Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 362            January 27, 2003

CONTENTS OF THIS ISSUE

  1. CDC releases recommendations on prevention and control of hepatitis virus infections in correctional settings
  2. IOM report urges caution in implementing national smallpox immunization program
  3. CDC publishes guidance for clinicians on smallpox vaccination and adverse reactions
  4. New! CDC's "2001-2002 State Immunization Requirements" now on IAC website
  5. CDC releases surveillance summary on safety after immunization
  6. Professional education pieces on the management of patients chronically infected with HBV are updated on IAC's website
  7. February 4 is the date for CDC's satellite broadcast and webcast on clinical management of smallpox adverse events
  8. CDC publishes report on a recent rabies death in Iowa
  9. CDC broadcast on smallpox and vaccinia for laboratorians is set for January 29
  10. MMWR notifies readers that vaccine research conference is set for May 5-7; February 7 is abstract deadline

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January 27, 2003
CDC RELEASES REPORT ON PREVENTION AND CONTROL OF HEPATITIS VIRUS INFECTIONS IN CORRECTIONAL SETTINGS

The Centers for Disease Control and Prevention (CDC) published "Prevention and Control of Infections with Hepatitis Viruses in Correctional Settings" in the January 24 issue of "MMWR Recommendations and Reports" (MMWR).

The report was prepared by the Division of Viral Hepatitis of the National Center for Infectious Diseases. The summary is reprinted below.

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This report consolidates previous recommendations and adds new ones for preventing and controlling infections with hepatitis viruses in correctional settings. These recommendations provide guidelines for juvenile and adult correctional systems regarding 1) identification and investigation of acute viral hepatitis; 2) preexposure and postexposure immunization for hepatitis A and hepatitis B; 3) prevention of hepatitis C virus infection and its consequences; 4) health education; and 5) release planning. Implementation of these recommendations can reduce transmission of infections with hepatitis viruses among adults at risk in both correctional facilities and the outside community. These recommendations were developed after consultation with other federal agencies and specialists in the fields of corrections, correctional health care, and public health at a meeting in Atlanta, March 5-7, 2001. This report can serve as a resource for those involved in planning and implementing health-care programs for incarcerated persons.

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To obtain the complete text of the report, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm

To obtain the report in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5201.pdf

The PDF version includes a free CDC-sponsored continuing education activity that can be completed online or submitted via U.S. mail for CME, CDU, CHES, or CNE credit. Simply read the MMWR report,  answer the questions at the end of the report, and follow instructions for submitting your answers.

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 27, 2003
IOM REPORT URGES CAUTION IN IMPLEMENTING NATIONAL SMALLPOX IMMUNIZATION PROGRAM

On January 17, the Institute of Medicine (IOM) of the National Academies issued a news release summarizing the content of IOM's first report advising the Centers for Disease Control and Prevention (CDC) on the implementation of the national smallpox vaccination program. CDC sponsored the report. A private, nonprofit institution, IOM provides health policy advice under a Congressional charter granted to the National Academy of Sciences.

Titled "Review of the Centers for Disease Control and Prevention's Smallpox Vaccination Program Implementation--Letter Report #1," the 52-page report urges CDC to take a cautious, deliberate  approach and to implement midcourse corrections as necessary. Excerpts from the news release are reprinted below.

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. . . . "While we recognize that CDC has been asked to initiate the immunization campaign rapidly, it's important to remember that recipients of the vaccine are voluntarily assuming its risks for the greater  public good. We agree with CDC and President Bush that safety is paramount, and we support efforts to minimize those risks," said Brian L. Strom, professor and chair, department of biostatistics and epidemiology, University of Pennsylvania School of Medicine, Philadelphia, and chair of the study committee. "Learning from experience, making midcourse corrections on every aspect of the program, and maintaining constant communication with the public are integral to developing the safest program possible. We support efforts by CDC and its state and local partners to share and analyze information  on the program's progress and outcomes, including safety concerns, at every step before proceeding to the next.". . . .

One of the committee's overarching concerns is that the preparations needed to educate vaccine recipients and the general public, train vaccine workers and health care providers, and fully address all other aspects of the vaccination program appear to require a more generous time frame than currently proposed for phase one. While the committee cited several issues that it would like to see addressed more fully before the first phase begins, at minimum it urged CDC to actively collect and evaluate adverse reaction data from vaccine recipients and vaccination clinics during this initial phase to inform any necessary changes prior to the start of phase two. Also, CDC should develop and communicate the criteria, such as a threshold number of adverse events, that would trigger midcourse changes to  the agency's current guidance on issues such as screening, contraindications, and administrative leave policies.

