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Immunization Action Coalition
IAC Express 2006
Issue number 635: December 11, 2006
 
Contents of this Issue
Select a title to jump to the article.
  1. New: CDC issues ACIP's recommendations on elimination of hepatitis B virus infection in U.S. adults
  2. New: CDC launches website to promote implementation of revised hepatitis B immunization recommendations for adults
  3. Important: Errors in table on vaccine storage temperatures in the 2006 General Recommendations have been corrected
  4. Reminder: Be sure to continue administering influenza vaccines throughout December and into 2007
  5. Revised VIS: CDC makes a minor change to interim VIS for meningococcal vaccines
  6. A must for every exam room: IAC's laminated U.S. adult immunization schedule—updated for 2006-07
  7. IAC revises its online Ask the Experts information on rotavirus, zoster, and pneumococcal polysaccharide vaccines
  8. December issue of CDC's Immunization Works electronic newsletter now available
  9. December 5 issue of IAC's Hep Express newsletter now online
  10. MMWR compiles information about all its current continuing-education exams into one handy reference list
  11. WHO issues position paper on Hib vaccines
  12. The Global Alliance for Vaccines and Immunization approves $100 million for pneumococcal vaccine funding
  13. PAHO publishes second edition of its book Recent Advances in Immunization
 
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 635: December 11, 2006
1.  New: CDC issues ACIP's recommendations on elimination of hepatitis B virus infection in U.S. adults

CDC published "A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults" in the December 8 issue of MMWR Recommendations and Reports. The summary and the section on major updates to the recommendations are reprinted below.

Also on December 8, John W. Ward, MD, sent a Dear Colleague letter to health professionals outlining the multifaceted strategy ACIP has recommended to increase hepatitis B vaccination coverage among adults. Dr. Ward is director; Division of Viral Hepatitis; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed); CDC. A link to Dr. Ward's letter appears at the end of this article.


SUMMARY
Hepatitis B vaccination is the most effective measure to prevent hepatitis B virus (HBV) infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission (e.g., heterosexuals with multiple sex partners, injection-drug users [IDUs], and men who have sex with men [MSM]) and among household contacts and sex partners of persons with chronic HBV infection.

This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for HBV infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005; 54 [No. RR-16]:1-33).

In settings in which a high proportion of adults have risks for HBV infection (e.g., sexually transmitted disease/human immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, healthcare settings targeting services to IDUs, healthcare settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, healthcare providers should inform all patients about the health benefits of vaccination, including risks for HBV infection and persons for whom vaccination is recommended, and vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, healthcare providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination. . . .

MAJOR UPDATES TO THE RECOMMENDATIONS
This report updates ACIP recommendations published previously for hepatitis B vaccination of adults. The primary changes from previous recommendations are as follows:
  • In settings in which a high proportion of persons are likely to be at risk for HBV infection (e.g., STD/HIV testing and treatment facilities, drug-abuse treatment and prevention settings, healthcare settings targeting services to IDUs, healthcare settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all adults who have not completed the vaccine series.
     
  • In primary care and specialty medical settings, ACIP recommends implementation of standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine services. To ensure vaccination of adults at risk for HBV infection who have not completed the vaccine series, ACIP recommends the following implementation strategies:
    • Provide information to all adults regarding the health benefits of hepatitis B vaccination, including risk factors for HBV infection and persons for whom vaccination is recommended.
    • Help all adults assess their need for vaccination by obtaining a history that emphasizes risks for sexual transmission and percutaneous or mucosal exposure to blood.
    • Vaccinate all adults who report risks for HBV infection.
    • Vaccinate all adults requesting protection from HBV infection, without requiring them to acknowledge a specific risk factor. . . .

To access a ready-to-print (PDF) version the recommendations, which includes Appendices A, B, and C, go to: http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf

Note: The PDF version includes a free CDC-sponsored education activity that can be completed online or submitted by U.S. mail for CME, CEU, or CNE credit. Simply read the primer, answer the questions at the end, and follow instructions for submitting your answers.

