Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 411            September 15, 2003

CONTENTS OF THIS ISSUE

  1. New: CDC releases VIS for intranasal influenza vaccine and makes minor change to inactivated influenza VIS
  2. Just in time for flu vaccination season: National Immunization Program posts 2003-04 "Flu Gallery" materials
  3. New: National Immunization Program issues Influenza Vaccine Bulletin #3 for the 2003-04 influenza season
  4. Minnesota expands and changes day care and school entry requirements for three childhood vaccines
  5. CDC reports on global progress toward childhood hepatitis B vaccination
  6. IAC's newest web section features PowerPoint presentations
  7. IAC posts new VIS translations for inactivated influenza, meningococcal, inactivated polio, and MMR vaccines
  8. IAC's Hepatitis Prevention Programs website now features 90 programs

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September 15, 2003
NEW: CDC RELEASES VIS FOR INTRANASAL INFLUENZA VACCINE AND MAKES MINOR CHANGE TO INACTIVATED INFLUENZA VIS

On September 4, the National Immunization Program, Centers for Disease Control and Prevention (CDC), posted the Vaccine Information Statement (VIS) for the new intranasal influenza vaccine.  Licensed in the United States earlier this year and sold under the trade name FluMist, the vaccine is an attenuated (weakened) live vaccine intended to be sprayed into vaccinees' nostrils.

To access a camera-ready (PDF) copy of the new VIS from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf

In addition, CDC made a minor change to topic four of the VIS for inactivated influenza vaccine. The change reflects the Advisory Committee on Immunization Practice's decision to rescind its  recommendation for staged administration and allow everyone to get the vaccine as soon as it's available. As this change is minor, CDC did not change the VIS issue date; it is still 5/6/03.

To access a camera-ready (PDF) copy of the revised VIS from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf

The two VISs are also posted on the IAC website. For information about the use of VISs, as well as VISs for additional vaccines (some in up to 28 languages), visit IAC's VIS web section at http://www.immunize.org/vis
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September 15, 2003
JUST IN TIME FOR FLU VACCINATION SEASON: NATIONAL IMMUNIZATION PROGRAM POSTS 2003-04 "FLU GALLERY" MATERIALS

On September 5, the National Immunization Program, Centers for Disease Control and Prevention posted the majority of its influenza patient-education materials on its 2003-04 "Flu Gallery" web section. This season's flu campaign emphasizes protecting yourself and the ones you love by getting a flu vaccine. You'll find materials for parents, Spanish speakers, those at high risk for flu complications, and immunization providers. Materials are free and can be downloaded easily.

Available for printing in color and/or black and white, the materials include the following:

One brochure: "Influenza and Your Child: Information for Parents," prints double sided; one side in English, one side in Spanish.

Four 8-1/2" x 11" flyers; all available in English and Spanish: (1) "Flu Vaccine Facts & Myths," (2) "To Protect Yourself and Those You Love," (3) "When Should You Get Your Flu Vaccination?" and (4) "Who Is at High Risk for Flu Complications?" (black and white only).

Three posters; all available in English and Spanish: (1) "Community Immunity: 'Dominos'," (2) "Protect Your Kids from Flu," (3) "Top Three Reasons to Get Your Flu Vaccine."

Other materials include the Vaccine Information Statements for inactivated influenza vaccine and live intranasal influenza vaccine [for more information, see the preceding "IAC EXPRESS" article], buttons, pediatric dosage chart, cover letter (English only), stickers (English only), three-sided stand-up table tent (English only), and flu logos for print materials or web sites.

These materials will soon be available on a free CD-ROM; the request form will be coming soon. The limit is one CD per order.

To access "Flu Gallery" materials, go to:
http://www.cdc.gov/nip/flu/gallery.htm

For further information, contact Carolyn O'Mara at mfo1@cdc.gov or (404) 639-8237 or Ron Nuse at ran0@cdc.gov or (404) 639-8738.
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September 15, 2003
NEW: NATIONAL IMMUNIZATION PROGRAM ISSUES INFLUENZA VACCINE BULLETIN #3 FOR THE 2003-04 INFLUENZA SEASON

On September 11, the National Immunization Program of the Centers for Diseases Control and Prevention (CDC) issued "Influenza Bulletin #3." It is reprinted below in its entirety, with the exception of one table.

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INFLUENZA VACCINE BULLETIN #3
Influenza Season 2003-04
September 11, 2003

The National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) publishes and distributes periodic bulletins to update partners about recent developments related to the production, distribution, and administration of influenza vaccine. All recipients of this bulletin are encouraged to distribute each issue widely to colleagues, members, and constituents.

