On July 24, CDC published "Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009" as an electronic MMWR Early Release. The Summary is reprinted below. At the end of this IAC Express article, URLs will be given to two items that will be of particular interest to some readers: "BOX 1. Summary of seasonal influenza vaccination recommendations, 2009: children and adolescents aged 6 months-18 years" and "BOX 2. Summary of seasonal influenza vaccination recommendations, 2009: adults."

To access "BOX 2. Summary of seasonal influenza vaccination recommendations, 2009: adults," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm#box2

[The following is cross posted from the "Front Page News" section of CDC's Immunization Works electronic newsletter, July 2009.]

ACIP HIGHLIGHTS: The Advisory Committee on Immunization Practices (ACIP) met June 24–26 in Atlanta, adding an extra half-day to their usual schedule to address the issue of influenza vaccination now that novel influenza A H1N1 is considered a pandemic influenza virus strain. The meeting produced several new and updated recommendations. These recommendations are provisional until they are reviewed by the director of CDC and published in the MMWR. Full minutes of the meeting, including slides from presentations, will be available soon on the ACIP Meetings web page (http://www.cdc.gov/vaccines/recs/acip/meetings.htm ).

General Recommendations: A clarification was made to the General Recommendations regarding combination vaccines, maintaining a general preference for combination vaccine products, but stating specific criteria by which a provider might choose the single-component products. Important considerations include provider assessment, patient preference, and potential for adverse events. Rabies Vaccine: The committee voted to reduce the number of rabies prevention from five to four. The schedule for administration of the doses is days 0, 3, 7, and 14. For more information, please see the Rabies Provisional Recommendation (http://www.cdc.gov/vaccines/recs/provisional/downloads/rabies-July2009-508.pdf).

Polio Vaccine: The minimum interval between dose 3 and dose 4 of polio-containing vaccines was changed from 4 weeks to 6 months.

Measles-Mumps-Rubella Vaccine: Modifications were made to the criteria for acceptable evidence of immunity to measles, mumps, and rubella for healthcare providers. Documentation of physician-diagnosed disease (previously considered evidence of measles and mumps immunity) is no longer an acceptable criterion. Birth before 1957 is still evidence of immunity, but facilities should consider vaccinating healthcare providers born before 1957 who have no other criterion for immunity with two doses of MMR vaccine. In an outbreak, two doses of vaccine are specifically recommended for healthcare providers born before 1957.

Meningococcal Vaccine: A recommendation was made for revaccination using meningococcal conjugate vaccine for persons who remain at high risk for meningococcal disease after their first vaccination (with either the polysaccharide or the conjugate meningococcal vaccine). These include persons with persistent complement component deficiencies, persons with anatomic or functional asplenia, persons infected with HIV, microbiologists who are routinely exposed to Neisseria meningitidis, and frequent travelers to or people living in areas with high rates of meningococcal disease, such as the African meningitis belt. For children 2 through 6 years of age the dose should be given at an interval of 3 years, for persons older than 6 years, at an interval of 5 years.

Japanese Encephalitis Vaccine: The ACIP voted to include the recently licensed Japanese encephalitis virus (JEV) vaccine, Ixiaro, in the list of recommended vaccines for U.S. travelers. Clarifications were also made to the existing recommendations for the use of Japanese encephalitis vaccine. The vaccine is recommended for travelers who will spend 1 month or more in an endemic-disease area during the JEV transmission season, or for short-term travelers if they have an increased risk of JEV exposure. The vaccine is not recommended for short-term travelers whose visit will be restricted to urban areas or times outside of a well-defined JEV transmission season. For more information, please see the Japanese Encephalitis Provisional Recommendation (http://www.cdc.gov/vaccines/recs/provisional/downloads/je-july2009-508.pdf).

Measles-Mumps-Rubella-Varicella Vaccine: Additional language was added to the recommendation for MMRV vaccine regarding combination vaccines versus separate injections of equivalent component vaccines. Combination vaccines are preferred, but considerations should include provider assessment, patient preference, and the potential for adverse events. In addition, a personal or family history of seizures was included as a precaution for MMRV vaccine use.

