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Immunization Action Coalition
IAC Express 2009
Issue number 776: January 26, 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. MMWR Early Release reports on five cases of Hib disease in Minnesota during 2008, including one death
  2. New Q&A newsletter for parents lays out the evidence showing that vaccines do not cause autism
  3. Richard E. Besser, MD, appointed acting CDC director and acting ATSDR administrator
  4. IAC's Video of the Week stresses the importance of pertussis vaccination for new parents and others with infant contact
  5. IAC's popular parent-education chart "Immunizations for Babies" now available in Spanish and six other languages
  6. Spanish-language version of the 2009 Recommended Adult Immunization Schedule now on CDC's website
  7. IAC reviews, updates, and reorganizes its hepatitis B "Ask the Experts" web section
  8. January issue of CDC's Immunization Works electronic newsletter recently released
  9. Important: Be sure to give influenza vaccine throughout the influenza season--through spring 2009
  10. February 23 is the nomination deadline for the 2009 Natalie J. Smith Award
  11. Bangladesh announces plan to vaccinate 4 million children annually with 5-in-1 combination vaccine
 
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 776: January 26, 2009
1.  MMWR Early Release reports on five cases of Hib disease in Minnesota during 2008, including one death

On January 23, CDC published "Invasive Haemophilus influenzae type b Disease in Five Young Children--Minnesota, 2008" in an MMWR Early Release. It is reprinted below in its entirety, excluding references, two figures, and a table.

Also on January 23, CDC posted updated information on its web section of resources titled "Hib: For Providers and Parents." A link to the web section is given at the end of this IAC Express article. CDC, in conjunction with the Minnesota Department of Health, held a media briefing on the topic on January 23. As IAC Express goes to press, the transcript of the media briefing has not yet been posted on the CDC website.


In 2008, five children aged <5 years were reported to the Minnesota Department of Health (MDH) with invasive Haemophilus influenzae type b (Hib) disease; one died. Only one of the children had completed the primary Hib immunization series; three had received no doses of Hib-containing vaccine. The five Hib cases are the largest number among children aged <5 years reported from Minnesota since 1992. The cases occurred during a Hib vaccine recall and continuing nationwide shortage that began in December 2007. The recall of certain lots of the two Hib-containing vaccines manufactured by Merck & Co., Inc. (West Point, Pennsylvania) and cessation of production of both vaccines left only one manufacturer of Hib vaccine in the United States (sanofi pasteur, Swiftwater, Pennsylvania). In response, CDC recommended that healthcare providers defer the routine 12-15 month booster dose for children not at increased risk for Hib disease. CDC also emphasized that all children should complete the primary series with available Hib-containing vaccines. However, Minnesota vaccination data indicate that primary Hib series coverage was lower during 2008 than coverage with other vaccines administered at the same ages and lower than Hib coverage in previous years. Increases in Hib cases like the one in Minnesota do not appear to have occurred in other states. The increase highlights the need to ensure that all children complete the primary Hib immunization series. Additional investigation to better elucidate the factors that led to these cases is being conducted by MDH and CDC.

Minnesota conducts surveillance for invasive H. influenzae disease as part of the Active Bacterial Core surveillance system of CDC's Emerging Infections Program. A Hib case is defined as isolation of H. influenzae from a normally sterile site in a resident of the state. Merck products are both Hib PRP-OMP vaccines, for which a primary series consists of 2 doses at 2 and 4 months. Sanofi pasteur products are Hib PRP-TT vaccines, for which a primary series consists of a 3-dose primary series at 2, 4, and 6 months. For both Hib vaccine series, a routine booster is recommended at age 12-15 months.

During 2008 in Minnesota, five children aged 5 months to 3 years were reported with invasive Hib disease; one died. The patients resided in five different counties in Minnesota and had no known relationship to each other. Three patients had received no vaccinations because of parent or guardian deferral or refusal. One child was aged 5 months and had received 2 doses of Hib PRP-TT vaccine in accordance with the primary series schedule. Another child had received 2 doses of Hib PRP-OMP vaccine, but no booster dose, per CDC recommendations during the shortage. Subsequent to Hib infection, this child was diagnosed with hypogammaglobulinemia. None of the five were enrolled in group child care. The five cases in 2008 were the most reported for 1 year from Minnesota since 1992, when 10 cases were reported.

