Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 553            September 26, 2005

CONTENTS OF THIS ISSUE

  1. New: CDC issues interim VIS for Tdap (tetanus-diphtheria-pertussis) vaccine for adolescents and adults
  2. MMWR issues correction to the influenza vaccination recommendations it published September 16
  3. News alert: On September 28 Dear Abby will publish a letter urging early influenza vaccination for high-risk persons
  4. New: Screening questionnaire identifies which patients are eligible to receive influenza vaccine before October 24
  5. New: CDC responds to Lancet article questioning the efficacy and effectiveness of influenza vaccines for older people
  6. Federal and military employees: Help IAC by using agency code 0233 when you contribute to the Combined Federal Campaign
  7. "Vote and Vax" booklet tells how to set up an influenza shot clinic in your community on Election Day
  8. Teleconference on adolescent immunization is scheduled for October 11
  9. Report compares influenza vaccination in managed healthcare plans during the 2003-04 and 2004-05 influenza seasons
  10. VIS translation: Thai-language VIS now available for hepatitis A vaccine
  11. Annual SIGN Alliance meeting to be held November 14-16 in Hanoi; October 1 is deadline for hotel reservations
  12. MMWR corrects data on 2003 influenza and pneumococcal coverage among persons age 65 years and older

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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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September 26, 2005
NEW: CDC ISSUES INTERIM VIS FOR Tdap (TETANUS-DIPHTHERIA-PERTUSSIS) VACCINE FOR ADOLESCENTS AND ADULTS

On September 22, CDC issued an interim VIS for the new Tdap (tetanus-diphtheria-pertussis) vaccine. CDC will issue the final VIS for Tdap vaccine after MMWR publishes the ACIP recommendations. Until then, healthcare providers should give patients the interim VIS before administering the vaccine.

VISs FOR VARIOUS TETANUS-AND-DIPHTHERIA-CONTAINING VACCINES
Several vaccines exist that contain tetanus and diphtheria toxoids; it is important that healthcare providers give patients the VIS that corresponds to the vaccine being administered:

(1) Two Tdap vaccines are licensed in the U.S.; one is for persons ages 10-18 years and the other for persons ages 11-64 years. Healthcare providers should give patients the interim Tdap vaccine VIS (dated 9/22/05) before administering this vaccine.

(2) Td vaccine is licensed for persons ages 7 years and older; healthcare providers must give patients the Td vaccine VIS (dated 6/10/94) before administering this vaccine.

(3) DTaP and DT vaccines are licensed for use in children younger than 7 years; healthcare providers must give the DTaP vaccine VIS (dated 7/30/01) before administering either vaccine.

OBTAINING THE INTERIM VIS FOR Tdap VACCINE
Please note that the interim VIS is currently available only in English.

To obtain a ready-to-copy (PDF) version of the interim VIS for Tdap vaccine from the NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-tdap.pdf

To obtain it from the IAC website, go to:
http://www.immunize.org/vis/tdap.pdf

For VISs for all the tetanus-and-diphtheria-containing vaccines, 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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September 26, 2005
MMWR ISSUES CORRECTION TO THE INFLUENZA VACCINATION RECOMMENDATIONS IT PUBLISHED SEPTEMBER 16

CDC published "Erratum: Vol. 54, No. 36" in the September 23 issue of MMWR. The correction, which concerns influenza recommendations for children displaced by Hurricane Katrina, is reprinted below in its entirety (corrected material is presented in capital letters).

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In the report, "Update: Influenza Activity--United States and Worldwide, May 22-September 3, 2005, and 2005-06 Season Vaccination Recommendations," on page 901, an error occurred in the second sentence under Vaccination Recommendations for Persons Displaced by Hurricane Katrina. The sentence should read as follows: Any displaced persons aged 6 months [or older] living in crowded group settings should be administered influenza vaccine; children aged 8 years [or younger] should be administered 2 doses, at least 1 month apart, UNLESS THEY HAVE A DOCUMENTED RECORD OF A PREVIOUS DOSE OF INFLUENZA VACCINE, IN WHICH CASE THEY SHOULD RECEIVE 1 DOSE OF INFLUENZA VACCINE.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5437a11.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5437.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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September 26, 2005
NEWS ALERT: ON SEPTEMBER 28 DEAR ABBY WILL PUBLISH A LETTER URGING EARLY INFLUENZA VACCINATION FOR HIGH-RISK PERSONS

