Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 512            February 21, 2005

CONTENTS OF THIS ISSUE

  1. CDC and NIH support influenza vaccination of elderly, though study states it may not prevent as many deaths as assumed
  2. CDC reports on hepatitis A vaccination coverage among U.S. children ages 24-35 months during 2003
  3. New: CDC website posts numerous resources for National Infant Immunization Week and Vaccination Week in the Americas
  4. New: Journal of Family Practice's immunization supplement, "Vaccines Across the Life Span, 2005," is now online
  5. New: February issue of CDC's Immunization Works electronic newsletter now available on the NIP website
  6. State officials: Betty Bumpers to speak at February 23 web conference on Vaccine Safety: What Legislators Need to Know
  7. AED launches listserv for members of the National Immunization Coalition TA Network

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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 21, 2005
CDC AND NIH SUPPORT INFLUENZA VACCINATION OF ELDERLY, THOUGH STUDY STATES IT MAY NOT PREVENT AS MANY DEATHS AS ASSUMED

On February 15, CDC and the National Institutes of Health (NIH) issued a statement supporting the ACIP recommendation that persons 65 years and older receive influenza vaccine yearly. A study, "Impact of Influenza Vaccination on Seasonal Mortality in the U.S. Elderly Population," published February 14 in the Archives of Internal Medicine, raises questions about the efficacy of influenza vaccination in preventing death among persons in this age group.

The CDC/NIH statement is reprinted below in its entirety. Following the statement is a link to the abstract of the article published in the Archives of Internal Medicine.

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"Impact of Influenza Vaccination on Seasonal Mortality in the U.S. Elderly Population" by Simonsen et al. (2005): A Statement by the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH)

A study published this week in the Archives of Internal Medicine reports that vaccination of the elderly population against influenza may be less effective in preventing death among the elderly than previously assumed. This study's findings have caused some confusion about whether people 65 years old and older should receive an influenza vaccination.

CDC and NIH continue to support the Advisory Committee on Immunization Practices (ACIP) recommendation that people aged 65 and older get vaccinated against influenza each year. People aged 65 and older are at highest risk for complications, hospitalizations, and deaths from influenza. Vaccination remains the best protection from influenza available for people 65 and older and their loved ones.

Numerous studies have shown that influenza vaccination works--including to help protect the elderly from serious illness and hospitalizations--but the degree to which it works varies from year to year and can be difficult to measure. For example, influenza seasons differ each year in length and severity, and the health status of individuals also matters.

In the current study by Simonsen et al., the authors in no way imply that the elderly should not receive influenza vaccine. Rather, the study concludes that the vaccine may prevent fewer deaths among the elderly than previous studies would have suggested. Therefore, the authors note that there is room for improvement in influenza prevention efforts, including research into developing more effective vaccines for the elderly and the increased use of medicines to treat flu.

In addition, recently published studies raise the possibility that it may be beneficial to vaccinate larger numbers of healthy persons, including children, to prevent transmission of influenza viruses to high-risk persons such as the elderly.

Expansion of groups for whom influenza vaccination is recommended is under discussion by the ACIP and CDC, and is partly contingent on adequate vaccine supply in the future.

The CDC and ACIP continually review their influenza vaccine recommendations as well as studies and published research in order to develop the best recommendations for protecting all Americans from influenza. This study is a reminder that there is room for improvement in how we protect the elderly from influenza, and CDC and NIH encourage research that strengthens our ability to do so.

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To access the CDC/NIH statement, go to:
http://www.cdc.gov/flu/pdf/statementeldmortality.pdf

To access the abstract of the article published in the Archives of Internal Medicine, go to:
http://archinte.ama-assn.org/cgi/content/abstract/165/3/265
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February 21, 2005
CDC REPORTS ON HEPATITIS A VACCINATION COVERAGE AMONG U.S. CHILDREN AGES 24-35 MONTHS DURING 2003

CDC published "Hepatitis A Vaccination Coverage Among Children Aged 24-35 Months--United States, 2003" in the February 18 issue of MMWR. The article is reprinted below in its entirety with the exception of one table, one figure, and references.

