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Immunization Action Coalition
IAC Express 2006
Issue number 626: October 23, 2006
 
Contents of this Issue
(Select a title to jump to the article.)
  1. CDC influenza web section posts letter to healthcare providers about influenza vaccine supply for 2006-07 season
  2. JAMA article links increased pertussis incidence to nonmedical exemptions to school immunization requirements
  3. Congratulations! Walt Orenstein, MD, elected to the Institute of Medicine
  4. Gene is linked to autism spectrum disorders in families with more than one affected child
  5. New: NIP posts web page of shingles (herpes zoster) vaccine information for healthcare providers and public
  6. CDC issues update on GBS among U.S. recipients of Menactra meningococcal conjugate vaccine during 2005-06
  7. New: Fact sheet available for health professionals and the public on GBS and meningococcal conjugate vaccine
  8. CDC reports on 2004 survey of STD-prevention counseling practices and HPV opinions of clinicians with teen patients
  9. More than half of U.S. states report >=95 percent vaccination coverage of children entering school in 2005-06
  10. CDC reports on U.S. varicella surveillance practices in 2004
  11. CDC's influenza web section begins posting the "Weekly Report: Influenza Summary Update" for the 2006-07 season
  12. Guidance on use of surgical masks and respirators in healthcare settings posted on Pandemic Influenza website
  13. Conference on preparing for influenza pandemic is planned for November 13-15 in Washington, DC
 
Abbreviations
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
  
Issue 626: October 23, 2006
1.  October 23, 2006
CDC INFLUENZA WEB SECTION POSTS LETTER TO HEALTHCARE PROVIDERS ABOUT INFLUENZA VACCINE SUPPLY FOR 2006-07 SEASON


On October 17, CDC's Influenza web section posted a letter informing healthcare providers about the supply of influenza vaccine for the 2006-07 season. The letter was written by Jeanne M. Santoli, MD, MPH, deputy director, Immunization Services Division, National Center for Immunization and Respiratory Diseases. Portions of it are reprinted below.

On October 18, Dr. Santoli conducted a press briefing on the influenza vaccine supply. A link to the transcript appears at the end of this IAC Express article.

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From Dr. Santoli's letter:
Because the U.S. influenza vaccine manufacturers are currently producing vaccine at or near full capacity, it isn't possible for all of the doses to be produced and distributed before the vaccination season begins. . . .

Especially during the first weeks of October, it is likely that different providers will have received different amounts of vaccine. Depending upon the manufacturer or distributor that a provider ordered vaccine from, it is likely that some providers will get vaccine ahead of others. In contrast to last year, we anticipate that these discrepancies will be more limited in both time and scope because all of the manufacturers continue to report good progress in vaccine production/lot release activities.

In planning influenza vaccination activities, CDC encourages providers to take this phased nature of influenza vaccine production and distribution into account. All providers should have some vaccine in September and October to allow them to begin vaccinating their patients. Thus, vaccination should begin NOW with available vaccine rather than waiting until more vaccine arrives because the optimal time to get vaccinated is in October and November. Additional vaccine will be arriving throughout the vaccination season, and we expect that there will be more vaccine available than ever before.

Phased vaccine production and distribution also means that many providers will not see their entire vaccine order until the end of November. For this reason, CDC urges providers to make significant effort to offer influenza immunization in December, January, and beyond, consistent with the most recent Advisory Committee on Immunization Practices (ACIP) recommendations for use of influenza vaccine. Vaccinating beyond November is important and beneficial because the peak of influenza disease typically occurs in February or later, and many high-risk persons and their household contacts who are recommended for vaccination are not vaccinated by the end of November. In addition, even when disease is present in a community, individuals may still benefit from vaccination.

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To access Dr. Santoli's complete letter, go to: http://www.cdc.gov/flu/whatsnew.htm and click on the pertinent link.