Please check the Dear Abby column in your newspaper on September 28. The column will feature a letter from Mitchel C. Rothholz, RPh, MBA, of the American Pharmacists Association. In his letter, Rothholz urges persons at high risk for influenza complications to get vaccinated early, even if vaccine is in short supply. He wrote the letter on behalf of the National Influenza Vaccine Summit.
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September 26, 2005
NEW: SCREENING QUESTIONNAIRE IDENTIFIES WHICH PATIENTS ARE ELIGIBLE TO RECEIVE INFLUENZA VACCINE BEFORE OCTOBER 24

CDC recently updated its influenza web section with a one-page screening questionnaire that can help health professionals identify which patients are eligible to receive injectable influenza vaccine before October 24. It is titled "Who should get inactivated influenza vaccine (the 'flu' shot) early?"

Available in English- and Spanish-language versions, the questionnaire is divided into two parts, one for patients to answer about their own health status and the other for parents to answer about the health status of their children ages 6 months to 18 years.

To access a ready-to-print (PDF) version of the English-language questionnaire, go to:
http://www.cdc.gov/flu/professionals/pdf/early_screening_form.pdf

To access a ready-to-print (PDF) version of the Spanish-language questionnaire, go to:
http://www.cdc.gov/flu/espanol/pdf/early_screening_form_spanish.pdf

CDC's Influenza web section offers an array of information and materials for health professionals and the public. Visit it often at http://www.cdc.gov/flu

For ongoing information about new and updated additions to the Influenza web section, go to:
http://www.cdc.gov/flu/whatsnew.htm
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September 26, 2005
NEW: CDC RESPONDS TO LANCET ARTICLE QUESTIONING THE EFFICACY AND EFFECTIVENESS OF INFLUENZA VACCINE FOR OLDER PEOPLE

On September 22, the website of the Lancet medical journal posted an early online version of the article "Efficacy and effectiveness of influenza vaccines in elderly people: a systemic review." The article concludes that influenza vaccine is less effective for people age 65 and older than previously assumed. CDC responded by creating a series of talking points that health professionals can use to answer questions raised by the article. The talking points are reprinted below in their entirety.

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FACTS ABOUT INFLUENZA VACCINE EFFICACY IN THE ELDERLY 09/22/05

A new report by T. Jefferson and colleagues (Cochrane Vaccines Field, Italy) entitled "Efficacy and effectiveness of influenza vaccines in elderly people: A systemic review" was published in the September 22, 2005, online issue of The Lancet. This article presents findings from a review of 64 studies that evaluated the efficacy and effectiveness of influenza vaccines in people aged 65 years and older. Fifteen of the 64 studies looked at vaccine efficacy in elderly individuals not residing in long-term care facilities, and 29 studies involved vaccine efficacy in persons living in long-term care facilities. The Centers for Disease Control and Prevention, which did not collaborate on this study, is providing the information below to help address questions that may be raised in response to the publication of this report.

CDC recommends influenza vaccination for people age 65 years and over and for all persons in long-term care facilities.

  • These recommendations are in place because people age 65 and over and those in long-term care facilities are at increased risk for complications from influenza.

Vaccination is the best way to protect people age 65 years and over from influenza and its complications.

  • Vaccine effectiveness is not 100%. Some older persons and persons with certain chronic diseases might develop less immunity than healthy young adults after vaccination and, thus, can remain susceptible to influenza infection and illness.
  • In general, the vaccine can be effective in preventing secondary complications and in reducing the risk for influenza-related hospitalization and death among adults aged 65 years and over with and without high-risk medical conditions (e.g., heart disease and diabetes).
  • Among elderly persons not living in nursing homes or similar long-term care facilities, influenza vaccine has been reported to be 30%-70% effective in preventing hospitalization for pneumonia and influenza.
  • Among older persons who do reside in nursing homes, influenza vaccine is most effective in preventing severe illness, secondary complications, and deaths. Among this population, the vaccine has been reported to be 50%60% effective in preventing influenza-related hospitalization or pneumonia and 80% effective in preventing influenza-related death, although the effectiveness in preventing influenza illness often ranges from 30% to 40%. In years when the vaccine is not well matched to circulating influenza strains, vaccine effectiveness is often lower.

