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Issue Number 433            December 22, 2003

CONTENTS OF THIS ISSUE

  1. Happy holidays from all of us at IAC
  2. CDC issues an update on influenza-related deaths among children less than 18 years old during the current influenza season
  3. CDC Health Advisory: CDC requests reports of all deaths among children with laboratory-confirmed influenza virus infection
  4. CDC adds significant new information to its influenza web page
  5. Transcript of the latest CDC news conference on the current influenza situation now available
  6. CDC issues an update on U.S. influenza activity during December 7-13
  7. Did you miss out on the 2003-04 Influenza Vaccination Pocket Information Guide? If so, download it from IAC's website
  8. CDC notifies readers about a shortage of pneumococcal conjugate vaccine (PCV7)
  9. December issue of CDC's "Immunization Works!" now available on IAC's website
  10. JAMA publishes NVAC recommendations for strengthening the U.S. vaccine supply
  11. New: Maps and figures depicting 2002 NIS data now available on the National Immunization Program website
  12. New: IAC web page has links to an array of artwork and photographic images related to immunization
  13. CDC issues guidelines for infection control in dental health-care settings
  14. New: Inactivated influenza VIS now available in French

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December 22, 2003
HAPPY HOLIDAYS FROM ALL OF US AT IAC

All of us at the Immunization Action Coalition wish the readers of "IAC EXPRESS" a safe, happy, and relaxing holiday season. Drive safely, wear your seat belt, and get some fresh air and exercise.

This is our last issue for 2003. We'll email you the next issue on January 5.
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December 22, 2003
CDC ISSUES AN UPDATE ON INFLUENZA-RELATED DEATHS AMONG CHILDREN LESS THAN 18 YEARS OLD DURING THE CURRENT INFLUENZA SEASON

The Centers for Disease Control and Prevention (CDC) published "Update: Influenza-Associated Deaths Reported Among Children Aged 18 Years and Under--United States, 2003-04 Influenza Season" in the December 19 issue of "MMWR Dispatch" (MMWR). According to CDC, "MMWR Dispatch" is published only for the "immediate release of important public health information." It is published "on the Web outside the routine weekly publication schedule" and will be available in a print issue of "Morbidity and Mortality Weekly Report" in the future.

The content of the "MMWR Dispatch" article is reprinted below in its entirety, excluding references, two tables, and a figure.

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Since October, 42 influenza-associated deaths among children aged less than 18 years have been reported to CDC. All patients had influenza virus infection detected by rapid antigen testing or other laboratory testing methods. This report describes preliminary findings based on data provided from multiple states, as of December 17, 2003. To improve surveillance, CDC has requested that all influenza-associated deaths of children aged less than 18 years be reported to CDC through state health departments.

Among the 42 reported deaths, 20 (48%) patients were male, and 21 (50%) were female; the sex of one patient was not reported. Twenty-three (55%) of the children were aged less than 5 years, and 13 (31%) were aged 6-23 months. The median age was 4 years (range: 9 weeks-17 years). Seventeen (40%) of the children had underlying chronic medical conditions; the previous medical status for four (10%) children was unknown. Among the 21 patients who had no underlying chronic medical condition, five had invasive bacterial co-infections, including three caused by methicillin-resistant Staphylococcus aureus (MRSA), one by Streptococcus pneumoniae, and one by Group A streptococcus. Three children with underlying chronic medical conditions had invasive bacterial co-infections, including one caused by MRSA, one caused by Streptococcus pneumoniae, and one caused by Neisseria meningitidis.

Influenza vaccination status was available for only seven patients; five (aged 1 year, 14 months, 20 months, 3 years, and 8 years) were not vaccinated; two (aged 21 months and 5 years) received 1 dose of influenza vaccine; however, their previous vaccination history was unknown. Influenza A viruses were isolated from 11 (26%) patients; 29 (69%) infections were detected by rapid diagnostic testing or by direct fluorescent antibody testing of respiratory specimens. In two (5%) patients, evidence of influenza A virus infection was solely by immunohistochemical staining (IHC) of postmortem tissue specimens at CDC. Five cases that were positive by rapid antigen testing of respiratory specimens also were tested by IHC; all five also had influenza A viral antigens detected in bronchial epithelium tissues obtained at autopsy. CDC continues to work with state health departments to collect additional information on all cases.

Editorial Note:

Influenza-associated deaths are not reportable conditions in the United States, and the average annual number of such deaths is unknown. However, cases of sudden death associated with influenza in previously healthy children in the United States have been reported (CDC, unpublished data, 2003). During 1990-1999, approximately 92 influenza-associated respiratory and circulatory deaths were estimated to have occurred annually among children aged less than 5 years. However, this estimate was based on mathematical modeling and not on counting fatalities associated with laboratory-confirmed influenza virus infection.

