Issue
Number 434
January 5, 2004
CONTENTS OF THIS ISSUE
- CDC reports on U.S. incidence of acute hepatitis
B
- January 12 is the registration deadline for
NIP's Netconference "Current Issues in Immunization"
- Paul Offit's vaccine-safety article available on
the "Pediatrics" website
- CDC issues an update on current U.S. influenza
activity
- MMWR publishes update on current
influenza-related deaths among U.S. children less than 18 years old
- Save the date: "Epidemiology and the Prevention
of Vaccine Preventable Diseases" to be broadcast in February and March
- Updated: IAC makes minor revisions to its VIS
professional-education sheet "It's Federal Law!"
- Subscribe today: CDC's free electronic news
service "Public Health Law News" is looking for readers
- January 26 is the deadline for proposals for
NACCHO's 2004 annual conference
- The Department of Health and Human Services
announces rule for Smallpox Vaccine Injury Compensation Program
----------------------------------------------------------
Back to Top
---------------------------------------------------------------
ABBREVIATIONS: AAP, American Academy of Pediatrics; ACIP, Advisory Committee
on Immunization Practices; CDC, Centers for Disease Control and Prevention;
FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR
Morbidity and Mortality Weekly Report; NIP, National Immunization Program;
VIS, Vaccine Information Statement; WHO, World Health Organization.
---------------------------------------------------------------
(1 of 10)
January 5, 2004
CDC REPORTS ON U.S. INCIDENCE OF ACUTE HEPATITIS B
CDC published "Incidence of Acute Hepatitis B--United States, 1990-2002" in
the January 2 issue of MMWR. The article is reprinted below in its entirety,
excluding references and a figure.
***********************
Hepatitis B virus (HBV) is a bloodborne and sexually transmitted virus that
is acquired by percutaneous and mucosal exposure to blood or other body
fluids of an infected person. Clinical manifestations of acute hepatitis B
can be severe, and serious complications (i.e., cirrhosis and liver cancer)
are more likely to develop in chronically infected persons. In the United
States, approximately 1.2 million persons have chronic hepatitis B virus (HBV)
infection and are sources for HBV transmission to others. However, since the
late 1980s, the incidence of acute hepatitis B has declined steadily,
especially among vaccinated children. To characterize the epidemiology of
acute hepatitis B in the United States, CDC analyzed national notifiable
disease surveillance data for 1990-2002. This report summarizes the results
of that analysis, which indicated that, during 1990-2002, the incidence of
reported acute hepatitis B declined 67%. This decline was greatest among
children and adolescents, indicating the effect of routine childhood
vaccination. The decline was lowest among adults, who accounted for the
majority of cases; incidence increased among adults in some age groups. To
reduce HBV transmission further in the United States, hepatitis B
vaccination programs are needed that target men who have sex with men (MSM),
injection-drug users (IDUs), and other adults at high risk.
CDC analyzed surveillance data for acute hepatitis B cases reported weekly
from state health departments and the District of Columbia during 1990-2002.
Data included each patient's county of residence, sex, race/ethnicity, and
age. Clinical and risk factor data were available for approximately 35% of
cases reported since 1990, including death from acute hepatitis B, reported
injection-drug use, sex and number of sex partners, and exposure to a
household or sex contact during incubation period. Acute hepatitis B
incidence was calculated by using population denominators from the U.S.
Census Bureau.
Summary of Incidence
During 1990-2002, the incidence of acute hepatitis B declined 67%, from 8.5
per 100,000 population (21,102 total cases reported) to 2.8 per 100,000
population (8,064 total cases reported). By region, in 2002, incidence was
highest in the South (3.6), followed by the Northeast (3.5), the West (2.3),
and the Midwest (1.6). During 1990-2002, decreases in incidence were
greatest in the West (78%), followed by the Midwest (72%), the South (59%),
and the Northeast (52%); however, incidence in the Northeast has increased
41% since 1999.
The incidence of acute hepatitis B among men has been consistently higher
than among women. In 1990, the incidence among men and women was 9.8 and
6.3, respectively; in 2002, the incidence was 3.7 and 2.2, respectively.
Overall, incidence among women has declined more than among men; the
male-to-female acute hepatitis B rate ratio was 1.5 in 1990, compared with
1.7 in 2002.
