Immunization Action Coalition and the Hepatitis B Coalition

IAC EXPRESS

Previous issues index

Home page

Issue Number 300            March 11, 2002

CONTENTS OF THIS ISSUE

  1. CDC publishes Notice to Readers on varicella and MMR vaccine shortages and interim recommendations
  2. CDC's National Immunization Program releases important news on influenza vaccine for the 2002-2003 season
  3. New guidelines on mixing schedules of single-antigen hepatitis vaccines and a combination vaccine are available on CDC's website
  4. IAC creates Pneumococcal Conjugate Information web page
  5. Recommended reading: "Living with Hepatitis B: A Survivor's Guide"
  6. Second B Informed Conference will be held June 28-29 in Doylestown, Pennsylvania
  7. CDC promotes "Increasing Adult Vaccination Rates: WhatWorks" CD-ROM

----------------------------------------------------------

Back to Top

(1 of 7)
March 11, 2002
CDC PUBLISHES NOTICE TO READERS ON VARICELLA AND MMR VACCINE SHORTAGES AND INTERIM RECOMMENDATIONS

On March 8, 2002, the Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Shortage of Varicella and Measles, Mumps and Rubella Vaccines and Interim Recommendations from the Advisory Committee on Immunization Practices" in the Morbidity and Mortality Weekly Report (MMWR). Because this topic currently affects the ability of health care providers nationwide to offer immunization services, IAC is presenting this Notice to you in full.

The Notice to Readers, excluding references, reads as follows:

*******************************

A temporary shortage of varicella (VARIVAX) and combined measles, mumps and rubella (MMR) (M-M-R II) vaccines in the United States has resulted from two voluntary interruptions to manufacturing operations by Merck & Co., Inc., the only U.S. manufacturer of these products. One interruption was attributed to modifications Merck made voluntarily in response to issues raised by the U.S. Food and Drug Administration (FDA) during a routine Good Manufacturing Practices inspection. The other was the result of scheduled modifications made to the manufacturer's facility, which took longer than expected to be completed and had a substantial impact on production during September-October 2001. Following the interruptions of production, vaccine supply rapidly declined at the end of 2001. [VARIVAX and M-M-R II are registered trademarks.]

VARICELLA VACCINE

Although the duration of the varicella vaccine shortage is uncertain, Merck predicts that the shortage will be resolved by late spring or early summer 2002. The annual need for varicella vaccine in the United States is about 6 to 7 million doses or 500,000-583,000 doses per month. Because of supply decreases, by March 4, approximately 1.1 million doses were on back order for both public and private sectors. Merck estimates an average of 60 days to fill these orders. Meanwhile, shortages are expected nationwide.

Interim ACIP Recommendations for Use of Varicella Vaccine

Varicella is a more severe disease among adolescents and adults; however, the highest incidence of disease is among elementary school aged children. Until adequate supplies of varicella vaccine are available, ACIP recommends that all vaccine providers in the United States delay administration of the routine childhood varicella vaccine dose from age 12-18 months until age 18-24 months. If the shortage persists after delaying the dose at age 12-18 months and is of sufficient severity that further prioritization of vaccine use is needed, recommendations for use (highest to lowest priority) of Varivax for susceptible persons are:

  1. Vaccination of health care workers, family contacts of immunocompromised persons, adolescents aged 13 years or older, and adults and high-risk children (e.g., children infected with human  immunodeficiency virus and children with asthma or eczema).
          
  2. Vaccination of susceptible children aged 5-12 years, particularly children entering school and adolescents aged 11-12 years. States may elect to provide guidance on priority cohorts for vaccination.
      
  3. Vaccination of children aged 2-4 years. Within this age group, states may elect to provide guidance on priorities (e.g., children attending child care centers) for vaccination.

