Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 176            July 14, 2000

CONTENTS OF THIS ISSUE

  1. CDC publishes notice on delayed supply of influenza vaccine and adjunct ACIP recommendations for the 2000-01 season
  2. CDC publishes report on 1998 hepatitis B vaccination coverage among Asian and Pacific Islander children in the United States
  3. CDC publishes summary of the joint statement on thimerosal in vaccines
  4. Employment opportunity: CDC is recruiting candidates for Director of the Epidemiology and Surveillance Division, National Immunization Program

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(1)
July 14, 2000
CDC PUBLISHES NOTICE ON DELAYED SUPPLY OF INFLUENZA VACCINE AND ADJUNCT ACIP RECOMMENDATIONS FOR THE 2000-01 SEASON
The Centers for Disease Control and Prevention (CDC) published a notice titled "Delayed Supply of Influenza Vaccine and Adjunct ACIP Influenza Vaccine Recommendations for the 2000-01 Influenza Season" in the July 14, 2000, issue of the MMWR.

The introduction to this notice reports: "For the 2000-01 influenza season in the United States, lower than anticipated production yields for this year's influenza A(H3N2) vaccine component and other manufacturing problems are expected to lead to a substantial delay in the distribution of influenza vaccine and possibly substantially fewer total doses of vaccine for distribution than last year. A more precise estimate of the vaccine supply will be available as production progresses during the summer."

In this report, CDC and the Advisory Committee on Immunization Practices (ACIP) issue additional influenza vaccination recommendations beyond those made by ACIP on April 14, 2000. The recommendations are reprinted here as follows:

ADJUNCT INFLUENZA VACCINE USE RECOMMENDATIONS FOR THE 2000-01 INFLUENZA SEASON

  1. Implementation of organized influenza vaccination campaigns should be delayed. Health-care providers, health organizations, commercial companies, and other organizations planning organized influenza vaccination campaigns for the 2000-01 influenza season should delay vaccination campaigns until early to mid-November. The purpose of this recommendation is to minimize cancellations of vaccine campaigns and wastage of vaccine doses resulting from delays in vaccine delivery.
       
  2. Influenza vaccination of persons at high risk for complications from influenza and their close contacts should proceed routinely during regular health-care visits. Routine influenza vaccination activities in clinics, offices, hospitals, nursing homes, and other health-care settings (especially vaccination of persons at high risk for complications from influenza, health-care staff, and other persons in close contact with persons at high risk for complications from influenza) should proceed as normal with available vaccine.
        
  3. Provider-specific contingency plans for an influenza vaccine shortage should be developed. All influenza vaccine providers, including health-care systems and organizers of vaccination campaigns, should develop a provider-specific contingency plan to maximize vaccination of high-risk persons and health-care workers. These plans should be available for implementation if a vaccine shortage develops.

The Additional Discussion section of the report is reprinted here:

In the United States, 70 to 76 million persons (approximately 35 million persons aged more than 65 years; 33 to 39 million persons aged less than 65 years with high-risk medical conditions; and 2 million pregnant women) are at high risk for serious complications from influenza infections, including hospitalizations and deaths. The expected delay in influenza vaccine distribution and a possible shortage for the 2000-01 influenza season has raised difficult questions of how to maximize protection against influenza for these persons. One complicating factor is that many vaccine providers must plan their fall vaccination activities now even though the vaccine supply is uncertain. Given the current situation, CDC and ACIP have issued modified recommendations for the 2000-01 season emphasizing the delay of organized influenza vaccine campaigns until November, the continuation of routine vaccination activities during regular health-care visits, and the development of provider-specific contingency plans in case a vaccine shortage should develop. There are additional important points worth emphasizing in addition to these main recommendations:

  • Influenza vaccine administered after mid-November can still provide substantial protective benefits. In general, ACIP recommends that routine vaccination of persons at high risk for complications from influenza begin in September. In previous years, ACIP has recommended that organized campaigns take place during October through mid-November. These timing recommendations balance several considerations, including the desirability of administering vaccine before substantial seasonal influenza activity has begun but not vaccinating so early such that vaccine antibody titers might substantially decrease in some persons. Nonetheless, many persons who should receive influenza vaccine remain unvaccinated after mid-November, and for many of these persons, influenza vaccination after mid-November will be beneficial. For the 2000-01 season, it is particularly important for vaccine providers to continue to administer vaccine after mid-November.
        
  • Once vaccine is available, health-care workers should provide vaccine to persons at high risk for complications from influenza as is normally done. This is particularly important for young children at high risk who are receiving influenza vaccination for the first time and who require two doses of vaccine.
        
