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Immunization Action Coalition
IAC Express 2008
Issue number 731: May 19, 2008
 
Contents of this Issue
Select a title to jump to the article.
  1. Today is World Hepatitis Day!
  2. CDC announces viral hepatitis awareness for May
  3. CDC releases ACIP recommendations for preventing herpes zoster
  4. CDC releases ACIP recommendations for preventing pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants
  5. CDC reports on acute hepatitis C virus infections attributed to unsafe injection practices in Nevada endoscopy clinic
  6. CDC offers new podcast on hepatitis B and Asian Pacific Islander Americans
  7. CDC releases revised and expanded National Immunization Survey data on hepatitis B birth dose
  8. CDC experts review and update twelve of IAC's online "Ask the Experts" Q&A sections
  9. Mark your calendar: IZTA's May 21 conference call will present the latest research on autism
  10. Enhanced surveillance detects hepatitis C virus infection among injection drug users in New York state
  11. Multi-vaccine VIS and interim varicella vaccine VIS now in Thai
  12. Important: Be sure to give influenza vaccine throughout the influenza season--from now through spring
 
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 731: May 19, 2008
1.  Today is World Hepatitis Day!

Today is World Hepatitis Day! This new international, patient-led initiative was launched in response to the fact that one in 12 people worldwide is living with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, yet there is a lack of awareness and political will to prevent and treat infection.

Did You Know?

  • 500 million people worldwide are currently infected with HBV or HCV
  • This number represents more than 10 times the number infected with HIV/AIDS
  • Between them, hepatitis B and C kill 1.5 million people a year
  • One in every three people on the planet has been exposed to either or both viruses
  • Most of the 500 million infected do not know

Today in Geneva, Switzerland, the World Hepatitis Alliance, a newly formed nongovernmental organization, called on governments around the world to do more to improve prevention, diagnosis, and treatment for people living with chronic HBV and HCV.

Charles Gore, President of the World Hepatitis Alliance, said a lack of data highlights the need for greater surveillance at local, national, and international levels. To this end, World Hepatitis Alliance has launched "The Hepatitis Atlas: Completing the Data Map," a resource designed to become the first global public compendium of statistics and information relating to chronic HBV and HCV.

For more information, visit http://www.worldhepatitisday.com or http://www.aminumber12.org (both addresses go to the same website).

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2 CDC announces viral hepatitis awareness for May

CDC published "Viral Hepatitis Awareness--May 2008" in the May 16 issue of MMWR. The announcement is reprinted below in its entirety, excluding one reference.


May 2008 marks the 13th anniversary of Hepatitis Awareness Month in the United States. May 19 is World Hepatitis Day, which recognizes the importance of global commitments to prevent liver disease and cancer caused by viral hepatitis. This issue of MMWR includes a report on an outbreak of acute hepatitis C associated with unsafe injection practices at an endoscopy clinic and a report on hepatitis C virus (HCV) infections among young injection-drug users. Both reports highlight the role of viral hepatitis surveillance in detecting outbreaks and populations at risk. Development of effective state and local surveillance for acute and chronic viral hepatitis is a public health priority.

HCV infection is the most common bloodborne illness, the leading cause of chronic liver disease, and the primary indication for liver transplantation in the United States. HCV is spread primarily through exposure to infectious blood; injection-drug use is the major contributor to HCV transmission in the United States. Although HCV infection can result in acute illness, most of its effects on the liver, including cirrhosis and liver cancer, are not apparent until years after exposure. Many of the estimated 3.2 million persons living with chronic HCV infection in the United States are unaware of their infection status.

CDC recommends HCV testing for persons at risk. Persons with HCV infection also should be assessed regularly for severity of liver disease, onset of liver cancer, and the need for treatment. Additional information about viral hepatitis is available at http://www.cdc.gov/hepatitis


To access a web-text (HTML) version of the complete announcement, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5719a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5719.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 releases ACIP recommendations for preventing herpes zoster

On May 15, CDC published "Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" as an MMWR Early Release. CDC publishes the web-based MMWR Early Release only for the immediate announcement of important public health information. The recommendations will be published in the standard MMWR format in the future. The recommendations' summary section is reprinted below.

