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Immunization Action Coalition
IAC Express 2009
Issue number 792: April 27, 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 reports on swine influenza investigation and gives interim recommendations; many continually updated resources available for healthcare professionals and the public
  2. CDC releases new VIS for pneumococcal polysaccharide vaccine
  3. National Vaccine Advisory Committee's recommendations on vaccine financing now available online
  4. Confirmed measles cases reported in Iowa, Maryland, Pennsylvania, Virginia, and Washington, DC
  5. Spread the word about the importance of childhood immunization during National Infant Immunization Week--April 25-May 2
  6. IAC's Video of the Week features CDC's Dr. Jeanne Santoli answering moms' tough questions about immunization
  7. CDC website posts Q&A for providers about Hib vaccine supply and Hib vaccination coverage
  8. VIS translation: Interim VIS for pneumococcal conjugate vaccine now available in Turkish
 
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 792: April 27, 2009
1.  CDC reports on swine influenza investigation and gives interim recommendations; many continually updated resources available for healthcare professionals and the public

 On April 25, CDC issued an official Health Advisory titled "Investigation and Interim Recommendations: Swine Influenza (H1N1)." It is reprinted below in its entirety. The investigation is ongoing, and many continually updated resources are available from CDC, WHO, and others. To access an overview of resources on this fast-moving situation, browse through the CDC's Swine Influenza (Flu) web section at http://www.cdc.gov/swineflu For a listing of useful links to specific information, see the end of this IAC Express article.


CDC, in collaboration with public health officials in California and Texas, is investigating cases of febrile respiratory illness caused by swine influenza (H1N1) viruses. As of 11 AM (EDT) April 25, 2009, 8 laboratory confirmed cases of Swine Influenza infection have been confirmed in the United States. Four cases have been reported in San Diego County, California. Two cases have been reported in Imperial County California. Two cases have been reported in Guadalupe County, Texas. Of the 8 persons with available data, illness onsets occurred March 28-April 14, 2009. Age range was 7-54 y.o. Cases are 63% male.

The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses.

CDC has also been working closely with public health officials in Mexico, Canada, and the World Health Organization (WHO). Mexican public health authorities have reported increased levels of respiratory disease, including reports of severe pneumonia cases and deaths, in recent weeks. CDC is assisting public health authorities in Mexico by testing specimens and providing epidemiological support. As of 11:00 AM (EDT) April 25, 2009, 7 specimens from Mexico at CDC have tested positive for the same strain of swine influenza A (H1N1) as identified in U.S. cases. However, no clear data are available to assess the link between the increased disease reports in Mexico and the confirmation of swine influenza in a small number of specimens. WHO is monitoring international cases. Further information on international cases may be found at:
http://www.who.int/csr/don/2009_04_24/en

Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who (1) live in San Diego or Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or (2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the 7 days preceding their illness onset.

Patients who meet these criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory. CDC requests that state public health laboratories promptly send all influenza A specimens that cannot be subtyped to the CDC, Influenza Division, Virus Surveillance and Diagnostics Branch Laboratory.

Persons with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness.

CDC has not recommended that people avoid travel to affected areas at this time. [Editor's Note: During an April 27 press conference, CDC announced it would be releasing a new travel advisory for Mexico, recommending that non-essential travel to Mexico be avoided, and offering steps people can take to avoid  infection if they need to travel to Mexico during this time. For developing information on this topic, go to http://www.cdc.gov/swineflu] Recommendations found at http://wwwn.cdc.gov/travel/contentSwineFluUS.aspx will help travelers reduce risk of infection and stay healthy.

Clinical guidance on laboratory safety, case definitions, infection control, and information for the public are available at: http://www.cdc.gov/swineflu/investigation.htm

Morbidity and Mortality Weekly Reports Dispatch (April 24) provide detailed information about the initial cases at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58d0424a1.htm

For more information about swine flu:
http://www.cdc.gov/swineflu

Additional information is also available by calling (800) CDC-INFO [(800) 232-4636]


To access the 4/25/09 Health Advisory, go to:
http://www.cdc.gov/swineflu/pdf/HAN_042509.pdf

To access CDC's Swine Influenza web section, go to:
http://www.cdc.gov/swineflu

To access a page of listings of online resources for healthcare professionals and the public titled What's New on the Swine Flu Site, go to: http://www.cdc.gov/swineflu/whatsnew.htm

To access a page of information and links titled Guidance for Clinicians & Public Health Professionals, go to:
http://www.cdc.gov/swineflu/guidance

To access links on CDC's Reports & Publications page, go to:
http://www.cdc.gov/swineflu/pubs

To access CDC Press Briefing Transcripts page, go to:
http://www.cdc.gov/swineflu/press

To access a page of general information for the public titled Questions & Answers: Swine Influenza and You, go to: http://www.cdc.gov/swineflu/swineflu_you.htm

To access a page of more in-depth information for the public titled Questions & Answers: Key Facts about Swine Influenza (Swine Flu), go to: http://www.cdc.gov/swineflu/key_facts.htm

To access a page of information for the Spanish-speaking public titled Datos importantes sobre la influenza porcina (gripe porcina), go to:
http://www.cdc.gov/swineflu/espanol/swine_espanol.htm

To access a two-page brochure for the public titled Swine Influenza in Pigs and People, go to:
http://www.cdc.gov/swineflu/pdf/brochure.pdf

To access information from the American Academy of Pediatrics about swine flu, go to:
http://www.aap.org/advocacy/releases/may09swineflu.htm

For international information from the WHO web page titled Disease Outbreak News, go to: http://www.who.int/csr/don/en

To access a WHO press release titled Swine Flu Illness in the United States and Mexico--Update 2 (dated 4/26/09), go to: http://www.who.int/csr/don/2009_04_26/en

To access a press release issued by HHS titled HHS Declares Public Health Emergency for Swine Flu, go to:
http://www.hhs.gov/news/press/2009pres/04/20090426a.html

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2 CDC releases new VIS for pneumococcal polysaccharide vaccine

On April 16, CDC issued a VIS for pneumococcal polysaccharide vaccine (PPSV); it replaces the VIS for PPSV dated 7/29/97. The PPSV VIS was updated mainly to reflect new indications for smokers and adults with asthma, but also to provide a general formatting facelift.

To access the 4/16/09 VIS for PPSV, go to:
http://www.immunize.org/vis/pneum3.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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3 National Vaccine Advisory Committee's recommendations on vaccine financing now available online

CDC published "Notice to Readers: National Vaccine Advisory Committee Recommendations on Vaccine Financing" in the April 24 issue of MMWR. The first paragraph of the notice is reprinted below.


In September 2008, the National Vaccine Advisory Committee (NVAC), a federal advisory group, approved a series of recommendations to improve vaccine financing systems in the United States. These 24 recommendations, the final product of 2 years of work, were developed with broad input and consensus from stakeholders, including healthcare providers, consumers, insurers, vaccine manufacturers, state and local public health authorities, and state and local government and Medicaid agencies. . .


The final report is titled "Assuring Vaccination of Children and Adolescents without Financial Barriers: Recommendations from the National Vaccine Advisory Committee (NVAC) U.S. Department of Health and Human Services" and is available at http://www.hhs.gov/nvpo/nvac/NVACVFWGReport.pdf

For a complete listing of NVAC reports and recommendations, go to: http://www.hhs.gov/nvpo/nvac/reports.html

To access a web-text (HTML) version of the MMWR notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5815a8.htm

 

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4 Confirmed measles cases reported in Iowa, Maryland, Pennsylvania, Virginia, and Washington, DC

On April 21, the Center for Infectious Diseases Research & Policy (CIDRAP) at the University of Minnesota issued a press release titled "States Sound Alarms over Measles Cases." Portions of the press release are reprinted below.


Health officials in the Washington, DC, area today said they were working to identify people who may have been exposed to a patient with measles, as officials in other states, including Virginia, Iowa, and Pennsylvania, were responding to three other recent measles exposures. . . .

Virginia's health department announced in a press release today that it had confirmed its first measles case of the year, in a Prince William county resident with no known link to the Washington, DC, case. Virginia officials are in the process of notifying people who may have been exposed to the patient at various sites between April 10 and 15.

Meanwhile, the Iowa Department of Public Health (IDPH) on April 16 reported measles in a child from the northwestern part of the state. The department said that it and local officials were determining who may have been exposed to the disease and investigating the source of the child's infection. . . .

