Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 359            January 13, 2003

CONTENTS OF THIS ISSUE

  1. JAMA reports U.S. influenza deaths rising steadily
  2. Freeware puts 2003 childhood immunization schedule in the palm of your hand
  3. Updated! NNii revises and adds new sections to its "Communicating with Patients about Immunization" resource kit
  4. CDC reports on a recent pertussis outbreak among adults in Illinois
  5. Take note: Registration begins January 23 for CDC's "Epidemiology and Prevention of Vaccine-Preventable Diseases" satellite broadcast and webcast series
  6. Reminder: CDC's National Hepatitis Coordinators' Conference set for January 26-30 in San Antonio
  7. ASTHO pandemic influenza report urges state officials to prepare for a likely epidemic
  8. New! Program report and advocacy booklet available online from the Children's Vaccine Program at PATH
  9. GAVI's most recent quarterly newsletter available online
  10. FDA advises blood-collection industry about accepting blood from donors recently vaccinated against smallpox
  11. CDC summarizes Cambodia's success in reducing measles incidence

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January 13, 2003
JAMA REPORTS U.S. INFLUENZA DEATHS RISING STEADILY

On January 8, the "Journal of the American Medical Association" (JAMA) published an article, "Mortality Associated with Influenza and Respiratory Syncytial Virus in the United States." Written by William W. Thompson, PhD; David K. Shay, MD, MPH; Eric Weintraub, MPH; Lynnette Brammer, MPH; Nancy Cox, PhD; Larry J. Anderson, MD; and Keiji Fukuda, MD, MPH, the article indicates that influenza deaths have risen significantly in the past two decades, in part because of the increase in the nation's aging population. Three sections from the article abstract--context, results, and conclusions--are reprinted below.

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Context
Influenza and respiratory syncytial virus (RSV) cause substantial morbidity and mortality. Statistical methods used to estimate deaths in the United States attributable to influenza have not accounted for RSV circulation.

Results
Annual estimates of influenza-associated deaths increased significantly between the 1976-1977 and 1998-1999 seasons for all 3 death categories (P less than .001 for each category). For the 1990-1991 through 1998-1999 seasons, the greatest mean numbers of deaths were associated with influenza A(H3N2) viruses, followed by RSV, influenza B, and influenza A(H1N1). Influenza viruses and RSV, respectively, were associated with annual means (SD) of 8097 (3084) and 2707 (196) underlying pneumonia and influenza deaths, 36,155 (11 055) and 11,321 (668) underlying respiratory and circulatory deaths, and 51,203 (15,081) and 17,358 (1086) all-cause deaths. For underlying respiratory and circulatory deaths, 90% of influenza- and 78% of RSV-associated deaths occurred among persons aged 65 years or older. Influenza was associated with more deaths than RSV in all age groups except for children younger than 1 year. On average, influenza was associated with 3 times as many deaths as RSV.

Conclusions
Mortality associated with both influenza and RSV circulation disproportionately affects elderly persons. Influenza deaths have increased substantially in the last 2 decades, in part because of aging of the population, underscoring the need for better prevention measures, including more effective vaccines and vaccination programs for elderly persons.

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In a related editorial, "Influenza-Related Mortality: Considerations for Practice and Public Health," David M. Morens, M.D., of the National Institute of Allergy and Infectious Diseases, concludes by  urging his medical colleagues to strongly recommend influenza vaccination to their patients and to be vaccinated themselves. Excerpts from the editorial's conclusion follow:

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. . . Now the medical and public health communities must . . .face the looming confrontation between an unstoppable force and an immovable object, the aging of the baby boom generation and the predictability of annual influenza. Simple demographics practically ensure an impending public health disaster of great proportion.

Hope lies in the realization that until better influenza and RSV vaccines become available, there still remains much good to be performed in clinical practice. This includes ending the many missed opportunities in the community, the office, and the institution to prevent influenza-associated death and severe illness. Endorsement by health care professionals appears to be the strongest determinant of a  patient's acceptance of influenza vaccine.

Physicians and other health care professionals can do even more to protect patients by receiving annual influenza vaccinations. Clinician vaccination prevents transmission to patients (a significant risk factor in many patient care situations), prevents the temporary loss of their services, sets a powerful example, and might even make a small contribution to community "herd immunity."

