Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 374            March 24, 2003

CONTENTS OF THIS ISSUE

  1. New on the Web: "Infectious Diseases in Children" monograph offers vital information on talking to parents about vaccines
  2. "Immunization Techniques" video--a powerful staff teaching tool you can't afford to be without
  3. New translations: PCV7 VIS available in Spanish; MMR VIS available in Thai
  4. Popular self-study course "Teaching Immunization Practices for Nurses" is updated for 2003
  5. Use "Power of 10" campaign materials to boost your adult patients' tetanus and diphtheria immunization rates
  6. CDC releases report on animal rabies prevention and control
  7. New: Yellow fever vaccine VIS now available
  8. CDC publishes clinical description of Severe Acute Respiratory Syndrome (SARS)
  9. CDC publishes an update on 2002-03 influenza season
  10. CDC reports on current outbreak of Severe Acute Respiratory Syndrome (SARS)
  11. CDC publishes an update of smallpox vaccine adverse events surveillance
  12. CDC publishes a Public Health Dispatch on transmission of d9 measles in the Region of the Americas

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March 24, 2003
NEW ON THE WEB: "INFECTIOUS DISEASES IN CHILDREN" MONOGRAPH OFFERS VITAL INFORMATION ON TALKING TO PARENTS ABOUT VACCINES

Titled "An Ounce of Prevention: Communicating the Benefits and Risks of Vaccines to Parents," the monograph to the January 2003 issue of "Infectious Diseases in Children" comprises four articles on  discussing childhood vaccine safety issues with parents. Written by four physicians at academic institutions, the articles are the result of an interactive symposium among 65 pediatricians, which was held in Chicago in September 2002. Following are a brief synopsis of each article, a brief professional biography of each author, and the URL for each article.

"TRUTHS ABOUT VACCINES" BY GARY S. MARSHALL, MD.
A review both of common misconceptions about vaccines and factually accurate information about vaccines. Dr. Marshall is professor of pediatrics, University of Louisville School of Medicine, Louisville,  KY; board certified in pediatric infectious diseases.

To access this article, go to:
http://www.idinchildren.com/monograph/0301/frameset.asp?article=truths.asp

"MYTHS REGARDING IMMUNIZATION" BY JAY M. LIEBERMAN, MD.
An overview of studies that counter misperceptions about the safety of various childhood vaccines. Dr. Lieberman is associate professor of pediatrics, University of California, Irvine; chief, pediatric  infectious diseases, Miller Children's Hospital, Long Beach, CA.

To access this article, go to:
http://www.idinchildren.com/monograph/0301/frameset.asp?article=myths.asp

"COMMUNICATION IN THE PHYSICIAN'S OFFICE" BY SHARON G. HUMISTON, MD, MPH.
A discussion of the findings of various studies, surveys, and focus groups that assess the current state of vaccine communication between health professionals and parents, as well as various techniques for  improving communication. Dr. Humiston is assistant professor of emergency medicine and pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

To access this article, go to:
http://www.idinchildren.com/monograph/0301/frameset.asp?article=communication.asp

"MATCHING COMMUNICATION STYLES WITH PARENT PERSONALITIES" BY STEPHEN R. BARONE, MD.
Presents approaches to speaking effectively and efficiently to parents with various personalities:  vaccine believer, relaxed parent, cautious parent, and unconvinced parent. Dr. Barone is associate  professor of pediatrics, New York University School of Medicine; affiliated with Schneider Children's Hospital at North Shore, Manhasset, NY.

To access this article, go to:
http://www.idinchildren.com/monograph/0301/frameset.asp?article=match.asp

To access the complete monograph, go to:
http://www.idinchildren.com/monograph/0301/splash.asp
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March 24, 2003
"IMMUNIZATION TECHNIQUES" VIDEO--A POWERFUL STAFF TEACHING TOOL YOU CAN'T AFFORD TO BE WITHOUT

If you're looking for a way to give your staff practical, high-quality, cost-effective immunization training, you'll want to order a copy of "Immunization Techniques: Safe, Effective, Caring." If you do, you'll be  in good company: health professionals across the nation have ordered more than 7,200 copies of the  video from the Immunization Action Coalition (IAC) since September 2001, when we first offered it.

