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IAC Express 2009
Issue number 791: April 20, 2009

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Contents of this Issue Select a title to jump to the article.
MMWR publishes article on FDA's December 2008 approval of expanded age indication for use of Tdap vaccine CDC's "Guide to Vaccine Contraindications and Precautions" available for downloading IAC's laminated versions of the 2009 child/teen and adult immunization schedules offer significant advantages over paper versions. Place your order today and use them throughout 2009! IAC's Video of the Week features former First Lady Rosalynn Carter's public service announcement about childhood immunization AAP's 2009 Red Book will be available in four formats in July; order by June 1 to save up to $40 Reminder: AAP makes its audiocast training course on countering vaccine misinformation available at no cost through April 30 May 13 is the deadline for public comment on the draft report of NVAC's Vaccine Safety Working Group May 8 is the deadline for public comment on proposed vaccination criteria for U.S. immigration CDC reports on U.S. influenza activity from September 28, 2008 to April 4, 2009, and on composition of 2009-10 influenza vaccine Celebrity spokespeople Gwyneth Paltrow and Hugh Laurie announce that November 2 is World Pneumonia Day MMWR publishes report on importations of wild poliovirus in 15 African countries in 2008-09 FDA approves rapid test for detecting avian influenza A virus in humans Conferences on novel vaccines scheduled for August 17-18 and August 18-19 in Providence, RI

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 791: April 20, 2009

MMWR publishes article on FDA's December 2008 approval of expanded age indication for use of Tdap vaccine

CDC published "FDA Approval of Expanded Age Indication for a Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine" in the April 17 issue of MMWR. A portion of the article is reprinted below.

On December 4, 2008, the Food and Drug Administration (FDA) approved an expanded age indication for the tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) Boostrix (GlaxoSmithKline Biologicals, Rixensart, Belgium). Boostrix is now licensed for use in persons aged 10-64 years as a single-dose booster immunization; the vaccine initially was licensed for persons aged 10-18 years. This announcement summarizes the indications for use of Boostrix. Complete recommendations of the Advisory Committee on Immunization Practices (ACIP) for Tdap vaccines have been described previously.

On October 23, 2008, ACIP was presented data on the safety and immunogenicity of Boostrix in adults aged 19-64 years and notified of the impending expanded age indication for Boostrix. Guidance for the use of Boostrix is the same as for Adacel (sanofi pasteur, Toronto, Canada), another Tdap vaccine licensed for use in adults. . . .

Indications and Guidance for Use
For prevention of tetanus, diphtheria, and pertussis, adolescents and adults are recommended to receive a one-time booster dose of Tdap. Adolescents aged 11-18 years who have completed the recommended childhood diphtheria and tetanus toxoids and pertussis vaccine (DTP)/DTaP vaccination series should receive a single dose of Tdap instead of tetanus and diphtheria toxoids (Td) vaccine, preferably at a preventive care visit at age 11 or 12 years. For adults aged 19-64 years who previously have not received a dose of Tdap, a single dose of Tdap should replace a single decennial Td booster dose.

Boostrix is now indicated for use as a single-dose booster immunization in persons aged 10-64 years. The recommended interval between 2 doses of Td-containing vaccines in adolescents and adults is at least 5 years because of concern over increased reactogenicity; however, data are available suggesting that intervals as short as approximately 2 years are safe. An interval <5 years between Td and Tdap may be used if increased risk for acquiring pertussis (e.g., during outbreaks or periods of increased pertussis activity in the community, or among healthcare workers) exists. The safety and effectiveness of Tdap have not been established in pregnant women, nursing mothers, and children aged <10 years. Current doses in stock can be used for persons aged 10-64 years.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5814.pdf

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

CDC's "Guide to Vaccine Contraindications and Precautions" available for downloading

In April, CDC posted "Guide to Vaccine Contraindications and Precautions" on the NCIRD website. The 32-page guide summarizes CDC's recommendations regarding common symptoms and conditions that do and do not contraindicate administering vaccines licensed for use in the United States.

