Issue
Number 511
February 14, 2005
CONTENTS OF THIS ISSUE
- ACIP recommends newly licensed meningococcal vaccine for
adolescents and college freshmen
- BRFSS data indicate influenza vaccine was given to
priority groups during the first part of the 2004-05 influenza season
- Act now: Free bulk copies of the latest issue of
"Vaccinate Adults" (October 2004) will go fast
- New: CMS has web resources for those who vaccinate
Medicare beneficiaries against influenza and pneumococcal disease
- CDC reports on a case of Japanese encephalitis in a U.S.
traveler returning from Thailand in 2004
- New conference listings: Adult immunization and health
promotion conferences are scheduled for March and May
- MMWR corrects errors in two recent issues
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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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February 14, 2005
ACIP RECOMMENDS NEWLY LICENSED MENINGOCOCCAL VACCINE FOR ADOLESCENTS AND
COLLEGE FRESHMEN
On February 10, NIP updated its website with information about ACIP's
recommendation regarding meningococcal conjugate vaccine. ACIP made the
recommendation during one of its regularly scheduled meetings, which was
held in Atlanta on February 10-11. The text of the information posted on the
NIP website is reprinted below in its entirety.
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February 10, 2005
MENINGOCOCCAL CONJUGATE VACCINE: MENINGOCOCCAL (GROUPS A, C, Y, AND W-135)
CONJUGATE VACCINE (MCV-4)
ACIP Recommends Meningococcal Vaccine for Adolescents and College Freshmen
The Advisory Committee on Immunization Practices (ACIP) to the Centers for
Disease Control and Prevention (CDC) this week recommended that children
11-12 and teens entering high school, as well as college freshman living in
dormitories, receive a newly licensed meningococcal vaccine.
Meningococcal disease is caused by bacteria that infect the bloodstream,
lining of the brain, and spinal cord, often causing serious illness. Every
year in the U.S., 1,400 to 2,800 people get meningococcal disease. Ten to 14
percent of people with meningococcal disease die, and 11-19 percent of
survivors have permanent disabilities (such as mental retardation, hearing
loss, and loss of limbs).
The disease often begins with symptoms that can be mistaken for common
illnesses, such as the flu. However, meningococcal disease is particularly
dangerous because it progresses rapidly and can kill within hours.
"Meningococcus is a serious disease that kills about 300 people each year in
the U.S. We are encouraged that today's ACIP recommendation will help to
prevent this potentially deadly disease among adolescents," said Dr. Stephen
Cochi, acting director of the National Immunization Program at CDC.
The ACIP has an existing recommendation for a routine doctor's visit for
11-12 year-olds, at which they may receive a tetanus-diphtheria booster
shot. With the new recommendation, 11-12 year-olds will also receive the
meningococcal vaccine at this routine visit. In order to foster the most
rapid reduction of meningococcal disease following this recommendation, the
committee also recommended that for the next 2-3 years teens entering high
school also be vaccinated. College freshman who live in dormitories are at
higher risk of meningococcal disease than other college students and should
also be vaccinated. Meningococcal vaccine may also be provided to college
students who do not live in dormitories and adolescents who want to reduce
their risk for meningococcal disease.
The vaccine is highly effective. However, it does not protect people against
meningococcal disease caused by "type B" bacteria. This type of bacteria
causes one-third of meningococcal cases. More than half of the cases among
infants aged <1 year are caused by "type B," for which no vaccine is
licensed or available in the United States. The new meningococcal vaccine
was licensed by the U.S. Food and Drug Administration (FDA) on January 14,
2005, for use in people 11-55 years of age. It is manufactured by sanofi
pasteur and is marketed as Menactra.
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To access NIP's web page about this recommendation, go to:
http://www.cdc.gov/nip/vaccine/meningitis/mcv4/mcv4_acip.htm
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February 14, 2005
BRFSS DATA INDICATE INFLUENZA VACCINE WAS GIVEN TO PRIORITY GROUPS DURING
THE FIRST PART OF THE 2004-05 INFLUENZA SEASON
On February 10, CDC issued two documents reporting on data collected by the
Behavioral Risk Factor Surveillance System (BRFSS) during the first three
weeks of January 2005. One document is a press release, which is reprinted
below in its entirety. The other is a five-page addition to the CDC
Influenza web section; a link to it is provided at the end of this article.
