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Immunization Action Coalition
IAC Express 2009
Issue number 786: March 23, 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. CDC Health Advisory stresses the need for all young children to receive the 3-dose primary series of Hib vaccine
  2. Pennsylvania Department of Health announces several recently reported Hib cases and strongly encourages clinicians to give the full primary series of Hib vaccine
  3. ACIP releases provisional recommendations for the use of influenza vaccine in the 2009-10 influenza season
  4. CDC publishes information on the recommendations ACIP members voted on at the February 25-26 ACIP meeting
  5. IAC's Video of the Week features a mother's story about her son's death from Hib disease
  6. The most recent version of IAC's popular parent-education piece "When Do Children and Teens Need Vaccinations?" now available in Spanish and six additional languages
  7. Influenza complications have killed 32 U.S. children during the current influenza season. It is vital to continue vaccinating through the spring months
  8. California Department of Public Health's "i choose" campaign validates and encourages the decision to immunize
  9. FDA alert: Healthcare professionals can lower the risk of transmitting hepatitis and HIV viruses by never sharing insulin pens and cartridges among patients
  10. FDA selects influenza virus strains for the 2009-10 influenza vaccine
  11. March issue of CDC's Immunization Works electronic newsletter recently released
  12. Attention healthcare professionals: Free CE credits are available at the National Immunization Conference
  13. Inactivated influenza vaccine VIS now available in the Karen language
  14. California Immunization Coalition's 2009 Summit is planned for April 20-21 in Pasadena
  15. North Dakota Vaccination Expedition 2009 scheduled for May 28-29 in Grand Forks
  16. Attention: March 31 is the deadline for early bird registration for the May 14 Points Across VI conference
  17. GAO publishes the findings of its study on sustaining U.S. efforts to plan and prepare for an influenza pandemic
 
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 786: March 23, 2009
1.  CDC Health Advisory stresses the need for all young children to receive the 3-dose primary series of Hib vaccine

On March 18 CDC issued an official Health Advisory titled "Invasive Haemophilus influenzae Type b Disease in Young Children and Importance for All Young Children to Receive 3-Dose Primary Series with Available Hib-containing Vaccine." The Health Advisory is reprinted below in its entirety.


BACKGROUND OF THE HIB VACCINE SHORTAGE
Healthcare providers must be vigilant about ensuring that all young children are appropriately vaccinated with the 3-dose primary series of Hib (Haemophilus influenzae type b) vaccine. A nationwide shortage of Hib vaccine began in December 2007 and is ongoing. The recall of certain lots of the two Hib-containing vaccines produced by Merck & Co., Inc., and cessation of production of both vaccines has left only one manufacturer of Hib vaccine in the United States (sanofi pasteur). The shortage resulted in a recommendation by CDC to defer the Hib booster (routinely recommended at 12 through 15 months) for children who are NOT at high risk of Hib infection temporarily, until supplies are restored. This recommendation is still in effect.

Temporary deferral of the booster dose at 12 through 15 months of age for non-high risk children may have resulted in increased Hib carriage and transmission in non-symptomatic children. There is potential to see increases in cases of Hib disease at the local level. During 2008 in Minnesota, five children aged 5 months through 3 years were reported with invasive Hib disease; one died. 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. The five cases in 2008 were the most reported for 1 year from Minnesota since 1992, when 10 cases were reported.

There is enough Hib-containing vaccine for all U.S. children to receive the primary series. All children should complete the primary series by 7 months of age; high-risk children should continue to receive the full primary series and the booster dose. Completion of the primary series with currently available vaccine products (manufactured by sanofi pasteur) requires a total of 3 doses of Hib-containing vaccine (2, 4, and 6 months). Although there is enough Hib-containing vaccine nationally to support these recommendations, there may be times when practitioners do not have an adequate supply of vaccine to meet local demand. If Hib vaccine is not available in the office at the time of a visit, children who are unable to receive one of the primary series doses should be tracked and recalled to schedule an appointment to receive their dose as soon as vaccine becomes available in the office.

