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Immunization Action Coalition
IAC Express 2008
Issue number 752: September 8, 2008
 
Contents of this Issue
Select a title to jump to the article.
  1. New interim rotavirus VIS: contains information about the Rotarix vaccine schedule
  2. CDC reports on 2007 NIS data on vaccination coverage among U.S. children ages 19-35 months
  3. National Adult Immunization Awareness Week is September 21-27; NFID posts extensive resources on its website
  4. Study results published in the Public Library of Science firmly show no connection between MMR vaccine and autism
  5. The Vaccine Education Center offers an updated version of its influenza resource
  6. This one-page ready-to-copy flyer will make conference attendees aware of hundreds of reliable immunization resources--all FREE from IAC!
  7. 2008-09 influenza vaccine update posted on CDC's seasonal flu web section
  8. South Carolina Immunization Conference to be held November 7 in Columbia
  9. MMWR publishes report on worldwide laboratory surveillance for wild and vaccine-derived polioviruses
 
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 752: September 8, 2008
1.  New interim rotavirus VIS: contains information about the Rotarix vaccine schedule

On August 28, CDC issued a revised version of the interim VIS for rotavirus vaccine; it replaces the interim VIS dated 4/12/06. The interim VIS dated 8/28/08 includes information about the Rotarix (GSK) vaccine schedule. Providers may use up stocks of the 4/12/06 interim VIS for patients receiving RotaTeq (Merck) vaccine; patients receiving Rotarix should receive the 8/28/08 interim VIS.

To access the 8/28/08 interim VIS for rotavirus vaccine from the IAC website, go to: http://www.immunize.org/vis/rota_06.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

For general information about VISs from CDC's website go to: http://www.cdc.gov/vaccines/pubs/vis

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2 CDC reports on 2007 NIS data on vaccination coverage among U.S. children ages 19-35 months

CDC published "National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months--United States, 2007" in the September 5 issue of MMWR. Portions of it are reprinted below. On September 4, the CDC (1) posted on its website the 2007 National Immunization Survey (NIS) data in graph and table formats, (2) held a press conference on the NIS data, and (3) issued a related press release. Links to the NIS data, the press conference transcript, and the press release appear at the end of this IAC Express article under the heading Related Resources.


The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19-35 months for each of the 50 states and selected urban areas. This report describes the results of the 2007 NIS, which provided coverage estimates among children born during January 2004-July 2006. Healthy People 2010 established vaccination coverage targets of 90% for each of the vaccines included in the combined 4:3:1:3:3:1 vaccine series and a target of 80% for the combined series. Findings from the 2007 NIS indicated that >=90% coverage was achieved for most of the routinely recommended vaccines. The majority of parents were vaccinating their children, with less than 1% of children receiving no vaccines by age 19-35 months. The coverage level for the 4:3:1:3:3:1 series remained steady at 77.4%, compared with 76.9% in 2006. Among states and local areas, substantial variability continued, with estimated vaccination coverage ranging from 63.1% to 91.3%. Coverage remained high across all racial/ethnic groups and was not significantly different among racial/ethnic groups after adjusting for poverty status. However, for some vaccines, coverage remained lower among children living below the poverty level compared with children living at or above the poverty level. Maintaining high vaccination coverage and continued attention to reducing current poverty disparities is needed to limit the spread [of vaccine]-preventable diseases and ensure that children are protected. . . .

In 2007, national coverage with the 4:3:1:3:3:1 series was 77.4%; this coverage has been stable since 2004. Coverage with the combined 4:3:1:3:3:1:4 vaccine series (i.e., the 4:3:1:3:3:1 series plus >=4 doses of 7-valent pneumococcal conjugate vaccine [PCV7]) is being reported for the first time and was 66.5%. National coverage was >=90% for each of the vaccines included in the 4:3:1:3:3:1 series except for >=4 doses of DTaP (84.5%); coverage with >=3 doses of DTaP was 95.5%. Coverage with >=1 dose of varicella vaccine (VAR) reached 90% for the first time. VAR coverage among American Indian/Alaska Native (AI/AN) children increased significantly, from 85.4% in 2006 to 94.9% in 2007. National vaccination coverage estimates for PCV7 continued to increase, from 86.9% in 2006 to 90.0% in 2007 for >=3 doses and from 68.4% to 75.3% for >=4 doses. Among AI/AN children, coverage with the fourth dose of PCV7 increased significantly, from 62.7% to 80.4%.