It includes these six appendices:

Appendix A: Summary of Contents of Vaccines Licensed in the United States
Appendix B: Latex in Vaccine Packaging
Appendix C: Reactions after a Previous Dose of Diphtheria-, Tetanus-, or Pertussis-Containing Vaccine
Appendix D: Suggested Intervals Between Administration of Immune Globulin Preparations and Measles- or Varicella- Containing Vaccine
Appendix E: Vaccinia (Smallpox) Vaccine (Routine, Non- Emergency Use)
Appendix F: Quick Reference--Contraindications and Precautions to Routine Childhood and Adolescent Vaccinations, by Vaccine

To access the guide, go to:
http://www.cdc.gov/vaccines/recs/vac-admin/contraindications.htm

IAC's laminated versions of the 2009 child/teen and adult immunization schedules offer significant advantages over paper versions. Place your order today and use them throughout 2009!

IAC's 2009 laminated immunization schedules are a must for every immunization setting: from conventional health clinics and private practices to walk-in shot clinics in workplaces, pharmacies, schools, and other sites. IAC offers the laminated schedules for two age groups. The child/teen immunization schedule is for people ages 0 through 18 years; the adult schedule is for those older than 18. Though both are adapted from the immunization schedules that were posted on the CDC website in January, the laminated schedules offer these advantages over downloadable paper versions:

Coated in thick plastic, the laminated schedules are washable and will hold up to a year's worth of use as teaching tools that providers in any immunization setting can use to give patients and parents authoritative information about the vaccines recommended for various age groups. You can also use them as a handy reference to consult at a moment's notice.
For the second year in a row, IAC has added a significant feature to the two laminated schedules. Each includes a guide to contraindications and precautions for the pertinent age group (i.e., the child/teen schedule has a guide to contraindications and precautions for child/teen vaccines, and the adult schedule has a guide for adult vaccines). Healthcare professionals will find these guides extremely valuable in making an on-the-spot determination about vaccinating any patient they see in any immunization setting.

The durable laminated schedules come complete with essential footnotes and are printed in color for easy reading. Each schedule has six pages (i.e., three double-sided pages), and when folded, measures 8.5" x 11".

For specific information about the child/teen schedule, to view images of it, or to order online or download an order form, visit http://www.immunize.org/shop/schedule_child.asp

For specific information about the adult schedule, to view images of it, or to order online or download an order form, visit http://www.immunize.org/shop/schedule_adult.asp

Prices start at $10 each for 1-4 copies and drop to $6.50 each for 5-19 copies. Discount pricing is available for 20 or more copies. For quotes on customizing or placing orders in excess of 999 schedules, call (651) 647-9009 or email admininfo@immunize.org

To learn about other essential immunization resources available for purchase from IAC, go to: http://www.immunize.org/shop

IAC's Video of the Week features former First Lady Rosalynn Carter's public service announcement about childhood immunization

IAC encourages IAC Express readers to take 30 seconds to view an excellent public service announcement developed by Every Child By Two (ECBT). The narrator is former First Lady Rosalynn Carter, a cofounder of ECBT. Note: To view the video, you may need to install Adobe Flash Player.

The video will be available on the home page of IAC's website through April 26. 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

AAP's 2009 Red Book will be available in four formats in July; order by June 1 to save up to $40

Slated for July publication, The American Academy of Pediatrics' "Red Book: 2009 Report of the Committee on Infectious Diseases" is now available for pre-ordering. The 2009 publication, the book's 28th edition, offers readers the latest clinically tested guidelines on the manifestations, etiology, epidemiology, diagnosis, and treatment of 200 childhood conditions. It was developed by the AAP Committee on Infectious Diseases, in conjunction with the CDC, FDA, and other leading institutions, and with contributions from hundreds of physicians nationwide.