When interpreting the findings from the Jefferson et al. study, there are a number of things to keep in mind:

  • The study did demonstrate that influenza vaccine is effective in preventing complications and death from influenza in older persons, both in the community and in long-term care facilities.
  • The highest estimate of vaccine effectiveness (VE) against laboratory-confirmed influenza was in the only large randomized trial among the elderly. Reasons for a lack of effectiveness against virologically proven influenza in some of the other studies reviewed are unclear.
  • Nearly all of the studies in elderly are non-randomized studies. Results from such studies can be difficult to interpret because of biases inherent in them.
  • Influenza vaccines should be well matched to circulating wild viruses to offer the best possible protection.
  • As the authors indicate, lower estimates of VE are expected when the study outcomes are not specific to influenza (e.g., influenza-like illness, ILI, or ICD-9 codes for pneumonia). Such non-specific outcomes were used for most of the studies.
  • The study results suggesting that the influenza vaccine is more effective among nursing home residents than among community-dwelling elderly is unexpected and not consistent with other data, including information on immune response to vaccination.
  • In the U.S., in contrast to what is implied by the authors, influenza vaccination is higher among elderly persons with chronic conditions and highest among nursing home residents, which would tend to bias VE estimates lower rather than higher VE.
  • As the authors indicate, better influenza vaccines that offer more protection in older persons are desirable and a high priority of influenza researchers.

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September 26, 2005
FEDERAL AND MILITARY EMPLOYEES: HELP IAC BY USING AGENCY CODE 0233 WHEN YOU CONTRIBUTE TO THE COMBINED FEDERAL CAMPAIGN

Federal and military employees have an easy, hassle-free option for contributing to IAC--the Combined Federal Campaign (CFC). Each fall, federal and military employees are allowed to make contributions to charities of their choice through CFC.

By filling out a CFC pledge card (available through your local campaign volunteers), you can contribute to IAC by cash, check, or payroll deduction. If you would like to contribute to us, please enter our four-digit agency code, 0233, and a dollar amount on your 2005 CFC pledge card. To our knowledge, IAC is the only immunization-specific organization approved to receive contributions through CFC.

If you choose, we would like to thank each of you personally for your contribution. To do that, we need you to check off the boxes on the pledge card that permit CFC to send us your name and contact information.

For more information about CFC, go to: http://www.opm.gov/cfc
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September 26, 2005
"VOTE AND VAX" BOOKLET TELLS HOW TO SET UP AN INFLUENZA SHOT CLINIC IN YOUR COMMUNITY ON ELECTION DAY

Just in time for fall elections, the Robert Wood Johnson Foundation has published "Vote and Vax: Setting up a successful clinic in your community." Based on the experience of several "Vote and Vax" pilot projects, the 11-page booklet presents practical advice on setting up influenza vaccination clinics at polling places.

To download a ready-to-print (PDF) version of the booklet, go to: http://www.rwjf.org/files/newsroom/VoteVax091405.pdf

For general information on "Vote and Vax" projects, go to:
http://www.rwjf.org/newsroom/featureDetail.jsp?featureID=1027
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September 26, 2005
TELECONFERENCE ON ADOLESCENT IMMUNIZATION IS SCHEDULED FOR OCTOBER 11

The National Immunization Coalition TA [technical assistance] Network has scheduled a teleconference on adolescent immunization. In particular, the teleconference will cover adolescent immunization as an emerging issue, given the recent development of new vaccines for adolescents and changing immunization recommendations. It will be held at 1:00PM, EDT, October 11. The presenter is yet to be determined.

NOTE: CDC will give updates on the current influenza vaccine supply at the beginning of this teleconference and at the beginning of future teleconferences throughout the influenza season.

To register for the teleconference, send an email to IZTA@aed.org Include this message: "Sign me up for the immunizations for adolescents teleconference."

