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Immunization Action Coalition
IAC Express 2009
Issue number 774: January 12, 2009
Please click here to subscribe to IAC Express as well as other FREE IAC periodicals.
Contents of this Issue
Select a title to jump to the article.
  1. New: CDC, AAFP, ACOG, and ACP release the 2009 Recommended Adult Immunization Schedule
  2. Erratum: MMWR corrects an error in its January 2 article about the 2009 Recommended Immunization Schedule for Persons Ages 0 Through 18 Years
  3. AAP article answers parents' questions about the number and timing of vaccines recommended in the childhood immunization schedule
  4. CDC study reveals that poor infection control practices by healthcare personnel expose patients to hepatitis B and C
  5. IAC's Video of the Week presents stories from families affected by influenza
  6. January 16 is the nomination deadline for the 2009 National Influenza Vaccine Summit's Immunization Excellence Awards
  7. Merck reports shortage of the adult formulation of its hepatitis B vaccine
  8. CDC issues media statement about oseltamivir resistance and antiviral recommendations
  9. January is Cervical Health Awareness Month: CDC encourages the public to learn about cervical cancer and HPV vaccination
  10. Use the Michigan Department of Public Health's monthly posters to encourage influenza immunization through April
  11. NAPNAP's immunization brochure encourages immunization for healthcare professionals who take care of children
  12. Important: Be sure to give influenza vaccine throughout the influenza season--through spring 2009
  13. Summary Report from the October 2008 ACIP meeting is now online
  14. January 29 Current Issues in Immunization Net Conference to focus on antiviral resistance among influenza A (H1N1) viruses
  15. January 12 issue of People magazine includes interview with Amanda Peet voicing support for childhood immunization
  16. Final Statement of October 2008 NIH Consensus Development Conference on Management of Hepatitis B now online
 
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 774: January 12, 2009
1.  New: CDC, AAFP, ACOG, and ACP release the 2009 Recommended Adult Immunization Schedule

CDC, the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP) have endorsed and released the "Recommended Adult Immunization Schedule--United States, 2009." On January 9, CDC published the schedule as an MMWR QuickGuide; it is reprinted below in its entirety, excluding references and two figures.


The Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended Adult Immunization Schedule to ensure that the schedule reflects current recommendations for the licensed vaccines. In October 2008, ACIP approved the Adult Immunization Schedule for 2009. No new vaccines were added to the schedule; however, several indications were added to the pneumococcal polysaccharide vaccine footnote, clarifications were made to the footnotes for human papillomavirus, varicella, and meningococcal vaccines, and schedule information was added to the hepatitis A and hepatitis B vaccine footnotes.

Additional information is available as follows: schedule (in English and Spanish) at http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm [IAC Express editor's note: the Spanish-language version is not yet available; it is anticipated to be available at the end of January]; adult vaccination at http://www.cdc.gov/vaccines/default.htm; ACIP statements for specific vaccines at http://www.cdc.gov/vaccines/pubs/acip-list.htm; and reporting adverse events at http://www.vaers.hhs.gov or by telephone, (800) 822-7967.

CHANGES FOR 2009

FORMAT CHANGES (Figures 1 and 2)
To make the figures easier to understand, several formatting changes were implemented to both the age group-based schedule and the medical and other indications schedule. The changes include (1) increasing the number of age groups; (2) deleting the hatched yellow bar for tetanus, diphtheria, pertussis (Td/Tdap) vaccine while adding explanatory text to the Td/Tdap bar; (3) simplifying the figures by removing schedule text from the vaccine bars; (4) revising the order of the vaccines to more appropriately group the vaccines, and (5) adding a legend box to clarify the meaning of blank spaces in the table.

FOOTNOTE (Figures 1 and 2)
  • The human papillomavirus (HPV) footnote (#2) has language added to indicate that healthcare personnel are not at increased risk because of occupational exposure, but they should be vaccinated consistent with age-based recommendations. Also, text has been added to indicate that vaccination with HPV may begin at age 9 years.
     
  • The varicella footnote (#3) has language added to clarify that adults who previously received only 1 dose of vaccine should receive a second dose.
     