One week earlier, the Pennsylvania Department of Health (PDH) reported that the source of a recent measles outbreak involving six patients in the southwestern part of the state was a traveler from India who arrived in the United States on March 7. In an earlier statement the PDH said the confirmed case-patients included three members of a Westmoreland County family--two children under age 5, who had not received the measles-mumps-rubella (MMR) vaccine, and their 33-year-old father, who had received only a single dose of the vaccine as a child. . . .

The spate of recent measles cases raises concerns like those expressed last year, when measles cases climbed to 138, after averaging about 50 a year between 2004 and 2007, according to the April 17 issue of Morbidity and Mortality Weekly Report (MMWR). As of Apr 11, the CDC had already recorded 14 measles  cases this year.

Rising measles cases herald a worrisome drop in overall U.S. vaccination rates, the CDC said in an August 2008 MMWR update on the disease. "Measles is one of the first diseases to reappear when vaccination coverage rates fall," the agency said. . . .

To access the complete CIDRAP press release, go to:
http://www.cidrap.umn.edu/cidrap/content/other/news/apr2109measles-br.html

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5 Spread the word about the importance of childhood immunization during National Infant Immunization Week--April 25-May 2

On April 23, CDC issued a press release titled "National Infant Immunization Week Highlights Importance of Protecting Infants from Life-Threatening Diseases." It is available in English and Spanish. Portions of it are reprinted below.


The Centers for Disease Control and Prevention will launch National Infant Immunization Week (NIIW) with events beginning April 25 and continuing through May 2, 2009. Parents, caregivers and healthcare providers will be reminded of the benefits of vaccination and the importance of routine childhood vaccination.

"Immunization is one of the single most important steps parents can take to help assure their children grow up to be strong and healthy. We prevent millions of cases of disease and thousands of deaths in children each year through immunization," said Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases. "NIIW provides a chance for us to remember how important vaccines are and renew our efforts to make sure no child needlessly suffers from a vaccine-preventable disease." . . . .

There are now vaccines to protect children against 14 diseases before age 2. Despite recent gains in infant immunization coverage, more than 20 percent of the nation's 2-year-olds are not fully immunized against infectious diseases to which they are especially vulnerable.

"The unnecessary death of even one child from a vaccine-preventable disease is tragic. Immunization is critical because many of the bacteria and viruses that cause these life-threatening diseases still circulate in our country," Dr. Schuchat said. "We have seen unfortunate resurgence of some of these illnesses recently."

For more information please visit http://www.cdc.gov/vaccines/events/niiw or call (800) CDC-INFO [(800) 232-4636].


To access the English version of the complete press release, go to: http://www.cdc.gov/media/pressrel/2009/r090423.htm

To access the Spanish version of the complete press release, go to: http://www.cdc.gov/media/pressrel/2009/rs090423.htm

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6 IAC's Video of the Week features CDC's Dr. Jeanne Santoli answering moms' tough questions about immunization

IAC encourages IAC Express readers to watch a 6.5-minute video that NCIRD staff developed after they had talked with parents across the country. Titled "Get the Picture: Childhood Immunizations," the video is intended to be a model that health professionals can use to answer tough questions that real moms have about childhood immunizations. 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 May 3. 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

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7 CDC website posts Q&A for providers about Hib vaccine supply and Hib vaccination coverage

On April 21, CDC added this Q&A to the NCIRD website: "Vaccines and Preventable Diseases: Hib Vaccine--Q&As for Providers about Hib Vaccine Supply and Hib Vaccination Coverage."

To access it, go to:
http://www.cdc.gov/vaccines/vpd-vac/hib/faqs-hcp-supply-coverage.htm

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8 VIS translation: Interim VIS for pneumococcal conjugate vaccine now available in Turkish

The current version (dated 12/09/08) of the interim VIS for pneumococcal conjugate vaccine (PCV7) is now available on the IAC website in Turkish. IAC gratefully acknowledges Mustafa Kozanoglu, MD, and Murat Serbest, MD, for the translation.

To obtain the interim VIS for PCV7 vaccine in Turkish, go to:
http://www.immunize.org/vis/tupnPCV7.pdf

To obtain the interim VIS for PCV7 vaccine in English, go to:
http://www.immunize.org/vis/pnPCV7.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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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.