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Immunization Action Coalition
IAC Express 2009
Issue number 802: June 1, 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. Study published in Pediatrics indicates children of parents who refuse pertussis vaccination are at high risk for the disease
  2. CDC continually posts new and updated information related to H1N1 influenza
  3. Three measles cases confirmed in unvaccinated children in Bucks County, PA
  4. IAC's Video of the Week features gripping case summaries and images of children with vaccine-preventable diseases
  5. MMWR notifies readers that "Immunization Update 2009" satellite broadcast and webcast is scheduled for July 30
  6. AAP's "Sound Advice" audio interviews are available to answer parents' questions about vaccination
  7. MMWR publishes report on large-scale human exposures to a rabid bat in Montana in 2008
  8. 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!
 
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 802: June 1, 2009
1.  Study published in Pediatrics indicates children of parents who refuse pertussis vaccination are at high risk for the disease

The June 2009 issue of the journal Pediatrics includes an article titled "Parental Refusal of Pertussis Vaccination Is Associated with an Increased Risk of Pertussis Infection in Children." It was written by Jason M. Glanz, PhD; David L. McClure, PhD; David J. Magid, MD, et al. The abstract is reprinted below.


OBJECTIVE. The objective of this study was to determine if children who contracted pertussis infection were more likely to have parents who refused pertussis vaccinations than a similar group of children who did not develop pertussis infection.

METHODS. We conducted a case-control study of children enrolled in the Kaiser Permanente of Colorado health plan between 1996 and 2007. Each pertussis case was matched to 4 randomly selected controls. Pertussis case status and vaccination status were ascertained by medical chart review.

RESULTS. We identified 156 laboratory-confirmed pertussis cases and 595 matched controls. There were 18 (12%) pertussis vaccine refusers among the cases and 3 (0.5%) pertussis vaccine refusers among the controls. Children of parents who refused pertussis immunizations were at an increased risk for pertussis compared with children of parents who accepted vaccinations. In a secondary case-control analysis of children continuously enrolled in Kaiser Permanente of Colorado from 2 to 20 months of age, vaccine refusal was associated with a similarly increased risk of pertussis. In the entire Kaiser Permanente of Colorado pediatric population, 11% of all pertussis cases were attributed to parental vaccine refusal.

CONCLUSIONS. Children of parents who refuse pertussis immunizations are at high risk for pertussis infection relative to vaccinated children. Herd immunity does not seem to completely protect unvaccinated children from pertussis. These findings stress the need to further understand why parents refuse immunizations and to develop strategies for conveying the risks and benefits of immunizations to parents more effectively.


To access the abstract, go to:
http://pediatrics.aappublications.org/cgi/content/abstract/123/6/1446

The text of the complete article requires AAP membership, a subscription to Pediatrics, or the purchase of short-term access to the article or the June 2009 issue of Pediatrics. You can also request the article from a medical library.

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2 CDC continually posts new and updated information related to H1N1 influenza

CDC recently posted new or updated information to four sub-sections of its H1N1 Flu web section. Following are the titles and URLs of documents that have been posted since the May 26 IAC Express.

FROM THE NOVEL H1N1 FLU (SWINE FLU) PUBLIC SERVICE ANNOUNCEMENTS (PSAs) SUB-SECTION
The "H1N1 Consumer Fraud PSA" is a 30-second audio that cautions consumers to be wary of ads they might receive through the Internet, email, and other sources that promote products that claim to prevent, cure, treat, or diagnose novel H1N1 influenza. The audio is available in English and Spanish for downloading to M3P players; the script is available in both languages.
http://www.cdc.gov/h1n1flu/psa/consumerfraud.htm

FROM THE "H1N1 FLU (SWINE FLU): STATE HEALTH DEPARTMENT WEBSITES" SUB-SECTION:
H1N1 Flu information posted on the websites of 50 state health departments and the Washington, DC, health department http://www.cdc.gov/h1n1flu/states.htm

FROM THE "H1N1 FLU (SWINE FLU): GENERAL INFORMATION" SUB-SECTION:
Questions & Answers: H1N1 Flu (Swine Flu) and You
http://www.cdc.gov/h1n1flu/qa.htm

FROM THE "H1N1 FLU CLINICAL AND PUBLIC HEALTH GUIDANCE" SUB-SECTION:
Interim Guidance for Correctional and Detention Facilities on Novel Influenza A (H1N1) Virus
http://www.cdc.gov/h1n1flu/guidance/correctional_facilities.htm

Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission
http://www.cdc.gov/h1n1flu/masks.htm

Update on School (K-12) and Child Care Programs: Interim CDC Guidance in Response to Human Infections with the Novel Influenza A (H1N1) Virus
http://www.cdc.gov/h1n1flu/K12_dismissal.htm

The home page of CDC's H1N1 Flu web section can be accessed from
http://www.cdc.gov/h1n1flu

IAC has gathered important information related to H1N1 influenza in a new web section to make it easier to keep up to date with developments. To access this resource, go to:
http://www.immunize.org/h1n1

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3 Three measles cases confirmed in unvaccinated children in Bucks County, PA

On May 26, the Bucks County, PA, health department posted a press release on its website announcing three confirmed measles cases. The total number of cases confirmed this year in Pennsylvania now stands at nine. Six cases were confirmed in the Pittsburgh area in April.

A portion of the press release about the Bucks County cases is reprinted below.


The Bucks County Health Department advises the public that it is closely monitoring three confirmed measles cases in the county--all of which are under control and limited to unvaccinated individuals who were in close contact with each other.

"There is no risk of transmission to others at this point from these cases, which involve three individuals who were unvaccinated," noted Bucks County Health Director Dr. David Damsker. "The first case involves a school-age child. The other two are directly related to the first case and all three individuals have been isolated from their schoolmates and the general population."

Dr. Damsker reiterated the importance of being vaccinated to provide the best protection against the measles and other communicable diseases. "There is no substitute for vaccination, which has been proven to be safe and effective," he added. . . .

To access the press release, go to:
http://www.buckscounty.org/news/2009/2009-05-26-MeaslesConfirmation.aspx

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4 IAC's Video of the Week features gripping case summaries and images of children with vaccine-preventable diseases

IAC encourages IAC Express readers to watch an 11-minute video developed by the Colorado Children's Immunization Coalition (CCIC). Available on YouTube, the video includes gripping case summaries of and images of Colorado children with VPDs, as well as information about immunization registries and the work that CCIC does in improving immunization coverage in Colorado communities.

The video will be available on the home page of IAC's website through June 7. 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.

Videos previously featured as IAC's Video of the Week are archived by month on IAC's website. To view any of them, go to: http://www.immunize.org/votw/apr09.asp Find the bar at the top of the page titled Video of the Week Archive 2008-2009, and click on one or more months.

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5 MMWR notifies readers that "Immunization Update 2009" satellite broadcast and webcast is scheduled for July 30

CDC published "Notice to Readers: Webcast: Immunization Update 2009" in the May 29 issue of MMWR. The notice is reprinted below in its entirety.


CDC will present a satellite broadcast and webcast, Immunization Update 2009, on July 30, 2009. The 2.5-hour broadcast will occur live during 9:00 a.m.-11:30 a.m. (EDT) and will be rebroadcast that day during 12:00 noon-2:30 p.m.

Anticipated topics include the novel influenza A (H1N1) virus, seasonal influenza, rotavirus, vaccine safety, and vaccine supply. "Alternative" vaccination schedules and other emerging vaccine issues also will be discussed. Both broadcasts will feature a live question-and-answer session in which participants can interact with course instructors via toll-free telephone lines. Additional information about the program is available at http://www2a.cdc.gov/phtn/immupdate2009/default.asp

No registration is necessary to access the webcast. Continuing education credit for this activity is pending. The program will become available as a self-study DVD and Internet-based program in October 2009.


To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5820a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5820.pdf

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6 AAP's "Sound Advice" audio interviews are available to answer parents' questions about vaccination

[The following is cross posted from the AAP Immunization Initiatives Newsletter, May 2009.]

Sound Advice Audio Interviews
To answer the questions that many parents have about their children's vaccines, the American Academy of Pediatrics offers a collection of interviews with pediatricians, researchers, and other parents. Access the interviews at http://www.cispimmunize.org/fam/soundadvice.html

To access the May issue of the AAP Immunization Initiatives Newsletter, go to:
http://www.cispimmunize.org/resour/pdf/May2009_enews.pdf

To be added to the newsletter listserv, email cispimmunize@aap.org with "Newsletter" in the subject line and your name and email address in the body of the email.

To access archived issues, go to:
http://www.cispimmunize.org/resour/rsc_main.html

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7 MMWR publishes report on large-scale human exposures to a rabid bat in Montana in 2008

CDC published "Human Exposures to a Rabid Bat--Montana, 2008" in the May 29 issue of MMWR. Portions of the article are reprinted below.


