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Immunization Action Coalition
IAC Express 2010
Issue number 877: July 12, 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. Six states expand immunization requirements for school attendance
  2. IAC's "Screening Questionnaire for Child and Teen Immunization" now in Spanish
  3. LOL as rapper "Tdap Vac" and his friends entertain teens with their "Get the Tdap Shot" message
  4. MMWR reports on increase in pertussis cases in California during January-June 2010
  5. A CDC Commentary video on Medscape tells clinicians which people need Tdap vaccination and the value of giving it
  6. Third edition of "The Vaccine Handbook: A Practical Guide for Clinicians" now available
  7. New: MMWR reports can now be accessed on Facebook and Twitter
  8. MMWR publishes report on Nigeria's progress toward poliomyelitis eradication from January 2009 to June 2010
  9. Save the date: Shots for Tots conference planned for October 28-29 in New Orleans
 
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 877: July 12, 2010
1.  Six states expand immunization requirements for school attendance

Alaska, Indiana, Massachusetts, Michigan, Ohio, and Tennessee have recently expanded their immunization requirements for pre-school, school, and/or college attendance. Details follow. [Note: "school year" is abbreviated as SY throughout this IAC Express article.]


BACKGROUND INFORMATION--ACTIONS TAKEN BY THE SIX STATES' LEGISLATIVE OR EXECUTIVE BRANCHES:

  • Alaska: In April 2008, the lieutenant governor filed revisions to the state's regulations governing immunization requirements. Exemptions to the requirements may be granted for medical reasons or if vaccination conflicts with the tenets and practices of the church or religious denomination of which the child is a member.
     
  • Indiana: On May 13, 2009, the governor signed a law requiring that school children receive additional immunization against meningitis, pertussis, and varicella. Exemptions to the requirements may be granted for medical reasons or on religious grounds.
     
  • Massachusetts: On January 8, 2010, regulations were issued that require certain students to receive additional immunization with measles-mumps-rubella (MMR) vaccine, tetanus-diphtheria toxoid and acellular pertussis (Tdap) vaccine, and varicella vaccine. Medical and religious exemptions to the requirements may be granted.
     
  • Michigan: In fall 2009, the state legislature approved new communicable disease rules for schools that expand vaccination requirements. Exemptions for medical reasons, religious convictions, or other objections may be granted.
     
  • Ohio: On December 9, 2009, the director of health approved revisions to the state's code governing immunization requirements. Exemptions may be granted for medical reasons or if the parent/guardian declines for reasons of conscience.
     
  • Tennessee: On December 9, 2009, amendments to rules governing requirements for immunization became effective for children in day care centers, elementary and secondary schools, and certain higher education settings. Exemptions to these and other requirements continue for medical reasons or if vaccination is contrary to the religious tenets and practices of the child's parent or guardian.


NEW REQUIREMENTS (LISTED IN ALPHABETICAL ORDER BY VACCINE):
HEPATITIS A
Tennessee: Rules amended in December 2009 require 1 dose of hepatitis A vaccine for children ages 18 through 59 months (effective 7/1/10) and 2 doses for students in kindergarten (effective 7/1/11). Laboratory evidence of immunity may be submitted to meet the requirements for hepatitis A vaccination.

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

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


HEPATITIS B
Tennessee: Rules amended in December 2009 require age-appropriate vaccination against hepatitis B virus infection for children enrolled in child care centers (effective 7/1/10). The hepatitis B vaccine series is required for health science students who expect to have patient contact, and who are enrolled full time in higher education institutions that have more than 200 students (effective 7/1/11). Laboratory evidence of immunity may be submitted to meet the requirements for hepatitis B vaccination.

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

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

IAC has compiled a chart of information about all states that have hepatitis B prevention mandates for college and university attendance. To access the information, go to: http://www.immunize.org/laws/hepbcollege.asp

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


HAEMOPHILUS INFLUENZAE type b (Hib)
Tennessee: Rules amended in December 2009 require the resumption of age-appropriate Hib vaccination for children younger than age 5 years for whom Hib vaccination was suspended in January 2008 because of a shortage of Hib vaccine (effective 12/9/09).