To access the transcript of Dr. Santoli's press briefing, go to:
http://www.cdc.gov/od/oc/media/transcripts/t061018.htm

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2.  October 23, 2006
JAMA ARTICLE LINKS INCREASED PERTUSSIS INCIDENCE TO NONMEDICAL EXEMPTIONS TO SCHOOL IMMUNIZATION REQUIREMENTS


On October 11, the Journal of the American Medical Association (JAMA) published the article "Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Associations of State Policies with Pertussis Incidence." The abstract is reprinted below.

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Context: School immunization requirements have played a major role in controlling vaccine-preventable diseases in the United States. Most states offer nonmedical exemptions to school requirements (religious or personal belief). Exemptors are at increased risk of acquiring and transmitting disease. The role of exemption policies may be especially important for pertussis, which is endemic in the United States.

Objective: To determine if (1) the rates of nonmedical exemptions differ and have been increasing in states that offer only religious vs. personal belief exemptions; (2) the rates of nonmedical exemptions differ and have been increasing in states that have easy vs. medium and easy vs. difficult processes for obtaining exemptions; and (3) pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions, and acceptance of parental signature as sufficient proof of compliance with school immunization requirements.

Design, Setting, and Participants: We analyzed 1991 through 2004 state-level rates of nonmedical exemptions at school entry, and 1986 through 2004 pertussis-incidence data for individuals aged 18 years or younger.

Main Outcome Measures: State-level exemption rates and pertussis incidence.

Results: From 2001 through 2004, states that permitted personal belief exemptions had higher nonmedical exemption rates than states that offered only religious exemptions, and states that easily granted exemptions had higher nonmedical exemption rates in 2002 through 2003 compared with states with medium and difficult exemption processes. The mean exemption rate increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004, among states that offered personal belief exemptions. In states that easily granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to 2.51% in 2004. No statistically significant change was seen in states that offered only religious exemptions or that had medium and difficult exemption processes. In multivariate analyses adjusting for demographics, easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence interval, 1.10-2.14), and availability of personal belief exemptions (incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were associated with increased pertussis incidence.

Conclusions: Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical U.S. exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence. States should examine their exemption policies to ensure control of pertussis and other vaccine-preventable diseases.

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To access the abstract, go to:
http://jama.ama-assn.org/cgi/content/abstract/296/14/1757

The full text is available to JAMA subscribers.

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3.  October 23, 2006
CONGRATULATIONS! WALT ORENSTEIN, MD, ELECTED TO THE INSTITUTE OF MEDICINE


On October 9, the Institute of Medicine (IOM) issued a press release announcing that it has elected 65 new members. Among the 65 is Walter A. Orenstein, MD. Dr. Orenstein is currently professor of medicine and director, Program for Vaccine Policy and Development, Department of Medicine, Emory University, Atlanta. Previously, he served for many years as director of CDC's National Immunization Program. He is also co-editor of the fourth edition of the textbook "Vaccines" and serves on IAC's Advisory Board.

To read the IOM press release, go to:
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10092006

On October 11, Emory University issued a press release; to read it, go to:
http://www.whsc.emory.edu/press_releases.cfm

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4.  October 23, 2006
GENE IS LINKED TO AUTISM SPECTRUM DISORDERS IN FAMILIES WITH MORE THAN ONE AFFECTED CHILD


On October 17, the National Institute of Mental Health (NIMH) issued a press release titled Gene Linked to Autism in Families with More Than One Affected Child. Portions of it are reprinted below.

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A version of a gene has been linked to autism in families that have more than one child with the disorder. Inheriting two copies of this version more than doubled a child's risk of developing an autism spectrum disorder, scientists supported by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) National Institute on Child Health and Human Development (NICHD) have discovered. In a large sample totaling 1,231 cases, they traced the connection to a tiny variation in the part of the gene that turns it on and off. People with autism spectrum disorders were more likely than others to have inherited this version, which cuts gene expression by half, likely impairing development of parts of the brain implicated in the disorder, report Drs. Daniel Campbell, Pat Levitt, Vanderbilt Kennedy Center at Vanderbilt University, and colleagues, online during the week of October 16, 2006 in the Proceedings of the National Academy of Sciences.

