Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 354            December 16, 2002

CONTENTS OF THIS ISSUE

  1. New! CDC issues smallpox Vaccine Information Statement
  2. A study published in "The Lancet" indicates infants rapidly eliminate mercury contained in thimerosal
  3. Gripping "Photo Notebook of Vaccine-Preventable Diseases" and "Slide Set of Vaccine-Preventable Diseases" still available
  4. CDC report on measles outbreak among internationally adopted children shows importance of immunization for adopting families
  5. Revised! IAC updates hepatitis B education article "If You Have Sex, Read This"
  6. Mark your calendars! CDC's four-part satellite broadcast of "Epidemiology and Prevention of Vaccine-Preventable Diseases" will be held in February and March
  7. First meeting of IOM Committee on Smallpox Vaccination Program Implementation set for December 18-20
  8. New poll shows public now slightly more willing to be vaccinated against smallpox than in May
  9. Hepatitis C integration training manual now available
  10. FDA approves supplemental license for hepatitis C treatment

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December 16, 2002
NEW! CDC ISSUES SMALLPOX VACCINE INFORMATION STATEMENT

The Centers for Disease Control and Prevention (CDC) issued a Vaccine Information Statement (VIS) for smallpox vaccine on December 11. It is important to note that unlike other VISs, the smallpox VIS must be used with a separate consent form that requires a signature. The form will be available soon from CDC.

To obtain a copy of the VIS from the website of the Immunization Action Coalition (IAC), go to: http://www.immunize.org/vis/index.htm#smallpox
Click on "English" to access the VIS in camera-ready (PDF) format.

For extensive, up-to-date information about smallpox disease and vaccine, visit the CDC's bioterrorism website at http://www.cdc.gov/smallpox

For information about the use of VISs, as well as VISs for additional vaccines (some in up to 28 languages), visit IAC's website at http://www.immunize.org/vis
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December 16, 2002
A STUDY PUBLISHED IN "THE LANCET" INDICATES INFANTS RAPIDLY ELIMINATE MERCURY CONTAINED IN THIMEROSAL

On November 30, "The Lancet" published an article titled "Mercury Concentrations and Metabolism in Infants Receiving Vaccines Containing Thimerosal: A Descriptive Study," which refutes the hypothesis that administration of vaccines containing thimerosal raises blood concentrations of mercury above safe levels in infants. The article is part of an established body of evidence that rebuts the existence of a link between thimerosal-containing vaccines and the development of autism. The complete abstract of the article follows.

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Background

Thimerosal is a preservative containing small amounts of ethylmercury that is used in routine vaccines for infants and children. The effect of vaccines containing thimerosal on concentrations of mercury in infants' blood has not been extensively assessed, and the metabolism of ethylmercury in infants is unknown. We aimed to measure concentrations of mercury in blood, urine, and stools of infants who received such vaccines.

Methods

40 full-term infants aged 6 months and younger were given vaccines that contained thimerosal (diphtheria-tetanus-acellular pertussis vaccine, hepatitis B vaccine, and in some children Haemophilus  influenzae type b vaccine). 21 control infants received thimerosal-free vaccines. We obtained samples of blood, urine, and stools 3-28 days after vaccination. Total mercury (organic and inorganic) in the samples was measured by cold vapor atomic absorption.

Findings

Mean mercury doses in infants exposed to thimerosal were 45.6 micrograms (range 37.5-62.5) for 2-month-olds and 111.3 micrograms (range 87.5-175.0) for 6-month-olds. Blood mercury in thimerosal-exposed 2-month-olds ranged from less than 3.75 to 20.55 nmol/L (parts per billion); in 6-month-olds all values were lower than 7.50 nmol/L. Only one of 15 blood samples from controls contained quantifiable mercury. Concentrations of mercury were low in urine after vaccination but were high in stools of thimerosal-exposed 2-month-olds (mean 82 ng/g dry weight) and in 6-month-olds (mean 58 ng/g dry  weight). Estimated blood half-life of ethylmercury was 7 days (95% CI 4-10 days).

Interpretation

Administration of vaccines containing thimerosal does not seem to raise blood concentrations of mercury above safe values in infants. Ethylmercury seems to be eliminated from blood rapidly via the  stools after parenteral administration of thimerosal in vaccines.