CDC has compiled a chart of information about all states that have Hib prevention mandates for child care attendance. To access the information, go to: http://www.immunize.org/laws/hib_childcare.pdf Note: the information on the chart is current for SY 2007-08.


MENINGOCOCCAL
Indiana: Revisions to Indiana's immunization administrative code, adopted in October 2009, require that all students in grades 6 through 12 have evidence of meningococcal conjugate vaccination (effective for SY 2010-11).

Michigan: Effective 1/1/10, students in grade 6 (as well as students ages 11 through 18 years who are changing school districts) are required to have documentation of 1 dose of meningococcal vaccine.

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

The 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


MEASLES-MUMPS-RUBELLA (MMR)
Massachusetts: Effective in fall 2011, students entering kindergarten and grade 7 are required to have 2 doses of MMR, as are full-time college freshman and health science students (currently these groups are required to have 2 doses of measles vaccine and 1 dose each of mumps and rubella vaccines). Enforcement of requirements for students in elementary and secondary schools will be progressive (i.e., students in the subsequent grade will be added each year).

CDC has compiled a chart of information about all states that require 2 doses of MMR for attendance in kindergarten and another chart for attendance in middle school.

To access the information for kindergarten, go to: http://www.immunize.org/laws/mmr_kinder_2nddose.pdf Note: the information in the chart is current for SY 2007-08.

To access the information for middle school, go to http://www.immunize.org/laws/mmr_middle_2nddose.pdf Note: the information in the chart is current for SY 2007-08.


PNEUMOCOCCAL
Tennessee: Rules amended in December 2009 require age-appropriate vaccination against pneumococcal disease in children younger than age 5 years enrolled in child care centers (effective 7/1/10).

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

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/pdfs/pcv7.pdf


TETANUS-DIPHTHERIA (Td) AND/OR TETANUS-DIPHTHERIA AND ACELLULAR PERTUSSIS (Tdap)
Indiana: Revisions to Indiana's immunization administrative code, adopted in October 2009, require that all students in grades 6 through 12 have evidence of 1 booster dose of Tdap vaccine (effective for SY 2010-11).

Massachusetts: Effective in fall 2011, students entering grade 7 are required to have 1 dose of Tdap vaccine, as are full-time college freshman and health science students (currently these groups are required to have 1 dose of Td toxoids). Enforcement of requirements for students in elementary and secondary schools will be progressive (i.e., students in the subsequent grade will be added each year).

Michigan: Effective 1/1/10, students in grade 6 (as well as students ages 11 through 18 years who are changing school districts) are required to have documentation of 1 dose of Tdap vaccine.

Ohio: Effective for SY 2010-11, students entering grade 7 are required to have evidence of either 1 booster dose of Td toxoids or Tdap vaccine. The requirement will be enforced progressively (i.e., the requirement will extend to the subsequent grade at the beginning of each new school year).

Tennessee: Rules amended in December 2009 require a 1-time dose of Tdap vaccine for all students enrolled in grade 7 (effective 10/1/10).

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

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


VARICELLA
Alaska: Effective 7/1/09, all children enrolled in kindergarten through grade 6 are required to have evidence of 2 doses of varicella vaccine.

Indiana: Revisions to Indiana's immunization administrative code, adopted in October 2009, require that all students enrolling in kindergarten have evidence of 2 doses of varicella vaccine (effective for SY 2010-11).

Massachusetts: Effective in fall 2011, students entering kindergarten and grade 7 are required to have 2 doses of varicella vaccine, as are full-time college freshman and health science students (currently, varicella vaccination is not mandated for college students). Enforcement of requirements for students in elementary and secondary schools will be progressive (i.e., students in the subsequent grade will be added each year).

Michigan: Effective 1/1/10, all students entering kindergarten and grade 6 are required to have documentation of 2 doses of varicella vaccine or history of chickenpox disease.

Ohio: Effective for SY 2010-11, students enrolling in kindergarten must have evidence of 2 doses of varicella vaccine. The requirement will be enforced progressively (i.e., the requirement will extend to the subsequent grade at the beginning of each new school year).