PRESS RELEASE
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For immediate release
February 10, 2005
CDC: INFLUENZA VACCINE WAS USED FOR PRIORITY GROUPS
Survey indicates vaccination rates are up for children 6 to 23 months
The Centers for Disease Control and Prevention (CDC) announced today that
influenza vaccine was used during the first part of the 2004-2005 flu season
to vaccinate those at highest risk of serious complications from influenza,
including young children, the elderly, those with chronic health conditions,
and healthcare workers.
Data collected during the first three weeks of January by the Behavioral
Risk Factor Surveillance System (BRFSS) indicated that 57.3 percent of
children aged six to 23 months were vaccinated during September through
December 2004, the first year that influenza vaccination was added to the
childhood immunization schedule. A 2002 survey indicated only 7.7 percent in
the same age group were vaccinated for influenza. Influenza vaccine has a
higher first-year vaccination coverage than the pneumococcal vaccine (PCV)
at 40.9 percent in 2002 or the varicella vaccine at 16 percent in 1996.
"It is wonderful news that so many children are being vaccinated against a
potentially life-threatening illness like influenza," said Dr. Julie
Gerberding, CDC director. "We must continue to urge parents to vaccinate
their children and urge those at high risk for serious complications from
influenza to step up and get vaccinated because the shot can save lives."
The BRFSS survey results show that influenza vaccination continued during
the month of December and was concentrated in the vaccination priority
groups outlined for the 2004-2005 season. Vaccination coverage among adults
in priority groups was 43.1 percent compared with 8.3 percent vaccination
coverage for adults not in priority groups. To date in this influenza
season, nearly 59 percent of persons aged 65 years and older reported
influenza vaccination through December 2004 compared to 65.5 percent of
persons in this age group who reported influenza vaccination in the 2003
National Health Interview Survey.
CDC estimates that approximately 3.5 million doses of influenza vaccine are
still available for use through the end of the influenza season. Because
February is often the most severe month of the influenza season and because
influenza viruses might continue to circulate for several more weeks, it's
not too late to benefit from vaccination this season. Persons at highest
risk for serious complications from influenza should continue to seek
influenza vaccine from their local health departments or healthcare
providers.
For more information about influenza, visit the CDC website:
www.cdc.gov/flu
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To access a web-text (HTML) version of the press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r050210.htm
ADDITION TO THE CDC INFLUENZA WEB SECTION
CDC has supplemented its Influenza web section with the following document:
Influenza vaccination among adults and children during the 2004-05 influenza
season: Behavioral Risk Factor System (BRFSS) Summary for data collected
January 2-22, 2005.
To access a ready-to-print (PDF) version of the document, go to:
http://www.cdc.gov/flu/professionals/vaccination/pdf/brfss0405season.pdf
To access a web-text (HTML) version of it, go to:
http://www.cdc.gov/flu/professionals/vaccination/brfss0405season.htm
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February 14, 2005
ACT NOW: FREE BULK COPIES OF THE LATEST ISSUE OF "VACCINATE ADULTS" (OCTOBER
2004) WILL GO FAST
IAC is giving away bulk copies (up to 50 per request) of the October 2004
issue of "Vaccinate Adults."
If you have an immunization conference or an educational program coming up
for adult medical specialists, this 12-page publication is an excellent item
to distribute. The October 2004 issue includes a patient-education sheet
that explains the vaccinations some or all adults should receive, the
Summary of Recommendations for Adult Immunization, a standing orders
protocol for administering influenza vaccine to adults, and a
patient-education brochure about hepatitis A disease and vaccine.
PLEASE NOTE: The October 2004 issue was printed in September 2004, before
the current influenza vaccine shortage began. Some of the influenza
vaccination information may therefore be outdated. For the most current
national information, visit CDC's Influenza web section at
http://www.cdc.gov/flu For current
local information, visit the website of your state immunization program,
which you can access by going to:
http://www.immunize.org/states
Because supplies of the October 2004 issue are limited, it's best to make
your request right away. Free copies go quickly. Sorry, we can mail orders
only to addresses within the United States.