INFLUENZA VACCINE DISTRIBUTION AND ADMINISTRATION

Timing of Influenza Vaccination During the 2003-04 Season

  • At its June meeting, the ACIP asked CDC, in collaboration with the FDA and the influenza vaccine manufacturers, to determine if vaccine supplies for the coming year would be adequate and timely. The CDC affirmed on August 11, 2003, that vaccine production for the 2003-04 influenza season is proceeding satisfactorily, and that projected production and distribution  schedules will allow for sufficient supply of influenza vaccine during October and November. Therefore, influenza vaccination can proceed for all high-risk and healthy persons, individually and through mass campaigns, as soon as vaccine is available.
     
    Review the Notice to Readers published in the August 22, 2003, Morbidity and Mortality Weekly Report (MMWR) for complete information and references at
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a6.htm

CMS Allows Exception to Electronic Reporting Requirement for Providers Submitting Roster Bills

  • On August 15, 2003, the Department of Health and Human Services (HHS) published the Final Rule for Electronic Submission of Medicare Claims. The Administrative Simplification Compliance Act (ASCA) requires nearly all claims sent to the Medicare Program be submitted electronically beginning October 16, 2003. However, providers wishing to submit paper roster bills for vaccinations are exempt from this requirement. Review the rule and the few exceptions to these requirements at
    http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/pdf/03-20955.pdf
     
    The Centers for Medicare and Medicaid Services (CMS) offers free training and testing to assure that providers and their business partners are able to send and receive HIPAA-compliant transactions. Contact your Medicare carrier to schedule testing.
     
    Additional HIPAA information can be found at http://www.cms.hhs.gov/hipaa/hipaa2

How to Bill Medicare for Influenza and Pneumococcal Vaccines

Redistribution of Influenza Vaccine

  • According to the Food and Drug Administration (FDA), providers may reallocate inactivated influenza vaccine to other local providers where vaccine distribution is uneven.
     
    The parameters for redistribution in keeping within the accepted principles of vaccine storage and handling are available on CDC's website at http://www.cdc.gov/nip/Flu/News.htm#redist

Projections of Influenza Vaccine Distribution

["IAC EXPRESS" Editor's Note: The table "Projections of Monthly Influenza Vaccine Distribution, United States, 2003" is accessible using the link provided at the end of this article.]

INFLUENZA VACCINE COMMUNICATIONS AND RESOURCES

MISCELLANEOUS INFORMATION

Pneumococcal Vaccine Payment Increase Effective October 1, 2003

  • Effective October 1, 2003, the Medicare Part B payment for the pneumococcal vaccine will be increased to either the charge billed to Medicare or the amount of $18.62, whichever is lower. Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners, and suppliers who administer pneumococcal vaccination must take assignment on the claim for the vaccine.
     
    For additional information about Medicare and immunizations, refer to the Immunizations Quick Reference Guide at http://www.cms.hhs.gov/medlearn/refimmu.asp

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To access a camera-ready (PDF) version of the bulletin from the Immunization Action Coalition website, go to: http://www.immunize.org/news.d/flubul91103.pdf
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September 15, 2003
MINNESOTA EXPANDS AND CHANGES DAY CARE AND SCHOOL ENTRY REQUIREMENTS FOR THREE CHILDHOOD VACCINES

On September 9, Minnesota's commissioner of health signed an order adopting new rules that add to and change current day care and school entry immunization requirements. Beginning with the 2004-05 school year, the following requirements will be in effect:

Varicella: Children in day care, kindergarten, and seventh grade will need to show proof they are vaccinated against varicella or have had the disease.

Pneumococcal disease: Children under age two in day care will need to show proof they are immunized against pneumococcal disease.

Measles, mumps, rubella (MMR): Children entering kindergarten will need to show proof of a second dose of MMR vaccine; previously, MMR was required by law at seventh grade entry.

The Immunization Action Coalition has compiled information about all states that have varicella mandates for day care, elementary, and middle school entry. To access the information, go to: http://www.immunize.org/laws/varicel.htm

This information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/varimap.pdf

For information about state mandates for other vaccines, go to: http://www.immunize.org/laws

We depend on our readers to help us stay informed and ensure our website contains the most current and accurate information available. Please let us know when any changes occur in your state by emailing us at admin@immunize.org
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September 15, 2003
CDC REPORTS ON GLOBAL PROGRESS TOWARD CHILDHOOD HEPATITIS B VACCINATION

The Centers for Disease Control and Prevention (CDC) published "Global Progress Toward Universal Childhood Hepatitis B Vaccination, 2003" in the September 12 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The article is reprinted below, excluding references and a map.