Among the 42 reported cases, laboratory-confirmed influenza virus infection was found in all of the children. Influenza can be confirmed by various methods, including commercially available rapid tests, viral culture, direct fluorescent antibody, reverse transcriptase polymerase chain reaction, IHC of tissues collected during autopsy, and paired serology.

CDC Request for Reports of Influenza-Associated Deaths Among Children

During the 2003-04 influenza season, CDC is requesting that all influenza-associated deaths among children aged less than 18 years be reported to CDC through state health departments. In addition, CDC is requesting submission of postmortem tissue specimens and autopsy reports where available. Influenza viral isolates in fatal cases also should be sent to CDC for antigenic characterization.

To report the influenza-associated death of a child aged less than 18 years, state health departments should contact CDC's Influenza Branch, telephone, (800) 232-4636; e-mail, eocinfluenza@cdc.gov Case-reporting and specimen-collection forms will be made available to state health departments and medical examiners via the Epidemic Information Exchange, available at http://www.cdc.gov/mmwr/epix/epix.html When completed, the forms should be sent with a cover sheet headed ATTN: Fatal Case Reporting to CDC via fax, (888) 232-1322.

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To access a web-text (HTML) version of this issue of "MMWR Dispatch," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm52d1219a1.htm

To access a ready-to-copy (PDF) version, go to:
http://www.cdc.gov/mmwr/pdf/wk/mm52d1219.pdf
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December 22, 2003
CDC HEALTH ADVISORY: CDC REQUESTS REPORTS OF ALL DEATHS AMONG CHILDREN WITH LABORATORY-CONFIRMED INFLUENZA VIRUS INFECTION

On December 19, the Health Alert Network of the Centers for Disease Control and Prevention (CDC) issued an official CDC Health Advisory. The advisory presents detailed information on reporting laboratory-confirmed influenza deaths of children. The advisory is reprinted below in its entirety.

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This is an official CDC Health Advisory
Distributed via Health Alert Network
December 19, 2003, 21:45 EST (9:45 PM EST)

REQUEST FOR REPORTS OF ALL DEATHS AMONG CHILDREN WITH LABORATORY-CONFIRMED INFLUENZA VIRUS INFECTION

During the 2003-04 influenza season, severe complications from influenza and influenza-associated deaths among children have been reported by several states.

The Centers for Disease Control and Prevention (CDC) requests that health care providers report all deaths associated with laboratory-confirmed influenza virus infection among children younger than 18 years of age to their state health department. Contact information for each state health department is available on the Council of State and Territorial Epidemiologists' website
http://www.cste.org/members/state_and_territorial_epi.asp

State health departments are asked to report information about these fatal cases to CDC. A death is considered to be influenza-associated if a diagnosis of influenza has been made based on laboratory testing of clinical or autopsy specimens, by one or more of the following:

  1. Viral culture
  2. Direct fluorescent antibody (DFA) staining
  3. Reverse transcriptase-polymerase chain reaction (RT-PCR)
  4. Rapid influenza diagnostic test
  5. Enzyme immunoassay (EIA)
  6. Immunohistochemical staining of autopsy tissue

In addition, cases of influenza-associated encephalopathy in persons younger than 18 years of age should also be reported to the state health department.

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December 22, 2003
CDC ADDS SIGNIFICANT NEW INFORMATION TO ITS INFLUENZA WEB PAGE

Since December 16, the Centers for Disease Control and Prevention (CDC) has added significant new information to its influenza web page (http://www.cdc.gov/flu). Following are titles and URLs for the new information.

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December 22, 2003
TRANSCRIPT OF THE LATEST CDC NEWS CONFERENCE ON THE CURRENT INFLUENZA EPIDEMIC NOW AVAILABLE

On December 19, Julie Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), held a press conference about the current influenza epidemic. A transcript is available on the CDC website at http://www.cdc.gov/od/oc/media/transcripts/t031219.htm
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December 22, 2003
CDC ISSUES AN UPDATE ON U.S. INFLUENZA ACTIVITY DURING DECEMBER 7-13

The Centers for Disease Control and Prevention (CDC) published "Update: Influenza Activity--United States, December 7-13, 2003" in the December 19 issue of "Morbidity and Mortality Weekly Report" (MMWR). Portions of the article are reprinted below.

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Influenza activity in the United States continued to increase during December 7-13, 2003. The proportion of patient visits to sentinel providers for influenza-like illness (ILI) overall was 7.4%, which is above the national baseline of 2.5%. Thirty-six state health departments reported widespread influenza activity, 12 states and New York City reported regional influenza activity, one state and the District of Columbia reported local influenza activity, and one state and Puerto Rico reported sporadic influenza activity. . . .

