Issue
Number 374
March 24, 2003
CONTENTS OF THIS ISSUE
- New on the Web: "Infectious Diseases in Children" monograph
offers vital information on talking to parents about vaccines
- "Immunization Techniques" video--a powerful staff teaching
tool you can't afford to be without
- New translations: PCV7 VIS available in Spanish; MMR VIS
available in Thai
- Popular self-study course "Teaching Immunization Practices for
Nurses" is updated for 2003
- Use "Power of 10" campaign materials to boost your adult
patients' tetanus and diphtheria immunization rates
- CDC releases report on animal rabies prevention and control
- New: Yellow fever vaccine VIS now available
- CDC publishes clinical description of Severe Acute Respiratory
Syndrome (SARS)
- CDC publishes an update on 2002-03 influenza season
- CDC reports on current outbreak of Severe Acute Respiratory
Syndrome (SARS)
- CDC publishes an update of smallpox vaccine adverse events
surveillance
- CDC publishes a Public Health Dispatch on transmission of d9
measles in the Region of the Americas
----------------------------------------------------------
Back to Top
(1 of 12)
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
----------------------------------------------------------------
Back to Top
(2 of 12)
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
---------------------------------------------------------------
Back to Top
(3 of 12)
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
----------------------------------------------------------------
Back to Top
(4 of 12)
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.
----------------------------------------------------------------
Back to Top
(5 of 12)
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."
----------------------------------------------------------------
Back to Top
(6 of 12)
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.
****************************
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.
****************************
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.
----------------------------------------------------------------
Back to Top
(7 of 12)
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
----------------------------------------------------------------
Back to Top
(8 of 12)
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.
*****************************
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 100.4蚌 [above 38.0蚓]). 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
*****************************
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
----------------------------------------------------------------
Back to Top
(9 of 12)
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.
****************************
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.
****************************
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
----------------------------------------------------------------
Back to Top
(10 of 12)
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.
***********************
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
***********************
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
----------------------------------------------------------------
Back to Top
(11 of 12)
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.
****************************
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.
****************************
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
----------------------------------------------------------------
Back to Top
(12 of 12)
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.
****************************
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.
****************************
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
|
