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Immunization Action Coalition

IAC Express 2011

Issue number 935: June 13, 2011

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. States, major cities, and counties across the nation report recent increases in measles cases
  2. Three states expand immunization requirements for school attendance
  3. ASTHO brief asserts that permissive state vaccine-exemption laws contribute to increasing spread of VPDs
  4. Spotlight on immunize.org: official releases from ACIP, CDC, FDA, WHO, and more
  5. IAC's Video of the Week features five short clips that answer parents' basic questions about immunization
  6. IAC makes major updates to "It's federal law! You must give your patients current Vaccine Information Statements (VISs)"
  7. IAC updates its useful handout "Vaccines with Diluents: How to Use Them"
  8. Varicella and shingles vaccines should not be transported or stored at temperatures colder than -58 degrees F; do not use dry ice when transporting
  9. CDC publishes interim results of state-specific U.S. influenza vaccination coverage during August 2010-February 2011
  10. IAC's popular laminated versions of the 2011 U.S. immunization schedules are available. Order a supply for your workplace today!
  11. Award-winning DVD! "Immunization Techniques: Best Practices with Infants, Children, and Adults"--from the California Department of Public Health, Immunization Branch
  12. May issue of CDC's Immunization Works newsletter now available
 
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 935: June 13, 2011
1.  States, major cities, and counties across the nation report recent increases in measles cases

Many U.S. locations have recently experienced increases in measles cases. Since mid-May, health departments in at least ten states, major cities, or counties have issued press releases for broad distribution to the general public and healthcare community. Following are titles of and links to the ten press releases:

1. New York City (6/8/11): "Alert #9: Increase in Measles Cases and Hospital Exposures"
http://www.nyc.gov/html/doh/downloads/pdf/cd/2011/11md09.pdf

2. Monterey County, CA (6/8/11): "Health Advisory--Increase in Measles Cases"
To read press release, click here.

3. Maryland (6/8/11): "Maryland Health Officials Investigating Possible Exposures to Measles"
http://www.dhmh.state.md.us/pressreleases/pdf/2011/measles%20060811.pdf
 
4. Vermont (6/7/11): No title given
http://healthvermont.gov/advisory/2011/060711_measles.aspx

5. Boston, MA (6/3/11): "Commission Reports New Case of Measles"
http://www.bphc.org/Newsroom/Pages/TopStoriesView.aspx?ID=223

6. Bear River Health Department (BRHD), UT (5/31/11): "BRHD Confirms Measles Case in Cache County"
To read press release, click here.

7. New York State (5/30/11): "State Health Department Confirms Measles Case in Capital Region"
http://www.health.state.ny.us/press/releases/2011/2011-05-30_measles.htm

8. Nassau County, NY (5/27/11): "Advisory: Case of Measles in Nassau County"
http://www.nassaucountyny.gov/agencies/health/NewsRelease/2011/5272011.html

9. Iowa (5/24/11): "Measles Reported in Central Iowa"
To read press release, click here.

10. Lawrence-Douglas County, KS (5/17/11): "Health Department Investigates Measles Case in Elementary School"
http://www.ldchealth.org/pdf/Press%20releases/Measles%20case%205.17.11.pdf

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2 Three states expand immunization requirements for school attendance

Idaho, Texas, and Vermont have recently expanded their immunization requirements for pre-school, school, and/or college attendance. Details follow.

BACKGROUND INFORMATION--ACTIONS TAKEN BY THE THREE STATES' LEGISLATIVE OR EXECUTIVE BRANCHES:
  • Idaho: On 4/7/11, the 2011 Idaho Legislature approved new school immunization requirements for children enrolled in child care facilities and schools. Exemptions to these requirements are permissible for medical, religious, or personal reasons.
     
  • Texas: On 5/27/11, the governor signed an amendment to the immunization mandates for new students enrolling in institutions of higher education or private or independent institutions of higher education in Texas. Further, the definition of a "new student" now includes those who were previously enrolled but took a break in enrollment of at least one semester. Exemptions to the requirements may be granted for medical reasons or "reasons of conscience."
     
  • Vermont: On 1/27/11, the legislative committee on administrative rules signed regulations for new vaccination requirements for children enrolled in child care facilities. The Vermont regulations continue to allow for exemptions for medical or religious reasons, or based on the moral convictions of the parents.


NEW REQUIREMENTS (listed in alphabetical order by vaccine):
HEPATITIS A
Idaho: Updates to the Idaho Administrative Code require that children born since 9/1/05, who are enrolling in a child care facility or school, have evidence of hepatitis A vaccination as follows: one dose for children ages 16 months to 2 years and two doses for children 2 years and older. The requirements became effective 4/7/11.