Tennessee: Rules amended in December 2009 require 2 doses of varicella vaccine for students in kindergarten, grade 7, and new enrollees (effective 7/1/10), as well as for students born on or after January 1, 1980, who are enrolled full time in higher education institutions that have more than 200 students (effective 7/1/11). Laboratory evidence of immunity may be submitted to meet the requirements for varicella vaccination, as may disease history as verified by a healthcare professional.

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

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

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2 IAC's "Screening Questionnaire for Child and Teen Immunization" now in Spanish

Updated in June 2010, IAC's popular "Screening Questionnaire for Child and Teen Immunization" is now available in Spanish. The questionnaire makes it easy for healthcare professionals to screen for vaccine contraindications.

To access the Spanish version of "Screening Questionnaire for Child and Teen Immunization," go to: http://www.immunize.org/catg.d/p4060-01.pdf

For English: http://www.immunize.org/catg.d/p4060.pdf

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

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3 LOL as rapper "Tdap Vac" and his friends entertain teens with their "Get the Tdap Shot" message

IAC's Video of the Week uses music and dance to send the message that kids in middle school and high school need a Tdap booster. Created by the Indiana chapter of AAP, the video has a run time of five minutes.

The video will be available on the home page of IAC's website through July 18. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week. After July 18, you can access the video directly (along with other Tdap information) at http://www.tdapvac.com

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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4 MMWR reports on increase in pertussis cases in California during January-June 2010

CDC published " Notes from the Field: Pertussis--California, January-June 2010" in the July 9 issue of MMWR. The notes are reprinted below in their entirety, excluding references.


The number of pertussis cases reported to the California Department of Public Health (CDPH) has increased substantially during 2010. The increase in cases was first noted in late March among patients admitted to a children's hospital. During January 1-June 30, 2010, a total of 1,337 cases were reported, a 418% increase from the 258 cases reported during the same period in 2009. All cases either met the Council of State and Territorial Epidemiologists definitions for confirmed or probable pertussis or had an acute cough illness and Bordetella pertussis-specific nucleic acid detected by polymerase chain reaction from nasopharyngeal specimens.

During January-June in California, the incidence of pertussis was 3.4 cases per 100,000 population. County rates ranged from zero to 76.9 cases per 100,000 (median: 2.0 cases). By age group, incidence was highest (38.5 cases per 100,000) among infants aged <1 year; 89% of cases were among infants aged <6 months, who are too young to be fully immunized. Incidence among children aged 7-9 years and 10-18 years was 10.1 cases and 9.3 cases per 100,000, respectively.

Of 634 case reports with available data, 105 (16.6%) patients were hospitalized, of whom 66 (62.9%) were aged <3 months. Incidence among Hispanic infants (49.8 cases per 100,000) was higher than among other racial/ethnic populations. Five deaths were reported, all in previously healthy Hispanic infants aged <2 months at disease onset; none had received any pertussis-containing vaccines.

The incidence of pertussis is cyclical, with peaks occurring every 3-5 years in the United States. The last peak was in 2005, when approximately 25,000 cases were reported nationally and approximately 3,000 cases in California, including eight deaths in infants aged <3 months. If the rates from the first half of the year persist throughout 2010, California would have its highest annual rate of pertussis reported since 1963 and the most cases reported since 1958.

CDPH is attempting to prevent transmission of pertussis to vulnerable infants by disseminating educational materials and clinical guidance, raising community awareness, and offering free tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to birthing hospitals and local health departments to support postpartum vaccination of mothers and close contacts of newborns.

To access the complete notes in web-text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a5.htm

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5 A CDC Commentary video on Medscape tells clinicians which people need Tdap vaccination and the value of giving it

On July 2, Medscape posted a 4-minute video titled "CDC Commentary: With Pertussis on the Rise, Who Needs a Tdap Vaccination?" In it, Stacy W. Martin, an epidemiologist with CDC's National Center for Immunization and Respiratory Diseases, discusses the recommendations and rationale for giving tetanus-diphtheria-acellular pertussis (Tdap) vaccine.

To view the video, go to: http://www.medscape.com/viewarticle/724242

Note: to access the video, you must register with Medscape. There is no charge for this service.

