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Immunization Action Coalition
IAC Express 2009
Issue number 826: October 5, 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. At long last--the VISs for injectable and nasal spray 2009 H1N1 influenza vaccine are now online
  2. Standing Orders for Administering Influenza A (H1N1) 2009 Monovalent Vaccines now available
  3. AAP publishes policy statement on the prevention and control of influenza in children
  4. CDC publishes a report on bacterial coinfections from fatal cases of 2009 pandemic influenza A (H1N1)
  5. CDC issues a Health Alert Network message about updated pediatric antiviral dosing syringe and compounding information for 2009 H1N1 and seasonal influenza
  6. HHS publications and web sections make it easy to educate patients about protecting themselves and their families against influenza
  7. Keep vaccinating against seasonal influenza!
  8. IAC's Video of the Week features Angelique Kidjo talking about UNICEF's campaign to eliminate maternal and neonatal tetanus
  9. CDC adds interim recommendations for clinical use of influenza diagnostic tests to its H1N1 web section
  10. CDC reports on influenza vaccination coverage among children ages 6 months-18 years during the 2008-09 influenza season
  11. CDC reports on influenza vaccination coverage among children ages 6-23 months during the 2007-08 influenza season
  12. IAC updates four print pieces that answer the public's questions about measles, mumps, rubella, and meningococcal
  13. October issue of CDC's Immunization Works electronic newsletter recently released
  14. IAC's padded screening questionnaires for contraindications now have English on the front, Spanish on the back--a popular translation at no added cost!
  15. "Vote and Vax" helps local public health agencies provide influenza vaccines at or near polling places on Election Day
  16. WHO issues position paper on hepatitis B vaccines
  17. 2009 Influenza Congress USA is scheduled for November 18-20 in Washington, DC
  18. It's Get Smart About Antibiotics Week--CDC has lots of information for health professionals and the public
 
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 826: October 5, 2009
1.  At long last--the VISs for injectable and nasal spray 2009 H1N1 influenza vaccine are now online

Dated 10/2/09, the VISs for inactivated (injectable) and live attenuated (nasal spray) 2009 H1N1 influenza vaccine are now available in English only. Important note: Spanish versions are not yet available. IAC Express will notify readers when versions in Spanish and other languages become available.

To access the VIS for injectable 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/h1n1_inactiveflu.pdf

To access the VIS for nasal spray 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/h1n1_liveflu.pdf

The VISs for seasonal influenza were released on August 11.

To access the VIS for seasonal injectable TIV in English, Spanish, Portuguese, Turkish, or Thai, go to:
http://www.immunize.org/vis/vis_flu_inactive.asp

To access the VIS for seasonal nasal spray LAIV in English, Spanish, or Portuguese, go to:
http://www.immunize.org/vis/vis_flu_live.asp

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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2 Standing Orders for Administering Influenza A (H1N1) 2009 Monovalent Vaccines now available

States are now or soon will be receiving influenza A (H1N1) monovalent vaccines. IAC has just developed a new print piece, "Standing Orders for Administering Influenza A (H1N1) 2009 Monovalent Vaccines."

The piece has information about administering both the H1N1 inactivated vaccine (injectable) and the H1N1 live, attenuated (nasal spray) vaccine. It is intended for use in vaccinating people as recommended by CDC.

To access "Standing Orders for Administering Influenza A (H1N1) 2009 Monovalent Vaccines," dated 10/09, go to:
http://www.immunize.org/catg.d/p3074b.pdf

To access a table with links to all IAC's standing orders protocols for vaccine administration and medical management of vaccine reactions, as well as standing orders for newborn-nursery hepatitis B vaccination, go to:
http://www.immunize.org/standingorders

IAC's Print Materials web section offers healthcare professionals and the public approximately 250 FREE English-language materials (many also available in translation), which we encourage website users to print out, copy, and distribute widely. To access all of IAC's free print materials, go to:
http://www.immunize.org/printmaterials

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3 AAP publishes policy statement on the prevention and control of influenza in children

On October 4, the American Academy of Pediatrics (AAP) published a policy statement in Pediatrics titled "Recommendations for the Prevention and Treatment of Influenza in Children, 2009-2010."

