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Immunization Action Coalition
IAC Express 2008
Issue number 745: August 4, 2008
 
Contents of this Issue
Select a title to jump to the article.
  1. VIS news: CDC issues two influenza VISs for the 2008-09 influenza season, one for injectable influenza vaccine, the other for nasal-spray influenza vaccine
  2. 2006 NIS data indicate 50 percent of newborns born between January 2003-June 2005 received the hepatitis B birthdose by age 3 days
  3. CDC corrects an "Ask the Experts" answer that appeared in recent issues of Needle Tips, Vaccinate Adults, and Vaccinate Women
  4. CDC issues recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or HIV virus and tetanus in persons wounded during bombings and other mass-casualty events
  5. CDC redesigns its viral hepatitis website
  6. MMWR notifies readers that the webcast of Immunization Update 2008 is scheduled for August 28
  7. July 31 issue of IAC's Hep Express electronic newsletter now available online
  8. Author reviews and revises two print materials on childhood hepatitis B virus infection
  9. Interim VIS for HPV vaccine now available in Vietnamese
  10. FDA website posts information on storing and using temperature-sensitive biological products after a power failure or flood
  11. MMWR notifies readers that the online application deadline for the Epidemic Intelligence Service is September 15
 
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 745: August 4, 2008
1.  VIS news: CDC issues two influenza VISs for the 2008-09 influenza season, one for injectable influenza vaccine, the other for nasal-spray influenza vaccine

On July 24, CDC released a new VIS for the trivalent inactivated influenza vaccine (TIV; injectable) and a new VIS for the live attenuated influenza vaccine (LAIV; nasal spray). The new VISs reflect changes made in ACIP's 2008 recommendations for preventing influenza, which were published July 17 in an MMWR Early Release.

VIS FOR INJECTABLE INFLUENZA VACCINE
To access the VIS for injectable influenza vaccine from the CDC website, go to:
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf

To access the VIS for injectable influenza vaccine from the IAC website, go to: http://www.immunize.org/vis/2flu.pdf

VIS FOR NASAL-SPRAY INFLUENZA VACCINE
To access the VIS for nasal-spray influenza vaccine from the CDC website, go to:
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flulive.pdf

To access the VIS for nasal-spray influenza vaccine from the IAC website, go to: http://www.immunize.org/vis/liveflu.pdf

For information about the use of VISs, and for VISs in more than 35 languages, visit IAC's VIS web section at http://www.immunize.org/vis

To access additional FREE, ready-to-print translations from the IAC website, go to:
http://www.immunize.org/printmaterials/translations.asp

IAC's Print Materials web section has more than 175 FREE, ready-to-print materials for healthcare professionals and the public. To access them, go to: http://www.immunize.org/printmaterials

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2 2006 NIS data indicate 50 percent of newborns born between January 2003-June 2005 received the hepatitis B birthdose by age 3 days

CDC published "Newborn Hepatitis B Vaccination Coverage Among Children Born January 2003-June 2005--United States" in the August 1 issue of MMWR. It is reprinted below in its entirety, excluding one table and references.

IAC Express editor's note: We have included links to several relevant resources at the end of this IAC Express article.


Hepatitis B vaccine was first recommended for administration to all infants in 1991 by the Advisory Committee on Immunization Practices (ACIP) as the primary focus of a strategy to eliminate hepatitis B virus (HBV) transmission in the United States. The recommended timing of administration of the first dose of hepatitis B vaccine to infants has evolved since then to optimize prevention of perinatal and early childhood HBV infections. In 1991, the first dose was recommended to be administered at birth before hospital discharge or at age 1-2 months. In 2002, ACIP indicated a preference for the first dose to be administered to newborns before hospital discharge. In December 2005, ACIP issued revised recommendations specifying that all medically stable newborns who weigh >=2,000 g (4.4 lbs) receive their first dose of hepatitis B vaccine before hospital discharge. To measure hepatitis B vaccination coverage during the neonatal period, CDC analyzed data from the 2006 National Immunization Survey (NIS). This report summarizes the results of this analysis and provides national, state, and local data on vaccination coverage for infants who received the hepatitis B vaccine during the first days of life. The findings reveal that, during January 2003-June 2005, before implementation of the 2005 ACIP hepatitis B vaccine recommendation, the national newborn hepatitis B vaccination coverage estimate was 42.8% at age 1 day and 50.1% at age 3 days, with substantial variation by states and local areas. To comply with ACIP recommendations and increase coverage, delivery hospitals should provide hepatitis B vaccination of newborns as a standard of care.

