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Issue Number 448            March 8, 2004

CONTENTS OF THIS ISSUE

  1. MMWR notifies readers about the updated recommendation to suspend routine use of third and fourth doses of PCV7
  2. Now's the time to get ready for National Infant Immunization Week 2004
  3. New: Monograph on influenza vaccination for health care workers now on "Infectious Diseases in Children" website
  4. Updated: NIP redesigns the Vaccines for Children web section
  5. Attention providers: You can download tri-fold parent, patient, and professional brochures from the NIP website
  6. NNii announces website redesign
  7. New: Pneumococcal polysaccharide vaccine (PPV23) VIS available for the first time in Chinese

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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 8, 2004
MMWR NOTIFIES READERS ABOUT THE UPDATED RECOMMENDATION TO SUSPEND ROUTINE USE OF THIRD AND FOURTH DOSES OF PCV7

CDC published "Notice to Readers: Updated Recommendations on the Use of Pneumococcal Conjugate Vaccine: Suspension of Recommendation for Third and Fourth Dose" in the March 5 issue of MMWR. The notice is reprinted below, excluding references.

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On March 2, this notice was posted on the MMWR website
(http://www.cdc.gov/mmwr).

On February 13, 2004, CDC recommended that health-care providers temporarily suspend routine use of the fourth dose of 7-valent pneumococcal conjugate vaccine (PCV7) when vaccinating healthy children. This action was taken to conserve vaccine and minimize the likelihood of shortages until Wyeth Vaccines, the only U.S. supplier of PCV7 (marketed as Prevnar), restores sufficient production capacity to meet the national need. Since that recommendation, PCV7 production has been much less than expected because of continuing problems with the PCV7 vial-filling production line. Shipments have been delayed, resulting in spot shortages that might continue beyond summer 2004 and become widespread. Effective immediately, to further conserve vaccine, CDC recommends that all health-care providers temporarily suspend routine administration of both the third and fourth doses to healthy children.

Approximately 1.3 million doses of PCV7 are needed each month to provide every infant in the United States with the full, 4-dose vaccination series. For January-April 2004, total shipments are estimated to be <=55% of the amount needed. Limiting healthy children to 2 doses of PCV7 will conserve vaccine and permit more children to receive at least 2 doses. More vaccine is expected to become available for distribution in May and June, but availability cannot be guaranteed. CDC will continue to update health-care providers on the status of vaccine supplies while the shortage persists.

PCV7 is highly effective. The routinely recommended 4-dose series has been 97% (95% confidence interval [CI] = 76%-100%) effective against invasive disease caused by serotypes represented in the vaccine; effectiveness in children who received 3 doses before age 1 year has been 87% (95% CI = 71%-94%), and effectiveness in children who received 2 doses has been 94% (95% CI = 84%-98%) (CDC, unpublished data, 2004). Efficacy data from a randomized, controlled trial suggest that 1-2 doses of pneumococcal conjugate vaccine are protective during the 2-month interval before the next dose, with 86% effectiveness (but a 95% CI that includes zero). Although limited data support a 2-dose schedule among infants, this regimen is preferable to vaccinating certain children with 3 doses and not vaccinating others. Because PCV7 is a new vaccine, no long-term data on vaccine effectiveness are available. However, the incidence of invasive pneumococcal disease declines rapidly after age 2 years, even in unvaccinated children. In 1998, before PCV7 was licensed, the incidence of invasive disease was 203 per 100,000 infants aged 1 year and 63 per 100,000 children aged 2 years.

To ensure that every child is protected against pneumococcal disease despite the PCV7 shortage, CDC, in consultation with the American Academy of Family Physicians, the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices, recommends that all health-care providers temporarily discontinue administering the third and fourth dose of PCV7 to healthy children. Health-care providers should continue to administer the routine 4-dose series to children at increased risk for severe disease*. Unvaccinated, healthy children aged 12-23 months should receive a single dose of PCV7. For children aged >=2 years, PCV7 is not recommended routinely.

