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Immunization Action Coalition
IAC Express 2008
Issue number 709: February 4, 2008
 
Contents of this Issue
Select a title to jump to the article.
  1. New: CDC's multi-vaccine VIS has information on all vaccines routinely given to infants between birth and age 6 months
  2. Did you contact ABC concerning the "Eli Stone" episode? Please tell us about your letter or phone call
  3. "Eli Stone" show follow-up and related resources for healthcare providers
  4. CDC releases Dear Colleague letter on influenza
  5. CDC releases revised interim meningococcal VIS
  6. IAC updates "Screening Questionnaire for Child and Teen Immunization" and "Screening Questionnaire for Adult Immunization"
  7. Official CDC Health Advisory: Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection
  8. New: Spanish-language version of the current recommended adult immunization schedule now online
  9. National Infant Immunization Week scheduled for April 19-26; CDC's online resources make it easy to promote
  10. February 22 is the nomination deadline for the fifth annual "Natalie J. Smith, MD, Award"
  11. Important: Be sure to give influenza vaccine throughout the influenza season--including the spring months
  12. ACIP meeting scheduled for February 27-28; registration deadline for U.S. citizens is February 8
 
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 709: February 4, 2008
1.  New: CDC's multi-vaccine VIS has information on all vaccines routinely given to infants between birth and age 6 months

On January 30, 2008, CDC posted a multi-vaccine VIS on its website. This new VIS may be used in place of individual VISs whenever routine birth through 6-month vaccines (DTaP, IPV, Hib, hepatitis B, PCV, and rotavirus) are administered, or when combination vaccines are used (e.g., Pediarix or Comvax). You don't need to give all 6 vaccines at one time in order to use this new VIS.

Before you hand this new VIS to the patient, you MUST go to page 1 of the VIS and place a check mark in front of the name of each vaccine you will be administering at that visit.

Using the multi-vaccine VIS is an alternative to providing single-vaccine VISs for each of these six vaccines.

Note that this new multi-vaccine VIS contains four 8-1/2" x 11" pages, in contrast to the standard single-vaccine VIS which contains two pages.

The multi-vaccine VIS is available from the IAC website at
http://www.immunize.org/vis/vis_multi1.pdf

For instructions on how to use this new VIS, go to:
http://www.immunize.org/vis/vis_multi1.asp

To access the VIS from the CDC website, go to:
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-multi.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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2 Did you contact ABC concerning the "Eli Stone" episode? Please tell us about your letter or phone call

Dear Immunization Colleagues,

Following last week's IAC EXPRESS story about the misrepresentations promoted in ABC-TV's January 31 episode of "Eli Stone," many of you and your colleagues communicated your concerns to ABC, Inc.

In order to understand the magnitude of the response to our request to contact ABC and also to learn details of the particular messages you sent, we are now asking that each of you who communicated with ABC send us the following:

Your name, title, and position
(Your organization)
Your contact information (complete mailing address)
Your email address
A copy (or a summary, if you prefer) of the email message you sent including any attachments
A description of any phone call you may have made

Please send this information to media@immunize.org (mailto:media@immunize.org?subject=ABC).

We will use your information to understand how such future efforts might also be successful and to create a list of interested individuals and organizations who might be willing to help in similar circumstances.

IAC will not distribute your contact information without your permission. We will use it only for IAC activities.

Please indicate if it is okay for us to publicly distribute your message. At this time, we have no plan to do so, but in the future an occasion might arise where distributing a copy of your communication would be useful.

All of us at IAC are so appreciative of everyone who was able to participate in what appears to be an outpouring of pressure on ABC. Thank you so much.

Sincerely,

Deborah L. Wexler, MD
Executive Director

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3 "Eli Stone" show follow-up and related resources for healthcare providers

After receiving thousands of phone calls and email messages from organizations and individuals about the misleading premise of Thursday's episode of the legal drama "Eli Stone," ABC added the following disclaimer which aired in 10 seconds at the conclusion of the show, both orally and in text: "The preceding story was fictional and did not portray any actual persons, companies, products or events. For information on autism, please visit Centers for Disease Control and Prevention (CDC)--www.cdc.gov/autism or call 1-800-CDC-INFO."