NIS provides estimates of vaccination coverage among noninstitutionalized children aged 19-35 months for each of the 50 states and selected local areas. To collect vaccination data, NIS conducts a random-digit-dialed telephone survey of households and a mail survey of children's vaccination providers identified by household respondents. Data are weighted to adjust for households with multiple telephone lines, household nonresponse, and exclusion of households without landline telephones. Infant age at vaccination was calculated by subtracting birth date from vaccination date. Children included in the 2006 NIS were born during January 2003-June 2005.

Household response rate for the survey was 64.5%, based on Council of American Survey and Research Organizations guidelines (CASRO); 21,044 children with provider-verified vaccination records were included in this report and represent 70.4% of all children with completed household interviews. National newborn hepatitis B vaccination coverage was 42.8% at age 1 day, 48.5% at 2 days, 50.1% at 3 days, 51.1% at 4 days, 51.8% at 5 days, and 52.5% at 6 days. State and local area rates showed substantial variability, with hepatitis B vaccination coverage at age 1 day ranging from 8.2% in Fresno County, California, to 77.5% in Detroit, Michigan. Among all states and local areas surveyed, the median coverage estimate was 50.3% at age 1 day and 58.7% at 3 days.

Editorial Note:
The analysis in this report indicates that, for the January 2003-June 2005 birth cohort, 42.8% of newborns had received hepatitis B vaccine by age 1 day and 50.1% had received hepatitis B vaccine by age 3 days. These data provide a baseline for assessing implementation of the December 2005 ACIP recommendation to administer hepatitis B vaccine to all newborns before hospital discharge. The 2009 NIS will be the first to include all survey-eligible children who were born after the December 2005 recommendation was made. Therefore, that survey will be the first to provide full estimates of national newborn vaccination coverage to evaluate the effect of the 2005 ACIP recommendation.

Newborn hepatitis B vaccination coverage estimates varied substantially among and within states. Administration of hepatitis B vaccine to newborns is dependent on hospital policies and procedures and on provider and parent preferences.

Although NIS does not distinguish whether hepatitis B vaccine was given before or after hospital discharge, National Hospital Discharge Survey data indicate that the average length of hospital stay for all newborns in 2004 was 3.3 days, with an average stay of 2.1 days for well newborns and an average stay of 5.0 days for ill newborns; 85.6% of all newborns were discharged by age 3 days.

The findings in this report are subject to at least four limitations. First, NIS is a telephone survey; although results are statistically adjusted to account for nonresponse and households without telephones, some bias might remain. Second, vaccination coverage is confirmed using provider-verified records. Although clinic providers might not always have records of a hospital-administered hepatitis B vaccine dose, this does not appear to result in substantial under-ascertainment of vaccination. A 2004 study in eight locations matched provider-reported vaccination records for the children sampled in NIS to their vaccination histories reported by the state Immunization Information Systems (IIS). NIS data underestimated birth dose coverage by no more than 5% at any one location when compared with the combined NIS and IIS coverage among children who had vaccination histories from both sources (M Khare, CDC, personal communication, February 2008). Third, estimates from state and local areas should be interpreted with caution because of smaller sample size and wider confidence intervals compared with the national estimate. Finally, infants who were not recommended to receive hepatitis B vaccine until age 1 month or after hospital discharge because their birth weights were <2,000 g and they were born to HBsAg-negative mothers could not be excluded from the coverage estimates. Inclusion of those infants in the denominator might result in an underestimate of newborn coverage, but the effect should be minimal because infants at this birth weight account for only 3% of births.

