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Issue Number 446            March 1, 2004

CONTENTS OF THIS ISSUE

  1. NFID issues a Call To Action: Influenza vaccination rates among health care workers must increase!
  2. CDC Health Update includes interim recommendations for persons with possible exposure to avian influenza
  3. Association of Immunization Managers seeks nominations for the "Natalie J. Smith, MD, Award"
  4. Gates Foundation makes $82.9 million grant for development of new tuberculosis vaccines
  5. Current West African polio immunization campaign to reach 63 million children

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ABBREVIATIONS: AAFP, American Academy of Family Physicians, 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; VPD, vaccine-preventable disease; WHO, World Health Organization.
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March 1, 2004
NFID ISSUES A CALL TO ACTION: INFLUENZA VACCINATION RATES AMONG HEALTH CARE WORKERS MUST INCREASE!

Citing the appalling statistic that a mere 36 percent of health care workers are immunized against influenza each year, the National Foundation for Infectious Diseases (NFID) recently issued a four-page report, "Influenza Immunization Among Health Care Workers: A Call to Action." The report has the support of 24 health care organizations, including AAFP, AAP, and the American Medical Association.

"Low influenza vaccination rates among health care workers pose a serious health threat to the patients in their care, including infants and children, the elderly, and chronically ill," said William Schaffner, MD, NFID board member and professor and chair of the department of preventive medicine at Vanderbilt School of Medicine. "Measures must be taken to ensure health care workers are provided convenient access to influenza vaccine and that employers of health care workers commit programs and resources toward institutionalizing immunization in the workplace."

The goal is to increase influenza immunization rates among health care workers in medical practices, general hospitals, specialty hospitals, long-term-care and rehabilitation facilities, home care sites, and other health care settings.

To complement the report, NFID plans to develop and issue a more comprehensive monograph outlining key strategies that will serve as a national model for improving health care worker immunization rates.

To access a ready-to-copy (PDF) version of the report, go to:
http://www.nfid.org/publications/calltoaction.pdf

ADDITIONAL RESOURCES

Following are several practical resources to help health care organizations increase influenza immunization rates among health care workers. The first four are specific to influenza immunization; the last two are general resources on increasing adult immunization rates.

  1. Hats off to the Massachusetts Medical Society, MassPRO, and the Massachusetts Department of Public Health. In 2002, they produced an outstanding, down-to-earth, foolproof, and comprehensive 32-page publication to help Massachusetts hospitals and nursing homes protect staff and patients from influenza by immunizing health care workers. Titled "Employee Flu Immunization Campaign Kit," it includes step-by-step instructions, information, worksheets, promotional materials, and tips to assist in planning and conducting a successful employee influenza immunization campaign. No longer in print, the kit can be accessed electronically (see below).
     
    A ready-to-copy (PDF) version of the kit is available at no cost from the website of the Massachusetts Medical Society at http://www.massmed.org/pages/flu_kit.pdf Please note that two pages of the kit are now outdated: page 2 and page 9.
     
    To find out more about the kit or to download each campaign step separately, go to:
    http://www.massmed.org/pages/flu_kit.asp
     
  2. CDC's National Center for Infectious Diseases offers a short list of practical tips for increasing health care workers' influenza immunization rates. To access the list, go to: http://www.cdc.gov/ncidod/hip/INFECT/flu_acute.htm#14 Click on topic 14, How To Prepare for Outbreaks.
     
  3. In 2003, IAC developed practical guidelines for using standing orders for influenza immunization. Titled "Standing Orders for Administering Influenza Vaccine to Adults," the guidelines are available from the IAC website at http://www.immunize.org/catg.d/p3074.pdf
     
  4. A CDC web page, "Strategies for Increasing Adult Immunization Rates--Applied to Influenza," contains numerous examples of using specific strategies, such as standing orders, to increase influenza immunization rates among adults. To access the web page, go to:
    http://www.cdc.gov/nip/publications/flustrat.htm
     
  5. Based on course material from one of CDC's interactive satellite videoconference broadcasts, the video "Adult Immunization: Strategies That Work" covers adult immunization strategies that have been successfully implemented in five health care settings. To learn more about the video's content and to obtain ordering information, go to:
    http://www.cdc.gov/nip/publications/adult-strategies/default.htm
     
  6. An interactive CD-ROM, "Increasing Adult Vaccination Rates: WhatWorks" is intended for primary care providers. It's available free of charge from the Association of Teachers of Preventive Medicine. For information, or to order a copy online, go to:
    http://www.atpm.org/immunization/whatworks.html

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March 1, 2004
CDC HEALTH UPDATE INCLUDES INTERIM RECOMMENDATIONS FOR PERSONS WITH POSSIBLE EXPOSURE TO AVIAN INFLUENZA

On February 24, CDC issued a Health Update outlining interim recommendations for persons with possible exposure to avian influenza. The Health Update is reprinted below in its entirety.

