Issue
Number 514
March 7, 2005
CONTENTS OF THIS ISSUE
- CDC issues an update on U.S. influenza activity during
the 2004-05 season
- CDC reports on interventions to increase influenza
vaccination of healthcare workers
- CDC reports on Connecticut's use of a state influenza
hotline as a way to increase influenza vaccination coverage
- New: NIP announces availability of a web-based training
course, "Immunization: You Call the Shots"
- Reminder: It's time to finalize your plans for the
National Immunization Conference
- Check it out: NIP website adds resources for National
Infant Immunization Week and Vaccination Week in the Americas
- New: ECBT's model statute will help states draft
legislation that permits immunization information to cross state lines
- 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.
***********************
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 |
