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Immunization Action Coalition
IAC Express 2008
Issue number 758: October 13, 2008
 
Contents of this Issue
Select a title to jump to the article.
  1. CDC publishes information on adolescent vaccination rates
  2. Association for Professionals in Infection Control and Epidemiology releases position paper on influenza immunization of healthcare personnel
  3. Journal of Child Neurology publishes letters about failure to disclose possible conflict of interest related to Poling case article
  4. CDC publishes updated recommendation for isolation of persons with mumps
  5. CDC answers additional questions about use of zoster vaccine
  6. IAC revises Spanish-language influenza screening questionnaires
  7. Current VISs for injectable and nasal-spray influenza vaccines now available in Karen
  8. September issue of The Vaccine Quarterly features article on advocating for vaccines
  9. Association for Prevention Teaching and Research offers updated training module on influenza
  10. Franklin Institute sponsoring public forum on HPV vaccine issues on October 30
  11. Summary of WHO global immunization work from 2006-07 available online
  12. CDC's "Baby Steps" campaign offers information on early recognition of developmental disabilities
 
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 758: October 13, 2008
1.  CDC publishes information on adolescent vaccination rates

CDC published "Vaccination Coverage Among Adolescents Aged 13–17 Years--United States, 2007" in the October 10 issue of MMWR. A portion of the summary made available to the press is reprinted below.


CDC conducts the National Immunization Survey–Teen (NIS–Teen) to determine vaccination coverage estimates in a national sample of adolescents aged 13–17 years. Three new vaccines have been recommended for adolescents since 2005: meningococcal conjugate vaccine (MCV4), tetanus, diphtheria, acellular pertussis vaccine (Tdap), and human papillomavirus vaccine (HPV4). Adolescents should also receive childhood vaccinations that were missed. Between 2006 and 2007, there were substantial increases in receipt of new adolescent vaccinations including Tdap (from 10.8 percent to 30.4 percent) and MCV4 (from 11.7 percent to 32.4 percent), and increases in coverage of childhood vaccinations including measles, mumps, and rubella (MMR), hepatitis B, and varicella vaccines (among those without prior disease history). For HPV4 coverage, which is reported for the first time, 25.1 percent of adolescent females had initiated the vaccine series (>1 dose). To improve vaccination coverage among adolescents, providers should take advantage of every healthcare visit as an opportunity to evaluate vaccination status and administer vaccines when needed.


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5740a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5740.pdf

To access a transcript from the related October 9 press briefing, go to:
http://www.cdc.gov/media/transcripts/2008/t081009.htm

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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2 Association for Professionals in Infection Control and Epidemiology releases position paper on influenza immunization of healthcare personnel

On October 9, the Association for Professionals in Infection Control and Epidemiology (APIC) released a position paper titled "Influenza Immunization of Healthcare Personnel." The first four paragraphs are reprinted below, excluding references.


Influenza is a serious disease that is associated with high rates of morbidity and mortality. In the United States, an estimated 5 percent to 15 percent of the population is affected by the virus each year. Influenza infections result in approximately 226,000 hospital admissions and 36,000 deaths annually. A recent study using a probability model from 2003 data estimated that annual influenza epidemics account for 610,660 life–years lost, 3.1 million days of hospitalization, and 31.4 million outpatient visits.

The most efficient method of preventing these outbreaks and the associated morbidity and mortality is through pre-exposure vaccination. Healthcare personnel (HCP) are at high risk for acquiring influenza infection due to their exposure to ill patients as well as their exposure in the community. Because those persons who are at greatest risk of developing complications of influenza are exposed to healthcare personnel in a variety of inpatient and outpatient settings, an important strategy to decrease exposure to these high-risk individuals is to immunize healthcare workers.

Although annual influenza vaccination for HCP has been recommended by the Centers for Disease Control and Prevention (CDC) since 1981, national survey data from 2005-2006, demonstrated a vaccination coverage level of 42 percent among these workers. Despite long-standing recommendations by APIC, CDC, and other national healthcare organizations, the response to voluntary vaccination has not risen significantly over the past decade. Even among those healthcare organizations having aggressive targeted campaigns, 30-50 percent of HCP remain unvaccinated.

As a profession, we must do a better job of immunizing HCP every year to ensure patient safety and protect those individuals at high risk of developing complications of influenza. Therefore, APIC recommends that hospitals, long-term care, and other facilities that employ healthcare personnel, implement a comprehensive strategy which incorporates all of the recommendations for influenza vaccination of HCP of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). As part of a comprehensive strategy, we recommend that influenza vaccine be required annually for all healthcare personnel with direct patient care. Organizations should adopt a system in which an informed declination is obtained from employees that decline for other than medical reasons. This information should be utilized by the facility to develop improvement strategies for the following vaccine season.