Note: A Continuing Education (CE) activity has been approved for the recommendations and will be included when the recommendations are published in the standard MMWR format on June 6. IAC Express will notify readers at that time.

Also on May 15, CDC issued a related press release, "CDC Recommends Shingles Vaccine: People age 60 and older should be vaccinated against shingles, or herpes zoster, a condition often marked by debilitating chronic pain, the Centers for Disease control and Prevention (CDC) recommended today." A link to the press release is given at the end of this IAC Express article.


These recommendations represent the first statement by the Advisory Committee on Immunization Practices (ACIP) on the use of a live attenuated vaccine for the prevention of herpes zoster (zoster) (i.e., shingles) and its sequelae, which was licensed by the U.S. Food and Drug Administration (FDA) on May 25, 2006. This report summarizes the epidemiology of zoster and its sequelae, describes the zoster vaccine, and provides recommendations for its use among adults aged >=60 years in the United States.

Zoster is a localized, generally painful cutaneous eruption that occurs most frequently among older adults and immunocompromised persons. It is caused by reactivation of latent varicella zoster virus (VZV) decades after initial VZV infection is established. Approximately one in three persons will develop zoster during their lifetime, resulting in an estimated 1 million episodes in the United States annually. A common complication of zoster is postherpetic neuralgia (PHN), a chronic, often debilitating pain condition that can last months or even years. The risk for PHN in patients with zoster is 10%-18%. Another complication of zoster is eye involvement, which occurs in 10%-25% of zoster episodes and can result in prolonged or permanent pain, facial scarring, and loss of vision. Approximately 3% of patients with zoster are hospitalized; many of these episodes involved persons with one or more immunocompromising conditions. Deaths attributable to zoster are uncommon among persons who are not immunocompromised.

Prompt treatment with the oral antiviral agents acyclovir, valacyclovir, and famciclovir decreases the severity and duration of acute pain from zoster. Additional pain control can be achieved in certain patients by supplementing antiviral agents with corticosteroids and with analgesics. Established PHN can be managed in certain patients with analgesics, tricyclic antidepressants, and other agents.

Licensed zoster vaccine is a lyophilized preparation of a live, attenuated strain of VZV, the same strain used in the varicella vaccines. However, its minimum potency is at least 14 times the potency of single-antigen varicella vaccine. In a large clinical trial, zoster vaccine was partially efficacious at preventing zoster. It also was partially efficacious at reducing the severity and duration of pain and at preventing PHN among those developing zoster.

Zoster vaccine is recommended for all persons aged >=60 years who have no contraindications, including persons who report a previous episode of zoster or who have chronic medical conditions. The vaccine should be offered at the patient's first clinical encounter with his or her healthcare provider. It is administered as a single 0.65 mL dose subcutaneously in the deltoid region of the arm. A booster dose is not licensed for the vaccine. Zoster vaccination is not indicated to treat acute zoster, to prevent persons with acute zoster from developing PHN, or to treat ongoing PHN. Before administration of zoster vaccine, patients do not need to be asked about their history of varicella (chickenpox) or to have serologic testing conducted to determine varicella immunity. . . .


To access a ready-to-print (PDF) version of MMWR Early Release of the recommendations, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr57e0515.pdf

To access a web-text (HTML) version of the MMWR Early Release of the recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0515a1.htm

To access the related CDC press release, go to:
http://www.cdc.gov/media/pressrel/2008/r080515.htm

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4 CDC releases ACIP recommendations for preventing pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants

On May 14, CDC published "Prevention of Pertussis, Tetanus, and Diphtheria Among Pregnant and Postpartum Women and Their Infants: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" as an MMWR Early Release. CDC publishes the web-based MMWR Early Release only for the immediate release of important public health information. The recommendations will be published in the standard MMWR format in the future.