Infants infected with HBV typically are asymptomatic and have a 90% likelihood of remaining chronically infected. Up to 25% of chronically infected children die prematurely of cirrhosis or liver cancer. Two primary modes of HBV transmission occur during infancy and early childhood: (1) from an infected mother to her infant during delivery, and (2) from infected household contacts to infant or child. Both modes of transmission can be prevented by immunization of newborn infants. For infants born to mothers identified as hepatitis B surface antigen (HBsAg)-positive (i.e., HBV-infected), administration of hepatitis B vaccine and hepatitis B immune globulin within 12 hours of birth is 85%-95% effective as postexposure prophylaxis in preventing HBV infection in the infant. In addition, hepatitis B vaccine alone is 70%-95% effective in preventing perinatal HBV transmission when the first dose is given within 24 hours of birth. Thus, administration of hepatitis B vaccine soon after birth provides timely postexposure prophylaxis to infants born to HBsAg-positive mothers who were not screened prenatally, or were not identified as HBsAg-positive because of testing errors or lapses in reporting or documentation of test results. Hepatitis B vaccination of all newborns also provides early preexposure protection to infants born to uninfected women during a period when the risk for developing chronic HBV infection is greatest.

The 2005 ACIP recommendation to administer the first dose of hepatitis B vaccine to all newborns before hospital discharge will increase hepatitis B vaccination coverage during the first days of life. Delivery hospitals play a key role in the national strategy to eliminate HBV transmission. The 2005 ACIP statement recommends that delivery hospitals have policies and procedures in place, including appropriate standing orders, to ensure (1) administration of hepatitis B vaccine to all newborns with birth weights >=2,000 g before hospital discharge and (2) identification of all infants born to HBsAg-positive mothers and infants born to mothers with unknown HBsAg status to allow initiation of postexposure prophylaxis within 12 hours of birth. State and local information on prevention of HBV infection in infants and children, including information on hospital-based policies and procedures to prevent HBV infection, is available through CDC-funded perinatal hepatitis B prevention coordinators based in state health departments. Contact information for those coordinators is available at http://www.cdc.gov/vaccines/vpd-vac/hepb/perinatal-contacts.htm


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5730.pdf

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

Relevant resources:
"A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Part 1: Immunization of Infants, Children and Adolescents": http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf

"AAP Endorsed Policy Statement: A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States": http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/404

"Guidelines for Standing Orders in Labor & Delivery & Nursery Units to Prevent Hepatitis B (HBV) Transmission to Newborns":
http://www.immunize.org/catg.d/p2130.pdf

"Hepatitis B Shots Are Recommended for All New Babies":
http://www.immunize.org/catg.d/p4110.pdf

"States Report Hundreds of Medical Errors in Perinatal Hepatitis B Prevention": http://www.immunize.org/catg.d/p2062.pdf

"Unprotected Babies: Two More Infants Chronically Infected with Hepatitis B Virus . . . the Medical Errors Continue":
http://www.immunize.org/catg.d/p2127.pdf

"Medical Errors Put Infants at Risk for Chronic Hepatitis B Virus Infection--Six Case Reports":
http://www.immunize.org/catg.d/p2128.pdf

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3 CDC corrects an "Ask the Experts" answer that appeared in recent issues of Needle Tips, Vaccinate Adults, and Vaccinate Women

IAC was informed by a careful reader that an incorrect answer was published in "Ask the Experts" in Needle Tips (March 2008, page 22), Vaccinate Adults (March 2008, page 10), and Vaccinate Women (June 2008, page 10). The question concerned pre-exposure prophylaxis for travelers to protect them from hepatitis A virus infection. The question and its corrected answer follow.

QUESTION:
What are the new recommendations for vaccination of travelers to protect them from hepatitis A virus (HAV) infection?

