Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 490            November 8, 2004

CONTENTS OF THIS ISSUE

  1. Immunization community mourns the death of Dr. John LaMontagne, NIAID deputy director
  2. Clinician alert: Take time today to register for CDC's Influenza Update Net Conference
  3. IFAS and CDC educate patients and professionals about pneumococcal disease and vaccine
  4. Don't miss out: Order IAC's "Adults Only Vaccination" kit while supplies last
  5. CDC continues to update its Web materials related to the current influenza vaccine shortage
  6. 2003 influenza and pneumococcal vaccination rates for elderly and some high-risk persons fell short of national objectives
  7. CDC reports 89% decrease in acute hepatitis B infection among U.S. children and adolescents during 1990-2002
  8. National Influenza Vaccine Summit's home page offers broad overview of current and ongoing influenza-vaccination issues
  9. CDC reports on reasons Medicare beneficiaries age >=65 years failed to receive influenza vaccination during 1991-2002

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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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November 8, 2004
IMMUNIZATION COMMUNITY MOURNS THE DEATH OF DR. JOHN LAMONTAGNE, NIAID DEPUTY DIRECTOR

John R. LaMontagne, PhD, deputy director of the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH), died suddenly in Mexico City on November 2, 2004. He was 61. Excerpts from a statement released by NIH follow.

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"All of us are profoundly saddened by the loss of John LaMontagne," said NIAID Director Anthony S. Fauci, MD. "Personally, he was a dear friend and one of the finest people I have ever known. Professionally, in an NIH career spanning nearly 30 years, his leadership and commitment to improving global health were remarkable. His generosity, wit, even-handedness, and kindness made him a friend to all who knew him. He will be sorely missed. . . ."

Dr. LaMontagne, a native of Mexico City, Mexico, received his PhD from Tulane University in 1971. In 1976, he came to NIH as the influenza program officer at the NIAID. He became the program officer for the Viral Vaccines Program in 1983, and the influenza and viral respiratory diseases program officer in 1984. Beginning in 1986, Dr. LaMontagne assumed the role of director of the AIDS Program. In 1987 he was appointed director of the Microbiology and Infectious Diseases Program, which became a division in 1988. Dr. LaMontagne was appointed deputy director of the NIAID in February 1998.

Dr. LaMontagne made significant contributions to the national and international effort against emerging and re-emerging infectious diseases, including biodefense-related activities, and has been recognized internationally for his leadership in this area. He played a central role in the organization of the Multilateral Initiative on Malaria, an international effort involving research, control, and development agencies from the U.S., Europe, and Africa. In addition, he served as a member of the Scientific Advisory Groups of Experts on Vaccines and Biologicals as well as for Vaccines and Immunization for the World Health Organization. He chaired the WHO Task Force on Strategic Planning for the Children's Vaccine Initiative, advised the Pan American Health Organization on their programs in vaccine research implementation, and served as a member of the board of the Global Alliance for Tuberculosis Drug Development. Dr. LaMontagne also served as a member of the Biomedical Research Confederation Executive Steering Committee at Ft. Detrick, Maryland, and as co-chair of the Research and Development Gaps Working Group, a component of the Weapons of Mass Destruction Subcommittee of the National Science and Technology Council. His outstanding administrative leadership at NIH included membership on the NIH Community Advisory Board for Security and the recently formed NIH Ethics Advisory Committee.

As an influential contributor to the field of infectious diseases, Dr. LaMontagne delivered numerous major lectures all over the world. He received many prestigious awards for his scientific accomplishments, including the PHS Special Recognition Award for leadership in childhood vaccine research programs, the Surgeon General's Certificate of Appreciation, the Presidential Meritorious Executive Rank Award, the Distinguished Executive Award for his work in the areas of infectious diseases research of global health relevance, the Secretary's Award for Distinguished Service for leadership of acellular pertussis vaccine trials, and most recently the Secretary's Award for Distinguished Service for design and implementation of critically important biodefense strategies.

