Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 486            October 20, 2004

CONTENTS OF THIS ISSUE

  1. Tune in tonight: "60 Minutes Wednesday" will air its report on parents' concerns about vaccine safety
  2. New: CDC issues interim chemoprophylaxis and treatment guidelines for influenza antiviral medications
  3. Updated: CDC expands information about LAIV and those who should receive influenza vaccine in the 2004-05 season
  4. New: DHHS issues press release about supply of influenza vaccine and antiviral medications
  5. CDC adds influenza-associated mortality among children <18 years of age to the list of nationally notifiable diseases
  6. Use IAC's adult immunization record card to educate adult patients about their lifelong need for vaccination
  7. CDC reports Hispanic persons ages 19-35 months and >=65 years lag non-Hispanic white persons in receiving vaccinations
  8. CDC's "Influenza" web section begins posting the "Weekly Report: Influenza Summary Update" for the 2004-05 season
  9. Mark your calendar: Day-long symposium on eliminating disparities in adult immunization scheduled for October 28
  10. New: October issue of IAC's "HEP EXPRESS" electronic newsletter now online

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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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October 20, 2004
TUNE IN TONIGHT: "60 MINUTES WEDNESDAY" WILL AIR ITS REPORT ON PARENTS' CONCERNS ABOUT VACCINE SAFETY

CBS's "60 Minutes Wednesday" will air its investigation into parents' concerns about vaccine safety, tonight, October 20, at 8PM ET. In the report "The Vaccine Question," correspondent Dan Rather will discuss the current rise in pertussis cases and examine claims that childhood vaccines can cause autism and other medical disorders. For more information, go to: http://www.cbsnews.com/stories/1999/05/24/60II/main48284.shtml
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October 20, 2004
NEW: CDC ISSUES INTERIM CHEMOPROPHYLAXIS AND TREATMENT GUIDELINES FOR INFLUENZA ANTIVIRAL MEDICATIONS

On October 18, CDC issued a three-page document, "Influenza Antiviral Medications: 2004-05 Interim Chemoprophylaxis and Treatment Guidelines." It is reprinted below in its entirety.

CDC also issued related web-based resources for health professionals concerning the indications for using antiviral agents for influenza, dosage, pharmacokinetics, side effects, antiviral-drug-resistant strains of influenza, and background information. Some information about antiviral drugs is also included for the public. To access these resources, go to: http://www.cdc.gov/flu/professionals/treatment/index.htm

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Guidelines & Recommendations
October 18, 2004

INFLUENZA ANTIVIRAL MEDICATIONS: 2004-05 INTERIM CHEMOPROPHYLAXIS AND TREATMENT GUIDELINES

Influenza antiviral medications are an important adjunct to influenza vaccine in the prevention and treatment of influenza. In the setting of the current vaccine shortage, CDC has developed interim recommendations on the use of antiviral medications for the 2004-05 influenza season. These interim recommendations are provided, in conjunction with previously issued recommendations on use of vaccine, to reduce the impact of influenza on persons at high risk for developing severe complications secondary to infection. The recommendations are not intended to guide the use of these medications in other situations, such as outbreaks of avian influenza. These interim recommendations may be updated as more information on the supply of influenza vaccine and antiviral medications becomes available.

Background

Influenza antiviral medications have long been used to limit the spread and impact of institutional influenza outbreaks. They also are used for treatment and chemoprophylaxis of persons in other settings. In the United States, four antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved for treatment of influenza, though limited supplies of zanamivir are currently available. When used for treatment within the first two days of illness, all four antiviral medications are similarly effective in reducing the duration of illness by one or two days. Only three antiviral medications (amantadine, rimantadine, and oseltamivir) are approved for chemoprophylaxis of influenza. More detailed information about each medication, including dosage and approved persons for use, may be found at http://www.cdc.gov/flu/professionals/treatment

2004-05 Antiviral Medications Usage Guidelines

CDC is issuing interim recommendations for the use of antiviral medications during the 2004-05 season. Local availability of these medications may vary from community to community, which could impact how these medications should be used.

