were nosafety concerns associated withLAIV. For years, studies have shownthat LAIV was very effective inprotecting against flu, particularlyin young people. However, datafrom 2013–2014 and 2015–2016showed poor, or relatively lower,effectiveness of LAIV against thepredominant circulating H1N1viruses.

Since FluMist® Quadrivalent is stillan FDA-licensed product, there

may be some available supply ofthe vaccine in the United Statesduring the 2016-2017 season.CDC, and its panel ofimmunization experts known as theACIP, make public healthrecommendations for the use ofapproved vaccines. Considerationof effectiveness and safety data maysometimes lead torecommendations that are morespecific or more limited than thoseoutlined in the FDA-approvedindications.

Based on manufacturerprojections, health officials expectthat supply of IIV for the2016–2017 season should besufficient to meet any increase indemand resulting from the ACIPrecommendation, though providersmay need to check more than onesupplier or purchase a flu vaccinebrand other than the one theynormally select.

Flu Vaccine and Egg AllergyStudies that have examined the useof both the nasal spray vaccine andflu shots in egg-allergic andnon-egg-allergic patients indicatethat severe allergic reactions inpeople with egg allergies areunlikely. Therefore, the egg allergyrecommendations for the2016–2017 flu season have beenupdated:• Anyone with an egg allergy canreceive any licensed flu vaccine,however the vaccine should beadministered in an inpatient or

The Flu, continued from page 1

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Fall 2016






The Flu, continued from page 4

previous doses do not need to havebeen given during the same seasonor consecutive seasons.

Children six months through eightyears who have previously receivedonly one dose or no doses ofinfluenza vaccine need two doses ofvaccine to be fully protected for the2016–2017 season. If thevaccination status is unknown forany child in this age group, thatchild should be given two doses ofseasonal flu vaccine.

For additional information aboutthe 2016–2017 flu season, pleaseview the MMWR Recommendationsand Reports available athttp://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6505.pdf.

For New Jersey specific information,please visit www.nj.gov/flu.

outpatient medical setting andthey should be supervised by ahealth care provider who is ableto recognize and manage severeallergic conditions.

• People with egg allergies nolonger have to wait 30 minutesfor observation after receivingtheir vaccine.

CDC has created an algorithm toreflect these new recommendationsavailable at https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm.(Please note, a previous severeallergic reaction to influenzavaccine, regardless of thecomponent suspected of beingresponsible for the reaction, is acontraindication to future receipt ofthe vaccine.)

Vaccine Doses for Children Aged SixMonths through Eight YearsSome children six months througheight years of age will require twodoses of flu vaccine for adequateprotection from flu. Children in thisage group who are gettingvaccinated for the first time willneed two doses of flu vaccine,spaced at least 28 days apart.

The current recommendation isthat children six months througheight years of age need only onedose of 2016–2017 seasonalinfluenza vaccine if the child haspreviously received two or moretotal doses of trivalent orquadrivalent influenza vaccinebefore July 1, 2016. The two

https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm

https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm

www.nj.gov/flu

http://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6505.pdf

http://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6505.pdf



Fall 2016






Get more information athttp://nj.gov/health/cd/handwashing.shtml.

Did you know?The building now referred toas the Old Barracks (which iscurrently a museum) just ashort walk from the NewJersey Department of Healthin Trenton, NJ, was onceused as a smallpoxinoculation site for theContinental Army.

Infectious Disease Fact

Dr. Faye Rozwadowski, MD joins theNJDOH as the new CDCEpidemic Intelligence ServiceOfficer. She received herBachelor of Science inBiochemistry at Virginia Tech,attended Georgetown UniversitySchool of Medicine inWashington, D.C. and completedher Family Medicine residency atNaval Hospital Jacksonville,Florida. She served for a total of11 years in the U.S. Navy as anactive duty and board certifiedFamily Physician prior to startingthis fellowship.

Susan Hannagan, MS, MPH joins theVaccine Preventable DiseaseProgram surveillance staff andwill be working primarily on acuteflaccid myelitis. She is a graduateof the Yale School of Public

Health and has previouslyworked with the ConnecticutEmerging Infections Programfoodborne disease unit.

Erika Lobe, MPH will be serving asthe new Adolescent/AdultImmunization Coordinator. Shereceived her Bachelor of Arts inSociology from UNC-ChapelHill and her Master of PublicHealth degree from JohnsHopkins Bloomberg School ofPublic Health. She comes to uswith experience in infectiousdiseases, international health,cervical cancer/HPV prevention,and as a former Peace Corpsvolunteer working withvaccination campaigns in Benin,West Africa.