  • Minimizing wastage of influenza vaccine is important. In particular, influenza vaccine purchasers should refrain from placing duplicate orders with multiple companies to minimize the amount of vaccine that is returned to a manufacturer and discarded. Options to promote redistribution of vaccine that otherwise would be returned or discarded are being developed.
      
  • In 2000, ACIP broadened its influenza vaccine recommendations to include all persons aged 50-64 years. This recommendation was based, in part, on an effort to increase vaccination coverage of persons in this age group with high-risk conditions. In the context of a possible vaccine shortage, it would be appropriate for contingency plans covering this age group to focus primarily on vaccinating persons with high-risk conditions rather than this entire age group.
       
  • Influenza vaccine is routinely recommended for persons in close contact with persons at high risk for complications from influenza because such persons are in a position to transmit influenza virus infection to high-risk persons. Vaccination of health-care workers has been highlighted in particular because health-care workers have frequent and close contact with many different high-risk persons at a time when high-risk persons are particularly vulnerable."

According to the report, CDC and the FDA will continue to issue updates as new information becomes available. If an influenza vaccine shortage appears imminent, CDC and ACIP will issue further recommendations.

To obtain the full text version (HTML format) of this notice, go to:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4927a4.htm

To obtain the text version (HTML format) of the April 14, 2000, statement of the ACIP titled "Prevention and Control of Influenza," go to:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4903a1.htm

To obtain a camera-ready version (PDF document) of this ACIP statement, go to: ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4903.pdf

To obtain a camera-ready version (PDF document) of the current 2000-01 Vaccine Information Statements (VISs), visit the following sites:

English: http://www.immunize.org/vis/2flu.pdf
Spanish: http://www.immunize.org/vis/spflu00.pdf

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article three below.
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(2)
July 14, 2000
CDC PUBLISHES REPORT ON 1998 HEPATITIS B VACCINATION COVERAGE AMONG ASIAN AND PACIFIC ISLANDER CHILDREN IN THE UNITED STATES
The Centers for Disease Control and Prevention (CDC) published a report titled "Hepatitis B Vaccination Coverage Among Asian and Pacific Islander Children--United States, 1998" in the July 14, 2000, issue of the MMWR. This MMWR report notes an ongoing need for focused vaccination programs for Asian and Pacific Islander (API) children and recommends that community-based catch-up hepatitis B vaccination programs continue to be implemented as quickly as possible.

The report summarizes the results of surveys conducted in 1998 to examine trends in hepatitis B vaccination rates among API children in six U.S. cities. Three cities (Milwaukee, St. Paul, and Seattle) had HBV vaccination programs directed specifically toward the Asian and Pacific Islander community. These three cities were compared with three others (Houston, Dallas, and Washington, DC) that had no vaccination programs targeting these children.

CDC reports that the surveys from the six cities and other states indicate that only 40% of all API children in the United States aged 7-18 years have completed their hepatitis B vaccination series. According to the CDC report, this low rate of vaccination coverage for a group at risk for HBV infection underscores the need for increased efforts to continue to provide catch-up vaccination to these children.

The Editorial Note states in part: "The findings in this report document the impact of targeted vaccination programs for populations at high risk for childhood HBV infection. In the three cities with ongoing API hepatitis B vaccination programs, coverage increased with each successive birth cohort over a 10-year period, reaching 83% among children born in 1993; however, in cities without programs, the overall vaccination coverage remained low, although coverage also increased with each successive birth cohort."

The report warns that in states without laws mandating vaccination for middle school entry, special efforts will be needed to ensure vaccination of Asian and Pacific Islander children. According to the report's Editorial Note: "Because no established vaccination visits exist for older adolescents, hepatitis B vaccination will depend primarily on self-identification, community-based programs, and health-care providers who are aware of the high risk for HBV infection among API children and who can meet specific API cultural and language needs."

To obtain the full text version (HTML format) of this MMWR article, go to:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4927a3.htm

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article three below.
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(3)
July 14, 2000
CDC PUBLISHES SUMMARY OF THE JOINT STATEMENT ON THIMEROSAL IN VACCINES
The Centers for Disease Control and Prevention (CDC) published a Notice to Readers titled "Summary of the Joint Statement on Thimerosal in Vaccines" in the July 14, 2000, issue of the MMWR. It reads as follows:

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In June 2000, a joint statement on thimerosal in vaccines was prepared by the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the Public Health Service (PHS) in response to 1) the progress in achieving the national goal declared in July 1999 to remove thimerosal from vaccines in the recommended childhood vaccination schedule, and 2) results of recent studies that examined potential associations between exposure to mercury in thimerosal-containing vaccines and health effects. In this statement, AAFP, AAP, ACIP, and PHS recommend continuation of the current policy of moving rapidly to vaccines that are free of thimerosal as a preservative. Until adequate supplies are available, use of vaccines that contain thimerosal as a preservative is acceptable.

