March 1, 2004
CONTENTS OF THIS ISSUE
- NFID issues a Call To Action: Influenza
vaccination rates among health care workers must increase!
- CDC Health Update includes interim
recommendations for persons with possible exposure to avian influenza
- Association of Immunization Managers seeks
nominations for the "Natalie J. Smith, MD, Award"
- Gates Foundation makes $82.9 million grant for
development of new tuberculosis vaccines
- 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
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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:
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.
- 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:
- 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.
- 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
- 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:
- 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,
- 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:
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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.
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.
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
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
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
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
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
- 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
- Virus isolation should not be attempted
unless a biosafety level 3+ facility is available to receive and culture
- 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
- 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
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:
For additional information, contact Claire Hannan, AIM executive
director, by email at
firstname.lastname@example.org, by phone at (202) 715-1676, or by fax at
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March 1, 2004
GATES FOUNDATION MAKES $82.9 MILLION GRANT FOR DEVELOPMENT OF NEW
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
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March 1, 2004
CURRENT WEST AFRICAN POLIO IMMUNIZATION CAMPAIGN TO REACH 63 MILLION
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: