Immunization Action Coalition and the Hepatitis B Coalition

IAC EXPRESS

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Issue Number 465            June 14, 2004

CONTENTS OF THIS ISSUE

  1. New: State legislatures enact immunization requirements
  2. Update: CDC makes a minor change to the MMR VIS
  3. Update: IAC adds information to its professional-education sheet on using standing orders to administer PPV vaccine
  4. New: Slides, handouts, and recordings of National Immunization Conference presentations now available on NIP's website
  5. New: CDC releases an update on SARS and avian influenza
  6. World Vaccine Congress to be held October 11-13 in Lyon, France

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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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June 14, 2004
NEW: STATE LEGISLATURES ENACT IMMUNIZATION REQUIREMENTS

In the 2003-04 legislative season, many state legislatures enacted immunization requirements. All states that have vaccination requirements have certain legal exemptions. Following is information about new legislation, organized by vaccine and state. At the end of the article is information about new legislation regarding pharmacists' scope of practice in immunization.

HEPATITIS B

Indiana: The governor signed a bill on 3/16/04 that adds hepatitis B requirements for students entering grades 9 and 12, effective 6/30/05. Note: Indiana currently has hepatitis B requirements for students in kindergarten through grade 6.

Kansas: By department of health regulation, all kindergarten enrollees in the 2004-2005 school year must have evidence of vaccination against hepatitis B.

Kentucky: The governor signed a bill on 4/2/04 that requires all public and independent post-secondary educational institutions to provide information on hepatitis B to all first-time, full-time students. The requirements become effective 7/15/04.

Ohio: The governor signed a bill on 4/13/04 that requires documentation of the hepatitis B vaccination status of post-secondary students living in on-campus housing in public colleges and universities. The law also requires the state department of health to post information about hepatitis B disease and vaccine on its website, so it is available to junior and senior high school students and their parents. Effective date: 7/1/05.

IAC has compiled information about states that have hepatitis B mandates for prenatal screening, and day care, elementary, and middle school entry. To access the information, go to: http://www.immunize.org/laws/hepb.htm

The information about mandates for day care and school entry is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/hepbdcmap.pdf

IAC has compiled information about states that have hepatitis B mandates for college and university entry. To access the information, go to: http://www.immunize.org/laws/hepbcollege.htm

This information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/hepbcolmap.pdf

INFLUENZA AND PNEUMOCOCCAL POLYSACCHARIDE (PPV)

California: The governor signed a bill on 4/29/04 that requires long-term care facilities to offer influenza and pneumococcal vaccination to residents. The new requirements become effective in calendar year 2005.

New Hampshire: Without the signature of the governor, a bill requiring hospitals, residential-care facilities, adult day care facilities, and assisted living facilities to offer vaccination against influenza and pneumococcal disease to residents/patients was enacted on 5/4/04. Effective 1/1/05, all hospitalized patients must be offered vaccination prior to hospital discharge; residents of the other specified facilities must be offered vaccination within five working days of becoming a patient. Documentation is required in the patient's chart. Medical and conscientious exemptions are permitted. The law requires annual reporting to the federal Department of Health and Human Services. It also requires the above-referenced facilities to offer vaccination against influenza by November 30 of each year for each employee. Employees who begin employment between October 1 and February 1 of each year must be offered vaccination before they begin their employment.

Virginia: The governor signed a bill on 4/12/04 that will require nursing homes to offer residents pneumococcal vaccination, as well as annual influenza vaccination. The law becomes effective 7/1/04.

IAC has compiled information about states with influenza and/or pneumococcal (PPV) vaccine mandates for residents in long-term care facilities. To access the information, go to: http://www.immunize.org/laws/ltc.htm

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/ltcmap.pdf

MENINGOCOCCAL

Colorado: The governor signed a bill on 4/20/04 that requires all public and nonpublic post-secondary educational institutions to provide information on meningococcal disease and the vaccine to all students residing in student housing, effective 7/1/05. Students must also provide information on their meningococcal vaccination status.

Iowa: The governor signed a bill on 4/2/04 that will require colleges and universities that have on-campus housing to provide information about meningococcal disease and the vaccination to each student. Students must indicate their meningococcal vaccination status on their student health forms. Effective 7/1/04.

Kentucky: The governor signed a bill on 4/22/04 that requires each public and private post-secondary educational institution to provide information about meningitis to full-time students living in residence housing. Students must indicate their meningococcal vaccination status. Effective: 2004-05 school year.

