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Issue Number 427            November 26, 2003

CONTENTS OF THIS ISSUE

  1. CDC Health Update warns that the 2003-04 influenza season could be more severe than those in the recent past
  2. The National Influenza Summit urges the public to get immunized against influenza this season
  3. CDC offers clinicians a host of resources for the current influenza season

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November 26, 2003
CDC HEALTH UPDATE WARNS THAT THE 2003-04 INFLUENZA SEASON COULD BE MORE SEVERE THAN THOSE IN THE RECENT PAST

On November 21, the Centers for Disease Control and Prevention (CDC) issued the following official CDC Health Update; it is reprinted below in its entirety.

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This is an official CDC Health Update

Distributed via Health Alert Network
November 21, 2003 20:10 EST (8:10 PM EST)

UPDATE: INFLUENZA ACTIVITY IN THE UNITED STATES, 2003-04 SEASON

Current surveillance data indicate that the United States is experiencing an early influenza season that could be more severe than in the past 3 years. The situation underscores the need for timely immunization of those people most at risk from serious complications of influenza and the people taking care of them, especially health-care workers.

The United States and some European countries are experiencing influenza morbidity earlier than usual. So far, the majority of the influenza viruses identified in the United States this winter have been type A(H3N2) viruses, which historically have been associated with relatively severe influenza epidemics. Of the influenza A(H3N2) viruses from the United States that have been analyzed at CDC, 78% are similar to the A/Fujian/411/2002 strain, which evolved or "drifted" from the A/Panama/2007/99 strain present in the current vaccine, and the remaining 22% are similar to the vaccine strain. The A/Fujian/411/2002 drift variant was the predominant influenza strain circulating in Australia and New Zealand during their most recent influenza season, which was characterized as "moderately severe." These factors could portend higher morbidity and mortality in the United States during the 2003-04 influenza season.

The influenza vaccine is safe and is the most effective way to prevent the disease and its complications. Although this year's vaccine contains the Panama strain of influenza A(H3N2), it is expected to provide some cross-protection against the Fujian-like viruses that are currently circulating. The other two virus strains (influenza A[H1N1] and influenza B) in the vaccine closely match their circulating counterparts.

CDC recommends the following individuals get vaccinated against influenza:

  • persons 50 years and older;
  • residents of nursing homes and other long-term care facilities that house persons of any age who have long-term illnesses;
  • adults and children 6 months of age and older who have chronic heart or lung conditions, including asthma;
  • adults and children 6 months of age and older who need regular medical care or had to be in a hospital because of metabolic diseases (like diabetes), chronic kidney disease, or weakened immune system (including immune system problems caused by medicine or by infection with HIV);
  • children and teenagers (6 months to 18 years of age) who are on long-term aspirin therapy and therefore could develop Reye syndrome after influenza;
  • women who will be more than 3 months pregnant during the influenza season.

In addition, CDC recommends vaccination of the following groups of people to reduce the risk of spreading influenza to persons at high risk for complications:

  • doctors, nurses, and other employees in hospitals and doctors' offices, including emergency response workers;
  • employees of nursing homes and long-term care facilities who have contact with patients or residents;
  • employees of assisted living and other residences for people in high-risk groups;
  • people who provide home care to those in high-risk groups;
  • household members (including children) of people in high-risk groups.
     
     
  • CDC also encourages, when feasible, vaccination of children aged 6-23 months and their caregivers.

The primary contraindication to influenza vaccination is allergy to eggs. For more information about influenza, visit CDC's website at www.cdc.gov

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November 26, 2003
THE NATIONAL INFLUENZA SUMMIT URGES THE PUBLIC TO GET IMMUNIZED AGAINST INFLUENZA THIS SEASON

On November 25, the National Foundation for Infectious Diseases (NFID) issued the following press release on behalf of the members of the National Influenza Summit, a partnership of more than 50 organizations including the Centers for Disease Control and Prevention (CDC), American Medical Association (AMA), NFID, and the Immunization Action Coalition. The press release is the start of a major public health initiative to encourage health professionals to get immunized against influenza and to continue immunizing beyond December and January; it is also intended to persuade the public to seek influenza immunization through December and beyond.

The press release is reprinted below in its entirety.

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Bethesda, MD
November 25, 2003

NATION'S TOP HEALTH GROUPS ISSUE CRITICAL INFLUENZA MESSAGE: GET IMMUNIZED THIS SEASON

AMA, CDC, and NFID Join 50+ Organizations to Launch Nationwide Initiative Urging Influenza Vaccination Before Virus Strikes

Over 50 medical and health organizations today announced a major national public health initiative aimed at urging everyone who has not already done so to be immunized against one of the top 10 causes of death in the United States--influenza. It is particularly important for those at high risk of complications from influenza to get vaccinated as soon as possible. Vaccination is the best protection against what the Centers for Disease Control and Prevention (CDC) warns may be a "more severe season than in the previous three years."