To access a web-text (HTML) version of the body of the recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a1.htm

To access a web-text (HTML) version of Appendix A: Immunization Management Issues, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a2.htm

To access a web-text (HTML) version of Appendix B: Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm

To access a web-text (HTML) version of Appendix C: Identification and Management of Hepatitis B Surface Antigen (HBsAg)-Positive Persons, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a4.htm

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

To access Dr. Ward's Dear Colleague letter, go to:
http://www.immunize.org/acip/hepbrecs06.pdf

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2 New: CDC launches website to promote implementation of revised hepatitis B immunization recommendations for adults

CDC has developed a new website to promote implementation of the revised adult hepatitis B immunization recommendations. It includes educational and other materials specifically designed for each setting where hepatitis B vaccination is recommended for adults, such as settings serving adults at high risk for contracting hepatitis B virus infection, primary care and specialty medical settings, and occupational health providers.

The new website is titled Hepatitis B Recommendations for Adults. To access it, go to: http://www.heprecenter.com

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3 Important: Errors in table on vaccine storage temperatures in the 2006 General Recommendations have been corrected

Several errors appeared in Table 9 (titled Vaccine Storage Temperature Recommendations) of the "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," published in the MMWR Recommendations and Reports on December 1. It is important that you print the corrected version of Table 9 and insert it into your copy of the General Recommendations.

The errors concerned the vaccine storage temperatures in Celsius, as described in "Errata: Vol. 55, No. RR-15" in the December 8 issue of MMWR. It is reprinted below in its entirety.


In the MMWR Recommendations and Reports, "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," in Table 9, on page 21, the vaccine storage temperatures in Celsius were incorrect for measles, mumps, rubella, and varicella vaccine; live-attenuated influenza vaccine; varicella vaccine; and herpes zoster vaccine. Following is the corrected table [IAC Express editor's note: in this issue of IAC Express, the corrected table can be accessed from the links below].

The corrected table is available in both web-text (HTML) and ready-to-print (PDF) formats (see below):

To access the corrected table in HTML format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5548a7.htm and scroll down to Table 9.

To access the corrected table in PDF format, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5548.pdf and scroll down to page 1304.

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4 Reminder: Be sure to continue administering influenza vaccines throughout December and into 2007

Remember, influenza vaccination should continue through the month of December and beyond! Visit the following websites often to find the information you need to keep vaccinating. Both are continually updated with the latest resources.

The National Influenza Vaccine Summit website at http://www.preventinfluenza.org

CDC's Influenza web section at http://www.cdc.gov/flu

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5 Revised VIS: CDC makes a minor change to interim VIS for meningococcal vaccines

On November 16, CDC made a minor change to the interim VIS for meningococcal vaccines. In light of new reports of Guillain-Barre Syndrome (GBS) following vaccination, a one-word change was made to Section 5, which is titled "What are the risks from meningococcal vaccines?" In the second bulleted item under the subhead titled "Severe Problems," the interim VIS now says that GBS has been reported in SOME people who received meningococcal conjugate vaccine (MCV4). Previously, the interim VIS stated that GBS had been reported in a FEW recipients of MCV4.

Note: CDC advises healthcare professionals that existing stores of the previous interim VIS for meningococcal vaccines, dated 10/7/05, may be used up. There is no reason to discard them.

To access a ready-to-print (PDF) version of the updated (ll/16/06) interim VIS from the CDC website, go to: http://www.cdc.gov/nip/publications/VIS/vis-mening.pdf

To access it from the IAC website, go to:
http://www.immunize.org/vis/menin06.pdf

For information about the use of VISs, and for VISs in more than 30 languages, visit IAC's VIS web section at http://www.immunize.org/vis

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6 A must for every exam room: IAC's laminated U.S. adult immunization schedule—updated for 2006-07

In 2006, IAC introduced the laminated version of CDC's adult immunization schedule—and healthcare providers made good use of it! We are now offering CDC's 2006-07 adult immunization schedule in laminated format. It provides comprehensive information on two new vaccines: Tdap (tetanus-diphtheria-acellular pertussis) and HPV (human papillomavirus), as well as updates that reflect changes to the immunization recommendations for hepatitis A and hepatitis B vaccines.

Did we mention that we've also reduced the price when you order five schedules or more?

IAC adapted the 2006-07 schedule from the one posted on the NIP and MMWR sections of CDC's website. Coated in durable plastic for heavy-duty use and printed in color for easy comprehension, the laminated schedule is formatted with essential footnotes. Following are details about the schedule, including pricing and ordering options.