Maine: The governor signed a bill on 3/30/04 that will require colleges and universities that have on-campus housing to provide information about meningococcal disease and the vaccination to new freshmen who will be living in dormitories. Students must indicate their meningococcal vaccination status on their student health forms. Implementation will begin in summer 2004.

New Jersey: An amendment to the state's existing meningococcal law was approved on 1/14/04 to expand the existing information requirements to include a vaccination requirement for students residing in campus dormitories, effective in September 2004.

Ohio: The governor signed a bill on 4/13/04 that requires documentation of the meningococcal vaccination status of post-secondary students living in on-campus housing in public colleges and universities. The law also requires the state department of health to post information about meningococcal disease and vaccine on its website, so it is available to junior and senior high school students and their parents. Effective date: 7/1/05.

IAC has compiled information about states with meningococcal prevention mandates for colleges and universities. To access the information, go to: http://www.immunize.org/laws/menin.htm

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/meninmap.pdf

VARICELLA

Kansas: By department of health regulation, all kindergarten enrollees in the 2004-05 school year must have evidence of vaccination against varicella.

North Dakota: The governor signed a bill on 3/17/03 that would require varicella vaccination for children in child care facilities and kindergarten. The department of health promulgated rules in October 2003 that specified the effective dates: child care requirements became effective in January 2004 and kindergarten requirements will become effective in the 2004-05 school year.

New Jersey: By department of health rulemaking, effective September 2004, all children born on or after 1/1/98 must have evidence of varicella vaccination (or disease history) to enroll in or attend kindergarten or first grade. All children 19 months of age and older must have such evidence to attend a child care center.

IAC has compiled information about all states that have varicella mandates for day care, elementary, and middle school entry. To access the information, go to: http://www.immunize.org/laws/varicel.htm

This information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/varimap.pdf

OTHER VACCINES

For information about state mandates for other vaccines, go to: http://www.immunize.org/laws

PHARMACISTS' SCOPE OF PRACTICE

Maryland: The governor signed a bill on 5/11/04 that allows pharmacists to administer influenza vaccination. The new law becomes effective 10/01/04.

IAC has compiled information about states that authorize pharmacists to vaccinate. To access the information, go to: http://www.immunize.org/laws/pharm.htm

The information is also depicted visually on a map of the United States. To access the map, go to: http://www.immunize.org/laws/pharmmap.pdf
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June 14, 2004
UPDATE: CDC MAKES A MINOR CHANGE TO THE MMR VIS

CDC recently made a one-word change to the current (1/15/03) Vaccine Information Statement for measles, mumps, and rubella (MMR) vaccine. In Section 3, the end of the sentence in the first bullet was changed from ". . . or a previous dose of MMR vaccine" to ". . . or to a previous dose of MMR vaccine" (i.e., the word "to" was added).

CDC has posted the updated VIS to its website, as has IAC (only the English-language version). The date on the VIS remains the same. CDC states that providers do NOT have to discard their existing supply of MMR VISs. However, the next time providers have a need to print more MMR VISs, they should get the updated version from the CDC or IAC websites.

To access a ready-to-copy (PDF) version of the updated MMR VIS from the CDC website, go to: http://www.cdc.gov/nip/publications/VIS/vis-mmr.pdf

To access a ready-to-copy (PDF) version of it from the IAC website, go to: http://www.immunize.org/vis/mmr03.pdf

For information about the use of VISs, and for VISs in a total of 31 languages, visit IAC's VIS web section at http://www.immunize.org/vis
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June 14, 2004
UPDATE: IAC ADDS INFORMATION TO ITS PROFESSIONAL-EDUCATION SHEET ON USING STANDING ORDERS TO ADMINISTER PPV VACCINE

IAC recently added information to its professional-education sheet "Standing Orders for Administering Pneumococcal Vaccine to Adults." The sheet now includes criteria for determining which patients require a second dose of pneumococcal polysaccharide vaccine (PPV). Following is the added material:

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2. Identify adults in need of a second and final dose of PPV if five or more years have elapsed since the previous vaccination and the patient is:

  1. Age 65 years or older and received prior PPV vaccination when less than age 65 years
     
  2. At highest risk for serious pneumococcal infection and/or likely to have a rapid decline in pneumococcal antibody levels . . .

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To access a camera-ready (PDF) version of the standing orders, go to:
http://www.immunize.org/catg.d/p3075.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p3075.htm
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June 14, 2004
NEW: SLIDES, HANDOUTS, AND RECORDINGS OF NATIONAL IMMUNIZATION CONFERENCE PRESENTATIONS NOW AVAILABLE ON NIP'S WEBSITE

CDC recently announced that slides, handouts, and recordings (audio and/or video) of many presentations made at the 38th National Immunization Conference are available on the NIP website. Additional files are continually being updated and uploaded; check the web page below often to access a more complete collection of presentation files.

