Issue
Number 469
July 12, 2004
CONTENTS OF THIS ISSUE
- Important: CDC notifies readers of recommendation to
reinstate third dose of pneumococcal conjugate vaccine (PCV7)
- NFID's new program, "Kids Need Flu Vaccine, Too!" helps
providers increase pediatric influenza vaccination rates
- NFID's online CME course gives physicians strategies for
implementing pediatric influenza immunization recommendations
- Save the date: Live satellite broadcast of CDC's
Immunization Update 2004 is scheduled for August 19
- CDC reports a fourth death linked to an organ transplant
donor infected with rabies virus
- CDC publishes hard copy of July 2 electronic article on
rabies transmission through solid organ transplantation
- Report discusses the role communication plays in
strengthening immunization programs in developing countries
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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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July 12, 2004
IMPORTANT: CDC NOTIFIES READERS OF RECOMMENDATION TO REINSTATE THIRD DOSE OF
PNEUMOCOCCAL CONJUGATE VACCINE (PCV7)
CDC published "Notice to Readers: Updated Recommendations for Use of
Pneumococcal Conjugate Vaccine: Reinstatement of the Third Dose" in the July
9 issue of MMWR. The recommendation is effective immediately.
The article is reprinted below in its entirety, excluding references and one
table, an interim catch-up immunization schedule titled "Recommended
7-valent pneumococcal conjugate vaccination (PCV7) regimens during the
vaccine shortage, by age, history, and condition." IAC Editor's Note: The
information in the table is important. You can access the table from the the
two links immediately following this article. You can also access the
information directly from the NIP website on the document titled "PCV7 (Prevnar)
Shortages and Reinstatement of the 3rd Dose in PCV7 Recommendation, July 8,
2004." You'll find the document at
http://www.cdc.gov/nip/news/shortages/pcv7-shortage-faqs-7-8-04.htm
Scroll down to the section titled "Recommended Regimens While the PCV7
Shortage Exists."
On July 9, CDC also issued a press release about the reinstated third dose;
a link to the press release is given at the end of this article.
***********************
In February 2004, production of the 7-valent pneumococcal conjugate vaccine
(PCV7), marketed as Prevnar and manufactured by Wyeth Vaccines
(Collegeville, Pennsylvania), failed to meet demand, resulting in shortages.
To conserve the limited supply, CDC recommended that the fourth dose of PCV7
be withheld from healthy children. In March, because evidence indicated that
production would be curtailed for several months, CDC recommended that the
third dose also be withheld. Production problems now appear to have been
resolved. As a result, deliveries are projected during the near term to
permit the recommendation that every child receive 3 doses. Some providers
might have short-term difficulties obtaining vaccine because of distribution
delays; however, every effort will be made to provide sufficient vaccine to
all providers.
Effective immediately, CDC, in consultation with the Advisory Committee on
Immunization Practices (ACIP), the American Academy of Family Physicians,
and the American Academy of Pediatrics, recommends that providers administer
3 doses of vaccine. The fourth dose should still be deferred for healthy
children until further production and supply data demonstrate that a 4-dose
schedule can be sustained. The full, 4-dose series should continue to be
administered to children at increased risk for pneumococcal disease because
of certain immunocompromising or chronic conditions (e.g., sickle cell
disease, anatomic asplenia, chronic heart or lung disease, diabetes,
cerebrospinal fluid leak, and cochlear implant). Alaska Native children and
American Indian children who live in Alaska, Arizona, or New Mexico, and
Navajo children who live in Colorado and Utah have a risk for invasive
pneumococcal disease more than twice the national average. These children
should receive the standard 4-dose PCV7 series despite the shortage.
An interim catch-up schedule is provided for children who are incompletely
vaccinated. The highest priority for catch-up vaccination is to ensure that
children aged <5 years at high risk for invasive pneumococcal disease are
fully vaccinated. Second priorities include vaccination of healthy children
aged <24 months who have not received any doses of PCV7 and vaccination of
healthy children aged <12 months who have not yet received 3 doses.
Because of the frequency of health care provider visits by children during
their first 18 months, catch-up vaccination might occur at regularly
scheduled visits for most children who receive vaccines from their
primary-care providers. Programs that provide vaccinations but do not see
children routinely for other reasons should consider a notification process
to contact undervaccinated children.
Wyeth Vaccines is allocating nonpublic-purchased doses of Prevnar directly
to all physicians on the basis of previous purchasing patterns or practice
birth cohort. Wyeth does not currently ship products to either wholesalers
or distributors. Providers with questions about their allocation or about
obtaining Prevnar should contact Wyeth's customer service department,
telephone (800) 666-7248. For problems not resolved by the customer service
department, providers can contact Wyeth directly, telephone (866) 447-8888,
extension 37932. For public-purchased vaccine, including Vaccines for
Children Program vaccine, providers should contact their state/grantee
immunization projects to obtain vaccine. These projects should contact their
project officers at the National Immunization Program at CDC for information
regarding vaccine supply.