In addition, using available Hib-containing vaccines has presented challenges associated with switching from the Merck to sanofi products for some providers.

There are indications that these challenges have led to lower completion of the primary series. Preliminary information comes from sentinel immunization information systems (registries) in select states, which have indicated up to 10% lower coverage with the third Hib dose in the primary series compared to other vaccines (DTaP, PCV7) commonly administered at the same visit. In the scenario of booster dose deferral, it is even more important that all infants receive the complete primary series.

Specifically, some of the challenges in using the currently available Hib-containing vaccines have included provider reluctance to switch inventory and schedules, misunderstanding regarding what constitutes primary versus booster doses, determining a catch-up schedule in the setting of the deferred booster, and provider and parent concerns about over vaccination resulting from switching to the sanofi pasteur Hib-containing vaccine. Despite these challenges, healthcare providers need to ensure that all children are appropriately vaccinated with the primary series. For example, if Pentacel (DTaP-IPV/Hib) is the only Hib-containing vaccine available, this combination product should be used to complete the primary series, even if doing so results in receipt of additional doses of other antigens (e.g., DTaP, IPV). The Hib-containing vaccine products that are available may not be what providers used previously in their practice; however, the potential for increased transmission of Hib makes it more important than ever that every child is adequately protected.

RECOMMENDATIONS
The following non-high risk children should be scheduled to receive the primary series of Hib vaccine as outlined below:
  • If the child is at least 6 weeks but less than 12 months of age and has received zero, one, or two doses of Hib vaccine, schedule him/her for the first or next dose(s) immediately with a minimum of four weeks between the doses. These children will need one booster dose when the Hib vaccine shortage is over.
     
  • If the child is between 12 and 14 months of age and has not had any doses of Hib vaccine, schedule appointments for two doses, eight weeks apart.
     
  • If the child is between 12 and 14 months of age and has received Hib vaccine but did not complete the primary series before they turned 1-year-old (i.e., had 1 dose of the Merck product OR 1-2 doses of the sanofi product), schedule an appointment for 1 additional dose, a minimum of eight weeks from the last dose.
     
  • If the child is at least 15 months of age but less than 5 years of age and has not received any doses of Hib vaccine OR has not completed the primary series (i.e., had 1 dose of the Merck product OR 1-2 doses of the sanofi product), schedule an appointment for one dose.
     
  • If the child is 5 years old or older and hasn't received any Hib vaccine, Hib vaccine is not necessary.

Certain children are at increased risk for Hib disease, including children with asplenia, sickle cell disease, human immunodeficiency virus infection, and certain other immunodeficiency syndromes, and malignant neoplasms. CDC recommends that providers continue to vaccinate these children with available Hib conjugate vaccines according to the routinely recommended schedules, including the 12-through-15-month booster dose. Providers who serve predominantly American Indian/Alaska Native (AI/AN) children living in AI/AN communities should continue to stock and use PRP-OMP–containing Hib vaccines (Merck product) and vaccinate according to the routinely recommended schedule, which includes the 2-dose primary series (ages 2 and 4 months) and a 12-through-15-month booster dose. This product is available from the VFC Pediatric Vaccine Stockpile, through their state immunization programs.

For more information about Hib disease and vaccination, contact your state or local public health official or CDC at (800) 232-4636/(800) CDC-INFO or by email at http://www.cdc.gov/vaccines/about/contact/nipinfo_contact_form.htm Information about current vaccine shortages and delays can be found at http://www.cdc.gov/vaccines/vac-gen/shortages/default.htm

ADDITIONAL SOURCES OF INFORMATION
CDC. Invasive Haemophilus influenzae Type b Disease in Five Young Children--Minnesota, 2008. MMWR 2009;58:1-3.

CDC. Continued Shortage of Haemophilus influenzae Type b (Hib) Conjugate Vaccines and Potential Implications for Hib Surveillance--United States, 2008. MMWR 2008;57(46):1252-1255.

