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Immunization Action Coalition
IAC Express 2007
Issue number 663: May 14, 2007
 
Contents of this Issue
Select a title to jump to the article.
  1. CDC updates readers on supply of vaccines containing varicella-zoster virus
  2. MMWR highlights Hepatitis Awareness Month
  3. CDC reports on epidemiology of chronic HBV infection in San Francisco
  4. CDC reports on hepatitis B prevention through universal infant immunization in China
  5. CDC publishes surveillance summary on health behaviors, including influenza and pneumococcal vaccination
  6. HAN issues official Health Advisory about influenza-associated pediatric mortality and the increase of Staphylococcus aureus co-infection
  7. CDC announces addition of hepatitis A module to its "You Call the Shots" training course
  8. NASTAD releases primer on viral hepatitis policymaking and programs
  9. Former CDC director writes about changes in public health from 1990-1993
  10. CDC publishes record of February ACIP meeting
  11. FDA clears first respirators for use in public health medical emergencies
  12. New pandemic influenza resources available
  13. CDC updates its avian influenza web section
  14. California Distance Learning Health Network to offer pandemic influenza school preparedness training on May 17
 
Abbreviations
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
  
Issue 663: May 14, 2007
1.  CDC updates readers on supply of vaccines containing varicella-zoster virus

CDC published a Notice to Readers titled "Update on Supply of Vaccines Containing Varicella-Zoster Virus" in the May 11 issue of MMWR. The article is reprinted below in its entirety, excluding footnotes.


In February 2007, CDC received notice from Merck & Co., Inc., that because of lower than expected amounts of varicella-zoster virus (VZV) in its recently manufactured bulk vaccine, Merck was prioritizing production of varicella (Varivax) and zoster vaccines (Zostavax) over production of MMR-V vaccine (ProQuad).

In May 2007, CDC received further notice from Merck that current projections of orders indicate ProQuad will be unavailable beginning in July 2007, although timing will depend on market demand. This might cause extended back orders for the next few months. After depletion of the existing supply, ProQuad is not expected to be available for the remainder of 2007. Merck is requesting that customers begin transitioning from ProQuad to M-M-R II and Varivax at their earliest convenience.

Merck expects to continue to meet demands for Varivax and M-M-R II to fully implement the recommended immunization schedule. This will allow for continued use of varicella vaccine for all age groups, including the routine 2-dose schedule for children aged 12-15 months and 4-6 years, catch-up vaccination with the second dose for children or adolescents who received only 1 dose, and vaccination with 2 doses for other children, adolescents, and adults without evidence of immunity. For zoster vaccine, the supply of Zostavax is expected to be adequate for routine vaccination of adults aged >=60 years.

Questions regarding the supply of these Merck products should be addressed to Merck's National Service Center at (800) 637-2590. Updates on vaccine shortages and delays are available from CDC at http://www.cdc.gov/nip/news/shortages/default.htm


To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a6.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf

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2 MMWR highlights Hepatitis Awareness Month

CDC published "Hepatitis Awareness Month--May 2007" in the May 11 issue of MMWR. The article is reprinted below in its entirety, excluding footnotes.


May 2007 marks the 12th anniversary of Hepatitis Awareness Month. This issue of MMWR highlights public health measures to vaccinate and protect children from hepatitis B virus (HBV) infection in China and to monitor the characteristics of persons with chronic hepatitis B in San Francisco, California.

Worldwide, 370 million persons have chronic HBV infection, and 500,000-700,000 persons die annually from HBV-related liver disease; approximately 75% of HBV infections occur in Asia. In the United States, approximately half of the 1 million persons with chronic HBV infection are Asians/Pacific Islanders, most of whom became infected with HBV before arriving in the United States, including many who remain unaware of their infection. The HBV-related death rate among Asians/Pacific Islanders is seven times greater than the rate among whites.

Persons with chronic HBV infection are at risk for premature death from liver cirrhosis and cancer. Hepatitis B vaccination of infants worldwide will protect successive generations from chronic HBV infection and associated liver disease. Persons already infected with HBV can benefit from HBV screening, care, and treatment to protect their health and prevent transmission to others.