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
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a7.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5326.pdf
To access the CDC press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r040708.htm
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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July 12, 2004
NFID'S NEW PROGRAM, "KIDS NEED FLU VACCINE, TOO!" HELPS PROVIDERS INCREASE
PEDIATRIC INFLUENZA VACCINATION RATES
The National Foundation for Infectious Diseases (NFID) recently launched a
new in-practice resource program, Kids Need Flu Vaccine, Too! The online
program gives health care practitioners an array of useful materials for
conducting in-practice pediatric influenza immunization clinics. By
conducting clinics, providers can increase influenza vaccination rates and
comply with new recommendations issued by CDC, AAP, and other organizations
to vaccinate children ages 6-23 months.
The program includes the following:
- Comprehensive checklist on how to plan and
implement in-practice clinics
- Physician-to-physician video featuring
leading pediatric infectious disease experts and practicing physicians
- Patient video and other patient materials
that underscore the importance of influenza vaccination
- Case studies on effective pediatric
immunization programs
- Sample articles for practice newsletters
and tips on communicating the importance of vaccination to parents
- Tips to ensure proper reimbursement
To access the materials, go to the NFID web
section Kids Need Flu Vaccine, Too! at
http://64.242.251.230/index1.html
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July 12, 2004
NFID'S ONLINE CME COURSE GIVES PHYSICIANS STRATEGIES FOR IMPLEMENTING
PEDIATRIC INFLUENZA IMMUNIZATION RECOMMENDATIONS
In February 2004, ACIP adopted a new pediatric influenza immunization
recommendation, which calls for giving influenza vaccine to all children
ages 6-23 months. In response, the National Foundation for Infectious
Diseases (NFID), has developed an online CME course, Increasing Pediatric
Influenza Immunization in Infants and Children.
The course is intended for family physicians, general practitioners,
pediatricians, pediatric infectious disease physicians, and others
interested in lessening the burden of influenza in children. It is divided
into four topics: (1) influenza epidemiology and disease burden in
children; (2) safety, immunogenicity, and efficacy of influenza vaccine in
children; (3) ten tips to increase influenza vaccination rates in your
office; and (4) increasing pediatric immunization rates with influenza
vaccine clinics in a private practice.
The course is intended to be completed in two hours. For more information
and to begin the course, go to:
http://www.pedflumodels.com
A CD-ROM of the course is also available; to request one, call NFID at
(866) 686-6343 or send an email to
info@pedflumodels.com
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July 12, 2004
SAVE THE DATE: LIVE SATELLITE BROADCAST OF CDC'S IMMUNIZATION UPDATE 2004
IS SCHEDULED FOR AUGUST 19
The live satellite broadcast and webcast Immunization Update 2004 will
provide up-to-date information on the rapidly changing field of
immunization. As of today, the course instructors, final course content,
and webcast information have not been announced. "IAC EXPRESS" will notify
readers when more information is available.
Sponsored by CDC, the live broadcast is scheduled for August 19 from 9AM
to 11:30AM ET. It will be rebroadcast later in the day from noon to 2:30PM
ET. Both broadcasts will feature a live Q&A session in which participants
nationwide can interact with the course instructors via toll-free
telephone lines.
Following is the anticipated course content: new recommendations for
influenza vaccine, including routine vaccination of children ages 6-23
months and expanded use of live attenuated intranasal vaccine;
pneumococcal conjugate vaccine shortage; varicella vaccine; and vaccine
safety issues.
The program's intended audience includes physicians, nurses, nurse
practitioners, physician assistants, Department of Defense
paraprofessionals, pharmacists, and their colleagues who either administer
vaccines or set policy for their offices, clinics, or communicable disease
or infection control programs. Private and public health care providers,
including pediatricians, family physicians, residents, and medical and
nursing students are encouraged to participate.
Registration will begin July 22. To register and receive continuing
education credits, you must register online on the Public Health Training
Network website at
http://www.phppo.cdc.gov/phtnonline
Pharmacists can earn continuing education credit through their own online
learning system. To register, pharmacists should go to:
http://www.pharmacist.com
For additional information, go to
http://www.cdc.gov/nip/ed/_satellite_broadcasts.htm#2, email
ce@cdc.gov or call (800) 418-7246.