CDC. Interim Recommendations for the Use of Haemophilus influenzae Type b (Hib) Conjugate Vaccines Related to the Recall of Certain Lots of Hib-containing Vaccines (PedvaxHIB and Comvax). MMWR 2007; 56(50):1318-1320.

To access the CDC Health Advisory, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00281

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2 Pennsylvania Department of Health announces several recently reported Hib cases and strongly encourages clinicians to give the full primary series of Hib vaccine

On March 13, the Pennsylvania Department of Health issued a Health Advisory regarding recently reported Hib cases in Pennsylvania. Two paragraphs from the Health Advisory are reprinted below.


The Pennsylvania Department of Health (PADOH) is releasing the following information related to the occurrence of Haemophilus influenzae type b (Hib) cases in Pennsylvania.

In the last six months, the PADOH has received reports of Haemophilus influenzae type b (Hib) invasive disease in four unvaccinated or incompletely vaccinated children less than five years of age in southeastern Pennsylvania. Isolates from three additional cases of Haemophilus influenzae invasive disease, also in unvaccinated children less than five years old from southeastern Pennsylvania, have not yet been serotyped. Three of these seven children died. Clinicians are strongly encouraged to ensure that children have received the full primary series of Hib vaccinations. . . .

To access the complete PADOH Health Advisory, go to:
http://www.dsf.health.state.pa.us/health/cwp/view.asp?A=171&Q=252640

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3 ACIP releases provisional recommendations for the use of influenza vaccine in the 2009-10 influenza season

On March 20, ACIP updated its website with its provisional recommendations for the use of influenza vaccine in the 2009-10 influenza season. Provisional recommendations are those ACIP has voted on but that are not yet approved by CDC or the Department of Health and Human Services and have not yet been published in MMWR. The influenza provisional recommendations are reprinted below in their entirety.


Date of ACIP vote: February 25, 2009

Date of posting provisional recommendations: March 2009

Tentative date of publication of recommendations in CDC Morbidity and Mortality Weekly Report: June 2009

On February 25, 2009, the ACIP made policy recommendations for use of influenza vaccine for the 2009-2010 influenza season.

Provisional recommendations for prevention and control of influenza (2009-2010 influenza season):
  • The 2009-2010 trivalent influenza vaccines will contain A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane/60/2008-like antigens. Compared to the 2008-09 Northern Hemisphere influenza vaccines, only the B strain has changed.
     
  • Age and risk groups previously recommended for annual vaccination against influenza have not changed.
     
  • All children aged 6 months through 18 years are recommended to receive vaccination against influenza for the 2009-2010 influenza season.
     
  • In the United States, most influenza A(H1N1) viruses have been resistant to oseltamivir, and most influenza A(H3N2) viruses have been resistant to amantadine and rimantadine, during the 2008-09 influenza season. Consult CDC's Interim Recommendations for Use of Influenza Antiviral Medications in the Setting of Oseltamivir Resistance among Circulating Influenza A(H1N1) Viruses (available at http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00279) for guidance pending new ACIP recommendations for use of antiviral medications.
     
  • ACIP recommendations for use of antiviral medications for the 2009-10 influenza season will be provided in a separate MMWR document. Discussion regarding recommendations for use of antiviral medications will be held, and a vote may be taken, at the June 2009 ACIP meeting. Publication of antiviral recommendations will occur before the 2009-10 influenza season.

This document can be found on the CDC website

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4 CDC publishes information on the recommendations ACIP members voted on at the February 25-26 ACIP meeting

[The following is cross-posted from CDC's Immunization Works electronic newsletter, March 2009.]

FRONT PAGE NEWS

ACIP RECOMMENDS HEPATITIS A VACCINE FOR HOUSEHOLD CONTACTS OF INTERNATIONAL ADOPTEES: Due to the identification of recent cases of hepatitis A in family members, the Advisory Committee on Immunization Practices (ACIP) voted to recommend hepatitis A vaccine for all household contacts of international adoptees. Those potential household contacts that travel abroad should be vaccinated prior to departure; the remaining household contacts should ideally be vaccinated prior to the arrival of the adoptee. ACIP meets three times annually and provides recommendations to the Director of the CDC and the Secretary of HHS concerning the prevention of vaccine-preventable diseases in the United States. Below are other key votes from the February meeting:

ANTHRAX VACCINE
The ACIP voted to change its recommendations regarding the timing and route of administration for Anthrax vaccination. This vaccine is now recommended as 5 intramuscular doses at time 0, 4 weeks, 6 months, 12 months, and 18 months, with annual boosters thereafter.