"This common gene variant likely predisposes for autism in combination with other genes and environmental factors," said Levitt. "It exerts the strongest effect detected thus far among autism candidate genes."

Autism is one of the most heritable mental disorders. If one identical twin has it, so will the other in nearly 9 out of 10 cases. If one sibling has the disorder, the other siblings run a 35-fold greater-than-normal risk of having it. Still, scientists have so far had only mixed success in identifying the genes involved.

While most previous studies had focused on genes expressed in the brain, Levitt's team saw a clue in the fact that some people with autism also have gastrointestinal, immunological, or neurological symptoms in addition to behavioral impairments. They focused on a gene that affects such peripheral functions, as well as the development of the cortex and cerebellum, brain areas disturbed in autism. Moreover, it is located in a suspect area of chromosome 7 that has been previously linked to autism spectrum disorders. . . .

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To access the complete press release, go to:
http://www.nimh.nih.gov/press/autismmetgene.cfm

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5.  October 23, 2006
NEW: NIP POSTS WEB PAGE OF SHINGLES (HERPES ZOSTER) VACCINE INFORMATION FOR HEALTHCARE PROVIDERS AND PUBLIC


On October 16, NIP posted a new web page for healthcare providers and the public on shingles (herpes zoster) vaccine. It contains links to information on the status of the vaccine, basic Q&As on the disease and vaccine, the vaccine information statement and package insert, and press releases. To access the web section, go to: http://www.cdc.gov/nip/vaccine/zoster

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6.  October 23, 2006
CDC ISSUES UPDATE ON GBS AMONG U.S. RECIPIENTS OF MENACTRA MENINGOCOCCAL CONJUGATE VACCINE DURING 2005-06


CDC published "Update: Guillain-Barre Syndrome Among Recipients of Menactra Meningococcal Conjugate Vaccine—United States, June 2005-September 2006" in the October 20 issue of MMWR. Portions of the article are reprinted below.

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In October 2005, reports indicating a possible association between Guillain-Barre Syndrome (GBS) and receipt of meningococcal conjugate vaccine (MCV4) (Menactra, sanofi pasteur, Inc., Swiftwater, Pennsylvania) were made to the Vaccine Adverse Event Reporting System (VAERS). GBS is a serious neurologic disorder involving inflammatory demyelination of the peripheral nerves. During March 2005-February 2006, eight confirmed cases had occurred within 6 weeks (i.e., the time window of elevated risk noted for GBS after administration of other vaccines) after MCV4 vaccination. This report summarizes nine additional GBS cases reported to VAERS during March-September 2006. This report also provides a preliminary analysis of data from VAERS and the Vaccine Safety Datalink (VSD) since MCV4 became available in the United States in March 2005 and includes all 17 cases of GBS reported since June 2005. Although these data suggest a small increased risk for GBS after MCV4 vaccination, the inherent limitations of VAERS and the uncertainty regarding background incidence rates for GBS require that these findings be viewed with caution. Because of the risk for meningococcal disease and the associated morbidity and mortality, CDC continues to recommend routine vaccination with MCV4 for adolescents, college freshmen living in dormitories, and other populations at increased risk. . . .

Editorial Note:
Neisseria meningitidis is a major cause of bacterial meningitis and sepsis in the United States. The case-fatality ratio for meningococcal disease is 10%-14%. Meningococcal disease also causes substantial morbidity; 11%-19% of survivors have sequelae (e.g., neurologic disability, limb loss, or hearing loss). Although rates of disease are highest among children aged <2 years, 62% of meningococcal disease cases in the United States occur among persons aged >11 years. During 1991-2002, the rate for persons aged 11-19 years was 1.2 per 100,000 per year and was higher than the rate for the general population. The Advisory Committee on Immunization Practices (ACIP) has recommended MCV4 vaccination for the prevention of invasive meningococcal disease.

