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Immunization Action Coalition
IAC Express 2010
Issue number 866: May 10, 2010
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. CDC publishes recommendations for use of combination measles, mumps, rubella, and varicella (MMRV) vaccine
  2. VIS for PCV7 vaccine is temporarily re-posted on CDC's and IAC's websites
  3. CDC announces Hepatitis Awareness Month
  4. CDC reports on the results of California's Adult Hepatitis Vaccine Project during 2007-08
  5. CDC reports on U.S. rotavirus vaccination coverage among infants age 5 months during June 2006-June 2009
  6. Five more healthcare organizations join IAC'S Honor Roll for Patient Safety
  7. Video presents a mother's account of the devastating effects pneumococcal disease had on her children
  8. IAC updates the popular print piece "Are you 11-19 years old?" and two other print pieces
  9. IAC updates its two standing orders for administering hepatitis A vaccine
  10. IAC updates online "Ask the Experts" Q&A section related to rotavirus vaccine
  11. CDC reports on U.S. trends in hepatocellular carcinoma incidence during 2001-06
  12. Turkish translations available for IAC's parent-education piece on hepatitis B vaccination and VIS for PCV13 vaccine
  13. MMWR corrects errors in "Human Rabies--Kentucky/Indiana, 2009," which was published April 9, 2010
 
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 866: May 10, 2010
1.  CDC publishes recommendations for use of combination measles, mumps, rubella, and varicella (MMRV) vaccine

CDC published "Use of Measles, Mumps, Rubella, and Varicella Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" in the May 7 MMWR Recommendations and Reports. The Summary section is reprinted below in its entirety.


This report presents new recommendations adopted in June 2009 by CDC's Advisory Committee on Immunization Practices (ACIP) regarding use of the combination measles, mumps, rubella, and varicella vaccine (MMRV, ProQuad, Merck & Co., Inc.). MMRV vaccine was licensed in the United States in September 2005 and may be used instead of measles, mumps, rubella vaccine (MMR, M-M-RII, Merck & Co., Inc.) and varicella vaccine (VARIVAX, Merck & Co., Inc.) to implement the recommended 2-dose vaccine schedule for prevention of measles, mumps, rubella, and varicella among children aged 12 months-12 years. At the time of its licensure, use of MMRV vaccine was preferred for both the first and second doses over separate injections of equivalent component vaccines (MMR vaccine and varicella vaccine), which was consistent with ACIP's 2006 general recommendations on use of combination vaccines (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55;[No. RR-15]). Since July 2007, supplies of MMRV vaccine have been temporarily unavailable as a result of manufacturing constraints unrelated to efficacy or safety. MMRV vaccine is expected to be available again in the United States in May 2010.

In February 2008, on the basis of preliminary data from two studies conducted postlicensure that suggested an increased risk for febrile seizures 5-12 days after vaccination among children aged 12-23 months who had received the first dose of MMRV vaccine compared with children the same age who had received the first dose of MMR vaccine and varicella vaccine administered as separate injections at the same visit, ACIP issued updated recommendations regarding MMRV vaccine use (CDC. Update: recommendations from the Advisory Committee on Immunization Practices [ACIP] regarding administration of combination MMRV vaccine. MMWR 2008;57:258-60). These updated recommendations expressed no preference for use of MMRV vaccine over separate injections of equivalent component vaccines for both the first and second doses.

The final results of the two postlicensure studies indicated that among children aged 12-23 months, one additional febrile seizure occurred 5-12 days after vaccination per 2,300-2,600 children who had received the first dose of MMRV vaccine compared with children who had received the first dose of MMR vaccine and varicella vaccine administered as separate injections at the same visit. Data from postlicensure studies do not suggest that children aged 4-6 years who received the second dose of MMRV vaccine had an increased risk for febrile seizures after vaccination compared with children the same age who received MMR vaccine and varicella vaccine administered as separate injections at the same visit.

In June 2009, after consideration of the postlicensure data and other evidence, ACIP adopted new recommendations regarding use of MMRV vaccine for the first and second doses and identified a personal or family (i.e., sibling or parent) history of seizure as a precaution for use of MMRV vaccine. For the first dose of measles, mumps, rubella, and varicella vaccines at age 12-47 months, either MMR vaccine and varicella vaccine or MMRV vaccine may be used. Providers who are considering administering MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers. Unless the parent or caregiver expresses a preference for MMRV vaccine, CDC recommends that MMR vaccine and varicella vaccine should be administered for the first dose in this age group. For the second dose of measles, mumps, rubella, and varicella vaccines at any age (15 months-12 years) and for the first dose at age >=48 months, use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR vaccine and varicella vaccine). This recommendation is consistent with ACIP's 2009 provisional general recommendations regarding use of combination vaccines (available at http://www.cdc.gov/vaccines/recs/provisional/downloads/combo-vax-Aug2009-508.pdf), which state that use of a combination vaccine generally is preferred over its equivalent component vaccines.