Substantial differences were observed in vaccination coverage among states and local areas. Estimated coverage for the 4:3:1:3:3:1 series ranged from 91.3% in Maryland to 63.1% in Nevada. Among the 14 local areas included in the 2007 NIS, coverage with the 4:3:1:3:3:1 series ranged from 82.2% in Philadelphia, Pennsylvania, to 69.6% in San Bernardino, California.

Vaccination coverage levels were higher among AI/ANs compared with whites for measles, mumps, and rubella (MMR) vaccine, hepatitis B (HepB) vaccine, and VAR. Coverage with the fourth dose of DTaP and the fourth dose of PCV7 among black children was not significantly lower than white children after controlling for poverty status. Vaccination coverage with the fourth dose of DTaP and the fourth dose of PCV7 was lower among children living below the poverty level compared with children living at or above the poverty level, but this difference declined from 6.1% in 2006 to 4.8% in 2007 for >=4 doses of DTaP and from 9.4% in 2006 to 3.5% in 2007 for >=4 doses of PCV7. Vaccination coverage levels were similar across all racial/ethnic groups for the 4:3:1:3:3:1 series. Coverage differed for this series among children living at or above the poverty level compared with children living below the poverty level, but this difference declined from 4.9% in 2006 to 3.2% in 2007. Coverage between white and black children with the  4:3:1:3:3:1:4 series was not significantly different after controlling for poverty status.

Editorial Note:
NIS is the only population-based, provider-verified survey to provide national, state, and local area estimates of vaccination coverage among children aged 19-35 months. The results of the 2007 survey indicate that vaccination coverage for vaccines recommended routinely by ACIP since 2000 and before reached record high levels. Improvements in vaccination coverage for VAR meant that national coverage estimates for all individual vaccines in the 4:3:1:3:3:1 series were >=90%, except coverage with >=4 doses of DTaP. Coverage with >=4 doses of PCV7 also was <90%. However, 3-dose coverage for both DTaP and PCV7 remained high. Coverage with >=4 doses of PCV7 increased significantly to 75.3% in 2007, a substantial increase since PCV7 was first recommended in 2000. However, coverage with >=4 doses of DTaP has not changed during the past 5 years. Increasing coverage for the fourth dose of DTaP and the fourth dose of PCV7 would improve national coverage for the 4:3:1:3:3:1 series and the 4:3:1:3:3:1:4 series, which will be used to monitor the Healthy People 2010 immunization objectives beginning with 2009 NIS data. The vaccine shortage that ended in September 2004 might have reduced coverage with the fourth dose of PCV7 among children in the 2007 NIS cohort (i.e., those born during January 2004-July 2006). Use of effective interventions, such as parent and provider reminder/recall, reducing out-of-pocket costs, increasing access to vaccination, and multicomponent interventions that include education might further improve overall coverage in areas where coverage is low. In addition, closing the coverage gap between areas with the highest and lowest coverage remains a priority. To achieve this, further collaborative efforts among CDC, state immunization coordinators, immunization programs, and other entities are essential.

Vaccination coverage among AI/AN children for VAR, MMR vaccine, and the fourth dose of PCV7 increased significantly in 2007 compared with 2006; in 2007, coverage levels among AI/AN children were higher for two of these vaccines (VAR and MMR vaccine) compared with white children. Improved exchange of data between the Indian Health Service information system and state immunization information systems and implementation of evidence-based strategies such as reminder/recall at Indian Health Service and tribal facilities, might have contributed to these increases in vaccination coverage (A. Groom, CDC, personal communication, August 2008). However, further monitoring is needed to determine whether these levels will be sustained.

