Issue
Number 598
May 15, 2006
CONTENTS OF THIS ISSUE
- New: HAN issues official Health Advisory about a case of
human rabies infection in Texas
- May is Hepatitis Awareness Month
- CDC reports chronic HBV infection among approximately
15% of newly tested Asian immigrants in New York City
- CDC reports on hepatitis B vaccination coverage of U.S.
adults in 2004
- CDC reports on vaccine-preventable child deaths and on
Global Immunization Vision and Strategy for 2006–15
- New: Professional-education sheet helps reduce confusion
about similar-looking vials of Tdap, DTaP, and Td vaccines
- Government website posts a viewer's guide and Q&A
section about the TV movie "Fatal Contact: Bird Flu in America"
- Reminder: Deadline for early-bird registration for
Public Health and the Law conference is May 20
- CDC adds to and updates its Influenza web section with
information about avian influenza
- New: CDC reports on 13-month delay between evaluation
and diagnosis of autism in children
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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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May 15, 2006
NEW: HAN ISSUES OFFICIAL HEALTH ADVISORY ABOUT A CASE OF HUMAN RABIES
INFECTION IN TEXAS
On May 10, the Health Alert Network (HAN) issued an official CDC Health
Advisory concerning a confirmed diagnosis of rabies in a Texas teenager. The
Health Advisory is reprinted below in its entirety.
**********************
THIS IS AN OFFICIAL CDC HEALTH ADVISORY
Distributed via Health Alert Network
May 10, 2006 12:40 EDT (12:40 PM EDT)
CONFIRMATION OF HUMAN RABIES INFECTION IN TEXAS
On May 9, 2006, the Centers for Disease Control and Prevention (CDC),
working together with Harris County Public Health and Environmental Services
(HCPHES) and the Texas Department of State Health Services (TDSHS),
confirmed a diagnosis of rabies as the cause of illness in a Texas teenager,
who has been hospitalized with encephalitis. This advisory provides
information about this case, an update for states that may receive inquiries
due to public concerns about rabies, and criteria for conducting risk
assessments to determine the need for postexposure prophylaxis (PEP).
Four-to-six weeks prior to admission, the patient had awakened due to direct
contact with a live bat in his bedroom. The bat was removed from the home
and was not available for testing. Bats are a widely distributed reservoir
of rabies throughout the United States. The child did not present for
medical attention until after symptoms had developed, thus rabies PEP was
not administered. Diagnosis was made on the basis of a positive direct
fluorescent antibody test for rabies virus antigen on a nuchal skin biopsy.
Further analysis of clinical specimens is ongoing in an effort to establish
a likely animal source for the infection, based upon viral characterization.
HCPHES and TDSHS, in collaboration with CDC, are continuing to conduct
investigations to identify contacts of the patient among family members, the
local community, and healthcare workers and to identify other persons who
may have had contact with the bat at the same time as the patient. Human
rabies PEP is recommended only in situations in which potentially infectious
material (e.g. saliva) from a rabid animal or human is introduced via a
bite, or comes into direct contact with broken skin or mucous membranes.
More detailed information regarding evaluation for and administration of PEP
is available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/00056176.htm
Additional information about rabies and its prevention is available from
HCPHES at (713) 212-0200, TDSHS at (512) 458-7455 and CDC, telephone (800)
CDC-INFO [232-4636] or at
http://www.cdc.gov/ncidod/dvrd/rabies This website is updated as new
information becomes available.
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To access the Health Advisory, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00245
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May 15, 2006
MAY IS HEPATITIS AWARENESS MONTH
CDC published "Hepatitis Awareness Month—May 2006" in the May 12 issue of
MMWR. The article is reprinted below in its entirety, excluding the
reference.
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May 2006 marks the 11th anniversary of Hepatitis Awareness Month. In the
United States, one of three persons has been infected with hepatitis A virus
(HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV).
HAV is spread by close contact with infected persons or through contaminated
food. Since the introduction of hepatitis A vaccines in 1995, reports of
hepatitis A have declined 84% (CDC, unpublished data, 2004).
HBV and HCV are spread by blood or sexual contact. In 2004, an estimated
60,000 new HBV infections and 26,000 new HCV infections occurred (CDC,
unpublished data, 2004). In 1991, CDC adopted a national vaccination
strategy to eliminate HBV transmission in the United States. Since then,
acute hepatitis B has declined 75%, with the highest incidence remaining
among adults.
Approximately 5%–25% of persons with chronic HBV and HCV infection will die
prematurely from cirrhosis and liver cancer. Approximately 1 million persons
in the United States have chronic HBV infection, and 3 million have chronic
HCV infection (CDC unpublished data, 2004). Although effective therapies for
viral hepatitis are available, the majority of persons with chronic HCV
infection are unaware of their infection.