Developed by the California Department of Health Services Immunization Branch and a team of national experts, the 35-minute video is designed for use as a "hands-on" instructional program. It can  be used to train new staff and to provide a refresher course for experienced staff who administer vaccines.

It teaches best practices for administering intramuscular (IM) and subcutaneous (SC) vaccines to infants, children, and adults and discusses the following:

Anatomic sites
Choice of needle size
Vaccines and routes of administration
How to "draw up" doses of vaccine from a vial

People of various ages--from infants to adults--are vaccinated in the video to demonstrate these techniques.

The video comes with presenter's notes that include instructional objectives, pre- and post-tests, photos showing vaccination sites appropriate for vaccinating people of different ages, and a skills checklist to  help you document that your staff is well trained.

IAC distributes the video and presenter's notes at $15 per set (to U.S. addresses). If you wish to order online (U.S. addresses only), go to:
https://www.immunize.org/iztech

To order by mail or fax, print an IAC order form, available at
http://www.immunize.org/catg.d/2020a.pdf

Send your order payment (check, credit card information, or purchase order) to Immunization Action Coalition, 1573 Selby Ave., Ste. 234, St. Paul, MN 55104, and include your complete mailing  information and phone number. You can fax your order form with payment information to IAC at (651) 647-9131. If you are placing an order from outside the United States, please call IAC at (651) 647-9009 for shipping cost information.

A Spanish-language version is available through the California Distance Learning Health Network (CDLHN) for $25. To order, call (619) 594-3348, email cdlhn@projects.sdsu.edu or visit CDLHN
online at http://www.cdlhn.com
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March 24, 2003
NEW TRANSLATIONS: PCV7 VIS AVAILABLE IN SPANISH; MMR VIS AVAILABLE IN THAI

PCV7 VIS IN SPANISH
The pneumococcal conjugate (PCV7) Vaccine Information Statement (VIS) in Spanish is now available on the Immunization Action Coalition (IAC) website. IAC gratefully acknowledges the California Department of Health for providing the Spanish translation.

To obtain a camera-ready (PDF) copy of the PCV7 VIS in Spanish, go to:
http://www.immunize.org/vis/sppnPCV7.pdf

To obtain a camera-ready (PDF) copy of the PCV7 VIS in English, go to:
http://www.immunize.org/vis/pnPCV7.pdf

MMR VIS IN THAI
The measles, mumps, rubella (MMR) Vaccine Information Statement (VIS) in Thai is now available on the IAC website. IAC gratefully acknowledges Asian Pacific Health Care Venture, Inc., for providing the Thai translation.

To obtain a camera-ready (PDF) copy of the MMR VIS in Thai, go to:
http://www.immunize.org/vis/th_mmr03.pdf

To obtain a camera-ready (PDF) copy of the MMR VIS in English, go to:
http://www.immunize.org/vis/mmr03.pdf

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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March 24, 2003
POPULAR SELF-STUDY COURSE "TEACHING IMMUNIZATION PRACTICES FOR NURSES" IS UPDATED FOR 2003

Updated in January, the self-study course "Teaching Immunization Practices (TIP) for Nurses" is intended for practicing nurses and nursing students. It can be downloaded from the Internet and is also available on CD-ROM.

The course covers basic principles of immunization and vaccine use, as well as immunization practice, delivery, and program design. The Association of Teachers of Preventive Medicine (ATPM) produced it, in collaboration with Centers for Disease Control and Prevention and the American Nurses Association.

For information on the course modules and to download a free copy of the course from the TIP website, go to: http://healthsoftonline.com/portal/tipdl.asp

To order a CD-ROM from ATPM for $25, call HealthSoft Inc. at (800) 235-0882 or call ATPM at (202) 463-0550.
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March 24, 2003
USE "POWER OF 10" CAMPAIGN MATERIALS TO BOOST YOUR ADULT PATIENTS' TETANUS AND DIPHTHERIA IMMUNIZATION RATES

A collaborative venture between the National Foundation for Infectious Diseases (NFID) and the National Coalition for Adult Immunization, the "Power of 10" campaign was launched in February. Its  goal is to promote the importance of adults' and adolescents' maintaining up-to-date tetanus and diphtheria booster vaccinations.