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To access the entire statement, go to:
http://www2.niaid.nih.gov/newsroom/releases/lamontagne.htm
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November 8, 2004
CLINICIAN ALERT: TAKE TIME TODAY TO REGISTER FOR CDC'S INFLUENZA UPDATE NET CONFERENCE

Scheduled for November 19 from 12PM to 1PM (ET), the next Influenza Update Net Conference will provide clinicians with the most up-to-date information on influenza. This is a limited-registration event; registration closes November 18 at midnight (ET) or when the course is full. Don't be disappointed, register NOW by going to http://www2.cdc.gov/nip/isd/fluconference

The conference presenters are immunization experts from CDC; the conference agenda follows:

  • Introduction by moderator Dr. William Atkinson
  • Influenza Vaccine Supply Update by Dr. Ray Strikas
  • Antiviral Medications for Influenza by Dr. Tim Uyeki
  • Infection Control Measures to Prevent Influenza Transmission by Dr. Arjun Srinivasan

The program will combine a telephone audio conference with simultaneous online visual content. It will include a Q&A session, accessible by telephone and Internet. Internet access and a separate phone line are needed to participate. For more information, see Instructions and System Requirements at http://www.cdc.gov/nip/ed/ciinc/instructions.htm

Graphics will be available to download as a PowerPoint file after the presentations. A replay of the web cast will be available within 24 hours of the conference.

For additional information, go to:
http://www.cdc.gov/flu/professionals/training/novnetconf.htm

If you have questions, direct them to Clinician Outreach and Communication Activity at COCA@cdc.gov
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November 8, 2004
IFAS AND CDC EDUCATE PATIENTS AND PROFESSIONALS ABOUT PNEUMOCOCCAL DISEASE AND VACCINE

The Institute for the Future of Aging Services (IFAS) and CDC have recently made patient- and professional-education material available on the topic of pneumococcal disease and pneumococcal polysaccharide vaccine (PPV23). With the current shortage of influenza vaccine, it is important that the public and health professionals realize the benefits of PPV23 for high-risk persons. In addition to reducing the risk for invasive pneumococcal disease, PPV23 also reduces complications of influenza infection. CDC estimates that supplies of the vaccine are adequate to meet expected demand.

IFAS PATIENT-EDUCATION BROCHURE
IFAS's patient-education brochure, "Pneumococcal Disease: Learn about how you can protect yourself from a leading killer of older people," urges older adults to receive PPV23. In addition to discussing the vaccine, the brochure describes the disease, its associated health risks, and the steps older people can take to prevent it.

To access a ready-to-print (PDF) version of it, go to:
http://www.futureofaging.org/PublicationFiles/Pneumonia.pdf

For additional information, contact Natasha Bryant by phone at (202) 508-1214 or by email at nbryant@aahsa.org

CDC'S WEB-BASED RESOURCES FOR PATIENTS AND PROFESSIONALS
A gateway to a broad array of materials for patients and professionals, CDC's "Pneumococcal Disease" web section directs users to a bi-lingual (English-Spanish) patient-education brochure, the ACIP recommendations, the Pink Book, the VIS for PPV23, and much more.

To access the "Pneumococcal Disease" web section, go to:
http://www.cdc.gov/nip/diseases/Pneumo/default.htm

PLEASE NOTE: The current VIS for PPV23 (dated 7/29/97) is available on the IAC website in eleven languages in addition to English. To access them, go to:
http://www.immunize.org/vis/index.htm#pneumococcal

For information about the use of VISs, and for VISs in a total of 32 languages, visit IAC's VIS web section at http://www.immunize.org/vis
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November 8, 2004
DON'T MISS OUT: ORDER IAC'S "ADULTS ONLY VACCINATION" KIT WHILE SUPPLIES LAST

In the past few weeks, IAC has received orders for substantial numbers of its immunization-delivery resource "Adults Only Vaccination: A Step-by-Step Guide" (the AOV kit). We have about 200 left and have no plans to produce more. If you want one (or more), place an order NOW! Ordering information is at the end of this article.

WHAT IS THE AOV KIT? IAC produced the kit to help health professionals in settings such as STD clinics, family planning clinics, college health services, OB/GYN practices, and prisons vaccinate their adult patients. The kit pares down immunization delivery to its essential components and presents each component in manageable, easy-to-master steps. The steps progress in logical order, starting with setting up a vaccine service at your site and ending with billing for the vaccine services you've delivered.

