Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 394            June 23, 2003

CONTENTS OF THIS ISSUE

  1. FDA approves license for FluMist intranasal influenza virus vaccine
  2. Seventy-five percent of U.S. tetanus deaths occur in people age 60 and older, according to CDC's 1998-2000 surveillance
  3. Three states enact immunization legislation for college attendance
  4. "Immunization Techniques" video prepares you and your staff for the summer and fall immunization rush
  5. CDC reports 32 new monkeypox cases as the outbreak spreads to three more states
  6. Old Vaccine Injury Compensation Program web address is functional again
  7. CDC reports on a hepatitis A outbreak among restaurant patrons in Massachusetts in 2001
  8. Tuesday, June 24, is the new abstract submission deadline for CDC's Fourth Immunization Registry Conference
  9. CDC reports on Nigeria's progress toward polio eradication

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June 23, 2003
FDA APPROVES LICENSE FOR FLUMIST INTRANASAL INFLUENZA VIRUS VACCINE

On June 17, the Food and Drug Administration (FDA) approved a license application for FluMist, a live trivalent intranasal influenza virus vaccine. FluMist is indicated for active immunization for the prevention of disease caused by influenza A and B viruses in healthy children and adolescents, ages 5-17 years, and healthy adults, ages 18-49 years. FluMist is a product of MedImmune Vaccines, Inc., Mountain View, CA.

To access the approval letter from the FDA website, go to:
http://www.fda.gov/cber/approvltr/inflmed061703L.htm

To access a camera-ready (PDF) version of the 19-page prescribing information (package insert) from the FDA website, go to:
http://www.fda.gov/cber/label/inflmed061703lb.pdf
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June 23, 2003
SEVENTY-FIVE PERCENT OF U.S. TETANUS DEATHS OCCUR IN PEOPLE AGE 60 AND OLDER, ACCORDING TO CDC'S 1998-2000 SURVEILLANCE

The Centers for Disease Control and Prevention (CDC) published "Tetanus Surveillance--United States, 1998-2000" in the June 20 issue of "MMWR Surveillance Summaries" (MMWR). The summary abstract is reprinted below in its entirety.

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Abstract

Problem/Condition: Tetanus is a severe and often fatal infection. The incidence of reported cases in the United States has declined steadily since introduction of tetanus toxoid vaccines in the 1940s.

Reporting Period: This report covers surveillance data for 1998-2000.

Description of System: Physician-diagnosed cases of tetanus were reported to CDC's National Notifiable Disease Surveillance System. Supplemental clinical and epidemiologic information were provided by states.

Results and Interpretation: During 1998-2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged 60 years and older (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged 60 years and older. No deaths occurred among those who were up-to-date with tetanus toxoid vaccination. Seventy-three percent of 129 cases with known injury information  available reported an acute injury; of these, only 37% sought medical care for the acute injury, and only 63% of those eligible received tetanus toxoid for wound prophylaxis.

Interpretation: The majority of tetanus cases occurred among persons inadequately vaccinated or with unknown vaccination history who sustained an acute injury. Adults aged 60 years and older were at highest risk for tetanus and tetanus-related death.

Public Health Actions: Tetanus is preventable through routine vaccination (i.e., primary series and decennial boosters) and appropriate management. A shortage of tetanus and diphtheria toxoids vaccine that began during 2000 ended in 2002. Efforts by health-care providers are warranted to vaccinate persons with delayed or incomplete vaccination, with emphasis on older persons and persons with high-risk conditions.

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To obtain the complete surveillance summary online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5203a1.htm

To obtain a camera-ready (PDF format) copy of the surveillance summary, go to: http://www.cdc.gov/mmwr/PDF/ss/ss5203.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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June 23, 2003
THREE STATES ENACT IMMUNIZATION LEGISLATION FOR COLLEGE ATTENDANCE

Three states--Minnesota, Mississippi, and Oklahoma--have enacted legislation concerning meningococcal immunization for students starting post-secondary education. In addition, Mississippi has passed similar legislation regarding hepatitis A and B vaccination, and Oklahoma has passed similar legislation regarding hepatitis B, measles, mumps, and rubella vaccination.

