Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 584            February 27, 2006

CONTENTS OF THIS ISSUE

  1. New: CDC publishes recommendations for preventing tetanus, diphtheria, and pertussis in adolescents
  2. New: ACIP recommends new rotavirus vaccine for infants
  3. New: ACIP expands its influenza vaccine recommendation for children
  4. New: CDC reports an investigational drug is available for postexposure varicella prophylaxis of high-risk patients
  5. CDC issues two Health Updates about a current case of inhalation anthrax in Pennsylvania
  6. CDC reports on an outbreak of mumps in a New York summer camp during 2005
  7. CDC reports on the 2004–05 mumps epidemic in the United Kingdom
  8. Avian influenza: WHO and CDC report on rapid spread of the disease in birds
  9. Influenza vaccination recommendations for healthcare personnel now in MMWR Recommendations and Reports format
  10. Updated: IAC revises two patient-education pieces
  11. Puzzled about the status of vaccine licensures and recommendations? "Red Book Online" has current information
  12. CDC reports on U.S. influenza activity during February 5–11
  13. Attention immunization coalitions: Meet 'n' Greet and teleconferencing opportunities are available in March
  14. Reminder: March 6 is registration deadline for meeting on management of hepatitis B virus

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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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February 27, 2006
NEW: CDC PUBLISHES RECOMMENDATIONS FOR PREVENTING TETANUS, DIPHTHERIA, AND PERTUSSIS IN ADOLESCENTS

On February 23, CDC published "Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" as an MMWR Early Release. Documents published in the MMWR Early Release format are available only electronically. Subsequently, they are published in MMWR Recommendations and Reports format and are available both electronically and in print.

Two sections of the recommendations are reprinted below—the Summary and the Introduction.

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SUMMARY
During spring 2005, two tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) products formulated for use in adolescents (and, for one product, use in adults) were licensed in the United States (BOOSTRIX, GlaxoSmithKline Biologicals, Rixensart, Belgium [licensed May 3, 2005, for use in persons aged 10–18 years], and ADACEL, sanofi pasteur, Toronto, Ontario, Canada [licensed June 10, 2005, for use in persons aged 11–64 years]). Prelicensure studies demonstrated safety and efficacy against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adolescents. To reduce pertussis morbidity in adolescents and maintain the standard of care for tetanus and diphtheria protection, the Advisory Committee on Immunization Practices (ACIP) recommends that: (1) adolescents aged 11–18 years should receive a single dose of Tdap instead of tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria and tetanus toxoids and whole cell pertussis vaccine (DTP)/diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) vaccination series (five doses of pediatric DTP/DTaP before the seventh birthday; if the fourth dose was administered on or after the fourth birthday, the fifth dose is not needed) and have not received Td or Tdap. The preferred age for Tdap vaccination is 11–12 years; (2) 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. An interval of at least 5 years between Td and Tdap is encouraged to reduce the risk for local and systemic reactions after Tdap vaccination. However, an interval less than 5 years between Td and Tdap can be used; and (3) vaccine providers should administer Tdap and tetravalent meningococcal conjugate vaccine (Menactra, sanofi pasteur, Swiftwater, Pennsylvania) to adolescents aged 11–18 years during the same visit if both vaccines are indicated and available. This statement (1) reviews tetanus, diphtheria, and pertussis vaccination policy in the United States, with emphasis on adolescents; (2) describes the clinical features and epidemiology of pertussis among adolescents; (3) summarizes the immunogenicity, efficacy, and safety data of the two Tdap vaccines licensed for use among adolescents; and (4) presents recommendations for tetanus, diphtheria, and pertussis vaccination among adolescents aged 11–18 years.

INTRODUCTION
Pertussis, an acute, infectious cough illness, remains endemic in the United States despite routine childhood pertussis vaccination for more than half a century and high coverage levels in children for more than a decade. A primary reason for the continued circulation of Bordetella pertussis is that immunity to pertussis wanes approximately 5–10 years after completion of childhood pertussis vaccination, leaving adolescents and adults susceptible to pertussis. Among the diseases for which universal childhood vaccination has been recommended, pertussis is the least well-controlled reportable bacterial vaccine-preventable disease in the United States.

