Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 417            October 13, 2003

CONTENTS OF THIS ISSUE

  1. Standards for Adult Immunization Practices and Child and Adolescent Immunization Practices now in public domain
  2. CDC publishes the Recommended Adult Immunization Schedule for 2003-04
  3. Dear Abby and IAC's executive director will team up to make the case for influenza immunization on October 14
  4. This week is Adult Immunization Awareness Week
  5. CDC reports on racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons age 65 and over
  6. New AAP policy statement: "Increasing Immunization Coverage" available in current issue of "Pediatrics"
  7. Causal relationship between thimerosal-containing vaccines and development of autism not supported by Danish study
  8. Revised: CDC updates the online version of its booklet "Guidelines for Vaccinating Pregnant Women"
  9. Revised: Case-based influenza prevention teaching module available at no charge on the ATPM website
  10. IOM releases its review of influenza vaccines and neurological complications

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October 13, 2003
STANDARDS FOR ADULT IMMUNIZATION PRACTICES AND CHILD AND ADOLESCENT IMMUNIZATION PRACTICES NOW IN PUBLIC DOMAIN

The Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Revised Standards for Adult Immunization Practices and Child and Adolescent Immunization Practices, 2003" in the October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted below in its entirety, excluding references.

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During the 1990s, two sets of standards were introduced to guide delivery of vaccinations for adults and children: Standards for Adult Immunization Practices, developed by the National Coalition for Adult Immunization in 1990, and Standards for Pediatric Immunization Practices, developed by the National Vaccine Advisory Committee (NVAC) in 1992. Under the leadership of NVAC, both sets of standards have been revised to reflect changes in the health-care delivery system, new tools and strategies for supporting vaccination providers, growing recognition of the importance of adolescent vaccination, and an increasing emphasis on improving communications regarding vaccine benefits and risks. Key partners and stakeholders contributed to the revisions, and leading medical and public health organizations have endorsed them.

The revised standards focus on making vaccines readily accessible; properly assessing patient vaccination status; effectively communicating with patients; ensuring proper storage, administration, and documentation; implementing strategies to improve vaccination rates; and developing community partnerships to reach target patient populations. Concise explanations of each of the standards describe how to implement them.

The intended audience for both sets of standards includes health-care providers, public health officials, policymakers, health-plan administrators, and employers who purchase health-care coverage. By applying these standards, health-care professionals can begin to develop a comprehensive plan to improve vaccination delivery in their practices, protect their patients from vaccine-preventable diseases, and help achieve the national health objectives for 2010. In addition, health-care providers and program managers who lack the resources to implement these standards should find them useful for defining and obtaining the necessary resources. Both standards have been published; they also are available at http://www.cdc.gov/nip/recs/rev-immz-stds.htm

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a8.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.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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October 13, 2003
CDC PUBLISHES THE RECOMMENDED ADULT IMMUNIZATION SCHEDULE FOR 2003-04

The Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Recommended Adult Immunization Schedule--United States, 2003-2004" in the October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted below in its entirety, excluding references.

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In June 2003, the Advisory Committee on Immunization Practices (ACIP) approved the revised Adult Immunization Schedule for 2003-2004. The format has been revised to better represent the schedule's two components, by age group and by medical condition, and [to] better indicate how the footnotes apply to both figures.

Revisions to the schedule and footnotes include 1) additional information regarding use of tetanus-diphtheria toxoids as prophylaxis in wound management; 2) clarification regarding the number of doses of the measles component of the measles-mumps-rubella vaccine; 3) guidance regarding the use of intranasally administered, live, attenuated influenza vaccine for healthy persons aged 5-49 years; 4) recommendations regarding administering influenza vaccination to pregnant women with or without pre-existing chronic diseases or conditions; and 5) added information regarding influenza and consideration of Haemophilus influenzae type b vaccine for asplenic persons.