To access a ready-to-print (PDF) version of the recommendations, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr5903.pdf

To access the recommendations in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm

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2 VIS for PCV7 vaccine is temporarily re-posted on CDC's and IAC's websites

On May 5, CDC's "News about Vaccine Information Statements" web section was updated with this announcement: "PCV7 VIS available temporarily. Due to a groundswell of popular demand, we have re-posted the PCV7 VIS for use by those providers who have not completed the transition to PCV13. It will be available as long as PCV7 supplies are being used. Please use the VIS appropriate to the formulation being administered. Both VISs can be downloaded from the Pneumococcal Conjugate section of CDC's VIS webpage."

IMPORTANT NOTE: IAC also has re-posted the VIS for PCV7 vaccine to its website.

To access the VIS for PCV7 vaccine, go to:
http://www.immunize.org/vis/vis_pcv7.pdf

To access the VIS for PCV13 vaccine, go to:
http://www.immunize.org/vis/vis-pcv.pdf

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3 CDC announces Hepatitis Awareness Month

CDC published "Hepatitis Awareness Month--May 2010" in the May 7 issue of MMWR. It is reprinted below.


May 2010 marks the 15th anniversary of Hepatitis Awareness Month in the United States, and May 19 is World Hepatitis Day. Globally, viral hepatitis is the cause of most (78%) primary liver cancer, the third leading cause of cancer deaths in the world. Prevention of hepatitis B and hepatitis C virus transmission and treatment for early disease can prevent primary liver cancer. This issue of MMWR includes a report describing vaccination of at-risk adults with hepatitis B vaccine in California and a report on continued increases in hepatocellular carcinoma incidence in the United States.

The Institute of Medicine (IOM) recently issued Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and Hepatitis C. The IOM strategy has four components: (1) accurate public health surveillance, (2) innovative approaches to community education, (3) immunization capacity to eliminate hepatitis B virus transmission, and (4) development of viral hepatitis services, including screening with referral for medical management. Taken together, these strategies can reduce morbidity associated with viral hepatitis, including primary liver cancer.

Additional information about viral hepatitis is available at http://www.cdc.gov/hepatitis The IOM report is available at http://www.iom.edu Information about World Hepatitis Day activities is available at http://www.nvhr.org

To access the announcement in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a1.htm

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4 CDC reports on the results of California's Adult Hepatitis Vaccine Project during 2007-08

CDC published " The Adult Hepatitis Vaccine Project--California, 2007-2008 " in the May 7 issue of MMWR. The first paragraph is reprinted below.


Since hepatitis B vaccine was first released in 1981, a public health goal has been to vaccinate adults at risk for infection because of risky sexual behaviors and needle-sharing practices. However, vaccination coverage for this group has remained low. During 2007, in the United States, among the estimated 43,000 persons newly infected with hepatitis B virus (HBV), the highest rate was reported among persons aged 25-44 years, and the majority of these infections were among at-risk adults. Surveillance data were similar in California. In 2006, when the Advisory Committee on Immunization Practices (ACIP) recommended that hepatitis B vaccination be offered to all adults as part of routine prevention services in settings where a high proportion of those served are at increased risk, CDC launched a national initiative encouraging states to use existing federal funds to purchase adult hepatitis B-containing (HepB) vaccine. In response, the California Department of Public Health (CDPH) established the Adult Hepatitis Vaccine Project (AHVP) to expand hepatitis B vaccination in sites serving at-risk adults. This report summarizes results for 2007-2008, which indicated that 28,824 doses of HepB vaccine were administered at 29 participating sites in the first 19 months of AHVP; 13 sites administered HepB vaccine for the first time. Federal provision of vaccine resulted in vaccination of many adults who otherwise might not have been vaccinated against HBV. Increased capacity to vaccinate all adults at risk is needed for the elimination of HBV transmission in the United States.