A study published in the "Annals of Internal Medicine" on May 7, 2002, found that 53 percent of the nation's adults are not adequately protected against tetanus and diphtheria. The "Power of 10"  campaign intends to improve the rate of 10-year Td boosters among adults and adolescents by using the mass media and Internet to educate the public.

The media campaign includes television and radio public service announcements featuring home-improvement expert Bob Vila discussing the risks associated with tetanus and diphtheria and encouraging the public to get routine Td boosters. In addition, Vila and NFID president Susan Rehm, MD, will speak with print and broadcast reporters nationwide.

An attractive, two-color, duo-fold consumer education pamphlet has already been developed. To  access it in camera-ready (PDF) format from the NFID website, go to: http://www.nfid.org/powerof10/pdf/brochure2.pdf

To order free copies in any quantity, email NFID at powerof10@nfid.org

To access additional information and a variety of resources from the Internet, go to the NFID website at http://www.nfid.org and click on "Power of 10 Tetanus and Diphtheria Protection."

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March 24, 2003
CDC RELEASES REPORT ON ANIMAL RABIES PREVENTION AND CONTROL

The Centers for Disease Control and Prevention (CDC) published "Compendium of Animal Rabies Prevention and Control, 2003: National Association of State Public Health Veterinarians, Inc. (NASPHV)," in the March 21 issue of the "MMWR Recommendations and Reports" (MMWR). CDC  noted the following: "The report is being published as a courtesy to both the National Association of State Public Health Veterinarians, Inc., and to the MMWR readership. Its publication does not imply endorsement by CDC."

The introductory paragraph is reprinted below in its entirety, excluding references.

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Rabies is a fatal viral zoonosis and a serious public health problem. The purpose of this compendium is to provide information to veterinarians, public health officials, and others concerned with rabies  prevention and control. These recommendations serve as the basis for animal rabies-control programs throughout the United States and facilitate standardization of procedures among jurisdictions, thereby contributing to an effective national rabies-control program. This document is reviewed annually and revised as necessary. Parenteral vaccination procedure recommendations are contained in Part I; Part II details the principles of rabies control; all animal rabies vaccines licensed by the United States Department of Agriculture (USDA) and marketed in the United States are listed in Part III.

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To obtain the complete text of the report online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5205a1.htm

To obtain a camera-ready (PDF format) copy of the report, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5205.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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March 24, 2003
NEW: YELLOW FEVER VACCINE VIS NOW AVAILABLE

The Centers for Disease Control and Prevention (CDC) recently issued its first Vaccine Information Statement (VIS) for yellow fever vaccine. Dated 3/14/03, the VIS is available on the websites of CDC and the Immunization Action Coalition (IAC).

To obtain a copy of the new VIS in camera-ready (PDF) format, go to:
http://www.immunize.org/vis/yfever03.pdf

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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March 24, 2003
CDC PUBLISHES CLINICAL DESCRIPTION OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

The Centers for Disease Control and Prevention (CDC) published "Preliminary Clinical Description of Severe Acute Respiratory Syndrome" in the March 21 issue of "MMWR Dispatch" (MMWR). CDC publishes the Web-based "MMWR Dispatch" only for the immediate release of important public health  information. Currently available only on the Web, the March 21 "MMWR Dispatch" will be available in a print issue of MMWR in the future. It is printed below in its entirety.

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Severe acute respiratory syndrome (SARS) is a condition of unknown etiology that has been described in patients in Asia, North America, and Europe. This report summarizes the clinical description of patients with SARS based on information collected since mid-February 2003 by the World Health Organization (WHO), Health Canada, and CDC in collaboration with health authorities and clinicians in Hong Kong, Taiwan, Bangkok, Singapore, the United Kingdom, Slovenia, Canada,  and the United States. This information is preliminary and limited by the broad and necessarily nonspecific case definition.