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
Vermont: Updates to Vermont's Immunization Regulations require that children age 2 months and older who are enrolled in a licensed child care facility have documentation of age-appropriate vaccination against hepatitis B, effective 3/5/11.

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


MENINGOCOCCAL
Idaho: Updates to the Idaho Administrative Code require documentation (e.g., by a written certificate, electronic medical health record) of receipt of one dose of meningococcal vaccine for all students prior to admission to the seventh grade, beginning with school year 2011-12. This requirement will be extended to the subsequent grade incrementally each year (e.g., grades 7-8 in school year 2012-13, etc.).

Texas: Revisions to Texas Education Code now require evidence of meningococcal vaccination for all new incoming students to institutions of higher education, including students who were previously enrolled but took a break in enrollment of at least one semester. (The previous requirement applied only to students living in on-campus housing.) Additionally, the date on which the most recent meningococcal vaccination was given must be within 5 years of the student's enrollment. The requirements go into effect immediately.

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

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

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


PNEUMOCOCCAL
Idaho: Updates to the Idaho Administrative Code require that children ages 3 to 59 months who are enrolling in child care facilities have evidence of age-appropriate pneumococcal vaccination, effective 4/7/11.

Vermont: Updates to Vermont's Immunization Regulations require that children age 2 months and older who are enrolled in a licensed child care facility have documentation of age-appropriate vaccination against pneumococcal disease, effective 3/5/11.

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


ROTAVIRUS
Idaho: Updates to the Idaho Administrative Code require that children ages 3 through 7 months who are enrolling in child care facilities have evidence of age-appropriate rotavirus vaccination, effective 4/7/11.

Note: Because Idaho is the only U.S. state to require rotavirus vaccination for enrollment in child care facilities, IAC has not developed a chart or map of information. We hope many other states will soon join Idaho in requiring vaccination to prevent the spread of this life-threatening, highly contagious disease in child care facilities.


TETANUS-DIPHTHERIA AND ACELLULAR PERTUSSIS (Tdap)
Idaho: Updates to the Idaho Administrative Code require documentation (e.g., by a written certificate, electronic medical health record) of one dose of Tdap for all students prior to admission to seventh grade, beginning with school year 2011-12. This requirement will be extended to the subsequent grade incrementally each year (e.g., grades 7-8 in school year 2012-13, etc.).

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/laws/tdap.pdf


VARICELLA
Idaho: Updates to the Idaho Administrative Code require that children age 16 months and older (and born after 9/1/05), who are enrolling in child care facilities have evidence of receipt of at least one dose of varicella vaccine, effective 4/7/11. Also, children born after 9/1/05 who are enrolling in school must have evidence of receipt of two doses of varicella vaccine, effective school year 2011-12. The requirement may also be met if a physician or licensed healthcare professional submits documentation of a personal examination of a child's diagnosed varicella disease.

Vermont: Updates to Vermont's Immunization Regulations will require that children age 15 months and older who are enrolled in a licensed child care facility have documentation of receipt of one dose of varicella vaccine, effective 3/5/11.

IAC has compiled a chart of information about all states that require varicella vaccination for child care or school attendance. To access the information, go to: http://www.immunize.org/laws/varicel.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

IAC has compiled a chart of information about all states that require two 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/vari_two.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 CDC's web section of resources on immunization requirements, go to: http://www.cdc.gov/vaccines/vac-gen/laws

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3 ASTHO brief asserts that permissive state vaccine-exemption laws contribute to increasing spread of VPDs

The Association of State and Territorial Health Officials (ASTHO) recently issued a brief titled Permissive State Exemption Laws Contribute to Increased Spread of Disease. The brief provides information on types of nonmedical exemptions, the increasing rates of nonmedical exemptions being granted, and the possible impact of nonmedical exemptions on the spread of vaccine-preventable diseases (VPDs). It encourages the use of this strategy for granting nonmedical exemptions:

"To address the risk of VPD, states should consider adopting more rigorous standards for non-medical vaccine exemptions that require parents to demonstrate that they have made a conscious, concerted, and informed decision in requesting these exemptions for their children. An example of such a standard might include a requirement for parents to complete a form that explicitly states the grounds for the exemption and requires them to acknowledge awareness of the disease-specific risks associated with not vaccinating their child(ren)."

To access the complete brief, go here.
 