For additional information, or to access earlier programs, go to: http://www.izcoalitionsta.org/confcall.cfm
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September 26, 2005
REPORT COMPARES INFLUENZA VACCINATION IN MANAGED HEALTHCARE PLANS DURING THE 2003-04 AND 2004-05 INFLUENZA SEASONS

CDC published "Influenza Vaccination Coverage Among Persons Aged 50-64 Years Enrolled in Commercial Managed Healthcare Plans--United States, 2003-04 and 2004-05 Influenza Seasons" in the September 23 issue of MMWR. Portions of the article are reprinted below.

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To combat an unexpected shortage of influenza vaccine in the fall of 2004, CDC issued guidance to direct available vaccine supplies to persons in designated priority groups (e.g., persons aged 65 years [and older], persons with certain health conditions, healthcare workers, and close contacts of persons at high risk for complications from influenza). Analyses of influenza vaccination coverage for the 2004-05 influenza season indicated that coverage levels for adults in priority groups nearly reached the levels of previous years, whereas coverage levels among adults not in priority groups were approximately half the levels of the 2003-04 season. These findings suggested that national public health actions to direct available vaccine supply to persons at high risk for complications from influenza during the supply disruption were successful. To assess influenza vaccination coverage among persons aged 50-64 years for the 2004-05 influenza season relative to the 2003-04 season and to estimate the effect of shortages on selected subgroups, the National Committee for Quality Assurance (NCQA) analyzed data from a survey of persons enrolled in commercial managed care health plans. This report summarizes the findings of that analysis, which indicated that, although vaccination coverage declined substantially from 2003-04 to 2004-05 among all subgroups in this age range, respondents who were older or who reported poorer health status exhibited smaller relative declines in vaccination coverage between the two seasons.

Data for this analysis are from the Consumer Assessment of Health Plans (CAHPS) survey, a national survey of members of commercial health plans. This annual survey samples the membership of more than 250 managed care organizations (MCOs) with approximately 70 million members, representing more than 90% of the total commercial MCO membership in the United States. . . .

The findings of this analysis indicated that, from 2003-04 to 2004-05, vaccination coverage for the surveyed population decreased from 52.4% (95% confidence interval [CI] = 52.0%-52.8%) to 28.1% (CI = 27.7%-28.4%), a decrease of approximately 46%. All eight regions of the United States experienced similar decreases, with the largest percentage decrease occurring in the Mid-Atlantic region (50.5%) and the smallest in New England (43.9%). Vaccination coverage increased with age, from 45.6% for persons aged 50-54 years to 60.1% for persons aged 60-64 years in 2003-04, with similar relative increases in 2004-05. Persons aged 50-54 years experienced the largest percentage decrease (51.3% compared with 40.9% for persons aged 60-64 years). Compared with women, men had lower vaccination coverage for 2003-04 (50.0% versus 53.9% for women), with a larger percentage decrease in 2004-05 (49.2% for men versus 44.2% for women). For both years, respondents with a high school education or greater had higher vaccination coverage than those with less than a high school education. However, this difference decreased in 2004-05 because of larger declines in vaccination coverage for those with a high school education or greater.

Self-reported health status had a substantial effect on vaccination coverage, with healthier respondents less likely to receive a vaccination. During 2003-04, respondents who described their health as "excellent" had vaccination coverage of 47.9% (CI = 46.8%-49.0%) compared with 58.6% (CI = 55.4%-61.6%) among those who reported having "poor" health. This difference increased in 2004-05, with coverage for respondents who reported being in excellent health decreasing to 23.2% (CI = 22.4%-24.1%), a decline of more than half (51.6%); coverage for respondents of self-reported poor health decreased to 44.8% (CI = 41.6%-47.9%), a decline of less than one fourth (23.5%).

During 2003-04, Hispanics had vaccination coverage of 44.8% (CI = 43.0%-46.5%) versus 53.0% (CI = 52.5%-53.4%) for non-Hispanics. In 2004-05, coverage for Hispanics decreased by less (44.4%) than that for non-Hispanics (46.6%). Similarly, coverage for whites and Native Hawaiians/Pacific Islanders was highest in 2003-04 (approximately 54%) but declined the most (47.1% and 48.3%, respectively) in 2004-05. Among all races, coverage for blacks was lowest in 2003-04 at 38.6% (CI = 37.1%-40.0%) and declined by 39.1% in 2004-05, to 23.5% (CI = 22.3%-24.7%). Multiple logistic regression analysis confirmed the independent effects of these factors on vaccine availability.