(1) CDC encourages the use of amantadine or rimantadine for chemoprophylaxis and use of oseltamivir or zanamivir for treatment as supplies allow, in part to minimize the development of adamantane resistance among circulating influenza viruses.

(2) People who are at high risk of serious complications from influenza may benefit most from antiviral medications. Therefore, in general, people who fall into these high-risk groups should be given priority for use of influenza antiviral medications:

Treatment

  • Any person experiencing a potentially life-threatening influenza-related illness should be treated with antiviral medications.
  • Any person at high risk for serious complications of influenza and who is within the first 2 days of illness onset should be treated with antiviral medications. (Pregnant women should consult their primary provider regarding use of influenza antiviral medications.)

Rimantadine is not approved for treatment of children aged <13 years. For treatment, these persons should receive amantadine (children aged 1-12), oseltamivir (children aged 1-12), or zanamivir (children aged 7-12).

Chemoprophylaxis

  • All persons who live or work in institutions caring for people at high risk of serious complications of influenza infection should be given antiviral medications in the event of an institutional outbreak. This includes nursing homes, hospitals, and other facilities caring for persons with immunosuppressive conditions, such as HIV/AIDS. When vaccine is available, vaccinated staff require chemoprophylaxis only for the 2-week period following vaccination. Vaccinated and unvaccinated residents should receive chemoprophylaxis for the duration of institutional outbreak activity. Rapid tests or other influenza tests should be used to confirm influenza as the cause of outbreaks as soon as possible. However, treatment and chemoprophylaxis should be initiated if influenza is strongly suspected and test results are not yet available. Other outbreak control efforts such as cohorting of infected persons, and the practice of respiratory hygiene and other measures also should be implemented. For further information on detection and control of influenza outbreaks in acute-care facilities, see http://www.cdc.gov/ncidod/hip/infect/flu_acute.htm
  • All persons at high risk of serious influenza complications should be given antiviral medications if they are likely to be exposed to others infected with influenza. For example, when a high-risk person is part of a family or household in which someone else has been diagnosed with influenza, the exposed high-risk person should be given chemoprophylaxis for 7 days.

(3) Antiviral medications can be considered in other situations when the available supply of such medications is locally adequate.

  • Chemoprophylaxis of persons in communities where influenza viruses are circulating, which typically lasts for 6-8 weeks:
    • Persons at high risk of serious complications who are not able to get vaccinated.
    • Persons at high risk of serious complications who have been vaccinated but have not had time to mount an immune response to the vaccine. In adults, chemoprophylaxis should occur for a period of 2 weeks after vaccination. In children aged <9 years, chemoprophylaxis should occur for 6 weeks after the first dose, or 2 weeks after the second dose, depending on whether the child is scheduled to receive one or two doses of vaccine.
    • Persons with immunosuppressive conditions who are not expected to mount an adequate antibody response to influenza vaccine.
    • Health-care workers with direct patient care responsibilities who are not able to obtain vaccine.
  • Treatment of infected adults and children aged >1 year who do not have conditions placing them at high risk for serious complications secondary to influenza infection.

(4) Where the supplies of both influenza vaccine and influenza antiviral medications may not be sufficient to meet demand, CDC does not recommend the use of influenza antiviral medications for chemoprophylaxis of non-high-risk persons in the community.

Private Sector Sources of Influenza Antiviral Medications

Pharmaceutical distributors should be contacted directly for availability and procurement of antiviral medications.

Strategic National Stockpile

The United States has a limited supply of influenza antiviral medications stored in the Strategic National Stockpile [SNS] for emergency situations. Efforts are underway by Health and Human Services to procure additional supplies of antiviral medications. Some of the supply will be held in reserve in the event of an influenza pandemic. However, some of the supply will be made available to States and Territories for use in outbreak settings, as might occur in a hospital or long term-care facility.

Requesting Influenza Antiviral Medications from the SNS

Influenza antiviral medications in the SNS can be requested only by State or Territory Health Departments. Institutions (hospitals or long-term care facilities) experiencing an urgent need for such medications should convey their request to the State or Territory Health Department.