The 2009 Red Book is available in four formats:

Red Book print (softbound)
Red Book online
Red Book Plus (print and online)
Red Book mobile/PDA

Order any of the formats by June 1 and receive a $5 discount on each. To order, go to: http://www.aap.org/bookstore and click on "Red Book/Infectious Diseases" in the left column under the heading Professional Resources.

Additional savings are available by ordering certain combinations of formats:

Save $40 when you order this combination by June 1: Red Book Plus and Red Book mobile/PDA (item #MA0505).
Save $15 when you order this combination by June 1: Red Book print and Red Book mobile/PDA (item #MA0503).

To order either combination, go to http://www.aap.org/bookstore and type the item number in the space in the left column under the heading Search the AAP Bookstore.

Reminder: AAP makes its audiocast training course on countering vaccine misinformation available at no cost through April 30

[The following is cross posted from "Got Your Shots? News," the Minnesota Department of Health's electronic immunization newsletter, March 2009.]

"Countering Vaccine Misinformation"--This new audiocast training program by the American Academy of Pediatrics is part of a monthly series offered free of charge through April 30, 2009, at http://www.prepaudio.org/default.aspx?id=16

May 13 is the deadline for public comment on the draft report of NVAC's Vaccine Safety Working Group

The web section of National Vaccine Advisory Committee (NVAC) recently posted the following information about the opportunity for public comment on the draft report of its Vaccine Safety Working Group:

"The NVAC Vaccine Safety Working Group is seeking public comment on their draft report on the draft ISO Scientific Agenda. An opportunity to submit written comments is now available. You can view the Federal Register notice requesting comments from the public. In addition to general comments, NVPO is seeking input on any additional gaps not addressed in the ISO Scientific Agenda [or] the NVAC Vaccine Safety Working Group draft report . . . ."

To access the NVAC Vaccine Safety Working Group Draft Report (4/14/09), click here.

For additional information on public input into the ISO Scientific Agenda, go to:
http://www.hhs.gov/nvpo/nvac/PublicEngagement.html

The deadline for written public comment is May 13. The notice in the Federal Register contains information on submitting comment electronically and by mail. To access the notice, go to:
http://edocket.access.gpo.gov/2009/E9-8399.htm

May 8 is the deadline for public comment on proposed vaccination criteria for U.S. immigration

On April 8, HHS and CDC posted a Federal Register notice on proposed vaccination criteria for U.S. immigration. The deadline for public comment is May 8.

For a fact sheet that outlines the current and proposed vaccination requirements for U.S. immigration, go to: http://www.cdc.gov/ncidod/dq/pdf/vaccine-criteria-fact-sheet.pdf

To access a web page of background information titled "Notice of Proposed Vaccination Criteria for U.S. Immigration," go to: http://www.cdc.gov/ncidod/dq/refugee

The notice in the Federal Register contains background information on the topic, as well as information on submitting comment electronically and by mail. To access the notice, go to: http://edocket.access.gpo.gov/2009/E9-7934.htm

CDC reports on U.S. influenza activity from September 28, 2008 to April 4, 2009, and on composition of 2009-10 influenza vaccine

CDC published "Update: Influenza Activity--United States, September 28, 2008-April 4, 2009, and Composition of the 2009-10 Influenza Vaccine" in the April 17 issue of MMWR. Portions of the article are reprinted below.

This report summarizes U.S. influenza activity from September 28, 2008, the start of the 2008-09 influenza season, through April 4, 2009, and reports on the 2009-10 influenza vaccine strain selection. Low levels of influenza activity were reported from October through early January. Activity increased from mid-January and peaked in mid-February. Influenza A (H1N1) viruses have predominated overall this season, but influenza B viruses have been isolated more frequently than influenza A viruses since mid-March. Widespread oseltamivir resistance was detected among circulating influenza A (H1N1) viruses and a high level of adamantane resistance was identified among influenza A (H3N2) viruses. . . .