The CDC, American Medical Association, National Foundation for Infectious Diseases, and other key partners in the National Influenza Summit are working together to encourage Americans, and particularly those at high risk of serious complications from influenza, to get their flu shot as soon as possible. As part of this initiative, the National Influenza Summit is also encouraging health care professionals to get vaccinated and to continue to offer influenza vaccination to patients in December and beyond.

"Flu viruses are circulating at a higher level than usual at this time with cases of influenza being reported in communities across the country," said Julie L. Gerberding, MD, MPH, director of CDC. "We are urging Americans, particularly those at high risk of complications from influenza, to get their flu shot as soon as possible. We are concerned the public has become complacent about influenza, and we need to get the word out that there is plenty of vaccine available and a flu shot is the best protection against influenza, which kills about 36,000 Americans during an average year."

As part of the National Influenza Summit initiative, the nation's leading medical and health organizations, which include public health agencies, health professional associations, health insurers, and others, have committed to implementing a unified communications program with activities to help ensure immunizers continue to stock the vaccine and immunize patients.

The campaign is designed to increase public awareness about the importance of influenza immunization, particularly for everyone aged 50 or older and people of any age who have a chronic illness. Vaccination is strongly recommended for people who were not immunized during the optimal vaccination months of October and November. Activities in the joint campaign will deliver flu shot messages during November, December, and January.

"We are collaborating on a far-reaching communications program to encourage people to be vaccinated in December and the remaining months of this influenza season," said Donald Palmisano, MD, JD, president of the AMA. "At the same time, we are appealing to health care professionals to continue their vaccination efforts during this time."

Outreach activities include nationwide television and radio public service announcements, featuring Tommy Thompson, Secretary of the U.S. Department of Health and Human Services (HHS), encouraging flu shots for everyone. Also planned are broadcast news releases, media tours, radio promotions, and website communications. Organizations involved with the National Influenza Summit also are considering ways to ensure they participate in the program and disseminate information to their constituents and the general public.

Get Vaccinated Sooner Rather Than Later

Multiple factors influence each influenza season, making the impact of influenza notoriously difficult to predict, according to Dr. Gerberding. Influenza cases have already been reported in more than 40 states, including Arizona, Alabama, Colorado, Florida, Louisiana, North Dakota, South Carolina, Texas, Utah, and Washington.

Public health officials report influenza vaccination activities typically decline as Thanksgiving approaches, suggesting that immunizers may stop offering the vaccine and that the general public is unaware of the CDC's recommendations to continue immunization programs into December, January, and beyond.

"If you haven't been vaccinated yet, see your doctor as soon as possible or find out where in your community the vaccine is being offered," said William Schaffner, MD, NFID board member and professor and chair of the department of preventive medicine at Vanderbilt University School of Medicine. "We hope this national awareness program will make sure everyone knows that you can still get a flu shot in December and into the winter season if you have not already done so."

Vaccination Appropriate For Most, Recommended For Many

CDC recommends vaccination for anyone who wants to avoid influenza and especially for groups considered at high risk of influenza-related complications. CDC's list of groups at risk for complications if they get the flu includes adults aged 65 and older; anyone with a chronic health problem such as heart or lung disease, asthma, diabetes, cancer, or HIV/AIDS; and pregnant women past their first trimester. Vaccination is recommended for those aged 50 to 64 and encouraged for healthy children 6 to 23 months of age and their caregivers. These young children are at as great a risk for being hospitalized due to flu-related complications as persons 65 years of age and older, a group already targeted for annual flu vaccinations. Health care workers and others who have close contact with people at high risk also should be vaccinated to reduce the odds of passing influenza to someone for whom it can be life threatening.

According to CDC, it takes 10 to 14 days after vaccination for the body to develop protection against influenza. Individuals with egg allergies or those who have had a previous vaccine-associated allergic reaction should talk with their health care providers before getting the vaccine. Persons with acute febrile illnesses (high fever) should usually wait until symptoms subside. However, flu shots may be given in the presence of minor illnesses, with or without fever, particularly among children with mild upper respiratory tract infections or hay fever.

An alternative vaccine option available to healthy persons is the intranasal spray also known as "live-attenuated influenza vaccine" or "LAIV." The intranasal vaccine is approved for use in healthy persons aged 5 to 49 years to prevent influenza A and B. While LAIV can be used in healthy people aged 5 to 49 years, the injectable inactivated influenza vaccine can be used for anyone, healthy or high-risk, 6 months of age and older.

CDC estimates that vaccine manufacturers will produce sufficient vaccine this season so all persons wishing to avoid influenza, regardless of age or health status, can be vaccinated.

