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Immunization Action Coalition
IAC Express 2007
Issue number 701: December 17, 2007
 
Contents of this Issue
Select a title to jump to the article.
  1. Happy holidays from all of us at IAC
  2. Merck announces voluntary recall of certain lots of its Hib-containing vaccines PedvaxHIB and COMVAX
  3. IAC website posts three Spanish-language immunization print resources
  4. IAC updates its print resource "MMR Vaccine Does Not Cause Autism: Examine the evidence!"
  5. December issue of CDC's Immunization Works electronic newsletter now available online
  6. December 12 issue of IAC's Hep Express electronic newsletter posted on IAC's website
  7. Important: Be sure to give influenza vaccine throughout the influenza season--from fall 2007 through spring 2008
  8. CDC publishes update on U.S. influenza activity from September 30 through December 1
  9. Nomination deadline for the 2008 National Influenza Vaccine Summit's Immunization Excellence Awards is January 17, 2008
  10. WHO issues position paper on rabies vaccines
 
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 701: December 17, 2007
1.  Happy holidays from all of us at IAC

All of us at IAC wish the readers of IAC Express a safe, happy, and relaxing holiday season--free from influenza.

We will not be producing an issue on December 24. We'll email you the next issue on December 31.

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2 Merck announces voluntary recall of certain lots of its Hib-containing vaccines PedvaxHIB and COMVAX

On December 13, Merck & Co. announced that it was recalling 10 lots of its PedvaxHIB (haemophilus b conjugate vaccine [meningococcal protein conjugate]) vaccine used in the United States and two lots of its COMVAX (haemophilus b conjugate [meningococcal protein conjugate] and hepatitis B [recombinant]) combination vaccine.

CDC is working closely with the alternative manufacturer of Hib vaccine (sanofi pasteur) to evaluate and ensure vaccine supply. Specific updates will be provided as soon as they are available; Future issues of IAC Express will announce the updates.

The Front Page News article of the December issue of CDC's Immunization Works electronic newsletter is devoted to the Hib vaccine recall. It is reprinted below in its entirety.

The end of this IAC Express article contains links to several addition resources: (1) information from CDC about the current supply of Hib vaccine, which contains updates made on December 12 and December 14; (2) a CDC Q&A web page for parents about the recall; (3) the transcript of a 12/12/07 CDC press briefing on the recall; and (4) information from FDA on the lots recalled.


IMMUNIZATION WORKS
FRONT PAGE NEWS

MERCK ANNOUNCES VOLUNTARY RECALL OF HIB VACCINE: Merck & Co. has initiated a voluntary recall in the United States for eleven lots [10 distributed in the U.S. and one used only in China] of PedvaxHIB [Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate)] and two lots of COMVAX [Haemophilus b Conjugate (Meningococcal Protein Conjugate) and Hepatitis B (Recombinant) Vaccine]. The affected doses were distributed starting in April 2007. No other lots of PedvaxHIB or COMVAX and no other Merck products are affected by this recall.

Merck is taking this step as a precautionary measure. The company cannot assure sterility for these specific vaccine lots. The potential contamination in these specific lots was identified as part of Merck's standard evaluation of their manufacturing processes. In routine testing of the vaccine manufacturing equipment used to produce PedvaxHIB and COMVAX, Merck identified the presence of a certain bacteria called Bacillus cereus. Sterility tests of the vaccine lots themselves have not found any contamination. The potential for contamination of any individual vaccine is low, and, if present, the level of contamination would be low. However, because they cannot guarantee the sterility of these specific lots of vaccine, Merck is conducting this recall.

CDC has posted a fact sheet [for providers], Q&As about Recall of Hib Vaccine (http://www.cdc.gov/vaccines/recs/recalls/hib-recall-faqs-12-12-07.htm) on their Vaccines website (http://www.cdc.gov/vaccines). Also, questions about medical and other issues related to this recall can be directed to Merck's National Service Center at (800) 672-6372.


(1) To access CDC information on the current supply of Hib vaccine, which contains updates made on December 12 and December 14, go to: http://www.cdc.gov/vaccines/vac-gen/shortages and scroll down to Note 1.