WHO NEEDS THE KIT? Designed to help integrate immunization services into sites new to vaccination, the AOV kit is equally valuable for settings experienced in vaccine delivery. Why? Because it puts ALL the information you need to vaccinate adults right at your fingertips. If you currently find any aspect of adult vaccination confusing, the kit will clarify the issue or give you resources for getting clarification. IF YOU VACCINATE ADULTS, YOU CAN'T AFFORD TO BE WITHOUT THE KIT.

WHAT'S IN THE KIT? The heart of the kit is the guide, which presents 157 pages of comprehensive, authoritative, CDC-reviewed information on ALL aspects of adult immunization. Organized into seven logically presented steps, the guide is designed to be useful and stay current for years: it has more than 45 patient and provider-education materials that will never go out of date because each is linked to the latest version on IAC's website.

Plus, the guide is tabbed for easy reference, spiral bound to lie flat, and plastic coated for durability. And, it has wide margins for jotting down practical information such as useful web and email addresses, ideas for improving certain aspects of vaccine delivery, etc. This allows you to customize your guide to suit your clinic or practice's unique needs.

In addition to the guide, the kit contains the following:

  • Two "how-to" instructional videos--"Immunization Techniques: Safe, Effective, Caring" (produced by California Distance Learning Health Network in 2001) and "How to Protect Your Vaccine Supply" (produced by CDC in 2004)
     
  • Standing orders protocols for administering eight vaccines commonly given to adults; these are indispensable for increasing your clinic or practice's adult immunization rates
     
  • Vital information for responding to vaccine-related medical emergencies, such as anaphylaxis, or to power outages
     
  • A pack of 25 adult immunization record cards

CAN I GET MORE INFORMATION ABOUT THE KIT? You can get complete information--including a look at the guide's many worksheets, checklists, protocols, and educational materials--by visiting IAC's website at http://www.immunize.org/guide

WHO SUPPORTS THE KIT? Immunization experts from NIP/CDC reviewed the kit. In addition, the following government agencies signed the guide's introductory letter: US Department of Health and Human Services (Women's Health); several divisions within CDC: the Division of HIV/AIDS Prevention, Division of Sexually Transmitted Diseases Prevention, and Division of Viral Hepatitis. The following professional organizations also signed the letter: the American College Health Association, American College of Obstetricians and Gynecologists, American Medical Association, National Medical Association, and Planned Parenthood Federation of America.

WHAT'S THE PRICE? The kit costs $75. Special discount pricing is available for orders of 10 copies or more (see the link below).

HOW CAN I ORDER THE KIT? You can order online or by fax or mail, using a credit card, purchase order, or check. To order, go to: http://www.immunize.org/guide Click on the appropriate link.
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November 8, 2004
CDC CONTINUES TO UPDATE ITS WEB MATERIALS RELATED TO THE CURRENT INFLUENZA VACCINE SHORTAGE

CDC recently updated its website with several new documents related to the influenza vaccine shortage. Following are links to the new information.

PROFESSIONAL INFORMATION
(1) The two-page flyer "Colleges and Universities: 2004-05 Influenza Season" is a collection of information and resources for college health services.

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/flu/school/pdf/college.pdf

To access a web-text (HTML) version, go to:
http://www.cdc.gov/flu/school/college.htm

(2) The three-page flyer "Questions and Answers: Information for Schools" is a collection of Q&As and resources for school administrators, teachers, staff, and parents.

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/flu/school/pdf/qa.pdf

To access a web-text (HTML) version, go to:
http://www.cdc.gov/flu/school/qa.htm

PATIENT INFORMATION
(3) The patient self-screening questionnaire "Patient Screening Form: Who Should and Who Should Not Get a Flu Shot?" is now available in Spanish: "Quien debe y quien no debe ponerse la vacuna contra la gripe?"