Composition of the 2009-10 Influenza Vaccine
WHO recommended that the 2009-10 Northern Hemisphere trivalent influenza vaccine contain A/Brisbane/59/2007-like (H1N1), A/Brisbane/10/2007-like (H3N2), and B/Brisbane/60/2008-like (B/Victoria lineage) viruses. The Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee recommended these same vaccine strains be included in the 2009-10 influenza vaccine for the United States. Only the influenza B component represents a change from the 2008-09 vaccine formulation. These recommendations were based on antigenic and genetic analyses of recently isolated influenza viruses, epidemiologic data, post-vaccination serologic studies in humans, and the availability of candidate vaccine strains and reagents. . . .

Pneumonia- and Influenza-Related Mortality
For the week ending April 4, 2009, pneumonia and influenza was reported as an underlying or contributing cause of death for 7.4% of all deaths reported through the 122 Cities Mortality Reporting System. This is below the epidemic threshold of 7.8% for that week. Since September 28, 2008, the weekly percentage of deaths attributed to pneumonia and influenza ranged from 6.1% to 7.6%, and remained below the epidemic threshold. . . .

Influenza-Associated Pediatric Mortality
Since September 28, 2008, CDC has received 45 reports of influenza-associated pediatric deaths that occurred during the current season. Of the 27 decedents who had specimens collected for bacterial culture from normally sterile sites, 12 (44.4%) were positive; Staphylococcus aureus was identified in eight of the 12 children. Three of the S. aureus isolates were sensitive to methicillin, and five were methicillin resistant. Among the 12 children with bacterial coinfections, all were aged >=5 years, and 10 (83.3%) were aged >=12 years. An increase in the number of influenza-associated pediatric deaths with S. aureus coinfections was first recognized during the 2006-07 influenza season.

Of the 36 decedents aged >6 months for whom patient vaccination status was known, five (13.9%) had been vaccinated against influenza according to 2008 Advisory Committee on Immunization Practices recommendations. These data are provisional and subject to change as more information becomes available. . . .

Vaccination remains the best method for preventing influenza virus infection and its complications. Influenza vaccination can prevent influenza infections from strains that are sensitive or resistant to antiviral medications. Thus far this season, all the influenza A viruses that have been characterized, including oseltamivir-resistant (H1N1) viruses, are antigenically related to the components in the vaccine. However, approximately 80% of influenza B viruses tested are from a distinct lineage that is not related to the vaccine strain. Limited or no protection is expected when the vaccine and circulating virus strains are from different lineages. The composition of the 2009-10 influenza vaccine includes the same influenza A (H1N1 and H3N2) components, and a change in the influenza B component from the Yamagata to the Victoria lineage. . . .

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5814.pdf

10.

Celebrity spokespeople Gwyneth Paltrow and Hugh Laurie announce that November 2 is World Pneumonia Day

On April 7, the GAVI Alliance posted the following press release on its website: "Child Health Leaders Call for Day to Unite against Pneumonia, World's Top Child Killer: Pneumonia is world's most neglected disease, kills more than 2 million children annually." Portions of the press release are reprinted below. IAC Express editor's note: Information on World Pneumonia Day is given at the end of this IAC Express article.

Child health groups united with Save the Children Artist Ambassadors Gwyneth Paltrow and Hugh Laurie today to establish an annual World Pneumonia Day on November 2, 2009.

The day will mobilize efforts to fight a neglected disease that kills more than two million children under the age of five each year worldwide. . . .

Preventing pneumonia is critical to reducing deaths. Research shows that a package of health measures provided globally, especially to the poorest communities, could dramatically cut childhood deaths from pneumonia.

Vaccines against two of pneumonia's common bacterial causes, Hib (Haemophilus influenzae type B) and pneumococcus, have prevented many deaths in industrialized countries. The GAVI Alliance, an international partnership devoted to improving child health, has helped low-income countries introduce Hib and pneumococcal vaccines within their public vaccination programs.