In October 2005 and April 2006, CDC and the Food and Drug Administration alerted healthcare providers about a possible association between GBS and MCV4. Since introduction of MCV4, a total of 15 cases of GBS have been reported in persons aged 11-19 years with onset within 6 weeks of MCV4 vaccination. The ratio calculated by using HCUP [Heathcare Cost and Utilization Project] data, but not VSD data, to define the background incidence rate, suggests a statistically significant increased risk for GBS after vaccination with MCV4.

The completeness of GBS reporting to VAERS, a passive surveillance system, is unknown. If underreporting to VAERS of GBS after MCV4 vaccination has occurred, the risk would be higher than estimated in this report. In addition, VSD has a limited ability to detect rare health events such as GBS; therefore, not finding any cases after vaccination in this population aged 11-19 years should not offer substantial reassurance regarding the safety of MCV4. Finally, the timing of onset of neurologic symptoms within 1-5 weeks of vaccination among reported cases continues to be of concern.

Using the HCUP background incidence rate and assuming the ratio of 1.78 accurately represents the true magnitude of increased risk after MCV4 vaccination, the number of excess cases of GBS for every 1 million doses distributed to persons aged 11-19 years is approximately 1.25 (CI [confidence interval] = 0.058-5.99). However, substantial uncertainty exists regarding the risk estimate, using either the HCUP or VSD background incidence rate. Furthermore, no surge in the frequency of GBS reports to VAERS was noted after either the October 2005 or April 2006 CDC reports, as might be expected if underreporting had occurred (e.g., after alerts for intussusception associated with RotaShield vaccine).

GBS is a rare illness, regardless of etiology; expected incidence rates for GBS are not precisely known, and the available data cannot determine with certainty whether MCV4 increases the risk for GBS. Ongoing evaluation of GBS after MCV4 vaccination is being performed using VSD data. A larger study will be necessary to provide a more definitive assessment, but any such study likely will take several years to accumulate cases and attain sufficient statistical power.

In May 2005, CDC recommended routine vaccination with MCV4 of adolescents, college freshmen living in dormitories, and others at high risk for meningococcal disease. However, CDC recommends that persons with a history of GBS not receive MCV4, although persons with a history of GBS at especially high risk for meningococcal disease (i.e., microbiologists routinely exposed to isolates of Neisseria meningitidis) might consider vaccination. Given the data in this report, ACIP will review the current recommendations for MCV4. A Vaccine Information Statement and fact sheet providing information on the vaccine and reported GBS cases is available at http://www.cdc.gov/nip/publications/vis/default.htm An updated fact sheet for healthcare workers on GBS and Menactra is available at http://www.cdc.gov/nip/vacsafe/concerns/gbs/menactra.htm Because of the ongoing risk for meningococcal disease and the limitations of the data indicating a small risk for GBS after MCV4 vaccination, the additional cases reported here do not affect or change current CDC recommendations.

CDC encourages all persons to report cases of GBS or any other clinically significant adverse events associated with MCV4 or any other vaccination to VAERS. Reports may be submitted securely online at http://www.vaers.hhs.gov or by fax at (877) 721-0366. Reporting forms and additional information are available at telephone, (800) 822-7967.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5541a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5541.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

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7.  October 23, 2006
NEW: FACT SHEET AVAILABLE FOR HEALTH PROFESSIONALS AND THE PUBLIC ON GBS AND MENINGOCOCCAL CONJUGATE VACCINE


On October 19, CDC's website posted a fact sheet for health professionals and the public titled Frequently Asked Questions about Guillain-Barre Syndrome [GBS] and Menactra Meningococcal Conjugate Vaccine. To access it, go to:
http://www.cdc.gov/od/science/iso/faq.htm

Additional information about the vaccine and Guillain-Barre syndrome is available at
http://www.cdc.gov/od/science/iso/gbsfactsheet.htm

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8.  October 23, 2006
CDC REPORTS ON 2004 SURVEY OF STD-PREVENTION COUNSELING PRACTICES AND HPV OPINIONS OF CLINICIANS WITH TEEN PATIENTS


CDC published "STD-Prevention Counseling Practices and Human Papillomavirus Opinions Among Clinicians with Adolescent Patients—United States, 2004" in the October 20 issue of MMWR. Portions of the article are reprinted below.