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/flu/professionals/flugallery/pdf/vaccinescreeningform-spa.pdf

(4) Two questions have been added to "Questions & Answers: The Disease." To access them, go to:
http://www.cdc.gov/flu/about/qa/disease.htm

(5) Two questions have been added to "Questions & Answers: Preventing the Flu." To access them, go to: http://www.cdc.gov/flu/about/qa/preventing.htm

(6) Patient information sheets are now available in Romanian. To access them, go to: http://www.cdc.gov/flu/languages.htm#rom
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November 8, 2004
2003 INFLUENZA AND PNEUMOCOCCAL VACCINATION RATES FOR ELDERLY AND SOME HIGH-RISK PERSONS FELL SHORT OF NATIONAL OBJECTIVES

CDC published "Influenza and Pneumococcal Vaccination Coverage Among Persons Aged >=65 Years and Persons Aged 18-64 Years with Diabetes or Asthma--United States, 2003" in the November 5 issue of MMWR. Portions of the article are reprinted below.

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[From the article]
Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy for preventing associated morbidity and mortality in the United States. Risk factors include older age and medical conditions that increase the risk for complications from infections. During the 1990-1999 influenza seasons, more than 32,000 deaths each year among persons aged >=65 years were attributed to complications from influenza infection. National health objectives for 2010 call for 90% influenza and pneumococcal vaccination coverage among noninstitutionalized persons aged >=65 years and 60% coverage among noninstitutionalized persons aged 18-64 years who have risk factors (e.g., diabetes or asthma) for complications from infections (objective nos. 14.29a-d). To estimate influenza and pneumococcal vaccination coverage among these populations, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that (1) influenza vaccination levels among adults aged 18-64 with diabetes or asthma, (2) pneumococcal vaccination levels among adults aged 18-64 years with diabetes, and (3) influenza and pneumococcal vaccination levels among adults aged >=65 years all were below levels targeted in the national health objectives for 2010. Moreover, vaccination coverage levels varied among states for both vaccines and both age groups. Innovative approaches and adequate, reliable supplies of vaccine are needed to increase vaccination coverage, particularly among adults with high-risk conditions. . . .

In 2003, of respondents aged >=65 years, influenza vaccination coverage levels during the preceding 12 months ranged from 34.9% [United States Virgin Islands (USVI)] to 80.3% (Minnesota), with a median of 69.9%. Among respondents aged >=65 years, the proportion reporting ever having received pneumococcal vaccine ranged from 31.6% (USVI) to 73.0% (Minnesota), with a median of 64.2%. Compared with 2002, a total of 41 and 38 states/areas experienced increases in influenza and pneumococcal coverage among those aged >=65 years, respectively; 11 of these increases were statistically significant for each vaccine.

Among adults aged 18-64 years with asthma or diabetes, substantial variation in vaccination coverage by area also was observed. For respondents with asthma, median influenza coverage was 34.0% and ranged from 22.5% (Puerto Rico) to 46.6% (Wyoming). Influenza vaccination rates among persons with asthma were higher among persons aged 50-64 years (median: 53.4%; range: 27.6%-74.9%) than among persons aged 18-49 years (median: 27.7%; range: 16.6%-41.1%). For respondents with diabetes, median influenza coverage was 49.0% and ranged from 26.5% (Puerto Rico) to 62.4% (South Dakota); the median pneumococcal coverage was 37.1% and ranged from 19.5% (Puerto Rico) to 58.2% (Montana). For persons with diabetes, vaccination rates were higher among those aged 50-64 years (for influenza, median: 56.5%; range: 23.7%-73.1% and for pneumococcal, median: 42.6%; range: 19.7%-68.1%) than among persons aged 18-49 years (for influenza, median: 37.8%; range: 22.2%-59.9% and for pneumococcal, median: 28.3%; range: 13.3%-56.7%).

[From the Editorial Note]
The findings in this report indicate an increase in influenza and pneumococcal vaccination coverage for the majority of areas from 2002 to 2003 among adults aged >=65 years; however, coverage among persons indicated for these vaccinations remains below the national health objectives for 2010. In addition, almost half of the states reported >50% influenza coverage levels for participants aged 18-64 years with diabetes; however, the median coverage level of influenza vaccination among participants with asthma and the median coverage level of pneumococcal vaccines among participants with diabetes were below the 2010 target of 60% for noninstitutionalized adults at high risk. Among respondents with asthma and diabetes, those aged 18-49 years had substantially lower vaccination coverage than those aged 50-64 years.