As of March 21, 2003, the majority of patients identified as having SARS have been adults aged 25-70 years who were previously healthy. Few suspected cases of SARS have been reported among children aged 15 years or younger.

The incubation period for SARS is typically 2-7 days; however, isolated reports have suggested an incubation period as long as 10 days. The illness begins generally with a prodrome of fever (above 100.4F [above 38.0C]). Fever often is high, sometimes is associated with chills and rigors, and might be accompanied by other symptoms, including headache, malaise, and myalgia. At the onset of illness, some persons have mild respiratory symptoms. Typically, rash and neurologic or gastrointestinal findings are absent; however, some patients have reported diarrhea during the febrile prodrome.

After 3-7 days, a lower respiratory phase begins with the onset of a dry, nonproductive cough or dyspnea, which might be accompanied by or progress to hypoxemia. In 10%-20% of cases, the  respiratory illness is severe enough to require intubation and mechanical ventilation. The case-fatality rate among persons with illness meeting the current WHO case definition of SARS is approximately 3%.

Chest radiographs might be normal during the febrile prodrome and throughout the course of illness. However, in a substantial proportion of patients, the respiratory phase is characterized by early focal interstitial infiltrates progressing to more generalized, patchy, interstitial infiltrates. Some chest radiographs from patients in the late stages of SARS also have shown areas of consolidation.

Early in the course of disease, the absolute lymphocyte count is often decreased. Overall white blood cell counts have generally been normal or decreased. At the peak of the respiratory illness,  approximately 50% of patients have leukopenia and thrombocytopenia or low-normal platelet counts (50,000-150,000/microliter). Early in the respiratory phase, elevated creatine phosphokinase levels (as  high as 3,000 IU/L) and hepatic transaminases (two to six times the upper limits of normal) have been noted. In the majority of patients, renal function has remained normal.

The severity of illness might be highly variable, ranging from mild illness to death. Although a few close contacts of patients with SARS have developed a similar illness, the majority have remained well. Some close contacts have reported a mild, febrile illness without respiratory signs or symptoms, suggesting the illness might not always progress to the respiratory phase.

Treatment regimens have included several antibiotics to presumptively treat known bacterial agents of atypical pneumonia. In several locations, therapy also has included antiviral agents such as oseltamivir or ribavirin. Steroids have also been administered orally or intravenously to patients in combination with ribavirin and other antimicrobials. At present, the most efficacious treatment regimen, if any, is unknown.

In the United States, clinicians who suspect cases of SARS are requested to report such cases to their state health departments. CDC requests that reports of suspected cases from state health departments,  international airlines, cruise ships, or cargo carriers be directed to the SARS Investigative Team at the CDC Emergency Operations Center, telephone (770) 488-7100. Outside the  United States, clinicians who suspect cases of SARS are requested to report such cases to their local public health authorities. Additional information about SARS (e.g., infection control guidance and procedures for reporting suspected cases) is available at http://www.cdc.gov/ncidod/sars Global case counts are available at http://www.who.int

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To obtain the complete text of the description online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/m2d321.htm

To obtain a camera-ready (PDF format) copy of the description, go to:
http://www.cdc.gov/mmwr/pdf/wk/m2d321.pdf
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March 24, 2003
CDC PUBLISHES AN UPDATE ON 2002-03 INFLUENZA SEASON

The Centers for Disease Control and Prevention (CDC) published "Update: Influenza Activity--United States, 2002-03 Season" in the March 21 issue of the "Morbidity and Mortality Weekly Report" (MMWR). A portion of a summary made available to the press is reprinted below.

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Influenza activity has been mild in the United States this season overall but has varied by region. The flu season appears to have peaked during early February, but influenza viruses continue to circulate in  the United States. Overall, influenza type B viruses have predominated but influenza type A viruses have been more frequently identified than influenza B during late February and early March.

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CDC noted the following: "Influenza surveillance reports for the United States are published weekly during October-May and are available at http://www.cdc.gov/ncidod/diseases/flu/weekly.htm or through CDC's voice [telephone, (888) 232-3228] and fax [telephone, (888) 232-3299, document number 361100] information systems."

