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Immunization Action Coalition
IAC Express 2009
Issue number 808: June 29, 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. July 2009 issue of Needle Tips now available online
  2. CDC recommends that providers reinstate the Hib booster dose for children ages 12-15 months
  3. Important: During the novel influenza A (H1N1) outbreak, administer PPSV to all people with existing indications
  4. Reminder: Novel influenza A (H1N1) and the 2009-10 seasonal influenza recommendations to be covered on CDC's July 16 net conference
  5. Florida Department of Health looking for three boys who played with a rabid bat
  6. CDC updates its novel influenza A H1N1 web section with revised guidance for businesses
  7. IAC's Video of the Week emphasizes the importance of hand-washing in stopping the spread of disease
  8. June issue of CDC's Immunization Works electronic newsletter recently released
  9. Standardized injection site maps help everyone in the office use the same anatomic sites for each vaccine
  10. IAC updates a print piece that answers the public's questions about meningococcal disease and vaccines
  11. HHS announces $35 million contract for a new way to produce influenza vaccine
  12. Save the date: July 7 is the new date for IZTA's Influenza Update conference call
  13. Order laminated U.S. immunization schedules today!
  14. Perfect for your waiting room: "The Saturday Shot" storybook presents a kid's-eye view of getting immunized
  15. MMWR article reports on the progress WHO's Western Pacific Region made in eliminating measles during 1990-2008
 
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 808: June 29, 2009
1.  July 2009 issue of Needle Tips now available online

The July 2009 issue of Needle Tips is now available for viewing and downloading. This free, popular, semi-annual, 24-page resource for health professionals is packed full of easy-to-read and CDC-reviewed educational content, as well as other resources for childhood, adolescent, and adult immunization.

The July 2009 issue is the first issue of Needle Tips that is not being distributed in print by U.S. mail. IAC assures IAC Express and Needle Tips readers that the content of the July 2009 issue--as well as all future issues--is fully up to the standards you have come to expect from the hardcopies of Needle Tips.

Here are the articles included in this issue:

  • Ask the Experts
  • Vaccine Highlights: Recommendations, schedules, and more
  • After the Shots . . . What to do if your child has discomfort
  • Do I Need Any Vaccinations Today?
  • Handouts on Vaccination Schedules for Your Patients
  • Recommended Immunization Schedules for Persons Ages 0 through 18 Years, U.S., 2009
  • Recommended Adult Immunization Schedule, U.S., 2009
  • How to Administer IM and SC Injections
  • Influenza Vaccination for Healthcare Workers: Our duty to our patients

This online issue of Needle Tips allows readers to navigate its content by using some of the more than 200 clickable links located throughout.

To download the entire issue, go to:
http://www.immunize.org/nslt.d/n40/n40.pdf

If you don't have time to print the entire issue, select from the clickable links, which you will find at http://www.immunize.org/nt

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2 CDC recommends that providers reinstate the Hib booster dose for children ages 12-15 months

CDC published "Updated Recommendations for Use of Haemophilus Influenzae Type b (Hib) Vaccine: Reinstatement of the Booster Dose at Ages 12-15 Months" in the June 26 issue of MMWR. It is reprinted below in its entirety, excluding references.


On December 13, 2007, certain lots of Haemophilus influenzae type b (Hib) vaccine marketed as PedvaxHIB (monovalent Hib vaccine) and Comvax (Hib-HepB vaccine), and manufactured by Merck & Co., Inc., were recalled voluntarily, and the company temporarily suspended production of these vaccines. To conserve the limited supply of Hib-containing vaccines, CDC, in consultation with the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP), on December 18, 2007, recommended that vaccination providers temporarily defer the routine Hib vaccine booster dose administered to most healthy children at age 12-15 months.

Production of Merck Hib vaccine products is still suspended. However, two other Hib-containing vaccines manufactured by sanofi pasteur have been available for use in the United States during this shortage: monovalent Hib vaccine (ActHIB) and DTaP-IPV/Hib (Pentacel). Beginning in July 2009, the manufacturer of these two vaccines will increase the number of doses of these two products available for use in the United States, which will result in the supply being sufficient to reinstate the Hib vaccine booster dose.