The laminated schedule is based on the ACIP/AAFP/ACOG/ACP-approved Recommended Adult Immunization Schedule, Oct. 2006–Sept. 2007. The 4-sided, 11" x 17" schedule is printed back-to-back and folded to 8.5" x 11". To view it, go to:
http://www.immunize.org/immschedules/immschedule_adult.pdf

It is priced at $5 each for 1–4 copies, $3 each for 5–19 copies, and $2.80 each for 20-99 copies. Discount pricing is available for larger quantities.

Order online with a credit card, or order by mail or fax, using a credit card, check, or purchase order. Shipping is free within the United States. To order, go to:
http://www.immunize.org/immschedules

Questions? Email admin@immunize.org or call (651) 647-9009.

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7 IAC revises its online Ask the Experts information on rotavirus, zoster, and pneumococcal polysaccharide vaccines

The IAC website recently posted updated Ask the Experts information on the following diseases and vaccines: rotavirus, zoster (shingles), and pneumococcal polysaccharide. IAC extends thanks to William L. Atkinson, MD, MPH, and Andrew T. Kroger, MD, MPH, for reviewing and revising these Ask the Experts web pages so that they reflect the most current information. Both are medical epidemiologists with CDC's National Center for Immunization and Respiratory Diseases.

To access the rotavirus vaccine Ask the Experts, go to:
http://www.immunize.org/catg.d/p2021r.htm

To access the zoster vaccine Ask the Experts, go to:
http://www.immunize.org/catg.d/p2021s.htm

To access the pneumococcal polysaccharide vaccine Ask the Experts, go to: http://www.immunize.org/catg.d/p2021o.htm

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8 December issue of CDC's Immunization Works electronic newsletter now available

The December issue of Immunization Works, a monthly email newsletter published by CDC, is available on NIP's website. The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

Some of the information in the December issue has already appeared in previous issues of IAC Express. Following is the text of four articles we have not covered.


OTHER NEWS AND SUMMARIES
PROVIDERS INFLUENCE VACCINATION COVERAGE: A November study in Pediatrics determined that vaccination coverage among children 19 to 35 months of age is associated with healthcare providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety. Parents of 7,695 children 19 to 35 months of age were sampled by the National Immunization Survey (NIS), a national telephone survey sponsored by CDC to assess vaccination coverage in children. Parents provided responses summarizing the degree to which they believed vaccines were safe, and the influence of providers on their decisions to vaccinate their children.

Parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. In addition, healthcare providers had a positive influence on parents to vaccinate their children, even parents who believed that vaccinations are unsafe. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a healthcare provider had an estimated vaccination coverage rate that was significantly higher (74%) than the estimated coverage rate among children whose parents' decision was not influenced by a healthcare provider (50%).

Due to the effectiveness of modern vaccination programs, parents may no longer be motivated to have their children vaccinated by the fear of vaccine-preventable diseases. Instead, parents may have concerns about vaccine safety and effectiveness. To address these concerns, healthcare professionals should increase their efforts to build honest and respectful relationships with parents.

The abstract can be found at the American Academy of Pediatrics website at http://pediatrics.aappublications.org (Pediatrics, November 2006, Volume 118, Issue 5).

REMINDER—VACCINE INFORMATION STATEMENTS: A federal statute requires all healthcare providers who administer vaccines covered by the National Vaccine Injury Compensation Program (NVICP) to give patients or parents a copy of the relevant Vaccine Information Statement (VIS). The VIS must be provided prior to vaccination. While CDC develops VIS statements for all vaccines, and encourages their use, it is a legal requirement that healthcare providers give patients or parents a VIS only if the vaccine is covered by NVICP. Also, the name of the statute, the National Childhood Vaccine Injury Act (NCVIA), can be confusing because the statute is not focused just on children. A vaccine receives coverage when CDC recommends a particular vaccine for routine administration to children. However, once the vaccine is in the program, the NVICP covers injuries to anyone who receives it, child or adult. More information about VIS statements and current VIS statements can be found on CDC's website at http://www.cdc.gov/nip/publications/vis/vis-facts.htm

GLOBAL POLIO ERADICATION HINGES ON FOUR COUNTRIES: The world's success in eradicating polio now depends on four countries—Afghanistan, India, Nigeria, and Pakistan—according to the Advisory Committee on Polio Eradication (ACPE), the independent oversight body of the eradication effort. On October 11-12, ACPE met in Geneva, Switzerland, to review recent global progress in polio eradication and recommend steps to (1) end poliovirus transmission rapidly in the remaining four endemic areas; (2) limit international spread of the virus; and (3) prepare for eventual eradication of polio and cessation of oral polio vaccination. To view a press release about the meeting, go to http://www.polioeradication.org/content/pressreleases/20061012press.asp