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To access the complete article from the JAMA website, go to:
http://jama.ama-assn.org/issues/v289n2/rfull/joc21709.html

To access a camera-ready (PDF) version of the article, go to:
http://jama.ama-assn.org/issues/v289n2/rpdf/joc21709.pdf

To access the complete editorial, go to:
http://jama.ama-assn.org/issues/current/ffull/jed20081.html

To access an array of information specific to the 2002-03 flu season from the website of the Centers for Disease Control and Prevention, go to: http://www.cdc.gov/nip/flu/default.htm

To access general influenza-related materials from the website of the Immunization Action Coalition, go to: http://www.immunize.org/influenza
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January 13, 2003
FREEWARE PUTS 2003 CHILDHOOD IMMUNIZATION SCHEDULE IN THE PALM OF YOUR HAND

"Shots 2003" is a quick, portable reference guide to the "Recommended Childhood and Adolescent Immunization Schedule--United States, 2003." Produced by the Group on Immunization Education of  the Society of Teachers of Family Medicine (STFM), this freeware for the Palm OS 3.1 provides detailed information on vaccines. All you have to do is click on them by name.

The program requires Palm OS 3.1 or higher and approximately 279 KB of memory. It runs on both color and non-color handhelds.

To download "Shots 2003," go to:
http://www.immunizationed.org/AnyPage.asp?Page=Shots2003

For more information, contact STFM by email at gieweb@pitt.edu
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January 13, 2003
UPDATED! NNii REVISES AND ADDS NEW SECTIONS TO ITS "COMMUNICATING WITH PATIENTS ABOUT IMMUNIZATION" RESOURCE KIT

In December 2002, the National Network for Immunization Information (NNii) updated and enlarged its "Communicating with Patients about Immunization" resource kit (a 114-page volume of vaccine-related resources). Designed to help health care professionals educate patients about immunization, the kit has patient-accessible information on a broad spectrum of immunization topics.

The section on Childhood Vaccine-Specific Information includes new information on influenza and updated information on hepatitis B, Hib, measles, mumps, rubella, and meningococcal diseases and vaccines. The Common Questions has updated information on vaccine safety, adverse events that follow vaccination, vaccination ingredients, school immunization laws, immunization doses and  schedules, and the immune system and vaccines. The Background has updated information on how vaccines work and monitoring vaccine safety. The Bibliography has also been updated.

To access sections of interest to you, go to:
http://www.immunizationinfo.org/healthProfessionals/resourceKit.cfm

To access a camera-ready (PDF) version of the entire kit, go to:
http://www.immunizationinfo.org/PDFs/KIT_FULL.pdf

Hard copies of the kit are no longer available; you can print out the complete kit from the link above, however.

NNii also publishes "Newsbriefs" newsletter, a Monday-Wednesday-Friday email summary of immunization news from around the world. To subscribe, go to:
http://www.immunizationinfo.org/newsbriefs/subscribe.cfm
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January 13, 2003
CDC REPORTS ON A RECENT PERTUSSIS OUTBREAK AMONG ADULTS IN ILLINOIS

The Centers for Disease Control and Prevention (CDC) published "Pertussis Outbreak Among Adults at an Oil Refinery--Illinois, August-October 2002" in the January 10 issue of the "Morbidity and Mortality Weekly Report" (MMWR). Part of the summary made available to the press is printed below:

"On September 16, 2002, a local county health department reported to the Illinois Department of Public Health (IDPH) four cases of cough illness among workers at an oil refinery. Following an investigation by IDPH, 17 individuals from the oil refinery were diagnosed with pertussis from August 1-October 9, 2002. Additionally, 7 patients with pertussis were identified in the local community from August 30-October 11, 2002. All 24 patients received treatment with antibiotics and there were no deaths. Among recommended childhood immunizations, pertussis is the only vaccine preventable disease with increased number of cases in the United States during the last 20 years. The number of pertussis cases in adults has risen substantially since the 1980s. Pertussis should be considered in adults with a cough illness lasting more than 2 weeks with paroxysms of coughing, inspiratory "whoop," or post-tussive vomiting."

The MMWR article discusses diagnosis and treatment of the disease and includes a box summarizing its epidemiology, diagnosis, treatment, and prevention.