To access the APIC position paper in full, click here.

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3 Journal of Child Neurology publishes letters about failure to disclose possible conflict of interest related to Poling case article

The September 2008 issue of the Journal of Child Neurology (JCN) contains three letters that may be of interest to readers who have been receiving inquiries about the case of Hannah Poling, a girl with neurological abnormalities including some autistic features, whose National Vaccine Injury Compensation Program (VICP) case was evaluated as compensable by the Department of Health and Human Services. Many have been confused by claims made in the media that this case proves vaccines can cause autism.

The three letters relate to the failure of Jon Poling, MD, PhD, the father of Hannah Poling, to disclose the fact that the family was engaged in litigation over Hannah's disabilities when he co-authored a report on her case which was published in JCN.

  • In the first letter, Dr. Poling apologizes for failing to disclose to JCN that the subject of the case report was his daughter, but seemingly argues that because he did not submit the JCN report to the court, and was not heavily involved in pursuing his daughter's case, the conflict of interest was immaterial.
     
  • In the second letter, the co-authors of the JCN case report denied knowing that the Polings were VICP litigants at the time the paper was submitted and expressed their regret that there had been no disclosure of Dr. Poling's relationship to the subject of the report and his status as a VICP petitioner.
     
  • In the third letter, JCN's editor-in-chief, Roger A. Brumback, MD, noted that the authors of the case report, including Poling, had explicitly stated they had no conflicts of interest when submitting their paper to JCN. He described failure to disclose a conflict of interest as an "appallingly troubling issue" because it threatens the integrity of the scientific literature. Dr. Brumback also expressed concern that media linkage of the JCN report with the Poling case might imply that JCN endorsed the government's decision in the Poling case.

While the exposure of Dr. Poling's conflict of interest doesn't shed additional light on Hannah Poling's health issues, it is a reminder that this case sits at the uncomfortable intersection of science and law, and that much of what has been portrayed as scientific fact is actually based on lay interpretations of legal conclusions.

The letters to the editor cited above can be found in the September 2008 issue of the Journal of Child Neurology. To view them electronically, one must be a subscriber to the journal or pay a fee for temporary access: http://jcn.sagepub.com/content/vol23/issue9

The abstract for the original report, "Developmental Regression and Mitochondrial Dysfunction in a Child With Autism," can be accessed at http://jcn.sagepub.com/cgi/content/abstract/21/2/170 The full article is available to subscribers or by paying a fee.

You can also check with your medical library to access this journal in print format.

The editor of IAC Express would like to thank Neurodiversity.com for bringing these letters to IAC’s attention. Interested readers can access the Neurodiversity.com report at http://neurodiversity.com/weblog/article/176

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4 CDC publishes updated recommendation for isolation of persons with mumps

CDC published "Updated Recommendations for Isolation of Persons with Mumps" in the October 10 issue of MMWR. A portion of the summary made available to the press is reprinted below.


National recommendations concerning the isolation for person with mumps for 9 days conflicted with other guidance that the infectious period of mumps extended through the 4th day after parotitis and resulted in confusion during the 2006 mumps resurgence in the U.S. with respect to the appropriate length of case isolation. To address this issue, researchers at the CDC and American Academy of Pediatrics (AAP) reviewed scientific evidence underlying the 9-day isolation recommendation including published articles on mumps transmission; viral isolation, detection, and load; and mumps in healthcare settings and, as a result, in 2007, revised the recommended isolation period for community and healthcare workers in ambulatory settings to 5 days. In February 2008, the Healthcare Infection Control Practices Advisory Committee approved a similar recommendation in in-patient settings. The evidence reviewed suggested that isolation of mumps virus is highest before or around the time of onset of parotitis, with the rate of mumps virus isolation and viral load declining rapidly during the 3 to 5 days following onset of parotitis. The risk of mumps transmission is considered to be low after 5 days; most transmission likely occurs before symptom onset or within the subsequent 5 days.


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5740a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5740.pdf

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5 CDC answers additional questions about use of zoster vaccine

On October 9, CDC added 7 new Q&As to its online Herpes Zoster Vaccine Q&A (Shingles) page.

To access this updated resource, go to:
http://www.cdc.gov/vaccines/vpd-vac/shingles/vac-faqs.htm

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6 IAC revises Spanish-language influenza screening questionnaires

IAC made small changes to the Spanish-language versions of its screening questionnaires for injectable and intranasal influenza vaccines.

The Spanish version of "Screening Questionnaire for Injectable Influenza Vaccination" had a website link updated.