To request copies, fill out the online form on IAC's website:
http://www.immunize.org/freeoffer
You will be asked to supply the following information:
- The number of copies you want (maximum 50)
- A description of how you plan to use the
copies
- Your name and complete contact
information, including mailing address, telephone number, and email
address
For further information, email
admin@immunize.org
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February 14, 2005
NEW: CMS HAS WEB RESOURCES FOR THOSE WHO VACCINATE MEDICARE BENEFICIARIES
AGAINST INFLUENZA AND PNEUMOCOCCAL DISEASE
The website of the Centers for Medicare & Medicaid Services (CMS) offers
two significant resources for those who vaccinate Medicare beneficiaries
against influenza and pneumococcal disease. Following is information on
both:
1. The web section Medicare Preventive Services: Influenza/Pneumococcal
Campaign offers billing information, educational material, standing orders
information, claims data, and more. To access it, go to:
http://www.cms.hhs.gov/preventiveservices/2.asp
2. The web section Immunization Educational Resource Web Guide has links
to the following: payment allowances, the immunization standing orders
regulation, educational materials, Medicare publications, CMS resources,
MedQIC [Medicare Quality Improvement Community], Health and Human Services
resources, and CMS immunization partners. To access it, go to:
http://www.cms.hhs.gov/medlearn/refimmu.asp#edu
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February 14, 2005
CDC REPORTS ON A CASE OF JAPANESE ENCEPHALITIS IN A U.S. TRAVELER
RETURNING FROM THAILAND IN 2004
CDC published "Japanese Encephalitis in a U.S. Traveler Returning from
Thailand, 2004" in the February 11 issue of MMWR. Portions of the article
are reprinted below.
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[From the article text]
Japanese encephalitis (JE) virus is a mosquito-borne flavivirus that is
closely related to the West Nile and St. Louis encephalitis viruses
endemic to North America. JE virus is a leading cause of viral
encephalitis in Asia but is rarely reported among travelers to countries
where JE is endemic. This report describes a case of an unvaccinated
Washington resident who had JE after traveling to northern Thailand. The
Advisory Committee on Immunization Practices (ACIP) recommends JE vaccine
for travelers to JE-endemic areas of Asia during the transmission season,
especially those spending >=1 month in those areas and whose travel
itineraries include rural settings. JE vaccine should also be considered
for travelers visiting areas with epidemic transmission or those engaging
in extensive outdoor activity in rural settings in areas where JE is
endemic, regardless of the duration of their visit. In addition,
healthcare providers and organized international travel programs should
ensure that travelers obtain appropriate preventive health guidance before
travel.
Case Report
In late June 2004, a previously healthy woman aged 22 years was admitted
to a Seattle hospital within hours of returning from a 32-day visit to
Thailand. She had become ill 2 days earlier with fever (101.5 degrees F
[38.6 degrees C]), nausea, headache, photophobia, and stiff neck that had
worsened over time. A lumbar puncture was performed; her cerebrospinal
fluid (CSF) revealed a white blood cell count of 47 cells/microliter (97%
polymorphonuclear leukocytes), glucose 60 mg/dL, and protein 37 mg/dL. The
patient was presumptively treated for herpes encephalitis with acyclovir
and for cerebral malaria with quinidine and corticosteroids.
Two days later, the patient had dysarthria, dysphagia, profound lethargy,
and fever (104.0 degrees F [40.0 degrees C]); as a result, she was sedated
and endotracheally intubated. A nonenhanced magnetic resonance image
revealed edema in the hypothalamus. Polymerase chain reaction studies of
CSF for herpes simplex virus and enteroviruses were negative, and
peripheral blood smears were negative for plasmodia. The patient improved
clinically and was extubated after 2 days but had onset of Bell's palsy on
hospital day 11. After 14 days of hospitalization, she was discharged and
underwent outpatient rehabilitation for 6 weeks. The patient had no
apparent neurologic sequelae. CSF and serum collected 4 days after illness
onset and serum collected 21 days after illness onset had JE
virus-specific IgM antibodies and neutralizing antibodies confirming a
recent JE viral infection.