In the United States during 1934–1943, an annual average of 200,752 pertussis cases and 4,034 pertussis-related deaths were reported. After the introduction of childhood pertussis vaccination during the 1940s, the number of reported pertussis cases declined dramatically, reaching an historic low of 1,010 in 1976. Since the 1980s, the number of reported pertussis cases has been steadily increasing, especially among adolescents and adults. Possible reasons for the increase in reported pertussis cases include a true increase in the burden of disease and an increase in the detection and reporting of cases; the relative contribution of each of these factors to the increase observed is unclear. . . .

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To access a web-text (HTML) version of the recommendations, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e223a1.htm

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr55e223.pdf
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February 27, 2006
NEW: ACIP RECOMMENDS NEW ROTAVIRUS VACCINE FOR INFANTS

On February 21, CDC issued a press release reporting that ACIP had recommended the newly licensed RotaTeq rotavirus vaccine for use in infants. The press release is reprinted below in its entirety.

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Press Release
For immediate release
February 21, 2006

CDC'S ADVISORY COMMITTEE RECOMMENDS NEW VACCINE TO PREVENT ROTAVIRUS: Rotavirus is the leading cause of gastroenteritis in infants and young children in the United States and worldwide.

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) in their meeting in Atlanta today voted to recommend a newly licensed vaccine to protect against rotavirus, a viral infection that can cause severe diarrhea, vomiting, fever, and dehydration (gastroenteritis) in infants and young children.

The ACIP recommendation is for infants to receive three doses of the oral vaccine at two, four, and six months of age. Children should receive the first dose of the vaccine by 12 weeks of age and should receive all doses of the vaccine by 32 weeks of age. There is insufficient data on safety and efficacy outside of these age ranges. The new vaccine, RotaTeq (marketed by Merck and Company), is the only vaccine approved in the United States for prevention of rotavirus gastroenteritis (vomiting and diarrhea).

"Rotavirus is the leading cause of severe gastroenteritis in infants and young children worldwide" said Dr. Anne Schuchat, director of CDC's National Immunization Program. "Nearly every child in the United States is infected with rotavirus by age five and most will develop gastroenteritis, leading to a large number of physician visits, emergency room visits, and hospitalizations, with a few deaths. Therefore, this vaccine will help reduce one of our most common and potentially severe childhood illnesses."

Each year, rotavirus is responsible for more than 400,000 doctor visits, more than 200,000 emergency room visits, 55,000 to 70,000 hospitalizations, and between 20 and 60 deaths in U.S. children younger than 5 years of age, leading to about $300 million in direct medical costs and $900 million in total societal costs. In developing countries, rotavirus is a major cause of childhood deaths, causing more than half a million deaths each year in children younger than five years of age.

Rotavirus vaccine will not prevent gastroenteritis caused by other viruses, but is very effective against rotavirus disease. Studies indicate the vaccine will prevent about 74 percent of all rotavirus cases and about 98 percent of the most severe cases, including 96 percent of rotavirus cases requiring hospitalization. In trials, the vaccine prevented 59 percent of all causes of gastroenteritis hospitalizations, which highlights the important role of rotavirus in severe childhood gastroenteritis.

In 1999, RotaShield, a different rotavirus vaccine, was withdrawn from the market after it was found to be associated with a rare type of bowel obstruction called intussusception. The risk of intussusception for RotaTeq, the new vaccine, was evaluated in a large-scale trial of over 70,000 children. In that study, there was no association found between the RotaTeq and an increased risk of intussusception and it did not cause fever to the extent caused by RotaShield.

"This is a different vaccine than the vaccine removed from the market because of problems with bowel obstructions," said Dr. Schuchat. "It is made differently and was not associated with intussusception in a large clinical trial. Nevertheless, we will continue to very closely monitor this vaccine to ensure there are no problems. At the same time it's important to remember that the known benefits of the vaccine far outweigh any known risks."

CDC will conduct a large study to rapidly detect any association between RotaTeq and intussusception as well as other potential adverse events through its Vaccine Safety Datalink Program that evaluates vaccine safety in approximately 90,000 infants every year. CDC and FDA will also regularly monitor reports of intussusception and other serious adverse events reported to the Vaccine Adverse Event Reporting System (VAERS). Merck has also committed to conducting a post-licensure study of approximately 44,000 children. In addition, the manufacturer will report cases of intussusception to FDA within 15 days of receiving them.