The recommendations' summary section is reprinted below. In addition, links to Appendix A and Appendix B are given at the end of this IAC Express article. Appendix A summarizes the salient points of the recommendations.


In 2005, two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines were licensed and recommended for use in adults and adolescents in the United States: ADACEL (sanofi pasteur, Swiftwater, Pennsylvania), which is licensed for use in persons aged 11-64 years, and BOOSTRIX (GlaxoSmithKline Biologicals, Rixensart, Belgium), which is licensed for use in persons aged 10-18 years. Both Tdap vaccines are licensed for single-dose use to add protection against pertussis and to replace the next dose of tetanus and diphtheria toxoids vaccine (Td). Available evidence does not address the safety of Tdap for pregnant women, their fetuses, or pregnancy outcomes sufficiently. Available data also do not indicate whether Tdap-induced transplacental maternal antibodies provide early protection against pertussis to infants or interfere with an infant's immune responses to routinely administered pediatric vaccines. Until additional information is available, CDC's Advisory Committee on Immunization Practices recommends that pregnant women who were not vaccinated previously with Tdap: (1) receive Tdap in the immediate postpartum period before discharge from a hospital or birthing center, (2) may receive Tdap at an interval as short as 2 years since the most recent Td vaccine, (3) receive Td during pregnancy for tetanus and diphtheria protection when indicated, or (4) defer the Td vaccine indicated during pregnancy to substitute Tdap vaccine in the immediate postpartum period if the woman is likely to have sufficient protection against tetanus and diphtheria. Although pregnancy is not a contraindication for receiving Tdap vaccine, healthcare providers should weigh the theoretical risks and benefits before choosing to administer Tdap vaccine to a pregnant woman. This report (1) describes the clinical features of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants, (2) reviews available evidence of pertussis vaccination during pregnancy as a strategy to prevent infant pertussis, (3) summarizes Tdap vaccination policy in the United States, and (4) presents recommendations for use of Td and Tdap vaccines among pregnant and postpartum women. . . .


To access a ready-to-print (PDF) version of MMWR Early Release of the recommendations (which includes Appendix A and Appendix B), go to:
http://www.cdc.gov/mmwr/pdf/rr/rr57e0514.pdf

To access a web-text (HTML) version of the MMWR Early Release of the recommendations (links to Appendix A and Appendix B are listed below), go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0514a1.htm

Please note: If you are using the HTML version of the recommendations, be sure to access the two links below to get the recommendations' complete content:

To access the web-text (HTML) version of Appendix A, "Summary of ACIP Recommendations for Prevention of Pertussis, Tetanus and Diphtheria Among Pregnant and Postpartum Women and Their Infants," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0514a2.htm

To access the web-text (HTML) version of Appendix B, "Abbreviations Used in This Report," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0514a3.htm

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5 CDC reports on acute hepatitis C virus infections attributed to unsafe injection practices in Nevada endoscopy clinic

CDC published "Acute Hepatitis C Virus Infections Attributed to Unsafe Injection Practices at an Endoscopy Clinic--Nevada, 2007" in the May 16 issue of MMWR. Portions of the article are reprinted below, including the complete text of a box titled "Injection safety recommendations."