In light of the increase of pertussis in the adult U.S. population, the article's Editorial Note gives the following information:

"Adults with pertussis can have mild symptoms and might not seek medical care, and clinicians might not consider pertussis as a cause of illness. . . .

"Outbreaks of pertussis in adults are controlled through prompt treatment of patients and antimicrobial prophylaxis for close contacts. Acellular pertussis vaccines are licensed in the United States for infants and children aged 6 weeks-6 years (i.e., before the seventh birthday). These vaccines might have a future role in the prevention of disease and control of outbreaks in older age groups."

To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5201a1.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5201.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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January 13, 2003
TAKE NOTE: REGISTRATION BEGINS JANUARY 23 FOR CDC'S "EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES" SATELLITE BROADCAST AND WEBCAST SERIES

Individual registration begins January 23 for "Epidemiology and Prevention of Vaccine-Preventable Diseases," a live satellite training course presented by the National Immunization Program (NIP) of the  Centers for Disease Control and Prevention (CDC). It is scheduled from noon to 3:30 pm ET on four consecutive Thursdays: February 13, 20, and 27, and March 6. Site registration began January 8.

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.

Presenters are William Atkinson, MD, MPH; Judy Schmidt, RN, EdD; and Donna Weaver, MN, RN. All are with CDC's immunization program.

Participants are strongly encouraged to buy a copy of the primary course text, "Epidemiology and Prevention of Vaccine-Preventable Diseases" (The Pink Book), 7th Edition. It is available for $25 from the Public Health Foundation by phone at (877) 252-1200 or online at http://bookstore.phf.org/prod171.htm

Registration is online only, at http://www.phppo.cdc.gov/phtnonline/

For additional registration information and questions, email ce@cdc.gov or call (800) 418-7246.

Webcast information and viewing options are available at
http://www.phppo.cdc.gov/phtn/webcast/epv03/default.asp

Technical support for the webcast is available at
http://www.phppo.cdc.gov/phtn/webcast/techsupport.asp

For general information online, go to:
http://www.phppo.cdc.gov/phtn/epv03/factsheet.asp
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January 13, 2003
REMINDER: CDC'S NATIONAL HEPATITIS COORDINATORS' CONFERENCE SET FOR JANUARY 26-30 IN SAN ANTONIO

Less than two weeks remain before the start of the Centers for Disease Control and Prevention's  National Hepatitis Coordinators' Conference. It will be held in San Antonio on January 26-30.

Designed to provide training and networking opportunities, the conference is intended for public health professionals, administrators, educators, counselors, social workers, and others working with clients at risk for viral hepatitis.

For complete information on continuing medical education credits, registration, meeting venue and accommodations, conference materials, pre- and post-conference sessions, and the conference program, go to:
http://www.med.umn.edu/cme/brochures2002/hepcoord2003/hepcoordbro2003.html

For registration information, call the conference planner, the University of Minnesota Office of Continuing Medical Education, (800) 776-8636.
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January 13, 2003
ASTHO PANDEMIC INFLUENZA REPORT URGES STATE OFFICIALS TO PREPARE FOR A LIKELY EPIDEMIC

The Association of State and Territorial Health Officials (ASTHO) recently announced that a new  publication, "Preparedness Planning for State Health Officials: Nature's Terrorist Attack--Pandemic Influenza," is now available on the ASTHO website.

Published in November 2002, the report identifies major issues that each state will face during an influenza pandemic and offers suggestions for linking pandemic planning to bioterrorism and other public health emergency preparedness efforts. Included is a checklist that gives officials a preliminary way to assess their states' readiness to respond to an influenza pandemic.

At the conclusion, the authors underscore the importance of seizing the moment by combining knowledge learned in past pandemics with knowledge learned from the September 11 terrorist attacks to create a comprehensive influenza pandemic plan. Part of the report's concluding two paragraphs are reprinted here.

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The World Trade Center and anthrax attacks served as harsh reminders of the importance of disaster planning for both terrorist and naturally occurring emergencies. While advance warning for a terrorist attack is unlikely, the warning already exists for pandemic influenza. It will happen again, but it is not possible to pinpoint the date. . . .