This recommendation reflects CDC's assessment of the existing national PCV7 supply and will be changed if the supply changes. Updated information about the national PCV7 supply is available from CDC at http://www.cdc.gov/nip/news/shortages/default.htm

Health-care providers should maintain lists of children for whom conjugate vaccine has been deferred so it can be administered when the supply allows. The highest priority for vaccination among children who have been deferred is children vaccinated with <=2 doses who are aged <1 year.

Because data on the long-term efficacy of 3-dose or 2-dose vaccine regimens are limited, health-care providers should consider the diagnosis of invasive pneumococcal disease in incompletely vaccinated children and are encouraged to report invasive pneumococcal disease after any regimen of pneumococcal conjugate vaccine to CDC through state health departments. If a pneumococcal isolate is available from a vaccinated child, CDC will perform serotyping to determine whether the type is included in the vaccine. Additional information is available from CDC at http://www.cdc.gov/nip/home-hcp.htm and by telephone, (404) 639-2215 or fax, (404) 639-3970.

* Including children with sickle cell disease and other hemoglobinopathies, anatomic asplenia, chronic diseases (e.g., chronic cardiac and pulmonary disease and diabetes), cerebrospinal fluid leak, human immunodeficiency virus infection and other immunocompromising conditions, immunosuppressive chemotherapy or long-term systemic corticosteroid use; children who have undergone solid organ transplantation, and children who either have received or will receive cochlear implants. All these children have been identified as being at either "high risk" or "presumed high risk" for severe invasive pneumoccocal disease.

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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5308a5.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5308.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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March 8, 2004
NOW'S THE TIME TO GET READY FOR NATIONAL INFANT IMMUNIZATION WEEK 2004

Scheduled for April 25-May 1, National Infant Immunization Week (NIIW) gives health departments, health care providers, and community leaders an excellent opportunity to highlight the positive impact immunization has on the lives of infants and children. Celebrated annually since 1994, NIIW emphasizes immunizing infants against 12 VPDs by the age of two. This year's theme--Vaccination: An Act of Love--reinforces the beneficial role vaccines play in promoting the health of our nation's children.

More than 500 U.S. communities are expected to participate this year by planning community awareness and media events that publicize infant immunizations to parents, caregivers, health care providers, and community groups. In addition, during this year's NIIW, the United States will join the Pan American Health Organization and the U.S.-Mexico Border Health Commission in supporting Vaccination Week in the Americas, which will promote immunization in all countries of the Americas.

To help health departments, providers, and community leaders increase community awareness of NIIW, NIP has posted numerous materials on its website; all can be downloaded at no charge. Included are resources to help create kickoff events, as well as sample public relations materials, radio public service announcements, posters, flyers, stickers, banners, and buttons. Many are available in both English and Spanish.

For more information about NIIW and to access resource materials, go to: http://www.cdc.gov/nip/events/niiw
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March 8, 2004
NEW: MONOGRAPH ON INFLUENZA VACCINATION FOR HEALTH CARE WORKERS NOW ON "INFECTIOUS DISEASES IN CHILDREN" WEBSITE

The February 2004 issue of the journal "Infectious Diseases in Children" includes a monograph, "Importance of Vaccinating Health Care Workers Against Influenza." Its four articles are based on interviews with Theodore C. Eickhoff, MD, W. Paul Glezen, MD, Caroline Breese Hall, MD, and Samuel L. Katz, MD.

To access the articles in the monograph, go to:
http://idinchildren.com/monograph/CMEframeset.asp?article=0402/splash.asp&mono=y
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March 8, 2004
UPDATED: NIP REDESIGNS THE VACCINES FOR CHILDREN WEB SECTION

NIP recently updated and redesigned the web section of the Vaccines for Children (VFC) program. It now offers Q&A information for parents and providers, as well as an array of information for state and territory immunization projects.