ANSWER:

The new recommendations (www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm) state that (1) hepatitis A vaccine is recommended for healthy susceptible persons ages 1 through 40 years who travel to or work in regions where hepatitis A is endemic and (2) hepatitis A vaccine should be given as soon as travel is considered, but it can be given any time prior to departure. For optimal protection, persons older than age 40 years, immunocompromised persons, and persons with diagnosed chronic liver disease or other chronic medical conditions, if departure will take place within two weeks, should also receive IG simultaneously with the first dose of hepatitis A vaccine but at a different anatomic injection site. For travelers younger than age 1 year, IG alone is recommended because hepatitis A vaccine is not licensed for use in this age group. Hepatitis A is endemic in all regions except the United States, Western Europe, New Zealand, Australia, Canada, and Japan.

IAC regrets the confusion the initial Q&A may have caused readers of Needle Tips, Vaccinate Adults, and Vaccinate Women.

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4 CDC issues recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or HIV virus and tetanus in persons wounded during bombings and other mass-casualty events

On August 1, CDC published "Recommendations for Postexposure Interventions to Prevent Infection with Hepatitis B Virus, Hepatitis C Virus, or Human Imunodeficiency Virus, and Tetanus in Persons Wounded During Bombings and Other Mass-Casualty Events--United States, 2008: Recommendations of the Centers for Disease Control and Prevention (CDC)" in MMWR Recommendations and Reports. The recommendations' Summary is reprinted below.


Summary
This report outlines recommendations for postexposure interventions to prevent infection with hepatitis B virus, hepatitis C virus, or human immunodeficiency virus, and tetanus in persons wounded during bombings or other events resulting in mass casualties. Persons wounded during such events or in conjunction with the resulting emergency response might be exposed to blood, body fluids, or tissue from other injured persons and thus be at risk for bloodborne infections. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass-casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma and emergency response medical communities participating in CDC's Terrorism Injuries: Information, Dissemination and Exchange (TIIDE) project. The recommendations contained in this report represent the consensus of U.S. federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. . . .


To access a ready-to-print (PDF) version of the recommendations, go to: http://www.cdc.gov/mmwr/PDF/rr/rr5706.pdf

To access a web-text (HTML) version of the recommendations, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5706a1.htm

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5 CDC redesigns its viral hepatitis website

[The following is cross posted from IAC's Hep Express electronic newsletter, 7/31/08.]

CDC's Division of Viral Hepatitis recently redesigned its website, accessed at http://www.cdc.gov/hepatitis

The changes are designed to make it easier for people to find hepatitis information and resources quickly. The pages for hepatitis A, B, and C information have separate entry portals for members of the public and health professionals.

Take a look and be sure to bookmark this great resource.

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6 MMWR notifies readers that the webcast of Immunization Update 2008 is scheduled for August 28

CDC published "Notice to Readers: Webcast: Immunization Update 2008" in the August 1 issue of MMWR. The notice is reprinted below in its entirety.


CDC and the Public Health Training Network will present a webcast, Immunization Update 2008, on August 28, 2008. The 2-hour broadcast will occur during 12:00 noon-2:00 p.m. EDT. Anticipated topics include influenza and zoster vaccines, recently approved vaccines, and updates on vaccine supplies and vaccine safety. Continuing education (CE) credits will be provided. Additional information about the program is available at http://www2a.cdc.gov/phtn/immupdate2008/default.asp

No registration is necessary to access the webcast via an Internet connection. The link to the webcast is available at http://www2a.cdc.gov/phtn/webcast/immupdate2008/default.asp

The webcast will remain accessible through an Internet connection until September 29, 2008. The program will become available as a self-study DVD and Internet-based program in October 2008.


To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5730.pdf

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7 July 31 issue of IAC's Hep Express electronic newsletter now available online

The July 31 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 preventing, screening, and treating viral hepatitis.

IAC Express has already covered some of the information presented in the July 31 Hep Express; titles of articles we have not yet covered follow.