Reinstatement of Hib Booster Dose
Effective immediately, CDC, in consultation with ACIP, AAFP, and AAP, is recommending reinstatement of the booster dose of Hib vaccine for children aged 12-15 months who have completed the primary 3-dose series. Infants should continue to receive the primary Hib vaccine series at ages 2, 4, and 6 months. Children aged 12-15 months should receive the booster dose on time. Older children for whom the booster dose was deferred should receive their Hib booster dose at the next routinely scheduled visit or medical encounter.  Although supply is sufficient to reinstate the booster dose and begin catch-up vaccination, supply is not yet ample enough to support a mass notification process to contact all children with deferred Hib booster doses.

Sufficient vaccine will be available to administer the primary series at ages 2, 4, and 6 months and a booster dose on time to children aged 12-15 months. As part of delivering the booster dose to those children for whom it was deferred at the next routinely scheduled appointment or medical encounter, practices should discuss with parents the reasons for the change in recommendation and might consider (1) reviewing electronic or paper medical records or immunization information system records to identify children in need of a booster dose before physician encounters, (2) evaluating children's vaccination status during their scheduled visit, and (3) sharing immunization schedules with parents to make them aware of this plan.

Use of Combination Vaccines
During the Hib shortage, children received protection from certain vaccine-preventable diseases in their primary vaccination series through various permutations of available combination vaccines (e.g., DTaP-IPV/Hib [Pentacel] and DTaP-IPV-HepB [Pediarix]) and monovalent vaccines (e.g., ActHib, HepB, and IPV). Therefore, a mismatch might exist between patient vaccination needs and the available stock of different vaccine formulations (e.g., combination products versus single-antigen vaccines) in local provider offices. This situation presents a challenge for providers to administer vaccines to ensure appropriate coverage while minimizing extra doses of unneeded vaccine. For example, if a provider is using DTaP-IPV/Hib (Pentacel) vaccine to protect infants against Hib disease, the provider should ensure that adequate stock of monovalent HepB vaccine is available to complete the HepB vaccine series [additional information available at http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/eo-hib-hepb-cov.pdf]. Children who need the Hib booster and who already have received 4 doses of DTaP should receive monovalent Hib vaccine (ActHIB) as their Hib booster dose. However, if DTaP-IPV/Hib is the only Hib-containing vaccine available, this combination product can be used to complete the series of Hib vaccination, even if the child already has received all the necessary doses of DTaP and IPV.

Information Regarding ActHIB or Pentacel
Vaccination providers with questions about their supplies of monovalent Hib vaccine (ActHIB) or DTaP-IPV/Hib (Pentacel) purchased with nonpublic funds should contact sanofi pasteur's customer service department (telephone, [800] 822-2463). Sanofi pasteur will work directly with physicians to increase allotments of Hib-containing vaccines on the basis of previous purchasing patterns or practice birth cohort and estimates of additional vaccine doses needed. For public vaccine supplies, including Vaccines for Children Program vaccine, providers should contact their state/local immunization program to obtain vaccine.

This recommendation reflects CDC's assessment of the existing national Hib vaccine supply and will be updated if the supply changes. Updated information about the national Hib vaccine supply is available at
http://www.cdc.gov/vaccines/vac-gen/shortages

Details about the routine Hib schedule are available at http://www.cdc.gov/vaccines/recs/schedules/default.htm#child Adverse events following receipt of any vaccine should be reported to the Vaccine Adverse Event Reporting System (VAERS) at http://vaers.hhs.gov


To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5824.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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3 Important: During the novel influenza A (H1N1) outbreak, administer PPSV to all people with existing indications

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

RECOMMENDATION FOR USE OF PPSV23 DURING NOVEL INFLUENZA A (H1N1) OUTBREAK: CDC has issued interim guidance on the use of pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak (http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm). CDC recommends a single dose of PPSV23 for all people 65 years and older and for persons 2 [through] 64 years of age with certain high-risk conditions. People in these groups are at increased risk of pneumococcal disease as well as serious complications from influenza. A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years as well as for people at highest risk, such as those who have no spleen, and those who have HIV infection, AIDS, or malignancy.