By age, the most significant decline (89%) in acute hepatitis B incidence
during 1990-2002 occurred among persons aged 0-19 years, from 3.0 in 1990 to
0.3 in 2002. Among persons aged 20-39 and 40 years and older, acute
hepatitis B incidence declined 67% and 39%, respectively; however, the
majority of this decline occurred during 1990-1998. Since 1999, the
incidence of acute hepatitis B has increased 5% among males aged 20-39 years
and 20% and 31%, respectively, among males and females aged 40 years and
older. Among 6,790 (32%) of the 21,102 cases reported in 1990 and 3,079
(38%) of the 8,064 cases reported in 2002 for which risk factor data were
available, the proportion of persons who reported injection-drug use was
similar (17% and 15%). However, the proportion of heterosexuals reporting
multiple sex partners increased from 14% to 29%, as did the proportion of
self-identified MSM, from 7% to 18%. During 1990-2002, the proportion of MSM
reporting multiple sex partners was approximately 50%.
Examples of Local Trends
Data from two counties illustrate the changing epidemiology of acute
hepatitis B in the United States. In both counties, overall incidence and
incidence among children have declined. In Baltimore County (Baltimore,
Maryland), acute hepatitis B incidence has been consistently higher than the
national average. Since 1990, incidence has declined 26% overall; however,
during 2000-2002, incidence increased 15%. In 2002, Baltimore County
reported 50 acute hepatitis B cases (29 among men and 21 among women) for an
overall incidence of 6.6; incidence for men and women was 8.1 and 5.3,
respectively, with a male-to-female rate ratio of 1.5. Of the 38 persons
with available risk factor data, 15 (40%) reported injection-drug use, eight
(21%) reported having multiple heterosexual sex partners, and three (8%)
reported both risk factors; six (16%) persons reported exposure to an HBV-infected
household or sex contact, and three (8%) reported being an MSM.
Since 1990 in Mecklenburg County (Charlotte, North Carolina), reported acute
hepatitis B incidence has been above the national average; however, during
the same period, incidence has declined 82%. In 2002, Mecklenburg County
reported 39 acute hepatitis B cases (28 among men and 11 among women) for an
overall incidence of 5.6; incidence for men and women was 8.2 and 3.1,
respectively, with a male-to-female rate ratio of 2.6. Risk factor data were
available for all 39 cases; eight (21%) persons reported having multiple
heterosexual sex partners, eight (21%) reported being MSM, and three (8%)
reported both risk factors. Five (13%) persons reported exposure to an HBV-infected
household or sex contact; no persons reported injection-drug use.
Editorial Note:
In 1991, a comprehensive strategy to eliminate HBV transmission was
implemented in the United States and has reduced the incidence of acute
hepatitis B among children. The strategy included universal infant
vaccination, universal screening of pregnant women, and postexposure
prophylaxis of infants born to infected mothers to prevent perinatal HBV
infection; since 1982, adolescents and adults at high risk have been
recommended to receive HBV vaccine. In 1995, the strategy was expanded to
include routine vaccination of all adolescents aged 11-12 years and, in
1999, to include all persons aged 0-18 years who had not been vaccinated
previously. The incidence of acute hepatitis B has declined steadily during
the preceding decade, in part because of successful vaccination and other
prevention programs. The observed decline in the incidence of acute
hepatitis B among children occurred coincident with an increase in hepatitis
B vaccination coverage among children aged 19-35 months, from 16% in 1992 to
90% in 2000.
Since 1999, after more than a decade of decline, hepatitis B incidence among
men aged older than 19 years and women aged 40 years and older has
increased. The most common risk factors reported among adults with acute
hepatitis B continue to be multiple sex partners, MSM, and injection-drug
use. Different high-risk behaviors accounted for the majority of
transmissions in different locales.
Increases in sexually transmitted diseases (STD), including syphilis and
human immunodeficiency virus (HIV) infection among MSM have been attributed
to increases in high-risk sexual behavior (e.g., unprotected anal
intercourse with more than one partner and unsafe sex while under the
influence of alcohol or recreational drugs). Changes in patterns of sexual
behavior also could be responsible for the increasing transmission of HBV
among MSM.
In 1982, the Advisory Committee on Immunization Practices recommended
hepatitis B vaccination for sexually active homosexual and bisexual men and
IDUs and, in 1985, for heterosexuals with multiple sex partners or a recent
STD. Trends in acute hepatitis B infection also reflect poor vaccination
coverage among persons who engage in these behaviors. Of 3,432 young MSM in
seven U.S. metropolitan areas, only 9% had received HBV vaccine. In a San
Diego County, California, survey, only 6% of IDUs had completed the 3-dose
HBV vaccine series.
Persons at high risk for HBV infection often seek health care in settings in
which vaccination services could be provided. During 1996-1998,
approximately half of persons reported with acute hepatitis B had been
treated for an STD or incarcerated: 89% of IDUs, 35% of MSM, and 70% of
persons with multiple sex partners. Both STD clinics and correctional
facilities are settings in which hepatitis B vaccination services are
recommended.
The findings in this report are subject to at least two limitations. First,
the quality of surveillance data varies at local and state levels. Second,
national viral hepatitis case-reporting is incomplete; only approximately
35% of all reported cases contain risk factor data.
The decline in acute hepatitis B among children indicates that successful
hepatitis B vaccination programs are possible. These programs must consider
the local epidemiology of hepatitis B and identify ways to reach populations
at high risk. Integration of hepatitis B vaccination into health-care
programs that target persons at high risk is feasible and cost effective.
Hepatitis B vaccination programs have been implemented in STD clinics,
juvenile and adult detention facilities, HIV-counseling and -testing
centers, and other sites.
No national adult hepatitis B program exists that is similar to those that
have proven successful for children and adolescents. Components of a
national adult vaccination program must include policies for vaccination,
including methods for achieving higher vaccination rates among adults at
greatest risk and appropriate resources to support implementation.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5251.pdf
Receive a FREE electronic subscription to MMWR (which includes new ACIP
statements) by going to
http://www.cdc.gov/mmwr/mmwrsubscribe.html
---------------------------------------------------------------
Back to Top
(2 of 10)
January 5, 2004
JANUARY 12 IS THE REGISTRATION DEADLINE FOR NIP'S NETCONFERENCE "CURRENT
ISSUES IN IMMUNIZATION"
Scheduled for January 15, from noon to 1 pm ET, the Netconference "Current
Issues in Immunization" is designed to provide clinicians with up-to-date
information on immunization. It will focus on two topics: influenza and
vaccine storage and handling.
The conference requires pre-registration. Registration will close when the
course is full or on January 12 (midnight eastern time).
To register for the conference, go to:
http://www2a.cdc.gov/nip/isd/ciinc/default.asp
For additional information, go to:
http://www.cdc.gov/nip/ed/ciinc/default.htm or call (404) 639-8225.
---------------------------------------------------------------
Back to Top
(3 of 10)
January 5, 2004
PAUL OFFIT'S VACCINE-SAFETY ARTICLE AVAILABLE ON THE "PEDIATRICS" WEBSITE
On December 6, 2003, AAP's journal "Pediatrics" published "Addressing
Parents' Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants,
Additives, or Residuals?" Written by Paul A. Offit, MD, and Rita K. Jew,
PharmD, the article summarizes the authors' review of the data. The abstract
is reprinted below.
*********************
Vaccines often contain preservatives, adjuvants, additives, or manufacturing
residuals in addition to pathogen-specific immunogens. Some parents, alerted
by stories in the news media or information contained on the World Wide Web,
are concerned that some of the substances contained in vaccines might harm
their children. We reviewed data on thimerosal, aluminum, gelatin, human
serum albumin, formaldehyde, antibiotics, egg proteins, and yeast proteins.
Both gelatin and egg proteins are contained in vaccines in quantities
sufficient to induce rare instances of severe, immediate-type
hypersensitivity reactions. However, quantities of mercury, aluminum,
formaldehyde, human serum albumin, antibiotics, and yeast proteins in
vaccines have not been found to be harmful in humans or experimental
animals.
