CONTENTS OF THIS ISSUE
- Fall/Winter issue of NEEDLE TIPS is in the mail--and up
on the web
- ACIP votes on pneumococcal conjugate and DTaP vaccine
- Letter on influenza vaccine from National Immunization
Program Director Walter Orenstein, M.D.
- Reminder for this Thursday, December 13: CDC satellite
broadcast about smallpox for clinicians
- CDC announces 7th edition of "The Pink Book" and
December discount on advance orders
- Register early for the National Immunization Conference
- New on IAC's website: "Skills Checklist for
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December 11, 2001
FALL/WINTER ISSUE OF NEEDLE TIPS IS IN THE MAIL--AND UP ON THE WEB
Look for your "golden-ink" copy of the Fall/Winter 2001-2002 issue of NEEDLE TIPS and the Hepatitis B Coalition
News in the mail! It's also now available on IAC's website (see links below).
The Fall/Winter 2001-2002 issue is filled with new and practical immunization
information for you to use and distribute to colleagues and patients. All of the
items are reviewed for technical accuracy by the Centers for Disease Control
and Prevention (CDC) with the exception of opinion pieces.
Once again NEEDLE TIPS features "Ask the Experts," with authoritative answers to immunization questions provided
by William Atkinson, M.D., M.P.H., and to hepatitis A and B questions by Harold Margolis, M.D., and
Linda Moyer, R.N. All three experts are, indeed, highly regarded specialists
with CDC. Whether it's a question about dosage or postexposure prophylaxis,
they let you know what needs to be done.
We are also excited to bring you two new educational pieces and two clinical
"tools" in NEEDLE TIPS. Because talking about hepatitis with patients can be
confusing for them, we've created a one-page chart that clarifies the issues
called "Hepatitis A, B, and C: Learn the Differences." Whether you give patients this chart to take
home or use it as a teaching tool, we hope you find it as helpful as our own staff does! For immunization providers,
we offer the up-to-date "Vaccine Products Licensed for Use in the United States, 2001."
Everybody is looking for better ways to get adult patients' immunization histories. Our new self-assessment
questionnaire for adults, simply titled "Do I Need Any Vaccinations Today?" is intended to make the adult
history-taking process both easy and timesaving for health professionals by allowing patients
to fill out the form before the history-taking process even begins.
Likewise, our new "Checklist for Safe Vaccine Handling and Storage" is intended to clarify the process of
safeguarding, monitoring, and documenting vaccine inventory. We hope this checklist will help establish--or
maintain--proper vaccine management protocol in clinics, hospitals, and other
practices with immunization services! Whether you keep it in a file or on a
clipboard or post it on your vaccine refrigerator, it can serve as a convenient
reminder of the basic storage and handling requirements for vaccines.
Don't forget to copy and distribute the newly revised "Summary of Recommendations for Adult Immunization." This
chart summarizes the most current recommendations from the Advisory Committee on Immunization
Practices (ACIP) on everything from schedules and routes of administration to
contraindications. Some practices laminate or make cardstock copies of this
document for each examination room and hand them out to immunization staff
as a ready-reference guide.
Finally, IAC Executive Director Deborah L. Wexler, M.D., has written a powerful piece for anyone interested in
infant health or hepatitis B prevention. Please read her "Unprotected Babies: Hepatitis B Vaccine at Birth Saves
Lives." You may be moved to reexamine or change your current infant hepatitis B vaccination practices (if you
haven't already). Although the "B" in hepatitis B doesn't stand for "birth dose," maybe you will agree after reading
this piece that we should all act as if it does.
Following are links to individual pages of NEEDLE TIPS and to the entire issue. Most pages are available in both PDF
and HTML formats, but a few are available only as PDF files.
- "Ask the Experts"
- "Letters to the Editor"
- "Vaccine Highlights"
- "Unprotected Babies: Hepatitis B at Birth Saves Lives!"
- "Checklist for Safe Vaccine Handling and Storage"
- "Hepatitis A, B, and C: Learn the Differences"
- "Do I Need Any Vaccinations Today?"