In May 2004, the patient had traveled with 21 other students to Chiang Mai
City, Thailand, on a university-affiliated study-abroad program. Although
the program did not require students to consult a healthcare provider
before travel, the patient consulted her primary-care physician. She did
not receive any vaccinations or malaria prophylaxis. During her month-long
stay, the patient slept in a dormitory, where her room did not have
screened windows or bed nets. She also spent one night in a poorly
screened cabin in the rural Chiang Mai Valley. The patient reported
receiving mosquito bites in both the dormitory and cabin. . . .
[From the Editorial Note]
JE virus is a leading cause of viral encephalitis in Asia; JE has a
case-fatality rate of approximately 30%. No virus-specific treatment
exists, and survivors commonly have neurologic sequelae. Although JE is a
substantial public health problem in Asian countries, transmission to
short-term travelers to JE-endemic countries rarely has been reported.
This report describes the first reported case in a U.S. traveler since
1992.
Less than 1% of JE virus-infected persons have onset of encephalitis;
however, because an effective JE vaccine is available, vaccination should
be considered for use in travelers to Asia. Although the risk for
infection among travelers is low overall, risk varies substantially by
season (e.g., risk is highest in the rainy season), geographic location,
duration of travel, outbreak presence, and activities of the traveler.
Risk estimates based on JE incidence among residents of countries where
the disease is endemic are often inaccurate because JE surveillance is not
conducted in many Asian countries. In countries with childhood vaccination
programs or where the majority of persons aged <15 years have developed
immunity after a natural, asymptomatic JE viral infection, the low
incidence among residents can be misleading. Despite a history of JE
outbreaks in rural Chiang Mai Valley and >=1 month's stay for all 22
travelers described in this report, 40% received no pre-travel medical
advice from a healthcare provider, and only one was vaccinated against JE.
. . .
JE vaccine is not recommended for all travelers to Asia. For each
traveler, careful consideration of the potential risks and benefits of
vaccination should be made by a healthcare provider familiar with the
person's itinerary, the vaccine, and current CDC recommendations for its
use. In general, vaccine should be offered to persons spending >=1 month
in JE-endemic areas during the transmission season, especially if travel
will include rural areas. Under specific circumstances, vaccine should be
considered for persons spending <1 month in JE-endemic areas (e.g.,
travelers to areas experiencing epidemic transmission and persons whose
activities, such as extensive outdoor activities in rural areas, place
them at high risk for exposure). In all instances, travelers should be
advised to take personal precautions to reduce exposure to mosquito bites
(e.g., avoidance of mosquitoes and use of repellents and protective
clothing).
To determine a traveler's need for vaccination and prophylaxis, healthcare
providers and travelers can review regularly updated CDC travel
recommendations for JE, malaria, other vector-borne diseases, and endemic
infectious diseases at
http://www.cdc.gov/travel In addition, healthcare providers can
call the CDC Division of Vector-Borne Infectious Diseases, telephone (970)
221-6400, or Division of Global Migration and Quarantine, telephone (404)
498-1600. Finally, organized international travel programs should ensure
that their clients obtain appropriate preventive health guidance before
travel.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5405.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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February 14, 2005
NEW CONFERENCE LISTINGS: ADULT IMMUNIZATION AND HEALTH PROMOTION
CONFERENCES ARE SCHEDULED FOR MARCH AND MAY
IAC recently posted the following conferences to its Calendar of Events
web section:
1. ISSUES AND STRATEGIES IN ADULT VACCINE-PREVENTABLE DISEASES.
SCHEDULED FOR March 11 at the Hilton Minneapolis/St. Paul Airport,
Bloomington, MN.
INTENDED FOR healthcare providers committed to preventing influenza,
pneumococcal disease, and other VPDs.
SPEAKERS INCLUDE Dr. Kristin Nichol, Veterans Affairs Medical Center; Dr.
Raymond Strikas, CDC; Dr. Fred Ruben, sanofi pasteur; Kristen Ehresmann
and Claudia Miller, Minnesota Department of Health.
REGISTRATION DEADLINE is March 2; registration fee is $90.