On January 2, 2008, the Nevada State Health Division (NSHD) contacted CDC concerning surveillance reports received by the Southern Nevada Health District (SNHD) regarding two persons recently diagnosed with acute hepatitis C. A third person with acute hepatitis C was reported the following day. This raised concerns about an outbreak because SNHD typically confirms four or fewer cases of acute hepatitis C per year. Initial inquiries found that all three persons with acute hepatitis C underwent procedures at the same endoscopy clinic (clinic A) within 35-90 days of illness onset. A joint investigation by SNHD, NSHD, and CDC was initiated on January 9, 2008. The epidemiologic and laboratory investigation revealed that hepatitis C virus (HCV) transmission likely resulted from reuse of syringes on individual patients and use of single-use medication vials on multiple patients at the clinic. Health officials advised clinic A to stop unsafe injection practices immediately, and approximately 40,000 patients of the clinic were notified about their potential risk for exposure to HCV and other bloodborne pathogens. This report focuses on the six cases of acute hepatitis C identified during the initial investigation, which is ongoing; additional cases of acute hepatitis C associated with exposures at clinic A might be identified. Comprehensive measures involving viral hepatitis surveillance, healthcare provider education, public awareness, professional oversight, licensing, and improvements in medical devices can help detect and prevent transmission of HCV and other bloodborne pathogens in healthcare settings. . . .

BOX. Injection safety recommendations
  • Never administer medications from the same syringe for more than one patient, even if the needle is changed.
  • Consider a syringe or needle contaminated after it has been used to enter or connect to a patient's intravenous infusion bag or administration set.
  • Do not enter a vial with a used syringe or needle.
  • Never use medications packaged as single-use vials for more than one patient.
  • Assign medications packaged as multi-use vials to a single patient whenever possible.
  • Do not use bags or bottles of intravenous solution as a common source of supply for more than one patient.
  • Follow proper infection-control practices during the preparation and administration of injected medications.
    . . . .


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5719a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5719.pdf

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6 CDC offers new podcast on hepatitis B and Asian Pacific Islander Americans

[The following is cross posted from IAC's Hep Express electronic newsletter, 5/15/08.]

CDC recently posted a podcast titled "Stopping the Silent Killer: Hepatitis B Among Asian Americans" on its website. This resource features Dr. John Ward, director of CDC's Division of Viral Hepatitis, and Dr. Sam So, founder of the Asian Liver Center at Stanford University, discussing the health threat of chronic HBV infection to many Asians and Pacific Islanders in the United States and the importance of testing, vaccination, and care.

To access this podcast, go to:
http://www2a.cdc.gov/podcasts/player.asp?f=8908

All CDC podcasts can be found at http://www2a.cdc.gov/podcasts

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7 CDC releases revised and expanded National Immunization Survey data on hepatitis B birth dose

CDC recently released revised 2006 National Immunization Survey (NIS) data about hepatitis B vaccination coverage rates within two days of life, as well as new information about hepatitis B vaccination coverage rates within one and three days of life.

To access this table directly in Excel format, click here.

You can also access NIS birth dose data from 2003-2006 on the Perinatal Hepatitis B Coordinator Resource Center web page at
http://www.cdc.gov/ncidod/diseases/hepatitis/resource/perinatalhepB.htm

Those interested in the specifics of the revision of the data can read "A Special Note for the April 2008 Revision" at
http://www.cdc.gov/vaccines/stats-surv/nis/data/april2008revision.doc

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8 CDC experts review and update twelve of IAC's online "Ask the Experts" Q&A sections

Vaccination experts at CDC recently reviewed and updated information on twelve of IAC's online "Ask the Experts" Q&A sections. All of IAC's "Ask the Experts" Q&As are reviewed and updated annually. The process is ongoing; IAC Express will inform readers as sections are reviewed and revised.

Here are the twelve most recently revised Q&A sections:

To access the revised Q&As on diphtheria, go to:
http://www.immunize.org/askexperts/experts_diph.asp

To access the revised Q&As on Haemophilus influenzae type b (Hib), go to: http://www.immunize.org/askexperts/experts_hib.asp

To access the revised Q&As on human papillomavirus (HPV), go to:
http://www.immunize.org/askexperts/experts_hpv.asp

To access the revised Q&As on influenza, go to:
http://www.immunize.org/askexperts/experts_inf.asp

To access the revised Q&As on measles-mumps-rubella (MMR), go to: http://www.immunize.org/askexperts/experts_mmr.asp

