Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 321            July 1, 2002

CONTENTS OF THIS ISSUE

  1. CDC publishes 20-year history of hepatitis B vaccine to mark the vaccine's anniversary
  2. CDC clarifies groups that should be vaccinated against influenza in the month of October
  3. Revised! IAC's "Summary of Recommendations for Adult Immunization"
  4. Dr. Harold Margolis to head CDC's Division of Viral Hepatitis
  5. New! Measles, mumps, and rubella information pages on IAC's website
  6. JAMA article examines, compares antivaccine websites
  7. Europe is polio-free says World Health Organization
  8. Group aims to increase participation in immunization registries
  9. Long- and short-term overseas immunization positions are now open

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July 1, 2002
CDC PUBLISHES 20-YEAR HISTORY OF HEPATITIS B VACCINE TO MARK THE VACCINE'S ANNIVERSARY

On June 28, 2002, the Centers for Disease Control and Prevention (CDC) published "Achievements in Public Health: Hepatitis B Vaccination--United States, 1982-2002" in Morbidity and Mortality Weekly Report (MMWR). The article includes a timeline of hepatitis B vaccination recommendations by the  Advisory Committee on Immunization Practices (ACIP), from the original high-risk-group recommendation to this year's birth-dose recommendation. "Substantial progress" has been made in reducing hepatitis B virus transmission since 1982, according to the article. Even so, after summarizing  strategies to prevent hepatitis B, the article concludes that "unless efforts to vaccinate adults at increased risk for HBV infection are greatly expanded, complete elimination of HBV transmission might take another 20 years to achieve."

The introduction to the article reads as follows (excluding footnotes):

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This year marks the 20th anniversary of the implementation in the United States of the world's first vaccine against hepatitis B virus (HBV). In addition to acute disease, persons infected with HBV are at risk for chronic HBV infection and severe morbidity and mortality from cirrhosis and hepatocellular carcinoma. Before 1982, an estimated 200,000-300,000 persons in the United States were infected annually with HBV, including approximately 20,000 children. No practical method of pre-exposure prophylaxis for HBV existed, and the only postexposure prophylaxis available was injection with hepatitis B immune globulin (HBIG).

Since 1982, substantial progress has been made toward eliminating HBV transmission in children and reducing the risk for HBV infection in adults. During 1982-2002, an estimated 40 million infants and children and 30 million adults received hepatitis B vaccine. Because of vaccination and changes in risk- eduction behaviors among at-risk populations in response to the HIV/AIDS epidemic, the number of persons infected in the United States declined to an estimated 79,000 in 2001. To eliminate HBV transmission, high vaccine-coverage rates must be sustained among infants, children, and adolescents, and programs to vaccinate adults at high risk for HBV infection must be expanded.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5125.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.
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July 1, 2002
CDC CLARIFIES GROUPS THAT SHOULD BE VACCINATED AGAINST INFLUENZA IN THE MONTH OF OCTOBER

On June 28, 2002, the Centers for Disease Control and Prevention (CDC) published "Erratum: Vol. 51, No. RR-3" in Morbidity and Mortality Weekly Report (MMWR). The Erratum concerns the MMWR Recommendation and Report publication titled "Prevention and Control of Influenza: Recommendations  of the Advisory Committee on Immunization Practices," dated April 12, 2002. Because children aged 6 months through 8 years receiving influenza vaccine for the first time need a booster dose a month later, they should get their first dose in October. This was not specified, according to the Erratum, in the section on "Timing of Organized Vaccination Campaigns."

The entire text of the Erratum follows (excluding one footnote):

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The MMWR Recommendations and Reports, "Prevention and Control of Influenza: Recommendations of  the Advisory Committee on Immunization Practices," published on April 12, 2002, contained an inconsistency in the recommended timing of vaccination of target groups. In the section, "Vaccination in October and November," persons at increased risk for influenza-related complications (e.g., persons aged 65 years and older and persons aged 6 months-64 years with high-risk medical conditions) and health-care workers were recommended for vaccination in October. In addition, children aged 6 months to <9 years receiving influenza vaccine for the first time need a booster dose 1 month (or more) after  the first dose and, thus, also were recommended to be vaccinated in October or earlier. However, in the section, "Timing of Organized Vaccination Campaigns," household contacts of persons at high risk were also included among those recommended to begin vaccination in October, but children aged <9 years receiving vaccine for the first time were not discussed.

To clarify, vaccination of the following groups should begin in October, regardless of the setting in which a person receives vaccination:

  • persons at increased risk for influenza-related complications (persons aged 65 years or older, persons aged 6 months-64 years with certain medical conditions, and healthy children aged 6-23  months);
       
  • health-care workers;
       
  • household contacts of persons at increased risk for influenza-related complications (including contacts of infants aged <6 months who are not eligible for influenza vaccine); and
      
  • children aged 6 months to <9 years receiving influenza vaccine for the first time.