INFLUENZA VACCINE
With the removal of the phrase "if feasible" from the previous recommendation, the ACIP now recommends influenza vaccine for all children 6 months through 18 years of age. The strains to be included in this year's vaccine are (A/Brisbane/59/2007 (H1N1)-like virus, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane/60/2008-like). The two "A" strains are unchanged from last year. The "B" strain represents a change in the lineage to the Victoria strain. Information on ocular and respiratory symptoms following TIV will be added to the safety section of this year's ACIP recommendations.

GENERAL RECOMMENDATIONS ON IMMUNIZATION
The ACIP voted to revise language in the General Recommendations on Immunization including a stated preference for stand-alone storage units (single refrigeration or single freezer units) over combination units.

Other topics discussed, but not voted on, include: a modified schedule for rabies vaccine, use of pneumococcal polysaccharide vaccine during an influenza pandemic, potential use of HPV vaccine among males, and the status of the global polio initiative. The next ACIP meeting will be held June 24-25 in Atlanta, GA.

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5 IAC's Video of the Week features a mother's story about her son's death from Hib disease

IAC encourages IAC Express readers to watch "Marijean's Story: Haemophilus influenzae type b," an eight-minute video that shows a mother recounting the illness and death of her toddler-age son from Hib disease at a time before Hib vaccine was available. The video is one of several videos in the series "Shot by Shot: Stories of vaccine-preventable diseases." Supported by the California Immunization Coalition, the series is a collection of video testimonies of people's personal experiences with VPDs. Its goal is to help illuminate and preserve the human experience of VPDs and create an ongoing, lasting database that can be used for the purposes of training, education, and awareness. Note: To view the clips, you may need to install Adobe Flash Player.

The video will be available on the home page of IAC's website through March 29. 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 view other videos in the "Shot by Shot" series, go to:
http://www.youtube.com/user/shotbyshotstories

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6 The most recent version of IAC's popular parent-education piece "When Do Children and Teens Need Vaccinations?" now available in Spanish and six additional languages

Updated in October 2008, "When Do Children and Teens Need Vaccinations?" is now available in Spanish, Arabic, Chinese, French, Korean, Russian, and Vietnamese.

To access the Spanish version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-01.pdf

To access the Arabic version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-20.pdf

To access the Chinese version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-08.pdf

To access the French version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-10.pdf

To access the Korean version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-09.pdf

To access the Russian version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-07.pdf

To access the Vietnamese version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050-05.pdf

To access the English version of "When Do Children and Teens Need Vaccinations?" go to:
http://www.immunize.org/catg.d/p4050.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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7 Influenza complications have killed 32 U.S. children during the current influenza season. It is vital to continue vaccinating through the spring months

During the week of March 8-14, CDC received reports of six more U.S. children killed by complications from influenza; the total of reported pediatric influenza deaths this influenza season now stands at 32. U.S. influenza activity decreased slightly in the week of March 8-14, with 30 states reporting widespread influenza activity, down from 35 reported during the week of March 1-7.

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; in some past influenza seasons, influenza has remained active into May. The supply of influenza vaccine is robust; if you run out of vaccine in your work setting, please place another order.

Many resources regarding influenza disease and vaccination are available to healthcare professionals and the public. Following is a list of some of them.