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In 1992, the World Health Organization (WHO) set a goal for all countries to integrate hepatitis B vaccination into their universal childhood vaccination programs by 1997. This report summarizes the global progress achieved toward vaccination of children against hepatitis B virus (HBV) infection. Although many countries have introduced hepatitis B vaccination into their national vaccination programs, efforts are needed to increase coverage with the 3-dose hepatitis B vaccination series and expand vaccination programs into countries where the vaccine has not yet been introduced.

In 2001, the most recent year for which complete program data are available, 126 (66%) of 191 WHO member states had universal infant or childhood hepatitis B vaccination programs. Through these programs, an estimated 32% of children aged less than 1 year were vaccinated fully with the 3-dose hepatitis B vaccination series. In the six WHO regions, the proportion of children aged less than 1 year who were vaccinated fully was 65% in the Western Pacific Region, 58% in the Americas Region, 45% in the European Region, 41% in the Eastern Mediterranean Region, 9% in the South-East Asian Region, and 6% in the African Region.

As of May 2003, a total of 151 (79%) of 192 WHO member states had adopted universal childhood hepatitis B vaccination policies, including six that have policies for vaccinating adolescents. Of the 137 member states that have adopted universal childhood hepatitis B vaccination and for which data are available, 76 (55%) have a policy for administering the first dose of vaccine soon after birth (birth dose).

Of the 89 member states with historically high prevalences of chronic HBV infection (i.e., prevalence of hepatitis B surface antigen [HBsAg] of 8% or greater) and for which universal infant hepatitis B vaccination is recommended specifically, 64 (72%) have adopted universal infant hepatitis B vaccination. Of these 64 member states, 34 (53%) have a policy for administration of a birth dose of vaccine. Goals for global hepatitis B vaccination are for the vaccine to be introduced in all countries by 2007 and for coverage with the 3-dose hepatitis B vaccination series to reach 90% by 2010.

Editorial Note:

Each year, approximately 600,000 HBV-related deaths occur worldwide (CDC and WHO, unpublished data, 2003). An estimated 93% of these deaths result from the chronic sequelae of HBV infection: cirrhosis and hepatocellular carcinoma (HCC) (CDC, unpublished data, 2003). Approximately 21% of HBV-related deaths result from infection acquired in the perinatal period and 48% from infection acquired in early childhood (age 5 years or less) (CDC, unpublished data, 2003). Therefore, vaccination of infants and children is the highest priority for hepatitis B vaccination programs. Three doses of hepatitis B vaccine are 90%-95% efficacious in preventing HBV infection and its chronic sequelae. To prevent perinatal HBV transmission, the first dose of vaccine should be administered within the first 24 hours after birth.

Hepatitis B vaccination has been shown to reduce the prevalence of chronic HBV infection and the incidence of HCC dramatically. In The Gambia, the prevalence of chronic infection among children declined from 10.0% to 0.6% after implementation of universal infant hepatitis B vaccination. Similar declines in prevalence of chronic infection associated with infant and childhood hepatitis B vaccination have been demonstrated in China, Indonesia, Senegal, and Thailand, and among Alaska Natives. After implementation of universal infant hepatitis B vaccination in Taiwan, the incidence of HCC among children declined from 0.7 to 0.36 per 100,000.

Several important challenges remain to achieve the goal of global childhood hepatitis B vaccination introduction. Countries that have not yet introduced hepatitis B vaccine should do so. For many of these countries, this will require strengthening their existing vaccination program infrastructure to accommodate the addition of a new vaccine. In countries where the vaccine has been introduced already, coverage with the 3-dose hepatitis B vaccination series should be increased to that of the 3-dose diphtheria-tetanus-pertussis (DTP) series, and then to 90% or greater. Countries that do not have a policy for administration of a birth dose of vaccine should consider the feasibility of implementing such a policy. In countries with high hepatitis B vaccination coverage among children, consideration should be given to catch-up vaccination of older children, adolescents, and adult populations at increased risk for HBV infection.

A major barrier to the introduction of hepatitis B vaccination has been the high cost of hepatitis B vaccines. Although the price of monovalent hepatitis B vaccine for developing countries has decreased from approximately U.S.$3.00 per dose in 1990 to U.S.$0.30 per dose in 2001, the cost remains higher than that of the older vaccines (e.g., DTP, oral polio, and measles), which cost U.S.$0.06-$0.10 per dose. Since 1999, support from the Global Alliance for Vaccines and Immunization (GAVI) and the Vaccine Fund (VF) has accelerated introduction of hepatitis B vaccine in the world's poorest countries. As of May 2003, of 75 countries eligible for GAVI/VF support, 48 (64%) had received funding for hepatitis B vaccination introduction.