Lack of awareness of the need for vaccination is common among adults aged <65 years with high-risk conditions, such as diabetes or asthma. In a 2003 survey, approximately 75% of unvaccinated persons aged 18-64 years with diabetes reported that they were unaware of the need for influenza vaccine (CDC, unpublished data, 2003). Although use of preventive health services by adults with diabetes has increased since 1995, a substantial proportion of generalist and subspecialist physicians did not strongly recommend influenza and pneumococcal vaccinations to their patients who are elderly or at high risk. Low vaccination rates among persons with high-risk conditions might reflect the challenge of targeting patients for vaccinations on the basis of high-risk conditions instead of age. Although a majority of patients seen by subspecialists might be those who most need vaccination, subspecialists might not perceive the provision of preventive services as their role. Primary care physicians and subspecialists should work together to ensure that persons at high risk receive appropriate vaccinations. In addition, strategies to increase awareness among young adults of the need for vaccinations could be emphasized by diabetes- and asthma-care programs. The Diabetes Quality Improvement Project, a collaborative effort between public and private organizations to improve preventive care for persons with diabetes, has been ongoing since 1995; this effort is one possible reason for the higher influenza vaccination rates among those with diabetes compared with those with asthma. . . .

The variation in influenza and pneumococcal vaccination coverage observed among areas suggests that vaccination coverage can be improved. Previous studies have indicated that organizational changes, such as nurse standing orders, combined with teamwork and collaboration, are effective intervention measures for increasing adult vaccination services. Effective measures to promote the use of such measures are needed for vaccination rates to increase.

Because of the 2004 influenza vaccine shortage, vaccine providers have been asked to direct available inactivated influenza vaccine to persons with chronic conditions, such as diabetes and asthma, and other priority groups. Further analysis of influenza vaccine coverage data will be needed to assess the impact of this shortage on influenza vaccine coverage and efforts to redirect vaccine to persons at greatest risk for influenza complications. Ensuring adequate amounts of influenza vaccine is critical if vaccination rates of persons at high risk are to continue improving. Pneumococcal vaccine supplies appear to be adequate to meet expected demand. Pneumococcal vaccination should be encouraged for populations at high risk, both to reduce the risk for invasive pneumococcal disease itself and to reduce complications of influenza infection.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a2.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5343.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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November 8, 2004
CDC REPORTS 89% DECREASE IN ACUTE HEPATITIS B INFECTION AMONG U.S. CHILDREN AND ADOLESCENTS DURING 1990-2002

CDC published "Acute Hepatitis B Among Children and Adolescents--United States, 1990-2002" in the November 5 issue of MMWR. The article is reprinted below in its entirety, excluding references, two figures, and a table.

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Since the 1991 adoption of a comprehensive strategy to eliminate hepatitis B virus (HBV) transmission in the United States, the incidence of acute hepatitis B cases has declined steadily. Declines have been greatest among children born after the 1991 recommendations for universal infant hepatitis B vaccination were implemented. In 1995, the elimination strategy was expanded to include routine vaccination of all adolescents aged 11-12 years and, in 1999, to include children aged <18 years who had not been vaccinated previously. To describe the epidemiology of acute hepatitis B in children and adolescents in the United States, CDC analyzed notifiable disease surveillance data collected during 1990-2002 and data collected during 2001-2002 through enhanced surveillance of reported cases of acute hepatitis B in children born after 1990. This report summarizes the results of that analysis, which indicated that the rate of acute hepatitis B in children and adolescents decreased 89% during 1990-2002 and that racial disparities in hepatitis B incidence have narrowed. Many confirmed cases in persons born after 1990 occurred among international adoptees and other children born outside the United States. Continued implementation of the hepatitis B elimination strategy and accurate surveillance data to monitor the impact of vaccination are necessary to sustain the decline of acute hepatitis B among children.