We at IAC heartily thank and commend all those who took the time to let their opinions be known. You made a difference!

Because many parents may have questions about the safety of vaccines after watching this fictional show, some useful resources for providers follow.

From CDC:

"Key Messages for Responding to Inquiries Generated by the Fictional Television Show "Eli Stone" Airing on ABC January 31"
http://www.immunize.org/press/pr_elistone_talkingpoints.pdf

"Timeline: Thimerosal in Vaccines (1999-2008)"
http://www.immunize.org/thimerosal/thimerosal_timeline.pdf

CDC's information on mercury and vaccines
http://www.cdc.gov/od/science/iso/concerns/thimerosal.htm

From AAP:

In light of the "Eli Stone" controversy, AAP is lifting the embargo on a new study published in the February issue of Pediatrics that shows that the ethyl mercury previously used in vaccines as a preservative is excreted much faster than other forms of mercury in the environment.

"Mercury Levels in Newborns and Infants After Receipt of Thimerosal-Containing Vaccines"
http://pediatrics.aappublications.org/cgi/content/full/121/2/e208

A related news release from the authors' institution, the University of Rochester, can be found at
http://www.urmc.rochester.edu/pr/news/story.cfm?id=1848

AAP's autism information
http://www.aap.org/healthtopics/autism.cfm

From IAC:

Collection of thimerosal information for healthcare professionals
http://www.immunize.org/thimerosal

Thimerosal in Vaccines web section for parents/patients
http://www.vaccineinformation.org/thimerosal.asp

Vaccine and Autism web section for parents/patients
http://www.vaccineinformation.org/autism.asp

From Every Child By Two:

Collection of articles about vaccine safety and the "Eli Stone" controversy
http://72.32.4.217/ecbt/media_articles.htm

From the Vaccine Education Center:

Thimerosal information
http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75807

From the National Network for Immunization Information:

Thimerosal/mercury
http://www.immunizationinfo.org/thimerosal_mercury_issues.cfm

Miscellaneous:

The Archives of General Psychiatry published a major study on January 7, 2008, that found autism cases in California continued to climb after thimerosal was removed from routine childhood vaccines in 2001.

"Continuing Increases in Autism Reported to California's Developmental Services System"
Click here to view the study.

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4 CDC releases Dear Colleague letter on influenza

On January 31, CDC released a Dear Colleague letter to healthcare and public health professionals in response to recent surveillance reports indicating that influenza activity is on the rise. The letter describes CDC's recommendation for a three-pronged approach to reduce the substantial burden of influenza on the U.S.: increasing the number of people vaccinated against influenza, using influenza antiviral agents appropriately, and promoting respiratory hygiene and cough etiquette. The text of the letter follows.


Dear Colleague,

Recent U.S. surveillance reports indicate that influenza activity is on the rise. To reduce the substantial burden of influenza on the U.S., CDC recommends a three-pronged approach: increasing the number of people vaccinated against influenza, appropriate use of influenza antiviral agents, and promoting respiratory hygiene and cough etiquette.

(1) First is the use of influenza seasonal vaccine. Vaccination now can still provide protection against influenza this season since different influenza viruses can circulate as late as May. Please continue to offer vaccine to people recommended for vaccination, including healthcare workers, and anyone else who wants to decrease their risk of getting influenza. If your practice has administered all of its vaccine, you can purchase additional vaccine, or refer patients to local health departments or other vaccine providers.

(2) An important second line of defense against influenza is the appropriate use of influenza antiviral medications. These can be used to treat or prevent influenza virus infection. Treatment should begin within 48 hours of symptom onset, and can reduce symptoms and illness duration. There are two influenza antiviral agents that should be used in the U.S.: oseltamivir and zanamivir. Oseltamivir is approved for treatment and prevention of influenza in persons 1 year and older. Zanamivir is approved for treatment of persons 7 years and older and for prevention in persons 5 years and older.

(3) Use respiratory hygiene and cough etiquette measures to prevent the spread of influenza. These everyday preventive actions include frequent hand washing, covering coughs and sneezes, and staying home when sick to keep from spreading illness.