This issue of MMWR reports on the prevalence of chronic HBV infection among
Asian/Pacific Islander populations in New York City and progress to
eliminate HBV transmission through vaccination of adults. Additional
information regarding hepatitis and Hepatitis Awareness Month is available
at http://www.cdc.gov/hepatitis
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5518a1.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5518.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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May 15, 2006
CDC REPORTS CHRONIC HBV INFECTION AMONG APPROXIMATELY 15% OF NEWLY TESTED
ASIAN IMMIGRANTS IN NEW YORK CITY
CDC published "Screening for Chronic Hepatitis B Among Asian/Pacific
Islander Populations—New York City, 2005" in the May 12 issue of MMWR. A
portion of the article is reprinted below.
***********************
Chronic hepatitis B virus (HBV) infection is the most common cause of
cirrhosis and liver cancer worldwide. In Asian and western Pacific countries
where HBV is endemic, estimated prevalence of chronic HBV infection ranges
from 2.4%–16.0%, and liver cancer is a leading cause of mortality. Although
population-based prevalence data for Asians/Pacific Islanders (A/PIs) living
in the United States are lacking, they are believed to constitute a sizeable
percentage of persons with chronic HBV infection in the United States, a
country of low endemicity. To assess the prevalence of chronic HBV infection
among A/PI populations living in New York City, the Asian American Hepatitis
B Program (AAHBP) conducted a seroprevalence study among persons who
participated in an ongoing hepatitis B screening, evaluation, and treatment
program. The results indicated that approximately 15% of participants who
had not been previously tested had chronic HBV infection; all were born
outside the United States. Screening programs are needed in A/PI communities
in the United States to identify persons with chronic HBV infection so that
they can be referred for appropriate medical management to prevent cirrhosis
and liver cancer and so that their susceptible household and sex contacts
can receive hepatitis B vaccine. . . .
Editorial Note:
The findings in this report on a screening program conducted among a
predominantly immigrant Asian population indicate that approximately 15% of
newly tested persons living in New York City had chronic HBV infection. The
prevalence among participants in the screening program was approximately 35
times that of the overall U.S. population. Half of those with chronic HBV
infection had been living in the United States for more than 10 years. These
persons likely acquired their infections in their countries of origin, where
HBV infection is endemic and infections usually are acquired at birth or
during early childhood. The majority of infected participants were
successfully referred for medical evaluation and follow-up.
Although this study was limited to New York City, screening programs in
Atlanta, Chicago, New York City, Philadelphia, and California have reported
similar prevalences of chronic HBV infection (10%–15%) among A/PI immigrants
to the United States. A smaller proportion of those born in South Korea,
compared with those born in China, were documented with chronic HBV
infection.
Perinatal and child-to-child transmission are the most common modes of HBV
transmission in Asia and other countries where HBV is endemic. Of persons
who acquire chronic HBV infection at early ages, an estimated 15%–40% will
subsequently have chronic liver disease, including cirrhosis and liver
cancer. Therefore, persons with chronic HBV infection need to be identified
so that they can receive counseling and appropriate medical management to
reduce their risk for chronic liver disease. Some will benefit from
treatment or screening to detect liver cancer at an early stage. To prevent
spread of HBV infection, household and sex contacts should be tested for HBV
infection and offered hepatitis B vaccination, where indicated.
Although members of A/PI communities in the United States generally are
aware that HBV infection is associated with increased risk for liver cancer,
fewer than half recognize that HBV infection is endemic among persons born
in Asia. Hepatitis B screening programs in U.S. A/PI communities can be an
effective means of identifying persons with chronic HBV infection and
motivating them to seek medical care. An evaluation of a hepatitis B
screening program for A/PI in California determined that 67% of those with
chronic HBV infection sought follow-up with their medical providers.
Approximately 71% of participants in the California program reported that,
before participating in the screening program, testing for HBV had not been
recommended, although 89% had a regular family physician. . . .
In collaboration with state and local partners, CDC supports programs to
prevent HBV infection in U.S. A/PI communities. Local health departments in
New York City and San Francisco, two cities with large A/PI populations,
conduct enhanced viral hepatitis surveillance for both acute and chronic
hepatitis B. The Asian Liver Center of Stanford University has developed
educational programs for A/PI youth and practitioners of traditional Chinese
medicine. State and local health departments have successfully implemented
vaccination strategies (e.g., achieving high vaccination coverage among
children and adolescents and high rates of HBsAg screening among pregnant
women) recommended by the Advisory Committee on Immunization Practices in
1991 to eliminate HBV transmission in the United States. Since 1991, acute
hepatitis B incidence has declined sharply among U.S. A/PI populations,
eliminating major health disparities in acute HBV infection. Additional
information regarding acute and chronic HBV infection and prevention
activities is available from CDC at
http://www.cdc.gov/ncidod/diseases/hepatitis/index.htm
U.S. A/PI populations are at disproportionately high risk for hepatitis
B-related chronic liver disease and liver cancer. Public health agencies and
medical providers who serve U.S. A/PI populations and other communities with
high proportions of persons born in countries where HBV infection is endemic
should promote educational campaigns and screening programs. Such programs
should identify persons with chronic HBV infection so that they can receive
appropriate counseling and treatment to prevent cirrhosis and liver cancer
and so that their contacts can be screened and given treatment, counseling,
or vaccination as appropriate. Programs such as the comprehensive,
community-based screening and evaluation program described in this report
can effectively reach persons at risk for chronic HBV infection.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5518a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5518.pdf
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May 15, 2006
CDC REPORTS ON HEPATITIS B VACCINATION COVERAGE OF U.S. ADULTS IN 2004
CDC published "Hepatitis B Vaccination Coverage Among Adults—United States,
2004" in the May 12 issue of MMWR. Portions of the article are reprinted
below.