Although the recall and cessation of production of Merck Hib-containing vaccines in December 2007 resulted in a nationwide Hib vaccine shortage, supply of the remaining two products manufactured by sanofi pasteur is adequate for all infants to complete the 3-dose primary vaccine series. However, in February 2008 the Minnesota Vaccines for Children program began receiving reports from vaccine providers regarding shortages of vaccine in their offices. In response, MDH advised providers to ensure completion of the primary series as recommended whenever possible and to track and recall infants who had not completed the primary series so that they could be vaccinated as soon as doses were available. On January 13, MDH examined 2008 vaccination coverage data in the Minnesota Immunization Information Connection (MIIC), Minnesota's immunization registry. Data were reviewed for 25,699 children born between November 1, 2007 and March 31, 2008. Among children aged 7 months, 3-dose primary Hib series coverage was 46.5%, which is lower than the age-appropriate coverage for children who had received pneumococcal conjugate or diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccination. In contrast, data from the 2007 National Immunization Survey, conducted prior to the shortage, showed that Hib vaccination coverage among children in Minnesota aged 19 months to 35 months was high and did not differ from the national average, suggesting that coverage has declined as a result of the shortage.

Editorial Note:
Before development of Hib conjugate vaccines, Hib was the most common cause of bacterial meningitis in children aged <5 years. Since implementation of the Hib conjugate vaccine immunization program in the United States in the early 1990s, the incidence of Hib disease has declined from a peak of 41 cases per 100,000 children aged <5 years in 1987 to approximately 0.11 cases per 100,000 in 2007. As with other bacterial diseases in which acquisition of carriage is necessary for development of invasive disease, reductions in asymptomatic carriage and transmission are substantial contributors to the reduction in Hib disease achieved through vaccination programs. This herd immunity provided by high vaccination coverage provides additional protection both for fully vaccinated and undervaccinated persons.

Three of the five Hib cases in Minnesota occurred in children who had not been vaccinated. One case occurred in a child who was too young to complete the primary series, and a fifth case occurred in a child with an immunodeficiency. Given the prolonged booster dose deferral and reduced primary series coverage in the state, the increase in the number of Hib cases likely reflects increasing carriage and transmission affecting those with suboptimal primary series vaccination coverage, or a weakening of herd immunity. None of the children failed to receive vaccine because of the vaccine shortage. However, MDH is planning evaluations to describe the extent of Hib carriage in the affected communities and understand reasons why some children are not vaccinated. While the shortage continues, completion of the primary series in all children is essential to safeguard individual protection as well as to strengthen herd immunity.

The current Hib vaccine supply in the United States is sufficient to ensure completion of the primary series for all children, but not yet to resume the booster dose. However, vaccine shortages are difficult to manage. Healthcare providers must maintain sufficient stocks on hand for every child brought for vaccination each day. During shortages, local supply/demand mismatches can occur, resulting in missed doses. Hib vaccine supply problems can be further complicated because the primary series for the recalled products consists of 2 doses, but the primary series for the available products consists of 3 doses. Regardless of brand or product used, full vaccination with the primary series of Hib vaccine by age 7 months is critical to rotect children from disease. Providers who have questions regarding Hib vaccine supply needed to complete the primary vaccine series should contact their state health departments. Combination products may be used for any or all doses of the Hib primary series. Further, if combination vaccines are the only vaccines available to providers, a combination product should be used to complete the primary Hib series, even when this results in receipt of additional doses of another antigen. In response to the findings described in this report, MDH is working with vaccination providers and other partners to resolve any local supply problems. As the vaccine supply resolves, MDH will expedite resumption of the booster dose in communities where Hib cases have been reported.

Invasive Hib disease in children aged <5 years is a nationally notifiable condition. Healthcare providers should promptly report all suspected cases of Hib to their local health department. CDC routinely analyzes national surveillance data for invasive Hib disease in children aged <5 years. As of January 13, 2009, no other increases in Hib cases in children aged <5 years had been reported from other states or territories. CDC is working with health departments to identify areas of suboptimal primary Hib series coverage that might lead to increased transmission and disease. Prompt recognition and reporting of Hib cases is important both in understanding the impact of the Hib vaccine shortage and in guiding recommendations for resuming routine booster vaccination and catch-up of undervaccinated children.