MEASLES, MUMPS AND RUBELLA VACCINE

Although the duration of the shortage is uncertain, the manufacturer predicts that problems with the MMR vaccine supply should be resolved in 1-3 months. The annual need for MMR vaccine in the United  States is about 13 million doses. The average number of MMR doses shipped during January-September 2001 was 943,000 doses; during October-November 2001, an average of 586,000 doses was shipped; during December 2001-February 2002, an average of 819,000 doses was shipped each month. As of March 4, a total of 1,077,670 doses was on back order for both the public and private sectors. As of February 28, 2002, the manufacturer projects that 5.6 million doses will be supplied during March-May 2002.

Interim ACIP Recommendation for Use of MMR Vaccine

Two doses of MMR vaccine, separated by at least a month and administered on or after the first birthday, are recommended for children, adolescents, and adults who lack adequate documentation of vaccination or other acceptable evidence of immunity. The first dose is recommended at age 12-15 months and the second dose at age 4-6 years. If providers are unable to obtain sufficient amounts of MMR vaccine to implement fully ACIP recommendations for MMR vaccination, ACIP recommends that they defer the second MMR dose. Because of the severity of measles in young children, providers should not delay administration of the first dose of the MMR series.

Tracking and Recall

Records should be maintained for children who experience a delay in administration of either varicella or MMR vaccines so they can be recalled when vaccine becomes available. The latest information about vaccine supply issues is available at: http://www.cdc.gov/nip/news/shortages

*******************************

To obtain the complete text of the Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5109a6.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5109.pdf

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://www.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 email.
---------------------------------------------------------

Back to Top

(2 of 7)
March 11, 2002
CDC'S NATIONAL IMMUNIZATION PROGRAM RELEASES IMPORTANT NEWS ON INFLUENZA VACCINE FOR THE 2002-2003 SEASON

On February 26, 2002, the National Immunization Program (NIP) issued the first of this year's annual series of influenza bulletins. Although it may seem too early to think about the next flu season when the current one is not yet over, now really is the time to start planning how to reach the target populations in your practice--and the time to order enough vaccine for them.

Influenza Bulletin #1 describes upcoming changes to current influenza vaccination recommendations, including "prioritizing" efforts in October and November and "encouraging" vaccination of healthy children under 2 years of age and the adults who work and/or live with them. The bulletin also suggests that providers order influenza vaccine soon and gives company phone numbers and other ordering information.

Following is the entire section from Influenza Bulletin #1 on "Influenza Vaccine Distribution and Administration":

*******************************

THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) HAS VOTED ON INFLUENZA RECOMMENDATIONS FOR THE 2002-03 SEASON. THESE RECOMMENDATIONS WILL BE PUBLISHED IN A FUTURE ISSUE OF CDC'S MMWR. THE MAJOR CHANGES ARE AS FOLLOWS:

The ACIP voted to prioritize vaccination efforts in October to target persons at high risk of complications from influenza and health care workers. In addition, because children under 9 years of age who are receiving vaccine for the first time need a booster dose one month after the initial dose, children between 6 months of age and 9 years of age receiving influenza vaccine for the first time should begin vaccinations in October. All other groups, including household members of high-risk persons, healthy persons 50-64, and others who wish to decrease their risk of influenza infection should begin vaccination in November. This strategy was initiated during the last two influenza seasons because of significant vaccine distribution delays and is being continued for the 2002-03 influenza season because of the possibility of similar situations in future years and to provide continuity in the recommendations.

In addition, the committee voted to "encourage when feasible" influenza vaccination for healthy children aged 6 months to 23 months because children in this age group are at substantially increased risk for influenza-related hospitalizations. A recommendation to annually vaccinate healthy children aged 6 months to 23 months is expected within the next one to three years. For many years, the committee has recommended vaccination of children 6 months and older who have high-risk medical conditions, such as asthma, diabetes mellitus and heart disease. High-risk children 6 months and older continue to be strongly recommended for annual vaccination.

Household contacts and out-of-home caregivers of children 0-23 months of age are also now encouraged to receive influenza vaccine in order to decrease the risk of contacts transmitting influenza virus to these children. Vaccination of contacts of children less than 6 months old is particularly encouraged since children less than 6 months of age cannot be vaccinated against influenza and are the pediatric age group at greatest risk of influenza-related hospitalization.