Information and materials on these measures, including downloadable flyers and audio announcements, as well as information on how to locate available influenza vaccine for purchase, are available at http://www.cdc.gov/flu We encourage you to visit our website and ask that you circulate this information widely. Thank you for your invaluable contributions to public health.


The letter was signed by Dr. Nancy Cox, director of CDC's Influenza Division, and Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases.

To access related campaign materials, go to the "Take 3" web page at http://www.cdc.gov/flu/protect/preventing.htm Resources include flyers, brochures, audience-specific informational articles, and public service announcements.

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5 CDC releases revised interim meningococcal VIS

A revised interim meningococcal VIS has been posted on the CDC website. This edition, dated 1/28/08, reflects the recent licensure of MCV4 for children age 2-10 years and changes in ACIP's recommendations to include use of MCV4 among those children. There are several other minor changes, including the incidence of meningococcal disease in Section 1 and the addition of a section on the Vaccine Injury Compensation Program.

The final meningococcal VIS is going through the mandated review process.

To access the interim VIS for meningococcal vaccines from the CDC website, go to:
http://www.cdc.gov/vaccines/pubs/vis/downloads/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 IAC updates "Screening Questionnaire for Child and Teen Immunization" and "Screening Questionnaire for Adult Immunization"

IAC recently revised two of its healthcare professional resources: "Screening Questionnaire for Adult Immunization" and "Screening Questionnaire for Child and Teen Immunization." A minor change was made to the adult questionnaire. A new question was added to the child/teen questionnaire relating to wheezing and asthma when administering nasal-spray influenza vaccine to children age 2-4 years.

To access a ready-to-print (PDF) version of the updated "Screening Questionnaire for Adult Immunization," go to:
http://www.immunize.org/catg.d/p4065.pdf

To access a ready-to-print (PDF) version of the updated "Screening Questionnaire for Child and Teen Immunization," go to: http://www.immunize.org/catg.d/p4060.pdf

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7 Official CDC Health Advisory: Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection

On January 30, CDC's Health Alert Network issued an official CDC Health Advisory titled "Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection." It is reprinted below in its entirety.


CDC is requesting that states report all cases of influenza-related pediatric mortality during the 2007-2008 influenza season. This health advisory contains updated information about influenza and bacterial co-infections in children and provides interim testing and treatment recommendations.

Background:
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 September 30, 2007, 73 deaths from influenza in children were reported to CDC from 39 state health departments and two city health departments. Data on the presence (or absence) of bacterial co-infections were recorded for 69 of these cases; 30 (44%) had a bacterial co-infection, and 22 (73%) of these 30 were infected with Staphylococcus aureus.

The number of pediatric influenza-associated deaths reported during 2006-07 was moderately higher than the number reported during the two previous surveillance years; the number of these deaths in which pneumonia or bacteremia due to S. aureus was noted represents a five-fold increase. Only one S. aureus co-infection among 47 influenza deaths was identified in 2004-2005, and 3 co-infections among 46 deaths were identified in 2005-2006. Of the 22 influenza deaths reported with S. aureus in 2006-2007, 15 children had infections with methicillin-resistant S. aureus (MRSA).

The median age of children with S. aureus co-infection was older than children without S. aureus co-infection (10 years versus 5 years, p<.01), and children with co-infection were more likely to have pneumonia and Acute Respiratory Distress Syndrome (ARDS). Influenza strains isolated from these children were not different from common strains circulating in the community, and the MRSA strains have been similar to those associated with MRSA skin infection outbreaks in the United States.

Recommendations:
Healthcare providers should test persons hospitalized with respiratory illness for influenza, including those with suspected community-acquired pneumonia. Healthcare providers should be alerted to the possibility of bacterial co-infection among children with influenza, and request bacterial cultures if children are severely ill or when community-acquired pneumonia is suspected. Healthcare providers should be aware of the prevalence of methicillin-resistant S. aureus strains in their communities when choosing empiric therapy for patients with suspected influenza-related pneumonia. Clinicians, healthcare providers, and medical examiners are asked to contact their local or state health department as soon as possible when deaths among children associated with laboratory-confirmed influenza are identified.

