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Issue Number 37            December 18, 1998

CONTENTS OF THIS ISSUE

  1. AAP now recommends IPV for the first two doses of the primary series for polio vaccine
  2. MMWR publishes announcement on FDA approval of a fourth acellular pertussis vaccine for use among infants and young children
  3. MMWR publishes article on the progress toward global measles control and regional elimination
  4. "Immunization Gateway" is a major immunization resource center on the web

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(1)
December 18, 1998
AAP NOW RECOMMENDS IPV FOR THE FIRST TWO DOSES OF THE PRIMARY SERIES FOR POLIO VACCINE
In order to reduce the risk of vaccine-associated paralytic poliomyelitis (VAPP), the American Academy of Pediatrics (AAP) now recommends that most children in the United States receive the inactivated poliovirus vaccine (IPV) for the first two doses of the primary series and either IPV or oral poliovirus vaccine (OPV) for the third and fourth doses.

This new polio vaccine recommendation is one of several polio vaccine guidelines that have been revised by the AAP. The complete statement, "Poliomyelitis Prevention: Revised Recommendations for Use of Inactivated and Live Oral Poliovirus Vaccines," is now available on AAP's website http://www.aap.org/policy/re9853.html and will be published in the January 1999 issue of "Pediatrics."

The AAP's revised polio vaccine guidelines are summarized in the following press release that was issued by the AAP on December 9:

AAP REVISES GUIDELINES ON THE USE OF POLIO VACCINES

CHICAGO-The American Academy of Pediatrics (AAP) issued a statement to its 55,000 member pediatricians offering new vaccine recommendations for the four dose immunization series to prevent polio in children. The policy recommendations appear in the December 1998 issue of AAP News, the official newsmagazine of the American Academy of Pediatrics.

The AAP now recommends that most children in the United States receive the inactivated poliovirus vaccine (IPV), which is received as an injection at 2 and 4 months of age for the first two doses. Either the IPV or the oral poliovirus vaccine (OPV) is recommended for the third dose at 6 to 18 months and the fourth dose at 4 to 6 years. Depending on the child's medical history, pediatricians also may choose to give IPV for the entire four dose schedule. This new recommendation also is aimed at reducing the rare instance of vaccine-associated paralytic poliomyelitis (VAPP), which is associated with the live virus within OPV.

In 1997, the AAP recommended that pediatricians could choose either an IPV-only, OPV-only or a schedule utilizing both vaccines sequentially for the complete four dose regimen against polio. However, the AAP states that since these 1997 guidelines were issued, "substantial progress in global eradication of poliomyelitis has occurred and the use of inactivated poliovirus vaccine has increased considerably in the United States with a corresponding decrease in the use of oral poliovirus vaccine (OPV)." Surveys indicate that the majority of physicians now
routinely immunize children with the sequential IPV-OPV schedule or the IPV-only schedule.

Some of the other recommendations from today's AAP statement are as follows:

OPV is acceptable when parents refuse either IPV or the number of injections needed to administer the other recommended vaccines for infants.

The IPV-only schedule is recommended for immunocompromised persons and their household contacts because OPV may pose possible side effects.

An OPV schedule is acceptable in infants and children in whom routine immunization is not initiated until after 6 months of age.

OPV continues to be the vaccine of choice for control of outbreaks of the wild-type polio virus in the United States, and the AAP supports the need for federal resources to ensure that there is an adequate supply of OPV for outbreak control.

Parents should speak with their child's pediatrician about the advantages and disadvantages of each vaccine and the medical history of their child. The AAP continues to support the World Health Organization recommendation for the use of OPV to achieve global eradication of poliomyelitis, especially in countries with continued or recent circulation of wild-type poliovirus.

[End of press release information]
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(2)
November 6, 1998
MMWR PUBLISHES ANNOUNCEMENT ON FDA APPROVAL OF A FOURTH ACELLULAR PERTUSSIS VACCINE FOR USE AMONG INFANTS AND YOUNG CHILDREN

A "Notice to Readers" on the FDA licensure of Certiva, a combined diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) manufactured by North American Vaccine, was published in the November 6, 1998, issue of the MMWR.

Certiva, which was licensed by the FDA on July 29, 1998, is approved for the first four doses of the diphtheria and tetanus toxoids and pertussis vaccination series administered to infants and children who are 6 weeks to 6 years of age. There are three other DTaP vaccines licensed for use in infants and young children in the United States. They are Acel-Imune, manufactured by Lederle Labs; Infanrix, manufactured by SmithKline Beecham; and Tripedia, manufactured by Pasteur Merieux Connaught.

NOTICE TO THOSE STILL USING DTP VACCINE INSTEAD OF DTaP: The "Notice to Readers" also reminds the reader of the ACIP recommendation to use a licensed DTaP vaccine for all five doses of the routine diphtheria, tetanus, and pertussis vaccination series as well as for the remaining doses in the series for children who have started the vaccination series with whole-cell DTP vaccine. The "Notice to Readers" states that the ACIP recommendation to use DTaP for all five doses was made because of the reduced frequency of adverse reactions and demonstrated efficacy of DTaP.

To access the complete text of this "Notice to Readers," click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055598.htm

TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR (delivered weekly), go to the MMWR website and sign up. When you sign up, you will also receive all new ACIP statements which are published as MMWR's "Recommendations and Reports." To get to the MMWR website, click here: http://www.cdc.gov/epo/mmwr/mmwr.html
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(3)
December 11, 1998
MMWR PUBLISHES ARTICLE ON THE PROGRESS TOWARD GLOBAL MEASLES CONTROL AND REGIONAL ELIMINATION

An article entitled, "Progress Toward Global Measles Control and Regional Elimination, 1990-1997" was published in the MMWR on December 11, 1998. This report updates progress toward global measles control and regional elimination. It also presents measles vaccination coverage and incidence for 1997 and World Health Organization (WHO) estimates of global measles morbidity and mortality in 1997 compared with the prevaccine era.

The article states that by the end of 1997, global measles morbidity and mortality had decreased 74% and 85%, respectively, compared with the annual morbidity and mortality during the prevaccine era.

The report also has WHO region-specific information on measles cases and vaccine coverage as well as information on which countries have conducted measles catch-up and/or follow up vaccination campaigns.

To access the complete text of this "Notice to Readers," click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055965.htm

TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR (delivered weekly), go to the MMWR website and sign up. When you sign up, you will also receive all new ACIP statements which are published as MMWR's "Recommendations and Reports." To get to the MMWR website, click here: http://www.cdc.gov/epo/mmwr/mmwr.html
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(4)
December 18, 1998
"IMMUNIZATION GATEWAY" IS A MAJOR IMMUNIZATION RESOURCE CENTER ON THE WEB

"Immunization Gateway: Your Vaccine Fact-Finder" is a major immunization resource center on the web. Visitors are offered hyperlinks to the best immunization resources on the web. This is a great place to get electronically connected to all the current ACIP recommendations on immunization, new immunization resources, information on clinical trials and vaccine research, and more, more, more.

The author of the Immunization Gateway is John D. Grabenstein, MSPharm, EdM, FASHP. He is also the author of "ImmunoFacts," an up-to-date, comprehensive reference book on vaccines and immunologic drugs. (Ordering information is at this website.)

To follow a quick electronic pathway to great vaccine information, visit "Immunization Gateway" at: http://www.immunofacts.com/

 

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 18, 1998