HEALTH CARE PROVIDERS SHOULD ORDER INFLUENZA VACCINE FOR THE 2002-03 INFLUENZA SEASON AS SOON AS POSSIBLE.

In 2001, the entire U.S. supply of influenza vaccine was prebooked before the end of May. Thus, early  ordering is essential for those wishing to ensure timely receipt of vaccine. Health care providers, distributors and vendors who are seeking influenza vaccine for 2002-03 should contact

Aventis Pasteur at 1-800-822-2463 [taking orders beginning March 4-18 online only at http://www.vaccineshoppe.com and after March 18 by phone, online, or fax (800) 561-1216].

Evans Vaccines through Henry Schein or its GIV or Caligor Divisions at 1-800-772-4346 or 1-800-521-7468 (currently taking orders).

Wyeth-Ayerst Labs at 1-800-358-7443 (taking orders sometime in March). Many other distributors and vendors may also be taking orders.

*******************************

To read Influenza Bulletin #1 on NIP's website, go to:
http://www.cdc.gov/nip/Flu/Bulletins_2002-03/bulletin_1.htm

To see previous bulletins from the series, go to:
http://www.cdc.gov/nip/Flu/News.htm#Bulletin
---------------------------------------------------------

Back to Top

(3 of 7)
March 11, 2002
NEW GUIDELINES ON MIXING SCHEDULES OF SINGLE-ANTIGEN HEPATITIS VACCINES AND A COMBINATION VACCINE ARE AVAILABLE ON CDC'S WEBSITE

The Division of Viral Hepatitis at the Centers for Disease Control and Prevention (CDC) has posted an article titled "Twinrix: Combined Hepatitis A and Hepatitis B Vaccine" on CDC's website. (Twinrix is a registered trademark.) The web-page article covers general information about this combination vaccine and specific dosing schedules.

Of special interest for health care providers is new information on mixing schedules--that is, administering doses of Twinrix and/or doses of single-antigen hepatitis A and hepatitis B vaccine to complete a patient's vaccination series. Readers should note that, according to the article, "In general, it is best to start and finish a series with the same vaccine formulation, using the licensed dosage and schedule." The mixed-schedule information is intended to help guide decision making regarding whether patients "who have received mixed schedules that include Twinrix need further vaccinations to complete the series."

To read "Twinrix: Combined Hepatitis A and Hepatitis B Vaccine," go to:
http://www.cdc.gov/ncidod/diseases/hepatitis/twinrix.htm
---------------------------------------------------------

Back to Top

(4 of 7)
March 11, 2002
IAC CREATES PNEUMOCOCCAL CONJUGATE INFORMATION WEB PAGE

The pneumococcal conjugate vaccine (PCV7, or Prevnar) was licensed in February 2000 to prevent infection from Streptococcus pneumoniae (pneumococcus), which remains the most frequent cause of childhood pneumonia, bacteremia, sinusitis, and acute otitis media. In the United States, S. pneumoniae causes approximately 17,000 cases per year of invasive disease in children under age 5 years, including 700 cases of meningitis and 200 deaths.

Now you can find sources of information that address your PCV7 questions on IAC's one-stop web  page devoted to the subject. This page currently features 20 links to journal articles; CDC recommendations; case histories; photos; and vaccine shortage information.

To visit IAC's new Pneumococcal Conjugate Information web page, go to:
http://www.immunize.org/pneumoconj/
---------------------------------------------------------

Back to Top

(5 of 7)
March 11, 2002
RECOMMENDED READING: "LIVING WITH HEPATITIS B: A SURVIVOR'S GUIDE"

"LIVING WITH HEPATITIS B: A SURVIVOR'S GUIDE" is an excellent new book that can be read not just by people diagnosed with hepatitis B, but also by noninfected people in high-risk groups and even interested members of the general public who like to learn about health issues. (After all, who would not benefit from the chapter "Learning about Your Liver: Your Body's Chemical Factory"?) Of course, the book is intended primarily for the nearly 1.25 million Americans who have chronic hepatitis B and their families and friends. This book will help them live--and live well--with their illness.