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In 2000, an estimated 18.9 million new cases of sexually transmitted diseases (STDs) occurred in the United States. Although young persons aged 15-24 years represented only 25% of the sexually active population, approximately 48% of STD cases in 2000 occurred in this age group. The most common sexually transmitted infection in persons aged <=24 years was attributed to human papillomavirus (HPV). Although the natural immunity of most young persons can clear HPV infections with no clinical consequences, certain infections persist and result in warts, precancerous changes, and invasive cancers of the anogenital region in both males and females. In 2000, an estimated 4.6 million new HPV infections occurred among persons aged 15-24 years, resulting in expected direct medical lifetime costs of $2.9 billion. In June 2006, the Food and Drug Administration licensed the first HPV vaccine for females aged 9-26 years for the prevention of cervical cancer (U.S. 2000 incidence rate: 9.4 cases per 100,000), precancerous genital lesions, and genital warts associated with HPV types included in the vaccine (HPV 6, 11, 16, and 18). Protection has been demonstrated for genital infections associated with HPV types included in the vaccine; therapeutic efficacy for persons already infected has not been demonstrated. To assess (1) STD risk assessment, counseling, and education practices of U.S. healthcare providers during routine adolescent checkups and (2) provider opinions regarding methods to prevent HPV acquisition, CDC and Battelle Centers for Public Health Research and Evaluation surveyed clinicians who provided adolescent primary care. The results of this survey indicated that most of the clinicians assessed STD risk in their adolescent patients, addressed STD prevention, and recommended various STD-prevention methods; however, clinician opinions varied regarding the effectiveness of methods for preventing HPV infection and whether their patients would adopt these methods for the long term. Clinicians periodically should assess STD risk in their adolescent patients and provide STD counseling and education to reduce the incidence of STDs in this age group at high risk.

The analyses described in this report resulted from a broader assessment of the knowledge, attitudes, and practices among U.S. linicians regarding HPV infections and general STD practice. In May 2004, CDC mailed surveys to 5,386 clinicians in seven specialties who commonly provide STD diagnosis, treatment, and prevention services. Nationally representative samples were drawn from databases that included members and nonmembers of the American Medical Association, American Association of Physicians' Assistants, American College of Nurse Midwives, and American Association of Nurse Practitioners. . . .

Editorial Note:
As recommended by national STD treatment guidelines, 81% of the clinicians surveyed in this study reported taking advantage of the routine checkup to assess STD risk in their adolescent patients. In addition, 93% of those with >=75% of their patients aged <18 years reported educating patients they believed were sexually active about prevention of STDs, and 69% reported specifically addressing HPV infection. Clinician counseling of adolescents regarding STD prevention has been determined to reduce the incidence of STDs. Current national recommendations encourage clinicians to periodically assess adolescents for STD risk and provide STD counseling.

Although abstinence is the surest method to reduce the risk for acquiring HPV infection and other sexually transmitted infections, monogamy, minimizing the number of sex partners, and condom use also can reduce the risk. Large proportions (78%-95%) of clinicians believed that consistent condom use, abstinence, monogamy, and limiting number of sex partners were highly effective methods to prevent acquisition of HPV infection or HPV-related conditions. However, only 6%-23% believed that the majority of their patients would adopt these methods for the long term.

In this study, clinicians were more likely to rate abstinence, monogamy, and limiting number of sex partners as highly effective compared with condom use; however, they rated condoms as the method their patients most likely would use long term. . . .