PRESENTED BY the Minnesota Coalition for Adult Immunization.
FOR A CONFERENCE BROCHURE, go to:
http://www.vaccinateadult.org/2005ConferenceBrochure.pdf
FOR ADDITIONAL INFORMATION, contact Chere Wood by email at
cwood@mnqio.sdps.org or by
phone at (952) 853-8558.
2. POINTS ACROSS II: HEALTH PROMOTION STRATEGIES FOR LASTING SUCCESS.
SCHEDULED FOR May 4 at the Sheraton Columbia Hotel, Columbia, MD.
INTENDED FOR health professionals interested in developing effective
health promotion campaigns.
FACULTY INCLUDES experts in social marketing, health literacy, program
evaluation, and events planning.
EARLY-BIRD REGISTRATION DEADLINE is March 15; early-bird registration fee
is $50 for Maryland Partnership for Prevention (MPP) members and $70 for
non-members. Early registration is suggested.
STANDARD REGISTRATION DEADLINE is April 15; standard registration fee is
$70 for MPP members and $90 for non-members.
PRESENTED BY MPP and the Center for Immunization, Maryland Department of
Health and Mental Hygiene.
FOR A CONFERENCE BROCHURE, go to:
http://www.mdhealthcoalitions.org Scroll down and click on the
link for Points Across II Conference Brochure.
FOR ADDITIONAL INFORMATION, email
mdpartnershipforprevention@msn.com or call (410) 902-4677.
FOR INFORMATION ON ADDITIONAL CONFERENCES of interest to those in the
immunization community, visit the IAC Calendar of Events web section at
http://www.immunize.org/calendar
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February 14, 2005
MMWR CORRECTS ERRORS IN TWO RECENT ISSUES
The February 11 MMWR included two notices about errors that appeared in
recent MMWR issues. One notice, "Errata: Volume 54, No. 3," pertains to
the article "Outbreaks of Pertussis Associated with Hospitals--Kentucky,
Pennsylvania, and Oregon, 2003," which appeared in the January 28 issue.
The other, "Errata: Vol. 54, No. 4," pertains to table III, "Deaths in 122
U.S. Cities, Week Ending January 29, 2005 (4th Week)," which appeared in
the February 4 issue. The notices are reprinted below in their entirety,
with the exception of one table.
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Errata: Volume 54, No. 3
In the report, "Outbreaks of Pertussis Associated with
Hospitals--Kentucky, Pennsylvania, and Oregon, 2003," an error occurred in
the last sentence on page 70 (continuing to page 71). The text should read
as follows: "A recent study that compared azithromycin administered as 10
mg/kg (maximum: 500 mg) on day 1 followed by 5 mg/kg (maximum: 250 mg) on
days 2-5 with a 10-day treatment of erythromycin (40 mg/kg/day in 3
divided doses; maximum 1 g/day) demonstrated equivalence between the two
treatments (9)."
In addition, on page 69, the first sentence of the third full paragraph
should read as follows: "In late September 2003, physician C treated an
infant aged 2 months with PCR-confirmed pertussis in the pediatric ICU."
Also on page 69, the first sentence of the Editorial Note should read as
follows:
"Despite high childhood coverage for pertussis vaccination (4), reported
pertussis incidence in the United States has increased from a low of 1,248
cases (0.54 per 100,000 population) in 1981 to an annual average of 9,431
cases during 1996-2004 (average annual rate: 3.3 per 100,000 population)
(5)."
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To access a web-text (HTML) version of this notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a8.htm
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Errata: Vol. 54, No. 4
In Table III, "Deaths in 122 U.S. Cities, Week Ending January 29, 2005
(4th Week)," on page 111, total deaths attributable to pneumonia and
influenza (P&I) for San Francisco, California; the Pacific Region; and
across all reporting cities were incorrectly reported. The correct
mortality data are as follows: [a portion of Table III, which IAC Express
cannot reproduce, appears at this point in the published document].
Corrected data are available at
http://www.cdc.gov/mmwr/distrnds.html, select "Search Mortality
Tables" and MMWR year 2005 and MMWR week 4.
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To access a web-text (HTML) version of this notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5405a9.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5405.pdf |