Other proven, low-cost techniques include exclusive breast feeding for six months, ensuring good nutrition, reducing indoor air pollution, using antibiotics, washing hands, and preventing mother-to-child transmission of HIV. . . .

To access the complete press release, click here.

Information on World Pneumonia Day
Goals of World Pneumonia Day are to increase awareness of pneumonia's death toll and encourage policy-makers and grass roots organizers to combat the disease with vaccines, early diagnosis, and use of antibiotics. These are the organizations spearheading the effort: GAVI Alliance, Save the Children, PneumoADIP at the Johns Hopkins Bloomberg School of Public Health, and Hedge Funds vs. Malaria & Pneumonia.

For additional information, go to:
http://www.worldpneumoniaday.org

11.

MMWR publishes report on importations of wild poliovirus in 15 African countries in 2008-09

CDC published "Wild Poliovirus Type 1 and 3 Importations--15 Countries, Africa, 2008-09" in the April 17 issue of MMWR. A summary made available to the press is reprinted below in its entirety.

Until the challenges in countries with ongoing wild poliovirus transmission have been fully addressed, the risk of wild poliovirus (WPV) importations will continue. Although countries that border countries with ongoing WPV transmission are at higher risk, all polio-free countries need to maintain sensitive surveillance systems and prepare for rapid response campaigns.

From 2007 to 2008, cases of polio in Africa increased 144 percent, from 387 in 2007 to 946 in 2008, primarily because of a resurgence of cases in Nigeria as well as an increase in Angola, Chad, and Sudan and the introduction of WPV from these countries into neighboring countries. These importations of WPV have resulted in 96 polio cases in 15 countries in West Central Africa, the Horn of Africa, and South Central Africa in 2008-2009 as of March 24. The majority of these cases were caused by importations of WPV originating in Nigeria; the remaining importations were from WPV originating in India, and were introduced either directly or after persistent transmission in another country. The four African countries from which multiple importations have spread--Angola, Chad, Nigeria, Sudan--have serious weaknesses in health infrastructure and require specific efforts to strengthen their fight again WPV circulation. Until polio eradication is reached, other countries need to have sensitive surveillance and plans to rapidly respond if imported WPV is found.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5814.pdf

12.

FDA approves rapid test for detecting avian influenza A virus in humans

On April 7, FDA issued a press release titled "FDA Clears Rapid Test for Avian Influenza A Virus in Humans." Portions of the press release are reprinted below.

The U.S. Food and Drug Administration today cleared for marketing a new, more rapid test for the detection of influenza A/H5N1, a disease-causing subtype of the avian influenza A virus that can infect humans.

The test, called AVantage A/H5N1 Flu Test, detects influenza A/H5N1 in throat or nose swabs collected from patients who have flu-like symptoms. The test identifies in less than 40 minutes a specific protein (NS1) that indicates the presence of the influenza A/H5N1 virus subtype. Previous tests cleared by the FDA to detect this influenza A virus subtype can take three or four hours to produce results. . . .

AVantage A/H5N1 Flu Test is manufactured by Arbor Vita Corporation, located in Sunnyvale, Calif.

To access the press release, go to:
http://www.fda.gov/bbs/topics/NEWS/2009/NEW01987.html

13.

Conferences on novel vaccines scheduled for August 17-18 and August 18-19 in Providence, RI

Two conferences on novel vaccines will be held in August in Providence, RI. Novel Vaccines: Design & Development is planned for August 17-18 and Novel Vaccines: Adjuvants & Delivery Systems for August 18-19.

To access the Novel Vaccines: Design & Development website, go to:
http://www.healthtech.com/vac.aspx

To access the Novel Vaccines: Adjuvants & Delivery Systems website, go to: http://www.healthtech.com/imt/adj

For a conference brochure, click here.

For online registration, go to:
https://chidb.com/register/2009/imt/reg.asp

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