Recommendations of the ACIP become recommendations of CDC once they are accepted by the director of CDC and the Secretary of Health and Human Services and are published in the Morbidity and Mortality Weekly Report.

For more information on rotavirus and the rotavirus vaccine, visit www.cdc.gov

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To access the press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060221.htm
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February 27, 2006
NEW: ACIP EXPANDS ITS INFLUENZA VACCINE RECOMMENDATION FOR CHILDREN

On February 23, CDC issued a press release reporting that ACIP had recommended that children ages 6 months to up to 5 years receive yearly influenza vaccination. Previously, the recommendation had been to give yearly vaccination to children ages 6–23 months. Portions of the press release are reprinted below.

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Press Release
For immediate release
February 23, 2006

CDC'S ADVISORY COMMITTEE RECOMMENDS EXPANDED INFLUENZA VACCINATIONS FOR CHILDREN

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC), in its meeting in Atlanta today, voted to recommend an expansion of routine influenza vaccination for children. With the expansion, the recommended influenza vaccination age will be from 6 months to up to 5 years old. The previous recommendation was for children 6 months to 23 months old. The new recommendation expands that recommendation to also cover children from 2 years to up to 5 years old.

The committee also voted to recommend expanding routine vaccination for household contacts (anyone who spends a significant amount of time in the home) and out-of-home caregivers of children 24–59 months old. The previous recommendation had been for household contacts and caregivers for children 6 months to 23 months old. This new recommendation takes into consideration a broader view of the burden of illness than the earlier recommendation for vaccination of children, which was based upon the prevention of hospitalization among children 6 months to 23 months old. . . .

Presenters at the meeting indicated that otherwise healthy children are at increased risk for requiring influenza-related medical care and that rates of medial outpatient visits for influenza-related illnesses are high in all childhood ages. It was also noted that children 24 months to 59 months old with influenza are nearly as likely to require visits to healthcare providers and emergency rooms as children 6 months to 23 months old. . . . Vaccination of all children who have certain chronic medical conditions such as asthma, diabetes, kidney disease or weakened immune systems continues to be strongly recommended by ACIP. . . .

The ACIP will continue to review new vaccination strategies for improving the prevention and control of influenza, including the possibility of expanding routine influenza vaccination recommendations to the entire U. S. population. Influenza vaccine manufacturers have indicated that they plan to produce between 100 million and 120 million doses of influenza vaccine for the 2006-07 influenza season.

The 2006-07 influenza vaccine will include two new strains, an A/Wisconsin/67/2005 (H3N2)-like virus and a B/Malaysia/2506/ 2004-like virus; the A/New Caledonia/20/99(H1N1)-like virus strain from the 2005-2006 season will remain in the upcoming vaccine.

Recommendations of the ACIP become recommendations of CDC once they are accepted by the director of CDC and the Secretary of Health and Human Services and are published in the Morbidity and Mortality Weekly Report.

For more information, visit www.cdc.gov

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To read the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060223.htm
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February 27, 2006
NEW: CDC REPORTS AN INVESTIGATIONAL DRUG IS AVAILABLE FOR POSTEXPOSURE VARICELLA PROPHYLAXIS OF HIGH-RISK PATIENTS

On February 24, CDC published "A New Product (VariZIG) for Postexposure Prophylaxis of Varicella Available Under an Investigational New Drug Application Expanded Access Protocol" as an MMWR Early Release. Documents published in the MMWR Early Release format are available only electronically. Subsequently, they are published in MMWR format and are available both electronically and in print.

Portions of the document are reprinted below.

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On October 27, 2004, the Advisory Committee on Immunization Practices (ACIP) was informed by the only U.S.-licensed manufacturer of varicella zoster immune globulin (VZIG), (Massachusetts Public Health Biologic Laboratories, Boston, Massachusetts), that the company had discontinued production of VZIG. The supply of the licensed VZIG product is now nearly depleted. In February 2006, an investigational (not licensed) VZIG product, VariZIG™ (Cangene Corporation, Winnipeg, Canada), became available under an investigational new drug application (IND) submitted to the Food and Drug Administration (FDA). This product can be requested from the sole authorized U.S. distributor, FFF Enterprises (Temecula, California), for patients who have been exposed to varicella and who are at increased risk for severe disease and complications.