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This is an official CDC Health Update

Distributed via Health Alert Network
February 24, 2004, 9:45 PM EST

INTERIM RECOMMENDATIONS FOR PERSONS WITH POSSIBLE EXPOSURE TO AVIAN INFLUENZA DURING OUTBREAKS AMONG POULTRY IN THE UNITED STATES

Outbreaks of avian influenza A occur among U.S. poultry flocks from time to time. Since early February 2004, avian influenza outbreaks have been reported in several locations in the United States, most recently in Texas. This document briefly describes the current outbreak in Texas and provides interim guidance for persons who might be exposed to avian influenza; health-care professionals; and consumers of poultry.

BACKGROUND
The state of Texas has reported an outbreak of highly pathogenic avian influenza A (H5N2) among poultry on one farm in Gonzales County, in south-central Texas. This is the first outbreak of highly pathogenic avian influenza in the United States in 20 years and was detected by routine state monitoring for avian influenza.

Birds on this farm were sold to live bird markets in the Houston area. Preliminary testing of birds at two of these markets found evidence of avian influenza. The farm and the two live bird markets have been quarantined, cleaned, and disinfected following the culling of affected poultry. In addition, extensive surveillance measures have been instituted around the affected premises. CDC and the U.S. Department of Agriculture (USDA) are working with the Texas Department of Health and the Texas Animal Health Commission on both the human health and animal/veterinary aspects to contain this outbreak in poultry and minimize risk to humans. The health risk to humans from the H5N2 influenza outbreak in Texas is considered low at this time.

The H5N2 strain in Texas is a different subtype of influenza A than the virus affecting parts of Asia. The H5N1 outbreaks among poultry in Asia have been associated with human cases in Thailand and Vietnam. There is no epidemiologic link between the H5N1 virus in Asia and the H5N2 virus in Texas.

Avian influenza viruses typically do not infect humans; however, several instances of human infections and outbreaks of avian influenza have been reported since 1997 (for more information, see "Basic Information About Avian Influenza"). It is believed that most cases of avian influenza infection in humans have resulted from contact with infected poultry or contaminated surfaces. Other means of transmission also are possible, such as the virus becoming aerosolized and landing on exposed surfaces of the mouth, nose, or eyes, or being inhaled into the lungs.

INTERIM CDC RECOMMENDATIONS
Because it is possible that avian influenza could be transmitted to humans, CDC is issuing the following interim U.S. guidance for (1) individuals who may be exposed to avian influenza, (2) health-care professionals, and (3) consumers of poultry. Guidance for individuals who may be exposed to avian influenza is based on the degree of risk associated with various levels and types of exposures. This document also contains interim guidance for health-care professionals who may need to evaluate, test, and diagnose potentially exposed individuals. Additionally, food safety information for consumers is provided to address concerns surrounding avian influenza outbreaks and poultry. The recommendations will be updated as necessary.

INDIVIDUALS PARTICIPATING IN AVIAN INFLUENZA OUTBREAK CONTROL AND ERADICATION ACTIVITIES
Persons involved in outbreak control and eradication activities (e.g., euthanasia, carcass disposal, and cleaning and disinfection of premises affected by avian influenza) on poultry farms or live bird markets are at increased risk for exposure to avian influenza. Such persons often have prolonged, direct contact with infected birds and/or contaminated surfaces in an enclosed setting. CDC and USDA have developed interim guidance to reduce these risks, including recommendations about personal protective equipment, vaccination with seasonal influenza vaccine, administration of antiviral drugs for prophylaxis, surveillance and monitoring of workers, and evaluation of workers who develop a febrile respiratory illness within 7 days of their last exposure (available at http://www.cdc.gov/flu/avian/protectionguid.htm).

OTHER INDIVIDUALS WITH POSSIBLE EXPOSURE TO AVIAN INFLUENZA
The risks for exposure to avian influenza viruses and the possibility of viral reassortment would be expected to be lower for persons with more routine (i.e., less intense and prolonged) occupational or other types of contact with poultry or contaminated surfaces or equipment on affected farms or in live bird markets. Individuals who develop a febrile respiratory illness within a week after their last exposure to avian-infected or exposed birds or potentially contaminated surfaces should consult a health-care provider. Before visiting a health-care setting, tell the provider about symptoms and recent possible exposures to avian influenza.

