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Issue Number 514            March 7, 2005

CONTENTS OF THIS ISSUE

  1. CDC issues an update on U.S. influenza activity during the 2004-05 season
  2. CDC reports on interventions to increase influenza vaccination of healthcare workers
  3. CDC reports on Connecticut's use of a state influenza hotline as a way to increase influenza vaccination coverage
  4. New: NIP announces availability of a web-based training course, "Immunization: You Call the Shots"
  5. Reminder: It's time to finalize your plans for the National Immunization Conference
  6. Check it out: NIP website adds resources for National Infant Immunization Week and Vaccination Week in the Americas
  7. New: ECBT's model statute will help states draft legislation that permits immunization information to cross state lines
  8. CDC reports on progress in reducing worldwide measles mortality, 1999-2003

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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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March 7, 2005
CDC ISSUES AN UPDATE ON U.S. INFLUENZA ACTIVITY DURING THE 2004-05 SEASON

CDC published "Update: Influenza Activity--United States, 2004-05 Season" in the March 4 issue of MMWR. Portions of the article are reprinted below.

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Influenza activity has increased steadily in the United States since late December and, as of February 19, might not have peaked. Laboratory-confirmed influenza infections have been reported from all 50 states. This report summarizes influenza activity during October 3, 2004-February 19, 2005. . . .

Editorial Note:

Influenza activity was low in the United States from October through mid-December but steadily increased during January and February and might not have peaked. In the United States, influenza activity typically peaks during December-March and, in 16 of the preceding 27 seasons, has peaked during February or later. During the 2003-04 influenza season, 153 pediatric deaths associated with influenza infection were reported from 40 states, whereas only nine such deaths have been reported so far this season. However, numerous influenza outbreaks have been reported in long-term care facilities and among school children, and the number of pediatric deaths associated with laboratory-confirmed influenza is expected to increase before the end of this season.

The viruses circulating this year include both influenza A and B viruses, but influenza A viruses have predominated, and most have been subtyped as influenza A (H3N2) viruses. Most of the influenza A (H3N2) viruses reported earlier in the season were antigenically similar to the influenza A (H3N2) component of the 2004-05 vaccine (A/Fujian/411/2002-like virus). However, since mid-January, an increasing proportion of influenza A (H3N2) viruses have been reported to be similar to A/California/7/2004, a recent reference strain that is related to A/Fujian/411/2002 but is antigenically distinguishable. Antibodies produced against A/Fujian/411/2002-like viruses cross-react with A/California7/2004-like viruses but at a lower level, and, because of this, effectiveness of the 2004-05 vaccine could be reduced against A/California/7/2004-like viruses.

Antiviral medications are useful for early treatment of influenza and as an adjunct to influenza vaccination for influenza prevention and control. They should be considered when treating persons with suspected influenza regardless of vaccination status during periods of community influenza activity. Influenza antiviral drugs differ in approved age groups, recommended dosages, routes of administration, adverse effects, development of antiviral resistance, and cost. When administered within 48 hours of symptom onset, antiviral treatment of influenza can reduce the duration of illness by approximately 1 day in healthy adults. Four prescription antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved for treatment of influenza A virus infections. Oseltamivir and zanamivir also are approved for treatment of influenza B virus infections. Antiviral chemoprophylaxis is approximately 70%-90% effective in preventing illness in healthy adults. Amantadine, rimantadine, and oseltamivir are approved for chemoprophylaxis of influenza A virus infections; only oseltamivir is approved for chemoprophylaxis of influenza B virus infections. Physicians should consult package inserts of antiviral drugs for information on approved age groups, dosing, and adverse effects.

Influenza surveillance reports for the United States are published weekly during October-May and are available at http://www.cdc.gov/flu/weekly or through the CDC voice [(888) 232-3228] and fax [(888) 232-3299, document number 361100] information systems.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a1.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5408.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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March 7, 2005
CDC REPORTS ON INTERVENTIONS TO INCREASE INFLUENZA VACCINATION OF HEALTHCARE WORKERS

CDC published "Intervention to Increase Influenza Vaccination of Healthcare Workers--California and Minnesota" in the March 4 issue of MMWR. Portions of the article are reprinted below.

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Vaccination of healthcare workers (HCWs) has been shown to reduce influenza infection and absenteeism among HCWs, prevent mortality in their patients, and result in financial savings to sponsoring health institutions. However, influenza vaccination coverage among HCWs in the United States remains low; in 2003, coverage among HCWs was 40.1% (CDC, unpublished data, 2005). This report describes strategies implemented in three clinical settings that increased the proportion of HCWs who received influenza vaccination. The results demonstrate the value of making influenza vaccination convenient and available at no cost to HCWs. . . .