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Hepatitis A vaccine was first licensed in the United States in 1995. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended vaccination of children aged >=24 months in populations with the highest incidence of hepatitis A (e.g., American Indian/Alaska Native [AI/AN], Asian/Pacific Islander, and selected Hispanic and religious communities). In 1999, these guidelines were expanded to recommend routine vaccination for children residing in 11 states where average annual hepatitis A incidence during 1987-1997 was at least 20 per 100,000 population (twice the national average) and to consider routine vaccination for children in six states where average annual incidence was 10-20 per 100,000 population. This report is the first national analysis of hepatitis A vaccination coverage among children. The results indicate that, in 2003, vaccination coverage levels with at least 1 dose of hepatitis A vaccine for children aged 24-35 months varied from 6.4% to 72.7% in areas where routine vaccination is recommended. In addition, hepatitis A vaccination coverage rates for children aged 24-35 months are lower than overall rates for other vaccines recommended for children. Sustaining and improving vaccination coverage among young children is needed to ensure continued declines in hepatitis A incidence in the United States.

The National Immunization Survey (NIS) provides annual estimates of vaccination coverage as of the time of household interview among children aged 19-35 months for the 50 states and 28 selected urban areas. In 2003, NIS began to collect data regarding hepatitis A vaccination coverage. Hepatitis A vaccine is a 2-dose regimen (administered at least 6 months apart) licensed for use in children aged >=24 months. Hepatitis A vaccination coverage data were limited to children aged 24-35 months and calculated by considering children who had received at least 1 vaccine dose. To collect vaccination data for all age-eligible children, NIS uses a quarterly, random-digit-dialing sample of telephone numbers for each of the 78 survey areas and determines vaccination status from healthcare provider records. During 2003, information on vaccination history was collected from telephone interviews for 19,979 children; provider verified vaccination records were available for 13,731 (68.7%).

Among children aged 24-35 months residing in the 11 states where routine hepatitis A vaccination is recommended, 50.9% (95% confidence interval [CI] = 47.6%-54.2%; range among states: 6.4%-72.7%) received at least 1 dose of hepatitis A vaccine. Among children aged 24-35 months residing in the six states where routine hepatitis A vaccination should be considered, 25.0% (CI = 21.8%-28.2%; range: 0.6%-32.3%) had received at least 1 dose of hepatitis A vaccine. Among children aged 24-35 months residing in the 33 states without a specific recommendation, 1.4% (CI = 1.0%-1.8%; range: 0.0%-4.3%) had received at least 1 dose of hepatitis A vaccine. Two states (Alaska and Arizona) and four urban areas had coverage estimates >60%. Hispanic and AI/AN children had higher coverage rates than non-Hispanic white or black children in areas where routine vaccination is recommended or should be considered.

Editorial Note:

The national hepatitis A vaccination coverage estimates described in this report indicate that, in 2003, current hepatitis A childhood vaccination recommendations were being implemented in many states. However, coverage varied among areas and populations, likely because of targeted programs within these states. For example, higher coverage in El Paso County, Texas (71%), compared with the overall Texas coverage rate (32%), likely is attributable to vaccination requirements in Texas border counties for all children attending child care programs.

Vaccination coverage also varied by race/ethnicity. Higher coverage among Hispanic and AI/AN children than among children of other racial/ethnic populations might be related to greater disease recognition in these populations and local and national vaccination recommendations that have identified these populations as having higher hepatitis A rates.

The findings in this report are subject to at least three limitations. First, NIS is a telephone survey; although statistical weights adjust for nonresponse and households without telephones, some bias might remain. Second, although NIS relies on provider-verified vaccination histories, incomplete records or reporting could result in underestimates of coverage. Finally, although national estimates are reliable, estimates for states and urban areas and for racial/ethnic populations should be interpreted with caution.

The 1999 ACIP hepatitis A prevention recommendations encouraged state and local immunization programs to analyze their surveillance data and implement vaccination strategies that address the epidemiology of hepatitis A in their areas. The variation by state in coverage among children aged 24-35 months likely reflects the varying vaccination strategies adopted by state and local public health officials in response to the ACIP recommendations. Higher coverage among Hispanic and AI/AN children is one indication that vaccination efforts targeting children at higher risk for illness have been successful.

These data do not provide information on why hepatitis A vaccination coverage for children aged 24-35 months remains below that for other childhood vaccinations in most areas where it is recommended. Low coverage rates for young children might be the result of (1) a focus by healthcare providers and immunization programs on vaccinating older children, (2) the few areas with hepatitis A vaccine mandates, or (3) the lack of a licensed hepatitis A vaccine that can be administered to children aged <24 months. Sustaining and improving vaccination coverage among young children is needed to ensure continued declines in hepatitis A incidence in the United States.

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To access a web-text (HTML) version of this article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a1.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5406.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 21, 2005
NEW: CDC WEBSITE POSTS NUMEROUS RESOURCES FOR NATIONAL INFANT IMMUNIZATION WEEK AND VACCINATION WEEK IN THE AMERICAS

On February 10, the website of CDC's National Immunization Program posted several resources that communities can use to promote vaccination during National Infant Immunization Week (NIIW), which is being held in conjunction with Vaccination Week in the Americas (VWA). This year, NIIW is April 24-30, and VWA is April 23-30.