To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.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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3 CDC reports on epidemiology of chronic HBV infection in San Francisco

CDC published "Characteristics of Persons with Chronic Hepatitis B--San Francisco, California, 2006" in the May 11 issue of MMWR. Portions of the article are reprinted below.


Chronic hepatitis B is the most common cause of cirrhosis and liver cancer worldwide. Approximately 45% of the world's population lives in regions where chronic hepatitis B virus (HBV) infection is endemic, including most of Asia and the Pacific Islands, Africa, and the Middle East. Nearly one-fourth of the population of San Francisco was born in Asia and the Pacific Islands. In 2006, the San Francisco Department of Public Health (SFDPH) received reports consistent with probable chronic HBV infection for 2,238 persons. To characterize persons with reported confirmed chronic HBV infection in San Francisco in 2006, SFDPH collected additional data on a subset of 567 cases reported to the SFDPH chronic hepatitis B registry. Eighty-four percent of the persons were Asians/Pacific Islanders (A/PIs), 80% of whom were foreign born. Fewer than half had been referred to a gastroenterologist/hepatologist for evaluation at the time of reporting. Persons with chronic HBV infection can benefit from medical care by providers with expertise in viral hepatitis. In addition, close contacts of infected persons should be screened and offered vaccination if found to be susceptible to HBV infection. Culturally appropriate counseling for and follow-up of persons with chronic HBV infection and their contacts could help reduce the transmission of HBV infection. . . .

Editorial Note:
The findings in this report suggest that, in 2006, nearly 85% of persons with confirmed chronic HBV infection in San Francisco were A/PIs, 80% of whom were born outside the United States. These persons likely acquired their infections in their countries of origin, countries where HBV infection is endemic and infections usually are acquired at birth or during early childhood. Of persons who acquire chronic HBV infection when they are aged <5 years, an estimated 15%-40% will eventually have chronic liver disease, including cirrhosis and liver cancer. Treatment for chronic hepatitis B is increasingly effective and can prevent or slow the development of these sequelae. However, fewer than one-third of persons with chronic HBV infection in San Francisco in 2006 had been referred to a specialist for evaluation or undergone treatment at the time of reporting.

Persons from countries where HBV infection is endemic might be unaware of their increased risk for hepatitis B-related liver disease. Hepatitis B screening programs in A/PI communities in the United States can be an effective means of identifying persons with chronic HBV infection and encouraging them to seek medical care.

Health departments and large health systems can use electronic disease registries to characterize and provide services for persons with chronic HBV infection and their close contacts. Persons with chronic HBV infection should receive referrals for appropriate medical care, which can include treatment for HBV infection. Their close contacts should undergo screening for HBV infection and, if found to be susceptible, should receive hepatitis B vaccination. Registries also can provide local population-based data on the epidemiology of chronic HBV infection. . . .


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf

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4 CDC reports on hepatitis B prevention through universal infant immunization in China

CDC published "Progress in Hepatitis B Prevention Through Universal Infant Vaccination--China, 1997-2006" in the May 11 issue of MMWR. The introductory paragraph is reprinted below, excluding footnotes.


Hepatitis B virus (HBV) infection is a leading cause of illness and death in China. Approximately 60% of the population has a history of HBV infection, and 9.8% of persons in China are chronically infected with HBV and at risk for premature death from liver disease. Each year, an estimated 263,000 persons in China die from HBV-related liver cancer or cirrhosis, accounting for 37%-50% of HBV-related deaths worldwide. Because most HBV infections occur during infancy or early childhood, when HBV infection is most likely to become chronic, vaccination of infants beginning at birth is the key strategy for preventing chronic HBV infection. This report describes China's progress in increasing coverage among infants with hepatitis B vaccine (HepB) and timely administration of the HepB birth dose (i.e., within 24 hours of birth). Infant vaccination coverage with both the timely birth dose and the complete vaccine series was substantially higher among children born during 2003 than among those born during 1997; timely birth-dose coverage increased from 29.1% to 75.8%, and HepB series completion increased from 70.7% to 89.8%. Furthermore, in economically disadvantaged populations in western and middle provinces targeted by the China-Global Alliance for Vaccines and Immunization (China-GAVI) project, reported coverage with timely HepB birth dose increased from 64% in 2004 to 81% in 2006, and coverage with the complete HepB series increased from 52% in 2001 to 92% in 2006. China has established a goal to reduce chronic HBV infection among children aged <5 years to <1% by 2010. Achieving this goal will require continued commitment to increasing vaccination coverage in impoverished regions and ensuring that infants born at home are vaccinated within 24 hours of birth. . . .