The purpose of the statement is to update current recommendations for routine use of trivalent seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children.

To access the statement in web-text (HTML) format, go to:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;124/4/1216

To access a ready-to-print (PDF) version of the statement, go to:
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;124/4/1216

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4 CDC publishes a report on bacterial coinfections from fatal cases of 2009 pandemic influenza A (H1N1)

CDC published "Bacterial Coinfections in Lung Tissue Specimens from Fatal Cases of 2009 Pandemic Influenza A (H1N1)--United States, May-August 2009" in the October 2 issue of MMWR. The first paragraph and a portion of the Editorial Note are reprinted below. On September 30, CDC issued a related press release. A link to it is available at the end of this IAC Express article, as is a link to CDC's document titled "Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak."


In previous influenza pandemics, studies of autopsy specimens have shown that most deaths attributed to influenza A virus infection occurred concurrently with bacterial pneumonia, but such evidence has been lacking for 2009 pandemic influenza A (H1N1). To help determine the role of bacterial coinfection in the current influenza pandemic, CDC examined postmortem lung specimens from patients with fatal cases of 2009 pandemic influenza A (H1N1) for bacterial causes of pneumonia. During May 1-August 20, 2009, medical examiners and local and state health departments submitted specimens to CDC from 77 U.S. patients with fatal cases of confirmed 2009 pandemic influenza A (H1N1). This report summarizes the demographic and clinical findings from these cases and the laboratory evaluation of the specimens. Evidence of concurrent bacterial infection was found in specimens from 22 (29%) of the 77 patients, including 10 caused by Streptococcus pneumoniae (pneumococcus). Duration of illness was available for 17 of the 22 patients; median duration was 6 days (range: 1-25 days). Fourteen of 18 patients for whom information was available sought medical care while ill, and eight (44%) were hospitalized. These findings confirm that bacterial lung infections are occurring among patients with fatal cases of 2009 pandemic influenza A (H1N1) and underscore both the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza.
 . . .

[From the Editorial Note]
The most common bacteria found in patients described in this report were S. pneumoniae. This infection was documented in 10 of the 22 patients. Although no data were available on the vaccination status of the 22 patients, one patient was aged <5 years and was therefore a candidate for pneumococcal conjugate vaccine, and 15 others had underlying medical conditions that were indications for PPSV23 vaccine. Persons at greatest risk for invasive pneumococcal disease include young children, older adults, and persons of any age with certain conditions, including chronic lung or cardiovascular disease and immunosuppressive conditions. All children aged <5 years should receive pneumococcal conjugate vaccine according to current Advisory Committee on Immunization Practices (ACIP) recommendations. In addition, PPSV23 is recommended for all persons aged 2-64 years with certain health conditions and all persons aged >=65 years. Available vaccination coverage data indicate that only a small proportion of persons aged 2-64 years in the United States who are recommended by ACIP to receive pneumococcal vaccine have received the vaccine. One study indicated that only 16% of persons aged 18-49 years with indications for PPSV23 vaccine had received the vaccine. Because of the higher rates of 2009 pandemic H1N1 illness and death among persons aged 2-64 years, providers should target persons in this group who have existing ACIP indications for PPSV23 to receive the vaccine.

The findings in this report also underscore the importance of managing patients with influenza who also might have bacterial pneumonia with both empiric antibacterial therapy and antiviral medications. In addition, public health departments should encourage the use of pneumococcal vaccine, seasonal influenza vaccine, and, when the vaccine becomes available, pandemic influenza A (H1N1) 2009 monovalent vaccine.