Cases of acute hepatitis B were reported weekly to CDC by all 50 states and the District of Columbia. Acute hepatitis B rates were calculated per 100,000 population by using population denominators from the U.S. Census Bureau. Acute hepatitis B was defined as an acute illness with (1) discrete onset of symptoms and jaundice or elevated serum aminotransferase levels and (2) laboratory evidence of either IgM antibody to hepatitis B core antigen (IgM anti-HBc) or hepatitis B surface antigen (HBsAg). Since March 2001, CDC has conducted enhanced hepatitis B surveillance, contacting states to confirm all reported cases of acute hepatitis B in persons born after 1990. State surveillance staff members were asked to verify each of the items in the case definition and provide information regarding vaccination history and country of birth. If errors were identified during this process, states were asked to correct the information in an updated submission to CDC.

National Surveillance
During 1990-2002, a total of 13,829 cases of acute hepatitis B were reported in the United States among persons aged <=19 years. The incidence of reported cases declined steadily during this period, from 3.03 per 100,000 population in 1990 to 0.34 in 2002, representing a decline of 89%. The incidence among adolescents aged 15-19 years was consistently higher than the incidence among younger age groups, ranging from 8.69 per 100,000 population in 1990 to 1.13 in 2002. Children and adolescents in all age groups experienced steep declines in incidence during 1990-2002; incidence declined 94% among children aged 0-4 years, 92% among children aged 5-9 years, 93% among those aged 10-14 years, and 87% among adolescents aged 15-19 years.

Among children and adolescents aged <=19 years in 1990, incidence per 100,000 population was highest among Asian/Pacific Islanders (A/PIs) (6.74) and blacks (4.29); whites had the lowest race-specific incidence (1.39). Differences in incidence between whites and A/PIs and between whites and blacks were 5.34 and 2.90, respectively. From 1990 to 2002, rates declined 92% among A/PIs, 88% among whites, 88% among blacks, and 84% among American Indians/Alaskan Natives (AI/ANs). In 2002, the highest incidence per 100,000 population was among A/PIs (0.55), followed by blacks (0.51), AI/ANs (0.43), and whites (0.16); since 1990, differences in incidence between whites and A/PIs and whites and blacks declined by 93% and 88%, respectively.

Case Investigations
Follow-up investigations conducted by CDC and state and local health departments verified 19 case reports from 2001 and 2002 as cases of acute hepatitis B among children born after 1990. Of the verified case reports, 12 (60%) involved males, eight (42%) involved children aged <2 years, and 11 (58%) involved children born in the United States. Seven (37%) reported race as A/PI, five (26%) as white, four (21%) as black, and three (16%) as unknown. Eight (42%) cases were reported in children born outside the United States, including six international adoptees (32%). Receipt of >=1 dose of hepatitis B vaccine was confirmed in three (16%) cases. Vaccination status was unknown for 12 cases (63%).

Editorial Note:
The incidence of acute hepatitis B cases in U.S. children and adolescents decreased during the era of universal childhood vaccination. This decline coincided with an increase in hepatitis B vaccination coverage among children aged 19-35 months, from 16% in 1992 to 90% in 2002, and among adolescents aged 13-15, from nearly 0 in 1992 to 67% in 2002.

Declines in incidence were observed for children of all races, including A/PIs, whose rates historically have been higher than the national average. Because of the disproportionate burden of hepatitis B in A/PI communities, A/PI children were among the first groups for whom hepatitis B vaccination was recommended. The reduction of the disparity between A/PIs and other children is consistent with recent observations noting a decline in seroprevalence of HBV infection and successful implementation of routine hepatitis B vaccination among Asians who have recently immigrated to the United States. However, of the 11 verified cases during 2001-02 of acute hepatitis B among children born in the United States, three (27%) involved A/PIs. Although the national origins of these children's household members are unknown, the substantial proportion of A/PIs suggests that horizontal transmission of HBV among first-generation Asians might be a persistent problem.

