Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 576            January 17, 2006

CONTENTS OF THIS ISSUE

  1. CDC issues official Health Advisory, recommending against the use of Amantadine and Rimandatine for the treatment or prophylaxis of influenza
  2. CDC issues interim VIS for hepatitis A vaccine
  3. CDC issues updated VIS for rabies vaccine
  4. Important information for those planning on attending ACIP meetings
  5. HHS releases a pandemic influenza guide for individuals and families
  6. AAFP publishes a pandemic influenza vaccine prioritization guide for providers
  7. IAC adds web section of pandemic influenza resources
  8. IAC adds autism web section to its website for the public and health professionals
  9. Influenza update: CDC reports on influenza activity during December 2531, 2005
  10. VIS translation: IAC posts Haitian Creole VIS for meningococcal vaccine
  11. CDC updates its influenza web section
  12. January issue of CDC's Immunization Works electronic newsletter now available on the NIP website

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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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January 17, 2006
CDC ISSUES OFFICIAL HEALTH ADVISORY, RECOMMENDING AGAINST THE USE OF AMANTADINE AND RIMANDATINE FOR THE TREATMENT OR PROPHYLAXIS OF INFLUENZA

On January 14, CDC issued an official Health Advisory for healthcare providers, recommending against the use of Amantadine and Rimandatine for the treatment of influenza in the United States during the 20052006 influenza season. The Health Advisory is reprinted below in its entirety.

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This is an official CDC Health Advisory
Distributed via Health Alert Network
Saturday, January 14, 2006, 15:30 EST (3:30 PM EST)

CDC Recommends against the Use of Amantadine and Rimandatine for the Treatment or Prophylaxis of Influenza in the United States during the 200506 Influenza Season: Recent evidence indicates that a high proportion of currently circulating Influenza A viruses in this country are resistant to these medications

While the primary strategy for preventing complications of influenza infections is annual vaccination, antiviral medications with activity against influenza viruses can be effective for the prophylaxis and treatment of influenza. Two classes of antivirals are currently available--the M2 ion channel inhibitors (i.e., the two adamantanes amantadine and rimantadine) and the neuraminidase inhibitors (i.e., oseltamivir and zanamivir). The neuraminidase inhibitors are effective for the treatment and prophylaxis of influenza A and B, while the adamantanes are only active against influenza A viruses. This alert provides new information about the resistance of influenza viruses currently circulating in the United States to the adamantanes, and it makes an interim recommendation that these drugs not be used during the 200506 influenza season. Amantadine is also used to treat the symptoms of Parkinson's disease, and should continue to be used for this indication.

Viral resistance to adamantanes can emerge rapidly during treatment because a single point mutation at amino acid positions 26, 27, 30, 31, or 34 of the M2 protein can confer cross-resistance to both amantadine and rimantadine. The transmissibility of adamantane-resistant viruses is not impaired by any of these amino acid changes. A recent report on the global prevalence of adamantane-resistant influenza viruses showed a significant increase (from 1.9% to 12.3%) in drug resistance over the past 3 years. In the United States, the frequency of drug resistance increased from 1.9% in 2004 to 14.5% during the first 6 months of the 200405 influenza season.

For the 200506 season, 120 influenza A (H3N2) viruses isolated from patients in 23 states have been tested at CDC through January 12, 2006; 109 of the isolates (91%) contain an amino acid change at position 31 of the M2 protein, which confers resistance to amantadine and rimantadine. Three influenza A(H1N1) viruses have been tested and demonstrated susceptibility to these drugs. All influenza viruses from the United States that have been screened for antiviral resistance at CDC have demonstrated susceptibility to the neuraminidase inhibitors.

On the basis of available antiviral testing results, CDC is providing an interim recommendation that neither amantadine nor rimandatine be used for the treatment or prophylaxis of influenza A in the United States for the remainder of the 200506 influenza season. During this period, oseltamivir or zanamivir should be selected if an antiviral medication is used for the treatment and prophylaxis of influenza. Testing of influenza isolates for resistance to antivirals will continue throughout the 200506 influenza season, and recommendations will be updated as needed. Annual influenza vaccination remains the primary means of preventing morbidity and mortality associated with influenza.

Additional information about the prevention and control of influenza is available at http://www.cdc.gov/flu. Specific information regarding the use of the neuraminidase inhibitors is available at http://www.cdc.gov/flu/protect/antiviral/index.htm. These websites will be updated as new information becomes available.