HEALTH-CARE PROFESSIONALS: EVALUATION OF ILL PERSONS
Health-care providers should be alert for respiratory illness among persons who may have been exposed to infected poultry. The following section provides recommendations for health-care professionals who may need to evaluate symptomatic persons with possible avian influenza exposure.

  • Persons who develop a febrile respiratory illness should have a respiratory sample (e.g., nasopharyngeal swab or aspirate) collected.
     
  • The respiratory sample should be tested by RT-PCR [reverse transcriptase polymerase chain reaction] for influenza A, and if possible for H1 and H3. If such capacity is not available in the state, or if the result of local testing is positive, then CDC should be contacted and the specimen should be sent to CDC for testing.
     
  • Virus isolation should not be attempted unless a biosafety level 3+ facility is available to receive and culture specimens.
     
  • Optimally, an acute- (within 1 week of illness onset) and convalescent-phase (after 3 weeks of illness onset) serum sample should be collected and stored locally in case testing for antibody to the avian influenza virus should be needed.
     
  • Requests for testing should come through the state and local health departments, which should contact the CDC Director's Emergency Operations Center at (770) 488-7100 before sending specimens for testing.

CONSUMERS: FOOD SAFETY GUIDANCE
There is no evidence that any human cases of avian influenza have been acquired by eating poultry products. Influenza viruses such as H5N2, H7N2, and H5N1 are destroyed by adequate heat, as are other foodborne pathogens. Consumers are reminded to follow proper food preparation and handling practices, including:

  • Cook all poultry and poultry products (including eggs) thoroughly before eating. (This means that chicken should be cooked until it reaches a temperature of 180 degrees Fahrenheit, throughout each piece of chicken.)
     
  • Raw poultry always should be handled hygienically because it can be associated with many infections, including salmonella. Therefore, all utensils and surfaces (including hands) that come in contact with raw poultry should be cleaned carefully with water and soap immediately afterwards. The World Health Organization has developed food safety guidance for the current situation in Asia. This is available at http://www.who.int/foodsafety/micro/avian/en

FOR MORE INFORMATION

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March 1, 2004
ASSOCIATION OF IMMUNIZATION MANAGERS SEEKS NOMINATIONS FOR THE "NATALIE J. SMITH, MD, AWARD"

The Association of Immunization Managers (AIM) recently announced it is seeking nominations for the 2004 "Natalie J. Smith, MD, Award." The award, which will be given at the National Immunization Conference in May, was established to honor the memory of Dr. Smith's outstanding management and leadership skills in the area of state and national vaccine-preventable disease programs. The deadline for nominations is April 16.

Dr. Smith, who died in 2003 at age 41, served as deputy director, National Immunization Program, CDC. Prior to accepting the position at NIP, she served for eight years as chief, Immunization Branch, California Department of Health Services. In that capacity, she wrote numerous significant publications on immunization and frequently presented and consulted on immunization-related issues to groups representing the public and private health sectors.

To access more information about the award, including the nomination criteria and a 2004 nomination form, go to: http://www.immunize.org/news.d/smithaward.pdf

For additional information, contact Claire Hannan, AIM executive director, by email at channan@astho.org, by phone at (202) 715-1676, or by fax at (202) 371-9797.
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March 1, 2004
GATES FOUNDATION MAKES $82.9 MILLION GRANT FOR DEVELOPMENT OF NEW TUBERCULOSIS VACCINES

On February 12, the Bill & Melinda Gates Foundation announced an $82.9 million grant to the Aeras Global TB Vaccination Foundation of Bethesda, MD. The grant, the largest ever for TB vaccine development, will allow Aeras to fund human trials of promising TB vaccines and early research on the next generation of vaccines.

Two billion people--one out of every three people on earth--are infected with Mycobacterium tuberculosis. Fueled by the HIV/AIDS epidemic, TB is resurgent in the developing world and is the leading killer of people infected with HIV. WHO projects that 36 million people could die of the disease over the next 20 years.

To access a press release about the grant from the Aeras website, go to: http://aeras.org/spotlight/gates829.html
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March 1, 2004
CURRENT WEST AFRICAN POLIO IMMUNIZATION CAMPAIGN TO REACH 63 MILLION CHILDREN

On February 20, WHO issued a press release announcing that 10 West African countries will conduct massive, synchronized polio immunization campaigns beginning February 23. The campaigns will achieve their goal of immunizing 63 million by sending tens of thousands of vaccinators from house-to-house over three days.

To access the press release from the WHO website, go to:
http://www.who.int/mediacentre/releases/2004/pr13/en

 

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 March 1, 2004