To obtain a ready-to-copy (PDF) version of the revised piece, go to: http://www.immunize.org/catg.d/p4066-01.pdf

To access the same "Screening Questionnaire for Injectable Influenza Vaccination" in English, go to:
http://www.immunize.org/catg.d/p4066.pdf

The Spanish version of "Screening Questionnaire for Intranasal Influenza Vaccination" had question #6 (regarding wheezing) revised.

To obtain a ready-to-copy (PDF) version of the revised piece, go to: http://www.immunize.org/catg.d/p4067-01.pdf
 
To access the same "Screening Questionnaire for Intranasal Influenza Vaccination" in English, go to:
http://www.immunize.org/catg.d/p4067.pdf

IAC's Print Materials web section offers healthcare professionals and the public more than 175 FREE, English-language materials (many available also in translation), which we encourage website users to print out, copy, and distribute widely. To access all of IAC's free print materials, go to: http://www.immunize.org/printmaterials

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7 Current VISs for injectable and nasal-spray influenza vaccines now available in Karen

Dated 7/24/08, the current VISs for trivalent inactivated influenza vaccine (TIV; injectable) and live attenuated influenza vaccine (LAIV; nasal spray) are now available in Karen. IAC gratefully acknowledges the Minnesota Department of Health for the translations.

TIV vaccine VIS
To access the Karen version of the TIV vaccine VIS, go to:
http://www.immunize.org/vis/ka_flu.pdf

To access the English version of the TIV vaccine VIS, go to:
http://www.immunize.org/vis/2flu.pdf

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

LAIV vaccine VIS
To access the Karen version of the LAIV vaccine VIS, go to:
http://www.immunize.org/vis/ka_LAIV.pdf

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

NOTE: The VIS for LAIV vaccine comes in additional languages, including Spanish. To access them, go to: http://www.immunize.org/vis/vis_flu_live.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

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

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8 September issue of The Vaccine Quarterly features article on advocating for vaccines

The September issue of The Vaccine Quarterly features an article by Diane Peterson titled "Advocating for Safe and Effective Vaccines." The article identifies resources for physicians to use in staying informed about current vaccine issues and to become stronger advocates for safe and effective vaccines.

To view the September issue in ready-to-print (PDF format), click here.

Each issue of The Vaccine Quarterly can be accessed online at no charge and includes literature reviews of articles relevant to clinical practice and an opportunity to earn CME credit. To access the index page, go to: http://www.vaccinequarterly.com

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9 Association for Prevention Teaching and Research offers updated training module on influenza

The Association for Prevention Teaching and Research recently updated its TIME (Teaching Immunization for Medical Education) module on influenza.

The module consists of six case-based scenarios that are designed to foster learner knowledge about influenza disease, the indications for administering the vaccines, and methods to increase vaccine coverage.

The facilitator' guide and small group booklet can be downloaded from the TIME index page at
http://76.12.16.132/resources/curriculum_time.html

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10.  Franklin Institute sponsoring public forum on HPV vaccine issues on October 30

The Franklin Institute, in partnership with the Center for Vaccine Ethics and Policy, is sponsoring a series of public forums on vaccine science, ethics, and policy. The second event in the series, "HPV Vaccines--Issues, Lessons, and Public Confidence in Vaccines," will take place from 7:00-8:30 PM (ET) at the Franklin Theater in Philadelphia.

The forum will explore the issues and lessons learned from ongoing HPV vaccine programs, and how this experience can inform strategies to address the crisis in public understanding and confidence around vaccines overall.

To download a flyer about this event, including a list of featured speakers, go to:
http://www.fi.edu/wellness/oct30.flyer.color.pdf

To read more about this series of public forums, go to:
http://www.fi.edu/wellness

For free tickets, call (215) 448-1254 by October 29.

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11.  Summary of WHO global immunization work from 2006-07 available online

WHO recently published "WHO Immunization Work: 2006-07 Highlights," a 125-page document that provides an overview of WHO's immunization activities during that two-year period.

To access a ready-to-print (PDF) version of this report, go to:
http://whqlibdoc.who.int/publications/2008/9789241596749_eng.pdf

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12.  CDC's "Baby Steps" campaign offers information on early recognition of developmental disabilities

Given that early recognition of developmental disabilities such as autism is key for parents and healthcare providers, CDC has invested in a campaign to help parents measure their children's progress by monitoring how they play, learn, speak, and act.

The campaign is called "Baby Steps: Learn the Signs. Act Early," and features online information including a video. To access the campaign web page, go to:
http://www.cdc.gov/ncbddd/autism/ActEarly

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Immunization Action Coalition  •  1573 Selby Ave  •  St. Paul, MN 55104
tel 651-647-9009  •  fax 651-647-9131
 
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.