CDC requests that state health departments report all cases of pediatric influenza-associated deaths 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, state health departments are asked to please contact the clinical agency that reported the case to determine if the S. aureus isolate is available. CDC will receive S. aureus isolates in order to better characterize those S. aureus isolates from children who have died from influenza.

If you have any questions about this Health Advisory, please call the Influenza Division, Epidemiology and Prevention Branch at (404) 639-3747.

To access the health advisory, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00268

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8 New: Spanish-language version of the current recommended adult immunization schedule now online

The 2007-2008 Recommended Adult Immunization Schedule is now available in Spanish and downloaded from the CDC website. The schedule, which was released in English in October 2007, has been approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians,the American College of Obstetricians and Gynecologists, and the American College of Physicians.

To access the Spanish-language schedule, click here.

To access CDC's web page featuring both the child and adult schedules in different formats, go to:
http://www.cdc.gov/vaccines/recs/schedules

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9 National Infant Immunization Week scheduled for April 19-26; CDC's online resources make it easy to promote

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. Since 1994, NIIW has served as a call to action for parents, caregivers, and healthcare providers to ensure that infants are fully immunized against 14 vaccine-preventable diseases. This year NIIW will be held April 19-26, 2008.

Vaccination plays a critical role in safeguarding public health globally. During NIIW 2008, hundreds of communities across the United States will join those in the Western Hemisphere and Europe to celebrate Vaccination Week in the Americas (VWA) and European Immunization Week. More than sixty countries around the world will participate.

Three states--Washington, Rhode Island, and Connecticut--will host special NIIW kick off events. Additionally, bi-national events are being planned along the United States-Mexico border in partnership with CDC, the Pan American Health Organization, the US-Mexico Border Health Commission, state and local health departments, and other immunization partners. They will be joined by hundreds of communities from across the United States in celebrating NIIW through community awareness, healthcare provider education, and media events to promote infant immunizations.

Please visit http://www.cdc.gov/vaccines/events/niiw for additional resources on planning an NIIW event and to download English and Spanish-language NIIW campaign materials including print ads, radio public service announcements (PSAs), sample op-ed articles, and other public relations and planning tools. You can also provide information on your 2008 NIIW activities/event via this web page.

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10.  February 22 is the nomination deadline for the fifth annual "Natalie J. Smith, MD, Award"

The Association of Immunization Managers is seeking nominations for the 2008 "Natalie J. Smith, MD, Award." The award, which will be presented at the National Immunization Conference in Atlanta, in March, was established to honor the memory of Dr. Smith's outstanding management and leadership skills in the area of state and national vaccine-preventable disease programs. Eligible candidates are current or recently retired (within the last two years) immunization program managers who are designated as the persons primarily responsible for directing the 64 city, state, or territorial immunization programs directly funded by the National Center for Immunization and Respiratory Diseases. The deadline for nominations is February 22.

Dr. Smith, who died in 2003 at age 41, was deputy director, National Immunization Program (NIP), CDC. Prior to accepting the NIP position, she served for eight years as chief, Immunization Branch, California Department of Health Services. Dr. Smith served as a member of the Advisory Committee on Immunization Practices and as chair of the Association of Immunization Managers. She wrote numerous significant publications on immunization and was a frequent presenter and consultant on immunization-related issues.

To access more information about the award, including the nomination criteria and a 2008 nomination form, click here. If a File Download box pops up on your computer screen, click on Open or Save to access the Word document.

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11.  Important: Be sure to give influenza vaccine throughout the influenza season--including the spring months

Influenza vaccination should continue from now into the spring. 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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12.  ACIP meeting scheduled for February 27-28; registration deadline for U.S. citizens is February 8

The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on February 27-28 at CDC's Clifton Road campus in Atlanta. The meeting is open to the general public.

To speed security clearance, ACIP attendees (participants and visitors) must register online. The deadline for online registration for non-U.S. citizens was February 1; the registration deadline for U.S. citizens is February 8.

To register online, go to:
http://www2a.cdc.gov/nip/ACIP/FebruaryRegistration.asp

For more information, go to: http://www.cdc.gov/vaccines/recs/acip/meetings.htm#dates or call (404) 639-8836.

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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.