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To access the Health Alert from the archives of the Health Alert Network, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00240

For a related press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060114.htm
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January 17, 2006
CDC ISSUES INTERIM VIS FOR HEPATITIS A VACCINE

On January 9, CDC posted an interim VIS for the hepatitis A vaccine. The interim VIS takes into account the licensing of hepatitis A vaccines for children 12 months and older. CDC will issue the final VIS for hepatitis A vaccine after MMWR publishes the ACIP recommendations. Until then, healthcare providers should give patients the interim VIS before administering the vaccine.

OBTAINING THE INTERIM VIS FOR HEPATITIS A VACCINE
Please note that the interim VIS (dated 1/9/06) is currently available only in English.

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

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

For VISs in a total of 33 languages, and for information about the use of VISs, visit IAC's VIS web section at http://www.immunize.org/vis
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January 17, 2006
CDC ISSUES UPDATED VIS FOR RABIES VACCINE

On January 12, CDC posted an updated VIS for rabies vaccine. A small change has been made in the rabies VIS. In Section 4 ("Tell your doctor if . . ."), a statement regarding anti-malarial drugs has been removed. This is because intradermal rabies vaccine is no longer available in the U.S., and this precaution applied only to the intradermal formulation. The revised VIS is dated 1/12/06. Stocks of the earlier version of the VIS may be used up, but patients should be made aware that use of anti-malarial drugs is no longer a precaution for rabies vaccination.

OBTAINING THE UPDATED VIS FOR RABIES VACCINE
Please note that the updated VIS is currently available only in English.

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

To obtain it from the IAC website, go to:
http://www.immunize.org/vis/rabies06.pdf

For VISs in a total of 33 languages, and for information about the use of VISs, visit IAC's VIS web section at http://www.immunize.org/vis
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January 17, 2006
IMPORTANT INFORMATION FOR THOSE PLANNING ON ATTENDING ACIP MEETINGS

In order to expedite the security clearance process at the CDC Clifton Road campus, all Advisory Committee on Immunization Practices (ACIP) attendees must now register online. This rule includes all CDC participants as well as all visitors. The registration forms for upcoming meetings can be accessed at http://www.cdc.gov/nip/ACIP/dates.htm

All non-U.S. citizens are required to register at least three weeks in advance of an ACIP meeting (e.g., for the February 2122 meeting, the latest registration date allowed would be January 25, 2006). Non-U.S. citizens will not be allowed to register on site. In addition to registering online, foreign attendees must also complete an additional document. To obtain this form, email Dee Gardner at dgardner@cdc.gov or call (404) 639-8836.

As a reminder, the next ACIP meeting will be held Tuesday, February 21 and Wednesday, February 22, 2006. For more information, go to: http://www.cdc.gov/nip/acip
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January 17, 2006
HHS RELEASES A PANDEMIC INFLUENZA GUIDE FOR INDIVIDUALS AND FAMILIES

On January 6, the U.S. Department of Health and Human Services (HHS) released a new tool to help Americans understand the threat of pandemic influenza and learn specific actions they can take to protect themselves and their families.

"Pandemic Influenza Planning: A Guide for Individuals and Families" includes a planning checklist intended to help individuals gather the information and resources they may need. The checklist breaks activities into three categories: "To plan for a pandemic," "To limit the spread of germs and prevent infection," and "Items to have on hand for an extended stay at home."

To access this new resource, go to:
http://www.pandemicflu.gov/plan/pdf/guide.pdf
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January 17, 1006
AAFP PUBLISHES A PANDEMIC INFLUENZA VACCINE PRIORITIZATION GUIDE FOR PROVIDERS

The American Academy of Family Physicians (AAFP) published "Preparing for an Influenza Pandemic: Vaccine Prioritization" by Jonathan L. Temte, MD, PhD, in the January 2006 issue of Family Practice Management. The article details how to determine which patients and employees in a medical practice should receive the influenza vaccine if a pandemic occurs.

To read this article online, go to:
http://www.aafp.org/fpm/20060100/32prep.html
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January 17, 2006
IAC ADDS WEB SECTION OF PANDEMIC INFLUENZA RESOURCES

IAC recently added a link to the home page of http://www.immunize.org to make it easier for visitors to access pandemic influenza information. Individuals can click on the "Pandemic influenza" link in the top right corner of the website, or go directly to the pandemic influenza index page at http://www.immunize.org/pandemic

This page features links to resources from the U.S. Department of Health and Human Services, the American Academy of Family Physicians, WHO, and CDC, including links to CDC's new newsletter, Pandemic Influenza Update. To read the January 5, 2006 issue of this newsletter, go to: http://www.immunize.org/pandemic/panflu010506.pdf
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January 17, 2006
IAC ADDS AUTISM WEB SECTION TO ITS WEBSITE FOR THE PUBLIC AND HEALTH PROFESSIONALS