MEETINGS, CONFERENCES & RESOURCES
NEW TIDE MODULE: Teaching Immunization Delivery and Evaluation (TIDE) is a curriculum designed by the Medical University of South Carolina and the Ambulatory Pediatric Association/Society for Adolescent Medicine to help health professionals increase immunization rates for children. TIDE's new Vaccine Storage and Handling Module is now available online for physicians, nurses, and other healthcare professionals responsible for immunization delivery. Free CNE, CME, and CEUs are provided. Information and registration for the Vaccine Storage and Handling Module and the rest of the TIDE program can be found at http://www2.edserv.musc.edu/tide/menu.lasso


To access the complete December issue from the NIP website, go to: http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200612.htm

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9 December 5 issue of IAC's Hep Express newsletter now online.

The December 5 issue of Hep Express, an electronic newsletter published by IAC, is now available online. It is intended for health professionals, program planners, and advocates involved in prevention, screening, and treatment of viral hepatitis.

IAC Express has already covered some of the information presented in the December 5 Hep Express. Following are the titles and a small amount of information about articles we have not yet covered.

  • "Updated U.S. Treatment Guidelines for Management of Chronic Hepatitis B Published" (The treatment algorithm for managing chronic hepatitis B in the United States, first published in 2004, has been updated.)
     
  • "APAMSA Develops New Hepatitis B Outreach Guide" (APAMSA is the Asian Pacific American Medical Student Association.)
     
  • "American Liver Foundation Launches Website for the Public about Liver Health" (The website is designed to teach the public about liver wellness and liver disease.)
     
  • "CDC's Division of Viral Hepatitis Offers Brochure in Multiple Languages" (The brochure, titled "Protect Your Baby for Life from Hepatitis B," is now available in Spanish, Chinese, Marshallese, Tagalog, and Vietnamese.)
     
  • "Hepatitis B Foundation Adds Turkish-Language Chapter to Its Website" (The Turkish chapter is a new addition; the website also offers users chapters in Chinese, Korean, Spanish, and Vietnamese.)

To access the December 5 issue, go to:
http://www.hepprograms.org/hepexpress/issue50.asp

To sign up for a free subscription to Hep Express, go to:
http://www.immunize.org/subscribe

To access previous issues of Hep Express, go to:
http://www.hepprograms.org/hepexpress

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10.  MMWR compiles information about all its current continuing-education exams into one handy reference list

CDC published "MMWR Continuing Education Exams Available for Credit" in the December 8 issue of MMWR. Several of the exams listed concern recent immunization recommendations and guidelines. If you are interested in receiving continuing-education credit for reading a recommendation or guideline and taking a brief exam, go to: http://www2a.cdc.gov/ce/availableactivities.asp

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11.  WHO issues position paper on Hib vaccines

The November 24 issue of the WHO periodical "Weekly Epidemiological Record" covered the latest WHO position paper on Haemophilus influenzae type b conjugate vaccine. To access it, go to: http://www.who.int/wer/2006/wer8147.pdf

A collection of WHO position papers on vaccines is available in alphabetical order at
http://www.who.int/immunization/documents/positionpapers

They are available in chronological order on the IAC website at
http://www.immunize.org/who

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12.  The Global Alliance for Vaccines and Immunization approves $100 million for pneumococcal vaccine funding

On November 29, the board of the Global Alliance for Vaccines and Immunization (GAVI) announced that it had approved $100 million for purchasing pneumococcal vaccine and for supporting the strategic and technical activities needed to support its use.

For additional information, go to the website of PneumoADIP at http://www.preventpneumo.org and click on the link titled "Read PneumoADIP Statement" under the heading "News from the Field" in the left column.

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13.  PAHO publishes second edition of its book Recent Advances in Immunization

The Pan American Health Organization (PAHO) recently announced the publication of the book Recent Advances in Immunization. It is primarily intended for national immunization program managers in the Americas and their staffs, but it has application for other health professionals. Currently, available only in English, PAHO's book on immunization advances will be available in Spanish, French, and Portuguese.

For a description of the book and ordering information, go to:
http://publications.paho.org/english/moreinfo.cfm?Product_ID=868

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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.