(2) To access a Q&A about the recall for parents, go to:
http://www.cdc.gov/vaccines/recs/recalls/hib-recall-parents-faqs-12-12-07.htm

(3) To access the transcript of the 12/12/07 CDC press briefing on the recall, go to:
http://www.cdc.gov/od/oc/media/transcripts/2007/t071212.htm

(4) To access FDA information on the lots recalled, go to:
http://www.fda.gov/cber/recalls/merckhib121107.htm

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3 IAC website posts three Spanish-language immunization print resources

IAC recently posted Spanish-language versions of three of its patient-education materials: (1) "Screening Questionnaire for Intranasal Influenza Vaccination" (2) "Are You 11-19 Years Old? Then you need to be vaccinated against these serious diseases!" and (3) "Questions Frequently Asked About Hepatitis B."

(1) To access the newly translated "Cuestionario de seleccion para la vacuna inranasal contra la influenza" ("Screening Questionnaire for Intranasal Influenza Vaccination") in ready-to-print (PDF) format, go to:
http://www.immunize.org/catg.d/p4067-01.pdf

To access "Screening Questionnaire for Intranasal Influenza Vaccination" in English, go to:
http://www.immunize.org/catg.d/p4067.pdf

(2) To access the recently updated (8/07) "Tienes de 11 a 19 anos? Entonces neccesitas vacunarte contra estas enfermedades serias!" ("Are You 11-19 Years Old? Then you need to be vaccinated against these serious diseases!") in ready-to-print (PDF) format, go to:
http://www.immunize.org/catg.d/p4020-01.pdf

To access "Are You 11-19 Years Old? Then you need to be vaccinated against these serious diseases!" in English, go to:
http://www.immunize.org/catg.d/p4020.pdf

(3) To access the recently updated (8/07) "Preguntas frecuentes acerca de la hepatitis B" ("Questions Frequently Asked About Hepatitis B") in ready-to-print (PDF) format, go to:
http://www.immunize.org/catg.d/p4090-01.pdf

To access "Questions Frequently Asked About Hepatitis B" in English, go to: http://www.immunize.org/catg.d/p4090.pdf

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4 IAC updates its print resource "MMR Vaccine Does Not Cause Autism: Examine the evidence!"

In August, IAC updated its print resource "MMR Vaccine Does Not Cause Autism: Examine the evidence!" with six additional journal references that concur with the bulk of the medical literature that there is no association between receiving MMR (measles-mumps-rubella) vaccine and developing autism.

To access a ready-to-print (PDF) version of the updated resource, go to: http://www.immunize.org/catg.d/p4026.pdf

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

The December issue of Immunization Works, a monthly email newsletter published by CDC, is available on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

The Front Page News article from the December issue appears as article #1 of this issue of IAC Express. Various other articles from the December issue of Immunization Works have already appeared in previous issues of IAC Express. Following is the text of six articles we have not covered.


OTHER NEWS & SUMMARIES

DRAMATIC INCREASE IN USE OF HIB VACCINE GLOBALLY: Since 2000, the GAVI Alliance (formerly known as the Global Alliance for Vaccines and Immunizations) has provided support for new and underutilized vaccines to the poorest countries in the world. While Haemophilus influenzae type B (Hib) vaccine has been widely utilized in developed countries for more than 15 years, uptake of the vaccine in developing countries has been slow. In 2005, the GAVI Alliance created the Hib Initiative to accelerate evidence-informed adoption and sustained use of Hib vaccine in GAVI-eligible countries. Worldwide, Hib disease is estimated to cause 3 million cases of meningitis and severe pneumonia, and approximately 386,000 deaths per year, in children under five years of age. The World Health Organization (WHO) recommends that all countries adopt the Hib vaccine into routine child immunizations. In September 2007, the GAVI Alliance received 21 applications (13 from Africa) for funding support for Hib-containing pentavalent vaccine. Of these, 16 were approved, and five received conditional approval. The introduction of Hib vaccine in these countries will increase the number of GAVI-eligible countries using or approved to use Hib vaccine from 31 countries to 47, and will cover a birth cohort of approximately 23 million children--a two-fold increase in existing coverage. CDC is a member of the Hib Initiative, along with WHO, Johns Hopkins Bloomberg School of Public Health, and the London School of Hygiene & Tropical Medicine.


