Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 539            July 25, 2005

CONTENTS OF THIS ISSUE

  1. New: Provisional ACIP recommendations for combined tetanus-diphtheria-pertussis vaccine are posted on NIP's website
  2. New: Interim VISs now available for both injectable and intranasal influenza vaccines
  3. July issue of CDC's Immunization Works electronic newsletter now available on the NIP website
  4. Updated: IAC revises a professional education piece on preventing perinatal hepatitis B virus transmission
  5. Pharmacists and medical assistants: NIP needs you to pilot test its training programs
  6. Oregon's Answer to Cancer race--a fund raiser for hepatitis B virus infection and liver cancer--is scheduled for August 6

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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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July 25, 2005
NEW: PROVISIONAL ACIP RECOMMENDATIONS FOR COMBINED TETANUS-DIPHTHERIA-PERTUSSIS VACCINE ARE POSTED ON NIP'S WEBSITE

NIP recently posted on its website the provisional ACIP recommendations for combined tetanus-diphtheria-pertussis (Tdap) vaccine for use in adolescents. The recommendations will become effective after they are reviewed by the director of CDC and the Department of Health and Human Services and will become official when published in the MMWR. Portions of the provisional recommendations are reprinted below.

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ADVISORY COMMITTEE ON IMMUNIZATION PRACTICE (ACIP) VOTES TO RECOMMEND ROUTINE USE OF COMBINED TETANUS, DIPHTHERIA, AND PERTUSSIS (Tdap) VACCINES FOR ADOLESCENTS

Two Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine, Adsorbed (Tdap) products were licensed by the FDA in 2005 as single-dose booster vaccines to provide protection against tetanus, diphtheria, and pertussis. Glaxo-Smith-Kline's BOOSTRIX is indicated for persons aged 10-18 years (www.fda.gov/cber/label/tdapgla050305LB.pdf), and sanofi pasteur's ADACEL is indicated for persons aged 11-64 years (www.fda.gov/cber/label/tdapave061005LB.pdf). On June 30, 2005, the Advisory Committee on Immunization Practices (ACIP) voted to recommend the routine use of Tdap vaccines in adolescents aged 11-18 years in place of tetanus and diphtheria toxoids (Td) vaccines (www.cdc.gov/nip/pr/pr_tdap_jun2005.htm).

Pertussis is a highly contagious respiratory tract infection; immunity from childhood vaccination wanes over time, leaving adolescents susceptible. In 2003, U.S. adolescents aged 11-18 years made up 36% (4,144) of the total 11,647 reported cases; reported cases underestimate the true burden of pertussis in adolescents. The clinical presentation of pertussis in adolescents ranges from mild cough illness to classic pertussis (i.e., paroxysms of cough, post-tussive emesis, and inspiratory whoop). The morbidity of pertussis in adolescents can be substantial with prolonged cough illness lasting weeks to months. Hospitalization and complications (e.g., pneumonia and rib fractures) occur in <=2% of reported cases. Pertussis outbreaks in schools with adolescents are disruptive and lead to significant public health control efforts.

The primary objective of the adolescent pertussis booster vaccination program is to protect adolescents against pertussis. Key ACIP recommendations for Tdap (single dose) and Td use in adolescents aged 11-18 years are summarized below. These ACIP recommendations are under review by the Director of CDC and the Department of HHS and will become official when published in CDC's Morbidity and Mortality Weekly Report (MMWR) (www.cdc.gov/mmwr).

Routine Tdap Vaccination in Adolescents 11-18 Years of Age

  • Adolescents aged 11-18 years should receive a single dose of Tdap instead of Td for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood DTP/DTaP vaccination series and have not received Td or Tdap. The preferred age for Tdap vaccination is 11-12 years; routinely administering Tdap to young adolescents will reduce the morbidity associated with pertussis in adolescents.
     
  • Adolescents aged 11-18 years who received Td but not Tdap are encouraged to receive a single dose of Tdap to provide protection against pertussis if they have completed the recommended childhood DTP/DTaP vaccination series. A 5-year interval between Td and Tdap is encouraged to reduce the risk of local or systemic reactions. However, intervals shorter than 5 years between Td and Tdap can be used. The benefits of protection from pertussis generally outweigh the risk of local or systemic reactions in settings with increased risk from pertussis (e.g., pertussis outbreaks and close contact with an infant aged <6 months).
     
  • Vaccine providers should administer Tdap (or Td) and tetravalent meningococcal polysaccharide-protein conjugate vaccine ([MCV4] Menactra) (which contains diphtheria toxoid) during the same visit if both vaccines are indicated and available (MCV4 recommendations are available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm).
     
  • Tdap (or Td) should be administered with other vaccines that are indicated during the same visit when feasible. Each vaccine should be administered using a separate syringe at different anatomic sites. Some experts recommend administering no more than two injections per deltoid, separated by one inch during one visit. . . .

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The provisional recommendations also include sections on the following: (1) special situations for Tdap (single dose) and Td use in adolescents 11-18 years of age;(2) contraindications and precautions for Tdap/Td; (3) reporting of adverse events after vaccination; and (4) future considerations.

To access the provisional recommendations in their entirety go to: http://www.cdc.gov/nip/vaccine/tdap/tdap_acip_recs.pdf
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July 25, 2005
NEW: INTERIM VISs NOW AVAILABLE FOR BOTH INJECTABLE AND INTRANASAL INFLUENZA VACCINES

On July 18, NIP posted two interim VISs for influenza vaccine to its website. Because influenza vaccine was recently added to the Vaccine Injury Compensation Program, the final VISs for influenza vaccine are being developed under a federally mandated process, which is time consuming. Providers are encouraged to use the interim VISs until the final VISs are issued, which may not happen until after the influenza vaccination season is underway.