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf

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5 CDC publishes surveillance summary on health behaviors, including influenza and pneumococcal vaccination

CDC published "Surveillance of Certain Health Behaviors Among States and Selected Local Areas--United States, 2005" in the May 11 MMWR Surveillance Summary. The survey collected data on behavioral risk factors such as smoking, poor diet, physical inactivity, excessive drinking, and use of preventive health services.

The two paragraphs related to immunization are reprinted below, excluding tables.


INFLUENZA VACCINATION
In 2005, state-specific prevalence estimates for self-reported influenza vaccination among persons aged >=65 years during the preceding 12 months ranged from 32.0% (CI = 28.3%-35.7%) in Puerto Rico to 78.1% (CI = 74.8%-81.4%) in Minnesota (median: 65.5%). Among MMSAs [metropolitan and micropolitan statistical areas], the prevalence of influenza vaccination ranged from 47.6% (CI = 39.1%-56.1%) in Orlando-Kissimmee, Florida, to 83.3% (CI = 74.7%-91.9%) in Fargo, North Dakota-Minnesota (median: 67.2%); among counties, the prevalence ranged from 40.8% (CI = 32.0%-49.6%) in Miami-Dade County, Florida, to 84.4% (CI = 76.0%-92.8%) in Ramsey County, Minnesota (median: 67.7%).

PNEUMOCOCCAL VACCINATION
The percentage of persons aged >=65 years who reported ever having a pneumococcal vaccination ranged from 28.3% (CI = 24.6%-32.0%) in Puerto Rico to 71.7% (CI = 68.6%-74.8%) in North Dakota (median: 65.7%). Among MMSAs, the prevalence of pneumococcal vaccination ranged from 52.0% (CI = 43.5%-60.5%) in Fayetteville-Springdale-Rogers, Arkansas-Missouri, to 82.2% (CI = 75.4%-89.0%) in Winston-Salem, North Carolina (median: 66.0%); among counties, the prevalence ranged from 34.8% (CI = 26.5%-43.1%) in Miami-Dade County, Florida, to 83.4% (CI = 75.3%-91.5%) in Forsyth County, North Carolina (median: 67.3%).


To access a web-text (HTML) version of the surveillance summary, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5604a1.htm

To access a ready-to-print (PDF) version of the surveillance summary, go to: http://www.cdc.gov/mmwr/PDF/ss/ss5604.pdf

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6 HAN issues official Health Advisory about influenza-associated pediatric mortality and the increase of Staphylococcus aureus co-infection

On May 9, the Health Alert Network (HAN) issued an official CDC Health Advisory about influenza-associated pediatric mortality and the increase of Staphylococcus aureus co-infection. The Health Advisory is reprinted below in its entirety.


THIS IS AN OFFICIAL CDC HEALTH ADVISORY
Distributed via Health Alert Network
Wednesday, May 9, 2007, 11:15 AM EDT

INFLUENZA-ASSOCIATED PEDIATRIC MORTALITY AND THE INCREASE OF STAPHYLOCOCCUS AUREUS CO-INFECTION

CDC is requesting that states report all cases of influenza-related pediatric mortality from the 2006-2007 influenza season.