  1. The State or Territory Health Department should call (770) 488-7100, the CDC 24/7 emergency number, to make a request for antiviral medications. A logistics plan is being drafted and will be available to all State and Territorial Health Departments in the near future.
  2. The State or Territory Health Department should indicate that there is an urgent priority use situation (as defined previously) that can be addressed by use of antiviral medications, and should indicate that all reasonable efforts have been made to procure influenza antiviral medications from private distributors.

For more information, visit http://www.cdc.gov/flu or call the National Immunization Hotline at (800) 232-2522 (English), (800) 232-0233 (Espanol), or (800) 243-7889 (TTY).

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To access a web-text (HTML) version of the guidelines, go to:
http://www.cdc.gov/flu/professionals/treatment/0405antiviralguide.htm

To access a ready-to-print (PDF) version of them, go to:
http://www.cdc.gov/flu/professionals/pdf/0405antiviralguide.pdf
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October 20, 2004
UPDATED: CDC EXPANDS INFORMATION ABOUT LAIV AND THOSE WHO SHOULD RECEIVE INFLUENZA VACCINE IN THE 2004-05 SEASON

On October 19, CDC updated its "Influenza" web section. "Questions & Answers: 2004-05 Flu Season" now offers expanded information about the use of live attenuated influenza vaccine (LAIV) and about the groups for whom influenza vaccine is recommended.

To access the updated information, go to: http://www.cdc.gov/flu/about/qa/0405season.htm Scroll down to the subhead titled "Vaccination."
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October 20, 2004
NEW: DHHS ISSUES PRESS RELEASE ABOUT SUPPLY OF INFLUENZA VACCINE AND ANTIVIRAL MEDICATIONS

On October 19, the Department of Health and Human Services (DHHS) issued a press release, "HHS Says Supply of Flu Vaccines, Medicines Will Help Keep People Safe During the Coming Flu Season." The opening two paragraphs are reprinted below.

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For immediate release
October 19, 2004

HHS SAYS SUPPLY OF FLU VACCINES, MEDICINES WILL HELP KEEP PEOPLE SAFE DURING THE COMING FLU SEASON: Department Stockpiles Medicines, Coordinates Flu Response, Invests in New Technology

HHS Secretary Tommy G. Thompson said today that about 60 million doses of influenza vaccine combined with an ample supply of antiviral medicines--potentially enough for more than 40 million people during the flu season--puts America in a strong position to keep people safe during the upcoming flu season.

Secretary Thompson said the nation's cache of vaccine and medicines includes an additional 2.6 million doses of influenza vaccine that Aventis said today it will make available in January. The Centers for Disease Control and Prevention (CDC) also issued today interim guidance on the use of antiviral medicines for preventing and treating the flu. In addition, the formalization of a federal government task force will help ensure an ongoing coordinated effort to manage the supply of medicine and prevent price gouging. . . .

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To access a web-text (HTML) version of the entire press release, go to: http://www.hhs.gov/news/press/2004pres/20041019a.html
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October 20, 2004
CDC ADDS INFLUENZA-ASSOCIATED MORTALITY AMONG CHILDREN <18 YEARS OF AGE TO THE LIST OF NATIONALLY NOTIFIABLE DISEASES

CDC published "Notice to Readers: Mid-Year Addition of Influenza-Associated Pediatric Mortality to the List of Nationally Notifiable Diseases, 2004" in the October 15 issue of MMWR. The notice is reprinted below in its entirety, excluding references.

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Beginning October 1, 2004, CDC added influenza-associated pediatric mortality (i.e., among persons aged <18 years) to the list of conditions voluntarily reportable to the National Notifiable Diseases Surveillance System (NNDSS). This action is based on recommendations developed collaboratively by the Council of State and Territorial Epidemiologists (CSTE) and CDC and approved at the 2004 CSTE annual meeting. The goals of surveillance and recommended methods for surveillance are described in the 2004 CSTE position statement for influenza-associated pediatric mortality. The CSTE-recommended public health surveillance case definition for this condition has been added to the NNDSS case definitions website.

States may begin reporting data for this condition in week 40 (week ending October 9, 2004). The results will be published in the MMWR Table I beginning the week ending October 16, 2004. Each week, MMWR Table I presents updated cumulative year-to-date incidence for low-incidence nationally notifiable diseases.