To help parents searching for reliable information about vaccines and autism, IAC has added a new section of information to its website for the public and health professionals. Visitors can click on the "Vaccines and Autism" link on the home page of http://www.vaccineinformation.org, or go directly to http://www.vaccineinformation.org/autism.asp The page includes information from the U.S. Department of Health and Human Services, CDC, the Institute of Medicine, the American Academy of Pediatrics, and IAC.
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January 17, 2006
INFLUENZA UPDATE: CDC REPORTS ON INFLUENZA ACTIVITY DURING DECEMBER 2531, 2005

CDC published "Update: Influenza Activity--United States, December 25-31, 2005" in the January 13 issue of MMWR. The article's first paragraph is reprinted below.

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During December 2531, 2005, the number of states reporting widespread influenza activity increased to seven. Three states reported regional activity, nine reported local activity, and 27 reported sporadic activity.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5501a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5501.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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January 17, 2006
VIS TRANSLATION: IAC POSTS HAITIAN CREOLE VIS FOR MENINGOCOCCAL VACCINE

The current interim version of the VIS for meningococcal vaccine is now available on the IAC website in Haitian Creole. IAC gratefully acknowledges the Massachusetts Department of Public Health for the translation.

MENINGOCOCCAL VACCINE VIS (dated 10/7/05)
To obtain a ready-to-print (PDF) version of the interim VIS for meningococcal vaccine in Haitian Creole, go to:
http://www.immunize.org/vis/ha_men05.pdf

To obtain it in English, go to:
http://www.immunize.org/vis/menin05.pdf

For VISs in a total of 33 languages, and for information about the use of VISs, visit IAC's VIS web section at http://www.immunize.org/vis
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January 17, 2006
CDC UPDATES ITS INFLUENZA WEB SECTION

CDC recently updated two pages on its Influenza web section:

  1. "Recent Avian Influenza Outbreaks in Asia and Europe" (1/10/06)
  2. "Key Facts: Information about Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus" (1/10/06)

To access these resources, go to: http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent link.

To access a broad range of continually updated information on seasonal influenza, avian influenza, and pandemic influenza, go to: http://www.cdc.gov/flu
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January 17, 2006
JANUARY ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER NOW AVAILABLE ON THE NIP WEBSITE

The January 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 January 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
CDC INFLUENZA LEAD ANNOUNCED: National Center for Infectious Diseases (NCID) and National Immunization Program (NIP) leadership announced that Jim LeDuc will serve as influenza lead and interim influenza goal team leader for CDC. Dr. LeDuc has been the Director of the Division of Viral and Rickettsial Diseases (DVRD) in NCID since 2000. Previously, he was the Associate Director for Global Health, NCID, and prior to that, he was technical advisor for arboviruses and hemorrhagic fevers at the World Health Organization (WHO) in Geneva, Switzerland. For over 20 years, Dr. LeDuc also served as an officer and research scientist in the U.S. Army Medical Research and Development Command, where he conducted field and laboratory investigations into the epidemiology of virus diseases, developed diagnostic tests, and participated in vaccine development efforts. Dr. LeDuc received his bachelor's degree from California State University at Long Beach, and his Masters of Science and Doctor of Philosophy degrees from the University of California at Los Angeles. He is the author of nearly 200 scientific papers and book chapters on infectious diseases and global health.

PROVIDER REMINDERS AT VISIT IMPROVE IMMUNIZATION COVERAGE:
A recently published study offers strong support for provider reminders about the child's next immunization visit at the time of the immunization visit. The study compared 4:3:1:3:3 (4+ doses of diphtheria and tetanus toxoids and pertussis vaccine, 3+ doses of poliovirus vaccine, 1+ doses of measles-containing vaccine, 3+ doses of Haemophilus influenzae type b vaccine, and 3+ doses of hepatitis B vaccine) coverage among children 19-35 months whose caregivers learned by different methods when their child's most recent immunization was needed. Methods included provider reminders during an immunization visit (of the next scheduled immunization visit); use of a shot card/record; use of reminder/recall systems; and informal methods such as reminders from relatives, friends, or daycare providers.

Of all methods, provider reminders during an immunization visit (of the next scheduled immunization visit) were found to be the most effective. Coverage rates for children of "reminded" caregivers were significantly higher than [for] children of "un-reminded" caregivers (77% vs. 70%). To access the complete article, published in BMC [BioMed Central] Pediatrics, please visit http://www.biomedcentral.com/1471-2431/5/44.

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To access the complete January issue of Immunization Works from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200601.htm

 

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 January 17, 2006