To access the VFC web section, go to: http://www.cdc.gov/nip/vfc/default.htm
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March 8, 2004
ATTENTION PROVIDERS: YOU CAN DOWNLOAD TRI-FOLD PARENT, PATIENT, AND PROFESSIONAL BROCHURES FROM THE NIP WEBSITE

CDC's NIP website offers several tri-fold immunization brochures useful for parent, patient, and professional education. Many are available in both English and Spanish, and most are formatted for office printing, as well as professional press printing. All are available for downloading; none is available for order.

To access the brochures, go to: http://www.cdc.gov/nip/publications/default.htm Scroll down to the Tri-Fold Brochures section to access the complete selection.

Following is a brief description of each brochure.

CHILDHOOD AND ADOLESCENT IMMUNIZATION BROCHURES
"Childhood Immunization: Protect the Child, Protect the Future." Intended for parents; available in English and Spanish.

"Adolescent Immunization: Give a Teen Complete Protection." Intended for parents; available in English and Spanish.

"Immunize Our Children: Protect the Circle of Life." Intended for American Indian and Alaska Native communities; available in English.

"You Keep Track of Your Child; Now Keep Track of Your Child's Immunizations." An immunization scheduler intended for parents; available in English.

"Immunization Impacts Your Schools." Intended for school administrators, leaders of parent organizations, teachers, school nurses, and other adults; available in English.

"Vaccines for Children Program: Information for Parents." Intended for parents; available in English.

"Vaccines for Children Program: Information for Health Care Providers." Intended for health professionals; available in English.

"Immunization Registries: Using Technology To Improve Our Health." Intended for health professionals; available in English.

ADULT IMMUNIZATION BROCHURE
"Adult Immunization: Protection for a Lifetime." Intended for patients; available in English and Spanish.

VACCINE SAFETY BROCHURES
"Immunization: Find the Source." Intended for health professionals, parents, and patients; available in English and Spanish.

"Vaccine Safety: Information for Parents." Intended for parents; available in English and Spanish.

"Helping Parents Who Question Vaccines: Providers' Guide." Intended for health professionals; available in English.

"Vaccine Safety: Information for Health Care Providers." Intended for health professionals; available in English.

ADDITIONAL VACCINE SAFETY RESOURCES
The websites of both NIP and IAC offer parents and health care providers a large selection of information about vaccine safety.

To access information from NIP, go to the Overview of Vaccine Safety web section at http://www.cdc.gov/nip/vacsafe

To access information from IAC, go to the Responding to Concerns About Vaccines web section at http://www.immunize.org/concerns

ADDITIONAL GENERAL IMMUNIZATION RESOURCES
To order free print publications and videos related to immunization from CDC, go to the NIP online order form at https://www2.cdc.gov/nchstp_od/PIWeb/niporderform.asp
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March 8, 2004
NNii ANNOUNCES WEBSITE REDESIGN

On February 25, the National Network for Immunization Information (NNii) issued a press release announcing that Immunization for Public Health (I4PH) recently redesigned NNii's website, adding new content for parents, health professionals, and the media.

Based in Galveston, TX, I4PH is a nonprofit corporation that provides immunization information to those who need it. In the near future, it will launch an English/Spanish immunization information website to address global immunization issues.

An affiliation of several health professional organizations and the University of Texas Medical Branch, NNii was established in 2000 to meet the public's need for science-based immunization information. To access its redesigned website, go to: http://www.immunizationinfo.org
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March 8, 2004
NEW: PNEUMOCOCCAL POLYSACCHARIDE VACCINE (PPV23) VIS AVAILABLE FOR THE FIRST TIME IN CHINESE

Dated 7/29/97, the most current version of the pneumococcal polysaccharide vaccine (PPV23) VIS is available in Chinese on IAC's website. We are grateful to the San Francisco Department of Public Health, Communicable Disease Prevention Unit, for the translation.

To access a ready-to-copy (PDF) version of the PPV 23 VIS in Chinese, go to: http://www.immunize.org/vis/ch_pne97.pdf

To access it in English, go to:
http://www.immunize.org/vis/pneum3.pdf

For information about the use of VISs, and for VISs in a total of 31 languages, go to: 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 March 8, 2004