Two measures initiated by the Centers for Medicare and Medicaid Services (CMS) are expected to increase vaccination among Medicare and Medicaid beneficiaries. First, in 2002, CMS enacted a new regulation allowing for the use of standing orders at Medicare- and Medicaid-participating hospitals, long-term-care facilities, and home-health agencies to deliver influenza and pneumococcal vaccinations as recommended by ACIP and the Task Force on Community Preventive Services. Second, CMS increased reimbursement rates for administering hepatitis, influenza, and pneumococcal vaccines from a national average of $3.98 in 2002 to $7.72 in 2003. In addition, expansion of the National Committee for Quality Assurance's Health Plan Employer Data and Information Set to include quality indicators on influenza vaccinations for persons aged 50-64 years in 2001 and pneumococcal vaccinations for persons aged 65 years and older in 2002 might improve vaccination-delivery services at managed-care organizations.

Health-care providers are reminded they should administer influenza vaccinations to all persons aged 50 years and older, regardless of preexisting medical conditions. Family physicians, internists, obstetrician/gynecologists, and other providers in private practice are urged to use the Adult Immunization Schedule in conjunction with the Standards for Adult Immunization Practices. Evidence indicates that chart reminders, patient reminders/recalls, and standing orders will reduce missed opportunities to vaccinate.

General information regarding adult immunization and vaccinating immunosuppressed persons can be obtained from state and local health departments and from CDC's National Immunization Program at http://www.cdc.gov/nip The 2003-2004 Adult Immunization Schedule is available at http://www.cdc.gov/nip/recs/adult-schedule.htm Vaccine information statements are available at http://www.cdc.gov/nip/publications/vis ACIP statements for each recommended vaccine are available at http://www.cdc.gov/nip/publications/acip-list.htm In addition, instructions for reporting adverse events after vaccination to the Vaccine Adverse Event Reporting System are available at http://www.vaers.org or by telephone, (800) 822-7967.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a6.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.pdf
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October 13, 2003
DEAR ABBY AND IAC'S EXECUTIVE DIRECTOR WILL TEAM UP TO MAKE THE CASE FOR INFLUENZA IMMUNIZATION ON OCTOBER 14

Be sure to turn the pages of your newspaper to Dear Abby's column on October 14. The column will run an ardent and informative letter urging the public to be immunized against influenza this fall. Written by the executive director of the Immunization Action Coalition (IAC), Deborah L. Wexler, MD, the letter succinctly states the serious nature of influenza's complications, dispels common misconceptions about the vaccine, and enlarges the public's understanding of the persons for whom the vaccine is recommended and encouraged in the U.S.

From IAC's past experience with being published in Dear Abby's column, we want to alert immunization providers that they may get a number of phone calls from people seeking appointments for influenza vaccination after the column is published. The column's reach is broad: the Dear Abby staff estimates 110 million people read it each day.

If possible, we would appreciate your clipping the October 14 column from your newspaper and faxing or mailing it to us. We'd like to see the headlines various papers wrote above the column.

Our fax number is (651) 647-9131; our mailing address is Immunization Action Coalition, 1573 Selby Ave., Ste. 234, St. Paul, MN 55104. Thank you for your help with this.
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October 13, 2003
THIS WEEK IS ADULT IMMUNIZATION AWARENESS WEEK

The Centers for Disease Control and Prevention (CDC) published "Notice to Readers: National Adult Immunization Week, October 12-18, 2003" in the October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted below in its entirety.

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This year's National Adult Immunization Awareness Week (NAIAW) will be observed October 12-18. NAIAW highlights the influenza vaccination season, which typically begins in early fall of each year. NAIAW emphasizes the need for health-care providers and public health officials to intensify their efforts to vaccinate adults and adolescents according to recommendations of the Advisory Committee on Immunization Practices. In addition to specifying the appropriate use of influenza and pneumococcal vaccines for adults and adolescents, the recommendations cover vaccination of adults and adolescents against diphtheria, hepatitis A and B, measles, mumps, rubella, tetanus, meningococcal disease, and varicella.