To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5838a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5838.pdf

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

To access the related press release, go to:
http://www.cdc.gov/media/pressrel/2009/r090930.htm

To access CDC's "Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak," go to:
http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm

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5 CDC issues a Health Alert Network message about updated pediatric antiviral dosing syringe and compounding information for 2009 H1N1 and seasonal influenza

On September 25, CDC's Health Alert Network (HAN) issued an Info Service Message titled "Updated Pediatric Antiviral Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu." A portion of the message is reprinted below. A link to the complete message, which contains many useful references, is given at the end of this IAC Express article, as is a link to the FDA document "FDA Public Health Alert: Potential Medication Errors with Tamiflu for Oral Suspension." The FDA document includes a dosing chart based on the weight of pediatric patients age 1 year and older.


BACKGROUND
As of September 25, 2009, influenza activity is increasing in the United States with 26 states reporting widespread influenza activity. So far, ninety-nine percent of all subtyped influenza viruses being submitted to CDC are 2009 influenza A (H1N1) viruses.

The current situation will likely affect pharmacies as a greater number of people than usual seek to fill prescriptions for influenza antiviral drugs or antibiotics to treat secondary bacterial infections, in addition to seeking advice on over-the-counter flu medications. This may affect supplies and availability of antiviral medications and other materials that may be needed to fill prescriptions.

Pharmacists and physicians who care for pediatric patients should be aware of two issues: (1) the possible need to compound Tamiflu on site if commercially manufactured pediatric oral suspension formulation is not available, and (2) the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match.

These situations are addressed in the updated interim recommendations issued by CDC on September 22, 2009, for the use of antivirals in the treatment and prevention of influenza which can be found at http://www.cdc.gov/H1N1flu/recommendations.htm and in the 2009-2010 Influenza Season: Information for Pharmacists available at
http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm

ALTERNATIVES TO TAMIFLU ORAL SUSPENSION FOR PEDIATRIC PATIENTS
If pediatric formulations of Tamiflu are not available, pharmacists may compound Tamiflu 75 mg capsules into an oral suspension onsite. For the FDA-approved instructions for the emergency compounding of an oral suspension from Tamiflu 75mg capsules, see the FDA approved manufacturer package insert for oseltamivir (Tamiflu), available on the FDA Web site at
http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM147992.pdf

Compounding an oral suspension from Tamiflu 75mg capsules provides an alternative when commercially manufactured oral suspension formulation is not readily available. Tamiflu capsules 75 mg may be compounded using either of two vehicles: Cherry Syrup (Humco) or Ora-Sweet SF (sugar-free) (Paddock Laboratories). Other supplies needed to compound include mortar and pestle and amber glass or amber polyethyleneterephthalate (PET) bottle.

NOTE ON TAMIFLU ORAL SUSPENSION SYRINGE
The second issue that pharmacists and physicians may face is the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match. An oral dosing dispenser with 30 mg, 45 mg, and 60 mg graduations of Tamiflu is provided in the packaging for the manufacturer's product rather than graduations in milliliters (mL) or teaspoons (tsp). This can lead to patient or caregiver confusion and dosing errors. When dispensing commercially manufactured Tamiflu oral suspension, pharmacists should ensure the units of measure on the dosing instructions match the dosing device provided. If prescription instructions specify administration using mL or tsp, then the device included in the Tamiflu product package should be removed and replaced with an appropriate measuring device, such as an oral syringe if the prescribed dose is in milliliters (mL). When dispensing Tamiflu oral suspension for children younger than 1 year of age, the oral dosing dispenser that is included in the product package should always be removed. Pharmacists and health care providers should provide an oral syringe that is capable of accurately measuring the prescribed milliliter (mL) dose, and counsel the caregiver how to administer the prescribed dose. Oseltamivir is authorized for emergency use in children younger than 1 year of age under an Emergency Use Authorization (EUA) issued by FDA. For the EUA, see
http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-hcp.pdf .
 . . .