NIIW will focus on the importance of immunizing infants against 12 vaccine-preventable diseases by age two. Coordinated by the Pan American Health Organization (PAHO), VWA is devoted to immunizing people in the Western Hemisphere who are often left behind--children and others residing in border regions, indigenous people and vulnerable groups, women of childbearing age, and the elderly.

Materials posted on the NIP website are intended to promote the benefits of immunization, particularly for infants and children. Materials currently available include information about creating a kickoff event, sample public relations materials, and a web-link banner and icon button for use on organization websites. Posters, stickers, and public service announcements will be added soon. To access these materials, go to:
http://www.cdc.gov/nip/events/niiw/2005/05default.htm

A particularly valuable resource includes a detailed description of activities conducted in communities in 17 states during NIIW 2004. Any organization interested in promoting immunization will benefit from perusing this information. To access it, go to:
http://www.cdc.gov/nip/events/niiw/2004/04activities.htm

To access the English-language version of PAHO's Vaccines and Immunization web section, go to:
http://www.paho.org/English/AD/FCH/IM/vaccines.htm

To access the Spanish-language version, go to:
http://www.paho.org/Spanish/AD/FCH/IM/vacunas.htm
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February 21, 2005
NEW: JOURNAL OF FAMILY PRACTICE'S IMMUNIZATION SUPPLEMENT, "VACCINES ACROSS THE LIFE SPAN, 2005," IS NOW ONLINE

Published in January, the Journal of Family Practice's immunization supplement, "Vaccines Across the Life Span, 2005," is now available online. Written by members of the Group on Immunization Education of the Society of Teachers of Family Medicine, the 72-page supplement contains six articles (titles below) and a color centerfold with pictures of vaccine-preventable diseases and immunization schedules.

Following are the titles of the six articles:

  1. Recent changes in influenza epidemiology and vaccination recommendations
  2. Routine vaccines across the life span, 2005
  3. Vaccines for persons at high risk due to medical conditions, occupation, environment, or lifestyle, 2005
  4. Vaccine schedules and procedures, 2005
  5. Communicating the benefits and risks of vaccines
  6. Immunization barriers and solutions

To access the supplement online, go to:
http://www.jfponline.com/supplements/supp_0105.asp
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February 21, 2005
NEW: FEBRUARY ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER NOW AVAILABLE ON THE NIP WEBSITE

The February issue of Immunization Works, a monthly email newsletter published by CDC, is available on NIP's website. The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

To access the February issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2005/200502.htm
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February 21, 2005
STATE OFFICIALS: BETTY BUMPERS TO SPEAK AT FEBRUARY 23 WEB CONFERENCE ON VACCINE SAFETY: WHAT LEGISLATORS NEED TO KNOW

IAC recently posted the following web conference to its Calendar of Events web section:

VACCINE SAFETY: WHAT LEGISLATORS NEED TO KNOW

SCHEDULED FOR February 23 at 2PM EST.

INTENDED FOR state legislators and others interested in learning about the importance of immunization and vaccine safety concerns and how state leaders are handling these issues.

SPEAKERS INCLUDE Betty Bumpers, co-founder and spokesperson for Every Child By Two and former First Lady of Arkansas; Dr. Melinda Wharton, acting deputy director, NIP; Dr. Harry Hull, state epidemiologist, Minnesota Department of Health.

REGISTER SOON; space is limited for this free event. To register online, go to: http://www.healthystates.csg.org/Events+and+Conferences Scroll down to the conference title and click on "click here to register."

PRESENTED BY the Council of State Governments.

FOR ADDITIONAL INFORMATION, contact Sarah Donta by email at sdonta@csg.org or by phone at (859) 244-8244.

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 21, 2005
AED LAUNCHES LISTSERV FOR MEMBERS OF THE NATIONAL IMMUNIZATION COALITION TA NETWORK

In January, the Academy for Educational Development (AED) launched IZNetwork, a listserv for members of the National Immunization Coalition TA [technical assistance] Network. The listserv's purpose is to increase networking and information sharing among members, help members respond to emerging issues collaboratively with coalitions nationwide, and provide knowledge and tools that can help members meet their coalition's goals.

To subscribe to the listserv, send an email to iznetwork@listserv.aed.org. Type "Sign Me Up" in the subject line, and leave the body of the email empty.

 

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 February 21, 2005