To access IAC's print piece titled "Don't take chances with your family's health--make sure you all get vaccinated against influenza every year!" go to:
http://www.immunize.org/catg.d/p4069.pdf

To access the National Influenza Vaccine Summit website, go to:
http://www.preventinfluenza.org

To access CDC's Seasonal Flu web section, go to:
http://www.cdc.gov/flu

Recently CDC's Seasonal Flu web section was updated with these eight resources:

Infectious Diseases Society of America's Diagnostic & Antiviral Guidelines at
http://www.journals.uchicago.edu/doi/full/10.1086/598513#h33

Podcast: Influenza Season Update at
http://www2a.cdc.gov/podcasts/player.asp?f=11007

Data & Statistics Feature: Influenza and Antivirals at
http://www.cdc.gov/features/dsFluView2009

Q&A: Seasonal Influenza-Associated Hospitalizations in the United States at http://www.cdc.gov/flu/about/qa/hospital.htm

Q&A: Questions and Answers Regarding Estimating Deaths from Influenza in the United States at
http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm

Podcast: Influenza Vaccination: What Your Patients Want to Know at http://www2a.cdc.gov/podcasts/player.asp?f=11042

Podcast: Influenza 2008-2009: ACIP Recommendations at
http://www2a.cdc.gov/podcasts/player.asp?f=11041

Podcast: Testing for Influenza: What It Can Tell Us at
http://www2a.cdc.gov/podcasts/player.asp?f=11040

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8 California Department of Public Health's "i choose" campaign validates and encourages the decision to immunize

[The following is cross posted from California Department of Public Health's "IZ Update" electronic newsletter, February 2009.]

"i choose" Campaign Launches

The Immunization Branch launched its "i choose" campaign in January 2009. The campaign is the first to utilize the pictures and voices of local advocates to promote immunization. The i choose theme allows individuals from all walks of life to validate and encourage the decision to immunize. It also reflects the choice to vaccinate as a social norm.

The i choose materials can be delivered through a variety of media such as outdoor advertising, print, television, radio, and the Internet.

The campaign website http://www.whyichoose.org offers a suite of posters available for download. The i choose gallery features pictures of people from around the state (and other states) who have taken a stand on the importance of immunizations. The site also incorporates interactive elements including user-generated content. Community members can upload their picture and statement explaining why they choose immunization. A downloadable poster template is provided. The template is customizable for any age group, ethnicity, or population and audience, including healthcare settings. In addition, the site offers trusted information resources for anyone inquiring about vaccine safety.

The i choose campaign was developed by the CDPH Immunization Branch in partnership with the California Immunization Coalition (CIC). To learn more about the campaign, or how to implement it in a local community, visit http://www.whyichoose.org or contact Edgar.Ednacot@cdph.ca.gov

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9 FDA alert: Healthcare professionals can lower the risk of transmitting hepatitis and HIV viruses by never sharing insulin pens and cartridges among patients

On March 19, FDA issued a press release reminding healthcare professionals that insulin pens and cartridges must not be shared. It is reprinted below in its entirety.


FDA: Insulin Pens and Insulin Cartridges Must Not Be Shared

The U.S. Food and Drug Administration today issued an alert to healthcare professionals reminding them that single-patient insulin pens and insulin cartridges should not be used to administer medication to multiple patients due to the potential risk of transmitting blood-borne pathogens such as HIV and the hepatitis viruses.

Insulin pens are pen-shaped injector devices that contain a disposable needle and either an insulin reservoir or an insulin cartridge. The devices typically contain enough insulin for a patient to self-administer several doses of insulin before the reservoir or cartridge is empty. All insulin pens are approved only for single-patient use (one device for only one patient).

The FDA is aware of incidents at two undisclosed hospitals involving more than 2,000 people in which the cartridge component of the insulin pens were used to administer insulin to multiple patients, although the disposable needles were reportedly changed among patients.

"Insulin pens are designed to be safe for one patient to use one pen multiple times with a new, fresh needle for each injection," said Amy Egan, MD, deputy director of safety at the FDA's Division of Metabolism and Endocrinology Products in the Center for Drug Evaluation and Research. "Insulin pens are not designed, and are not safe, for one pen to be used by more than one patient, even if needles are changed between patients due to the risk of transmitting blood-borne pathogens."