To access the entire HAN message, go to:
http://www.cdc.gov/h1n1flu/HAN/092509.htm

To access the FDA public health alert, go to:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm183649.htm

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6 HHS publications and web sections make it easy to educate patients about protecting themselves and their families against influenza

The U.S. Department of Health and Human Services (HHS) influenza website has recently posted a number of attractive, downloadable brochures, fact sheets, and posters on influenza disease and vaccines. Healthcare providers can print these out and use them to educate parents and patients. HHS has also added patient-friendly videos to its website that providers can make patients aware of. Details follow.

FLU ESSENTIALS: WHAT YOU NEED TO KNOW
This is a collection of attractive 1-page information sheets that cover various groups of people (e.g., asthmatics, diabetics, pregnant women) for whom influenza vaccine is recommended. The collection also includes information for the general public.

To access the information sheets in this collection, go to:
http://www.flu.gov/know.html

OF PARTICULAR NOTE: The sheet titled "Emergency Warning Signs" is essential information that every individual, family, work group, church, day care facility, school classroom, or other venue should post prominently. It lists the symptoms--for children and adults--that indicate that medical attention is needed urgently.

To access "Emergency Warning Signs," go to:
http://www.flu.gov/pdfs/emergencywarningsigns.pdf

WWW.FLU.GOV
This website offers information for the media, individuals and families, healthcare professionals, and major institutions (i.e, work places, schools, transportation, hospitals, state and local governments, etc.). In addition to print resources and web pages, the site offers users access to information through a blog, Twitter, FaceBook, YouTube, and recent CDC videos.

To access this website, go to: http://www.flu.gov

CDC'S FREE RESOURCES WEB SECTION
The section on 2009-10 Flu Season Print Materials includes flyers, brochures, and fact sheets, some of which have messages relating to H1N1 influenza as well as to seasonal influenza. New materials this year include two attractive tri-fold brochures, "2009 H1N1 Flu & You" and "CDC Says 'Take 3' Steps to Fight the Flu," and a 2-page information sheet, "2009 H1N1 and Seasonal Flu: What to Do if You Get Sick." All materials are free and downloadable.

To access this web section, go to:
http://www.cdc.gov/flu/freeresources/print.htm

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7 Keep vaccinating against seasonal influenza!

If you're wondering if you should continue to vaccinate against seasonal influenza once H1N1 influenza vaccine becomes available, the answer is YES! The 2009 H1N1 influenza vaccine will not protect people against seasonal influenza, and seasonal influenza vaccine will not protect against H1N1 influenza.

Unfortunately, some healthcare facilities are having difficulty finding available vaccine to purchase. Be assured that though seasonal influenza vaccine may be in temporary short supply in some settings right now, production is expected to catch up to demand soon.

To assist providers in finding seasonal influenza vaccine available for purchase, the National Influenza Vaccine Summit supports IVATS (Influenza Vaccine Availability Tracking System). IVATS provides information about vaccine manufacturers and distributors with vaccine available for purchase. To access this information in Excel spreadsheet format, go to:
http://www.preventinfluenza.org/ivats/ivats_09_10.xls

Many resources regarding influenza disease and vaccination are available to healthcare professionals and the public. Following is a list of some of them.

To access the National Influenza Vaccine Summit website, go to:
http://www.preventinfluenza.org

To access IAC's Seasonal Influenza web section, go to:
http://www.immunize.org/influenza

To access IAC's H1N1 Influenza web section, go to:
http://www.immunize.org/h1n1

To access CDC's Seasonal Flu web section, go to:
http://www.cdc.gov/flu

To access CDC's Novel H1N1 Flu web section, go to:
http://www.cdc.gov/h1n1flu

To access IAC's print pieces related to influenza, including screening questionnaires, patient education pieces, and sample standing orders, go to:
http://www.immunize.org/printmaterials/dis_inf.asp

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8 IAC's Video of the Week features Angelique Kidjo talking about UNICEF's campaign to eliminate maternal and neonatal tetanus

IAC encourages IAC Express readers to watch a highly informative and lively 5-minute video of Angelique Kidjo speaking about growing up in Africa where it was common for her to hear about a post-partum mother and her new born dying after the umbilical cord was cut with a tetanus-tainted knife. Kidjo made the video in her role as UNICEF's goodwill ambassador for the Give the Gift of Life campaign to eliminate maternal and neonatal tetanus.