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To access the article abstract from the PubMed website of the National Center for Biotechnology Information, click here and then click on the author's names (hyperlink) in the citation.

To access more journal articles and other web resources that rebut the existence of a relationship between vaccines and autism, use the following links:

"A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism"
Authors: Madsen KM, Hviid A, Vertergaard M, et al
Source: New England Journal of Medicine, November 7, 2002, Vol.347(19):1477-1482
http://content.nejm.org/cgi/content/abstract/347/19/1477

"Neurologic Disorders after Measles-Mumps-Rubella Vaccination"
Authors: Makela A, Nuorti JP, Peltola H
Source: Pediatrics, November 2002, Vol. 110:957-963
http://www.pediatrics.org/cgi/content/abstract/110/5/957

"Measles, Mumps, and Rubella Vaccination and Bowel Problems or Developmental Regression in Children with Autism: Population Study"
Authors: Taylor B, Miller E, Lingam R, Andrews N, Simmons A, Stowe J
Source: British Medical Journal, February 16, 2002, Vol. 324(7334):393-6
http://bmj.com/cgi/content/full/324/7334/393/DC1

"No Evidence for a New Variant of Measles-Mumps-Rubella-Induced Autism"
Authors: Fombonne E, Chakrabarti S
Source: Pediatrics, October 2001, Vol. 108(4):E58
http://www.pediatrics.org/cgi/content/full/108/4/e58

"Measles-Mumps-Rubella Vaccine and Autism" (summary report)
Source: Institute of Medicine
http://www.iom.edu/IOM/IOMHome.nsf/Pages/mmr+report

"Vaccines and Autism"
Author: Offit PA
Source: Vaccine Education Center, Children's Hospital of Philadelphia
http://www.immunize.org/catg.d/p2065.htm

The Immunization Action Coalition's "Autism Information" web page (includes related journal articles and resources for health professionals and parents)
http://www.immunize.org/safety/autism.htm

The Centers for Disease Control and Prevention's "Vaccines and Autism Theory" web page (includes fact sheets, FAQs, etc.)
http://www.cdc.gov/nip/vacsafe/concerns/autism

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December 16, 2002
GRIPPING "PHOTO NOTEBOOK OF VACCINE-PREVENTABLE DISEASES" AND "SLIDE SET OF VACCINE-PREVENTABLE DISEASES" STILL AVAILABLE

Two powerful visual aids--the "Photo Notebook of Vaccine-Preventable Diseases" and the "Slide Set of Vaccine-Preventable Diseases"--will be of interest to health departments and medical practices that don't already have them. Developed by the Immunization Action Coalition (IAC), the notebook and slide  set are intended for staff and community outreach workers who conduct immunization presentations. Whether viewed as photos on a tabletop or as slides on a screen, many have found these images to be worth more than a thousand words each, and we think you and your patients will, too.

Photo Notebook

A three-ring binder holds 20 plastic-protected, 8"x10" color photographs of children and adults with vaccine-preventable diseases. Each picture is accompanied by simple text that explains the disease portrayed. When you show your patients pictures of infants with severe varicella disease and other infections, they will begin to understand the seriousness of the diseases that vaccines can prevent.

To see the photos from the Photo Notebook on our website, go to: http://www.immunize.org/news.d/6025pix.pdf

To view an image of the Photo Notebook, go to: http://www.immunize.org/images/r2053.jpg

To order your own "Photo Notebook of Vaccine-Preventable Diseases" online (item R2053, $75 each), go to: http://www.immunize.org/photobook

The images also can be downloaded for free from IAC's website at: http://www.immunize.org/catg.d/pict001.htm

Be sure to scroll down to the thumbnail images and click on the "live labels" next to them to view at different sizes.

Slide Set

The Slide Set contains eight more images than the Photo Notebook. To assist you with slide presentations, an English-language script comes with the Slide Set. A Spanish-language script is also available upon request. (The Puerto Rico Immunization Program generously provided the Spanish-language translation to IAC.)