To access the revised Q&As on meningococcal disease, go to:
http://www.immunize.org/askexperts/experts_men.asp

To access the revised Q&As on pertussis, go to:
http://www.immunize.org/askexperts/experts_per.asp

To access the revised Q&As on pediatric pneumococcal conjugate vaccine (PCV7), go to:
http://www.immunize.org/askexperts/experts_pcv.asp

To access the revised Q&As on rotavirus, go to:
http://www.immunize.org/askexperts/experts_rota.asp

To access the revised Q&As on tetanus, go to:
http://www.immunize.org/askexperts/experts_tet.asp

To access the revised Q&As on varicella, go to:
http://www.immunize.org/askexperts/experts_var.asp

To access the revised Q&As on zoster, go to:
http://www.immunize.org/askexperts/experts_zos.asp

To access the index of "Ask the Experts" sections, go to:
http://www.immunize.org/askexperts

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9 Mark your calendar: IZTA's May 21 conference call will present the latest research on autism

The Immunization Coalitions Technical Assistance Network (IZTA) conference call on May 21 will present two CDC autism experts in a discussion about autism. The goal of the call is to address misconceptions about autism that have appeared in the media in the recent past. The call will not address the recent vaccine injury compensation case or the alleged relationship between vaccines and autism. Rather, it will be a discussion of the disorder itself. IZTA is a program of the Center for Health Communication, Academy for Educational Development.

The presenters are Georgina Peacock, MD, and Catherine Rice, PhD. Both are with CDC's National Center on Birth Defects and Developmental Disabilities. The mother of a young autistic child will also present.

The May 21 call will be held at 2PM, ET. To register, send an email to izta@aed.org Include this message: "Sign me up for the "Understanding Autism Call."

For additional information, or to access earlier programs, go to: http://www.izta.org/confcall.cfm

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10.  Enhanced surveillance detects hepatitis C virus infection among injection drug users in New York state

CDC published "Use of Enhanced Surveillance for Hepatitis C Virus Infection to Detect a Cluster Among Young Injection-Drug Users--New York, November 2004-April 2007" in the May 16 issue of MMWR. A press summary of the article is reprinted below in its entirety.


Establishing effective systems that reliably detect hepatitis C virus (HCV) infections among all populations could have a lasting effect on HCV disease control.

Surveillance for hepatitis C is challenging due to the nature of the disease and the effort required to collect complete information. When resources are limited, algorithms to prioritize cases for investigation can guide targeted response initiatives to get affected people needed help and prevent additional hepatitis C infections. During the summer of 2007, the New York State and Erie County departments of health investigated a cluster of hepatitis C among adolescents and young adults in Erie County. The major risk factor reported was intravenous drug use. The departments cooperated to investigate the cluster and implement interventions that included education, testing, and referral to medical, mental health, and addiction therapy. This demonstrates the utility of enhanced surveillance to guide effective resource deployment.


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5719a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5719.pdf

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11.  Multi-vaccine VIS and interim varicella vaccine VIS now in Thai

The multi-vaccine VIS and the interim varicella vaccine VIS are now available in Thai. IAC gratefully acknowledges Asian Pacific Health Care Venture of Los Angeles for the translations.

Multi-vaccine VIS (dated 1/30/08)
To access the Thai version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/th_multi.pdf

To access the English version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/vis_multi1.pdf

NOTE: The multi-vaccine VIS comes in additional languages, including Spanish. To access them, go to:
http://www.immunize.org/vis/vis_multi1.asp Click on the link to the pertinent language.


Interim varicella vaccine VIS (dated 3/13/08)
To access the Thai version of the interim varicella VIS, go to:
http://www.immunize.org/vis/th_var98.pdf

To access the English version of the interim varicella VIS, go
to: http://www.immunize.org/vis/varic07.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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12.  Important: Be sure to give influenza vaccine throughout the influenza season--from now through spring

Influenza is currently circulating, and vaccination should continue from now until May. 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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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.