Antigenic Characterization

Of 269 influenza viruses collected by U.S. laboratories since October 1 and characterized antigenically by CDC, 265 were influenza A (H3N2) viruses, two were influenza A (H1) viruses, and two were influenza B viruses. The hemagglutinin proteins of the influenza A (H1) viruses were similar antigenically to the hemagglutinin of the vaccine strain A/New Caledonia/20/99. Of the 265 influenza A (H3N2) isolates that have been characterized, 62 (23%) were similar antigenically to the vaccine strain A/Panama/2007/99 (H3N2), and 203 (77%) were similar to a drift variant, A/Fujian/411/2002 (H3N2). Both influenza B viruses characterized were similar antigenically to B/Sichuan/379/99.

Pneumonia and Influenza (P&I) Mortality Surveillance

As of the week ending December 13, P&I accounted for 7.2% of all deaths reported through the 122 Cities Mortality Reporting System. The epidemic threshold for that week was 7.7%. . . .

Weekly updates on influenza activity will be published in MMWR during the influenza season. Additional information about influenza activity is available from CDC at http://www.cdc.gov/flu

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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5250a5.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5250.pdf

Receive a FREE electronic subscription to MMWR (which includes new ACIP statements) by going to
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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December 22, 2003
DID YOU MISS OUT ON THE 2003-04 INFLUENZA VACCINATION POCKET INFORMATION GUIDE? IF SO, DOWNLOAD IT FROM IAC'S WEBSITE

In September, the Immunization Action Coalition, in collaboration with a host of professional organizations, developed and produced the Influenza Vaccination Pocket Information Guide. Vaccine manufacturers financed its printing and distribution.

Intended for use by front-line health care personnel, the guide presents useful information about the use of both inactivated (injectable) and live (intranasal) influenza vaccine. It lists the groups targeted to receive the vaccine, as well as vaccine contraindications, dosing, administration methods, and side effects. In addition, it supplies providers with talking points useful in convincing hesitant patients about the importance of being vaccinated.

In the past two months, several professional organizations distributed 500,000 copies of the guide. If you did not receive one, you can easily create a copy by printing one of the ready-to-print versions (listed below) on card stock. The guide is designed to fit in a shirt or lab coat pocket (3-3/4" x 6-3/4"); after you have printed your copy, cut it on the trim lines provided.

For a color version (black, orange, and white) of the guide, go to: http://www.immunize.org/influenza/pocketguide.pdf

For a black-and-white version, go to:
http://www.immunize.org/influenza/pocketguidebw.pdf

To read more about the pocket guide, go to:
http://www.immunize.org/influenza/pocketguide.htm
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December 22, 2003
CDC NOTIFIES READERS ABOUT A SHORTAGE OF PNEUMOCOCCAL CONJUGATE VACCINE (PCV7)

The Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Limited Supply of Pneumococcal Conjugate Vaccine" in the December 19 issue of "Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted below in its entirety, excluding references.

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CDC has received notice from Wyeth Vaccines, the only U.S. supplier of 7-valent pneumococcal conjugate vaccine (PCV7, marketed as Prevnar), that production constraints could cause delays in shipments in the first or second quarters of 2004. Until full production capacity is resumed, local shortages might occur. To minimize shortages, Wyeth Vaccines will implement an allocation plan to ensure the equitable distribution of vaccine supply among private purchasers. CDC will work with Wyeth Vaccines to help achieve equitable vaccine distribution to the states that order through CDC contracts; this distribution will be based in large part on state PCV7 inventories and past usage.

Current supply assessments indicate that the U.S. PCV7 supply is adequate to vaccinate all children beginning at age 2 months using the 4-dose schedule recommended in October 2000. Health-care providers who have not received sufficient PCV7 for their private purchase supply should contact their local Wyeth Vaccines representative or call Wyeth Vaccines, telephone (800) 666-7248. Providers with insufficient supply from the public sector, including vaccine obtained through the Vaccines for Children (VFC) program, should contact their state health department immunization program. CDC is working closely with Wyeth Vaccines and state health departments to monitor the PCV7 supply on a frequent basis and to ensure equitable vaccine distribution in both the private and public sectors. Schedule recommendations might be modified if future PCV7 supplies prove to be insufficient. Updated information about the national PCV7 supply can be found at http://www.cdc.gov/nip/news/shortages/default.htm

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5250a6.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5250.pdf
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December 22, 2003
DECEMBER ISSUE OF CDC'S "IMMUNIZATION WORKS!" NOW AVAILABLE ON IAC'S WEBSITE

The December issue of "Immunization Works!" a monthly email newsletter published by the Centers for Disease Control and Prevention (CDC), is available on the website of the Immunization Action Coalition. The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

All of the articles in the December issue have appeared in previous issues of "IAC EXPRESS." To access a ready-to-copy (PDF) version of the issue from the IAC website, go to:
http://www.immunize.org/news.d/news1203.pdf
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December 22, 2003
JAMA PUBLISHES NVAC RECOMMENDATIONS ON STRENGTHENING THE U.S. VACCINE SUPPLY

On December 17, the Journal of the American Medical Association (JAMA) published the recommendations of the National Vaccine Advisory Committee (NVAC) as an article titled "Strengthening the Supply of Routinely Recommended Vaccines in the United States." The article abstract is reprinted below in its entirety.