All people who have existing indications for PPSV23 should continue to be vaccinated according to current ACIP recommendations during the outbreak of novel influenza A (H1N1). Emphasis should be placed on vaccinating people aged less than 65 years who have established high-risk conditions because PPSV23 coverage among this group is low and because people in this group appear to be overrepresented among severe cases of novel influenza A (H1N1) infection, based on currently available data. PPSV23 coverage estimates are available online (http://www.cdc.gov/flu/professionals/vaccination/pdf/NHIS89_07ppvvaxtrendtab.pdf).

Use of PPSV23 among people without current indications for vaccination is not recommended at this time. This recommendation may be revised as the epidemiology and clinical presentation of novel influenza A (H1N1) virus infection as well as the frequency and severity of secondary pneumococcal infections are better understood.

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4 Reminder: Novel influenza A (H1N1) and the 2009-10 seasonal influenza recommendations to be covered on CDC's July 16 net conference

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

UPCOMING NET CONFERENCE: Please mark your calendars for July 16th from 12 Noon-1:00 PM ET for a live net conference program titled "Current Issues in Immunization." Dr. Joseph Bresee, will present on "Novel Influenza A (H1N1) Update and Seasonal Influenza Recommendations for the 2009-2010 Season." This program will combine a telephone audio conference with simultaneous online visual content. It will allow for a question and answer segment both by telephone and via the Internet. Internet access and a separate phone line are needed to participate. On-demand replays and presentations will be available shortly after each event. For more information, visit CDC's Current Issues in Immunization web page (http://www.cdc.gov/vaccines/ed/ciinc/#next).

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5 Florida Department of Health looking for three boys who played with a rabid bat

On June 25, the Florida Department of Health issued a press release titled "Florida Health Department Still Looking for 3 Boys Who Played With Rabid Bat: Rabies Confirmed in Rescued Bat." The press release is reprinted below in its entirety.


Three of the 5 boys that were seen handling a rabid bat last week on a Florida beach are still unidentified. Since rabies is a fatal disease, the Lee County Health Department is trying to locate the 3 remaining youth in order to administer rabies vaccinations.

On Monday, June 15, at approximately 4:00 p.m., an eyewitness saw at least 5 boys estimated to be between 10-12 years of age handling, playing, and kissing a bat at the Ft. Myers Beach pier. An eyewitness retrieved the bat and since bats are known to carry rabies, it was sent to the state laboratory in Tampa, FL, for testing, which confirmed the bat had rabies. The state laboratory identified the bat as a Brazilian Free Tail bat.

"Rabies is a fatal disease. There is no known cure for rabies, only vaccination. Therefore, it is critical that the youth who were playing with the bat on Ft. Myers Beach pier are vaccinated as soon as possible," said Dr. Judith A. Hartner, MD, MPH, MPA, director of the Lee County Health Department.

For those youth and parents that were visiting Ft. Myers Beach pier in Florida on Monday, June 15, and have any information on how to contact the youth seen handling a bat, please contact the Lee County Health Department at (239) 332-9501. The phone number will be operational 24 hours per day/7 days a week.

For more information concerning rabies and how it spreads, please refer to the Florida Department of Health website: http://www.doh.state.fl.us/environment/medicine/rabies/rabies-education.html and the Centers for Disease Control website: http://www.cdc.gov/RABIES/bats.html or http://www.cdc.gov/ncidod/dvrd/kidsrabies

The press release has not yet been posted on the Florida Department of Health website. When it is posted, you will find it at
http://esetappsdoh.doh.state.fl.us/pressreleasesearch/search.aspx

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6 CDC updates its novel influenza A H1N1 web section with revised guidance for businesses

CDC recently posted updated information to one of the documents in the "H1N1 Flu Clinical and Public Health Guidance" sub-section of its H1N1 Flu web section. Titled "General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers," the document is available at http://www.cdc.gov/h1n1flu/guidance/workplace.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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7 IAC's Video of the Week emphasizes the importance of hand-washing in stopping the spread of disease

IAC encourages IAC Express readers to watch "Put Your Hands Together," a 4-minute video created by CDC. It emphasizes that frequent, thorough hand-washing may be the single most important act a person can take to stop the spread of infectious disease and stay healthy. An English-language script is also available; you'll find a link to it at the end of this IAC Express article.

The video will be available on the home page of IAC's website through July 5. 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.