In conjunction with NAIAW, CDC is introducing Immunize Now, a tool kit designed to assist doctors and nurses in minimizing staff time and maximizing patient care during their influenza vaccination efforts. The kit highlights new developments in influenza vaccination and contains bilingual patient education materials.

Additional information about influenza, the influenza vaccine, the Immunize Now provider tool kit, and other influenza education materials is available at http://www.cdc.gov/nip/flu Information about NAIAW is available from the National Foundation for Infectious Diseases, the National Coalition for Adult Immunization, 4733 Bethesda Avenue, Suite 750, Bethesda, MD 20814; telephone, (301) 656-0003; fax, (301) 907-0878; email, jhan@nfid.org; and the National Partnership for Immunization, 121 North Washington Street, Suite 300, Alexandria, VA 22314, telephone, (703) 836-6110, fax, (703) 836-3470, email, npi@hmhb.org Information about NAIAW also is available at http://www.nfid.org, http://www.partnersforimmunization.org and at http://www.cdc.gov/nip/events/naiaw/default.htm

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a7.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.pdf
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October 13, 2003
CDC REPORTS ON RACIAL/ETHNIC DISPARITIES IN INFLUENZA AND PNEUMOCOCCAL VACCINATION LEVELS AMONG PERSONS AGE 65 AND OVER

The Centers for Disease Control and Prevention (CDC) published "Racial/Ethnic Disparities in Influenza and Pneumococcal Vaccination Levels Among Persons Aged 65 Years and Over--United States, 1989-2001" in the October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR). Portions of the article are reprinted below.

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[The article's introductory paragraph]
Influenza and pneumococcal diseases are key causes of mortality among persons aged 65 years and over, accounting for approximately 36,000 and 3,400 deaths per year, respectively, during 1990-1999. Substantial racial/ethnic disparities in adult vaccination have been documented in national surveys. Although the national health objective for 2000 of 60% receipt of influenza vaccination during the preceding 12 months by persons aged 65 years and over (objective no. 20.11) was met in 1997, and the objective of 60% for pneumococcal vaccination was nearly met in 2000, vaccine coverage levels among non-Hispanic blacks and Hispanics were 31% and 30%, respectively, compared with 57% for non-Hispanic whites. To characterize these disparities, CDC analyzed data from the 2000 and 2001 National Health Interview Surveys (NHIS) and examined trends in NHIS results for 1989-2001. This report summarizes the results of these analyses, which indicate that marked differences in vaccination coverage by race/ethnicity are observed even among persons most likely to be vaccinated (e.g., persons with the highest education level and persons with frequent visits to health-care providers). Racial/ethnic disparities in influenza and pneumococcal vaccination coverage have persisted over time. Several approaches to reduce these disparities are needed, including increasing demand for vaccination among racial/ethnic minority populations and the use of standing orders and other systems changes that promote vaccination.

[The article's fourth and fifth paragraphs]
During 2000-2001, the average influenza and pneumococcal coverage levels reported, respectively, were 66% and 57% for non-Hispanic whites, 48% and 33% for non-Hispanic blacks, and 54% and 32% for Hispanics. In general, influenza vaccination coverage was highest for non-Hispanic whites, followed by Hispanics and then non-Hispanic blacks; for pneumococcal vaccination, coverage was similar for non-Hispanic blacks and Hispanics. Vaccine coverage was less than 60% for all subgroups of non-Hispanic blacks and the majority of subgroups of Hispanics.

After accounting for variations in sex, age, education, poverty status, region, insurance status, number of doctor visits, and high-risk conditions, non-Hispanic blacks remained significantly less likely than non-Hispanic whites to report influenza vaccination (odds ratio [OR] = 0.7; 95% CI = 0.6-0.8); the difference between Hispanics and non-Hispanic whites was not statistically significant (OR = 0.9; 95% CI = 0.7-1.1). Both non-Hispanic blacks and Hispanics were significantly less likely than non-Hispanic whites to report a pneumococcal vaccination (OR = 0.4; 95% CI = 0.3-0.5 and OR = 0.4; 95% CI = 0.3 and 0.5, respectively).