The investigational VariZIG, similar to licensed VZIG, is a purified human immune globulin preparation made from plasma containing high levels of anti-varicella antibodies (immunoglobulin class G [IgG]). Unlike the previous product, the investigational product is lyophilized. When properly reconstituted, VariZIG is approximately a 5% solution of IgG that can be administered intramuscularly. As with any product used under IND, patients must be informed of potential risks and benefits and must give informed consent before receiving the product.

INDICATIONS FOR USE OF INVESTIGATIONAL VARIZIG
Patients without evidence of immunity to varicella (i.e., without history of disease or age-appropriate vaccination) who are at high risk for severe disease and complications, who have been exposed to varicella, and from whom informed consent has been obtained, are eligible to receive the IND application product under an expanded access protocol. The patient groups recommended by ACIP to receive VariZIG include the following:

  • Immunocompromised patients.
  • Neonates whose mothers have signs and symptoms of varicella around the time of delivery (i.e., 5 days before to 2 days after).
  • Premature infants born at 28 [or more] weeks of gestation who are exposed during the neonatal period and whose mothers do not have evidence of immunity.
  • Premature infants born at [less than] 28 weeks of gestation or who weigh 1,000 g [or less] at birth and were exposed during the neonatal period, regardless of maternal history of varicella disease or vaccination.
  • Pregnant women.

Varicella vaccine was recommended in 1999 for postexposure prophylaxis of other persons without evidence of varicella immunity and who have no contraindications to vaccination. The vaccine should be administered preferably within 96 hours and possibly up to 120 hours postexposure. If illness occurs, with or without postexposure vaccination, antiviral treatment (e.g., acyclovir) can be considered for adolescents and adults. . . .

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To access a web-text (HTML) version of the complete document, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55e224a1.htm

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm55e224.pdf
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February 27, 2006
CDC ISSUES TWO HEALTH UPDATES ABOUT A CURRENT CASE OF INHALATION ANTHRAX IN PENNSYLVANIA

On February 22, the Health Alert Network (HAN) issued an official CDC Health Update about a New York City resident who contracted inhalation anthrax while working with untreated animal hides imported from Africa. On February 24, HAN issued another official CDC Health Update reporting further information about the case investigation. Portions of both Health Updates are reprinted below.

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This is an official CDC HEALTH UPDATE
Distributed via Health Alert Network
Wednesday, February 22, 2006, 15:58 EST (03:58 PM EST)

INHALATION ANTHRAX CASE IN PENNSYLVANIA

On February 16, a 44-year-old male presented to a hospital in Pennsylvania with respiratory symptoms including dry cough, shortness of breath and general malaise. Laboratory Response Network (LRN) and Polymerase Chain Reaction (PCR) on 2/21 and gamma phage lysis on 2/22 from blood culture isolate were positive for Bacillus anthracis.

Patient resides in New York City and makes drums from unprocessed domestic and imported (Africa) animal hides (cow and goat). Patient reports frequent travel to Africa (most recent travel 12/4/05–12/21/05). Patient reports last work with animal hides on 2/15. Process includes cleaning and removal of hair from hides without chemical fixatives. While traveling to Pennsylvania on 2/16, the patient collapsed with rigors and was transported and admitted to a small local hospital.

Patient transferred to a tertiary care center on 2/18. Patient is reported to be stable on antibiotic therapy in the ICU [intensive care unit] without mechanical ventilation. No signs of cutaneous or pharyngeal anthrax lesions. Preliminary clinical impression suggests anthrax sepsis secondary to inhalation route of exposure due to spores from contaminated animal hides.

Ongoing investigation by PA and NYC departments of health in coordination with law enforcement includes environmental assessment of patient's storage/work facility and home, and identification of individuals who may have had contact with unprocessed hides. . . .

