Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 158            April 18, 2000

CONTENTS OF THIS ISSUE

  1. CDC publishes new ACIP statement on prevention and control of influenza
  2. CDC's new influenza VIS now available online!
  3. CDC's new meningococcal VIS now available online!
  4. CDC launches new internet site in Spanish
  5. CDC publishes report on measles outbreak in the Netherlands
  6. CDC publishes report on fatal case of yellow fever in traveler to Venezuela
  7. Free audiotape program focuses on strategies to improve adult vaccination against influenza and pneumococcal disease

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(1)
April 14, 2000
CDC PUBLISHES NEW ACIP STATEMENT ON PREVENTION AND CONTROL OF INFLUENZA

"Prevention and Control of Influenza" is the title of a new issue of "MMWR Recommendations and Reports" published April 14, 2000, by the Centers for Disease Control and Prevention (CDC). This report updates the 1999 recommendations of the Advisory Committee on Immunization Practices (ACIP) for the use of influenza vaccine and influenza antiviral agents.

The "Summary" of this MMWR report reads as follows:

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Summary: This report updates 1999 recommendations by the Advisory Committee on Immunization Practices (ACIP) on the use of influenza vaccine and antiviral agents (MMWR 1999;48[No. RR-4]:1-29). These recommendations include five principal changes:

(a) the age for universal vaccination has been lowered to 50 years
     from 65 years;
(b) scheduling of large, organized vaccination campaigns
     after mid-October may be considered because the availability
     of vaccine in any location cannot be assured consistently in the
     early fall;
(c) 2000-2001 trivalent vaccine virus strains are A/Moscow/10/99
     (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and
     B/Beijing/184/93-like strains; 
(d) information on neuraminidase-inhibitor antiviral drugs has been
     added; and
(e) a list of other influenza-related infection control documents for
     special populations has been added.

This report and other information on influenza can be accessed at the website for the Influenza Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC at http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm

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The sections below summarize additional information provided in this MMWR report.

1. NEW RECOMMENDATIONS ON UNIVERSAL INFLUENZA VACCINATION
FOR ALL PERSONS AGED 50 OR OLDER (pp. 1-2):

"Beginning with the 2000-2001 influenza season, the ACIP has added persons aged 50-64 years to the primary target group for annual influenza vaccination. This age group was added because a substantial proportion of persons aged 50-64 years (24%-32%) have one or more chronic medical conditions that place them at high risk for influenza-related hospitalization and death. Rates of influenza-related excess hospitalization among adults aged <65 years with one or more high-risk conditions have been estimated at 56-635 per 100,000 persons compared with 13-60 per 100,000 among those without high-risk conditions. Despite the increased risk of severe illness, only an estimated 40%-41% of persons aged 50-64 years with chronic medical conditions and 28%-29% of those without high-risk conditions were vaccinated against influenza in 1997 (National Immunization Program, CDC, unpublished data, 2000). Age-based strategies have been more successful than patient-selection strategies based on medical conditions; thus, targeting all persons 50-64 years of age will likely increase vaccination rates among persons in this age group with high-risk conditions. In addition, this strategy will also likely help to increase vaccination of persons without high-risk conditions for whom annual vaccination is recommended because they live with or care for persons at increased risk of influenza-related complications. 

"Of the approximately 41 million persons in the United States aged 50-64 years, 28-31 million are without identified chronic underlying medical conditions (National Immunization Program, CDC, unpublished data, 2000). Although healthy adults are at low risk for severe illness, influenza can result in substantial morbidity, health-care provider visits, and lost work days. Vaccination of healthy adults aged <65 years can reduce the number of illnesses and physician visits, work absenteeism, and antibiotic use. Further, 50 years is an age when other preventive services begin and when routine assessment of vaccination and other preventive services has been recommended."

2. RECOMMENDATIONS CONCERNING SPECIFIC TARGET GROUPS FOR
INFLUENZA VACCINATION (pp. 6-7):

"Vaccination is recommended for the following groups of persons who are at increased risk for complications from influenza or who have a higher prevalence of chronic medical conditions that place them at risk for  influenza-related complications:

* persons aged [greater than or equal to] 50 years; 
* residents of nursing homes and other chronic-care facilities that
  house persons of any age who have chronic medical conditions; 
* adults and children who have chronic disorders of the pulmonary
  or cardiovascular systems, including asthma; 
* adults and children who have required regular medical follow-up
  or hospitalization during the preceding year because of chronic
  metabolic diseases (including diabetes mellitus), renal
  dysfunction, hemoglobinopathies, or immunosuppression
  (including immunosuppression caused by medications or by
  human immunodeficiency virus); 
* children and teenagers (aged 6 months to 18 years) who are
   receiving long-term aspirin therapy and therefore might be at risk
   for developing Reye syndrome after influenza infection; and 
* women who will be in the second or third trimester of pregnancy
   during the influenza season." 