Recent surveys indicate that a significant percentage of the public misunderstands the risks and safety of the smallpox vaccine, the severity of the disease, and how the vaccination program will proceed. Clearer, consistent communication with the public is essential if the campaign is to succeed, the committee said. . . .

For example, many potential vaccine recipients may falsely assume that the provisions of the Homeland Security Act of 2002 would reimburse them for medical expenses or lost income resulting from complications of vaccination. However, the act covers only injuries that result from vaccine that was negligently manufactured or administered. . . .

While highly effective, the smallpox vaccine carries considerable side effects and may be the least-safe vaccine ever used on a large scale, making data collection on all adverse events paramount to the current campaign's success. . . . CDC has proposed using the existing Vaccine Adverse Event Reporting System (VAERS) to monitor for adverse events. However, VAERS is a passive surveillance system and will not capture all complications, the report says. The committee strongly urges the agency to use the planned Pre-event Vaccination System, a secure data exchange system, to actively collect information on adverse events. Data on adverse reactions collected from the first phase should be evaluated before the next phase gets under way.

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To access the full report from the website of the National Academies Press, go to: http://www.nap.edu/books/NI000489/html

To access the news release, go to:
http://www4.nationalacademies.org/news.nsf/isbn/01172003?OpenDocument
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January 27, 2003
CDC PUBLISHES GUIDANCE FOR CLINICIANS ON SMALLPOX VACCINATION AND ADVERSE REACTIONS

The Centers for Disease Control and Prevention (CDC) published "Smallpox Vaccination and Adverse Reactions: Guidance for Clinicians" in the January 24 issue of "MMWR Dispatch" (MMWR). CDC explained that its policy is to publish "MMWR Dispatch" only for the "immediate release of important public health information." It is published "on the Web outside of the routine weekly publication schedule" and will be available in a print issue of MMWR in the future.

The 50-page report includes information on interpreting vaccination results, transmission of vaccinia virus, adverse reactions, prophylaxis, laboratory diagnosis, treatments, and smallpox vaccine adverse  event reporting. A portion of the report's summary is reprinted below.

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The material in this report originated in the National Center for Infectious Diseases, James M. Hughes, M.D., Director, and the Bioterrorism Preparedness and Response Program, Charles Schable, M.S.,  Acting Director; and the National Immunization Program, Walter A. Orenstein, M.D., Director, and the Epidemiology and Surveillance Division, Melinda Wharton, M.D., Director.

The guidance in this report is for evaluation and treatment of patients with complications from smallpox vaccination in the preoutbreak setting. Information is also included related to reporting adverse events  and seeking specialized consultation and therapies for these events. The frequencies of smallpox vaccine-associated adverse events were identified in studies of the 1960s. Because of the unknown  prevalence of risk factors among today's population, precise predictions of adverse reaction rates after smallpox vaccination are unavailable. The majority of adverse events are minor, but the less-frequent serious adverse reactions require immediate evaluation for diagnosis and treatment. Agents for treatment of certain vaccine-associated severe adverse reactions are vaccinia immune globulin (VIG), the first-line therapy, and cidofovir, the second-line therapy. These agents will be available under Investigational New Drug (IND) protocols from CDC and the U.S. Department of Defense (DoD).

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To access an HTML version of the complete report, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/di52cha1.htm

To access a camera-ready (PDF) version, go to:
http://www.cdc.gov/mmwr/pdf/wk/MMWRDispatch1-24-03.pdf
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January 27, 2003
NEW! CDC'S "2001-2002 STATE IMMUNIZATION REQUIREMENTS" NOW ON IAC'S WEBSITE

"2001-2002 State Immunization Requirements," a Centers for Disease Control and Prevention (CDC) publication, is available on the website of the Immunization Action Coalition. According to its foreword,  the publication "reflects state laws,regulations, or rule making that impose vaccination requirements for enrollment and/or attendance in day care, Head Start, kindergarten, grades 1 through 12, colleges, and universities."

The comprehensive, 35-page publication is based on data validated in February 2002. It represents information supplied by program managers from 50 states, the District of Columbia, the Commonwealth of Puerto Rico, and staff from CDC's National Immunization Program. The information is organized by vaccine and presented in table and map formats.