To order a Slide Set online (item S3010, $25 each), go to:
http://www.immunize.org/slideset

To access the English-language script, go to:
http://www.immunize.org/catg.d/3010slid.pdf

To access the Spanish-language script, go to:
http://www.immunize.org/catg.d/3010-01.pdf

You may also order Photo Notebooks or Slide Sets by sending a check to IAC, Orders Dept., 1573 Selby Avenue, Suite 234, St. Paul, MN 55104, or faxing your order along with your credit card  information to (651) 647-9131. Questions? Call (651) 647-9009 (no phone orders, please).

Please allow 3-4 weeks for delivery of these items.
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December 16, 2002
CDC REPORT ON MEASLES OUTBREAK AMONG INTERNATIONALLY ADOPTED CHILDREN SHOWS IMPORTANCE OF IMMUNIZATION FOR ADOPTING FAMILIES

The Centers for Disease Control and Prevention (CDC) published "Measles Outbreak Among Internationally Adopted Children Arriving in the United States, February-March 2001" in the December 13 issue of the "Morbidity and Mortality Weekly Report" (MMWR).

A separate synopsis available to the press states that "a 10-month-old child adopted from an orphanage in China" traveled to and within the United States on commercial airlines while in "an infectious stage of measles," potentially exposing "multiple persons during the communicable period. Subsequent investigations identified 14 U.S. measles cases related to this case." The synopsis encouraged parents of internationally adopted children to be sure they and their family members are current in their immunizations.

The concluding paragraph of the Editorial Note of the MMWR report is printed below.

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Since 1996, all persons seeking a U.S. immigrant visa are required to show proof of having received at least the first vaccine of each series of vaccinations recommended by the Advisory Committee on  Immunization Practices (ACIP), which includes measles. However, internationally adopted children who are 10 years of age or younger are exempted from the Immigration and Nationality Act vaccination requirements with a signed statement from the adopting parent(s) indicating that the child will receive vaccination within 30 days of entry into the United States. Parents of internationally adopted children should be aware of the importance of confirming that they and their family members are current in their vaccinations and that, soon after arrival in the United States, their adopted children's vaccination status is updated according to ACIP guidelines. In addition, persons who will be in contact with internationally adopted children during their first 3 weeks in the United States, especially household members and caretakers, should be immune to measles or be vaccinated before the adoption.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5149.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 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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December 16, 2002
REVISED! IAC UPDATES HEPATITIS B EDUCATION ARTICLE "IF YOU HAVE SEX, READ THIS"

The Immunization Action Coalition (IAC) made a minor modification to its patient education article "If You Have Sex, Read This . . . And Stop a Killer STD From Sneaking Up On You!" The article, written by Lynda Liu, first appeared in "Mademoiselle" magazine in 1999. It relates the true story of a young woman who contracted hepatitis B and encourages people to get vaccinated against the disease.

The single modification was the addition of an editorial note advising readers that the price for hepatitis B vaccination may have dropped in the past few years.

To access an HTML version of the revised article, go to:
http://www.immunize.org/catg.d/4113sex.htm

To access a camera-ready (PDF) version, go to:
http://www.immunize.org/catg.d/4113sex.pdf
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December 16, 2002
MARK YOUR CALENDARS! CDC'S FOUR-PART SATELLITE BROADCAST OF "EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES" WILL BE HELD IN FEBRUARY AND MARCH

The National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) will be presenting its live satellite training course "Epidemiology and Prevention of Vaccine-Preventable Diseases" on four consecutive Thursdays: February 13, 20, and 27, and March 6. Each session lasts four hours. Times have not been announced, and registrations are not being accepted yet.

The course is intended for health professionals who provide immunization services. Course content is described as a comprehensive overview of the principles of vaccination, general recommendations, immunization strategies for providers, and specific information about vaccine-preventable diseases and the vaccines that prevent them.

To access preliminary course information, go to:
http://www.cdc.gov/nip/ed/newsatellite.htm#1

To access information about the power point slide set or the text, "Epidemiology and Prevention of Vaccine-Preventable Diseases" (The Pink Book), 7th Edition, go to:
http://www.cdc.gov/nip/ed/epi&Prev-materials.htm
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December 16, 2002
FIRST MEETING OF IOM COMMITTEE ON SMALLPOX VACCINATION PROGRAM IMPLEMENTATION SET FOR DECEMBER 18-20

The first meeting of a new Institute of Medicine (IOM) Committee on Smallpox Vaccination Program Implementation will be held December 18-20 in Washington, DC. The December 19 session is open to the public; the sessions on December 18 and 20 are closed. Because of space limitations, registration for the open session will close December 17.