Scientific data link HPV infection to cervical cancer. Screening tests for HPV infection and the new vaccine to prevent infections from HPV genotypes that cause most cases of cervical HPV infection are now available, in addition to traditional Pap tests for precancerous and cancerous cervical lesions. The Advisory Committee on Immunization Practices issued provisional recommendations that this vaccine be routinely administered to girls aged 11-12 years and used for catch-up immunization in females aged 13-26 years. Clinicians should be prepared to discuss with their adolescent patients prevention of HPV infection and other viral and bacterial STDs.

To support clinician risk assessment and prevention counseling for HPV infection, CDC and others have updated online training and support materials. A web cast, HPV and Cervical Cancer: An Update on Prevention Strategies, is available at http://www.phppo.cdc.gov/phtn/hpv-05; a net conference, Human Papillomavirus (HPV), Cervical Cancer, and HPV Vaccine and Recommendations, is available at http://www.cdc.gov/nip/ed/ciinc/hpv.htm Materials regarding HPV infection also have been updated for patients and the general public to increase awareness of these topics and various prevention strategies. An overview of HPV infection and information regarding STDs is available at http://www.cdc.gov/std/hpv, and information regarding HPV vaccine is available at http://www.cdc.gov/nip/vaccine/hpv

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5541a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5541.pdf

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9.  October 23, 2006
MORE THAN HALF OF U.S. STATES REPORT >=95 PERCENT VACCINATION COVERAGE OF CHILDREN ENTERING SCHOOL IN 2005-06


CDC published "Vaccination Coverage Among Children Entering School—United States, 2005-06 School Year" in the October 20 issue of MMWR. Portions of the article are reprinted below.

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One of the national health objectives for 2010 is to achieve and sustain >=95% vaccination coverage among children in kindergarten through first grade for the following vaccines: hepatitis B vaccine; diphtheria and tetanus toxoids and pertussis vaccine, diphtheria and tetanus toxoids and acellular pertussis vaccine, or diphtheria and tetanus toxoids vaccine (DTP/DTaP/DT); poliovirus (polio) vaccine; measles, mumps, and rubella vaccines; and varicella vaccine. To determine vaccination coverage among children entering kindergarten, data were analyzed from reports submitted to CDC by states and the District of Columbia (DC) for the 2005-06 school year. This report summarizes the results of that analysis, which indicated that coverage for each vaccine was reported to have exceeded 95% in more than half of the states. . . .

Editorial Note:
More than half of reporting states indicate that they have already reached the Healthy People 2010 goal of >=95% coverage for each of the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP); the remaining states are making progress toward this goal. However, required vaccines and methods for surveying kindergarten-aged children vary substantially from state to state; the majority of states rely on self-reports by schools, rather than audits by health departments, to determine coverage, which might lead to underestimations or overestimations. CDC provided a new online reporting system, which has been available since the 2002-03 school year, to help states and U.S.-affiliated jurisdictions collect and report data on vaccination coverage among children entering school. Anecdotal reports from states indicate that this system, which automates data-management and calculation tasks, has made reporting coverage easier. CDC also has promoted greater standardization of reporting, for example, by encouraging all states to report coverage based on ACIP recommendations rather than on state requirements. These improvements in survey methods and assessment procedures will help ensure that health jurisdictions are accurately reporting progress toward the >=95% coverage goal.

State laws requiring proof of vaccination at school entry have been considered a safety net for the U.S. vaccination program because they are intended to ensure that no child is missed. This safety net relies on school nurses, teachers, health department staff, and others to identify children who are not up to date with their vaccinations. Findings of high nationwide coverage in recent years underscore the success of school entry requirements in boosting vaccination coverage, which increased substantially when entry requirements were established. Childhood vaccination coverage also is measured nationally among children aged 19-35 months. Higher percentages of children are up to date when entering kindergarten than at younger ages, suggesting that school entry laws are an important factor in maintaining high vaccination coverage and ensuring completion of the vaccine doses recommended at ages 4-6 years.