3. SOURCES FOR INFORMATION ON INFLUENZA AND ITS SURVEILLANCE
(p. 27):

"Information regarding influenza surveillance is available through the CDC Voice Information System (influenza update), (888) 232-3228; CDC Fax Information Service, (888) 232-3299; or website for the Influenza Branch, DVRD, NCID, CDC at http://www.cdc.gov/ncidod/diseases/flu/weekly.htm. From October through May, the information is updated at least every other week. In addition, periodic updates about influenza are published in the weekly MMWR. State and local health departments should be consulted regarding availability of influenza vaccine, access to vaccination programs, information about state or local influenza activity, and for reporting influenza outbreaks and receiving advice regarding outbreak control."

4. ADDITIONAL INFORMATION ON INFLUENZA DISEASE AND VACCINE:

The report also contains information on vaccination coverage levels and progress toward the "Healthy People 2000" objectives, vaccination of specific patient populations, recommendations for vaccination of health professionals and others in contact with high-risk patients, persons who should not be vaccinated, and strategies for implementing these recommendations in health-care settings.

To obtain the complete text version (HTML format) of this MMWR report, go to: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4903a1.htm

To obtain a camera-ready copy (PDF format) of this report, go to: ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4903.pdf

The PDF version of this report includes a free CDC-sponsored continuing education activity that can be completed online or submitted via U.S. mail for CME, CEU, or CNE credit. Simply read the MMWR report, answer the questions about the report, and follow the instructions for submitting your answers.

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article six below.
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(2)
April 18, 2000
CDC'S NEW INFLUENZA VIS NOW AVAILABLE ONLINE!

The Centers for Disease Control and Prevention (CDC) has issued a new Vaccine Information Statement (VIS) for influenza (dated 4-14-00) based on the most recent ACIP statement on influenza (also dated 4-14-00). This new influenza VIS is now available on CDC's website and the website of the Immunization Action Coalition (IAC). To date there are no foreign-language translations of this document available. 

To obtain a camera-ready copy (PDF format) of this VIS, visit one of the following web pages: 

CDC: http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf
IAC: http://www.immunize.org/vis/2flu.pdf
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(3)
April 18, 2000
CDC'S NEW MENINGOCOCCAL VIS NOW AVAILABLE ONLINE!

On March 31, 2000, the Centers for Disease Control and Prevention (CDC) released a Vaccine Information Statement (VIS) for meningococcal vaccine. This new VIS reflects the modified recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding meningococcal vaccination based on its October 20, 1999, meeting. 

ACIP recommends that those who provide medical care to college freshman dormitory residents should provide information to these students and their parents about meningococcal disease and the benefits of vaccination. On October 20, 1999, CDC issued a press release titled "ACIP Modifies Recommendations for Meningitis Vaccination." This press release states in part:

"The Advisory Committee on Immunization Practices (ACIP) has modified its guidelines for use of the polysaccharide meningococcal vaccine to prevent bacterial meningitis, particularly for college freshmen who live in dormitories, a group found to be at a modestly increased risk of meningococcal disease relative to other persons their age. 

"At its October 20 meeting, the ACIP, citing results of two CDC studies done in 1998 which identified the slightly higher risk among freshman dormitory residents, recommended that those who provide medical care to this group give information to students and their parents about meningococcal disease and the benefits of vaccination. Vaccination should be provided or made easily available to those freshmen who wish to reduce their risk of disease. Other undergraduate students wishing to reduce their risk of meningococcal disease can also choose to be vaccinated."