*********************
To access a web-text (HTML) version of the abstract, go to:
http://pediatrics.aappublications.org/cgi/content/abstract/112/6/1394
To access a web-text (HTML) version of the complete article, go to:
http://pediatrics.aappublications.org/cgi/content/full/112/6/1394
To access a ready-to-copy (PDF) version, go to:
http://pediatrics.aappublications.org/cgi/reprint/112/6/1394.pdf
---------------------------------------------------------------
Back to Top
(4 of 10)
January 5, 2004
CDC ISSUES AN UPDATE ON CURRENT U.S. INFLUENZA ACTIVITY
CDC published "Update: Influenza Activity--United States, December 14-20,
2003" in the January 2 issue of MMWR. Portions of the article are reprinted
below.
***********************
Influenza activity in the United States continued to increase during
December 14-20, 2003. The proportion of patient visits to sentinel providers
for influenza-like illness (ILI) overall was 7.7%, which is above the
national baseline of 2.5%. Influenza activity was reported as widespread by
health departments in 45 states, New York City, and the District of
Columbia; four states reported regional influenza activity; and one state
reported local influenza activity. . . .
Antigenic Characterization
Of the 330 influenza viruses collected by U.S. laboratories since October 1
and characterized antigenically by CDC, 326 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 326 influenza A (H3N2) isolates that have been
characterized, 80 (25.0%) were similar antigenically to the vaccine strain
A/Panama/2007/99 (H3N2), and 246 (75.0%) 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 20, P&I accounted for 7.8% of all deaths
reported through the 122 Cities Mortality Reporting System. The epidemic
threshold for that week was 7.8%. . . .
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
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a5.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5251.pdf
---------------------------------------------------------------
Back to Top
(5 of 10)
January 5, 2004
MMWR PUBLISHES UPDATE ON CURRENT INFLUENZA-RELATED DEATHS AMONG U.S.
CHILDREN LESS THAN 18 YEARS OLD
CDC published "Update: Influenza-Associated Deaths Reported Among Children
Aged Less Than 18 Years--United States, 2003-04 Influenza Season" in the
January 2 issue of MMWR. Originally published in the web-based "MMWR
Dispatch," the update has not been available in hard-copy format until now.
To access a web-text (HTML) version of the update online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5251.pdf
---------------------------------------------------------------
Back to Top
(6 of 10)
January 5, 2004
SAVE THE DATE: "EPIDEMIOLOGY AND THE PREVENTION OF VACCINE PREVENTABLE
DISEASES" TO BE BROADCAST IN FEBRUARY AND MARCH
A live, four-part satellite broadcast by CDC, "Epidemiology and the
Prevention of Vaccine Preventable Diseases," is scheduled from noon to 3:30
pm ET on four consecutive Thursdays: February 19 and 26, and March 4 and 11.
Individual registration begins January 22. Watch future issues of "IAC
EXPRESS" for details.
To access a course overview from the website of the Public Health Training
Network, go to:
http://www.phppo.cdc.gov/PHTN//epv04/default.asp
---------------------------------------------------------------
Back to Top
(7 of 10)
January 5, 2004
UPDATED: IAC MAKES MINOR REVISIONS TO ITS VIS PROFESSIONAL-EDUCATION SHEET
"IT'S FEDERAL LAW!"
In December 2003, IAC revised one of its VIS professional-education sheets,
"It's Federal Law! You Must Give Your Patients Current Vaccine Information
Statements (VISs)." IAC added information on the rabies VIS, which the
Centers for Disease Control and Prevention updated on 11/4/03.
To access a web-text (HTML) version of the updated sheet, go to:
http://www.immunize.org/catg.d/2027law.htm
To access a ready-to-copy (PDF) version, go to:
http://www.immunize.org/catg.d/2027law.pdf
---------------------------------------------------------------
Back to Top
(8 of 10)
January 5, 2004
SUBSCRIBE TODAY: CDC'S FREE ELECTRONIC NEWS SERVICE "PUBLIC HEALTH LAW NEWS"
IS LOOKING FOR READERS
CDC published "Notice to Readers: Subscriptions to the CDC Public Health Law
News" in the January 2 issue of MMWR. The notice is reprinted below in its
entirety.