  • Presentations from Hepatitis B Foundation's (HBF) patient conference now available online
  • HBF posts Spring 2008 issue of "B Informed" newsletter on its website
  • HBF adds more Expert Speaker presentations to its website

To access the July 31 issue, go to:
http://www.hepprograms.org/hepexpress/issue73.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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8 Author reviews and revises two print materials on childhood hepatitis B virus infection

Sarah Jane Schwarzenberg, MD, recently reviewed two of her print materials on childhood hepatitis B virus infection and revised one of them. Both print materials are posted on IAC's website.

Dr. Schwarzenberg is a pediatric gastroenterologist and an associate professor in the Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Minnesota. She is also a member of the Immunization Action Coalition Advisory Board.

"Brief Introduction to Hepatitis B for Parents of Adopted Children" was reviewed and found to be still accurate. To access
it, go to: http://www.immunize.org/catg.d/p4150.pdf

Minor changes were made to "What the Physician Can Do to Help the Child with Chronic Hepatitis B Virus Infection." To access
it, go to: http://www.immunize.org/catg.d/p2170.pdf

IAC's Print Materials web section has more than 175 FREE, ready-to-print English-language materials for healthcare professionals and the public--as well as many in translation. To access all of IAC's print materials, go to: http://www.immunize.org/printmaterials

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9 Interim VIS for HPV vaccine now available in Vietnamese

The interim VIS for human papillomavirus (HPV) vaccine (dated 2/2/07) is now available in Vietnamese. IAC gratefully acknowledges the Minnesota Department of Health for the translation.

To access the Vietnamese version of the interim VIS for HPV vaccine, go to: http://www.immunize.org/vis/vn_hpv.pdf

To access the English version of the interim VIS for HPV vaccine, go to: http://www.immunize.org/vis/vis-hpv-gardasil.pdf

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

For information about the use of VISs, and for VISs in more than 35 languages, visit IAC's VIS web section at http://www.immunize.org/vis

IAC's Print Materials web section has more than 175 FREE, ready-to-print English-language materials for healthcare professionals and the public--as well as many in translation. To access all of IAC's print materials, go to: http://www.immunize.org/printmaterials

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10.  FDA website posts information on storing and using temperature-sensitive biological products after a power failure or flood

On July 31, the FDA website posted the three-page document "Impact of Severe Weather Conditions on Biological Products." It provides interested persons with information concerning the storage and use of temperature-sensitive biological products that have been involved in a temporary electrical power failure or flood conditions. The document includes information on vaccines that require refrigeration or frozen storage.

To access the document, go to:
http://www.fda.gov/cber/weatherimpact.htm

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11.  MMWR notifies readers that the online application deadline for the Epidemic Intelligence Service is September 15

CDC published "Notice to Readers: Epidemic Intelligence Service Online-Only Application Deadline--September 15, 2008" in the August 1 issue of MMWR. The notice is reprinted below in its entirety.


Applications for CDC's July 2009-June 2011 Epidemic Intelligence Service (EIS) program are now being accepted. This year, applications are only being accepted via the new EIS online application system.

EIS is a 2-year, postgraduate program of service and on-the-job training for health professionals interested in the practice of epidemiology. Each year, EIS provides approximately 90 persons, selected from applicants around the world, opportunities to gain hands-on experience in epidemiology at CDC or at state or local health departments. EIS officers, often called CDC's "disease detectives," have gone on to occupy leadership positions at CDC and other public health agencies nationally and internationally. However, the experience also is useful for health professionals who want to gain a population health perspective.

Persons with a strong interest in applied epidemiology who meet at least one of the following qualifications may apply to EIS:
  • physicians with >=1 year of clinical training;
  • persons with a PhD, DrPH, or other doctoral degree in epidemiology, biostatistics, social or behavioral sciences,natural sciences, or nutrition sciences;
  • dentists, physician assistants, and nurses with an MPH or equivalent degree;
  • or veterinarians with an MPH or equivalent degree or relevant public health experience.

Additional information regarding the EIS program and the new online application system is available at http://www.cdc.gov/eis/applyeis/toapply.htm; by telephone ([404]) 498-6110); or by email (eisepo@cdc.gov).


To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5730.pdf

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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.