[Portions of the article's Editorial Note]
The findings in this report indicate that although influenza and pneumococcal vaccination rates have increased for non-Hispanic blacks and Hispanics, as they have for non-Hispanic whites, substantial gaps persist by race/ethnicity. Differences in coverage are observed among persons with similar education levels, similar numbers of health-care encounters, and similar insurance status. These differences remain after controlling for factors with multivariable analysis, with the exception of receipt of influenza vaccination among Hispanics. Increases in vaccination rates for non-Hispanic blacks and Hispanics have not occurred at a rate sufficient to reach the national health objective for 2010 of eliminating disparities in health. Among non-Hispanic whites, influenza vaccination coverage was stable during 1997-2001 at less than 70%, and for all three groups, coverage was below the 90% health objective for 2010.

Reasons for differences in coverage are poorly understood. In this analysis, substantial racial/ethnic disparities in vaccination coverage were observed among persons with zero to one, two to nine, and 10 or more health-care provider contacts during the preceding 12 months, suggesting that access to care might not be a key factor. In the 1996 Medicare Current Beneficiary Survey, race/ethnicity was not related to reasons given for not being vaccinated. For influenza vaccination, the two leading reasons for not being vaccinated were not knowing it was recommended and concerns about the vaccine (e.g., fear of getting influenza and fear of side effects); for pneumococcal vaccination, the leading reason for not being vaccinated was not knowing it was recommended. Determining the reasons for the racial/ethnic disparity requires further examination. Possible reasons might include non-Hispanic blacks and Hispanics receiving care disproportionately in settings in which vaccination coverage is lower or differences in the provider-patient interaction for non-Hispanic blacks and Hispanics compared with non-Hispanic whites. . . .

System changes that promote adherence to evidence-based guidelines play a key role in reducing disparities. The absence of racial/ethnic disparities in Veteran's Administration clinics, in which standing orders and other interventions to increase vaccination have been implemented, suggests that this approach might be effective in eliminating disparities. In addition, programs are needed to increase demand for vaccination among older non-Hispanic blacks and Hispanics through state and local outreach programs and coalitions to engage new partners.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.pdf
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October 13, 2003
NEW AAP POLICY STATEMENT: "INCREASING IMMUNIZATION COVERAGE" AVAILABLE IN CURRENT ISSUE OF "PEDIATRICS"

On October 6, the American Academy of Pediatrics (AAP) issued a press release announcing the publication of its new policy statement, "Increasing Immunization Coverage," in the October issue of "Pediatrics." The first paragraph of the press release is reprinted below.

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NEW STRATEGIES RECOMMENDED TO IMPROVE IMMUNIZATION RATES
October 6, 2003

A new AAP policy entitled, "Increasing Immunization Coverage" recommends that pediatricians and child health professionals take additional steps to improve child immunization rates. Despite advances in vaccine delivery, only 77.2 percent of toddlers, ages 19 to 35 months, had received all recommended vaccinations in 2001. Children who are poor, or a member of a racial or ethnic minority group, are especially at risk. The new policy recommends that pediatricians mail parents reminders for upcoming visits and vaccine recall notices, use prompts during office visits to remind parents and staff about immunization, and ensure that nurses and other support staff routinely screen patients for needed vaccines. The policy also calls for a reduction in socioeconomic and racial disparities in immunization rates, and reiterates the importance of every child having a medical home, where all medical records, including immunization information, are maintained.

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To access a copy of the policy statement from the AAP website, go to: http://www.aap.org/policy/s060014.html
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October 13, 2003
CAUSAL RELATIONSHIP BETWEEN THIMEROSAL-CONTAINING VACCINES AND DEVELOPMENT OF AUTISM NOT SUPPORTED BY DANISH STUDY

On October 1, the "Journal of the American Medical Association" published "Association Between Thimerosal-Containing Vaccine and Autism." Portions of the abstract are reprinted below.

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Objective: To determine whether vaccination with a thimerosal-containing vaccine is associated with development of autism.