To access the 2001-2002 CDC requirements in camera-ready (PDF) format from the IAC website, go to: http://www.immunize.org/laws/izlaws01-02.pdf

To access information on state mandates on immunization requirements, organized by vaccine-preventable disease, from the IAC website, go to: http://www.immunize.org/laws

To access information on school-entry requirements, organized by state, from the website of the National Network for Immunization Information, go to:
http://www.immunizationinfo.org/search/index.cfm
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January 27, 2003
CDC RELEASES SURVEILLANCE SUMMARY ON SAFETY AFTER IMMUNIZATION

The Centers for Disease Control and Prevention (CDC) published "Surveillance for Safety After Immunization: Vaccine Adverse Event Reporting System (VAERS)--United States, 1991-2001" in the January 24 issue of "MMWR Surveillance Summaries" (MMWR).

A summary made available to the press is reprinted below.

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VAERS was established in 1990 under the joint administration of CDC and the Food and Drug  Administration (FDA) to accept reports of suspected adverse events after administration of any vaccine licensed in the United States. VAERS is a passive surveillance system: reports of events are voluntarily submitted by those who experience them, their caregivers, or others. During 19912001, VAERS  received 128,717 reports, whereas more than 1.9 billion net doses of human vaccines were distributed. Overall, the most commonly reported adverse event was fever, which appeared in 25.8 percent of all reports, followed by injection-site hypersensitivity (15.8 percent), rash (unspecified) (11.0 percent), injection-site edema (10.8 percent), and vasodilatation (10.8 percent). A total of 14.2 percent of all reports described serious adverse events, which by regulatory definition include death, life-threatening illness, hospitalization or prolongation of hospitalization, or permanent disability.

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To obtain the complete text of the summary, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5201a1.htm

To obtain the summary in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/PDF/ss/ss5201.pdf
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January 27, 2003
PROFESSIONAL EDUCATION PIECES ON THE MANAGEMENT OF PATIENTS CHRONICALLY INFECTED WITH HBV ARE UPDATED ON IAC'S WEBSITE

The liver-disease experts who work with the Immunization Action Coalition (IAC) have modified five professional education pieces on the management of patients chronically infected with hepatitis B  virus. The pieces now reflect information about a new drug, adefovir dipivoxil (trade name Hepsera), which was recently approved for use in the United States.

The titles of the five pieces, information about the authors, and direct links to each piece follow.

  • "Does Your Patient Have Chronic Hepatitis B?" by Coleman I. Smith, MD, was revised January 2003. Dr. Smith is a gastroenterologist/hepatologist at Minnesota Gastroenterology, Minneapolis. He is also a member of IAC's Advisory Board.
     
    To access his paper in HTML format, go to:
    http://www.immunize.org/nslt.d/n18/p2162.htm
     
    To access it in PDF format, go to:
    http://www.immunize.org/catg.d/p2162.pdf

     
  • "Management of Chronic Hepatitis B in Adults," by Brian J. McMahon, MD, was revised in December 2002. Dr. McMahon, internal medicine specialist, is director, Viral Hepatitis Program, Alaska Native Medical Center, Anchorage.
     
    To access his paper in HTML format, go to:
    http://www.immunize.org/catg.d/p2161.htm
     
    To access it in PDF format, go to:
    http://www.immunize.org/catg.d/p2161.pdf

     
  • "Management of Chronic Hepatitis B in Adults" and "Management of Chronic Hepatitis B in Children," both written by Hari S. Conjeevaram, MD, were revised in January 2003. Dr. Conjeevaram is with the Division of Gastroenterology, University of Michigan, Ann Arbor.
     
    To access his paper on management in adults in HTML format, go to: http://www.immunize.org/catg.d/p2141.htm
     
    To access it in PDF format, go to:
    http://www.immunize.org/catg.d/p2141har.pdf

     
    To access his paper on management in children in HTML format, go to: http://www.immunize.org/catg.d/p2140.htm
     
    To access it in PDF format, go to:
    http://www.immunize.org/catg.d/p2140har.pdf

     
  • "What the Physician can do to Help the Child who is a Hepatitis B Carrier," by Sarah Jane Schwarzenberg, MD, was revised January 2003. Dr. Schwarzenberg is with the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis.
     
    To access her paper in HTML format, go to:
    http://www.immunize.org/catg.d/p2170.htm
     
    To access it in PDF format, go to:
    http://www.immunize.org/catg.d/p2170sjs.pdf

To access all five revised pieces on IAC's "Management of Chronic Hepatitis B in Children and Adults" web page, go to: http://www.immunize.org/catg.d/p2164.htm
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January 27, 2003
FEBRUARY 4 IS THE DATE FOR CDC'S SATELLITE BROADCAST AND WEBCAST ON CLINICAL MANAGEMENT OF SMALLPOX ADVERSE EVENTS

The Centers for Disease Control and Prevention (CDC) will offer a live satellite broadcast, "Clinical Management of Adverse Events Following Smallpox Vaccination: A National Training Initiative," on February 4 from 1 to 2:30 pm ET.