To access the presentation files, visit the interactive conference agenda at http://www.cdc.gov/nip/nic/#agenda Follow the instructions provided.
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June 14, 2004
NEW: CDC RELEASES AN UPDATE ON SARS AND AVIAN INFLUENZA

On June 10, CDC issued a Health Update on SARS and avian influenza. It is reprinted below in its entirety.

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This is an official CDC Health Update
Distributed via Health Alert Network
Thursday, June 10, 2004, 17:47 EDT (5:47 PM EDT)

UPDATE ON SARS AND AVIAN INFLUENZA A (H5N1)

This update reviews the current situation and the surveillance and diagnostic recommendations for both severe acute respiratory syndrome (SARS) and avian influenza A (H5N1). The updates have been combined because the clinical presentation and travel history of persons with avian influenza A (H5N1) or SARS coronavirus (SARS-CoV) infection may overlap. The recommendations for SARS have been revised downward because the most recent SARS activity in China has been contained. The recommendations for avian influenza A (H5N1) remain at the enhanced level established in February 2004. As detailed in the recommendations below, vigilance in the clinical setting for SARS and avian influenza (H5N1) requires that health care providers consistently obtain international travel and other exposure risk information for persons who have specified respiratory symptoms.

SEVERE ACUTE RESPIRATORY SYNDROME
Current situation
During April 22-29, 2004, the Chinese Ministry of Health (MOH) reported a total of nine cases (one fatal) of SARS in China; seven of the patients were from Beijing, and two were from Anhui Province, located in east-central China. Two of the nine patients were graduate students who worked at National Institute of Virology Laboratory (NIVL) in Beijing, which is known to conduct research on SARS-CoV. The NIVL was closed on April 23 and remains closed to date. Possible sources of infection for the two laboratory workers, neither of whom is known to have worked directly with SARS-CoV, are being investigated. Of the seven other SARS cases, two were directly linked to close contact with one of the graduate students who worked at NIVL; these two cases were in the graduate student's mother (who died) and in a nurse who provided care to the graduate student. The remaining five cases were linked to close contact with the nurse.

No further cases of SARS in China or anywhere else in the world have been reported since April 29, 2004. On May 18, the World Health Organization (WHO) reported on its website that the outbreak in China appears to have been contained, but that laboratory biosafety concerns remain and further investigation is under way. CDC is in close communication with WHO and is working with its other public health partners to reinforce the need for strict adherence to applicable biosafety precautions to reduce the risk of laboratory-related exposures to SARS-CoV.

Recommended U.S. SARS control measures
Given that the recent SARS outbreak in China appears tohave been contained with relatively limited secondary transmission, CDC is revising previously issued guidance for enhanced surveillance of SARS in travelers to China (http://www.cdc.gov/ncidod/sars/han/han_China042304.htm). In the current setting, surveillance efforts should aim to identify patients who (1) require hospitalization for radiographically confirmed pneumonia or acute respiratory distress syndrome without identifiable etiology AND (2) have one of the following risk factors in the 10 days before the onset of illness:

  1. Travel to mainland China, Hong Kong, or Taiwan, or close contact with an ill person with a history of recent travel to one of these areas, OR
     
  2. Employment in an occupation associated with a risk for SARS-CoV exposure (e.g., health care worker with direct patient contact; worker in a laboratory that contains live SARS-CoV), OR
     
  3. Part of a cluster of cases of atypical pneumonia without an alternative diagnosis.

When individuals meeting these criteria are identified, appropriate infection control should be instituted, as described in the guidelines at www.cdc.gov/ncidod/sars/absenceofsars.htm Diagnostic testing should be performed judiciously, and preferably only in consultation with the local or state health department. SARS-CoV testing should be considered if no alternative diagnosis is identified 72 hours after initiation of the clinical evaluation and the patient is thought to be at high risk for SARS-CoV disease (e.g., part of a cluster of unexplained pneumonia cases). Infection control practioners and other health-care personnel also should be alert for clusters of pneumonia among two or more health care workers who work in the same facility.