The interim VISs reflect changes outlined in "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," which was published July 13 as an electronic MMWR "Early Release."

INTERIM VIS FOR TRIVALENT INACTIVATED INFLUENZA VACCINE (TIV)
Information in sections 1, 2, 3, 7, and 8 was changed. To access a ready-to-print (PDF) version of the interim VIS (dated 7/18/05) from the NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf

To access it from the IAC VIS web section, go to:
http://www.immunize.org/vis/2flu.pdf

INTERIM VIS FOR LIVE INTRANASAL INFLUENZA VACCINE (LAIV)
Information in sections 1, 7, and 8 was changed. To access a ready-to-print (PDF) version of the interim VIS (dated 7/18/05) from the NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf

To access it from the IAC VIS web section, go to:
http://www.immunize.org/vis/liveflu.pdf

For information about the use of VISs, and for VISs in a total of 33 languages, visit IAC's VIS web section at http://www.immunize.org/vis
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July 25, 2005
JULY ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER NOW AVAILABLE ON THE NIP WEBSITE

The July 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.

Some of the information in the July issue has already appeared in previous issues of IAC Express. Following is the text of two articles we have not covered.

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OTHER IMMUNIZATION NEWS

COULD UK MUMPS OUTBREAK IMPACT US? The United Kingdom is experiencing a large outbreak of mumps. Since 2003, reported mumps cases in England and Wales have been on the rise. During the 1990's only a few hundred cases were reported annually. In 2004, 16,000 cases were reported, and as of June 17th, the current total for 2005 is 40,367. Most impacted are young adults 19-23 years of age, who are too old to have received two doses of MMR vaccine in the UK's national vaccination program.

In the United States, high MMR vaccination levels in preschool, school, and college-age students for the last 10-15 years have kept the number of mumps cases low, less than 300 annually since 2001 (CDC, unpublished data). However, given today's level of globalization, US physicians should be prepared to recognize, confirm, and report cases of mumps suspected in both US- and foreign-born individuals. Physicians should also review the vaccination histories of their patients and provide all indicated vaccines. Imported mumps cases may spread in unvaccinated populations, including infants too young to be vaccinated and persons who are unvaccinated for medical, religious, or philosophical reasons. To view a recent article on this topic, please visit
http://bmj.bmjjournals.com/cgi/content/full/331/7508/E363

ACIP MEETING: The Advisory Committee on Immunization Practices (ACIP) held a meeting on June 29-30, 2005, in Atlanta, Georgia. Minutes from the meeting are forthcoming and will be posted at  the ACIP website: http://www.cdc.gov/nip/acip/default.htm In addition, Immunization Works will publish information about the new recommendations in its August issue.

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To access the complete July issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2005/200507.htm
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July 25, 2005
UPDATED: IAC REVISES A PROFESSIONAL EDUCATION PIECE ON PREVENTING PERINATAL HEPATITIS B VIRUS TRANSMISSION

IAC recently updated its one-page professional-education piece "Labor & Delivery and Nursery Unit Guidelines to Prevent Hepatitis B Virus Transmission." The primary revision was to add emphasis to the information about the hepatitis B vaccine birth dose. When MMWR publishes the new ACIP hepatitis B recommendations for children, IAC will update this piece again.

To access a ready-to-print (PDF) version of the revised piece, go to: http://www.immunize.org/catg.d/p2130per.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p2130.htm
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July 25, 2005
PHARMACISTS AND MEDICAL ASSISTANTS: NIP NEEDS YOU TO PILOT TEST ITS TRAINING PROGRAMS

NIP/CDC is currently seeking pharmacists and medical assistants who would be willing to volunteer to pilot test NIP training programs. These are mostly self-study courses that can be completed on the Internet. The typical pilot test involves reviewing a specific course, taking the course evaluation, and providing feedback. It takes from two to four hours.

CDC is seeking pharmacists and medical assistants as these two groups are under-represented in its current pool of volunteers. Pilot testers can obtain continuing education (CE) credits once the training program becomes approved for such credit. To volunteer, contact Melissa Barnett at mbarnett2@cdc.gov or at (404) 639-6202. If you know of pharmacists or medical assistants who might be interested, please forward this message to them.
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July 25, 2005
OREGON'S ANSWER TO CANCER RACE--A FUND RAISER FOR HEPATITIS B VIRUS INFECTION AND LIVER CANCER--IS SCHEDULED FOR AUGUST 6

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

2005 ANSWER TO CANCER RACE.

SCHEDULED FOR August 6 at Evergreen Aviation Museum, McMinnville, OR; registration begins at 7:30AM.

BACKGROUND INFORMATION: The Answer to Cancer race is the flagship fund-raising event for the Answer To Cancer Foundation. This year the funds raised will benefit the Jade Ribbon Campaign, Asian Liver Center, Stanford University; the MD Anderson Cancer Institute, University of Texas, Houston; the Hepatitis B Foundation, Doylestown, PA; and the Willamette Valley Cancer Care Center, McMinnville, OR.

FOR RACE INFORMATION, including course info, online registration, pledge raising, and sponsors, go to: http://www.answertocancer.org/raceinfo/index.html

TO DONATE ONLINE, go to: http://www.answertocancer.org Click on Make a Donation in the left column.

FOR INFORMATION ON ADDITIONAL EVENTS of interest to those in the immunization community, visit the IAC Calendar of Events web section at http://www.immunize.org/calendar

 

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 July 25, 2005