The current projected distribution of U.S. influenza vaccine for 2002-2003, on the basis of aggregate manufacturer's estimates, is 92-97 million doses, with the majority of doses expected to be distributed by the end of October. This projection is based on early estimates and might change as the season  progresses. Thus, supplies are expected to be adequate for prioritization of persons at increased risk  for influenza complications, their household contacts, and health-care workers for vaccination in October.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a4.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5125.pdf

To read or print "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices," go to:
HTML: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5103a1.htm
PDF: http://www.cdc.gov/mmwr/pdf/rr/rr5103.pdf
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July 1, 2002
REVISED! IAC's "SUMMARY OF RECOMMENDATIONS FOR ADULT IMMUNIZATION"

The Immunization Action Coalition (IAC) has incorporated the most current guidelines for vaccinating adults in the widely used two-sided chart, "Summary of Rules for Adult Immunization."

Lyme disease vaccine information has been removed from the chart. In addition, the meningococcal vaccine recommendation to vaccinate people with risk factors has been added at the beginning of the  meningococcal vaccine text. A few other more minor clarifications in wording have been made on such  matters as simultaneous administration of certain vaccines.

To obtain a copy of the revised "Summary of Recommendations for Adult Immunization," go to:
HTML: http://www.immunize.org/catg.d/p2011b.htm
PDF: http://www.immunize.org/catg.d/p2011b.pdf
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July 1, 2002
DR. HAROLD MARGOLIS TO HEAD CDC'S DIVISION OF VIRAL HEPATITIS

The National Center for Infectious Diseases (NCID), within the Centers for Disease Control and Prevention (CDC), has announced the appointment of Harold Margolis, M.D., to the position of Director, Division of Viral Hepatitis.

The formal personnel announcement from NCID reads as follows:

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I am very pleased to announce that Dr. Hal Margolis has accepted the position of Director, Division of Viral Hepatitis (DVH). Dr. Margolis was named the Acting Director, DVH when it was established in October 2001. Most recently he has been on a detail to the CDC OD [Office of the Director] as a Special Assistant to the Deputy Director for Science and Public Health to oversee and coordinate the Agency's smallpox preparedness activities.

Previously Dr. Margolis has been Chief of the Hepatitis Branch, Division of Viral and Rickettsial  Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, and Director of a World Health Organization Collaborating Center for Research and Reference in Viral Hepatitis since 1987. He initially joined CDC in 1975 as an Epidemic Intelligence Service (EIS) officer following completion of his pediatric residency at the University of Colorado. He subsequently did a fellowship in immunology at the National Jewish Center for Immunology Research in Denver. He is a Fellow of the American Academy of Pediatrics and the Infectious Disease Society of America.

His interests include vaccine development and evaluation, development and evaluation of strategies to prevent viral hepatitis, and the molecular pathogenesis of viral hepatitis. He has been a leader in the  development of current recommendations for hepatitis B immunization strategies in the United States  and a consultant to a number of countries in the development of hepatitis B immunization and prevention programs. He is the author or coauthor of over 100 papers or chapters in the field of viral hepatitis.

Jim Hughes
[Director, National Center for Infectious Diseases]

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Congratulations to Dr. Margolis, a long-time viral hepatitis elimination visionary and immunization champion. The Immunization Action Coalition is so glad to have you back in viral hepatitis.
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July 1, 2002
NEW! MEASLES, MUMPS, AND RUBELLA INFORMATION PAGES ON IAC'S WEBSITE

Next time you or your patients have questions about the measles-mumps-rubella (MMR) vaccine or the diseases themselves, you can find journal articles, recommendations, state laws, case histories, photos,  and more on IAC's new "MMR" web pages.

Resources pertaining to the trivalent vaccine are repeated on all pages.

To view IAC's Measles Information web page, go to:
http://www.immunize.org/measles

To view IAC's Mumps Information page, go to:
http://www.immunize.org/mumps

To view IAC's Rubella Information web page, go to:
http://www.immunize.org/rubella
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July 1, 2002
JAMA ARTICLE EXAMINES, COMPARES ANTIVACCINE WEBSITES

The June 26 issue of JAMA, the Journal of the American Medical Association, contains a feature article titled "Content and Design Attributes of Antivaccination Web Sites" (vol. 287, no. 24). Written by Robert  M. Wolfe, M.D., Lisa K. Sharp, Ph.D., and Martin S. Lipsky, M.D., all from Northwestern University, the  article examines "the specific claims and concerns expressed by antivaccination groups" on 22 websites.

Eleven common antivaccination claims are identified in the websites and discussed in the article, as well as ten website design features such as chat rooms and links to similar sites.

