On October 21, Merck posted a letter to healthcare providers on its website stating that on the counsel of ACIP and other advisors, the company has decided not to resume production of its monovalent measles, mumps, and rubella vaccines. A portion of the letter is reprinted below.

In a related move, CDC posted "Q&As about Monovalent M-M-R Vaccines" on its Vaccines Shortages & Delays web page. A link to the Q&As is given at the end of this IAC Express article.

To access "Q&As about Monovalent M-M-R Vaccines," go to:
http://www.cdc.gov/vaccines/vac-gen/Shortages/mmr-faq-12-17-08.htm

On October 23, FDA issued a press announcement titled " FDA Authorizes Emergency Use of Intravenous Antiviral Peramivir for 2009 H1N1 Influenza for Certain Patients, Settings." Portions of the press announcement are reprinted below.

In a related move, CDC posted Q&As about Peramivir for healthcare providers. A link to the Q&As is given at the end of this IAC Express article.

To access "Peramivir IV Questions and Answers for Healthcare Providers, go to:
http://www.cdc.gov/h1n1flu/EUA/pdf/peramivir_qa.pdf

CDC published "Announcement: World Pneumonia Day--November 2, 2009" in the October 30 issue of MMWR. The announcement is reprinted below in its entirety. Articles #4 and #14 in this issue of IAC Express have additional information on global childhood pneumococcal disease and World Pneumonia Day.

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

IAC encourages IAC Express readers to watch a 4-minute video created by the Global Alliance for Vaccines and Immunization (GAVI Alliance). The video gives viewers a front-line look at the fight to protect children from pneumococcal disease using the first vaccine to be specifically designed for the developing world.

The video will be available on the home page of IAC's website through November 8. 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!

To learn more about pneumococcal disease and World Pneumonia Day, go to:
http://worldpneumoniaday.org

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

CDC recently added or updated the following H1N1 influenza information for healthcare professionals.

Use of Influenza A (H1N1) 2009 Monovalent Influenza Vaccine in Pregnant Women
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/ucm188099.htm

Influenza A (H1N1) 2009 Monovalent Vaccine Dosage Chart
http://www.cdc.gov/h1n1flu/pdf/monovalent_vaccine_dosage_chart.pdf

Prevention Of Pneumococcal Infections Secondary To Seasonal And 2009 H1N1 Influenza Viruses Infection
http://www.cdc.gov/h1n1flu/vaccination/provider/provider_pneumococcal.htm

Questions and Answers: Emerging Infectious Diseases (EID) article "Estimates of the Prevalence of Pandemic (H1N1) 2009, United States, April-July 2009"
http://www.cdc.gov/h1n1flu/eid_qa.htm

Peramivir IV Questions and Answers for Healthcare Providers
http://www.cdc.gov/h1n1flu/EUA/pdf/peramivir_qa.pdf

CMS Free Care Rule for 2009 H1N1 Influenza Vaccination

Questions and Answers: NEJM article "Hospitalized Patients with 2009 H1N1 Influenza in the United States--April-June 2009"
http://www.cdc.gov/h1n1flu/njem_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 easy 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

CDC recently made a slight revision and posted its Influenza Vaccination Record card on the "2009 H1N1 Flu: Free Resources" section of its website. The card previously was not available on the CDC website.

The printed version of the record card is packaged in bundles of 100 and included with other ancillary supplies that accompany each shipment of 100 doses of H1N1 vaccine. Healthcare providers have discovered that more cards are sometimes needed to compensate for the additional doses necessary when children younger than age 3 years are given the recommended 0.25 mL dose of FluZone from the 5.0 mL vial, rather than the 0.5 mL dose that older persons are given.

The card has space for healthcare providers to record information for both H1N1 and seasonal influenza vaccine. This allows providers who are administering only seasonal vaccine to use the card to give their patients a record of seasonal vaccination.

The online version of the record card can be printed on an office printer or taken to a photocopy store. The link to a PDF version of the card suitable for printing 6 cards to a page, as well as instructions for use of the card, can be found at http://www.cdc.gov/h1n1 Scroll down and click on a hyperlink titled Free Resources. When you are on the Free Resources web page, scroll down to the item titled "2009-10 Influenza Vaccination Record Card--October 30, 2009."

The card is also available on the website of the National Influenza Vaccine Summit. For detailed information about the card, including printing instructions, go to the paragraphs under the subtitle "Influenza Vaccination Record card" at
http://www.preventinfluenza.org/profs_strategies.asp#record

To access a ready-to-print PDF version of the card directly from the Summit's website, go to:
http://www.preventinfluenza.org/flu_record_card_2009.pdf

CDC advises healthcare professionals that during the current outbreak of novel influenza A (H1N1), all people who have existing indications for pneumococcal polysaccharide vaccine (PPSV) should be vaccinated according to current ACIP recommendations. This is important because people with existing indications are not only at increased risk for pneumococcal disease, but are also at increased risk for serious complications from influenza.