All the videos featured as an IAC Video of the Week are now archived on IAC's website. To view any of the videos previously featured, go to: http://www.immunize.org/votw/jun09.asp

To access the "Put Your Hands Together" script, go to:
http://www.cdc.gov/CDCTV/HandsTogether/Transcripts/HandsTogether.pdf

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

CDC recently released the June issue of its monthly newsletter Immunization Works; it is 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 June issue has already appeared in previous issues of IAC Express. Following is the text of two articles we have not covered.


NEW ZOSTER (SHINGLES) MATERIALS: CDC has developed a new web button for shingles vaccine resources (http://www.cdc.gov/vaccines/vpd-vac/shingles/web-button.htm). The button takes visitors directly to CDC's main shingles page, which includes links to frequently asked questions about shingles and shingles vaccine, fact sheets and printable materials, and other useful resources. In addition, CDC updated its list of Frequently Asked Questions for Shingles Vaccine (http://www.cdc.gov/vaccines/vpd-vac/shingles/vac-faqs.htm). The questions reflect the most up-to-date requests for information about shingles vaccine from the general public and vaccination providers. For all of CDC's shingles materials, visit the Shingles (Herpes Zoster) Vaccination Web page (http://www.cdc.gov/vaccines/vpd-vac/shingles).


IMPROVED WEBSITE FOR HEALTHCARE PROFESSIONALS: Visit CDC's new web page, Vaccines and Immunizations for Healthcare Professionals (http://www.cdc.gov/vaccines/hcp.htm) to see its new look! Incorporating feedback directly from healthcare professionals, CDC has organized topics under clear headings and simplified the layout while still providing the same reliable information on vaccines and immunizations. Bookmark this page and quickly link to information on immunization training, clinical resources, administrative tools, patient education, and vaccine-preventable diseases. Be sure to email your feedback about the website to NCIRDwebteam@cdc.gov

To access the complete June issue from CDC's Vaccines & Immunizations website, go to:
http://www.cdc.gov/vaccines/news/newsltrs/imwrks/2009/200906.htm

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9 Standardized injection site maps help everyone in the office use the same anatomic sites for each vaccine

Medical offices and clinics commonly administer more than one vaccine to a patient during a single visit. If a patient or parent later calls to report a reaction, it can be puzzling for healthcare personnel to determine which vaccine caused the reaction.

Use of standardized injection site maps can help prevent this dilemma. With site maps, healthcare personnel can jointly decide which anatomic site everyone in the office will use when administering a certain vaccine. For example, everyone can agree to administer DTaP in the upper right thigh, Hib in the lower right thigh or PCV7 in the upper left thigh, HepB in the lower left thigh.

CDC has sample injection site maps for administering vaccines to children. Included are illustrations that show where healthcare workers can administer all indicated doses to children ranging in age from infancy to pre-teen. To access them, go to:
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/site-map.pdf

The California Department of Public Health has an injection site map for administering vaccines to adults. Access it at
http://www.eziz.org/PDF/IMM-718adult.pdf

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10.  IAC updates a print piece that answers the public's questions about meningococcal disease and vaccines

IAC recently revised its print piece "Meningococcal: Questions and Answers" to incorporate changes made in the age indication for meningococcal conjugate vaccine.

The piece is a ready-to-print version of some of the CDC-reviewed material located on IAC's Vaccine Information website (www.vaccineinformation.org). The website is intended for the public, health professionals, and the media.

To access the revised ready-to-print (PDF) print piece "Meningococcal: Questions and Answers," go to:
http://www.immunize.org/catg.d/p4210.pdf

To view an HTML version of these Q&As, go to the following:

(1) Meningococcal disease:
http://www.vaccineinformation.org/menin/qandadis.asp

(2) Meningococcal vaccine:
http://www.vaccineinformation.org/menin/qandavax.asp

To access Q&As about other diseases and vaccines in PDF format, go to:
http://www.immunize.org/printmaterials/questions.asp

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11.  HHS announces $35 million contract for a new way to produce influenza vaccine

On June 23, the Department of Health and Human Services (HHS) issued a press release announcing that the department will pursue a new way to make influenza vaccine. Portions of the press release are reprinted below.