To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a2.htm

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5 CDC reports on U.S. rotavirus vaccination coverage among infants age 5 months during June 2006-June 2009

CDC published "Rotavirus Vaccination Coverage Among Infants Aged 5 Months--Immunization Information System Sentinel Sites, United States, June 2006-June 2009" in the May 7 issue of MMWR. The first paragraph is reprinted below.


In February 2006, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of all U.S. infants with 3 doses of a pentavalent rotavirus vaccine administered at ages 2, 4, and 6 months. In June 2008, ACIP updated its recommendations to include use of a second rotavirus vaccine, a 2-dose monovalent vaccine, administered at ages 2 and 4 months. The maximum age for the first dose of either rotavirus vaccine (RV) is 14 weeks and 6 days. CDC recently analyzed data from Immunization Information System (IIS) sentinel sites (1) to assess trends in coverage with >=1 dose of RV during June 2006-June 2009 among infants aged 5 months and (2) to compare RV coverage in the second quarter of 2009 with that of two other routinely recommended vaccines for U.S. infants: diphtheria, tetanus, and acellular pertussis (DTaP) vaccine, and 7-valent pneumococcal conjugate vaccine (PCV7). RV coverage increased following vaccine introduction and, in June 2009, averaged 72% at the eight currently participating IIS sentinel sites. However, >=1 dose RV coverage among infants aged 5 months was 13% lower than the average coverage with >=1 dose of DTaP and PCV7 at these same sites. Lower RV coverage could reflect typical new-vaccine coverage dynamics, the presence of RV-specific barriers, or both. Identifying and reducing barriers to vaccination and educating parents and providers about the health benefits of rotavirus vaccination should increase coverage and help prevent severe rotavirus disease.

To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a4.htm

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6 Five more healthcare organizations join IAC'S Honor Roll for Patient Safety

IAC encourages qualifying healthcare organizations to apply for its Honor Roll for Patient Safety. Since April 19, when IAC Express last reported on the Honor Roll for Patient Safety, one public health department (and its associated facilities) and four institutions have enrolled. The honor roll recognizes hospitals, medical practices, professional organizations, and government entities that have taken a stand for patient safety by strengthening mandatory influenza vaccination policies for healthcare workers.

The public health department that has joined since April 19 is Cook County Health & Hospitals System, Oak Park, IL; the institutions are Altru Health, Grand Forks, ND; Davidson HealthCare, Lexington, NC; Emory Healthcare, Atlanta, GA; and Waverly Health, Waverly, IA. The addition of these five organizations brings the total number of enrolled institutions and medical practices to 54.

To be included in the honor roll, an 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.

To find out specific information on the mandates of the enrolled organizations, go to: http://www.immunize.org/honor-roll This web page also includes information about applying to be included on the honor roll.

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7 Video presents a mother's account of the devastating effects pneumococcal disease had on her children

IAC encourages IAC Express readers to watch a 4-minute video developed by PKIDs. It features a mother recounting her daughter's death from pneumococcal disease and her son's hospitalization with the same disease.

The video will be available on the home page of IAC's website through May 16. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week.

Material from the video is available in 30- and 60-second video and audio public service announcements (PSAs). To access the PSAs, go to: http://www.pkids.org/im_videos_pneumo.php

A 2-page transcript is available at
http://pkids.org/transcripts/Pneumococcal%20Disease.pdf

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

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8 IAC updates the popular print piece "Are you 11-19 years old?" and two other print pieces

IAC recently revised the following three print resources.

(1) "Are you 11-19 years old? Then you need to be vaccinated against these serious diseases!" was recently updated to include new recommendations related to human papillomavirus (HPV) vaccine and influenza vaccine.

To access the revised ready-to-print (PDF) piece "Are you 11-19 years old?" go to: http://www.immunize.org/catg.d/p4020.pdf

(2) "Supplies You May Need at a Community Adult Immunization Clinic" (formerly titled "Suggested Supplies Checklist for an Adult Immunization Clinic") was reorganized, and minor content changes were made.

To access the revised "Supplies You May Need at a Community Adult Immunization Clinic," go to: http://www.immunize.org/catg.d/p3047.pdf

(3) "Supplies You May Need at a Community Immunization Clinic" (formerly titled "Suggested Supplies Checklist for a Pediatric and Adult Immunization Clinic") was reorganized, and minor content changes were made.