For case definitions, treatment guidelines, laboratory testing procedures, etc., see Anthrax Information for Healthcare Providers [at]
http://www.bt.cdc.gov/agent/anthrax/anthrax-hcp-factsheet.asp

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To read the complete 2/22/06 Health Update, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00241

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Distributed via Health Alert Network
Friday, February 24, 2006, 16:08 EST (04:08 PM EST)

INHALATION ANTHRAX CASE INVESTIGATION, PENNSYLVANIA, NEW YORK CITY—UPDATE, 2/24/2006

Laboratory testing from the patient's storage/work facility, his van and his residence have identified Bacillus anthracis. These findings are consistent with the hypothesis that the patient's exposure occurred while working on contaminated hides while making traditional drums.

The patient remains hospitalized in Pennsylvania.

Investigation of other potentially exposed persons continues; seven persons are currently on post-exposure prophylaxis for inhalation anthrax. None of these individuals have symptoms of anthrax. In addition, surveillance has not identified any other illness consistent with anthrax disease in NY and PA.

Animal hides pose a low risk of cutaneous anthrax, and an extremely low risk of inhalation anthrax. Exotic animal hides may pose a higher risk for exposure than domestic (U.S.-origin) hides. The risk of contracting Bacillus anthracis from handling individual hides is believed to be very low. The industrial handling of large numbers of hides, or hair from multiple animals, has historically been associated with increased risk of anthrax. Among the 236 cases of anthrax reported to CDC from 1955 to 1999, 153 (65%) were associated with industrial handling of animal hide or hair. Only 9 of the 153 cases (6%) associated with industrial handling of hair or hide were inhalation anthrax. . . .

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To read the complete 2/24/06 Health Update, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00242
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February 27, 2006
CDC REPORTS ON AN OUTBREAK OF MUMPS IN A NEW YORK SUMMER CAMP DURING 2005

CDC published "Mumps Outbreak at a Summer Camp—New York, 2005" in the February 24 issue of MMWR. Portions of the article are reprinted below.

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On July 26, 2005, the Sullivan County Health Department (SCHD) and the New York State Department of Health (NYSDOH) were notified of a cluster of cases of parotitis among campers and staff members at a summer camp. An investigation conducted by NYSDOH identified 31 cases of mumps, likely introduced by a camp counselor who had traveled from the United Kingdom (UK) and had not been vaccinated for mumps. This report summarizes the results of the subsequent investigation by NYSDOH, which determined that, even in a population with 96% vaccination coverage, as was the case with participants in the summer camp, a mumps outbreak can result from exposure to virus imported from a country with an ongoing mumps epidemic.

Camp was in session during June 28–August 18. A case of mumps was defined as unilateral or bilateral parotitis of [more than] 2 days' duration with no other apparent cause in a camper or staff member who was examined during June 30–September 1, 2005. Among 541 campers and staff members, 31 cases of mumps were identified (attack rate: 5.7%), with illness onsets during June 30–August 9. The index patient was a man aged 20 years who resided in the UK and who had not been vaccinated for mumps. The man came to the United States on June 19 to work as a counselor at the camp; on June 30, he had left-sided parotitis, sore throat, and a low-grade fever. However, mumps was not considered as a diagnosis by healthcare staff members at the infirmary.

The patient was not isolated and continued to work among the camp population. During July 15–23, a total of 25 additional cases of parotitis were identified, consistent with exposure beginning June 28. However, the diagnosis of mumps was not made by members of the healthcare staff at the infirmary or by community healthcare providers for any patient with parotitis until July 24. SCHD and NYSDOH were alerted to a possible outbreak on July 26, and diagnosis of mumps for the first 23 (74%) cases was made via retrospective chart review by NYSDOH on July 27. At that time, five (16%) patients were either symptomatic or in isolation. Subsequently, an additional three (10%) cases were identified, beginning on August 2. . . .

Twelve (39%) of the 31 mumps cases were among campers. All were U.S. residents aged 10–15 years who had been vaccinated with 2 doses of measles, mumps, and rubella (MMR) vaccine after the first birthday. Nineteen (61%) of the mumps cases were among staff members; of these, nine (47%) were UK residents, five (26%) were U.S. residents, three (16%) were residents of Australia, and two (11%) were residents of Germany. Staff members with mumps ranged in age from 19 to 41 years (median: 21 years). Of the 17 staff members with mumps for whom vaccination history could be obtained by vaccination or medical record, nine (53%) had not been vaccinated for mumps, four (24%) had been vaccinated with 1 dose, and four (24%) had been vaccinated with 2 doses of a mumps-containing vaccine. Symptoms, illness duration, and complications (e.g., orchitis) did not differ substantially between vaccinated and unvaccinated patients. . . .