HHS Secretary Kathleen Sebelius announced today that the department will pursue advanced development of new way to make influenza vaccine. The work will be done by Protein Sciences Corporation, Inc., of Meriden, Conn., under a new $35 million contract. The contract could be extended up to five years at a total cost of approximately $147 million.

"The technology has advanced in recent years to a point that we believe it could help meet a surge in demand for U.S.-based vaccine for seasonal and pandemic flu," Secretary Sebelius said. "We want to use the technology to help our nation respond to emerging infectious diseases."

With this new technology, known as recombinant influenza vaccine, a gene would be extracted from a flu virus and placed into an insect virus called baculovirus, which does not affect people and can multiply quickly to high levels in insect cells. The cells are purified to become a basic part of a human vaccine.

Using this method, vaccine candidates, clinical investigational lots, and commercial-scale vaccine production may be available faster than by using traditional vaccine production methods. Because the basic cells can be frozen and stored indefinitely, manufacturing large quantities of a vaccine is also faster using this recombinant technology. . . .

If this new technology is demonstrated to be safe and effective and the FDA licenses the new technology for flu vaccines, the contract requires the company to establish domestic manufacturing capability to provide a finished vaccine within 12 weeks of pandemic onset and to produce at least 50 million doses of pandemic flu vaccine within six months of pandemic onset. . . .

To read the complete press release, go to:
http://www.hhs.gov/news/press/2009pres/06/20090623c.html

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12.  Save the date: July 7 is the new date for IZTA's Influenza Update conference call

The Immunization Coalitions Technical Assistance Network (IZTA) has rescheduled its Influenza Update conference call. Previously scheduled for June 16, it will now be held on July 7. If you registered for the June 16 call, you do not need to re-register.

The call features L.J. Tan, MS, PhD, presenting his engaging and informative annual update. It will include the latest research from the 2008-09 influenza season and predictions and plans for the 2009-10 season.

The July 7 call will be held at 1PM, ET. To sign up, send an email to izta@aed.org Include the subject line "Sign me up for the Influenza Update call."

IZTA is a program of the Center for Health Communication, Academy for Educational Development.

To access earlier programs, go to:
http://www.izta.org/confcall.cfm

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13.  Order laminated U.S. immunization schedules today!

IAC has two laminated immunization schedules for 2009--one for children/teens ages 0 through 18 years and one for adults. Based on CDC's 2009 immunization schedules, the laminated schedules offer two significant advantages over paper schedules:

(1) They are covered with a tough, washable coating that lets them stand up to a year's worth of use as at-your-fingertips guides to immunization and as teaching tools you can use to give patients and parents authoritative immunization information.

(2) Each schedule includes a guide to vaccine contraindications and precautions, an additional feature that will help you to make on-the-spot determinations about vaccinating patients of any age.

IAC's 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, such as personal immunization record cards, padded screening questionnaires, and educational videos, go to: http://www.immunize.org/shop

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14.  Perfect for your waiting room: "The Saturday Shot" storybook presents a kid's-eye view of getting immunized

"The Saturday Shot" tells the story of a young girl going to the doctor's office for a check-up and vaccine. Written by a child for children, this book provides a child's perspective on getting immunized.

Published in 2009, it is available from Tate Publishing. You can order it, download it digitally, or download an audio book. To access the various options, go to: http://tatepublishing.com/bookstore/book.php?w=978-1-60696-129-2

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15.  MMWR article reports on the progress WHO's Western Pacific Region made in eliminating measles during 1990-2008

CDC published "Progress Toward the 2012 Measles Elimination Goal--Western Pacific Region, 1990-2008" in the June 26 issue of MMWR. A portion of a summary made available to the press is reprinted below.


The Western Pacific Region of WHO has made progress towards its goal of measles elimination by 2012. Routine immunization coverage has been increasing; more and better vaccination campaigns have been conducted; surveillance is being enhanced; and an extensive laboratory network is in place. Twenty-four of the Region's 37 countries and jurisdictions already have likely eliminated or nearly eliminated measles. However, large numbers of measles cases continue to occur in several countries, especially in China and Japan, which together account for 82 percent of the Region's population. Increased political, financial, and human resource commitment, and efforts by countries and partners, are required to implement the WHO-recommended strategies and achieve the 2012 goal.


To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5824a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5824.pdf

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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.