The new meningococcal VIS is now available on CDC's website and the website of the Immunization Action Coalition (IAC). To date there are no foreign-language translations of this document. To obtain a camera-ready copy (PDF format) of this VIS, go to one of the following web pages:

CDC: http://www.cdc.gov/nip/publications/VIS/Mening2000.pdf
IAC: http://www.immunize.org/vis/menin00.pdf

MORE INFORMATION ON MENINGOCOCCAL DISEASE AND VACCINE:
To obtain the complete text version (HTML format) of the CDC press release described in this article, go to:  http://www.cdc.gov/ncidod/dbmd/diseaseinfo/meningococcal_college.htm

For additional links to resources about meningococcal disease and vaccination, visit IAC's "Meningococcal Disease and Vaccine" web page at: http://www.immunize.org/genr.d/menin.htm
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(4)
April 14, 2000
CDC LAUNCHES NEW INTERNET SITE IN SPANISH

The Centers for Disease Control and Prevention published a "Notice to Readers" titled "CDC Launches Internet Site in Spanish" in the April 14, 2000, issue of the MMWR. The "Notice" reads as follows:

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CDC has launched its Spanish language web site, CDC En Espanol, on the World-Wide Web at http://www.cdc.gov/spanish/. It is also accessible from the left navigation side bar of the CDC home page.

CDC En Espanol is not a translation of the English language web site but is a site tailored to Hispanic/Latino populations. It provides health-related information to the Hispanic/Latino professional and to the Spanish-speaking community. The site also includes information directed at special groups, such as adolescents, students, teachers, patients, health-care providers, women, and men. 

Included is information from the CDC and Agency for Toxic Substances and Disease Registry (ATSDR) centers, institutes, and offices and appropriate links to other key federal agency web sites that are important to the Hispanic/Latino community. CDC En Espanol provides an opportunity for CDC/ATSDR and its national and international partners to access common information and discuss issues. Questions related to CDC En Espanol can be sent by e-mail to spanish@cdc.gov.

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To obtain the text version (HTML format) of this MMWR "Notice to Readers," go to: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4914a4.htm

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article six below.
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(5)
April 14, 2000
CDC PUBLISHES REPORT ON MEASLES OUTBREAK IN THE NETHERLANDS

The Centers for Disease Control and Prevention (CDC) published an article titled "Measles Outbreak--Netherlands, April 1999-January 2000" in the April 14, 2000, issue of the MMWR. This report summarizes the investigation of the measles outbreak, which demonstrated that measles can be a severe disease among unvaccinated populations. 

According to the article, five cases of measles were reported on June 21, 1999, among 390 students attending a religiously-affiliated elementary school in the Netherlands. Persons belonging to this religious denomination routinely do not accept vaccination. Municipal health services found 160 suspected measles cases among children attending the school. By February 4, 2000, three measles-related deaths and 2961 measles cases had been reported to the national registry by the municipal health services. 

The report's "Editorial Note" states in part: 

"The three measles-related deaths and 68 hospitalizations that occurred among 2961 cases in the Netherlands indicate that measles can be severe and may result in death even in industrialized countries. Rates of complications reported in this outbreak are comparable with those in the United States and other industrialized countries....

"Although measles is more severe in malnourished or immunosuppressed persons, severe disease or death may result in persons with no underlying illness. Measles vaccine is a highly effective method for preventing this disease, and lack of vaccination resulted in this outbreak."

To obtain the complete text version (HTML format) of this MMWR article, go to: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4914a2.htm

MORE INFORMATION ON MEASLES DISEASE AND VACCINE:
To obtain the text version (HTML format) of the Advisory Committee on Immunization Practices (ACIP) statement titled "Measles, Mumps, and Rubella--Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps" (5/22/98), go to:  http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00053391.htm

To obtain a camera-ready copy (PDF format) of this ACIP statement, go to: ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4708.pdf

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article six below.
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(6)
April 14, 2000
CDC PUBLISHES REPORT ON FATAL CASE OF YELLOW FEVER IN TRAVELER TO VENEZUELA

The Centers for Disease Control and Prevention (CDC) published an article titled "Fatal Yellow Fever in a Traveler Returning from Venezuela, 1999" in the April 14, 2000, issue of the MMWR. The report describes the investigation of a fatal case of yellow fever in a previously healthy 48-year-old man from California who traveled to rainforests in southern Venezuela. The patient had received tetanus toxoid, typhoid vaccine, hepatitis A vaccine, and malaria prophylaxis before his trip, but not yellow fever vaccine.