EDITORIAL NOTE
Previous investigations of mumps outbreaks reported similar clinical symptoms among vaccinated and unvaccinated patients. With the decrease in mumps incidence in the United States, healthcare providers have become less likely to suspect mumps in patients with parotitis. In the camp outbreak, although patients were evaluated by multiple healthcare providers, including camp and hospital physicians, parotitis was not recognized as mumps until well into the outbreak. Providers, parents, and child care and school staff members need to be aware of mumps signs and symptoms, potential complications, and communicability and the need to suspect mumps regardless of patient vaccination status. In addition, given the low prevalence of mumps in the U.S. population, laboratory confirmation should be encouraged to diagnose mumps accurately.

In the camp outbreak, mumps likely was introduced by an unvaccinated counselor who traveled from the UK, where an epidemic of mumps was ongoing, with 56,390 notified cases reported during 2005 in England and Wales. The likelihood of disease in U.S. residents as a result of imported virus from areas with mumps epidemics remains high. Vaccination of counselors who will be working in summer camps is recommended, particularly because mumps vaccine effectiveness can be [less than] 85% in outbreak settings. As a result of this outbreak, agencies involved in assigning foreign staff to U.S. camps and organizations of camp administrators have begun revising their admission requirements to include immunity to vaccine-preventable diseases such as mumps.

The outbreak described in this report likely resulted from a combination of delay in diagnosis of mumps and failure to report the cluster of illnesses in a timely manner, in addition to close contact and social mixing among camp participants. Controlling the outbreak resulted in a substantial burden on the camp and its staff, including cancellation of activities and likely loss of revenue. Previous mumps outbreaks also have carried substantial burden, particularly with respect to costs associated with school absenteeism. To prevent large outbreaks of mumps in their communities, U.S. healthcare providers should suspect mumps independent of vaccination history, diagnose mumps by using laboratory testing, and report mumps immediately to local health authorities.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5507.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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(7 of 14)
February 27, 2006
CDC REPORTS ON THE 2004–05 MUMPS EPIDEMIC IN THE UNITED KINGDOM

CDC published "Mumps Epidemic—United Kingdom, 2004–2005" in the February 24 issue of MMWR. Portions of the article are reprinted below.

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During 2004-2005, the United Kingdom (UK) experienced a nationwide epidemic of mumps, which peaked during 2005 when 56,390 notified cases were reported in England and Wales. The majority of confirmed cases during 2004–2005 were in persons aged 15–24 years, most of whom had not been eligible for routine mumps vaccination. Mumps usually is a self-limited viral disease that appears as parotitis. However, mumps also can lead to serious complications such as encephalitis or pancreatitis. This report summarizes the epidemiology of the 2004–2005 mumps epidemic in England and Wales.

Reporting was based on notified cases (i.e., clinically diagnosed cases of mumps reported by general practitioners). Since late 1994, laboratory confirmation of all notified cases of mumps has been recommended using a test to detect mumps-specific IgM antibodies in either serum or an oral fluid. The proportion of such cases began to increase in 1999 and increased further in each subsequent year, indicating an increase in the incidence of true infection. . . .

During 2004, approximately 79.1% of confirmed cases were in persons aged 15–24 years. Among all mumps patients during 2004, approximately 3.3% were reported as having received 2 doses of measles, mumps, and rubella (MMR) vaccine, and another 30.1% had received 1 dose of MMR. The number of notified cases of mumps continued to increase through the first 6 months of 2005, with 20,653 cases occurring during the first quarter and 21,981 cases during the second quarter. During the third quarter of 2005, the number of notified cases decreased by 64.0% to 7,907; during the fourth quarter, a further decrease to 5,882 notified cases was observed. During the first month of 2006, notified cases of mumps averaged approximately 500 per week.

During 2005, the majority of notified mumps cases were in persons aged 19–23 years and attending colleges or universities; the third-quarter decrease in the number of notified cases coincided with summer vacations. Local health services have been encouraged by the UK Health Protection Agency to ensure that all students have received 2 doses of MMR before leaving school. In addition, many universities have advised enrolling first-year students to receive MMR vaccination before arriving at college.