The video is a collaboration between CDC and Medscape; it is one of a series of commentaries designed to deliver CDC's authoritative guidance directly to healthcare professionals. To view the available commentary choices, go to: http://www.medscape.com/partners/cdc/public/cdc-commentary

Medscape, a free resource for clinicians and other healthcare professionals, provides timely and relevant clinical information.

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6 Third edition of "The Vaccine Handbook: A Practical Guide for Clinicians" now available

The third edition of "The Vaccine Handbook: A Practical Guide for Clinicians"--widely known as the Purple Book--is now available for purchase.

Since the first edition was published in 2004, the Purple Book has become a vital source of practical, up-to-date information for vaccine providers and educators. The driving principle behind the book is simple: to draw together the latest vaccine science and guidance into a concise, user-friendly, practical resource that can be used in the private office, public health clinic, and hospital.

The Purple Book is replete with scientific background and references, but unlike some academic textbooks, the language is plain, simple, and accessible. It is complete in terms of authoritative recommendations, but it expands upon the official publications of professional societies and governmental agencies by including, in one place, information on such things as how vaccines are developed, tested, and licensed; how vaccine policy is made; what constitutes the vaccine safety net; the legal obligations binding on vaccine providers; billing; and office logistics. The Purple Book is ideal for pediatricians, family physicians, internists, obstetrician/gynecologists, nurses, nurse practitioners, physician's assistants, clinic staff, students, and residents. Some parents and patients might also find it useful.

The Purple Book's author, Gary Marshall, MD, is professor of pediatrics; chief, Division of Pediatric Infectious Diseases; and director, Pediatric Clinical Trials Unit at the University of Louisville School of Medicine. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

You can order the Purple Book directly from the publisher, Professional Communications Inc., at http://www.pcibooks.com/books/view/49 or you can buy it from your favorite local bookstore.

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7 New: MMWR reports can now be accessed on Facebook and Twitter

CDC published "Announcement: MMWR on Facebook and Twitter" in the July 9 issue of MMWR. The announcement is reprinted below in its entirety.


MMWR reports now can be accessed on social networking websites Facebook and Twitter. Readers can download and comment on MMWR weekly reports, recommendations and reports, surveillance summaries, and podcasts from the MMWR website. Readers can follow MMWR on Facebook by visiting http://www.facebook.com/cdcmmwr and on Twitter by visiting http://www.twitter.com/cdcmmwr

To access the announcement in web-text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a7.htm

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8 MMWR publishes report on Nigeria's progress toward poliomyelitis eradication from January 2009 to June 2010

CDC published "Progress Toward Poliomyelitis Eradication--Nigeria, January 2009-June 2010" in the July 9 issue of MMWR. A synopsis prepared for the media is reprinted below in its entirety.


There have been substantial reductions of wild poliovirus (WPV) cases in Nigeria during January-June 2010 compared with the same period in 2009.

Nigeria has maintained a high incidence of wild poliovirus (WPV) cases due to persistently high proportions of under- and unimmunized children, and, for many years, the country has served as the reservoir for substantial international spread. In 2008, Nigeria reported 798 polio cases, the highest number of any country in the world. Reported WPV cases in Nigeria decreased to 388 during 2009, and WPV incidence in Nigeria reached an all-time low during January-June 2010, with only three reported cases. During 2009-2010, increased engagement of traditional, religious, and political leaders has improved community acceptance of vaccination and implementation of high quality supplementary immunization activities (SIAs). Enhanced surveillance for polioviruses, further strengthened implementation of SIAs, and immediate immunization responses to newly identified WPV and circulating type 2 vaccine-derived poliovirus (cVDPV2) cases will be pivotal in interrupting WPV and cVDPV2 transmission in Nigeria.

To access the entire article in web-text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a2.htm

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9 Save the date: Shots for Tots conference planned for October 28-29 in New Orleans

Louisiana's Shots for Tots immunization conference is scheduled for October 28-29 in New Orleans. To access the conference brochure, which includes information about the conference program, accommodations, and a mail-in registration form, go to: http://www.shotsfortots.com/18thBrochure2.pdf

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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.