Since 2004, the Influenza-Associated Pediatric Mortality Surveillance System, part of the Nationally Notifiable Disease Surveillance System, has collected information on deaths among children due to laboratory-confirmed influenza, including the presence of other medical conditions and bacterial infections at the time of death. From October 1, 2006 through May 7, 2007, 55 deaths from influenza in children have been reported to CDC from 23 state health departments and two city health departments. Data on bacterial co-infections were reported for 51 cases; 20 (39%) had a bacterial co-infection, and 16/20 were infected with Staphylococcus aureus. While the number of pediatric influenza associated deaths is similar to that reported during the two previous years, there has been an increase in the number of deaths in which both influenza and pneumonia or bacteremia due to S. aureus were identified. Only one influenza and S. aureus co-infection was identified in 2004-2005, and 3 were identified in 2005-2006. Of the 16 children reported with S. aureus so far in 2006-2007, 11 children had methicillin-resistant (MRSA) isolated from a sterile site (9) or sputum (2), and 5 had methicillin-susceptible S.aureus isolated from a sterile site (3) or sputum (2). The median age of children with S. aureus co-infection was older than children without S.aureus co-infection (11 years versus 4 years, p<.01). Children with influenza and S. aureus co-infections were reported to be in good health before illness onset but progressed rapidly to severe illness. Influenza strains isolated from these children have not been different from common strains circulating in the community and the MRSA strains have been typical of those associated with MRSA skin infection outbreaks in the United States.

Healthcare providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures when bacterial co-infection is suspected. Clinicians, clinical agencies, and medical examiners are asked to contact their local or state health department as soon as possible when deaths among children due to laboratory-confirmed influenza are identified. CDC requests that all cases of pediatric influenza-associated deaths be reported promptly by state health departments to CDC through http://sdn.cdc.gov and that information about bacterial pathogens isolated from sterile sites and/or from sputum or endotracheal aspirates be completed on the Influenza-Associated Pediatric Mortality Surveillance System case report form. If the influenza death was complicated by S. aureus infection, please contact the clinical agency to determine if the S. aureus isolate is available. CDC is interested in receiving S. aureus isolates to better characterize those from fatal cases of influenza in children.

If you have any questions about this Health Advisory, please call the Influenza Division, Epidemiology and Prevention Branch at (404) 639-3727.

To access the Health Advisory online, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00259

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7 CDC announces addition of hepatitis A module to its "You Call the Shots" training course

CDC recently announced the addition of a hepatitis A module to the web-based training course "Immunization: You Call the Shots." This module discusses hepatitis A virus infection, the hepatitis A vaccines, recommendations for vaccine use, and indications for administration of immune globulin. Extra learning opportunities, self-test practice questions, reference and resource materials, and a glossary are all provided.

For additional information on "You Call the Shots," go to:
http://www.cdc.gov/nip/ed/youcalltheshots.htm

To access the hepatitis A module, go to:
http://www2.cdc.gov/nip/isd/ycts/mod1/courses/hepa/start.asp

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8 NASTAD releases primer on viral hepatitis policymaking and programs

On May 5, the National Alliance of State & Territorial AIDS Directors (NASTAD) released a primer titled "Raising the Profile, Raising Your Voice: A Primer on Viral Hepatitis Policymaking and Programs at the Federal Level."

This new document serves to educate persons who are dedicated to viral hepatitis prevention and care about the federal policy process and the programs that address viral hepatitis. Understanding the process through which federal viral hepatitis funding and program decisions are made is critical to impacting policies affecting state hepatitis programs and persons living with hepatitis.

To access a ready-to-print (PDF) version of this resource, go to:
http://www.nastad.org/Docs/highlight/200754_NASTAD_VH_Primer_May07.pdf

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9 Former CDC director writes about changes in public health from 1990-1993

CDC published "CDC's 60th Anniversary: Director's Perspective--William L. Roper, MD, MPH, 1990-1993" in the May 11 issue of MMWR. The years 1990-1993 saw tremendous change in public health, with CDC strengthening the public health infrastructure, improving the health of children, and making prevention a practical reality in the nation's health system.

The article cites many examples of activities that helped fulfill these objectives. Two specifically related to immunization are vaccine financing and polio eradication; the associated sections are reprinted below, excluding footnotes.


VACCINE FINANCING
Today, the life-saving and health-preserving impact of immunizations exceeds almost all other public health interventions, both in terms of effectiveness and cost-effectiveness. However, in the early 1990s, costs were a significant barrier to obtaining recommended vaccines for persons who were uninsured or underinsured. The necessity for achieving high vaccination coverage rates was made especially clear through a resurgence of measles in 1989, which involved more than 55,000 cases and 123 deaths, with preschoolers disproportionately affected. In 1993, the challenge of addressing vaccine financing led to the Childhood Immunization Initiative, which set a goal of 90% vaccination coverage for preschool children and addressed vaccine financing to make this possible.