Program information
Intended to prepare clinicians to recognize, report, and clinically manage adverse reactions to smallpox vaccination, the program is directed to the following health professionals:

  • Clinical specialists such as infectious disease specialists, dermatologists, critical care specialists, neurologists, ophthalmologists, allergists, and immunologists
     
  • Primary care clinicians including emergency room clinicians, internists, pediatricians, and family medicine physicians
     
  • State and local health department staff involved in adverse event assessment and reporting

Technical information
Webcast information and viewing options are available at
http://www.phppo.cdc.gov/phtn/webcast/smallpox0204/default.asp

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


Procedural information
Additional information, including participant registration (encouraged but not required), options for  submitting questions during the broadcast, and options for ordering a post-broadcast videotape or CD-ROM of the program, is available at http://www.phppo.cdc.gov/phtn/smallpox0204.asp

Registration questions will be answered by phone at (800) 418-7246 or (404) 639-1292; or by email at ce@cdc.gov (when emailing, type "Clinical Management of Adverse Events Following Smallpox Vaccination" in the subject line).
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January 27, 2003
CDC PUBLISHES REPORT ON A RECENT RABIES DEATH IN IOWA

The Centers for Disease Control and Prevention (CDC) published "Human Rabies--Iowa, 2002" in the January 24 issue of the "Morbidity and Mortality Weekly Report" (MMWR). Part of a summary made available to the press is reprinted below.

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In September 2002, a 20-year-old man, residing in Iowa, died from rabies. This is the first human case of rabies in that state since 1951. The source of the patient's infection remains unclear. Because the patient was a musician who had traveled to recording studios in several cities in Iowa and Illinois during the infectious stage of his illness, family members permitted the public release of his name to the media. A total of 53 family members or associates of the patient were given rabies post-exposure prophylaxis (PEP). Additionally, 71 hospital staff members were also given PEP. This case represents the third report of human rabies during 2002.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5203a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5203.pdf
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January 27, 2003
CDC SATELLITE BROADCAST AND WEBCAST ON SMALLPOX AND VACCINIA FOR LABORATORIANS IS SET FOR JANUARY 29

The Centers for Disease Control and Prevention (CDC) will offer a live satellite broadcast, "Smallpox and Vaccinia Laboratory Testing: A National Training Initiative," on January 29 from  1 to 3 pm ET.

Program information
The program is intended to prepare the nation's laboratorians to respond effectively to vaccine adverse events and the intentional release of smallpox. It is directed to the following health professionals: All  laboratorians and those who use laboratory services; laboratorians in state and local public health, clinical, reference and physician office laboratories; pathologists, physicians, phlebotomists, and specimen handlers and transporters; and state chief medical officers and epidemiologists.

Procedural information
Additional information, including participant registration (encouraged but not required), options for submitting questions during the broadcast, and options for ordering a post-broadcast videotape or CD-ROM of the program, is available at http://www.phppo.cdc.gov/phtn/smallpox0129.asp

Registration questions will be answered by phone at (800) 418-7246 or (404) 639-1292; or by email at ce@cdc.gov (when emailing, type "Smallpox and Vaccinia Laboratory Testing: A National Training Initiative" in the subject line).
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January 27, 2003
MMWR NOTIFIES READERS THAT VACCINE RESEARCH CONFERENCE IS SET FOR MAY 5-7; FEBRUARY 7 IS ABSTRACT DEADLINE

The Centers for Disease Control and Prevention (CDC) published a Notice to Readers: "Conference on Vaccine Research" in the January 24 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted below in its entirety.

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The sixth annual conference on Vaccine Research: Basic Science, Product Development, Clinical and Field Studies will be held May 5-7, 2003, in Arlington, Virginia. The meeting is co-sponsored by CDC, the National Foundation for Infectious Diseases (NFID), and nine other national and international agencies, institutes, and organizations involved in research, development, and use of vaccines and associated technologies for the prevention of human and veterinary diseases through vaccination.

The deadline for online submission of abstracts for oral and poster presentations is February 7. Program announcements and forms for abstract submission, registration, and hotel reservation are available at http://www.nfid.org/conferences/vaccine03 and from NFID, Suite 750, 4733 Bethesda Avenue, Bethesda, MD, 20814-5278; telephone (301) 656-0003, ext. 19; fax (301) 907-0878; or email vaccine@nfid.org

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To obtain the notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5203a4.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5203.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 27, 2003