This committee was established to advise the Centers for Disease Control and Prevention (CDC) on selected aspects of pre-event smallpox vaccination program implementation. At the December 19 session, representatives from CDC, the Department of Health and Human Services, and the Department of Defense will present the Committee with comprehensive and current information about smallpox planning.

To register for the December 19 session and view the meeting agenda and the Committee roster, go to: http://www.iom.edu/smallpox

For further information, contact Nicole Amado at namado@nas.edu (email), (202) 334-2481 (phone), or (202) 334-2939 (fax).
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December 16, 2002
NEW POLL SHOWS PUBLIC NOW SLIGHTLY MORE WILLING TO BE VACCINATED AGAINST SMALLPOX THAN IN MAY

The results of a public poll commissioned by the Robert Wood Johnson Foundation showed that six percent more people (65 percent) were willing to be vaccinated against smallpox than were in May (59 percent), when a similar poll was taken. Conducted in late October and released December 11, the poll  drew on the responses of 1,002 adults as a way of gauging public attitudes toward bioterrorism preparedness and the state of the U.S. public health system one year after the anthrax attacks.

The following two paragraphs are reprinted from the press release.

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As the Bush Administration and public health experts gear up to implement a broad-scale smallpox vaccination plan, a new poll shows that an increasing number of Americans are willing to be immunized against the disease. Despite the risks associated with smallpox immunization, 65 percent of the poll's  respondents say they are willing to be vaccinated, up from 59 percent last May. The findings reflect a growing concern about the potential use of smallpox in a terrorist attack and could signal the public's  uncertainty about the ability of the nation's health officials to contain a smallpox outbreak. . . .

The survey found that, one year after the anthrax attacks, Americans are feeling "uneasy." Although the public accepts that many important steps have been taken to improve national readiness for bioterrorism, it still feels more needs to be done to prepare the public health system to respond to an attack.

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To access a camera-ready (PDF) version of the 11-page full report of the poll from the website of the Robert Wood Johnson Foundation, go to:
http://www.rwjf.org/publications/publicationsPdfs/02report-d7.pdf

For a 2-page summation of the report's key findings, go to:
http://www.rwjf.org/news/special/bioterrorismKeyFindings1.jhtml

For further information, call Jennifer Hudman, Chuck Alexander, or Janet Firshein at (301) 652-1558.
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December 16, 2002
HEPATITIS C INTEGRATION TRAINING MANUAL NOW AVAILABLE

A publication of the American Liver Foundation (ALF), funded by the Centers for Disease Control and Prevention (CDC), "HIT'M--The Hepatitis Integration Training Manual," is available for order on ALF's website.

The manual is a comprehensive guide that integrates hepatitis C education in the areas of HIV/AIDS, sexually transmitted disease, harm reduction and/or substance abuse treatment. It shows readers how to incorporate hepatitis C information into existing health messages using trainer notes, session outlines and presentation tips, slide shows, and other hepatitis resources.

It also equips health care professionals and harm reduction counselors with current hepatitis information and resources they can use to impart life-saving messages to people who need hepatitis C education the most.

To learn more about the manual or to order it, go to ALF's website at http://www.liverfoundation.org or call Jackie Spencer at (800) 465-4837.
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December 16, 2002
FDA APPROVES SUPPLEMENTAL LICENSE FOR HEPATITIS C TREATMENT

On December 3, the Food and Drug Administration (FDA) approved a supplemental license application for Peginterferon alfa-2a (Pegasys) to include combination therapy with Ribavirin, USP (Copegus), for the treatment of chronic hepatitis C virus infection. Peginterferon alfa-2a, alone or in combination with Copegus, is indicated for the treatment of adults who have compensated liver disease and have not been previously treated with interferon alpha. Peginterferon alfa-2a is marketed by Hoffmann-LaRoche under the trade name Pegasys.

To view the approval letter for the supplemental license, go to:
http://www.fda.gov/cber/approvltr/pegihof120302L.htm

To view the approval letter for the initial license, go
to: http://www.fda.gov/cber/approvltr/pegihof101602L.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 December 16, 2002