CDC'S PRE-TEEN VACCINE CAMPAIGN WINS NATIONAL AWARD: Women in Government, a national organization representing women state legislators in the United States, recently recognized CDC's Pre-teen Vaccine Campaign with a Presidential Leadership Award. The award honors individuals and groups that are advancing efforts to eliminate cervical cancer in the United States and worldwide. In November, at a ceremony held at the John F. Kennedy Center in Washington, DC, the award was accepted on behalf of the campaign by Pre-teen Vaccine Campaign manager Kari Sapsis. The CDC's Pre-teen Vaccine Campaign is designed to engage parents and others in a dialogue to ensure pre-teen vaccinations are not forgotten. Through extensive audience research, CDC has created posters and flyers, in English and Spanish, to educate parents and providers about the three pre-teen vaccines and the 11 and 12 year old medical check-up. More information about the campaign, and free campaign materials, can be found at the CDC's Pre-teen Vaccine Campaign website (http://www.cdc.gov/vaccines/spec-grps/preteens-adol/07gallery).


MEETINGS, CONFERENCES & RESOURCES

NEW CDC FLU MATERIALS: A new CDC fact sheet, Questions & Answers about the 2007-2008 Flu Season (http://www.cdc.gov/flu/about/qa), can be found at CDC's Seasonal Flu website. The fact sheet, which is intended for a general public audience, answers questions about this year's flu season, the effectiveness of the flu vaccine, and other common questions. Also, CDC has posted ten new posters, including several in Spanish, at the CDC Flu Gallery (http://www.cdc.gov/flu/professionals/flugallery/index.htm#nivwflupsa).


PARTNER FLU PSAs: The National Influenza Vaccine Summit, (NIVS), which is co-sponsored by the American Medical Association, and the Centers for Disease Control and Prevention (CDC), has posted a number of influenza public service announcements (PSAs) on its website. The PSAs, many of which are free or available from partners for a nominal fee, can be found on the on the News and Media page under the Public Service Announcements heading of the NIVS website (http://www.preventinfluenza.org/media.asp).


GET READY FOR NIC: The 42nd National Immunization Conference (NIC) will be held from March 1720, 2008, in Atlanta, Georgia, and will comprise six topic tracks: Adolescent and Adult Vaccination, Epidemiology and New Vaccines, Health and Risk Communication, Immunization Information Systems, Influenza, and Programmatic Issues. Abstract submission is now closed. More information can be found on the NIC Website (http://www.cdc.gov/vaccines/events/nic/default.htm). Or, questions can be addressed to the Conference Planning Team at nipnic@cdc.gov


ON-SITE TRAINING IN ATLANTA: A two-day Epidemiology and Prevention of Vaccine-Preventable Diseases course (http://www.cdc.gov/vaccines/ed/onsite-trg.htm) will be held in Atlanta on April 15 and 16, 2008, at CDC. Space is limited.

Issues of Immunization Works are posted on CDC's Vaccines & Immunizations website a few days after publication. To access the December issue, go to: http://www.cdc.gov/vaccines/news/newsltrs/imwrks Click on the link titled "Dec" under the banner titled "2007 Newsletters Available Online."

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6 December 12 issue of IAC's Hep Express electronic newsletter posted on IAC's website

The December 12 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 12 Hep Express; titles of articles we have not yet covered follow.

  • CDC releases new report on health disparities in HIV/AIDS, viral hepatitis, STDs, and tuberculosis
  • Washington State API [Asian Pacific Islander] Hepatitis B Task Force offers 2008 calendar
  • New APIA [Asian Pacific Islander Americans] brochure available from Free Hepatitis Info
  • Selected studies presented at November AASLD [American Association for the Study of Liver Diseases] meeting available online
  • APAMSA's [Asian Pacific American Medical Student Association's] November Hepatitis B Training meeting slides available online
  • VHPB [Viral Hepatitis Prevention Board] updates its website with new resources
  • Journal articles you may have missed

To access the December 12 issue, go to:
http://www.hepprograms.org/hepexpress/issue65.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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7 Important: Be sure to give influenza vaccine throughout the influenza season--from fall 2007 through spring 2008

Influenza vaccination should continue from now into the early months of 2008. 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 Seasonal Flu web section at http://www.cdc.gov/flu

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8 CDC publishes update on U.S. influenza activity from September 30 through December 1

CDC published "Update: Influenza Activity--United States, September 30-December 1, 2007" in the December 14 issue of MMWR. Portions of the article are reprinted below.