The higher incidence among older adolescents (aged 15-19 years) likely is attributable to their having been born before universal infant hepatitis B vaccination was recommended in 1991. Incidence among older adolescents is expected to decline further as the vaccinated cohort ages and as 1999 recommendations to vaccinate all previously unvaccinated persons aged 0-18 years are fully implemented. The expected decline in rates among adolescents also might be augmented by laws in 32 states requiring proof of hepatitis B vaccination before entry into middle school.

Follow-up information obtained through surveillance of reported cases suggests that children born outside the United States, especially international adoptees, represent a substantial proportion of cases. Cases of acute hepatitis B among international adoptees might result from undervaccination and increased risk for exposure while living in areas with high prevalence of chronic HBV infection. International adoptees are exempt from U.S. regulations that bar entry to immigrants without documentation of hepatitis B vaccination. Studies have demonstrated that international adoptees exhibit low rates of protective titers of antibodies to vaccine-preventable diseases upon arrival in the United States, including adoptees with written evidence of age-appropriate vaccination provided by the birth country. Appropriate evaluation and remediation of the immunization status of international adoptees has been promoted through national guidelines; however, the extent to which these guidelines have been implemented is unknown.

Despite the decline in acute hepatitis B cases among children in the United States, the presence of confirmed cases highlights the importance of infant vaccination and timely completion of the 3-dose vaccination series. The vaccination series should be started at birth, preferably before the newborn is discharged from the hospital. Infants born to women who are HBsAg positive or who have not had prenatal HBsAg testing should receive the first dose of hepatitis B vaccine within 12 hours of birth. Beginning the vaccination series at birth decreases the risk for perinatal HBV transmission and predicts successful completion of the series.

Although enhanced surveillance data from verified case reports suggest that international adoptees and other children born outside the United States might particularly benefit from future prevention efforts, many case reports lacked risk factor information. As the incidence of acute hepatitis B among children and adolescents declines, accurate surveillance data become increasingly important to monitor the effect of immunization recommendations. Continued efforts of local, state, and national surveillance staff to improve data quality are critical to eliminating HBV transmission 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/mm5343a4.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5343.pdf
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November 8, 2004
NATIONAL INFLUENZA VACCINE SUMMIT'S HOME PAGE OFFERS BROAD OVERVIEW OF CURRENT AND ONGOING INFLUENZA-VACCINATION ISSUES

A partnership of more than 50 organizations cosponsored by CDC and the American Medical Association (AMA), the National Influenza Vaccine Summit offers health professionals an array of influenza-immunization resources on its home page. Located on the AMA website, the home page includes information from CDC/ACIP, the American Medical Association, PKIDS (Parents of Kids with Infectious Diseases), IAC, and other organizations. It also contains information about the summit's annual meetings.

To access the home page, go to:
http://www.ama-assn.org/ama/pub/article/1826-8377.html
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November 8, 2004
CDC REPORTS ON REASONS MEDICARE BENEFICIARIES AGE >=65 YEARS FAILED TO RECEIVE INFLUENZA VACCINATION DURING 1991-2002

CDC published "Influenza Vaccination and Self-Reported Reasons for Not Receiving Influenza Vaccination Among Non-Institutionalized Medicare Beneficiaries Aged >=65 Years--United States, 1991-2002" in the November 5 issue of MMWR. A summary made available to the press is reprinted below in its entirety.

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Annual influenza vaccination coverage among Medicare beneficiaries has been increasing since 1991, but increases are threatened by a lack of knowledge among the elderly about the benefits of the vaccine, as well as the potential for disruption in vaccine supplies. From 1991-2002, the Medicare Current Beneficiaries Survey (MCBS) shows a steady upward trend in influenza vaccination coverage among Medicare beneficiaries 65 years of age and older. The exception to this upward trend occurred during the 2000-2001 influenza season, in which vaccine distribution was delayed. Vaccine unavailability was reported as a reason for nonvaccination by respondents for the first time in 2000-2001. However, the most frequently cited survey reasons for not receiving influenza vaccine were not knowing that influenza vaccination was needed and concerns that vaccination might cause influenza or side effects, indicating that further efforts are needed to educate the elderly regarding the benefits of influenza vaccination.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a3.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5343.pdf

 

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 November 8, 2004