To access a ready-to-print (PDF) version of the MMWR Early Release, go to: http://www.cdc.gov/mmwr/pdf/wk/mm58e0123.pdf

To access a web-text (HTML) version of the MMWR Early Release, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0123a1.htm

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

To access CDC's "Hib: For Providers and Parents" web section, go to:
http://www.cdc.gov/vaccines/vpd-vac/hib/providers-parents.htm

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2 New Q&A newsletter for parents lays out the evidence showing that vaccines do not cause autism

The Vaccine Education Center (VEC) of the Children's Hospital of Philadelphia has developed a four-page newsletter, "Q&A: Vaccines and Autism: What you should know." It answers parents' concerns that there is a link between vaccines and autism by presenting scientific evidence that no connection exists between autism and the following: MMR vaccine, thimerosal, or vaccinating babies according to the recommended immunization schedule.

English- and Spanish-language versions are available. Healthcare professionals can order two packs of 50 newsletters in each language at no charge. Additional packs are available for $4 each, plus shipping.

To access the English version of the newsletter, click here.
 
To access the Spanish version of the newsletter, click here.

To order online, go to:
https://www.chop.edu/vaccine/vec/profOrder.cfm

Order by phone at (215) 590-9990, by fax at (215) 590-2025, or by email at vaccines@email.chop.edu

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

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3 Richard E. Besser, MD, appointed acting CDC director and acting ATSDR administrator

On January 22, CDC posted a notice that Richard E. Besser, MD, has been appointed the acting director of CDC and the acting administrator of the Agency for Toxic Substance and Disease Registry (ATSDR). The notice is reprinted below in its entirety.


Richard Besser, MD, took the helm as acting director of the Centers for Disease Control and Prevention and acting administrator of the Agency for Toxic Substance and Disease Registry on January 22, 2009.

He began his career at CDC in the Epidemic Intelligence Service working on the epidemiology of food–borne diseases. He has served as the epidemiology section chief in the Respiratory Diseases Branch, acting chief of the Meningitis and Special Pathogens Branch in the National Center for Infectious Disease, and as the medical director of Get Smart: Know When Antibiotics Work, CDC's national campaign to promote appropriate antibiotic use in the community.

Doctor Besser received his bachelor of arts degree in economics from Williams College in Williamstown, Massachusetts, and his medical degree from the University of Pennsylvania. He completed a residency and a chief residency in pediatrics at Johns Hopkins University Hospital in Baltimore, Maryland. He has authored and co–authored more than 100 presentations, abstracts, chapters, editorials, and publications and has received many awards for his work in public health and his volunteer service.

To access the notice, go to:
http://www.cdc.gov/about/leadership/leaders/besser.htm

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4 IAC's Video of the Week stresses the importance of pertussis vaccination for new parents and others with infant contact

IAC encourages IAC Express readers to watch a 15-second video that features actress Keri Russell raising awareness about the importance of pertussis vaccinations for new parents and people who come in close contact with infants. The video is a partnership between Ms. Russell and Parents of Kids with Infectious Diseases (PKIDs).

The video will be available on the home page of IAC's website through February 1. 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. It may take a few moments for the video to begin playing; please be patient!

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

To access PKIDs' pertussis web section, go to:
http://www.pkids.org/dis_pert_stsop.php

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5 IAC's popular parent-education chart "Immunizations for Babies" now available in Spanish and six other languages

The most recent version of the IAC chart "Immunizations for Babies: A guide for parents--these are the vaccinations your baby needs!" is now available in Spanish, Arabic, Chinese, French, Korean, Russian, and Vietnamese. The chart shows parents when babies should receive the pediatric vaccines routinely recommended for them during the first 23 months of life. It also includes basic information on the diseases the pediatric vaccines prevent.