Results: During 2,986,654 person-years, we identified 440 autism cases and 787 cases of other autistic-spectrum disorders. The risk of autism and other autistic-spectrum disorders did not differ significantly between children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine. . . .

Conclusion: The results do not support a causal relationship between childhood vaccination with thimerosal-containing vaccines and development of autistic-spectrum disorders.

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To access the entire abstract, go to:
http://jama.ama-assn.org/cgi/content/abstract/290/13/1763

To access journal articles and other resources on autism from the Immunization Action Coalition (IAC) website, go to:
http://www.immunize.org/safety/autism.htm

To access journal articles and other resources on thimerosal from the IAC website, go to:
http://www.immunize.org/safety/thimerosal.htm
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October 13, 2003
REVISED: CDC UPDATES THE ONLINE VERSION OF ITS BOOKLET "GUIDELINES FOR VACCINATING PREGNANT WOMEN"

CDC has recently updated one of its online resources, the "Guidelines for Vaccinating Pregnant Women." The revised booklet now includes information that pregnant women are among the populations that should not be vaccinated with live attenuated influenza vaccine (LAIV; trade name FluMist).

To access the document online, go to:
http://www.cdc.gov/nip/publications/preg_guide.htm

To access a camera-ready (PDF) copy, go to:
http://www.cdc.gov/nip/publications/preg_guide.pdf
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October 13, 2003
REVISED: CASE-BASED INFLUENZA PREVENTION TEACHING MODULE AVAILABLE AT NO CHARGE ON THE ATPM WEBSITE

On October 2, the Association of Teachers of Preventive Medicine (ATPM) announced the availability of an updated case-based teaching module on influenza prevention. The updated module is the latest one released by the Teaching Immunization for Medical Education (TIME) project, a collaboration of ATPM, the Centers for Disease Control and Prevention, and a national advisory committee of medical experts. TIME's goal is to improve the teaching of immunization and vaccine-preventable diseases to health professionals.

The updated module has two components, a facilitator's guide and a small-group booklet. Both are available at no charge from the ATPM website.

To access the facilitator's guide, go to:
http://www.atpm.org/Immunization/TIME/FLU_Facilitators_Guide.pdf

To access the small-group booklet, go to:
http://www.atpm.org/Immunization/TIME/FLU_SmallGroup.pdf

TIME has many existing no-cost immunization teaching modules and anticipates releasing several more in the next year. To access other modules and for more information about TIME, go to:
http://www.atpm.org/Immunization/TIME/body_time.html

For additional information, call ATPM at (540) 380-5883 or (202) 463-0550.
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October 13, 2003
IOM RELEASES ITS REVIEW OF INFLUENZA VACCINES AND NEUROLOGICAL COMPLICATIONS

On October 6, the Institute of Medicine (IOM) of the National Academies released a report, "Immunization Safety Review: Influenza Vaccines and Neurological Complications." The report is the result of IOM's Committee on Immunization Safety's review of the data on influenza vaccine and neurological conditions. Portions of a press release announcing the report follow.

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Scientific evidence shows that influenza vaccines do not trigger relapses of multiple sclerosis (MS) in adults with the disease, says the latest report on vaccine safety from the Institute of Medicine of the National Academies.

In addition, the report confirmed the well-studied link between the specific influenza vaccine used to ward off an anticipated epidemic of the "swine flu" in 1976 and several hundred cases of the rare paralytic disorder Guillain-Barré syndrome (GBS) that occurred in vaccinated adults. . . .

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To access the complete press release, go to:
http://www4.nationalacademies.org/news.nsf/isbn/0309090865?OpenDocument

To access a synopsis of the report, go to:
http://www.iom.edu/report.asp?id=15625

To access a prepublication copy of the report, go to:
http://www.nap.edu/books/0309090865/html

To place a prepublication order, go to:
http://books.nap.edu/allpricing.phtml?record_id=10822

To contact the customer service department of the National Academies Press, call (800) 624-6242.

 

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 October 16, 2003