  • Asthma and cigarette smoking have been added as indications for pneumococcal polysaccharide vaccination (#7). Also, text has been added to clarify vaccine use in Alaska Natives and American Indians.
     
  • The Hepatitis A footnote (#9) has additional schedule information for the 4-dose combined hepatitis A/hepatitis B vaccine.
     
  • The Hepatitis B footnote (#10) has additional schedule information for the 4-dose combined hepatitis A/hepatitis B vaccine, and a clarification of schedule information for special formulation indications has been added.
     
  • The meningococcal vaccine footnote (#11) clarifies that the revaccination interval is 5 years.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5753a6.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5753.pdf

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

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2 Erratum: MMWR corrects an error in its January 2 article about the 2009 Recommended Immunization Schedule for Persons Ages 0 Through 18 Years

CDC published "Erratum: Vol. 57, Nos. 51 & 52" in the January 9 issue of MMWR. The erratum concerns an error that appears in the MMWR QuickGuide article titled "Recommended Immunization Schedules for Persons Aged 0 Through 18 Years--United States, 2009," which was published on January 2. The error appeared only in the article about the immunization schedule; the information in the actual PDF-format schedule is correct. The erratum is reprinted below in its entirety.


In the "Recommended Immunization Schedules for Persons Aged 0 Through 18 Years--United States, 2009," an error occurred on page Q-1. The first bulleted sentence should read as follows:
  • "Recommendations for rotavirus vaccines include changes for the maximum age for the first dose (14 weeks 6 days) and the maximum age for the final dose of the series (8 months 0 days)."

To access a web-text (HTML) version of the erratum, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5753a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5753.pdf

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3 AAP article answers parents' questions about the number and timing of vaccines recommended in the childhood immunization schedule

AAP published "Adhering to Vaccine Schedule Is Best Way to Protect Children from Disease" in the January issue of AAP News. Written in a Q&A format, the article gives succinct, clearly written answers to questions many parents ask their healthcare providers, such as "why so many vaccines?" "why start so early?" "why not spread out the schedule?" and more.

To access the article, go to:
http://www.cispimmunize.org/fam/schedule_whysomany.html

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4 CDC study reveals that poor infection control practices by healthcare personnel expose patients to hepatitis B and C

On January 6, CDC issued a press release, "CDC Study: Failures to Follow Infection Practices Have Placed More than 60,000 Patients at Risk for Hepatitis B and C." Portions of the press release are reprinted below.


In the last decade, more than 60,000 patients in the United States were asked to get tested for hepatitis B virus (HBV) and hepatitis C virus (HCV) because healthcare personnel in settings outside hospitals failed to follow basic infection control practices, according to a new study by the CDC.

This first full review of all the CDC investigations over the past 10 years of healthcare-associated viral hepatitis outbreaks appears in the January 6th issue of the journal Annals of Internal Medicine.

"This report is a wake-up call," said Dr. John Ward, director of CDC's Division of Viral Hepatitis. "Thousands of patients are needlessly exposed to viral hepatitis and other preventable diseases in the very places where they should feel protected. No patient should go to their doctor for health care only to leave with a life-threatening disease."

In the United States, transmission of HBV and HCV while receiving health care has been considered uncommon. However, a review of CDC outbreak information revealed a total of 33 identified outbreaks outside of hospitals in 15 states, during the past decade: 12 in outpatient clinics, six in hemodialysis centers, and 15 in long-term care facilities, resulting in 450 people acquiring HBV or HCV infection. . . .

To access the complete press release, go to:
http://www.cdc.gov/media/pressrel/2009/r09106.htm

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5 IAC's Video of the Week presents stories from families affected by influenza

IAC encourages IAC Express readers to watch a seven-minute video narrated by parents who have lost a child to influenza or have a child who has experienced severe medical complications from influenza. Titled "Why Flu Vaccination Matters: Personal Stories from Families Affected by Flu," the video was produced by CDC and Families Fighting Flu. To safeguard children from influenza, CDC recommends influenza vaccination every year for children ages 6 months through 18 years.