***********************
Public Health Law News is a free electronic newsletter published every
weekday except holidays by CDC's Public Health Law Program. The newsletter
contains summaries of news reports on public health law and related
subjects; announcements of public health law--related publications,
conferences, congressional hearings, and other events; a news quotation of
the day; and other timely material. The newsletter is available at
http://www.phppo.cdc.gov/od/phlp
Information about subscribing via e-mail is available at
http://www.cdc.gov/subscribe.html
***********************
To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5251a6.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5251.pdf
---------------------------------------------------------------
Back to Top
(9 of 10)
January 5, 2004
JANUARY 26 IS THE DEADLINE FOR PROPOSALS FOR NACCHO'S 2004 ANNUAL CONFERENCE
January 26 is the deadline for session and speaker proposals for the 2004
annual conference of the National Association of County and City Health
Officials (NACCHO). The conference will be held on July 14-17 in St. Paul,
MN. Its theme is "Shaping Our Potential: Competencies, Capacities, and Core
Functions in Local Public Health."
For information on submitting a proposal, go to:
http://www.naccho.org/general915.cfm
For information on the conference, go to:
http://www.naccho.org/files/documents/2004_naccho_annual.html
For additional information, contact Caryn Ayers by email at
carynayers@conferencemanagers.com or by phone at (301) 984-9450,
ext. 17.
---------------------------------------------------------------
Back to Top
(10 of 10)
January 5, 2004
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES ANNOUNCES RULE FOR SMALLPOX
VACCINE INJURY COMPENSATION PROGRAM
On December 19, 2003, CDC published an official Health Alert Network Info
Service Message about the interim final rule for the Smallpox Vaccine Injury
Compensation Program. The message is reprinted below in its entirety.
************************
This is an official CDC HAN Info Service Message
Distributed via the HAN Info Service
December 19, 2003, 14:15 EST (2:15 PM EST)
HHS ISSUES RULES FOR SMALLPOX VACCINE INJURY COMPENSATION PROGRAM
HHS [Department of Health and Human Services] Secretary Tommy G. Thompson
today announced an interim final rule that implements a law Congress passed
earlier this year to identify and compensate people injured as a result of
receiving a smallpox vaccine. The interim rule for the new Smallpox Vaccine
Injury Compensation Program describes eligibility criteria, the process for
requesting benefits and receiving payments, and other necessary policies and
procedures. Funded at $42 million, the program provides financial and
medical benefits to eligible members of an HHS-approved smallpox emergency
response plan who sustain certain medical injuries caused by a smallpox
vaccine.
In addition, unvaccinated individuals injured after coming into contact with
vaccinated members of an emergency response plan--or with a person with whom
the vaccinated person had contact--may be eligible for program benefits. The
program also provides benefits to survivors of eligible individuals whose
death resulted from a covered injury.
Those who wish to file a claim will find forms and information at
www.hrsa.gov/smallpoxinjury
HHS is also making special efforts to ensure that all those involved in the
smallpox vaccination effort, and especially anyone who may have been
injured, will receive notification quickly that the claims system is now
operational.
The interim rule was scheduled to be published in the December 16, 2003, Federal
Register and will be effective immediately. The public may comment on its
contents, and HHS may amend it later based on those comments.
HHS began implementation of the compensation program by publishing a
Smallpox Vaccine Injury Compensation Table in the Aug. 27, 2003, edition of
the Federal Register. The table became effective upon publication. The table
identifies medical injuries and adverse effects presumed to have been caused
by a smallpox vaccine or contact. It also lists time intervals in which the
first symptom or manifestation must appear in order for the presumption of a
vaccine-caused injury to apply. The benefit of such a table is that a causal
relationship need not be demonstrated between a smallpox vaccine and an
injury listed in it. Because it is possible to incur a medical injury not
listed on the table that may have been caused by a smallpox vaccination or
contact, a person who can present sufficient evidence to prove likely
causation may still be eligible for program benefits.
In order to be eligible to receive benefits, requesters must satisfy the
filing deadlines described in the interim final rule. Because these
deadlines may fall as early as Jan. 24, 2004, individuals interested in
applying for benefits with the program are encouraged to file a Request Form
as soon as possible. Anyone interested in eligibility or application
information can contact the Smallpox Vaccine Injury Compensation Program,
located in HHS' Health Resources and Services Administration, at (888)
496-0338, or by sending an email to
smallpox@hrsa.gov
************************
|