CDC published "Neurologic Complications Associated with Novel Influenza A (H1N1) Virus Infections in Children--Dallas, Texas, May 2009" in the July 24 issue of MMWR. The opening paragraph of the article is reprinted below.

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5828.pdf

Florida, Georgia, Nebraska, and Texas have recently expanded their immunization requirements for pre-school or school attendance. In June, Maine became the 50th state to authorize pharmacists to vaccinate. More detailed information follows. [Note: "School year" is abbreviated as SY throughout this IAC Express article.]

INFLUENZA INFORMATION
Florida: On June 10, the governor approved a bill making it a legal requirement that each year, in August or September, certain child care and day care providers distribute detailed information about influenza (i.e., causes, symptoms, and transmission) to the parents of enrolled children. The goal is to educate parents about the importance of annual influenza vaccination of their children. The law went into effect on June 10 and will be implemented in August and September 2009.

Note: At this time, IAC has no chart that lists influenza laws for child care or day care attendance.


MENINGOCOCCAL INFORMATION/VACCINATION
Georgia: On May 5, the governor signed a law requiring schools to provide parents/guardians of students in grades 6 through 12 with information on meningococcal meningitis disease/vaccine. The requirement will be effective for SY 2009-10.

Texas: On March 5, the executive commissioner of Health and Human Services (HHS) approved a revision to the state's administrative code that requires 1 dose of meningococcal conjugate vaccine (MCV) for students entering grade 7. The requirement goes into effect on August 1; it will phase into higher grades, leading up to grade 12 by SY 2014-15.

IAC has compiled a chart of information about all states that have meningococcal prevention mandates for elementary and secondary school attendance. To access the information, go to:
http://www.immunize.org/laws/menin_sec.asp

This information is also depicted visually on a map of the United States. To access the map, go to:
http://www.immunize.org/laws/menin_sec.pdf


TETANUS-DIPHTHERIA-ACELLULAR PERTUSSIS (Tdap) VACCINATION
Nebraska: On May 27, the governor approved a requirement for a one-time dose of Tdap vaccine for all students entering grade 7. The requirement becomes effective on July 1, 2010.

Texas: On March 5, the executive commissioner of HHS approved a revision to the state's administrative code that requires a one-time dose of Tdap for all students entering grade 7. The requirement goes into effect on August 1; it will phase into higher grades, leading up to grade 12 by SY 2014-15.

IAC has compiled a chart of information about all states that require Tdap vaccination for middle school and high school attendance. To access the information, go to:
http://www.immunize.org/laws/tdap_mandates.pdf

This information is also depicted visually on a map of the United States. To access the map, go to:
http://www.immunize.org/laws/tdap.pdf 


HEPATITIS A VACCINATION
Texas: On March 5, the executive commissioner of HHS approved a revision to the state's administrative code that requires evidence of 2 doses of hepatitis A vaccine for students entering kindergarten. The requirement goes into effect on August 1; it will phase into higher grades, leading up to grade 12 by SY 2021-22.

IAC has compiled a chart of information about all states that have hepatitis A prevention mandates for day care and school attendance. To access the information, go to:
http://www.immunize.org/laws/hepa.asp


MEASLES-MUMPS-RUBELLA (MMR) VACCINATION
Texas: On March 5, the executive commissioner of HHS approved a revision to the state's administrative code that requires evidence of 2 doses of MMR vaccine for students entering kindergarten. The requirement goes into effect on August 1; it will phase into higher grades, leading up to grade 12 by SY 2021-22.

CDC has compiled a chart of information about all states that require 2 doses of measles-containing vaccine for kindergarten entry. To access the information, go to:
http://www.immunize.org/laws/mmr_kinder_2nddose.pdf Note: the information is current for SY 2007-08; CDC has not yet updated it for SY 2009-10.


VARICELLA VACCINATION
Texas: On March 5, the executive commissioner of HHS approved a revision to the state's administrative code that requires evidence of 2 doses of varicella vaccine for students entering either kindergarten or grade 7 (disease history of chickenpox may be substituted for varicella vaccine). The requirement goes into effect on August 1; it will phase into higher grades, leading up to grade 12 by SY 2014-15.