"LIVING WITH HEPATITIS B" was written by Gregory T. Everson, M.D., F.A.C.P., Director of Hepatology, University of Colorado Health Sciences Center, and Hedy Weinberg, award-winning writer and hepatitis B patient. The authors cover hepatitis B in history, early warning symptoms, diagnosis, emotional effects of the disease, nutrition, liver transplants, the hepatitis B vaccine, and more. Hatherleigh Press, an affiliate of W.W. Norton, accurately promotes the 303-page book as "a comprehensive handbook written in understandable language."

For more information about "LIVING WITH HEPATITIS B," go to:
http://www.hepatitisonline.com

For information from the book's publisher, go to:
http://www.hatherleighpress.com

"LIVING WITH HEPATITIS B: A SURVIVOR'S GUIDE" is available through most bookstores and retails  for $15.95. Group purchases can be made by calling (800) 528-2550.
---------------------------------------------------------

Back to Top

(6 of 7)
March 11, 2002
SECOND B INFORMED CONFERENCE WILL BE HELD JUNE 28-29 IN DOYLESTOWN, PENNSYLVANIA

The B Informed 2002 Conference, sponsored by the Hepatitis B Foundation and the Hepatitis B Information and Support List, will take place June 28-29 at Delaware Valley College, Doylestown, Pennsylvania. It is the "second gathering of HBV friends."

The registration fee for B Informed is $60 for the first participant and just $30 for family members and friends of that participant. This fee includes everything--lodging in the College dormitories, meals, a mug, and all programming.

Doc Misra will present on the topic "Integrating the HBV Knowledge of West and East." Other presentation topics will include vaccine therapy, health insurance rights, and treatment of patients with hepatitis B virus mutations.

For more information on B Informed 2002, email Steve Bingham at srb@rmci.net or Sheree Martin at martins@zoomnet.net or call Steve Bingham at (208) 342-3945.

To learn about other conferences and seminars related to immunization and hepatitis B, visit IAC's online Calendar of Events at: http://www.immunize.org/calendar/
---------------------------------------------------------

Back to Top

(7 of 7)
March 11, 2002
CDC PROMOTES "INCREASING ADULT VACCINATION RATES: WHATWORKS" CD-ROM

On March 8, 2002, the Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Availability of Continuing Education CD-ROM Program on Strategies to Increase Adult Vaccination Rates" in the Morbidity and Mortality Weekly Report (MMWR).

Following is the entire Notice to Readers:

*******************************

The Association of Teachers of Preventive Medicine (ATPM) and the National Immunization Program (NIP)/CDC have released "Increasing Adult Vaccination Rates: WhatWorks," an interactive instructional program on CD-ROM that offers primary-care providers strategies to increase vaccination rates among their adult patients.

The program gives users the opportunity to test their knowledge of vaccine usage and explore facts about vaccine-preventable diseases; access reference materials and answers to frequently asked questions; review information about effective strategies (e.g., standing orders, chart reminders, and mailed/telephoned reminders) and test their knowledge of how to best implement these strategies; and develop a customized adult vaccination action plan for their practice.

The CD-ROM features web links to appropriate resources, predominantly those on the NIP/CDC Web site. The program is approved for 2 hours of Continuing Medical Education credit, 2.3 hours Continuing Nursing Education credit, and 0.2 hours Continuing Education units through CDC.

WhatWorks can be ordered free of charge through ATPM at http://www.atpm.org Additional information is available through ATPM, telephone (800) 789-6737, or by email at whatworks@atpm.org

*******************************

To obtain the complete text of the Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5109a7.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5109.pdf

IAC announced this CD-ROM in IAC EXPRESS #280, which can be found at:
http://www.immunize.org/genr.d/issue280.htm

 

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 March 11, 2002