Editorial Note:

Influenza vaccination among U.S. HCWs increased from 10% in 1989 to 34% in 1997 and only slowly increased to 40% in 2003. The interventions described in this report underscore the importance of making vaccination convenient and available at no cost to HCWs. The study of southern California nursing homes, the only controlled evaluation of efforts to influenza vaccination coverage among HCWs, suggests that publicity and educational messages about the importance of vaccination are only effective when combined with other approaches to increase coverage. The results of the interventions conducted by the Minneapolis VAMC [Veterans Administration Medical Center] and Mayo Clinic indicate that combining free vaccination with programs to increase vaccine accessibility by using either mobile carts or peer vaccination can overcome certain barriers to HCW influenza vaccination. These findings were supported by a recent cross-sectional evaluation of interventions for HCWs in neonatal and pediatric intensive-care units and hematology-oncology units that demonstrated that use of mobile carts and educational materials were associated with higher vaccination rates. The Mayo Clinic intervention suggests that additional incentives might increase coverage further.

The results described in this report are consistent with other studies demonstrating that organizational change (e.g., separate clinics devoted to prevention), free vaccine, and gift incentives are particularly effective methods of increasing vaccination among adults. Interventions that were used to increase coverage among HCWs, including standing orders and reducing out-of-pocket costs, both in conjunction with education, are consistent with interventions strongly recommended by the Task Force on Community Preventive Services.

The findings in this report are subject to at least two limitations. First, ascertainment of vaccination status in the southern California study was based on self-report, and only 61% of HCWs responded. Second, the VAMC and Mayo Clinic studies did not control for other factors that might have increased influenza vaccination; none of the studies were able to determine what proportion of HCWs had risk factors other than their status as HCWs that might have put them at increased risk for influenza and its complications. Nonetheless, each of the interventions described in this report resulted in vaccination rates exceeding national averages.

The influenza vaccine shortage during the 2004-05 season might have prevented healthcare institutions from implementing aggressive campaigns for vaccination of HCWs. However, HCWs remain a high-priority group for vaccination. The National Foundation for Infectious Diseases has produced a call to action to improve rates of influenza vaccination in HCWs. The interventions described in this report suggest that making vaccination easily accessible at no cost to HCWs and designated peer vaccination champions are likely to increase vaccine coverage among HCWs.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a2.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5408.pdf
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March 7, 2005
CDC REPORTS ON CONNECTICUT'S USE OF A STATE INFLUENZA HOTLINE AS A WAY TO INCREASE INFLUENZA VACCINATION COVERAGE

CDC published "Brief Report: Vaccination Coverage Among Callers to a State Influenza Hotline--Connecticut, 2004-05 Influenza Season" in the March 4 issue of MMWR. A summary made available to the press is reprinted below in its entirety.

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State and local health departments should consider a hotline as a method for educating the public regarding influenza vaccination and a follow-up system as a means to improve vaccination coverage, especially among those at greatest risk.

In response to the recent influenza vaccine shortage in the United States, the Connecticut Department of Public Health operated a telephone hotline to address questions from the public regarding the availability of influenza vaccine, reduce the number of telephone inquiries to physicians and local health departments, and advise callers regarding which groups were most at risk and in need of influenza vaccination. The results indicated that vaccination coverage varied by age group and that persons receiving follow-up calls from their local health departments were more likely to receive vaccination. Vaccination coverage among the callers surveyed was greater than that reported previously for the general public in the United States during September–November 2004.

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To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a3.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5408.pdf
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March 7, 2005
NEW: NIP ANNOUNCES AVAILABILITY OF A WEB-BASED TRAINING COURSE, "IMMUNIZATION: YOU CALL THE SHOTS"

NIP recently announced the availability of the first module of its web-based training course "Immunization: You Call the Shots." Titled "Understanding the Basics: General Recommendations on Immunization," the first module offers participants basic immunization principles, learning opportunities, practice questions, reference and resource materials, and an extensive glossary.

The training course is an interactive self-study program that participants can complete at their own pace. A total of 13 modules are planned. The course is intended for nurses, nursing students, medical assistants, pharmacists, health educators, immunization program managers, Department of Defense paraprofessionals, and other healthcare providers working in private offices, hospitals, and public health settings.

For additional information on "You Call the Shots," go to:
http://www.cdc.gov/nip/ed/youcalltheshots.htm

To access the module "Understanding the Basics: General Recommendations on Immunization," go to:
http://www2.cdc.gov/nip/isd/ycts/mod1/courses/genrec/start.asp
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March 7, 2005
REMINDER: IT'S TIME TO FINALIZE YOUR PLANS FOR THE NATIONAL IMMUNIZATION CONFERENCE

You have just two weeks to tie up any loose ends for the National Immunization Conference, which will be held March 21-24 in Washington, DC. Here's some information that can help you take care of last-minute business:

Registration will be accepted throughout the duration of the conference. To register online, go to: http://conferences.taskforce.org/2005NIC/2005NIC.htm For registration information or assistance, contact Gloria Freeman by phone at (404) 687-5629 or by email at gfreeman@taskforce.org

Accommodations at the headquarters hotel at the specially negotiated conference rate are no longer available. Rooms at nearby hotels may be available at a reduced rate. For updated information, go to: http://www.cdc.gov/nip/NIC/default.htm#accommodations

Plan your conference participation by using the Draft Conference Agenda at http://cdc.confex.com/cdc/nic2005/techprogram/meeting_nic2005.htm You might find the new NIC Track System useful in making your plans. For information about it, go to:
http://www.cdc.gov/nip/NIC/default.htm#tracks