- "Vaccine Products Licensed for Use in the United
- "How's Your State Doing? Current Immunization Rates and
Hep B Mandates by State"
- "Summary of Recommendations for Adult Immunization"
- "Pneumococcal Congugate Vaccine: What You Need to
- "National Resources"
- "Need Help? Call Your Immunization, Hepatitis, and VFC
- "Coalition Catalog: Publications and Resources"
To view the NEEDLE TIPS table of contents with links to
both the text (HTML format) and camera-ready (PDF format) versions of individual pages, go to: http://www.immunize.org/nslt.d/n25/index.htm
WARNING: The PDF format version of the entire issue below
is a large file, and some printers cannot print a file of
this size. For some helpful tips on downloading and
printing PDF files, go to: http://www.immunize.org/nslt.d/tips.htm
To download a camera-ready (PDF format) copy of the entire issue, go to: http://www.immunize.org/nslt.d/n25/n25.pdf
If you are a health professional and would like to receive a hard copy of NEEDLE TIPS or be added to our mailing
list, please contact us by e-mail at firstname.lastname@example.org
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December 11, 2001
ACIP VOTES ON PNEUMOCOCCAL CONJUGATE AND DTAP VACCINE RECOMMENDATIONS
On December 7, 2001, the Advisory Committee on Immunization Practices (ACIP) voted to temporarily revise recommendations
for pneumococcal conjugate vaccine and to continue previously
issued DTaP recommendations.
The Centers for Disease Control (CDC) released the following message about the votes:
PNEUMOCOCCAL CONJUGATE VACCINE VOTE
The Advisory Committee on Immunization Practices (ACIP) voted today to temporarily revise recommendations for the
pneumococcal conjugate vaccine due to continued shortages
of the vaccine that are insufficient to allow full implementation of the 4-dose schedule for infants.
Pneumococcal conjugate vaccine is highly effective in preventing invasive pneumococcal disease in young children.
Prior to the introduction of PCV-7, pneumococcal infections
caused approximately 700 cases of meningitis, 17,000 cases
of bacteremia--blood stream infections--and 200 deaths each year in children under age five. Meningitis is the most
severe type of pneumococcal disease. About 5 percent of
children under 5 years old with pneumococcal meningitis will die of their infections.
The ACIP had previously revised recommendations for the vaccine on September 14, 2001, for shortages which at the
time were anticipated to be brief. However, according to manufacturer estimates, about 1.2 million doses
of vaccine will be distributed per month through March 2002, less than the 1.5
million doses per month needed, based on current demand.
The shortage of the vaccine is due to a rapid increase in demand and manufacturing problems that have prevented the
manufacturer from producing at full capacity. The shortage is expected to continue until
mid-2002, depending on adherence [to] the revised recommendations.
The ACIP is making revised recommendations to limit pneumococcal conjugate vaccine use until supplies are
adequate. Two key principles underlie the revised
recommendations. First, providers should conserve vaccine supply by decreasing the number of doses administered to
healthy infants, rather than leaving some children in the group recommended for
vaccination completely unprotected.
Second, changes in pneumococcal conjugate vaccine use and
ordering should be made by all providers, regardless of the
current vaccine supply in their own practice.
The ACIP revised recommendations are as follows:
- High risk children less than 5 years of age should
continue to be vaccinated as recommended by the ACIP in
- Healthy infants and children less than 24 months old
should receive a decreased number of pneumococcal conjugate doses based on the age
at which vaccination is initiated and the provider's estimate of vaccine
their practice. All providers should defer the 4th dose for infants who are vaccinated beginning at less than 6 months
of age. Additional recommendations to decrease vaccine use are included in the
specific recommendations adopted by the
Committee. (Guidelines will be given when the recommendations are published in CDC's Morbidity and
Mortality Weekly Report.)
- Further studies should be done to evaluate the immune
response to a pneumococcal polysaccharide vaccine booster
dose among children 12-15 months of age. Polysaccharide vaccine is recommended for
children more than 2 years old
who are at increased risk of invasive pneumococcal infection. It is not licensed for use in children less than 2
- Providers should maintain a list of children for whom PCV-7
has been deferred so that it can be administered when the
supply situation improves.