The article's "Editorial Note" reads in part:

"This report describes the second case of imported fatal YF [yellow fever] in a U.S. resident returning from South America since 1996, and the first such cases since 1924. Neither patient had received YF vaccine before travel. In the case described in this report, viral hemorrhagic fever was suspected and reported to the local health department. Histopathology, IHC [immunohistochemistry] studies, nucleic acid testing, and serology all demonstrated that the traveler died of YF complicated by angioinvasive aspergillosis. In 1996, a Tennessee resident returned from a 9-day trip to Brazil with fever, headache, and myalgias. He died 10 days after onset of symptoms, and YF virus was identified from tissue culture.

"YF occurs in at least seven tropical South American countries (Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Venezuela) and much of sub-Saharan Africa. The sylvatic cycle involves nonhuman primates and mosquitoes that breed in tree holes. Persons living or working in proximity to such jungle or forest habitats who are bitten by infected mosquitoes can develop "jungle YF." Another cycle exists between humans and Aedes aegypti mosquitoes. Ae. aegypti mosquitoes are present in most urban centers of South and Central America, the Caribbean, and parts of the southern United States; persons in these areas are at risk for urban YF infection. YF has not been reported from India or other parts of Asia despite the presence of Ae. aegypti.

"World Health Organization (WHO) data suggest that YF transmission is increasing. After adjustments for underreporting, WHO estimates that approximately 200,000 YF cases occur each year, most in sub-Saharan Africa. Concomitant with increased YF transmission, the number of travelers from the United States to South America and Africa has more than doubled since 1988. These travelers may be at risk for YF unless precautions are taken, including receipt of YF vaccine....

"CDC recommends YF vaccination for travelers to countries reporting YF. Vaccination also is recommended for travel outside urban areas of countries that officially do not report the disease but are in the YF-enzootic zone."

To obtain the complete text version (HTML format) of this MMWR article, go to: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4914a3.htm

MORE INFORMATION ON YELLOW FEVER:
According to the MMWR article, yellow fever is subject to international quarantine regulations. All suspected and confirmed cases should be reported immediately to CDC's Division of Quarantine at (404) 639-8100. 

For more information about yellow fever disease and vaccine, as well as a list of yellow fever vaccination requirements for international travel, visit CDC's website at: http://www.cdc.gov/travel/diseases.htm#yellow

HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the "Morbidity and Mortality Weekly Report" (MMWR), visit CDC's MMWR website at: http://www2.cdc.gov/mmwr Select "Free MMWR Subscription" from the menu at the left of the screen. Once you have submitted the required information, weekly issues of the MMWR and all new ACIP statements (published as MMWR's "Recommendations and Reports") will arrive automatically by e-mail.
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(7)
April 18, 2000
FREE AUDIOTAPE PROGRAM FOCUSES ON STRATEGIES TO IMPROVE ADULT VACCINATION AGAINST INFLUENZA AND PNEUMOCOCCAL DISEASE

The audiotape series "Improving Adult Immunization for Influenza and Streptococcus Pneumoniae Infections," which was originally part of a CME program sponsored by the Medical Society of New York, is available at no charge just for the asking! Although it is no longer possible to obtain CME credit for this six-audiotape series, you can still use this excellent resource to gain practical information that can help you make adult immunization an even greater priority in your practice or clinic. With adult immunization rates for influenza at 65.5% and for pneumococcal vaccine at 45.4% nationwide, this program emphasizes the importance of enhancing health professionals' practices to prevent disease.

Created in September 1998, this audiotape program consists of a roundtable discussion among leaders in the field of adult immunization, including Pierce Gardner, MD, Professor of Medicine, State University of New York at Stony Brook; F. Marc LaForce, MD, Professor of Medicine, University of Rochester School of Medicine and Dentistry; Kristin Nichol, MD, Professor of Medicine, University of Minnesota; William Schaffner, MD, Professor of Medicine, Vanderbilt University School of Medicine; Stuart J. Cohen, EdD, Professor of Public Health Sciences, Wake Forest University School of Medicine; and Barry Klitsberg, Region 2 Immunization Coordinator, Health Care Financing Administration.

To obtain a copy of this free audiotape program, send your request (including your complete mailing address and phone number) to Sicola Communications via e-mail at cta13@aol.com or by fax at (770) 844-6216. Quantities are limited so place your order early.

 

Immunization Action Coalition1573 Selby AvenueSt. Paul MN 55104
E-mail: admin@immunize.org Web: http://www.immunize.org/
Tel: (651) 647-9009Fax: (651) 647-9131

This page was updated on April 18, 2000