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July 12, 2004
CDC REPORTS A FOURTH DEATH LINKED TO AN ORGAN TRANSPLANT DONOR INFECTED
WITH RABIES VIRUS
CDC published "Update: Investigation of Rabies Infections in Organ Donor
and Transplant Recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004"
in the July 9 issue of "MMWR Dispatch." CDC publishes the web-based "MMWR
Dispatch" only for the immediate release of important public health
information. The article will be published in a print issue of MMWR in the
future.
The July 9 "MMWR Dispatch" is reprinted below in its entirety, excluding
one reference.
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On July 1, 2004, CDC reported laboratory confirmation of rabies as the
cause of encephalitis in an organ donor and three organ recipients at
Baylor University Medical Center (BUMC) in Dallas, Texas. Hospital and
public health officials in Alabama, Arkansas, Oklahoma, and Texas
initiated public health investigations to identify donor and recipient
contacts, assess exposure risks, and provide rabies postexposure
prophylaxis (PEP). As of July 9, PEP had been initiated in approximately
174 (19%) of 916 persons who had been assessed for exposures to the organ
recipients or the donor. As a result of its public health investigation,
the Arkansas Department of Health determined that the donor had reported
being bitten by a bat (Frank Wilson, MD, Arkansas Department of Health,
personal communication, 2004).
On July 7, CDC was notified of an additional organ transplant patient at
BUMC who had died of encephalopathy of unknown origin in early June. This
case was detected as part of an ongoing review of transplant-patient
autopsies. The patient, who had end-stage liver disease, had received a
liver transplant at BUMC in early May 2004. The patient remained
hospitalized with transplant-related complications and began having
neurologic abnormalities in early June, progressing to seizure, coma, and
death. On July 7, pathologists at BUMC identified intracytoplasmic
inclusions, suggestive of rabies, in neurons in multiple areas of the
brain.
Specimens from the recipient were sent to CDC on July 7, and direct
fluorescent antibody and immunohistochemical staining procedures confirmed
the presence of rabies viral antigens in multiple areas of the brain,
including the hippocampus, midbrain, pons, medulla, and cerebellum.
Similar to the findings with the three previously known rabies-infected
transplant recipients, preliminary antigenic characterization of the agent
was consistent with a rabies virus variant associated with insectivorous
bats. On July 8, CDC laboratory testing of tissues and serum from the
donor who provided the liver yielded no evidence of infection with rabies
virus.
Review of surgical procedures at BUMC determined that a segment of iliac
artery recovered from the donor subsequently determined to have rabies had
been stored at the facility for future use in liver transplants. This
artery segment subsequently was used in the transplantation of the liver
in the most recently identified rabies-infected recipient. Investigation
of rabies transmission sources is ongoing, although current evidence
suggests that the artery segment originating from the rabies-infected
donor likely is the source of the latest rabies infection. Identification
of contacts of this liver recipient is under way, and initiation of PEP
when indicated or as appropriate is in progress.
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To access a web-text (HTML) version of the "MMWR Dispatch," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm53d709.htm
To access a ready-to-copy (PDF) version of it, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm53d709.pdf
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July 12, 2004
CDC PUBLISHES HARD COPY OF JULY 2 ELECTRONIC ARTICLE ON RABIES
TRANSMISSION THROUGH SOLID ORGAN TRANSPLANTATION
CDC published "Investigation of Rabies Infections in Organ Donor and
Transplant Recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004" in
the July 9 issue of MMWR. Originally published July 2 in the web-based "MMWR
Dispatch," the article has not been available in hard-copy format until
now.
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a6.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5326.pdf
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July 12, 2004
REPORT DISCUSSES THE ROLE COMMUNICATION PLAYS IN STRENGTHENING
IMMUNIZATION PROGRAMS IN DEVELOPING COUNTRIES
"Strengthening Immunization Programs: The Communication Component" was
published in May 2004 by the Basic Support for Institutionalizing Child
Survival Project (BASICS II) for the United States Agency for
International Development (USAID). The 36-page report is available in
English and French.
According to its abstract, the report "provides an overview of
immunization communication and describes how to maximize its contribution
to immunization programs in developing countries. The discussion and
examples focus on communication's place within immunization planning,
activities, and partnerships, based on lessons learned from
behavior-centered analyses and programming. A detailed case study of
Madagascar's immunization communication activities is provided as an
example of country implementation."
To access a web-text (HTML) version of the report in English, go to:
http://www.basics.org/publications/abs/abs_StrengtheningImmunization.html
To access it in French, go to:
http://www.basics.org/publications/abs/abs_StrengtheningImmunizationFR.html
For other useful documents and tools in immunization and other child
survival interventions, visit the BASICS II website at
http://www.basics.org |