The video will be available on the home page of IAC's website through October 11. 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

To learn more about UNICEF's Give the Gift of Life campaign and how you can support it, go to:
http://www.unicef.org/immunization/index_51235.html

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9 CDC adds interim recommendations for clinical use of influenza diagnostic tests to its H1N1 web section

On September 29, CDC issued interim recommendations for clinical use of diagnostic tests during the 2009-10 influenza season. The recommendations are intended for the use of clinicians in treating patients with suspected 2009 H1N1 influenza virus infection. They and a related Q&A for healthcare providers are posted at the CDC's H1N1 Flu web section.

"Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season
http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm

Related Q&A
http://www.cdc.gov/h1n1flu/diagnostic_testing_clinicians_qa.htm

CDC's H1N1 Flu web section contains hundreds of documents for healthcare professionals and the public. To access the web section's home page, go to: http://www.cdc.gov/h1n1flu

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

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10.  CDC reports on influenza vaccination coverage among children ages 6 months-18 years during the 2008-09 influenza season

CDC published "Influenza Vaccination Coverage Among Children Aged 6 Months-18 Years--Eight Immunization Information System Sentinel Sites, United States, 2008-09 Influenza Season" in the October 2 issue of MMWR. Portions of the Editorial Note are reprinted below.


Editorial Note:
These data describe vaccination coverage among children aged 6 months-18 years during the 2008-09 influenza season, including all children aged 5-18 years who were not included in ACIP recommendations for influenza vaccination until guidance published in August 2008. Vaccination coverage increased from the 2007-08 season to the 2008-09 season among children aged 6 months-4 years at all eight sentinel sites. Increases have been observed previously at some, but not all, sentinel sites and have not been consistent from season to season. Monitoring influenza vaccination coverage among children aged 6 months-4 years remains important because younger children are at increased risk for influenza-related hospitalizations.

During the 2008-09 influenza season, a greater proportion of children aged 6-23 months were vaccinated late in the season compared with children in all other age groups. Although reasons for this are not clear, children aged 6-23 months likely have more visits to healthcare providers, resulting in more opportunities for influenza vaccination; the later vaccinations also might reflect children in this age group returning for a second influenza vaccine dose.

The 2008-09 influenza season was the first for which influenza vaccination coverage at IIS [Immunization Information System] sentinel sites was assessed among children aged 5-18 years, a group newly recommended for vaccination by ACIP. Coverage was low at all sites in this group, suggesting that vaccine providers had not incorporated annual influenza vaccination into routine preventive measures for healthy children aged 5-18 years. IIS sites might under-ascertain influenza vaccination of older children and adolescents because vaccinations administered at pharmacies, urgent-care clinics, school vaccination clinics, and other sites might be less likely reported to IIS than those administered at healthcare provider offices. School vaccination campaigns have been used in past influenza seasons to increase the number of children receiving vaccine and reduce influenza-related illness. Immunization programs should work with vaccination providers in traditional and complementary settings to ensure that all administered doses are entered into the IIS. . .

Development of a second vaccine recommended for the 2009-10 influenza season, the influenza A (H1N1) 2009 monovalent vaccine, poses a challenge for vaccination providers, particularly with regard to younger children, who might require 2 doses of seasonal influenza vaccine and 2 doses of influenza A (H1N1) 2009 monovalent vaccine to be fully protected. School vaccination clinics and other vaccination sites outside of healthcare provider offices might become increasingly important to maximizing opportunities for older children and adolescents to receive influenza vaccine. State and local immunization programs should identify opportunities in traditional and other settings to administer influenza vaccinations to children and adolescents and should work with vaccination providers to ensure that the doses administered are reported to their IIS. Monitoring IIS data will continue to be an important means of providing rapid assessment of progress toward increasing influenza vaccination coverage for seasonal influenza and 2009 pandemic influenza A (H1N1).