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4 Spotlight on immunize.org: official releases from ACIP, CDC, FDA, WHO, and more

Looking for official publications and authoritative news releases pertaining to immunization? Look no further. IAC's New Releases web section provides a chronological listing of just-published ACIP and AAP vaccine recommendations, FDA licensures, CDC news releases, and other resources. Updated frequently, this section has subsections devoted to information from AAP, ACIP, CDC, FDA, and WHO.

To access New Releases, visit http://www.immunize.org/newreleases
 
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5 IAC's Video of the Week features five short clips that answer parents' basic questions about immunization

IAC encourages IAC Express readers to watch a series of five video clips that answer parents' most frequently asked questions about immunization. The clips, which run less than a minute each, were developed by the National Association of Pediatric Nurse Practitioners.

The video clips will be available on the home page of IAC's website through June 19. To access them, go to: http://www.immunize.org and click on the image under the words Video of the Week.

Remember to bookmark IAC's home page to view a new video every Monday.

To access the archives of IAC's Videos of the Week, go to: http://www.immunize.org/votw
 
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6 IAC makes major updates to "It's federal law! You must give your patients current Vaccine Information Statements (VISs)"

IAC recently combined two of its handouts related to vaccine information statements (VIS). Information from the one-page handout titled "The Facts about Using VISs" have been combined with information included in "It's federal law! You must give your patients current Vaccine Information Statements (VISs)." "It's Federal Law!" is now a two-page document; "The Facts about Using VISs" has been discontinued as a stand-alone handout. Go to: http://www.immunize.org/catg.d/p2027.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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7 IAC updates its useful handout "Vaccines with Diluents: How to Use Them"

IAC recently revised information about yellow fever vaccine and removed information about Japanese encephalitis vaccine on the handout titled "Vaccines with Diluents: How to Use Them." Go to: http://www.immunize.org/catg.d/p3040.pdf
 
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8 Varicella and shingles vaccines should not be transported or stored at temperatures colder than -58 degrees F; do not use dry ice when transporting

The Iowa Department of Public Health (IDPH) and the Minnesota Department of Health have alerted IAC that effective June 6, 2011, Merck is no longer transporting its varicella (Varivax) and shingles (Zostavax) vaccines using dry ice--and neither should you. Following is the information IAC received from IDPH.


In the past, Varivax and Zostavax have been shipped using dry ice. Both of these vaccines will now be packed for shipping with six frozen gel packs as refrigerant in the shipping containers. The gel packs are for one-time use only and should be discarded upon receipt of the vaccine. The vaccine shipping containers are packed according to Merck guidelines that take into account the maximum temperature to which the container will be exposed, the time in transit, and the need to keep the vaccine at the appropriate temperature during shipping.

The shipping containers are designed to maintain proper temperatures for three days from the shipment date, which is located on the packing list. It is important to verify the date vaccine was shipped on the packing list to assure the vaccine arrived within the three-day window for delivery.

If the container is received after the three-day shipping time period or you have questions about the condition of the vaccine upon arrival, store the vaccine appropriately, mark do not use, and contact the vaccine manufacturer, Merck, for additional guidance.

To maintain potency of Varivax and Zostavax, the vaccine must be stored frozen between -58 degrees F and +5 degrees F (-50 degrees C to -15 degrees C). Diluent must be stored in the refrigerator (2 degrees C to 8 degrees C or 35 degrees F to 46 degrees F) or at room temperature (20 degrees C to 25 degrees C or 68 degrees F to 77 degrees F). The diluent is located in the top compartment of the shipping box underneath the cardboard cap.

The manufacturer recommends that the vaccine NOT be transported on dry ice. Use of dry ice may subject the product to temperatures colder than -58 degrees F (-50 degrees C).


On May 26, Merck posted information about this topic on its website. To access it, go here.
 
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9 CDC publishes interim results of state-specific U.S. influenza vaccination coverage during August 2010-February 2011

CDC published "Interim Results: State-Specific Influenza Vaccination Coverage--United States, August 2010-February 2011" in the June 10 issue of MMWR. A press summary of the article is reprinted below


The CDC estimates that 2010-11 seasonal influenza (flu) vaccination coverage among persons 6 months and older in 43 states and the District of Columbia was nearly 43 percent by the end of February 2011. This preliminary finding suggests that the record high national seasonal vaccination coverage seen in 2009-10 was sustained during this non-pandemic season. This season, national influenza vaccination coverage increased among children (49 percent vs. 42.3 percent during 2009-10), and improved coverage among non-Hispanic black and Hispanic children eliminated racial/ethnic disparities in child vaccination coverage. There was wide variation in influenza vaccination coverage between states, particularly among children, and several states had overall coverage levels for children that were above 60 percent. Coverage in adults was similar to levels reported in the 2009-10 season, and racial/ethnic disparities persisted among adults. The 2010-11 season marked the first post-pandemic vaccination season and the first full season since the Advisory Committee on Immunization Practices' (ACIP) universal influenza vaccination recommendation went into effect. Getting a flu vaccination remains the first and most important step to prevent influenza and its complications.