IAC has compiled a chart of information about all states that require 2 doses of varicella vaccine for child care and school attendance. To access the information, go to:
http://www.immunize.org/laws/var2_mandates.pdf

This information is also depicted visually on a map of the United States. To access the map, go to:
http://www.immunize.org/laws/vari_two.pdf


PHARMACIST AUTHORIZATION TO VACCINATE
Maine: On June 9, the governor signed legislation that will allow licensed pharmacists to administer certain drugs and vaccines.

IAC has compiled a chart of information about all states that authorize pharmacists to administer vaccinations. To access the information, go to:
http://www.immunize.org/laws/#pharm

This information is also depicted visually on a map of the United States. To access the map, go to:
http://www.immunize.org/pdfs/pharm.pdf


WANT MORE INFORMATION ON STATE IMMUNIZATION MANDATES?
To access more information about state mandates, visit our State Mandates on Immunization and Vaccine-Preventable Diseases web section at http://www.immunize.org/laws

IAC Express depends on readers to help us stay informed and ensure our website contains the most current and accurate information available. Please let us know when any changes occur in your state by emailing us at admin@immunize.org

The CDC website has a section of resources on immunization requirements for school attendance, healthcare workers, patients in various healthcare settings, and residents of various institutional settings. Among the resources is a searchable database on state immunization laws. To access this section of resources, go to:

http://www.cdc.gov/vaccines/vac-gen/laws/default.htm

On July 20, FDA issued a press release announcing that it has approved the vaccine for 2009-10 seasonal influenza. A portion of it is reprinted below.

Editor's note: The press release includes the brand names of the six vaccines approved for use during the 2009-10 seasonal influenza season. At the end of this IAC Express article, readers will find links to IAC's package inserts web page for the 2009-10 live attenuated influenza vaccine (LAIV) and 2009-10 trivalent inactivated influenza vaccines (TIV; injectable).

To access IAC's index page of package inserts for 25 vaccine, go to:
http://www.immunize.org/packageinserts

[The following is cross posted from the "More News & Summaries" section of CDC's Immunization Works electronic newsletter, July 2009.]

NOVEL H1N1 INFLUENZA UPDATE: CDC estimates that there have been at least one million cases of novel H1N1 influenza in the United States. CDC's goals during this public health emergency are to reduce transmission and illness severity, and to provide information to assist healthcare providers, public health officials, and the public in addressing the challenges posed by this newly identified influenza virus.

Vaccines are a very important part of a response to pandemic influenza. CDC has isolated the novel H1N1 virus, made a candidate vaccine virus strain that can be used to create vaccine, and has provided this virus to industry so they can begin scaling up for production of a vaccine. It is expected that novel H1N1 influenza vaccine may be available as early as mid-October. On July 8, 2009, CDC issued guidance for state and local public health departments to assist them in planning for a novel H1N1 influenza vaccine campaign (http://www.cdc.gov/h1n1flu/vaccination/statelocal/planning.htm).

For the latest information about the novel Influenza A (H1N1) outbreak and CDC's response, visit CDC's H1N1 influenza website (http://www.cdc.gov/h1n1flu), sign up to receive CDC email updates (https://service.govdelivery.com/service/subscribe.html?code=USCDC_53), subscribe to RSS (http://www.cdc.gov/h1n1flu/rss), or follow CDC Emergency on Twitter (http://twitter.com/cdcemergency).

IAC encourages IAC Express readers to watch a 1-minute video that encourages people to create a 15-, 30-, or 60-second public service announcement (PSA) that will inform and motivate people to take steps that will help prevent the spread of influenza. In the video, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius presents details about the contest rules.

The video will be available on the home page of IAC's website through August 2. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week. 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. To view an IAC Video of the Week from the past, go to the video archive at http://www.immunize.org/votw/jun09.asp

In response to demand, IAC now has a Spanish-language translation of the questions on its padded Screening Questionnaire for Child and Teen Immunization and Screening Questionnaire for Adult Immunization. Printed on the back of the English page, the Spanish page has been added to this product at no additional cost.