EDITORIAL NOTE
In October 1988, mumps vaccination was added to the UK vaccination schedule as part of the new combined MMR vaccine. . . .

During November 1994, approximately 8 million school children aged 5–16 years (i.e., born during September 1978–August 1989) were offered combined measles-rubella vaccine to prevent a predicted epidemic of measles. At that time, a global shortage prevented offering MMR to this group. Therefore, a proportion of the 8 million children remained susceptible to mumps. Modeling based on serologic surveillance data for 1993 estimated that 19% of children aged 11–15 years in 1997 (i.e., aged 19–23 years in 2005) would be susceptible to mumps.

The 2004-2005 mumps epidemic in the UK did not result from the decrease in MMR vaccination coverage in recent years, but rather from gaps in eligibility of certain cohorts, which has been evident during the epidemic by the age breakdown among patients with confirmed cases; mumps occurred predominantly in older teens and young adults, with the highest attack rate occurring in those born during 1983–1986. Persons born before September 1987 generally were not eligible for any routine mumps vaccination, although some might have received 1 dose of MMR upon school entry as part of a catch-up campaign after October 1988 that targeted children who missed their measles vaccination. Persons born before 1982 are more likely to have been exposed to mumps infection when it was still a common childhood disease. Only 2.4% of confirmed cases in 2004 occurred in persons who would have been eligible for 2 doses of MMR routinely.

The UK epidemic illustrates the susceptibility of certain cohorts who have not been vaccinated and have not developed immunity through exposure to mumps because of a decrease in mumps circulation after implementation of a childhood immunization program. The epidemic also underscores the importance of ensuring high levels of mumps immunity among adolescents and young adults when vaccination with mumps-containing vaccine is introduced into the routine immunization schedule for children.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5507.pdf
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February 27, 2006
AVIAN INFLUENZA: WHO AND CDC REPORT ON RAPID SPREAD OF THE DISEASE IN BIRDS

It was recently posted on the websites of WHO and CDC that numerous countries have reported their first cases of avian influenza in birds. In addition, Iraq reported two fatal cases of the disease in humans. Following is information from both websites.

WHO
On February 21, the WHO website posted an article, "Avian influenza—spread of the virus to new countries." Portions of the article are reprinted below.

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The occurrence of the disease in India, reported on 18 February, is part of a recent pattern of rapid geographical spread of the virus in wild and domestic birds. India is one of 13 countries that have reported their first cases of H5N1 infection in birds since the beginning of February. (The 13 countries, listed in order of reporting, are Iraq, Nigeria, Azerbaijan, Bulgaria, Greece, Italy, Slovenia, Iran, Austria, Germany, Egypt, India, and France.)

On 20 February, Malaysia reported a fresh outbreak in poultry after having been considered free of the disease for more than a year. . . .

Apart from Iraq, none of the countries newly affected during February has reported human cases. Iraq has reported two human cases, both of which were fatal; samples from several other patients are currently undergoing tests. . . .

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To read the complete article, go to:
http://www.who.int/csr/don/2006_02_21b/en

For comprehensive, continually updated information on avian influenza worldwide, visit WHO's Avian Influenza web section at http://www.who.int/csr/disease/avian_influenza/en


CDC
CDC recently updated its Influenza web section with information that the following were added to a list of countries reporting animal cases of avian influenza:

India, Bosnia, and Herzegovina (posted 2/21/06); Austria, Egypt, and France (posted 2/20/06); Azerbaijan (posted 2/17/06); and Iran (posted 2/16/06).

In addition, the following document was updated with an introduction, "Past Avian Influenza Outbreaks" (posted 2/17/06)

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

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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February 27, 2006
INFLUENZA VACCINATION RECOMMENDATIONS FOR HEALTHCARE PERSONNEL NOW IN MMWR RECOMMENDATIONS AND REPORTS FORMAT

On February 24, "Influenza Vaccination of Health-Care Personnel: Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP)" was published in print and electronically in MMWR Recommendations and Reports. Previously, the document was available only electronically as an MMWR Early Release.