A joint statement issued by AAP and PHS in July 1999 and agreed to by the AAFP later in 1999 established the goal of removing thimerosal as soon as possible from vaccines routinely recommended for infants. The goal was established as a precautionary measure. No evidence existed of any harm caused by low levels of thimerosal in vaccines. Public concern had been expressed about the health effects of mercury exposure of any sort, and the elimination of mercury from vaccines was considered a feasible means of reducing an infant's total exposure to mercury in a world where other environmental sources of exposure are more difficult or impossible to eliminate (e.g., certain foods).

Since July 1999, substantial progress has been made in removing thimerosal from vaccines. As of March 2000, all U.S. children had access to hepatitis B vaccines that do not contain thimerosal as a preservative. Beginning July 2000, only single-dose thimerosal-free Haemophilus influenzae type b vaccine will be produced in the United States; previously manufactured multidose vials containing thimerosal still may be in distribution. One diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) that does not contain thimerosal is available, and it is projected that additional DTaP vaccines without thimerosal as a preservative will become available in early 2001. On the basis of this progress, the most likely maximum amount of ethylmercury that an infant may be exposed to from the routine vaccination schedule has been reduced by 60%, from 187.5 mcg to 75 mcg. Measles-mumps-rubella, varicella, inactivated polio, and pneumococcal conjugate vaccines have never contained thimerosal.

Research on the potential health effects of exposure to thimerosal is continuing, and findings will be monitored closely by PHS to determine whether any changes in policy are needed. AAFP, AAP, and PHS, in consultation with the ACIP, reaffirm the goal set in July 1999 to remove or greatly reduce thimerosal from vaccines as soon as possible. On the basis of information from the Food and Drug Administration and manufacturers, PHS projects that the United States will complete its transition to a secure routine pediatric vaccine supply free of thimerosal as a preservative by the first quarter of 2001.

The vaccination of children in much of the world will continue to require the use of multidose vials because of cost, production, and storage capacity. Multidose vials require a preservative to prevent microbial contamination after the vial is opened. For multidose vials, manufacturers are encouraged to seek alternatives to thimerosal.

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To obtain the full online text version (HTML format) of this summary of the joint statement, go to:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4927a5.htm

For a more complete listing of thimerosal-related information, visit CDC's website at: http://www.cdc.gov/nip/vacsafe/concerns/thimerosal/ or visit the website of the Immunization Action Coalition at: http://www.immunize.org/genr.d/thimer.htm

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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(4)
July 14, 2000
EMPLOYMENT OPPORTUNITY: CDC IS RECRUITING CANDIDATES FOR DIRECTOR OF THE EPIDEMIOLOGY AND SURVEILLANCE DIVISION, NATIONAL IMMUNIZATION PROGRAM

CDC has a position vacancy for its Director of Epidemiology and Surveillance Division, within the National Immunization Program. The Immunization Services Division is requesting assistance in filling the position. The position is posted as a Senior Biomedical Science Researcher (SBRS), Medical Officer, or Supervisory Epidemiologist. It will remain open until August 15, 2000. A portion of the announcement letter is reprinted here:

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Director of the Epidemiology and Surveillance Division,
National Immunization Program (NIP)

The Epidemiology and Surveillance Division conducts epidemiologic research and surveillance regarding vaccines and vaccine-preventable diseases, and is responsible for policy development and technical consultation in this area. The Director leads and manages the division's branches (Child Vaccine Preventable Diseases, Adult Vaccine Preventable Diseases, Vaccine Safety and Development, and Anthrax Vaccine), establishes and oversees the division research agenda, and serves as a senior member of NIP's leadership team. The Director also serves as NIP's lead representative for the Advisory Committee on Immunization Practices. In this capacity, the Director works closely with committee members, other CDC organizations, and representatives from the American Academy of Pediatrics, American Academy of Family Physicians, the Food and Drug Administration, and the National Institute of Allergy and Infectious Diseases to formulate national immunization policy and future program directions. Current division resources total approximately $22 million/year and 97 employees. 
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For additional information about the position, contact Susan Y. Chu at (404) 639-8727 or Clio Friedewald at (404) 639-8202.

To view the online position description for this opportunity on the CDC website, go to:
http://www2.cdc.gov/hrmo/vdetail.asp?AnnouncementNumber=10-00-039

For application guidelines, visit: http://www.cdc.gov/ and click on "Training and Employment."

 

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 July 14, 2000