To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5838a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5838.pdf

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11.  CDC reports on influenza vaccination coverage among children ages 6-23 months during the 2007-08 influenza season

CDC published "Influenza Vaccination Coverage Among Children Aged 6-23 months-United States, 2007-08 Influenza Season" in the October 2 issue of MMWR. Portions of the Editorial Note are reprinted below.

Note: Standing orders are one of the strategies CDC endorses to improve influenza vaccination coverage. At the end of this IAC Express aticle, you'll find links to IAC's standing orders protocols for administering seasonal influenza vaccine to children and teens and to adults.


Editorial Note:
This report of influenza vaccination coverage during the 2007-08 influenza season, the fourth season since ACIP recommended routine vaccination for all children aged 6-23 months, indicates the percentage of children receiving >=1 dose increased 28.0% and the percentage fully vaccinated increased 9.9%, compared with the 2006-07 season. However, despite these increases, the percentage of children fully vaccinated remains low (23.4%). Similarly suboptimal influenza vaccination coverage during the 2007-08 season has been reported for other groups, using data from the National Health Interview Survey: 40.3% among children aged 2-4 years, 38.4% among persons aged 50-64 years, 30.4% among persons with high-risk conditions aged 18-49 years, and 24.2% among pregnant women.

Strategies that have been successful at improving influenza vaccination coverage among children include standing orders, vaccination-only visits for children requiring only immunization services, and reminder/recall systems. Severity of the influenza season and the amount of corresponding media attention also have been found to affect parental perceptions and acceptance of vaccine for their children.

In 2007, ACIP recommended that children aged <9 years who received only 1 dose in their first year of vaccination receive 2 doses the following year, with single annual doses in subsequent years. This change in recommendation was based on a study indicating that children aged <9 years who received only 1 dose during their initial year of vaccination and then received 2 doses the following season had better protection against influenza than children who received only 1 dose in each of their first two seasons. Although this change in recommendation increased by 19% the number of children in the NIS sample who were recommended to receive 2 doses, a 9.9% increase in the percentage of children receiving full vaccination was observed from 2006-07 to 2007-08. . .

During the 2009-10 influenza season, children aged 6-23 months are recommended to receive both the seasonal influenza vaccine and influenza A (H1N1) 2009 monovalent vaccine; many children in this age group might require 2 doses of each vaccine. Vaccination providers are encouraged to begin offering doses as soon as vaccine becomes available and to continue vaccination efforts throughout the influenza season. These recommendations are especially important for children who require 2 doses. When possible, providers should use strategies shown to improve vaccination coverage such as reminder/recall systems and standing orders.


To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5838a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5838.pdf

Standing orders protocols
To access IAC's Standing Orders for Administering Seasonal Influenza Vaccines to Children & Adolescents, go to:
http://www.immunize.org/catg.d/p3074a.pdf

To access IAC's Standing Orders for Administering Seasonal Influenza Vaccines to Adults, go to:
http://www.immunize.org/catg.d/p3074.pdf

To access standing orders for administering numerous vaccines to infants, children, adolescents, and adults, and for medical management of vaccine reactions, go to:
http://www.immunize.org/standingorders

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12.  IAC updates four print pieces that answer the public's questions about measles, mumps, rubella, and meningococcal

IAC recently revised four of its Q&A patient-education print pieces: "Measles: Questions and Answers," "Mumps: Questions and Answers," "Rubella: Questions & Answers," and "Meningococcal: Questions & Answers." All were updated to incorporate changes recently made in vaccine recommendations.

The revised pieces are ready-to-print versions 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.