An evening event, Monuments by Moonlight, is available at 8PM March 23. For information, go to:
http://www.cdc.gov/nip/NIC/default.htm#night

For comprehensive information about the conference, go to:
http://www.cdc.gov/nip/nic

For additional information, contact the conference planning team by phone at (404) 639-8225 or by email at NIPNIC@cdc.gov
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March 7, 2005
CHECK IT OUT: NIP WEBSITE ADDS RESOURCES FOR NATIONAL INFANT IMMUNIZATION WEEK AND VACCINATION WEEK IN THE AMERICAS

This year, National Infant Immunization Week (NIIW) is being held in conjunction with Vaccination Week in the Americas (VWA), a project coordinated by the Pan American Health Organization (PAHO). NIIW is April 24-30, and VWA is April 23-30.

NIP's NIIW web section now includes a link to pertinent information from the United States-Mexico Border Health Commission. The commission, in partnership with CDC, PAHO, and the Mexico Secretary of Health, is participating in NIIW and VWA. For details, go to: http://www.borderhealth.org

If you are planning an NIIW activity, large or small, NIP would love to hear from you. Those willing to post information about their planned activity should complete the online form located at http://www.cdc.gov/nip/events/niiw/2005/05activity.htm

NIP updates the NIIW web section regularly. To stay informed about new resources, go to:
http://www.cdc.gov/nip/events/niiw/2005/05default.htm#more

To access an article about NIIW and VWA from the February 21 issue of IAC Express, go to:
http://www.immunize.org/genr.d/issue512.htm#n3
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March 7, 2005
NEW: ECBT'S MODEL STATUTE WILL HELP STATES DRAFT LEGISLATION THAT PERMITS IMMUNIZATION INFORMATION TO CROSS STATE LINES

Every Child By Two (ECBT) recently published a Special Notice Newsletter announcing that it has posted on its website a model statute intended to help states draft legislation that will permit them to share immunization information across state lines. Portions of the newsletter are printed below.

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February 2005

MODEL INTERSTATE IMMUNIZATION INFORMATION SHARING STATUTE NOW AVAILABLE ONLINE!

According to the Healthy People 2010 initiative, "population-based immunization registries will be a cornerstone of the nation's immunization system by 2010." One of the objectives of the initiative includes the goal of increasing the proportion of children who participate in these immunization information systems (also known as immunization registries) to 95% of children under age 6. The CDC reports that as of 2002, every state is either operating or developing statewide or regional immunization information systems, which have enrolled approximately 43% of children aged 6 years or younger. However, few immunization information systems have legal agreements to share immunization data across state lines.

Nationwide, families often change their residence from state to state. Other persons, particularly those who live close to state borders, may receive immunization services in a jurisdiction other than where they attend school. To ensure that vaccination information follows the individual, immunization information systems must develop the capability to exchange data among jurisdictions.

To assist states who would like to begin sharing immunization information across state lines, Every Child By Two (ECBT) partnered with the Department of Health Policy at the George Washington University School of Public Health and Health Services to create a model interstate immunization information sharing statute. It was developed after consultation with numerous immunization registry managers, public health officials, and legal researchers. This model statute proposes language to state legislators, public health officials and others who wish to ensure the timely, secure interstate exchange of immunization information. It is expected that policymakers will use the draft as a tool, and that each jurisdiction will tailor the language according to their states' individual needs. . . .

The information sharing law will not alter the state's current notification and opt-out requirements.

If you have any questions about the model statute, please contact Jennifer Zavolinsky, senior manager, Immunization Outreach Initiatives, by email at Jennifer@ecbt.org or by phone at (202) 783-7034 ext. 21. . . .

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To access the complete newsletter, go to:
http://www.ecbt.org/FINALModelBackground.pdf

To access the model statute, go to:
http://www.ecbt.org/FINALModelInfo-sharingStatute1-25-05.doc
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March 7, 2005
CDC REPORTS ON PROGRESS IN REDUCING WORLDWIDE MEASLES MORTALITY, 1999-2003

CDC published "Progress in Reducing Measles Mortality--Worldwide, 1999-2003" in the March 4 issue of MMWR. A summary made available to the press is reprinted below in its entirety.

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As a result of accelerated measles control activities, it is estimated that global measles mortality declined 39 percent between 1999 and 2003.

This MMWR reports on progress toward the goal endorsed by the 2003 World Health Assembly of reducing global deaths from measles by half by 2005 relative to 1999. The strategy to reduce deaths includes achieving high routine immunization coverage in every district and offering a second opportunity for immunization to all children. WHO and UNICEF estimate that global routine measles vaccination coverage increased from 71 percent in 1999 to 77 percent in 2003. In 2001, 150 countries offered children a second opportunity for immunization, as compared to 164 countries in 2003. As a result of these activities, global measles deaths have fallen 39 percent from an estimated 873,000 in 1999 to an estimated 530,000 in 2003. If progress continues at rates achieved during the preceding years, the 2005 mortality reduction goal will be met.

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To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5408a4.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5408.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 March 7, 2005