CDS Welcomes New Staff!

http://nj.gov/health/cd/handwashing.shtml

http://nj.gov/health/cd/handwashing.shtml



Fall 2016






Get Smart AboutAntibioticsWeek (GSW) is

an annual observance toraise awareness ofantibiotic resistance andthe importance ofappropriate antibioticprescribing and use.According to theCenters for DiseaseControl and Prevention(CDC), at least 2 millionpeople become infectedwith bacteria that areresistant to antibiotics and at least23,000 people die as a direct resultof these infections. Many morepeople die from other conditionsthat were complicated by anantibiotic-resistant infection.

Each year, the New JerseyDepartment of Health (NJDOH)partners with the CDC todisseminate messages and materialsin support of the week’s goal toincrease awareness. As in previousyears, NJDOH will post a series ofsocial media messages on Twitterand Facebook and provide hardcopies of educational materials tohealth care and public healthorganizations by request.

Be sure to follow NJDOH on Twitterat https://twitter.com/NJDeptofHealthand “like” us on Facebook athttps://www.facebook.com/NJDeptof

Health/. The CDC GSW page athttp://www.cdc.gov/getsmart/community/about/index.html has manytools and resources to assistorganizations with planning eventsand promoting the observance. TheNJDOH antibiotic resistance webpage also has materials available andcan be viewed at http://www.nj.gov/health/cd/ar/index.shtml. NJDOHhas a supply of antibiotic resistancematerials. If you are interested inplacing an order, please contactSuzanne Miro [email protected] or at609-826-5964 to place an order.Available items include brochures,posters, Spanish-languagefotonovelas, viral prescription padsand tear pads for patientsemphasizing appropriate use ofantibiotics.

Get Smart About Antibiotics Week 2016!

https://www.cdc.gov/getsmart

mailto:[email protected]

http://www.nj.gov/health/cd/ar/index.shtml

http://www.nj.gov/health/cd/ar/index.shtml

http://www.cdc.gov/getsmart/community/about/index.html

http://www.cdc.gov/getsmart/community/about/index.html

https://www.facebook.com/NJDeptofHealth/

https://www.facebook.com/NJDeptofHealth/

https://twitter.com/NJDeptofHealth



https://www.cdc.gov/getsmart

Fall 2016






Bergen County Public Health NursesHost CDS Presentations

On September 9, 2016Patricia Barrett,Healthcare Associated

Infection Coordinator, andSuzanne Miro, Sr. HealthCommunication Specialistaddressed antibiotic resistance withhealth professionals in BergenCounty. Hosted by Edith Collazzi,Nursing In-Service Instructor forthe Bergen County Department ofHealth Services, the presentationswere part of a continuingprofessional education class toincrease awareness of antibioticresistance and to provide themwith tools to help combat thisproblem. According to Ms.Collazzi, “It’s an important topicand in the recent past we have notoffered anything on antibioticresistance so we decided it wouldbe valuable to incorporate into our

continuing professional educationprogram.” Ms. Barrett gave adetailed overview of antibioticresistance, how resistance occursamong humans, and emphasizedthe impact that is has on thepopulation. Ms. Miro followed byproviding a training to theaudience entitled “TeachingCommunities About AntibioticResistance.” Each participantreceived a toolkit of resources tohelp them engage theircommunities in discussion aboutantibiotic resistance and how all ofus play a part in reducing thisproblem by using antibioticscorrectly. If you have a group thatis interested in being trained,please contact Suzanne Miro [email protected] or609-826-5964.

HopeFest Raises Community Awarenessof Health Services

In August 2016, the Assemblyof God (AG) Church inTrenton, New Jersey hosted

their first community health fairappropriately titled “HopeFest.”Approximately 2,000 communitymembers attended HopeFest whichfeatured 25 vendors including theNew Jersey Department of Health,Vaccine Preventable DiseaseProgram (VPDP). The VPDPdistributed immunization healtheducation materials for all agegroups in both English andSpanish. Since cost and awareness

of health services can be potentialbarriers for vaccination, one of themany resources provided includeda flyer listing nearby locations toaccess free or low-cost vaccines.

Attendees of HopeFest were alsoable to receive free healthscreenings, groceries, backpacks, aswell as live entertainment, facepainting, and activities for children.Due to the large turnout andfavorable feedback from thecommunity, AG Church will behosting HopeFest again in 2017.

mailto:[email protected]



Fall 2016






The New Jersey Department of Health(NJDOH), Vaccine Preventable DiseaseProgram (VPDP), was the recipient of the

Healthy People 2020 Immunization Coverage Awardfor two categories. The National ImmunizationConference, sponsored by the Centers for DiseaseControl and Prevention, awarded the NJDOH foroutstanding progress in immunization coverage forinfluenza vaccination among children andimmunization coverage for adolescents aged 13-17years.

Vaccine Preventable Disease Program Wins

National AwardH

Pictured are VPDP staff left to right: Ramona Braddock, Natalie Kratz,Jenish Sudhakaran, Barbara Montana, and Jill Dinitz-Sklar.



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