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Between late 2000 and the spring of 2003, the United States experienced shortages of vaccines against 8 of 11 preventable diseases in children. In response, the Department of Health and Human Services requested that the National Vaccine Advisory Committee (NVAC) make recommendations on strengthening the supply of routinely recommended vaccines. The NVAC appointed a Working Group to identify potential causes of vaccine supply shortages, develop strategies to alleviate or prevent shortages, and enlist stakeholders to consider the applicability and feasibility of these strategies. The NVAC concluded that supply disruptions are likely to continue to occur. Strategies to be implemented in the immediate future include expansion of vaccine stockpiles, increased support for regulatory agencies, maintenance and strengthening of liability protections, improved communication among stakeholders, increased availability of public information, and a campaign to emphasize the benefits of vaccination. Strategies requiring further study include evaluation of appropriate financial incentives to manufacturers and streamlining the regulatory process without compromising safety or efficacy.

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The full text of the article in JAMA format is available only to JAMA subscribers. To access the abstract, go to: http://jama.ama-assn.org/cgi/content/abstract/290/23/3122

To access a web-text version of the recommendations from the National Vaccine Program Office website, go to: http://www.cdc.gov/od/nvpo/bulletins/nvac-vsr.htm

To access a ready-to-copy (PDF) version of the recommendations, go to: http://www.cdc.gov/od/nvpo/bulletins/nvac-vsr.pdf
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December 22, 2003
NEW: MAPS AND FIGURES DEPICTING 2002 NIS DATA NOW AVAILABLE ON THE NATIONAL IMMUNIZATION PROGRAM WEBSITE

The National Immunization Program, Centers for Disease Control and Prevention (CDC), recently posted maps and figures on its website that depict data from the 2002 National Immunization Survey (NIS). NIS is an on-going survey of immunization coverage among U.S. pre-school children (19-35 months old).

The maps and figures present immunization coverage data by state. Coverage data is included for the following vaccines and vaccine series: 4:3:1 series; 4:3:1:3 series; 4:3:1:3:3 series; DTP, DTaP, or DT--4 or more doses; DTP, DTaP, or DT--3 or more doses; hepatitis B--3 or more doses; Hib--3 or more doses; MMR--1 or more doses; polio--3 or more doses; varicella--1 or more doses.

To access the maps and figures, go to:
http://www.cdc.gov/nip/coverage/NIS/figures/02/02-map-menu.htm
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December 22, 2003
NEW: IAC WEB PAGE HAS LINKS TO AN ARRAY OF ARTWORK AND PHOTOGRAPHIC IMAGES RELATED TO IMMUNIZATION

The Immunization Action Coalition recently added a new web page to its website. "Artwork and Photographic Images Related to Immunization" has links to several collections of posters, photographs, charts, and artwork depicting images related to immunization.

Most of the images are in the public domain; feel free to use them to create posters or to illustrate newsletters and other publications. To access the new web page, go to:
http://www.immunize.org/art
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December 22, 2003
CDC ISSUES GUIDELINES FOR INFECTION CONTROL IN DENTAL HEALTH-CARE SETTINGS

The Centers for Disease Control and Prevention (CDC) published "Guidelines for Infection Control in Dental Health-Care Settings--2003" in the December 19 issue of "MMWR Recommendations and Reports" (MMWR). The guidelines have a section on preventing transmission of bloodborne pathogens, which includes information about hepatitis B virus, hepatitis C virus, hepatitis D virus, and human immunodeficiency virus. The section also outlines exposure prevention methods and postexposure management and prophylaxis.

To access a web-text (HTML) version of the guidelines, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf
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December 22, 2003
NEW: INACTIVATED INFLUENZA VIS NOW AVAILABLE IN FRENCH

The 2003-04 inactivated influenza Vaccine Information Statement (VIS) in French is now available on the website of the Immunization Action Coalition (IAC). IAC gratefully acknowledges the American Embassy Tunis--Medical Unit for the translation.

To obtain a ready-to-copy (PDF) version of the VIS in French, go to: http://www.immunize.org/vis/fr_flu03.pdf

To obtain it in English, go to:
http://www.immunize.org/vis/2flu.pdf

For information on the use of VISs, and for VISs in a total of 30 languages, visit IAC's VIS web page at http://www.immunize.org/vis

 

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 December 22, 2003