EDITORIAL NOTE
Data from CAHPS provide insight into the effects of the fall 2004 influenza vaccine shortage on vaccination coverage for a population at low risk for complications from influenza. Overall, the limited availability of vaccine, the media attention to the problem, and calls from public health authorities to direct available supplies to persons at high risk appear to have resulted in decreases in vaccination coverage among MCO enrollees compared with the preceding season. These decreases were consistent across all eight geographic regions, suggesting that available supplies were distributed uniformly across the United States, although variations within smaller geographic areas might have been more extreme.

Respondents who were older or who reported poorer health status exhibited smaller relative reductions in vaccination coverage; this suggests that efforts to target vaccination to higher-risk members of the survey population were somewhat successful. However, CAHPS data indicate that substantial reductions in vaccination coverage occurred among commercially insured persons with fair or poor health status. . . .

A simple self-assessment question about health status administered in a waiting room might help clinicians and public health authorities identify persons at high risk and target vaccine to priority groups during vaccine shortages.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5437a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5437.pdf
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September 26, 2005
VIS TRANSLATION: THAI-LANGUAGE VIS NOW AVAILABLE FOR HEPATITIS A VACCINE

Dated 8/4/04, the current version of the VIS for hepatitis A vaccine is now available on the IAC website in Thai. IAC gratefully acknowledges Asian Pacific Healthcare Venture, Los Angeles, for the translation.

To obtain a ready-to-copy (PDF) version of the VIS in Thai, go to: http://www.immunize.org/vis/th_hpa04.pdf

To obtain the VIS in English, go to:
http://www.immunize.org/vis/v-hepa.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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September 26, 2005
ANNUAL SIGN ALLIANCE MEETING TO BE HELD NOVEMBER 14-16 IN HANOI; OCTOBER 1 IS DEADLINE FOR HOTEL RESERVATIONS

The annual meeting of WHO's Safe Injection Global Network (SIGN) Alliance will be held November 14-16 in Hanoi. The SIGN meeting precedes the International Scientific Conference on Occupational and Environmental Health, which will be held in Hanoi on November 16-18.

The SIGN meeting will be held in the Sofitel Plaza Hanoi Hotel; the deadline for hotel reservations is October 1.

To access comprehensive information about the meeting, including the preliminary meeting agenda, an online reservation form, and travel information, go to: http://www.who.int/injection_safety/en/
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September 26, 2005
MMWR CORRECTS DATA ON 2003 INFLUENZA AND PNEUMOCOCCAL COVERAGE AMONG PERSONS AGE 65 YEARS AND OLDER

CDC published "Errata: Vol. 53, No. 43" in the September 23 issue of MMWR. The erroneous information was published in the MMWR of November 5, 2004. The correction is reprinted below in its entirety.

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In the report, "Influenza and Pneumococcal Vaccination Coverage Among Persons Aged 65 Years [and older] and Persons Aged 18-64 Years with Diabetes or Asthma--United States, 2003," errors occurred in Tables 1 and 2.

Table 1. The influenza vaccination coverage among adults aged 65 years [and older] in Hawaii should be 76.4% (95% confidence interval [CI] +3.5%), % change +2.5%, and in Illinois should be 62.2% (CI +3.5%), % change +1.1%. Pneumococcal vaccination coverage in Hawaii should be 69.4% (CI +3.9%), % change +9.8%, and in Illinois should be 57.0% (CI +3.6%), % change +0.3%. The overall median pneumococcal coverage for adults aged 65 years [and older] should be 64.5%.

Table 2. The influenza vaccination coverage among adults aged 18-64 years with asthma in Hawaii should be 41.6% (CI = 33.5-50.3), and in Illinois should be 33.9% (CI = 28.5-39.8). The influenza vaccination coverage among adults aged 18-64 years with diabetes in Hawaii should be 61.1% (51.4-70.0), and in Illinois should be 37.2% (30.6-44.2). Pneumococcal vaccination coverage among adults aged 18-64 years with diabetes in Hawaii should be 29.0% (CI = 21.0-38.5), and in Illinois should be 26.7% (CI = 20.9-33.4).

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5437a10.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5437.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 September 26, 2005