MENINGOCOCCAL
Minnesota. The Minnesota State Legislature passed legislation requiring all institutions of higher learning to provide incoming students residing on campus with information on meningococcal disease and vaccine. The governor signed the legislation May 28; it went into effect June 1, 2003.

Mississippi. The Mississippi Legislature passed legislation requiring all institutions of higher learning to provide all incoming students with information about meningococcal disease and vaccine. The governor signed the legislation April 22; it goes into effect July 1, 2003.

Oklahoma. The Oklahoma Legislature passed legislation requiring all institutions of higher learning to (1) provide all students living in on-campus housing with information about meningococcal disease and vaccine and (2) require incoming students to be vaccinated against the disease or sign a waiver indicating they have received information and declined vaccination. The governor signed the legislation May 29; it goes into effect in the 2004-2005 academic year.

HEPATITIS A AND B
Mississippi. The Mississippi Legislature passed legislation requiring all institutions of higher learning to provide all incoming students with information about hepatitis A and B diseases and vaccines. The governor signed the legislation April 22; it goes into effect July 1, 2003.

HEPATITIS B, MEASLES, MUMPS, AND RUBELLA
Oklahoma. The Oklahoma Legislature passed legislation requiring (1) all institutions of higher learning to provide all incoming students with information about hepatitis B, measles, mumps, and rubella and (2) all students enrolling in institutions of higher learning to provide written documentation of immunization against hepatitis B, measles, mumps, and rubella or to complete immunization against these diseases within ten months of enrollment. A signed waiver is required to exempt a student from these immunizations for medical or religious reasons. The governor signed the legislation May 29; it goes into effect in the 2004-2005 academic year.

The Immunization Action Coalition (IAC) has compiled information about all states that have meningococcal prevention mandates for colleges and universities. To access the information, go to: http://www.immunize.org/laws/menin.htm

IAC is developing a new web page of information about states that have hepatitis B prevention mandates for colleges and universities. For this information (and for comprehensive information on state laws for a variety of immunizations), please check our state laws web page soon by going to http://www.immunize.org/laws

We depend on our readers to help us stay informed and to ensure our website contains the most current and accurate information available. Please let us know when any changes occur in your state.
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June 23, 2003
"IMMUNIZATION TECHNIQUES" VIDEO PREPARES YOU AND YOUR STAFF FOR THE SUMMER AND FALL IMMUNIZATION RUSH

Seasoned health professionals know that a thorough grounding in administering vaccinations is the best  preparation for the busy summer and fall immunization season. The video "Immunization Techniques: Safe, Effective, Caring" offers practical information for immunizing the preschool and school age children now arriving in your waiting room to catch up on missed vaccinations before school begins, as well as for immunizing summer travelers of all ages. As the fall influenza vaccination season approaches, even more people will need to be immunized.

In fact, the video is such a high-quality, cost-effective immunization-training tool that health professionals across the nation have ordered approximately 7,600 copies of it from the Immunization Action Coalition (IAC) since September 2001, when IAC 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 of the video 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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June 23, 2003
CDC REPORTS 32 NEW MONKEYPOX CASES AS THE OUTBREAK SPREADS TO THREE MORE STATES

The Centers for Disease Control and Prevention (CDC) published "Update: Multistate Outbreak of Monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003" in the June 20 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The article reports that as of June 18, monkeypox spread to three additional states--Kansas, Missouri, and Ohio. Of the 87 reported cases,  38 were found in Wisconsin; 24 in Indiana; 19 in Illinois; 4 in Ohio; and 1 each in Kansas and Missouri.

The article updates epidemiologic, laboratory, and animal data for U.S. cases and presents an updated interim case definition for human cases of monkeypox in table form.