To access the Spanish version of "Immunizations for Babies," go to: http://www.immunize.org/catg.d/p4010-01.pdf

To access the Arabic version of "Immunizations for Babies," go to:
http://www.immunize.org/catg.d/p4010-20.pdf

To access the Chinese version of "Immunizations for Babies," go to: http://www.immunize.org/catg.d/p4010-08.pdf

To access the French version of "Immunizations for Babies," go to:
http://www.immunize.org/catg.d/p4010-10.pdf

To access the Korean version of "Immunizations for Babies," go to:
http://www.immunize.org/catg.d/p4010-09.pdf

To access the Russian version of "Immunizations for Babies," go to: http://www.immunize.org/catg.d/p4010-07.pdf

To access the Vietnamese version of "Immunizations for Babies," go to: http://www.immunize.org/catg.d/p4010-05.pdf

To access the English version of "Immunizations for Babies," go to: http://www.immunize.org/catg.d/p4010.pdf

IAC's Print Materials web section offers healthcare professionals and the public approximately 250 FREE English-language materials (many also available 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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6 Spanish-language version of the 2009 Recommended Adult Immunization Schedule now on CDC's website

On January 14, the Spanish-language version of the "Recommended Adult Immunization Schedule--United States, 2009" was posted to the CDC website. To access it, click here.

To access the English-language version of the schedule in various formats, go to:
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm#print Scroll down to find the format you want.

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7 IAC reviews, updates, and reorganizes its hepatitis B "Ask the Experts" web section

IAC recently reviewed, updated, and reorganized information on its online "Ask the Experts" web section on hepatitis B. The web section includes information on the following: hepatitis B disease; general hepatitis B vaccine issues; hepatitis B tests and interpretation; pregnancy, perinatal, and infant hepatitis B; child and teen hepatitis B vaccination; adult hepatitis B vaccination; healthcare workers and hepatitis B; and chronic hepatitis B virus infection.

To access the updated hepatitis B "Ask the Experts" web section, go to: http://www.immunize.org/askexperts/experts_hepb.asp

All of IAC's "Ask the Experts" web sections are reviewed and updated annually. The process is ongoing; IAC Express will inform readers as sections are reviewed and revised.

To access all of IAC's "Ask the Experts" web sections, go to:
http://www.immunize.org/askexperts

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8 January issue of CDC's Immunization Works electronic newsletter recently released

CDC recently released the January issue of its monthly newsletter Immunization Works; it will soon be posted on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

Following are titles of articles that appear in the January issue:

  • Increase in Hib cases in Minnesota, parents urged to make sure infants and children under five are vaccinated
  • Updated immunization schedules for all ages
  • PCV7 vaccine is a success: fewer hospitalizations for all-cause pneumonia among young children
  • Status of Merck hepatitis B vaccine
  • Status of monovalent measles, mumps, and rubella vaccines
  • Interim recommendations for influenza antiviral medications
  • Antiviral resistance net conference
  • Seasonal flu podcasts: CDC's Flu Gallery
  • Annual conference on vaccine research
  • Mark your calendars for NIC
  • Twins battle pertussis, become immunization champions

Issues of Immunization Works are posted on CDC's Vaccines & Immunizations website a few days after publication. To access the January issue, go to: http://www.cdc.gov/vaccines/news/newsltrs/imwrks Click on the link titled "JAN" under the banner titled "2009 Newsletters Available Online."

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9 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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10.  February 23 is the nomination deadline for the 2009 Natalie J. Smith Award

The Association of Immunization Managers (AIM) is soliciting nominations for the 2009 Natalie J. Smith Award for excellence in program management. Nominations are due on February 23. The award is given annually at the National Immunization Conference to an outstanding program manager of one of the 64 federal immunization grantee immunization programs.

The nomination form is available on the AIM website at
http://www.immunizationmanagers.org

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11.  Bangladesh announces plan to vaccinate 4 million children annually with 5-in-1 combination vaccine

The GAVI Alliance recently issued a press release announcing that Bangladesh plans to vaccinate 4 million children annually with a combination vaccine that protects against five diseases: Haemophilus influenzae type b (Hib), tetanus, diphtheria, pertussis, and hepatitis B. The GAVI Alliance is an organization that aligns public and private resources in a global effort to increase immunization.

The press release explains the significance of the use of the 5-in-1 vaccine as follows: "Instead of three different injections (for DPT, hepatitis B, and Hib), children will only need one injection at three different times during their first year of life: at the age of 6 weeks, 10 weeks, and 14 weeks. This will make it easier for health workers who will need less time and less logistics to immunize all children. It will also increase the uptake of vaccine as each child will get all five vaccines at once."

To access the complete press release, go to:
http://www.gavialliance.org/media_centre/press_releases/Bangladesh_HIB.php

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Immunization Action Coalition  •  Saint Paul, MN
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.