Additional SARS information
For more information about current U.S. SARS control guidelines, see the CDC document "In the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and Reporting" at http://www.cdc.gov/ncidod/sars/absenceofsars.htm Additional information about SARS preparedness is available in CDC's document "Public Health Guidance for Community-Level Preparedness and Response to Severe Acute Respiratory Syndrome (SARS)" at http://www.cdc.gov/ncidod/sars/sarsprepplan.htm; general information about SARS is available at http://www.cdc.gov/ncidod/sars

AVIAN INFLUENZA A (H5N1)
Current situation
Since January 2004, a total of 34 confirmed human cases of avian influenza A (H5N1) virus infections have been reported in Vietnam (22 cases, 15 deaths) and Thailand (12 cases, 8 deaths). The last case officially reported by Vietnam occurred in February 2004. One additional case was described in several media reports in mid-March in southern Vietnam http://www.who.int/csr/don/2004_03_22a/en All persons with confirmed H5N1 influenza had severe illness and were hospitalized with pneumonia; most cases occurred in children and young adults who had direct close contact with live, sick, or dead poultry. There currently is no evidence of efficient human-to-human transmission of avian influenza A (H5N1) viruses. These cases were associated with widespread H5N1 poultry outbreaks that occurred at commercial and small backyard poultry farms. Since December 2003, eight countries have reported H5N1 outbreaks among poultry. Outbreaks in South Korea and Japan were limited to commercial farms and have been adequately contained; however, outbreaks in Vietnam, Thailand, Indonesia, Cambodia, Laos, and China have been more extensive and the degree to which they have been controlled remains uncertain. On the basis of current information, human infection with avian influenza A (H5N1) viruses remains a public health risk in these countries.

Enhanced U.S. Surveillance, Diagnostic Evaluation, and Infection Control Precautions for Avian Influenza A (H5N1): CDC recommends maintaining the enhanced surveillance efforts by state and local health departments, hospitals, and clinicians to identify patients at increased risk for avian influenza A (H5N1) that were issued by CDC on February 3, 2004 http://www.cdc.gov/flu/han020302.htm Guidelines for enhanced surveillance are:

Testing for avian influenza A (H5N1) is indicated for hospitalized patients with:

  1. Radiographically confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness for which an alternate diagnosis has not been established, AND
     
  2. History of travel within 10 days of symptom onset to a country with documented H5N1 avian influenza in poultry and/or humans (for a listing of H5N1-affected countries, see the OIE Web site at http://www.oie.int/eng/en_index.htm and the WHO Web site at http://www.who.int/en).

Testing for avian influenza A (H5N1) should be considered on a case-by-case basis in consultation with state and local health departments for hospitalized or ambulatory patients with:

  1. Documented temperature of >38C (>100.4F), AND
     
  2. One or more of the following: cough, sore throat, shortness of breath, AND
     
  3. History of contact with poultry (e.g., visited a poultry farm, a household raising poultry, or a bird market) or a known or suspected human case of influenza A (H5N1) in an H5N1-affected country within 10 days of symptom onset.

Infection control precautions for H5N1 remain unchanged from the CDC interim recommendations published on February 3, 2004, http://www.cdc.gov/flu/han020302.htm. These recommendations are further described in the CDC guidance document "Interim Recommendations for Infection Control in Health-Care Facilities Caring for Patients with Known or Suspected Avian Influenza" http://www.cdc.gov/flu/avian/professional/infect-control.htm

Additional avian influenza A (H5N1) information

  • For information about reported outbreaks of avian influenza A (H5N1) among poultry, see the website of the World Organization of Animal Health (OIE) at http://www.oie.int/eng/AVIAN_INFLUENZA/home.htm
     
  • For information about human H5N1 cases, see the WHO website http://www.who.int/en
     
  • For clinical information about human H5N1 cases, see:
    • CDC. Cases of influenza A (H5N1)--Thailand, 2004. MMWR 2004;53:100-103 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a2.htm
       
    • Hien TT, Liem AT, Dung NT, et al. Avian influenza A (H5N1) in 10 patients in Vietnam. New England Journal of Medicine 2004;350:1179-1188.

For general information about influenza, see the CDC website at www.cdc.gov/flu

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June 14, 2004
WORLD VACCINE CONGRESS TO BE HELD OCTOBER 11-13 IN LYON, FRANCE

Intended for vaccine industry executives, officials from national and international organizations, and high-level scientists, the World Vaccine Congress will be held in Lyon, France, October 11-13.

To access the conference program, go to:
http://www.lifescienceworld.com/2004/wvcl_FR/confprog.asp

To register online, go to:
http://transaction.terrapinn.com/form_page1.asp?SEID=480&DF=1

For additional information, contact Sarah Butt, sponsorship manager, by phone at +44 (0)207 827 5962 or by email at sarah.butt@terrapinn.com

 

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 June 14, 2004