Patients exposed to shared insulin pens are being contacted by the two hospitals and are being offered testing for hepatitis and HIV. Some of the potentially exposed patients have reportedly tested positive for the hepatitis C virus, although it is not known if the virus was spread as a result of insulin pen sharing.

The FDA is working with the Centers for Disease Control and Prevention and professional organizations to address infection control issues related to insulin pens.

For Information:

Information for Healthcare Professionals: Risk of Transmission of Blood-borne Pathogens from Shared Use of Insulin Pens
http://www.fda.gov/cder/drug/InfoSheets/HCP/insulin_pensHCP.htm

To access the press release, go to:
http://www.fda.gov/bbs/topics/NEWS/2009/NEW01976.html

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10.  FDA selects influenza virus strains for the 2009-10 influenza vaccine

The FDA recently posted the following information on its website.


FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met in Silver Spring, Maryland, on February 18, 2009, to select the influenza virus strains for the composition of the influenza vaccine for use in the 2009-2010 U.S. influenza season. During this meeting, the advisory panel reviewed and evaluated the surveillance data related to epidemiology and antigenic characteristics, serological responses to 2008/2009 vaccines, and the availability of candidate strains and reagents.

The panel recommended that vaccines to be used in the 2009-2010 influenza season in the U.S. contain the following:
  • an A/Brisbane/59/2007 (H1N1)-like virus; [see Note 1 below]
  • an A/Brisbane/10/2007 (H3N2)-like virus; [see Note 2 below]
  • a B/Brisbane/60/2008-like virus.

Note 1: A/Brisbane/59/2007 is a current vaccine virus; A/South Dakota/6/2007 (an A/Brisbane/59/2007-like virus) is a current vaccine virus used in live attenuated vaccines.

Note 2: A/Brisbane/10/2007 and A/Uruguay/716/2007 (an A/Brisbane/10/2007-like virus) are current vaccine viruses.

The influenza vaccine composition to be used in the 2009-2010 influenza season in the U.S. is identical to that recommended by the World Health Organization on February 12, 2009, for the Northern Hemisphere's 2009-2010 influenza season.

To access the information from the FDA website, go to:
http://www.fda.gov/cber/flu/flu2009.htm

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11.  March issue of CDC's Immunization Works electronic newsletter recently released

CDC recently released the March 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.

Some of the information in the March issue has already appeared in this or previous issues of IAC Express. Following is the text of some articles we have not covered.


ADOLESCENT VACCINATION RECOMMENDATIONS UPDATE: In 2006, the Assistant Secretary for HHS asked the National Vaccine Advisory Committee (NVAC) to assess issues and make recommendations for developing a comprehensive and successful adolescent immunization program in the U.S. Years of research have culminated in the publication of a report, entitled Adolescent Vaccination, Recommendations from the National Vaccine Advisory Committee, which appears in the March 2009 issue of the American Journal of Preventive Medicine and details recommendations for five key areas: venues for vaccine administration, consent for immunizations, communication, surveillance, and the potential for school mandates.


SURVEY OF HIB CARRIAGE IN MINNESOTA: Concerned that the increase in invasive Hib disease may be the result of increased Hib circulation among children in Minnesota, the Minnesota Department of Health (MDH) is conducting a survey of Hib carriage. "Carriage" occurs when bacteria live in the nose and throat without causing illness. Vaccine reduces not only Hib disease among children, but also Hib carriage. The MDH survey aims to estimate the current proportion of Hib carriage among children less than five years-old in Minnesota. Using roughly a dozen pediatric clinics across the state, MDH staff are enrolling approximately 2,000 children in the study when they come to these clinics for well or sick child visits. In addition to obtaining a throat swab of the child and reviewing the child's immunization records, the child's caregiver will be asked to complete a brief questionnaire. MDH is hopeful that this evaluation will help them understand reasons why some children are not vaccinated. While the Hib vaccine shortage continues, completion of the primary series in all children is essential to safeguarding individual protection as well as to strengthening herd immunity. Visit CDC's Hib Resource Webpage  for the latest tools and information.