According to the Comment section, "Our results show that such sites express a variety of claims that are largely unsupported by peer-reviewed scientific literature. . . .While the majority of the public accepts immunization, it appears that increasing numbers of parents are seeking philosophical exemptions from vaccination for their children. . . . We believe our study findings can help direct research aimed at more effectively addressing the concerns of individuals opposing childhood vaccination."

To read JAMA's "Brief Report" on the article, go to:
http://jama.ama-assn.org/issues/v287n24/abs/jbr20117.html

The entire article is available online at no charge only to registered users or subscribers to JAMA. To order the article online on a Pay Per View basis ($9 fee), go to: https://secure.edoc.com/PPV2.html

To order individual reprints, call the JAMA reprint office at (312) 464-4594 or contact one of the independent reprint vendors listed at: http://pubs.ama-assn.org/docdelivery.html
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July 1, 2002
EUROPE IS POLIO-FREE SAYS WORLD HEALTH ORGANIZATION

On June 21, 2002, the World Health Organization (WHO) announced that no indigenous cases of polio have been detected in its European Region in the past three years. The last case of wild poliomyelitis  occurred in eastern Turkey in 1998 in a 2-year-old unvaccinated boy who was paralyzed by the virus.

In a meeting of the European Regional Commission for Certification of Poliomyelitis Eradication (RCC), the European Region (51 countries) joined the Americas and the Western Pacific in achieving "polio-free" certification. The Global Polio Eradication Initiative aims to certify the world polio-free by the end of the year 2005.

As RCC chairman Sir Joseph Smith stated in the WHO press release about the certification, "Our work does not stop here. Throughout the European Region, ongoing vaccination and surveillance is vital. The risk of poliovirus being imported into Europe will continue until we eradicate polio globally."

To read the WHO press release, "Europe Achieves Historic Milestone As Region Is Declared Polio-Free," go to: http://www.who.int/inf/en/pr-EURO.2002-12.02.html
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July 1, 2002
GROUP AIMS TO INCREASE PARTICIPATION IN IMMUNIZATION REGISTRIES

The following news report originally appeared in the June Immunization Works Newsletter published by  the National Immunization Program (NIP) and distributed to NIP grantees. The Immunization Action Coalition (IAC) is reproducing it here as a service to IAC EXPRESS readers.

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Currently, only 24% of children in the U.S. less than 6 years of age are participating in a population-based immunization registry. One of the Healthy People 2010 immunization registry objectives is to increase the number of children under 6 participating in an immunization registry to 95%. In order to  achieve this objective, participation by health care professionals needs to increase dramatically over the next 8 years. The CDC is supporting activities to include the private sector in this work. A Provider Participation Work Group has been formed with representation from numerous organizations with an immunization, registry or pediatric focus in their mission. The purposes of a May 20 meeting were to inform participants of the current status of immunization registries, define the problem of provider non-participation in registries, and initiate a discussion of the issues impacting participation by health care professionals in community- and state-based immunization registries. Future meetings will continue to identify barriers and develop solutions of increasing registry participation. If you or your organization is interested in working with the Provider Participation Work Group, please contact Karen Fowler, Work Group Chairman, at kgf1@cdc.gov <mailto:kgf1@cdc.gov> or (404) 639-8295.

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July 1, 2002
LONG- AND SHORT-TERM OVERSEAS IMMUNIZATION POSITIONS ARE NOW OPEN

The following announcement originally appeared in the June Immunization Works Newsletter published by the National Immunization Program (NIP) and distributed to NIP grantees. The Immunization Action Coalition (IAC) is reproducing it here as a service to IAC EXPRESS readers.

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The CDC's Global Immunization Division within the National Immunization Program works to prevent and eliminate vaccine preventable disease around the world. CDC, the World Health Organization (WHO),  UNICEF, Rotary International and other partners are working toward the global certification of polio eradication by 2005 and developing measles mortality reduction activities. WHO and UNICEF have  asked CDC to assist them in filling critical positions, both long and short term. Long-term, two-year positions exist for Medical Epidemiologists and Technical Officers in Africa, Asia and Europe for measles reduction activities. Assignees will assist WHO, host governments and partners in organizing  National Immunization Days, supplemental immunization activities, surveillance and accelerated measles activities. Eligible applicants are epidemiologists and technical officers with at least five years of international public health, disease surveillance and immunization program experience. More information is available from Carla Lee at cel1@cdc.gov <mailto:CEL1@cdc.gov> [or from Liz Bell at eib6@cdc.gov]. Short term positions of twelve weeks are available for polio eradication consultants. Assignments include Africa, Asia and the Eastern Mediterranean. The work focuses on disease surveillance and/or assisting with planning, monitoring, and evaluating National Immunization Days. More information may be obtained by visiting www.cdc.gov/nip/global/ <http://www.cdc.gov/nip/global/>.

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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 1, 2002