To find out more, go to: http://www.familiesfightingflu.org

The video will be available on the home page of IAC's website through January 18. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week, which you'll find toward the top of the page.

Remember to bookmark IAC's home page to view a new video every Monday. While you're at our home page, we encourage you to browse around--you're sure to find resources and information that will enhance your practice's immunization delivery.

To view IAC's video collection, go to:
http://www.vaccineinformation.org/video

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6 January 16 is the nomination deadline for the 2009 National Influenza Vaccine Summit's Immunization Excellence Awards

The nomination form for National Influenza Vaccine Summit's Immunization Excellence Awards is now available. The awards recognize individuals and organizations that have made extraordinary contributions toward improved adult and/or childhood influenza vaccination within their communities. Awards will be presented during the National Immunization Conference, which will be held in Dallas during March 30-April 2. The deadline for nominations is January 16 (this coming Friday).

To access complete information and the online nomination form, go to: http://fs16.formsite.com/APhA/2009NIVSAwards

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7 Merck reports shortage of the adult formulation of its hepatitis B vaccine

On December 30, 2008, NCIRD posted information on its Current Vaccine Shortages & Delays web section about a shortage in Recombivax HB, Merck's adult hepatitis B vaccine. The information is reprinted below in its entirety.


Beginning in January 2009, Merck expects to experience a supply interruption in the U.S. for the adult formulation of their hepatitis B vaccine, Recombivax HB. Merck anticipates that supplies of the different images of the adult formulation of Recombivax HB (vials and syringes) as well as the dialysis formulation will be depleted over the first quarter of 2009. Merck will provide updates on supply of the adult formulations as additional information becomes available. At this time Merck does not anticipate the pediatric formulation will be affected, and expects it to be available in adequate supply to meet anticipated demand. Supply of GSK's Adult hepatitis B vaccine (Adult Engerix-B) and Adult hepatitis A/hepatitis B combination vaccine (Twinrix) is currently sufficient to meet demand for routine adult usage of this vaccine as well as CDC's ongoing High Risk Adult Hepatitis B Initiative. GSK is gearing up production of these vaccines, to meet ongoing demand.

To access the information from the CDC website, go to: http://www.cdc.gov/vaccines/vac-gen/shortages The information will be updated as needed to provide public information on vaccine shortages and/or delays.

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8 CDC issues media statement about oseltamivir resistance and antiviral recommendations

On January 9, CDC issued a media statement titled "CDC Statement on Oseltamivir (Tamiflu) Resistance and Antiviral Recommendations." Portions of it are reprinted below.


On December 19, 2008, CDC issued interim guidance for healthcare professionals on the use of influenza antiviral medications this flu season. The guidance was issued in response to early data from a limited number of states indicating that a high proportion of influenza A (H1N1) viruses are resistant to the influenza antiviral medication oseltamivir (Tamiflu). Worldwide, the proportion of H1N1 viruses that are resistant to oseltamivir has been increasing so this development is not surprising.

Recent media reports may have led some to believe that these developments mean physicians are without influenza treatment options for the 2008-2009 flu season.

At this time, it's not possible to predict how common H1N1 viruses will be during the rest of this flu season, as there are many different flu viruses and every influenza season is different. The current samples studied come from a handful of states, and may not be indicative of how the rest of the season will progress or what viruses will circulate in other states. However the circulation of oseltamivir-resistant viruses does have treatment implications for healthcare professionals. CDC is continuing to monitor this situation very closely, but has issued interim guidance for healthcare professionals to guide their treatment decisions in the current situation.

In fact, the interim CDC guidance provides advice for clinicians on how to treat patients with influenza antiviral medications this season. Clinicians can use influenza test results and information, if available, about which viruses are circulating, to help decide which antiviral(s) should be used. If H1N1 viruses are circulating in the community, or it's not clear which viruses are circulating, healthcare providers are recommended to use an alternative antiviral, zanamivir (Relenza), or to use combination therapy of oseltamivir and rimantadine. Use of zanamivir or dual therapy with oseltamivir and rimantadine would provide effective treatment against all circulating influenza viruses. In some instances, oseltamivir alone can still be used, such as when influenza B is diagnosed, or H1N1 viruses are not circulating.