The findings in this report are subject to at least two limitations. First, the substantial variation in assessment methods limits the comparability of these data and suggests, in some cases, that data quality could be improved (e.g., by using methods other than self-report, standardizing measurement of vaccination coverage, monitoring data for validity and reliability, and using appropriate sampling methods). Second, children attending private schools or home schools were not surveyed by all states. The difference in vaccination rates between children schooled at home and children in public or private school environments is unknown.

Additional information about assessing and reporting vaccination coverage among children entering school is available at http://www.cdc.gov/nip/coverage/schoolsurv/overview.htm The schedule of recommended vaccinations for children is available at http://www.cdc.gov/nip/recs/child-schedule-4pg-landscp.pdf

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5541a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5541.pdf

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10.  October 23, 2006
CDC REPORTS ON U.S. VARICELLA SURVEILLANCE PRACTICES IN 2004


CDC published "Varicella Surveillance Practices—United States, 2004" in the October 20 issue of MMWR. Portions of a summary made available to the press are reprinted below.

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In 2004, to assess the progress in varicella surveillance in the United States, CDC surveyed immunization program managers in selected public health jurisdictions. This report describes the results of that survey, which indicated that substantial progress has been made toward the implementation of case-based surveillance as recommended by CSTE [Council of State and Territorial Epidemiologists] in 2002. As of 2004, however, 28 jurisdictions still had not implemented case-based surveillance. To monitor the effect of the vaccination program on the changing epidemiology of varicella disease, every state should conduct case-based surveillance for varicella. This is particularly important in light of the 2006 recommendation by the Advisory Committee on Immunization Practices for a routine second dose of varicella vaccine for children aged 4-6 years because enhanced surveillance is needed to further monitor varicella epidemiology.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5541a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5541.pdf

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11.  October 23, 2006
CDC'S INFLUENZA WEB SECTION BEGINS POSTING THE "WEEKLY REPORT: INFLUENZA SUMMARY UPDATE" FOR THE 2006-07 SEASON


CDC collects surveillance data year-round and reports on U.S. influenza activity each week from October through May in its "Weekly Report: Influenza Summary Update." For the 2006-07 influenza season, each Weekly Report will include these components: background, synopsis, laboratory surveillance, pneumonia and influenza (P&I) mortality surveillance, influenza-associated pediatric mortality, influenza-associated pediatric hospitalizations, influenza-like illness (ILI) surveillance, and influenza activity as assessed by state and territorial epidemiologists.

To access Weekly Reports for the 2006-07 influenza season, as well as reports from previous seasons, go to: http://www.cdc.gov/flu/weekly/fluactivity.htm This link will also give you access to a U.S. map showing current influenza activity and to websites that contain international influenza surveillance data.

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12.  October 23, 2006
GUIDANCE ON USE OF SURGICAL MASKS AND RESPIRATORS IN HEALTHCARE SETTINGS POSTED ON PANDEMIC INFLUENZA WEBSITE


The federal government's PandemicFlu website recently posted the document "Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings During an Influenza Pandemic." To access it, go to: http://www.pandemicflu.gov/plan/maskguidancehc.html

To access a broad range of continually updated information on seasonal influenza, avian influenza, and pandemic influenza, go to: http://www.cdc.gov/flu

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13.  October 23, 2006
CONFERENCE ON PREPARING FOR AN INFLUENZA PANDEMIC IS PLANNED FOR NOVEMBER 13-15 IN WASHINGTON, DC


A three-day conference, End-to-End Preparedness for Pandemic Influenza: Opportunities for Public-Private Collaboration, will be held November 13-15 in Washington, DC. Its goal is to bring together senior government officials and top industry executives to develop a partnership for preparing the public health response to an influenza pandemic. CDC and FDA are participants.

For additional information, including the conference brochure and a link for online registration, go to: http://www.infocastinc.com/pand06.html

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