As in 2006, the results of the 2007 NIS indicate that differences in poverty status accounted for the observed differences in coverage between white and black children for the fourth dose of DTaP and fourth dose of PCV7. In 2007, these differences in coverage between children living at or above the poverty level compared with children living below the poverty level were reduced by one percentage point for DTaP and by nearly six percentage points for PCV7. Continued efforts are needed to improve vaccination coverage among children of all racial and ethnic groups living below the poverty level.

The 2007 NIS results confirm that the majority of parents are vaccinating their children, with less than 1% of children receiving no vaccines by age 19-35 months. Although vaccination coverage in this age group remains high, recent outbreaks of measles have occurred in certain communities. Several factors might explain this apparent paradox. Despite record high coverage with MMR vaccine, nearly 8% of children aged 19-35 months surveyed for the 2007 NIS remained unvaccinated. Measles is highly contagious, and clustering of unimmunized children within geographic areas can increase risk for measles and other vaccine-preventable disease transmission. Clusters of unimmunized children might not be detected by NIS methods and might not be visible in national and state rates. Furthermore, any changes in vaccination behaviors among parents of children born after July 2006 would not have been detected by the 2007 survey. Increased attention to parental concerns about vaccine safety has become apparent in recent years. The 2008 NIS is collecting information on parental concerns about vaccine safety to better assess parental attitudes and beliefs about vaccines. In addition, CDC and its partners are developing new educational materials that can assist parents in making fully informed decisions about immunizing their children. . . .

Achieving and maintaining high vaccination coverage levels is important to further reduce the burden of vaccine-preventable diseases and prevent a resurgence of measles and other diseases that have been eliminated in the United States. Although vaccination coverage estimates were at record highs and above the Healthy People 2010 target for most of the routinely recommended vaccines in 2007, ongoing efforts through partnerships among national, state, local, private, and public entities are needed to sustain these levels and ensure that vaccination programs in the United States remain strong.


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5735.pdf

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

RELATED RESOURCES
To access the 2007 NIS data, go to:
http://www.cdc.gov/vaccines/stats-surv/nis/nis-2007-released.htm

To access a transcript of the press conference, go to:
http://www.cdc.gov/media/transcripts/2008/t080905.htm

To access the press release, titled "Most US. Parents are Vaccinating According to New CDC Survey: Vaccination Coverage Rates for Children Remain High," go to:
http://www.cdc.gov/media/pressrel/2008/r080904.htm

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3 National Adult Immunization Awareness Week is September 21-27; NFID posts extensive resources on its website

The National Foundation for Infectious Diseases (NFID) issued a press release announcing that September 21-27 is National Adult Immunization Awareness Week (NAIAW). Also, the NFID website posted a campaign kit comprising extensive resources on adult and adolescent immunization. The press release, which includes a link to the campaign kit, is reprinted below in its entirety.


National Adult Immunization Awareness Week (NAIAW) will be held September 2127, 2008. The National Foundation for Infectious Diseases (NFID) coordinates this annual observance to coordinate awareness-raising activities that focus on adult and adolescent immunization. This year marks the 21st consecutive observance. NAIAW serves as a great opportunity for individuals and organizations to promote the importance of adult and adolescent immunization. "Immunization: Supporting a Healthier Life Throughout the LifeSpan" is the theme for NAIAW 2008 campaign.

NFID will hold its annual influenza and pneumococcal disease news conference on Wednesday, September 24, 2008. This event has become a major national public awareness forum for influenza and pneumococcal disease.

NFID has developed a campaign kit, a compilation of materials and resources that will assist in promoting adult and adolescent immunization on many levels, during NAIAW and the rest of the year. A PDF of the kit may be downloaded from http://www.nfid.org/pdf/publications/naiaw08.pdf NFID encourages organizations to download the campaign kit, to duplicate the materials included in the kit, and to modify the information to fit unique needs.

NFID's website can be accessed at http://www.nfid.org

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4 Study results published in the Public Library of Science firmly show no connection between MMR vaccine and autism

Amidst concerns over increasing measles cases in unvaccinated individuals, a new study firmly concludes no connection between measles, mumps, rubella (MMR) vaccine and autism.

In the recent case control study, the presence of measles virus RNA was no more likely in children with autism and gastrointestinal (GI) disturbances than in children with only GI disturbances. Furthermore, GI symptom and autism onset were unrelated to MMR vaccine timing.