The ACIP voted to continue prior CDC recommendations (published March 16, 2001) for providers who had insufficient
quantities of DTaP vaccine due to spot shortages of the vaccine.
The recommendation applies only to providers with insufficient quantities of DTaP vaccine and recommends that they
vaccinating infants with the initial 3 DTaP doses, and if necessary, to defer the 4th DTaP dose. The ACIP also added
that if deferring the 4th DTaP dose still does not provide enough vaccine to vaccinate infants with 3 DTaP
the 5th DTaP dose can be deferred. When adequate DTaP vaccine becomes available, steps should be taken to recall all children
who did not receive a DTaP dose for remedial immunization.
Children should be vaccinated in accordance with existing ACIP recommendations to assure
immunity to pertussis,
diphtheria, and tetanus during the elementary school years.
The vaccine protects against diphtheria, tetanus, and pertussis or whooping
cough. Diphtheria, tetanus, and pertussis are serious diseases caused by bacteria. Diphtheria
and pertussis are spread from person to person. Tetanus enters the body through cuts or wounds.
For more information on the revised ACIP recommendations and the vaccines addressed, go to the website of CDC's
National Immunization Program at: http://www.cdc.gov/nip/news/shortages/pneumo-and-dtap.htm#DTaP-questions
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December 11, 2001
LETTER ON INFLUENZA VACCINE FROM NATIONAL IMMUNIZATION PROGRAM DIRECTOR WALTER ORENSTEIN, M.D.
On December 4, 2001, a letter to colleagues in medicine and public health
was issued by the office of Walt Orenstein, M.D., director, National Immunization Program,
Centers for Disease Control and Prevention. The letter urges continued administration of influenza vaccine for
high-risk people and assures an adequate and available
The text of the letter reads as follows:
If you are seeing patients who need or want influenza vaccine, I urge you to
continue to offer influenza vaccine throughout the month of December and beyond for as long as
vaccine is available. As you know, distribution of a portion of this year's influenza vaccine was delayed, and
insufficient quantities were available to meet all the demand during the optimal period for
vaccination, October and November. Thus, MANY INDIVIDUALS 65 AND ABOVE AND
THOSE WITH MEDICAL CONDITIONS PLACING THEM AT HIGH RISK
FOR COMPLICATIONS FROM INFLUENZA REMAIN UNVACCINATED. In addition, other young, healthy persons who wish to
reduce their risk from influenza this year were not vaccinated. And finally,
many work-site clinics were cancelled due to unavailability of vaccine.
Now that vaccine production is complete, plentiful amounts of influenza vaccine are available for immediate shipment
from the three primary suppliers of vaccine in the United
States: Aventis Pasteur, Wyeth-Lederle, and Henry Schein
(and its GIV and Caligor divisions) at current market prices. Other marketers may also have product available.
I urge you to take advantage of this situation and continue to vaccinate until all persons who want or need
influenza vaccine are vaccinated or the available supply is exhausted.
To date, influenza activity in the United States remains quite limited with only a
couple of small outbreaks and a relatively small number of isolated outbreaks
Influenza disease has peaked in January or later in 15 of the past 19 influenza seasons. BUT EVEN WHEN INFLUENZA IS
OCCURRING IN A COMMUNITY, INDIVIDUAL PATIENTS WHO HAVE NOT
YET BEEN EXPOSED, ESPECIALLY THE ELDERLY AND THOSE WITH RISK CONDITIONS, CAN BENEFIT FROM VACCINATION. For
businesses that want to protect their work forces and minimize absenteeism caused by
clinics in December or later can still help meet that
objective. And the many young, healthy individuals who deferred vaccination
earlier in the year can now be
The medical literature has documented that when health care providers recommend vaccination to patients, those
patients almost always agree to be vaccinated. I hope
that you will continue to offer influenza vaccine to your patients. If you require additional vaccine, I encourage
you to contact a supplier and obtain the needed
quantities. For those of you concerned about this year's
Medicare payment rate for influenza vaccine, all Medicare carriers are now paying $7.12 per dose of vaccine (which
exceeds the prices being offered by the three primary
suppliers) plus an administrative fee that ranges from $3.00 to $5.79 depending upon locale.