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

Also recently, CDC issued a comprehensive document on the subject, "Prevention of pneumococcal infections secondary to seasonal and 2009 H1N1 influenza virus infection." To access it, go to:
http://www.cdc.gov/h1n1flu/vaccination/provider/provider_pneumococcal.htm

If your healthcare setting is vaccinating a lot more people than usual because of H1N1 influenza, this is a great time for your staff to review the recommended immunization techniques shown in the video Immunization Techniques: Safe, Effective, Caring. This popular and highly lauded 35-minute video offers healthcare providers a way to train their staff--quickly, effectively, and affordably (only $10.50 for each DVD or VHS ordered).

Developed in 2001 by the California Department of Health Services Immunization Branch in collaboration with a team of national experts, the video teaches best practices for administering intramuscular (IM) and subcutaneous (SC) vaccines to infants, children, and adults. PLEASE NOTE however, that because the video was released in 2001, it does NOT provide instruction on administering the nasal-spray influenza vaccines or the oral rotavirus vaccines. These vaccines were licensed after 2001.

Available in DVD and VHS formats, the video is designed for use as a "hands-on" instructional program for new staff, as well as a refresher course for experienced healthcare professionals. It discusses the following:

• Anatomic sites
• Choice of needle size
• Vaccines and routes of administration
• Demonstrations of infants, toddlers, kindergartners, and adults being vaccinated
• How to "draw up" doses of vaccine

TO ORDER OR FOR ADDITIONAL INFORMATION. The cost is $10.50 per copy of the DVD or VHS.

For additional information about the DVD, or to order online or to download an order form, visit
http://www.immunize.org/shop/toolkit_iztechdvd.asp

For additional information about the VHS, or to order online or to download an order form, visit
http://www.immunize.org/shop/toolkit_iztechvhs.asp

Since October 19, when IAC Express last reported on the Honor Roll for Patient Safety, seven medical practices and two hospitals have enrolled. The honor roll recognizes medical practices, hospitals, professional organizations, and government entities that have taken a stand for patient safety by strengthening mandatory influenza vaccination policies for healthcare workers.

Vaccination is one of the most effective ways to prevent influenza transmission in healthcare settings, but U.S. healthcare worker influenza vaccination rates have only reached 50 percent. Key elements of the stronger policies that have recently been initiated in some healthcare settings are the inclusion of barrier measures to prevent influenza transmission and the discontinuation of policies that allowed workers to exempt themselves from influenza vaccination because of their personal beliefs.

The seven medical practices that have joined since October 19 are Affiliates in Medical Specialties Medical Group, West Hills, CA; Agape Outreach, Arlington, TX; Hometown Home Health, Tulsa and Oklahoma City, OK; Longs Peak Family Practice, Longmont, CO; NewYork-Presbyterian Hospital, NY; Open Door Family Medical Centers, NY; and Woodcreek Healthcare, Bonney Lake and Puyallup, WA.

The newly enrolled hospitals are Johns Hopkins Health System, MD; and Spectrum Health Hospitals, Grand Rapids, MI.

To find out specific information on the mandates of these organizations and previously enrolled organizations, go to:
http://www.immunize.org/laws/influenzahcw.asp

JOIN THE HONOR ROLL TODAY
To be included in the honor roll, your organization's mandate must require influenza vaccination for employees and must include serious measures to prevent transmission of influenza from unvaccinated workers to patients. Such measures might include a mask requirement, reassignment to non-patient-care duties, or dismissal of the employee.

Fill out this online form to tell IAC about influenza vaccination mandates in your healthcare setting:
http://www.immunize.org/laws/mandates.aspx

On October 22, the American Medical Association (AMA) issued a press release titled "AMA Launches Nation's First Comprehensive Web-Based Flu Health-Assessment Program for Patients and Physicians." A portion of the press release is reprinted below. A link to the health-assessment program, called AMAfluhelp.org, is given at the end of this IAC Express article.

To access the AMAfluhelp.org health-assessment program directly, go to:
https://www.amafluhelp.org/public/consumer/home.aspx

The IMD Aware Coalition will host a teleconference for healthcare professionals on November 17 at 11AM ET. "IMD" is the abbreviation for Infant Meningococcal Disease, a potentially fatal bacterial infection that CDC estimates affects 1,000-3,000 U.S. infants each year.

Speakers include Mathuram Santosham, MD, MPH, FAAP, Johns Hopkins Bloomberg School of Public Health; Jennifer Shu, MD, FAAP, American Academy of Pediatrics; Mary Beth Koslap-Petraco, DNC, PNP-BC, CPNP, National Association of Pediatric Nurse Practitioners; Jerome Klein, MD, FAAP, National Foundation for Infectious Diseases; Frankie Milley, Meningitis Angels; and Lynn Bozof, National Meningitis Foundation.

To register for the November 17 event, go to:
http://www.videonewswire.com/event.asp?id=63078

If you're wondering if you should continue to vaccinate against seasonal influenza now that H1N1 influenza vaccine has become 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, supplies are expected to catch up to demand.

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

With vaccination against 2009 H1N1 influenza underway, it is important to remember that seasonal influenza vaccination efforts must continue. To aid in these efforts, the Immunization Action Coalition is inviting IAC Express readers to place orders now for the National Influenza Vaccine Summit's 2009-10 Seasonal Influenza Vaccination Pocket Information Guides. They're free!