To access the full article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a3.htm
 
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10.  IAC's popular laminated versions of the 2011 U.S. immunization schedules are available. Order a supply for your workplace today!

IAC's laminated versions of the 2011 U.S. child/teen and adult immunization schedules are covered with a tough, washable coating that lets them stand up to a year's worth of use in every area of your workplace where immunizations are given. Each has six pages (i.e., three double-sided pages) and is folded to measure 8.5" by 11".

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions--a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

PRICING
1-4 copies: $7.50 each
5-19 copies: $5.50 each
20-99 copies: $4.50 each

To view images of the laminated schedules, or to order online or download an order form, go to: http://www.immunize.org/shop/laminated-schedules.asp

For quotes on customizing or placing orders in excess of 999 schedules, call (651) 647-9009 or email admininfo@immunize.org

To learn about other essential immunization resources available for purchase from IAC, go to: http://www.immunize.org/shop
 
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11.  Award-winning DVD! "Immunization Techniques: Best Practices with Infants, Children, and Adults"--from the California Department of Public Health, Immunization Branch

The California Department of Public Health (CDPH), Immunization Branch, has updated its award-winning training video, "Immunization Techniques: Best Practices with Infants, Children, and Adults." The 25-minute program can be used to train new employees and to refresh the skills of experienced staff. The video demonstrates the skills and techniques needed to administer vaccines to patients of all ages.

Prices start at $17 each for 1-9 copies and are greatly reduced for large orders, dropping to $3 each for 1,000-1,499 copies.

To learn more about the DVD, and find out how to order it, go to: http://www.immunize.org/shop/toolkit_iztechdvd.asp

For quotes on larger quantities, call (651) 647-9009 or email admininfo@immunize.org

The Immunization Action Coalition is the only nationwide vendor of this new DVD.

Note for healthcare settings located in California: Contact your local health department immunization program for a free copy.
 
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12.  May issue of CDC's Immunization Works newsletter now available

CDC recently released the May issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

Most articles in the May Immunization Works newsletter have been covered in this or previous issues of IAC Express. Here is information about two topics we haven't covered.


1. Global Immunizations
  • Applications for the STOP program: CDC's Stop Transmission of Polio (STOP) program is in need of experienced mid-career epidemiologists as global polio eradication efforts are at a critical juncture. If you are interested in being a STOP team member, visit the STOP application web page at http://www.cdc.gov/vaccines/programs/stop/application.htm
     
  • Polio in Pakistan: Pakistan is the only one of the four polio-endemic countries that experienced an increase of polio cases in 2011.
     
  • Polio and Measles in DRC: In the Democratic Republic of Congo (DRC), the political, economic, and health crises of the early 1990s has resulted in epidemics of polio, measles, and other diseases throughout the country. The total number of polio cases for 2011 is 46 (through May 4, 2011). A measles outbreak has resulted in more than 36,591 measles cases and 288 deaths through April 24, 2011. CDC has deployed epidemiologists to support the response to these outbreaks. During these short term assignments Global Immunization Division (GID) staff will collaborate with WHO and the DRC Ministry of Health to develop vaccination initiatives.

2. An App to Train Clinicians on Pertussis Testing: NCIRD's Division of Bacterial Diseases (DBD) and CDC's Electronic Media Branch, working in collaboration with Epocrates.com (http://www.epocrates.com), have launched CDC: Pertussis Testing, an Essential Points mobile learning activity that is now available to healthcare professionals and students who use Epocrates on iPhone. The activity will be accessible for one year. DBD provided content and video for this project. Epocrates will track participant responses to the activity and share aggregated statistics such as open rates, completion rates, responses to pre- and post-test questions, and responses to the built-in survey questions about the perceived value of the video components. Learn more about pertussis at http://www.cdc.gov/pertussis


To access the complete May issue of Immunization Works, go to: http://www.cdc.gov/vaccines/news/newsltrs/imwrks/2011/201105.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.