On September 29, 2008, the Ravalli County Public Health Department (RCPHD) notified the Montana Department of Public Health and Human Services (MDPHHS) of a large-scale human exposure to a dead bat at an elementary school. On October 1, the bat was confirmed to be rabid, and on October 4, MDPHHS requested assistance from CDC in evaluating persons for rabies exposure. Of 107 persons assessed, only one person (1%) was recommended for rabies postexposure prophylaxis (PEP) in accordance with guidance from the Advisory Committee on Immunization Practices (ACIP); however, 74 persons (68%) ultimately pursued rabies PEP. This report describes the incident and public health response, and highlights the importance of unified risk communication. After a potential large-scale exposure to rabies virus, guidance from clinicians should be consistent with ACIP recommendations to ensure appropriate use of rabies PEP.

Incident Description
On September 28, a parent of two students at a Ravalli County elementary school found a dead bat carried into the house by the family cat. The bat carcass was placed in a jar and stored overnight. On September 29, one parent accompanied the children to school with the bat, and before leaving school premises, removed the carcass from the jar and presented it to eight different classrooms (one kindergarten, four 5th-grade, and three 4th-grade classrooms). Students and teachers in at least five classrooms touched the bat, along with a few other staff members of the school.

Later that morning, the school nurse notified RCPHD after learning of the presentation. RCPHD subsequently advised the parent to submit the bat for rabies diagnosis. That afternoon, the parent took the bat carcass to an off-campus soccer practice attended by students from the school. Some of these children touched the bat. On September 30, the bat was shipped to the Montana Veterinary Diagnostic Laboratory (MVDL). On October 1, MVDL detected the presence of rabies viral antigen in the animal's brain via direct fluorescent antibody testing. On October 16, CDC identified the implicated virus variant as one associated with the silver-haired bat (Lasionycteris noctivagans).

On September 30, while awaiting the results of the laboratory testing, school officials sent letters home with students enrolled in the five classrooms (kindergarten and 5th grade) where the teacher observed students touching the bat. The letter described concern for potential exposure to the rabies virus. School officials did not send letters home to students enrolled in the three 4th-grade classrooms because teachers did not observe any of these students touching the bat. On the evening of October 1, school officials telephoned households of students in the kindergarten and 5th-grade classes with news of the positive laboratory findings; voice-mail messages were left if no one answered. The cat that had discovered the bat received a rabies booster shot after a veterinarian confirmed its current rabies vaccination status. The cat was observed in the owner's home for 45 days and was reported to be healthy at the time of this report. . . .

Editorial Note
Large-scale human contact with rabid animals requires mobilization of substantial resources and involvement of public health officials, as demonstrated by this incident, a similar occurrence in New Hampshire during 1994, and a multistate incident in 2007. These incidents typically generate high public anxiety, which can lead to unnecessary rabies PEP. This report differs from accounts of previous large-scale human rabies exposures because it describes the compliance with ACIP recommendations by persons who were evaluated and counseled by public health officials.

During 2007-2009, the human rabies vaccine supply was limited because of temporary suspension of production by one manufacturer. To acquire rabies vaccine during that time, clinicians were required to first consult with state or local public health officials. MDPHHS requested CDC assistance because of the anticipated challenges posed by assessing and counseling so many persons in this incident, especially during a time of limited vaccine supply.

Approximately one third of rabies large-scale exposures occur in school settings, which also are ideal sites for educational outreach to promote safe animal practices. Such outreach should include messages that warn against contact with wildlife (both dead and alive) and instructions on what to do if an animal is found on school or home premises. School policies that prohibit bats and other common rabies reservoirs in classrooms are recommended to lessen exposure risks. All animals suspected of being infected with the rabies virus should be handled carefully and brought promptly to public health officials for testing.

Risk communication is an integral component of a public health response after potential large-scale exposures, including those involving potential exposure to the rabies virus. Many of the persons who pursued PEP in this incident appear to have acted upon advice from community physicians in preference to information provided by public health officials. Clinicians can play an important role in ensuring that only persons with exposure that meet ACIP criteria receive PEP. Coordination among the medical and public health officials involved in a response to a potential large-scale rabies exposure is critical to ensuring the delivery of a unified message to the public regarding the appropriateness of PEP. Timely dissemination of ACIP exposure criteria to local clinicians via the Health Alert Network (HAN) or other communication tools might help ensure that exposed persons receive advice consistent with recommended public health practice.


To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5820a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5820.pdf

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

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8 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:

(1) 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.

(2) 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

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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.