National Influenza Summit Participants

The National Influenza Summit is comprised of more than 50 organizations, including AMA, CDC, NFID and other partners with an interest in issues related to influenza vaccine research, production, distribution, and vaccine administration. Participants in the National Influenza Summit advise on and respond to issues of influenza vaccination throughout the year. For a complete list of the National Influenza Summit partners, visit the AMA website at
http://www.ama-assn.org/ama/pub/article/1826-7688.html

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To access the press release, go to:
http://www.ama-assn.org/ama1/pub/upload/mm/36/flu_late_season_rele.doc

CDC has created an influenza immunization toolkit to help physician and other health care professionals provide influenza vaccination to their patients and the public. The AMA is working with the CDC to help distribute the toolkit. To access the toolkit from the AMA website, go to:
http://www.ama-assn.org/ama/pub/category/11733.html
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November 26, 2003
CDC OFFERS CLINICIANS A HOST OF RESOURCES FOR THE CURRENT INFLUENZA SEASON

On November 21, National Immunization Program, Centers for Disease Control and Prevention (CDC) sent the Immunization Action Coalition a list of influenza and SARS [Severe Acute Respiratory Syndrome] resources for clinicians available on the CDC website. Following are links to CDC's clinician resources.

INFLUENZA RESOURCES FOR PROVIDERS

The primary link is to Flu Information for Healthcare Providers: http://www.cdc.gov/nip/Flu/provider.htm This web page includes links to pages discussing virtually all aspects of influenza vaccination of concern to clinicians, including the following:

1. Flu Information for Healthcare Providers

* Qs & As for FluMist (posted Oct. 28):
   http://www.cdc.gov/ncidod/diseases/flu/laiv.htm
* No Recalled Influenza Vaccine (a press release posted Oct. 17):
   http://www.cdc.gov/od/oc/media/pressrel/r031017a.htm
* Materials for Immunize Now provider kit (posted Oct. 8):
  http://www.cdc.gov/nip/Flu/providerkit.htm

2. Recent Changes to Flu VIS and Flu Dosage Chart (posted Sept. 23): http://www.cdc.gov/nip/Flu/provider.htm#changes

* Vaccine Information Statement for trivalent inactivated influenza vaccine (TIV):
   http://www.cdc.gov/nip/flu/pubs_04/vis_flushot03_pt.pdf
* Vaccine Information Statement for live activated influenza vaccine (LAIV):
   http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf
* Changes to the influenza VIS:
   http://www.cdc.gov/nip/publications/VIS/flunote.htm
* Influenza vaccine dosage chart:
   http://www.cdc.gov/nip/Flu/gallery.htm#chart

3. Webcast for Immunization Update 2003 (new as of Sept. 12):
http://www.phppo.cdc.gov/PHTN/Imm-up2003/default.asp

4. Vaccine Supply, Storage, and Handling (updated Sept. 26):
http://www.cdc.gov/nip/Flu/provider.htm#Supply

5. Safety of Thimerosal-Containing Flu Vaccine:
http://www.cdc.gov/nip/Flu/provider.htm#thimerosal

6. Influenza Prevention and Management (revised Sept. 25):
http://www.cdc.gov/nip/Flu/provider.htm#Treatment

7. ACIP Recommendations for 2003-04 Flu Season:
http://www.cdc.gov/nip/Flu/acip03-04_recs.htm

8. Flu Vaccine and SARS (updated Oct. 3):
http://www.cdc.gov/nip/Flu/provider.htm#sars

9. CDC Flu Surveillance:
http://www.cdc.gov/nip/Flu/provider.htm#watcher

10. State Flu Contingency Plans:
http://www.cdc.gov/nip/Flu/provider.htm#Contingency

11. Flu Shot to Be Recommended for Children 6-23 Months (new Nov. 18; exit CDC site):
http://www2.efamilypracticenews.com/scripts/om.dll/serve?article=aqf030332201

12. Quick Qs & As for Influenza (new; exit site):
http://www.immunize.org/nslt.d/n28/exprt28.htm#influenza

13. Why Patients with Asthma Need Flu Vaccine (posted Oct. 31):
http://www.cdc.gov/nceh/airpollution/asthma/flushot.htm

14. National Center for Infectious Diseases (NCID) Influenza Information for Healthcare Providers:
http://www.cdc.gov/ncidod/diseases/flu/hc_providers.htm

15. NCID Flu Site:
http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm

16. 2003-04 MMWRs for Influenza (updated Oct. 30):
http://www.cdc.gov/nip/Flu/News.htm#Reports

* ACIP recommendations for FluMist vaccine:
  http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5213a1.htm
* FluMist Storage and Handling:
  http://www.cdc.gov/nip/Flu/acip03-04_recs.htm#laivspec
* Racial & Ethnic Disparities in Influenza Vaccination:
  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a3.htm

17. Research that Works for YOU: Communicating about Immunization:
http://www.cdc.gov/nip/Flu/flu_qualresearch.htm

18. Change to Inactivated Influenza Vaccine VIS:
http://www.cdc.gov/nip/publications/VIS/flunote.htm

19. Gallery of Influenza Patient Education Materials:
http://www.cdc.gov/nip/Flu/gallery.htm


SARS RESOURCES FOR PROVIDERS

1. This is CDC's SARS home page with links to the latest clinician, laboratory, and other SARS information on the CDC website:
http://www.cdc.gov/ncidod/sars

2. This is the principal CDC website for clinician information on SARS: http://www.cdc.gov/ncidod/sars/clinicians.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 November 26, 2003