Administration of a birth dose of vaccine presents a challenge. Worldwide, approximately 50% of infants are born at home and do not have immediate access to health care. However, because hepatitis B vaccine has been shown to be heat stable, it could be administered by trained birth attendants to infants born at home. The feasibility of such a strategy has been demonstrated in Indonesia, where trained birth attendants were taught to administer the birth dose of vaccine to infants born at home by using a single-use, pre-filled injection device.

WHO, in collaboration with CDC and other GAVI partners, conducted process evaluations of hepatitis B vaccination introduction in five African countries where the vaccine had been introduced recently. These evaluations demonstrated that hepatitis B vaccine introduction did not negatively impact the existing vaccination programs, including coverage with the other childhood vaccines. However, several problems were identified related to the management of this relatively costly vaccine: vaccine freezing during storage and shipment, and vaccine wastage. Outcome evaluations are needed to document the impact of vaccination on the prevalence of chronic HBV infection and HBV-related morbidity and mortality.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5236a5.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5236.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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September 15, 2003
IAC'S NEWEST WEB SECTION FEATURES POWERPOINT PRESENTATIONS

[The following is cross posted from the Immunization Action Coalition's "HEP EXPRESS" electronic newsletter, 9/10/03.]

The Immunization Action Coalition (IAC) recently launched a new web section featuring public domain Microsoft PowerPoint presentations. These presentations were collected to provide health professionals easy access to educational tools for both staff training and patient education.

The site features links to presentations from the Centers for Disease Control and Prevention's (CDC) National Immunization Program, CDC's Division of Viral Hepatitis, the World Health Organization, UNICEF, OSHA, the Rotary Foundation, the Children's Vaccine Program at PATH, and more.

Subjects covered in these presentations include the basics of childhood vaccines, vaccine safety, needle safety, global issues, and viral hepatitis. The web page indicates whether a presentation is intended for health professionals or the public.

Visit this new resource at http://www.immunize.org/presentations If you know of any other available PowerPoint presentations, please let us know by writing to: teresa@immunize.org
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September 15, 2003
IAC POSTS NEW VIS TRANSLATIONS FOR INACTIVATED INFLUENZA, MENINGOCOCCAL, INACTIVATED POLIO, AND MMR VACCINES

The Immunization Action Coalition (IAC) recently posted Vaccine Information Statements (VISs) for inactivated influenza and meningococcal vaccines (Thai), inactivated polio vaccine (Polish), and measles-mumps-rubella (MMR) vaccine (Marshallese). IAC gratefully acknowledges Asian Pacific Health Care Venture, Inc., for the Thai translations, Danusia Filipowski, MD, for the Polish translation, and the Hawai'i State Department of Health for the Marshallese translation.

To access the VIS for inactivated influenza vaccine in Thai, go to: http://www.immunize.org/vis/th_flu03.pdf

To access the VIS for meningococcal vaccine in Thai, go to:
http://www.immunize.org/vis/th_men03.pdf

To access the VIS for inactivated polio vaccine in Polish, go
to: http://www.immunize.org/vis/po_pol00.pdf

To access the VIS for MMR vaccine in Marshallese, go to:
http://www.immunize.org/vis/ma_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 VIS web section at http://www.immunize.org/vis
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September 15, 2003
IAC'S HEPATITIS PREVENTION PROGRAMS WEBSITE NOW FEATURES 90 PROGRAMS

[The following is cross posted from the Immunization Action Coalition's "HEP EXPRESS" electronic newsletter, 9/10/03.]

The Immunization Action Coalition (IAC) recently added four new programs to its Hepatitis Prevention Programs website, bringing the total number of featured programs to 90. The site, www.hepprograms.org, highlights programs successfully preventing hepatitis A, B, and/or C in adults and adolescents at risk of infection.

The new projects are:

Hawaii State Department of Health STD/AIDS Prevention Branch
http://www.hepprograms.org/msm/msm18.asp

HCV Prison Support Project
http://www.hepprograms.org/adult/adult11.asp

New York City Department of Health and Mental Hygiene Bureau of STD Control, Hepatitis Program
http://www.hepprograms.org/std/std13.asp

Pennsylvania Department of Health Division of Immunizations
http://www.hepprograms.org/std/std12.asp

In addition, the following program information was updated:

Rhode Island Department of Corrections (formerly listed as the Harold and Esther Chester Immunology Center, Miriam Hospital)
http://www.hepprograms.org/adult/adult6.asp

In addition to the 90 model programs, the site includes links to hundreds of other related resources, including journal articles, organizations, and provider and client education materials.

If you have a hepatitis prevention program for adults or adolescents at risk that is not listed, we would love to add your project to the site: just complete the form titled "Tell us about your program" at http://www.hepprograms.org/tellus.htm

 

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 September 16, 2003