During September 30-December 1, 2007, influenza activity remained low in the United States. This report summarizes U.S. influenza activity since September 30, the start of the 2007-08 influenza season.

Viral Surveillance
During September 30-December 1, 2007, World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System collaborating laboratories in the United States tested 24,897 respiratory specimens for influenza viruses, and 559 (2.2%) were positive. Of these, 515 (92%) were influenza A viruses, and 44 (8%) were influenza B viruses. One hundred thirty-five (26%) of the 515 influenza A viruses were subtyped; 112 (83%) of these were influenza A (H1) viruses, and 23 (17%) were influenza A (H3) viruses. Influenza virus-positive tests have been reported from the District of Columbia (DC) and 32 states in all nine surveillance regions since September 30.

Antigenic Characterization
WHO collaborating laboratories in the United States are requested to submit a subset of their influenza isolates to CDC for further antigenic characterization. Viral isolates are necessary for antigenic characterization. Many of the positive tests reported to CDC are from rapid antigen testing and, therefore, cannot be characterized further. Since September 30, 2007, U.S. laboratories have submitted approximately 80 influenza isolates for antigenic characterization, the majority of these during November 18-December 1. To date, CDC has antigenically characterized 27 influenza viruses; 19 (70%) of these were influenza A (H1) isolates, five (19%) were influenza A (H3) isolates, and three (11%) were influenza B isolates. Other isolates received since September 30 are being grown and characterized.

All of the 19 influenza A (H1) viruses were A/Solomon Islands/3/2006-like, a recent antigenic variant of A/New Caledonia/20/99 and the strain recommended by WHO as the influenza A (H1) component for both the 2007-08 Northern Hemisphere influenza vaccine and the 2008 Southern Hemisphere influenza vaccine. Two influenza A (H3) isolates were A/Wisconsin/67/2005-like, the strain included in the 2007-08 Northern Hemisphere vaccine formulation. Three influenza A (H3) isolates were antigenically similar to A/Brisbane/10/2007, the strain recommended as the 2008 A (H3) component of influenza vaccines for the Southern Hemisphere.

Each of the three influenza B viruses characterized belongs to the B/Yamagata/16/88 lineage. Influenza B viruses currently circulating worldwide can be divided into two antigenically distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. The recommended influenza B component for the 2007-08 influenza vaccine is a B/Malaysia/2506/2004-like virus, belonging to the B/Victoria lineage.

Novel Influenza A Viruses
One case of novel influenza A infection was reported from Michigan during the week ending November 3, 2007; a child aged 18 months was infected with swine influenza A (H1N2) virus in August 2007 after attending an agricultural event where swine were exhibited. The child walked through a barn containing pigs but was reported to have had no direct contact with the animals. The child recovered from the illness; no contacts of the child were reported to be ill.

Outpatient Illness Surveillance
Since September 30, 2007, weekly percentages of outpatient visits for influenza-like illness (ILI) reported by approximately 1,300 U.S. sentinel providers in 50 states, New York City, Chicago, and DC have ranged from 0.9% to 1.6%. Weekly percentages of outpatient visits for acute respiratory illness (ARI) reported by approximately 800 U.S. Department of Veterans Affairs (VA) BioSense outpatient treatment facilities and 350 U.S. Department of Defense (DoD) BioSense outpatient treatment facilities have ranged from 1.8% to 2.4%. During the week ending December 1, approximately 1.6% of outpatient visits through the U.S. sentinel providers were attributed to ILI, and 2.4% of outpatient visits to the VA and DoD BioSense facilities were attributed to ARI, both of which are below the respective national baselines of 2.2% and 3.2%. For the week ending December 1, all nine regions reported percentages of outpatient visits for ARI below their respective region-specific baselines. ARI data from the VA and DoD BioSense facilities also are analyzed by age groups (0-4 years, 5-17 years, 18-49 years, 50-64 years, and >=65 years). The percentages of outpatient visits for ARI for all five age groups were below their respective age-specific baselines.