Many solutions were considered and supported by various perspectives, but the compromise approach involved passage in 1993 of the Vaccines for Children (VFC) Act, which ensures that children who are uninsured or on Medicaid, who are American Indians/Alaska Natives, or who are underinsured and seen in Federally Qualified Health Centers, all have a right to receive free of charge any vaccines recommended by the Advisory Committee on Immunization Practices. The innovation of this entitlement was provision of vaccines directly to clinical-care providers, who then administer them to children as needed, permitting children to remain in their primary medical homes without requiring referrals and without loss of continuity of care. This collaboration between public health and the private sector created a large network of VFC providers and within 3 years led to >75% vaccination coverage. Today, more than 40% of vaccinations for children are provided through VFC, and vaccination rates are at record or near-record highs. Measles vaccinations for preschoolers exceed 90%, and racial and ethnic disparities in vaccination have been reduced dramatically.

POLIO ERADICATION
In 1988, CDC had joined forces with the World Health Organization (WHO), UNICEF, and Rotary International to spearhead the Global Polio Eradication Initiative. Despite elimination from the Americas in 1991, polio remained at high rates in many countries in Asia and Africa. CDC's commitment to global eradication intensified in the early 1990s, when CDC began assigning epidemiologists to the Pan American Health Organization and WHO to help in the polio battle. These dedicated CDC workers traveled around the world helping other countries develop and implement plans of action to eradicate polio. At the same time, CDC began hosting global polio eradication meetings. With the technical aid of CDC's immunization, laboratory, and epidemiology experts, as well as substantial financial contributions, the number of children with paralytic polio has been reduced worldwide from 350,000 in 1988 to approximately 2,000 in 2006. . . .


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf

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10.  CDC publishes record of February ACIP meeting

CDC has published a record of the proceedings of the February 21-22, 2007, meeting of the Advisory Committee on Immunization Practices (ACIP).

To access a Word version of the meeting proceedings, go to: http://www.cdc.gov/nip/ACIP/minutes/acip_min_feb07.doc

To access a ready-to-print (PDF) version of the meeting proceedings (96 pages), go to:
http://www.cdc.gov/nip/ACIP/minutes/acip_min_feb07.pdf

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11.  FDA clears first respirators for use in public health medical emergencies

On May 8, the Food and Drug Administration (FDA) cleared for marketing the first respirators that can help reduce the user's exposure to airborne pathogens during a public health medical emergency, such as an influenza pandemic.

The two facepiece respirators, manufactured by the 3M Company, will be available to the general public without a prescription.

To read the FDA press release about these products, go to:
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01630.html

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12.  New pandemic influenza resources available

Two organizations released new resources related to pandemic influenza on May 9.

The Department of Defense announced the release of its "National Pandemic Influenza Strategy Implementation Plan." The plan, dated August 2006, provides strategic guidance to all Department of Defense components for preparation and response to an outbreak of pandemic influenza.

To access a ready-to-print (PDF) version of the plan, click here.

The World Health Organization published "Questions and Answers on Pandemic Influenza Vaccine."

To access a web-text (HTML) version of these Q&As, go to:
http://www.who.int/immunization/newsroom/PI_QAs/en/print.html

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13.  CDC updates its avian influenza web section

On May 7, CDC posted an updated version of "Questions and Answers About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus" on its Influenza web section.

To access this resource and more, go to: http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent link.

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

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14.  California Distance Learning Health Network to offer pandemic influenza school preparedness training on May 17

The California Distance Learning Health Network has collaborated with the California Department of Health Services and the Department of Education to develop a satellite broadcast and exercise to help schools across the nation plan and increase their preparedness for a possible influenza pandemic.

The broadcast will cover topics such as school closure, continuity of education, average daily attendance, issues specific to certain populations, and ways schools can incorporate pandemic influenza planning into their existing safe school plans.

The live broadcast will be accessible from various locations around the nation on May 17, from 9:00-10:30AM PT. A tabletop exercise will follow, during which participants will develop a portion of a plan or analyze their existing plan, exercise their plan, and debrief the results.

For more information, click here.

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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.