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To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5340a8.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5340.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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October 20, 2004
USE IAC'S ADULT IMMUNIZATION RECORD CARD TO EDUCATE ADULT PATIENTS ABOUT THEIR LIFELONG NEED FOR VACCINATION

Many of your adult patients probably don't realize they may need to receive one or more vaccinations in the near future. If you're looking for an easy, effective, and economical way to educate them, you should consider using IAC's Adult Immunization Record Card.

EASY
Succinct and focused, the record card is a superb educational and motivational tool to use with adults. It lists seven vaccines that all adults or certain adults should receive. Use it during patient encounters to make the point that vaccine-preventable diseases still exist in the United States and have serious health consequences for adults as well as children.

Then discuss the patient's vaccination status with them and suggest vaccinations they might need. Administer the needed vaccines, if possible, or get the patient to commit to making an appointment to receive them. Jot down the patient's next vaccination due dates on the record card, and give the card to the patient. Encourage them to refer to it to find out when they're due for their next Td booster, a pneumococcal vaccine dose, or other vaccination.

In a matter of minutes, you've educated your patient about their lifelong need for vaccination, discussed their particular situation, and given them a way to remember which vaccines they need and when.

EFFECTIVE
The adult immunization record card must work: Since introducing it in May 2002, IAC has filled orders for more than 2.1 million cards. Health care providers across the nation are ordering and using it.

In addition, we have every reason to believe that patients are using it as well. Printed on rip-proof, smudge-proof, waterproof paper, the card is virtually indestructible. In addition it is sized to fit in a wallet, where it's unlikely to be misplaced. And its bright yellow color makes it hard to miss. Once you give one to a patient, chances are good the patient will retain it and refer to it.

ECONOMICAL
The cost for one 250-count box is $30; two boxes (500 cards), $55; three boxes (750 cards), $75; four boxes (1,000 cards), $90. That is a remarkable price for a tool that can educate and motivate an adult patient to engage in a lifesaving preventive act over the course of a lifetime.

Additional pricing for larger quantities can be found on the online order form (see link below). NOTE: THE FIRST ORDER OF A 250-CARD BOX COMES WITH A 30-DAY MONEY-BACK GUARANTEE.

To order IAC's Adult Immunization Record Cards online (including online with a purchase order), go to:
https://www.immunize.org/adultizcards

To print an order form to send with payment information by fax or mail, go to:
http://www.immunize.org/adultizcards/izorder.pdf

If you have questions about IAC's Adult Immunization Record Card, call us at (651) 647-9009, or email us at admin@immunize.org (Use the same email address to receive sample cards.)
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October 20, 2004
CDC REPORTS HISPANIC PERSONS AGES 19-35 MONTHS AND >=65 YEARS LAG NON-HISPANIC WHITE PERSONS IN RECEIVING VACCINATIONS

CDC published "Health Disparities Experienced by Hispanics--United States" in the October 15 issue of MMWR. Portions of the article are reprinted below.

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[From the article text]
In the 2000 census, 35.3 million persons in the United States and 3.8 million persons in the Commonwealth of Puerto Rico identified themselves as Hispanic (i.e., Hispanic, Spanish, or Latino; of all races). Hispanics constituted 12.5% of the U.S. population in the 50 states . . . For certain health conditions, Hispanics bear a disproportionate burden of disease, injury, death, and disability when compared with non-Hispanic whites . . . . This week's MMWR is the second in a series focusing on racial/ethnic health disparities; eliminating these disparities will require culturally appropriate public health initiatives, community support, and equitable access to quality health care. . . .

Despite recent progress, ethnic disparities persist among the leading indicators of good health identified in the national health objectives for 2010. Hispanics or Hispanic subpopulations trailed non-Hispanic whites in various measures, including . . . children aged 19-35 months who are fully vaccinated (73% versus 78%, 2002) and adults aged >=65 years vaccinated against influenza (49% versus 69%, 2002) and pneumococcal disease (28% versus 60%, 2002) during the preceding 12 months. . . .