In 1998, a report of the presence of measles virus RNA in intestinal tissue from children with autism spectrum disorders and GI disturbances (Wakefield et al.) resulted in public concern over the safety of MMR vaccine. Although epidemiological investigations found no associations between MMR vaccine and autism, this is the first study to test for the presence of viral RNA in GI tissues of children with autism and GI disturbances, and examine the temporal relationship of MMR, GI disturbances, and autism.

To access the study published as "Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study" online in the Public Library of Science, go to: http://dx.plos.org/10.1371/journal.pone.0003140

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5 The Vaccine Education Center offers an updated version of its influenza resource

The Vaccine Education Center at the Children's Hospital of Philadelphia recently updated its two-page education sheet, "Influenza: What you should know." Intended for patients, parents, and providers, the sheet answers the most frequently asked questions about influenza disease and vaccines. English- and Spanish-language versions are available.

Health professionals can order two 50-sheet pads in each language at no charge. Additional pads are available for $3, plus shipping.

To access a ready-to-copy (PDF) version of the sheet in English,  click here.

To access a ready-to-copy (PDF) version of the sheet in Spanish,  click here.

Order by email at vaccines@email.chop.edu or by phone at (215) 590-9990.

For additional ordering information, go to:
http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75982

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6 This one-page ready-to-copy flyer will make conference attendees aware of hundreds of reliable immunization resources--all FREE from IAC!

We want to make IAC Express readers aware of a one-page ready-to-copy flyer that they can distribute at conferences to make conference attendees aware of links to hundreds of reliable immunization resources. Titled "Handy Resources: Practical information about immunization and vaccine-preventable diseases," the handout includes links to the following FREE materials:

  • IAC's subscription page, http://www.immunize.org/subscribe, where one can subscribe to IAC's three print periodicals--Needle Tips, Vaccinate Adults, and Vaccinate Women--as well as to IAC's weekly email news service, IAC Express
     
  • IAC's main website, http://www.immunize.org, which has hundreds of ready-to-copy immunization and viral hepatitis print materials for patients and staff
     
  • IAC's website for the public, healthcare professionals, and the media, http://www.vaccineinformation.org, which contains disease and vaccine information, including photos and videos

To download the ready-to-copy flyer, go to:
http://www.immunize.org/catg.d/u6005.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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7 2008-09 influenza vaccine update posted on CDC's seasonal flu web section

On August 28, CDC posted "Questions & Answers: 2008-09 Influenza Vaccine Updates" on its Seasonal Flu website. To access it, go to: http://www.cdc.gov/flu/flu_vaccine_updates.htm

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

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8 South Carolina Immunization Conference to be held November 7 in Columbia

Scheduled for November 7 in Columbia, the 2008 South Carolina Immunization Conference is open to all interested healthcare providers, including those from other states. The conference will focus on the latest information on vaccines.

For information, call the Immunization Division of the South Carolina Department of Health and Environmental Control at (803) 898-0460.

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9 MMWR publishes report on worldwide laboratory surveillance for wild and vaccine-derived polioviruses

CDC published "Laboratory Surveillance for Wild and Vaccine-Derived Polioviruses--Worldwide, January 2007-June 2008 " in the September 5 issue of MMWR. A portion of a summary made available to the press is reprinted below.


The Global Polio Laboratory Network (GPLN), comprising 145 laboratories in 100 countries, provides comprehensive virologic support to the WHO Global Polio Eradication Initiative. Despite a steadily increasing workload (>230,000 stool specimens from patients with acute flaccid paralysis were analyzed over the past 18 months), proficiency remains high, and 99 percent of GPLN laboratories are fully accredited by WHO. By incorporating new technologies (e.g., PCR), reporting times have been cut in half. All wild poliovirus (WPV) isolates from every polio case are sequenced, and global and local pathways of WPV transmission are resolved at high resolution. GPLN also screens for and characterizes genetically divergent vaccine-derived polioviruses (VDPVs) capable of causing outbreaks in areas of low polio vaccine coverage and prolonged infections in persons with primary immunodeficiencies.


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5735.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.