These laminated, 3.75 x 6.75-inch, 2-color cards serve as a convenient reference for front-line healthcare professionals who vaccinate patients. The cards provide the following information:

• Indications, contraindications, and precautions for the injectable and intranasal seasonal influenza vaccines
   
• Populations targeted for seasonal influenza vaccination
   
• Dosage and route of administration for all the various seasonal influenza vaccine products
   
• Talking points for discussing seasonal influenza vaccination with patients

See an image of the seasonal influenza vaccine pocket guide at
http://www.preventinfluenza.org/fluguide/pocketguide_flu.pdf

These pocket guides also serve as a reminder to keep giving seasonal influenza vaccine throughout the influenza season (through the spring months).

The Summit is also pleased to be able to offer pocket guides for the administration of pneumococcal polysaccharide vaccine (PPSV). See an image of the PPSV pocket guide at
http://www.immunize.org/ppvguide/pocketguide.pdf

Each of these pocket guides is designed to be used by healthcare professionals only; THEY ARE NOT PATIENT HANDOUTS.

HOW TO ORDER
Each order must be for a minimum of 100 pocket guides. Place your order at http://www.preventinfluenza.org/pocketguides There is no cost for the pocket guides, shipping, or handling within the U.S. Quantities are limited, so to avoid disappointment, place your order today!

If you have questions, email admininfo@immunize.org

BACKGROUND
These pocket guides were developed by, and are being provided under the sponsorship of the National Influenza Vaccine Summit, http://www.preventinfluenza.org The Summit brings together public and private stakeholders to facilitate and promote influenza vaccination. The pocket guides are also distributed by many major medical, nursing, and pharmacist organizations, specialty societies, state health departments, Indian Health Service Area facilities, Quality Improvement Organizations, Visiting Nurse Associations, community vaccinators, and many others.

Thanks for your dedication to immunization, and don't forget to keep vaccinating against seasonal influenza through the spring months!

To draw attention to the plight of the 2 million children worldwide who die each year from pneumococcal disease, and in observance of World Pneumonia Day, GiveVaccines.org will donate all proceeds during the month of November to the Global Coalition Against Child Pneumonia and the World Pneumonia Day Coalition. Based in Orange, CA, GiveVaccines.org is a non-profit organization that administers a "free vaccines" vocabulary game.

All net proceeds from advertising revenues will be donated to the GAVI Alliance and other organizations for the purchase of life-saving vaccines. It is estimated that a typical vaccine to prevent pneumonia will cost approximately $0.15, which equates to 150 accumulative correct answers on GiveVaccines.org. The whole idea of the interactive vocabulary quiz is to have fun, expand one's vocabulary, and at the same time provide the funds to purchase live-saving vaccines for those in need.

Be sure to visit http://www.givevaccines.org as often as you can and enjoy the vocabulary challenge.

For more information about GiveVaccines.org, go to:
http://www.givevaccines.org/about.php

Dated 10/2/09, the VISs for 2009 H1N1 inactivated influenza vaccine (injectable) and 2009 H1N1 live attenuated influenza vaccine (nasal spray) are now available in Hmong, Somali, and Turkish. IAC gratefully acknowledges the Minnesota Department of Health for the Hmong and Somali translations and Dr. Mustafa Konzanoglu and Dr. Murat Serbest for the Turkish translations.

VISs FOR THE INJECTABLE 2009 H1N1 INFLUENZA VACCINE

To access the Hmong version of the VIS for the injectable 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/hm_h1n1_inact.pdf

To access the Somali version of the VIS for the injectable 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/so_h1n1_inact.pdf

To access the Turkish version of the VIS for the injectable 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/tu_h1n1_inact.pdf

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

NOTE: The VIS for injectable 2009 H1N1 influenza vaccine comes in additional languages, including Spanish. To access them, go to:
http://www.immunize.org/vis/vis_h1n1_inactive.asp Click on the link to the pertinent language.

VISs FOR THE NASAL-SPRAY 2009 H1N1 INFLUENZA VACCINE

To access the Hmong version of the VIS for the nasal-spray 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/hm_h1n1_live.pdf

To access the Somali version of the VIS for the nasal-spray 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/so_h1n1_live.pdf

To access the Turkish version of the VIS for the nasal-spray 2009 H1N1 influenza vaccine, go to:
http://www.immunize.org/vis/tu_h1n1_live.pdf

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

NOTE: The VIS for nasal-spray 2009 H1N1 influenza vaccine comes in additional languages, including Spanish. To access them, go to:
http://www.immunize.org/vis/vis_h1n1_live.asp Click on the link to the pertinent language.

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

The Department of Health and Human Services' proposed Healthy People 2020 objectives are now available online for public comment. Healthy People provides science-based, 10-year national objectives for promoting health and preventing disease.

To read the proposed Healthy People 2020 objectives by topic, go to:
http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.aspx

To access the public comment database, and to submit your comments, go to:
http://www.healthypeople.gov/hp2020/Comments

For comprehensive information about Healthy People, go to:
http://www.healthypeople.gov