In addition, since the 1970s, ethnic disparities in measles-vaccine coverage during childhood and in endemic measles have been all but eliminated; however, during 1996-2001, the vaccination-coverage gap between non-Hispanic white and Hispanic children widened by an average of 0.5% each year for children aged 19-35 months who were up to date for the 4:3:1:3:3 series of vaccines recommended to prevent diphtheria, tetanus, and pertussis; polio; measles; Haemophilus influenzae type b disease; and hepatitis B. . . .

[From the Editorial Note]
For Hispanics in the United States, health disparities can mean decreased quality of life, loss of economic opportunities, and perceptions of injustice. For society, these disparities translate into less than optimal productivity, higher health care costs, and social inequity. By 2050, an estimated 102 million Hispanics will reside in the United States, nearly 24.5% of the total U.S. population. If Hispanics experience poorer health status, this expected demographic change will magnify the adverse economic, social, and health impact of such disparities in the United States. . . .

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5340a1.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5340.pdf
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October 20, 2004
CDC'S "INFLUENZA" WEB SECTION BEGINS POSTING THE "WEEKLY REPORT: INFLUENZA SUMMARY UPDATE" FOR THE 2004-05 SEASON

CDC collects surveillance data year-round and reports on U.S. influenza activity each week from October through May in its "Weekly Report: Influenza Summary Update." For the 2004-05 influenza season, each Weekly Report will include these components: a synopsis, laboratory surveillance, pneumonia and influenza (P&I) mortality surveillance, influenza-associated pediatric mortality, influenza-associated pediatric hospitalizations, influenza-like illness (ILI) surveillance, and influenza activity as assessed by state and territorial epidemiologists.

To access Weekly Reports for the 2004-05 influenza season, as well as reports from previous seasons, go to: http://www.cdc.gov/flu/weekly/fluactivity.htm This link will also give you access to a U.S. map showing current influenza activity and to websites that contain international influenza surveillance data.
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October 20, 2004
MARK YOUR CALENDAR: DAY-LONG SYMPOSIUM ON ELIMINATING DISPARITIES IN ADULT IMMUNIZATION SCHEDULED FOR OCTOBER 28

Achieving Immunizations for All: Eliminating Adult Immunization Disparities, a free day-long symposium, will be held October 28 at the National Center for Primary Care (NCPC), Morehouse School of Medicine, Atlanta. Dr. David Satcher, NCPC director and former U.S. surgeon general, will give the opening presentation.

Experts from CDC, academic health centers, and community-based programs will share ideas and solutions for issues associated with adult immunization. The symposium is intended for community health care providers and professionals specializing in adult immunization and public health.

To download a symposium registration form, go to:
http://www.msm.edu/Immunization_Symposium/Registration%20Form.pdf

For additional information about the symposium, go to:
http://www.msm.edu/Immunization_Symposium/immunization.htm or call (404) 756-8908.

For information about NCPC, go to:
http://www.msm.edu/NCPC2003/index.html
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October 20, 2004
NEW: OCTOBER ISSUE OF IAC'S "HEP EXPRESS" ELECTRONIC NEWSLETTER NOW ONLINE

The October 13 issue of "HEP EXPRESS," an electronic newsletter published by IAC, is now available online. "HEP EXPRESS" is intended for health and social service professionals involved in the prevention and treatment of viral hepatitis. The October 13 issue includes articles on the following:

  • CDC's newly released Hepatitis Surveillance Report No. 59
     
  • CDC and WHO's response to a journal article on hepatitis B vaccine and multiple sclerosis
     
  • IAC's revision of three education brochures related to viral hepatitis
     
  • CDC's expansion of its Web resources on hepatitis C and injection drug use
     
  • A hepatitis task force's website launch

To access the October 13 issue, go to:
http://www.hepprograms.org/hepexpress/issue22.asp

To sign up for a free subscription to "HEP EXPRESS," go to:
http://www.hepprograms.org/hepexpress/signup.asp

To access previous issues of "HEP EXPRESS," go to:
http://www.hepprograms.org/hepexpress/index.asp

 

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 October 20, 2004