By combining lessons learned from the 2001 terrorist incidents with those gleaned from pandemic history and the annual influenza season, the public health community can develop an effective response. State health officials have an unprecedented opportunity, using their states' bioterrorism preparedness assessments and plans as scaffolding, to help create strategies that address unique influenza preparedness issues and to improve the nation's response as a whole to future pandemics.

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To access a camera-ready (PDF) copy of the report (20 pages) and State Health Official Checklist (4 pages) from the ASTHO website, go to: http://www.astho.org/pubs/Pandemic%20Influenza.pdf

For a print copy, email publications@astho.org or call (202) 715-1630.
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January 13, 2003
NEW! PROGRAM REPORT AND ADVOCACY BOOKLET AVAILABLE ONLINE FROM THE CHILDREN'S VACCINE PROGRAM AT PATH

In December 2002, the Children's Vaccine Program (CVP) at the Program for Appropriate Technology in Health (PATH) released its 28-page biennial report, "Building the Future of Immunization." To access a camera-ready (PDF) version of the report, go to: http://www.childrensvaccine.org/files/Building_the_Future_Screen.pdf

A 16-page advocacy booklet, "The Case for Childhood Immunization," is also available. For a copy in camera-ready (PDF) format, go to: http://www.childrensvaccine.org/files/CVP_Occ_Paper5.pdf

For information about CVP and for an array of immunization resources in English, Spanish, and French, visit CVP's website at http://www.childrensvaccine.org
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January 13, 2003
GAVI'S MOST RECENT QUARTERLY NEWSLETTER AVAILABLE ONLINE

The December 2002 issue of "Immunization Focus," the quarterly electronic newsletter published by the Global Alliance for Vaccines and Immunization (GAVI), is now available on the GAVI website.

An invaluable source of information on global vaccine topics, the newsletter provides updates and topical debate about key immunization issues. The current issue's lead article is "An Investment for Life," a summary of several GAVI-supported countries' use of funds raised by the Vaccine Fund. The other articles are "Polio: Can Immunization Ever Stop?" and "Yellow Fever: New Momentum for Epidemic Control."

To access a camera-ready (PDF) version of the December issue, go to:
http://www.vaccinealliance.org/site_repository/resources/Dec02.pdf

To access the GAVI website, go to: http://www.vaccinealliance.org

For additional information, email gavi@unicef.org
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January 13, 2003
FDA ADVISES BLOOD-COLLECTION INDUSTRY ABOUT ACCEPTING BLOOD FROM DONORS RECENTLY VACCINATED AGAINST SMALLPOX

In December 2002, the Food and Drug Administration (FDA) issued a guidance document for the blood- and plasma-collection industry. FDA is concerned that people who receive blood transfusions  may be harmed by blood donated by recent smallpox vaccine recipients. Though the risk of harm is slight, FDA recommends that the blood- and plasma-collection industry defer accepting blood donations from people who have been inoculated with the smallpox vaccine until at least 21 days after vaccination.

To access the final guidance document on the FDA website, go to:
http://www.fda.gov/cber/gdlns/smpoxdefquar.htm

To access a camera-ready (PDF) version of the document, go to:
http://www.fda.gov/cber/gdlns/smpoxdefquar.pdf
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January 13, 2003
CDC SUMMARIZES CAMBODIA'S SUCCESS IN REDUCING MEASLES INCIDENCE

The Centers for Disease Control and Prevention (CDC) published "Accelerated Measles Control--Cambodia, 1999-2002" in the January 10 issue of the "Morbidity and Mortality Weekly Report" (MMWR). Part of the summary made available to the press is reprinted below:

"Cambodia is currently rebuilding its public health infrastructure following a long civil war and has limited trained personnel and logistic capacity. However, the country has made significant strides in the control of measles since 1999. 'Rolling' vaccination campaigns have improved measles vaccination coverage in the country. These campaigns have led to a marked decline in reported cases from 11,940 cases in 2000 to 1,234 in 2002 (through 18 October 2002). To continue to improve measles control, Cambodia will need to further increase vaccination coverage through both routine services and periodic supplementary campaigns and strengthen surveillance. The lessons learned in Cambodia may be useful in planning measles control in other post-conflict settings."

To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5201a2.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5201.pdf

 

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 January 13, 2003