SAVE THE DATE: GET SMART ABOUT ANTIBIOTICS WEEK: Mark your calendars for "Get Smart about Antibiotics Week", October 5th-11th, 2009. For more information, please contact Darcia Johnson at clq7@cdc.gov or visit the "Get Smart" web page (http://www.cdc.gov/drugresistance/community).


APPROPRIATE ANTIBIOTIC PRESCRIBING TRAINING: CDC is offering a free, interactive case-based online learning experience for clinicians, Improving Appropriate Antibiotic Prescribing for Acute Respiratory Infections (http://www.getsmartcolorado.com/08course.htm). Participants can choose to take the course for credit (CME, CNE, or AAFP).

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

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12.  Attention healthcare professionals: Free CE credits are available at the National Immunization Conference

[The following is cross-posted from CDC's Immunization Works electronic newsletter, March 2009.]

HOW YOU CAN GET FAST AND FREE CE AT NIC: Did you know that free Continuing Education credits will be offered at The National Immunization Conference (NIC) in Dallas? Come to the CE Room/Cyber Cafe at the conference for more information. And here's a tip: You can avoid the Number One Headache for CE seekers: Come to the conference with your password and login in hand! Go online beforehand if you need a password reset: www.cdc.gov/tceonline Contact sfarrall@cdc.gov if you have questions. NIC will be held March 30–April 2, 2009, at the Sheraton Dallas. The draft NIC agenda is now posted (http://cdc.confex.com/cdc/nic2009/webprogram/meeting.html).

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13.  Inactivated influenza vaccine VIS now available in the Karen language

The current version of the VIS for trivalent inactivated influenza vaccine (TIV; injectable), dated 7/24/08, is now available in the Karen language, which is spoken in Myanmar. IAC was informed that the previous Karen-language translation of the VIS for TIV contained an error. IAC gratefully acknowledges the Minnesota Department of Health for making the corrected translation available.

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

To access the English version of the VIS for TIV, go to:
http://www.immunize.org/vis/2flu.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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14.  California Immunization Coalition's 2009 Summit is planned for April 20-21 in Pasadena

"Strengthening Trust in Vaccines" is the theme of the California Immunization Coalition's 2009 Summit. It will be held in Pasadena on April 20-21. Featured speakers include Paul A. Offit, MD, chief, Infectious Diseases, Children's Hospital in Philadelphia and professor of pediatrics at University of Pennsylvania School of Medicine; and Litjen (L.J.) Tan, PhD, director, Medicine and Public Health, American Medical Association.

For comprehensive information, go to:
http://immunizeca.org//index.pacq

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15.  North Dakota Vaccination Expedition 2009 scheduled for May 28-29 in Grand Forks

Sponsored by the Grand Forks Public Health Department and Greater Grand Forks Immunization Coalition, North Dakota Vaccination Expedition 2009 will be held in Grand Forks on May 28-29. Speakers include CDC's William L. Atkinson, MD, MPH, medical epidemiologist, NCIRD; and Gary S. Marshall, MD, professor of pediatrics, University of Louisville School of Medicine.

For comprehensive information, go to:
http://www.grandforksgov.com/gfgov/health.nsf/pages/immunizations

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16.  Attention: March 31 is the deadline for early bird registration for the May 14 Points Across VI conference

Scheduled for May 14 in Baltimore, the Points Across VI conference will present information on professional development and self-care for health promotion professionals. The deadline for early bird registration in March 31.

To download information about the conference, including registration information, go to: http://www.edcp.org/pdf/2009_Points_Across_VI_Brochure.pdf

For additional information, email info@immunizemaryland.org or call (410) 902-4677.

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17.  GAO publishes the findings of its study on sustaining U.S. efforts to plan and prepare for an influenza pandemic

In February, the Government Accountability Office (GAO) published the findings of its study on preparing for, responding to, and recovering from a possible influenza pandemic. Titled "Sustaining Focus on the Nation's Planning and Preparedness Efforts," the report is available for downloading.

To access the document, go to:
http://www.gao.gov/products/GAO-09-334

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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.