Measles
To access the revised ready-to-print (PDF) print piece "Measles: Questions and Answers," go to:
http://www.immunize.org/catg.d/p4209.pdf

Mumps
To access the revised ready-to-print (PDF) print piece "Mumps: Questions and Answers," go to:
http://www.immunize.org/catg.d/p4211.pdf

Rubella
To access the revised ready-to-print (PDF) print piece "Rubella: Questions and Answers," go to:
http://www.immunize.org/catg.d/p4218.pdf

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

For web-text (HTML) versions of these and other fully formatted documents, go to: http://www.vaccineinformation.org and click on the disease. You will be taken to Q&As about each disease and vaccine.

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

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13.  October issue of CDC's Immunization Works electronic newsletter recently released

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


H1N1 AND SEASONAL INFLUENZA UPDATE

STAY INFORMED! Because information surrounding 2009 Pandemic Influenza A (H1N1) is updated frequently, please look to the following websites for the most up-to-date information:

VACCINE SUPPLY UPDATE: Current estimates for seasonal flu vaccine from manufacturers is 114-115 million doses, which is slightly lower (3%) than, but not substantially changed from, earlier estimates. Slight changes in production estimates are to be anticipated because of the uncertainties involved in making biological products.

H1N1 vaccine production efforts currently under way are being carried out in such a way as to minimize any impact upon the total amount of seasonal vaccine available.

Some providers seeking to order vaccine currently and during the past several weeks have experienced challenges in doing so. Reasons for these challenges include
  • One of the manufacturers adjusted down their seasonal flu vaccine estimates, which resulted in some customers switching prebooks to other products. These switches reserved un-prebooked vaccines that were still available for order, making doses that are normally available for order during the summer and early fall months no longer available.
     
  • There may be more providers seeking to purchase vaccine at this time of year than normally occurs due to (1) recent H1N1 influenza and its coverage in the media that may have increased the demand for seasonal flu vaccination, and (2) a desire to complete seasonal flu vaccination efforts in advance of H1N1 flu vaccination efforts to the extent possible.

RESOURCE: CDC's seasonal influenza web site is now live at http://www.cdc.gov/flu with a new design, the latest information updates, and free resources.


MORE NEWS AND SUMMARIES

UPDATE: VACCINES FOR WOMEN, ADOLESCENCE THROUGH ADULTHOOD:
On August 11, the Journal of Women's Health published an article discussing routine vaccinations of adolescent and adult women. Obstetrician-gynecologists are the primary, and sometimes only, contact with the healthcare system for many adolescent and adult women and, as such, are uniquely positioned to provide vaccination services to the country's female population. Vaccine costs, storage and handling requirements, lack of access to immunization information systems (also known as vaccine registries), and unfamiliarity with current recommendations are potential obstacles to ensuring that all adolescent females and women are appropriately vaccinated. Obstetrician-gynecologists can help reduce some of these obstacles by availing themselves of existing vaccination resources. Please see Journal of Women's Health: Update: Vaccines for Women, Adolescence through Adulthood
http://www.liebertonline.com/doi/abs/10.1089/jwh.2009.1525


MEETINGS, CONFERENCES & RESOURCES

SEASONAL AND H1N1 INFLUENZA ARTICLES AVAILABLE FOR REPRINTING: The Academy for Educational Development (AED) is working with CDC to release a new series of articles covering seasonal and 2009 H1N1 influenza. The articles will detail the seriousness of influenza and explain why vaccination is so important for the indicated groups. The articles, which will be 400-800 words in length, are designed for republication in magazines, newsletters, and on the Web. The articles will be available at no cost and some will be offered in Spanish. For more information, please contact AED's Allison Bozniak at abozniak@aed.org or (202) 884-8374.


NATIONAL INFANT IMMUNIZATION WEEK: An early reminder: National Infant Immunization Week (NIIW) will be held April 24-May 1, 2010. Check the NIIW website (http://www.cdc.gov/vaccines/events/niiw/default.htm) for more details as they become available.


2010 NATIONAL COALITION CONFERENCE: Please mark your calendars for the 9th National Conference on Immunization and Health Coalitions "Strengthening Our Connections" (http://www.ilmaternal.org/ncihc2010.htm). The conference will take place May 26-28, 2010, in Chicago, Illinois. More information will be available in future issues of this publication.