Thank you for your continued effort to provide influenza vaccine to high-risk
individuals and others who seek it,
especially in light of the delays in distribution we have
experienced these past two years. Please continue your efforts to help ensure that in 2001/2002, we achieve the
highest influenza vaccine coverage levels ever and protect
more individuals, especially the most vulnerable, against
the ravages of influenza.
Walter A. Orenstein, M.D.
Assistant Surgeon General
National Immunization Program
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December 11, 2001
REMINDER FOR THIS THURSDAY, DECEMBER 13: CDC SATELLITE BROADCAST ABOUT SMALLPOX FOR CLINICIANS
The Centers for Disease Control (CDC) will present a live satellite and web
broadcast, "Smallpox: What Every
Clinician Should Know," on Thursday, December 13, 12:00-2:00 p.m. Eastern Time. The program will be
rebroadcast on Monday, December 17, 5:00-7:00 p.m. Eastern Time.
A panel of experts from CDC will present information on virology, epidemiology, clinical features and diagnosis of
smallpox, and the characteristics and use of smallpox
For program details, registration, continuing education credit information, and
satellite specifications, go to:
If you are unable to view the live broadcast, CDC will provide a single VHS
videotape of the program free of charge. Videotapes will be available after
January 9, 2002.
To order a videotape, contact the Public Health Foundation by phone at 1-877-252-1200 or email at
Or order online at: http://bookstore.phf.org/prod184.htm
Additional copies may be purchased in packages of five copies for $35, with
a 15% discount on orders of 20 or more five-packs.
Webcast links for the entire series of bioterrorism broadcasts since October
18 can be found at:
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December 11, 2001
CDC ANNOUNCES 7TH EDITION OF "THE PINK BOOK" AND DECEMBER DISCOUNT ON ADVANCE ORDERS
The Centers for Disease Control and Prevention (CDC) has announced that the 7th edition of EPIDEMIOLOGY AND
PREVENTION OF VACCINE-PREVENTABLE DISEASES, also known as THE PINK BOOK, will
be available in February 2002. THE
PINK BOOK provides physicians, nurse practitioners, physician assistants, nurses, pharmacists, and others
- comprehensive information on vaccine-preventable
- general recommendations on immunizations
- immunization strategies for health care practices and
- strategies to increase vaccination
- revised vaccine recommendations
Order by mail, telephone, or online as instructed below. Until December 31,
2001, the cost is $22 per copy plus
$5.50 each shipping and handling; for bulk orders of 250 or more, the cost is $16.50 each plus shipping
and handling. Starting January 1, 2002, the cost increases to $25 per copy
$5.50 each shipping and handling; $18.75 each for bulk orders of 250 or
Send your prepaid order to:
Public Health Foundation
P.O. Box 753
Waldorf, MD 20604
To order by phone, call (877) 252-1200.
To order online, go to: http://www.phf.org
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December 11, 2001
REGISTER EARLY FOR THE NATIONAL IMMUNIZATION CONFERENCE
The 36th National Immunization Conference (NIC) will be held April 29-May 2,
2002 in Denver, Colorado. The theme is "Reaching for New Heights in Immunization."
You may register online now for an "early bird" discount!
To register online, go to: http://www.cdc.gov/nip/nic/#Conference
Also, remember that the deadline for abstracts is December 14, 2001. Abstracts should be submitted online at:
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December 11, 2001
NEW ON IAC'S WEBSITE: "SKILLS CHECKLIST FOR IMMUNIZATION"
This self-assessment tool for health care staff who administer vaccines is now
available on IAC's website.
Originally, this checklist was designed to accompany the popular video "Immunization Techniques: Safe, Effective,
Caring" that IAC promoted in the fall and continues to offer for sale. However,
because the checklist is also useful on its own, we decided to make it
direct downloading. It's a great way to assure all staff members' competency in all stages of the immunization process.
To obtain a camera-ready (PDF format) copy of the "Skills Checklist," go to:
To read more about the video, go to: http://www.immunize.org/genr.d/issue273.htm#n2