Issue
Number 486
October 20, 2004
CONTENTS OF THIS ISSUE
- Tune in tonight: "60 Minutes Wednesday" will air its report on
parents' concerns about vaccine safety
- New: CDC issues interim chemoprophylaxis and treatment guidelines for
influenza antiviral medications
- Updated: CDC expands information about LAIV and those who should
receive influenza vaccine in the 2004-05 season
- New: DHHS issues press release about supply of influenza vaccine and
antiviral medications
- CDC adds influenza-associated mortality among children <18 years of
age to the list of nationally notifiable diseases
- Use IAC's adult immunization record card to educate adult patients
about their lifelong need for vaccination
- CDC reports Hispanic persons ages 19-35 months and >=65 years lag
non-Hispanic white persons in receiving vaccinations
- CDC's "Influenza" web section begins posting the "Weekly Report:
Influenza Summary Update" for the 2004-05 season
- Mark your calendar: Day-long symposium on eliminating disparities in
adult immunization scheduled for October 28
- New: October issue of IAC's "HEP EXPRESS" electronic newsletter now
online
----------------------------------------------------------
Back to Top
---------------------------------------------------------------
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.
---------------------------------------------------------------
(1 of 10)
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
---------------------------------------------------------------
Back to Top
(2 of 10)
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
***********************
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.
- 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.
- 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).
***********************
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
---------------------------------------------------------------
Back to Top (3 of 10)
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."
---------------------------------------------------------------
Back to Top (4 of 10)
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.
*********************
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. . . .
*********************
To access a web-text (HTML) version of the entire press release, go to:
http://www.hhs.gov/news/press/2004pres/20041019a.html
---------------------------------------------------------------
Back to Top (5 of 10)
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.
***********************
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.
***********************
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
---------------------------------------------------------------
Back to Top (6 of 10)
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.)
---------------------------------------------------------------
Back to Top (7 of 10)
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.
***********************
[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. . . .
***********************
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
---------------------------------------------------------------
Back to Top (8 of 10)
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.
---------------------------------------------------------------
Back to Top (9 of 10)
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
---------------------------------------------------------------
Back to Top (10 of 10)
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 |