Issues of Immunization Works are posted on CDC's Vaccines & Immunizations website a few days after publication.

To access the October issue, go to: http://www.cdc.gov/vaccines/news/newsltrs/imwrks Click on the link titled "OCT" under the banner titled "2009 Newsletters Available Online."

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14.  IAC's padded screening questionnaires for contraindications now have English on the front, Spanish on the back--a popular translation at no added cost!

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 form, the Spanish form 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 the following:

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

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15.  "Vote and Vax" helps local public health agencies provide influenza vaccines at or near polling places on Election Day

With Election Day coming up on November 3, now is a good time for local public health agencies to start planning to offer influenza vaccine to voters at or near polling places. That's the thinking of the people involved in organizing this year's "Vote & Vax" campaign. Last year's campaign resulted in community health agencies from 42 states administering more than 21,000 influenza vaccinations on Election Day. About half of these were administered to "new" recipients--people who had not been vaccinated in the previous year or would not otherwise have been vaccinated.

Vote & Vax" is a terrific way for vaccination providers to find a new, non-traditional way to deliver influenza vaccine to their community.

To find out how your agency can become involved, go to:
http://www.voteandvax.org/ClinicProviders.aspx

For comprehensive information on "Vote & Vax," go to:
http://www.voteandvax.org

"Vote & Vax" is a national project of The Robert Wood Johnson Foundation in collaboration with SPARC (Sickness Prevention Achieved through Regional Collaboration). This year, the Immunization Coalitions Technical Assistance Network (IZTA) is collaborating on the campaign. IZTA is a program of the Center for Health Communication, Academy for Educational Development.

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16.  WHO issues position paper on hepatitis B vaccines

The October 2 issue of the WHO periodical "Weekly Epidemiological Record" covered the latest WHO position paper on hepatitis B vaccines. To access it, go to:
http://www.who.int/wer/2009/wer8440.pdf

A collection of WHO position papers on vaccines is available in alphabetical order at
http://www.who.int/immunization/documents/positionpapers

They are available in chronological order on the IAC website at
http://www.immunize.org/who

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17.  2009 Influenza Congress USA is scheduled for November 18-20 in Washington, DC

Influenza Congress USA 2009 will be held in Washington, DC, on November 18-20. For comprehensive information, go to:
http://www.terrapinn.com/2009/usaflu

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18.  It's Get Smart About Antibiotics Week--CDC has lots of information for health professionals and the public

CDC published "Announcement: Get Smart About Antibiotics Week--October 5-11, 2009" in the October 2 issue of MMWR. The announcement is reprinted below in its entirety. Note: The link given in the reprinted announcement below will direct you to a wealth of information about appropriate antibiotic use. The information (some of which is in Spanish) is intended for health professionals and the public. A link to a CDC press release titled "Pharmacists Join CDC Efforts in Promoting Appropriate Antibiotic Use" is given at the end of this IAC Express article.


Get Smart About Antibiotics Week is scheduled for October 5-11, 2009. This annual effort coordinates the work of CDC's Get Smart: Know When Antibiotics Work campaign, state-based appropriate antibiotic use campaigns, nonprofit partners, and for-profit partners during a week-long observance focused on antibiotic resistance and the importance of appropriate antibiotic use.

Inappropriate use of antibiotics can promote antibiotic resistance. To reduce the spread of resistance, the Get Smart program urges healthcare providers to avoid prescribing antibiotics to treat viral upper respiratory infections (URIs) and to (1) identify and discuss patient concerns related to URIs, (2) recommend symptomatic therapy for URIs, and (3) prescribe a targeted antibiotic (rather than broad-spectrum) for bacterial infections. Additional information is available at http://www.cdc.gov/getsmart


To access the announcement in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5838a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5838.pdf

To access the CDC press release, go to:
http://www.cdc.gov/media/pressrel/2009/r091001b.htm

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Immunization Action Coalition  •  Saint Paul, MN
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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.