To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a4.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5211.pdf
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March 24, 2003
CDC REPORTS ON CURRENT OUTBREAK OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

The Centers for Disease Control and Prevention (CDC) published "Outbreak of Severe Acute Respiratory Syndrome--Worldwide, 2003" in the March 21 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The Editorial Note is reprinted below in its entirety, excluding references.

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During 2000, approximately 83 million nonresident passengers arrived in China, 13 million in Hong Kong, and 2 million in Vietnam, and approximately 460,000 residents of China, Hong Kong, and  Vietnam traveled to the United States. During January 1, 1997-March 18, 2003, an estimated 5% of ill tourists worldwide who sought post-travel care from one of 35 worldwide GeoSentinel travel clinics had  pneumonia (International Society of Tropical Medicine, unpublished data, 2003). In the United States,  approximately 500,000 persons with pneumonia require hospitalization each year; in approximately half of these cases, no etiologic agent is identified despite intensive investigation. On the basis of these  data and the broad and necessarily nonspecific case definition, cases meeting the criteria for SARS  [Severe Acute Respiratory Syndrome] are anticipated worldwide and in the United States. However, most of the anticipated cases are expected to be unrelated to the current outbreak.

Electron microscopic identification of paramyxovirus-like particles has been reported from Germany and Hong Kong. This family of viruses includes measles, mumps, human parainfluenza viruses, and respiratory syncytial virus in addition to the recently identified henipaviruses and metapneumovirus. Additional testing is under way to confirm a definitive etiology. Identification of the causative agent should lead to specific diagnostic tests, simplify surveillance, and focus treatment guidelines and infection control guidance.

Clinicians and public health officials who suspect cases of SARS are requested to report such cases to their state health departments. CDC requests that reports of suspect cases from state health departments, international airlines, cruise ships, or cargo carriers be directed to the SARS Investigative Team at the CDC Emergency Operations Center, telephone (770) 488-7100. Additional information about SARS (e.g., infection control guidance and procedures for reporting suspected cases) is available at http://www.cdc.gov/ncidod/sars Global case counts are available at http://www.who.int

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a5.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5211.pdf
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March 24, 2003
CDC PUBLISHES AN UPDATE OF SMALLPOX VACCINE ADVERSE EVENTS SURVEILLANCE

The Centers for Disease Control and Prevention (CDC) published a Notice to Readers, "Smallpox Vaccine Adverse Events Among Civilians--United States, 2003," in the March 21 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The Notice is reprinted below in its entirety.

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During January 24-March 14, smallpox vaccine was administered to 21,698 civilian health-care and public health workers in 52 jurisdictions. Surveillance for adverse events during the civilian smallpox  vaccination program is ongoing. The number of weekly smallpox vaccine adverse events reported among civilian vaccinees and civilian contacts of civilian and military vaccinees that are received by CDC from the Vaccine Adverse Event Reporting System is posted every Thursday at http://www.cdc.gov/od/oc/media/smpxrprt.htm Surveillance reports including brief clinical descriptions of noteworthy cases are published regularly in MMWR.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a7.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5211.pdf
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March 24, 2003
CDC PUBLISHES A PUBLIC HEALTH DISPATCH ON TRANSMISSION OF d9 MEASLES IN THE REGION OF THE AMERICAS

The Centers for Disease Control and Prevention (CDC) published a Public Health Dispatch, "Absence of Transmission of the d9 Measles Virus--Region of the Americas, November 2002-March 2003," in the March 21 issue of the "Morbidity and Mortality Weekly Report" (MMWR). A summary made available to the press is reprinted below in its entirety.

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In 1994, countries in the Region of the Americas set a goal to interrupt indigenous measles transmission. As of March 16, 2003, the Region of the Americas has been free for 17 weeks from known circulation of the d9 measles virus, the strain responsible for the only large outbreak of measles in the region during 2002. However, measles is still endemic in other regions, and sporadic cases continue to occur in the Region of the Americas because of importation.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5211a6.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5211.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 March 24, 2003