State-Specific Activity Levels
For the week ending December 1, 2007, influenza activity was reported as local in four states (Colorado, Florida, Texas, and Virginia) and as sporadic in 33 states and DC. Thirteen states reported no activity. To date, no states have reported regional or widespread influenza activity this season.

Pneumonia- and Influenza-Related Mortality
For the week ending December 1, 2007, pneumonia and influenza (P&I) was listed as an underlying or contributing cause of death for 6.1% of all deaths reported through the 122 Cities Mortality Reporting System. This percentage is below the epidemic threshold of 6.4% for that period. During the 2007-08 influenza season, the weekly percentage of deaths attributed to P&I has ranged from 5.7% to 6.1%. The percentage of deaths attributed to P&I exceeded the epidemic threshold for 3 consecutive weeks during September 30-October 20 but has remained below the epidemic threshold since the week ending October 27.

Influenza-Associated Pediatric Hospitalizations
Pediatric hospitalizations associated with laboratory-confirmed influenza infections are monitored by two population-based surveillance networks, the Emerging Infections Program (EIP) and the New Vaccine Surveillance Network (NVSN). To date, no influenza-associated pediatric hospitalizations have been reported from NVSN this season. During September 30-November 24, 2007, the preliminary laboratory-confirmed influenza-associated hospitalization rate reported by EIP for children was within the expected range for this time of year. For children aged 0-17 years, the influenza-associated hospitalization rate was 0.006 per 10,000. For children aged 0-4 years and 5-17 years, the rates were 0.01 and 0.003 per 10,000, respectively.

Influenza-Related Pediatric Mortality
One influenza-associated pediatric death occurring during the 2007-08 season has been reported to CDC through the National Notifiable Diseases Surveillance System. The death occurred in Texas during the week ending November 10, 2007, and was reported to CDC during the week ending December 1. . . .

Editorial Note:
Vaccination is the best method for prevention of influenza and its potentially severe complications. Influenza vaccine should be administered to any person who wants to reduce the likelihood of becoming ill with influenza or transmitting influenza to others. Annual influenza vaccination, as recommended by the Advisory Committee on Immunization Practices (ACIP), is targeted toward persons at increased risk for influenza-related complications and severe disease (e.g., children aged 6-59 months, pregnant women, persons aged >=50 years, and persons aged 5-49 years with certain chronic medical conditions) and their close contacts (e.g., healthcare workers and household contacts of persons at increased risk, including contacts of children aged <6 months). In addition, all children aged 6 months-9 years who have not been vaccinated previously at any time should receive 2 doses of influenza vaccine, and those who only received 1 dose in their first year should receive 2 doses in the following year.

To maximize the benefit from vaccination, persons should be vaccinated before increases of influenza activity occur in their community. Because influenza activity remains low in all parts of the United States and does not typically peak until January or later, persons not yet vaccinated should get vaccinated and vaccine providers should continue to encourage vaccination in December and beyond. . . .


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5649a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5649.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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9 Nomination deadline for the 2008 National Influenza Vaccine Summit's Immunization Excellence Awards is January 17, 2008

The National Influenza Vaccine Summit recently posted the nomination form for its Immunization Excellence Awards. The awards recognize individuals and organizations that have made extraordinary contributions toward improved adult and/or childhood influenza vaccination within their communities. Awards will be presented during the National Immunization Conference, which will be held in Atlanta during March 17-20, 2008. The deadline for nominations is January 17, 2008.

To access a downloadable nomination form and additional information, go to:
http://www.preventinfluenza.org/nominationform2008.pdf

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10.  WHO issues position paper on rabies vaccines

The December 7 issue of the WHO periodical "Weekly Epidemiological Record" covered the latest WHO position paper on rabies vaccines. To access it, go to:
http://www.who.int/wer/2007/wer8249_50.pdf

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

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

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Immunization Action Coalition  •  1573 Selby Ave  •  St. Paul, MN 55104
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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.