To access the revised "Supplies You May Need at a Community Immunization Clinic," go to: http://www.immunize.org/catg.d/p3046.pdf

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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9 IAC updates its two standing orders for administering hepatitis A vaccine

IAC recently revised its "Standing Orders for Administering Hepatitis A Vaccine to Children & Teens" and "Standing Orders for Administering Hepatitis A Vaccine to Adults." Both were updated to include new recommendations related to the need for vaccinating contacts of certain international adoptees and the need to consider pregnancy as a precaution for vaccination.

To access the revised ready-to-print (PDF) piece "Standing Orders for Administering Hepatitis A Vaccine to Children & Teens," go to: http://www.immunize.org/catg.d/p3077a.pdf

To access the revised ready-to-print (PDF) piece "Standing Orders for Administering Hepatitis A Vaccine to Adults," go to: http://www.immunize.org/catg.d/p3077.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

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10.  IAC updates online "Ask the Experts" Q&A section related to rotavirus vaccine

IAC's online "Ask the Experts" Q&A section about rotavirus vaccine was recently updated with input from vaccination experts at CDC. IAC's "Ask the Experts" Q&As are reviewed and updated annually. The process is ongoing; IAC Express will inform readers as sections are reviewed and revised.

To access the revised rotavirus Q&As, go to:
http://www.immunize.org/askexperts/experts_rota.asp

To access the index page of "Ask the Experts" Q&As for all other vaccines, go to: http://www.immunize.org/askexperts

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11.  CDC reports on U.S. trends in hepatocellular carcinoma incidence during 2001-06
CDC published "Hepatocellular Carcinoma--United States, 2001-2006" in the May 7 issue of MMWR. The first paragraph is reprinted below.


Liver cancer, primarily hepatocellular carcinoma (HCC), is the third leading cause of death from cancer worldwide and the ninth leading cause of cancer deaths in the United States. Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for an estimated 78% of global HCC cases. To determine trends in HCC incidence in the United States, CDC analyzed data for the period 2001-2006 (the most recent data available) from CDC's National Program of Cancer Registries (NPCR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) surveillance system. This report summarizes the results of that analysis, which determined that the average annual incidence rate of HCC for 2001-2006 was 3.0 per 100,000 persons and increased significantly from 2.7 per 100,000 persons in 2001 to 3.2 in 2006, with an average annual percentage change in incidence rate (APC) of 3.5%. The largest increases in HCC incidence rates were among whites (APC = 3.8), blacks (APC = 4.8), and persons aged 50-59 years (APC = 9.1). Among states, HCC incidence rates varied widely, ranging from 1.4 per 100,000 in South Dakota to 5.5 in Hawaii. The results demonstrate a continuation of long-term increases in HCC incidence and persistent HCC racial/ethnic disparities. Development of viral hepatitis services, including screening with care referral for persons chronically infected with HBV or HCV, full implementation of vaccine-based strategies to eliminate hepatitis B, and improved public health surveillance are needed to help reverse the trend in HCC.

To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a3.htm

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12.  Turkish translations available for IAC's parent-education piece on hepatitis B vaccination and VIS for PCV13 vaccine

Updated in March 2010, IAC's parent-education piece "Hepatitis B shots are recommended for all new babies" is now available in Turkish, as is the VIS for pneumococcal conjugate vaccine (PCV13), which is dated 4/16/10. IAC gratefully acknowledges Dr. Mustafa Kozanoglu for the translations.

To access the Turkish version of "Hepatitis B shots are recommended for all new babies," go to: http://www.immunize.org/catg.d/p4110-21.pdf

To access the English version of "Hepatitis B shots are recommended for all new babies", go to: http://www.immunize.org/catg.d/p4110.pdf

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

To access the Turkish translation of the VIS for PCV 13 vaccine, as well as this VIS in English, go to: http://www.immunize.org/vis/vis_pcv.asp Click on the pertinent languages.

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

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13.  MMWR corrects errors in "Human Rabies--Kentucky/Indiana, 2009," which was published April 9, 2010

CDC published " Errata: Vol. 59, No. 13" in the May 7 issue of MMWR. It is reprinted below.


In the report "Human Rabies--Kentucky/Indiana, 2009," an error occurred in the third sentence of the fourth paragraph on page 395. The sentence should read, "Ample use of a 10% solution of bleach for disinfection is recommended both during and after the procedure to ensure decontamination of all exposed surfaces and equipment." In addition, the fifth bulleted item in the box on page 396 should read, "Use ample amounts of a 10% solution of bleach during and after the procedure to ensure decontamination of all exposed surfaces and equipment."

To access errata in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5917a8.htm

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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.