To access a web-text (HTML) version of the MMWR Recommendations and Reports, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5502.pdf
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February 27, 2006
UPDATED: IAC REVISES TWO PATIENT-EDUCATION PIECES

IAC recently updated two of its patient-education pieces: "Are you 11–19 years old? Then you need to be vaccinated against these serious diseases!" and "Vaccinations for adults: You're NEVER too old to get immunized!"

On each piece, the section on tetanus, diphtheria, and pertussis vaccine was revised to include information on the newly licensed Tdap vaccine. Other minor revisions were also made.

To access a ready-to-print (PDF) version of "Are you 11–19 years old?" go to: http://www.immunize.org/catg.d/11teens8.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4020.htm

To access a ready-to-print (PDF) version of "Vaccinations for adults," go to: http://www.immunize.org/catg.d/p4030a.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n18/p4030new.htm
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February 27, 2006
PUZZLED ABOUT THE STATUS OF VACCINE LICENSURES AND RECOMMENDATIONS? "RED BOOK ONLINE" HAS CURRENT INFORMATION

On February 8, AAP updated the table "Status of Licensure and Recommendations for New Vaccines," which is part of the publication "Red Book Online." The table's content is based on information from vaccine manufacturers, ACIP meetings, and AAP. It is updated as changes occur.

To access a ready-to-print (PDF) version of the table, go to:
http://aapredbook.aappublications.org/news/vaccstatus.pdf

To access a web-text (HTML) version, go to:
http://aapredbook.aappublications.org/news/vaccstatus.shtml
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February 27, 2006
CDC REPORTS ON U.S. INFLUENZA ACTIVITY DURING FEBRUARY 5–11

CDC published " Update: Influenza Activity—United States, February 5–11, 2006" in the February 24 issue of MMWR. The opening paragraph of the article is reprinted below.

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During February 5–11, 2006, the number of states reporting widespread influenza activity increased to 13. Twenty-one states reported regional activity, 11 reported local activity, and five 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/mm5507a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5507.pdf
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February 27, 2006
ATTENTION IMMUNIZATION COALITIONS: MEET 'N' GREET AND TELECONFERENCING OPPORTUNITIES ARE AVAILABLE IN MARCH

The National Immunization Coalition TA [technical assistance] Network has arranged a Meet 'n' Greet opportunity for its members at the National Immunization Conference (NIC) on March 8. In addition, the network has scheduled a teleconference for March 14.

MEET 'N' GREET AT NIC
A Meet 'n' Greet gathering is planned from noon to 2PM on March 8 in the Cypress Room of the Omni Hotel. Staff from the network hope to meet network members at the event. Feel free to bring questions and materials.

NOTE: The network has cancelled workshops it had planned for March 5, the day before NIC begins. Instead, workshops will be held during the National Conference for Immunization Coalitions, which is scheduled for August 9–11 in Denver.

TELECONFERENCE
The teleconference will focus on how to set up a Vote and Vax clinic (an influenza vaccination clinic at polling places) on Election Day in fall 2006. It will be held at 1:00PM, ET, March 14.

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.

The Vote and Vax presenter is Douglas Shenson, MD, MPH, president, Sickness Prevention Achieved through Regional Collaboration (SPARC).

Teleconference participants will learn (1) how to choose the right polling place; (2) what to expect on Election Day; (3) how to do outreach and publicity; (4) what to do if influenza vaccine is in short supply.

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

For additional information, or to access earlier programs, go to: http://www.izcoalitionsta.org/confcall.cfm
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February 27, 2006
REMINDER: MARCH 6 IS REGISTRATION DEADLINE FOR MEETING ON MANAGEMENT OF HEPATITIS B VIRUS

The registration deadline for the Management of Hepatitis B Virus meeting is March 6. The meeting is scheduled for April 6–8 in Bethesda, MD. It is sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, the American Association for the Study of Liver Diseases, the Hepatitis B Foundation, and Hepatitis Foundation International.

The goals of the meeting are to assess current understanding of hepatitis B virus, the disease that it causes, and its optimal management; and to make recommendations for directions for future research, both basic and clinical.

For comprehensive meeting information, go to:
http://www.niddk.nih.gov/fund/other/hbv2006

 

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 February 27, 2006