The questionnaires give you and your patients a quick, easy, and thorough way to determine if they have contraindications and precautions to vaccination. Patients fill out the questionnaire with yes-or-no answers while waiting to be seen, allowing you to review their responses quickly and be confident you're not missing any contraindications or precautions.

The questionnaires come in convenient tear-off pads of 100 sheets. The price per pad is economical (discounts for two pads or more), so you'll be able to keep pads at the receptionist's desk, the nurse's station, and in every exam room. Each pad comes with four English-language reference sheets (printed on heavy-weight paper) for health professionals.

Prices start at $16 each for one pad and drop to $12 each for two, $11 each for three, and $10 each for four. For quotes on larger quantities or customizing, call (651) 647-9009 or email admininfo@immunize.org

To learn more about the padded screening questionnaires, or to order online or download an order form, visit

Screening Questionnaire for Child and Teen Immunization
http://www.immunize.org/shop/pad_sqchild.asp

Screening Questionnaire for Adult Immunization
http://www.immunize.org/shop/pad_sqadult.asp

IAC's offers other products for sale, including educational videos and personal immunization record cards, at http://www.immunize.org/shop

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

To access the complete July issue from the NCIRD website, go to:
http://www.cdc.gov/vaccines/news/newsltrs/imwrks/2009/200907.htm

On July 22, the National Institutes of Health (NIH) issued a press release, "NIAID Set to Launch Clinical Trials to Test 2009 H1N1 Influenza Vaccine Candidates." Portions of the press release are reprinted below.

To access the complete press release, go to:
http://www.nih.gov/news/health/jul2009/niaid-22.htm

CDC recently posted new or updated information to various sub-sections of its H1N1 Flu web section. Following are the titles and URLs of documents that have been posted since the July 20 issue of IAC Express:

CDC Novel H1N1 Vaccination Planning Q&A [provides answers, to the extent they are now known, on H1N1 influenza vaccine purchase, distribution, allocation, and administration] http://www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm

Questions & Answers: Novel H1N1 Influenza Vaccine http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm

H1N1 Monitoring Questions & Answers [Q&As about CDC's novel H1N1 influenza surveillance] http://www.cdc.gov/h1n1flu/reportingqa.htm

CDC Interim Guidance for People who have Close Contact with Pigs in Non-commercial Settings: Preventing the Spread of Influenza A Viruses, Including the Novel Influenza A (H1N1) Virus http://www.cdc.gov/h1n1flu/guidelines_pig_workers.htm

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

IAC has gathered information related to H1N1 influenza in a single web section at http://www.immunize.org/h1n1

The London-based organization Sense about Science has a downloadable 8-page booklet that healthcare professionals may want to make their patients aware of. Titled "I don't know what to believe . . . making sense of science stories," the booklet explains the peer review process in simple, everyday language. It is intended to help its readers know what to look for in judging the validity of scientific information presented in the mainstream media.

To access the booklet, go to:
http://www.senseaboutscience.org.uk/pdf/ShortPeerReviewGuide.pdf

If your health department, clinic, or practice creates a publication for patients, you may be interested in learning that CDC's online newsroom provides formatted one-page articles at no cost. Intended for use in any publication, the articles present basic information on various health topics, including immunization.

You can get publication-ready articles by following the steps outlined in the three paragraphs that appear under the Get Email Updates subhead on this page:
http://www.cdc.gov/media/subtopic/matte.htm

To review the text and graphic images presented in immunization-specific articles, go to: http://www.cdc.gov/media/subtopic/matte/matteDisease.htm Scroll down and click on the appropriate graphic image.

The National Committee for Quality Assurance (NCQA) is offering a free online continuing education (CE) program, Best Practices in Childhood and Adolescent Immunization. Intended for physicians, registered nurses, pharmacists, and other treating practitioners, the program is approved for 1.5 contact hours.

For additional information, go to:
http://www.ncqa.org/tabid/82/Default.aspx and click on the appropriate graphic image.