It is important to remember that CDC recommends annual influenza vaccination as the first and best step in preventing the flu. It is not too late to get vaccinated and this year's influenza vaccine is expected to be effective against currently circulating oseltamivir-resistant influenza A (H1N1) viruses. . . .

To access the complete media statement, go to:
http://www.cdc.gov/media/pressrel/2009/s090109.htm

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9 January is Cervical Health Awareness Month: CDC encourages the public to learn about cervical cancer and HPV vaccination

CDC recently updated its online cervical cancer information for the public, in time for the January observance of Cervical Health Awareness Month. The updated information covers the following: cervical cancer prevention, including HPV vaccination; risk factors; signs and symptoms; and treatment.

To access the updated information, go to:
http://www.cdc.gov/cancer/cervical/basic_info

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10.  Use the Michigan Department of Public Health's monthly posters to encourage influenza immunization through April

To encourage healthcare providers to talk with patients about influenza vaccination throughout the influenza season, the Michigan Department of Public Health (MDPH) has developed a series of monthly posters for use through April.

In addition to the monthly posters, MDPH offers other resources directed at extending the influenza vaccination season, including a poster from the National Foundation for Infectious Diseases that tells providers to continue vaccinating because influenza activity typically peaks in February.

To access these and other resources, click here.

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11.  NAPNAP's immunization brochure encourages immunization for healthcare professionals who take care of children

The National Association of Pediatric Nurse Practitioners (NAPNAP) recently developed an immunization brochure for healthcare providers who care for children. The brochure encourages healthcare providers to get immunized, not only to protect themselves but to protect the children and families that they care for.

To access the brochure, go to:
http://www.napnap.org/userfiles/File/NAP_NAP_BROCHURE.pdf

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12.  Important: Be sure to give influenza vaccine throughout the influenza season--through spring 2009

Influenza activity is increasing, and yearly vaccination is the first and most important step in protecting against influenza and its complications. It is important to continue vaccinating into the spring months. The supply of influenza vaccine is robust; if you run out of vaccine in your work setting, please place another order.

For abundant information about influenza vaccination, visit the following two websites often. They 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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13.  Summary Report from the October 2008 ACIP meeting is now online

The CDC website recently posted the Summary Report of the ACIP meeting held on October 22-23, 2008. To access a ready-to-print (PDF) version of the report, go to:
http://www.cdc.gov/vaccines/recs/acip/downloads/min-oct08.pdf

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14.  January 29 Current Issues in Immunization Net Conference to focus on antiviral resistance among influenza A (H1N1) viruses

CDC's next "Current Issues in Immunization" net conference will be held on January 29 from noon to 1PM ET. Moderated by Dr. Andrew T. Kroger, the net conference will feature Dr. Anthony Fiore speaking on antiviral resistance among influenza A (H1N1) viruses and interim guidance for antivirals.

Registration is limited and will close on January 28 or when the course is full. To register, go to:
http://www2.cdc.gov/vaccines/ed/ciinc

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15.  January 12 issue of People magazine includes interview with Amanda Peet voicing support for childhood immunization

Every Child By Two (ECBT) recently announced that actress Amanda Peet, the campaign spokesperson for ECBT's Vaccinate Your Baby campaign, is featured in the January 12 issue of People magazine. In the article, Ms. Peet discusses the research she did before deciding to vaccinate her daughter and the importance of parents' making vaccination decisions based on hard scientific evidence.

Healthcare professionals might want to make the parents of young children aware of the interview or might want to provide parents with copies of it. The magazine was on newsstands as of January 7.

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16.  Final Statement of October 2008 NIH Consensus Development Conference on Management of Hepatitis B now online

On October 20-22, 2008, the National Institutes of Health convened a consensus development conference on the management of hepatitis B. The final statement of the conference is available at http://consensus.nih.gov/2008/2008HepatitisBCDC120main.htm

To order free print copies of the final statement, which will be available in the spring, go to:
http://www.meetinglink.org/OMAR/hepb/orderfinal.aspx

For additional information, email consensus@mail.nih.gov or call (888) 644-2667.

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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.