To obtain the complete text of the article online, including the updated interim case definition, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5224a1.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5224.pdf
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June 23, 2003
OLD VACCINE INJURY COMPENSATION PROGRAM WEB ADDRESS IS FUNCTIONAL AGAIN

The Health Resources and Services Administration (HRSA) recently reactivated the old web address for the Vaccine Injury Compensation Program (VICP). The old address is http://www.hrsa.gov/bhpr/vicp Last year, the VICP web address was changed to http://www.hrsa.gov/osp/vicp, and the old address was made nonfunctional.

In response to the address change, the Centers for Disease Control and Prevention (CDC) changed the VICP web address on Vaccine Information Statements (VISs) for the following routine childhood vaccines: diphtheria, tetanus, and pertussis (DTaP), pneumococcal conjugate (PCV7), inactivated polio (IPV), Haemophilus influenzae type b (Hib), hepatitis B, and varicella. CDC informed health professionals that they could give patients VISs with the old VICP web address as long as the VISs were otherwise current (for further information, see "IAC EXPRESS" issue #389 at http://www.immunize.org/genr.d/issue389.htm#n4).

Now that both the old and new web addresses are functional, health professionals may use VISs that have either VICP web address printed on them.

To access copies of the newly revised VISs for routine childhood vaccines from the VIS web page of the Immunization Action Coalition, go to: http://www.immunize.org/vis The VIS web page has information about the use of VISs and also has VISs in up to 28 languages.
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June 23, 2003
CDC REPORTS ON A HEPATITIS A OUTBREAK AMONG RESTAURANT PATRONS IN MASSACHUSETTS IN 2001

The Centers for Disease Control and Prevention (CDC) published "Foodborne Transmission of Hepatitis A--Massachusetts, 2001" in the June 20 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The opening paragraph states: "This report summarizes the investigation of an outbreak of foodborne hepatitis A in Massachusetts in which a food handler with hepatitis A, who was considered unlikely to transmit HAV, was implicated as the source. The findings underscore challenges faced by local and state health departments when determining whether PEP [postexposure prophylaxis] is appropriate."

To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5224a2.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5224.pdf
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June 23, 2003
TUESDAY, JUNE 24, IS THE NEW ABSTRACT SUBMISSION DEADLINE FOR CDC'S FOURTH IMMUNIZATION REGISTRY CONFERENCE

The Centers for Disease Control and Prevention (CDC) has extended the deadline for submitting abstracts to its Fourth Immunization Registry conference until midnight (PST) Tuesday, June 24. CDC has extended the deadline for oral and poster presentations in an effort to include as many abstracts as possible from its partners and colleagues in the field. The previous deadline was June 17.

To submit an abstract, go to CDC's online system at http://cdc.confex.com/cdc/irc2003

For comprehensive information about the conference, scheduled for October 27-29 in Atlanta, go to the conference web site at http://www.cdc.gov/nip/registry/irc

For additional information, contact Amanda Bryant by email at siisclear@cdc.gov or by phone at (404) 639-8247.
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June 23, 2003
CDC REPORTS ON NIGERIA'S PROGRESS TOWARD POLIO ERADICATION

The Centers for Disease Control and Prevention (CDC) published "Progress Toward Poliomyelitis Eradication--Nigeria, January 2002-March 2003" in the June 20 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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The estimated global occurrence of poliomyelitis has decreased more than 99 percent since 1998, when the World Health Assembly resolved to eradicate polio worldwide. Despite progress, Nigeria remains one of the three global poliovirus reservoirs (along with northern India and Pakistan) whose low routine OPV vaccination coverage and high population density favor poliovirus transmission. This report summarizes the progress toward polio eradication in Nigeria during January 2002-March 2003, highlighting progress in acute flaccid paralysis surveillance. The findings of wild poliovirus circulation in areas of lower vaccination coverage underscore the importance of achieving high quality supplementary immunization activities.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5224a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5224.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 June 23, 2003