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Hepatitis B virus (HBV) infection is a major cause of cirrhosis and liver
cancer in the United States. The Advisory Committee on Immunization
Practices (ACIP) has recommended a comprehensive strategy to eliminate HBV
transmission, including prevention of perinatal HBV transmission; universal
vaccination of infants; catch-up vaccination of unvaccinated children and
adolescents; and vaccination of unvaccinated adults at increased risk for
infection. The incidence of acute hepatitis B has declined 75%, from 8.5 per
100,000 population in 1990 to 2.1 per 100,000 population in 2004, with the
greatest declines (94%) among children and adolescents. Incidence remains
highest among adults, who accounted for approximately 95% of the estimated
60,000 new infections in 2004. To measure hepatitis B vaccination coverage
among adults, data were analyzed from the 2004 National Health Interview
Survey (NHIS). This report summarizes the results of that analysis, which
indicated that, during 2004, 34.6% of adults aged 18–49 years reported
receiving hepatitis B vaccine, including 45.4% of adults at high risk for
HBV infection. To accelerate elimination of HBV transmission in the United
States, public health programs and clinical care providers should implement
strategies to ensure that adults at high risk are offered hepatitis B
vaccine.
NHIS is a multipurpose household health survey of the U.S. civilian,
noninstitutionalized population, conducted by in-person interview. Hepatitis
B vaccination coverage was estimated from self reports of sampled adults.
The analysis was restricted to adults aged 18–49 years, age groups that
account for approximately 80% of adult HBV infections.
In the 2004 NHIS, adults who responded "yes" to the question, "Have you ever
received hepatitis B vaccine?" were assumed to have received [at least] 1
vaccine dose. For this analysis, adults were considered at high risk for HBV
infection if they reported a risk factor in answering any of three questions
related to human immunodeficiency virus (HIV) and sexually transmitted
disease (STD) risk behaviors. . . .
During 2004, a total of 31,326 adults were interviewed, including 18,269
aged 18–49 years. The response rate was 72.5%. Of eligible adults aged 18–49
years, 17,249 (94%) who responded to the hepatitis B vaccination questions
were included in this analysis, including 1,048 (5.7%) adults at high risk.
A weighted analysis of adults who were surveyed indicated that 34.6% (95% CI
[confidence interval] = 33.5%–35.6%) reported receiving hepatitis B vaccine.
Coverage was highest among persons aged 18–20 years and declined with
increasing age. Coverage also was higher for persons in occupations for
which vaccination is specifically recommended, including healthcare workers
(80.5%; CI = 77.3%–83.4%) and police officers or firefighters (63.6%; CI =
56.6%–70.1%), and for adults at high risk (45.4%; CI = 41.7%–49.2%).
Report of hepatitis B vaccination also was associated with certain
population characteristics, including female sex, non-Hispanic ethnicity,
and higher educational achievement. Persons with a routine source of health
care (e.g., primary doctor, health maintenance organization, or clinic) and
persons with health insurance also were more likely to report vaccination
than those with no routine source of health care. The same demographic and
healthcare use characteristics were associated with higher likelihood of
vaccination among persons at high risk as among other respondents. In a
multivariate model, after controlling for age, sex, education, occupation,
and HIV test history, high risk remained a statistically significant
predictor (adjusted odds ratio = 1.3) of hepatitis B vaccination. . . .
Editorial Note:
The findings in this report suggest that hepatitis B vaccination coverage
among adults at high risk, as measured by NHIS, has increased substantially
from 30% in 2000 to 45% in 2004. Some of this increase in coverage
represents the aging of persons vaccinated as adolescents, reflecting the
effect of ACIP recommendations for routine vaccination of adolescents that
were first made in 1995. In addition, higher vaccination coverage among
persons of all ages at high risk suggests successes vaccinating targeted
adults and likely contributed to a decline in hepatitis B incidence. From
2000 to 2004, hepatitis B incidence among adults decreased 27%, from 3.7 to
2.7 per 100,000 population (CDC, unpublished data, 2006). However, hepatitis
B vaccination coverage of adults at high risk remained lower than
vaccination coverage of children (92%) and adolescents (86%) in 2004, two
other age groups included in the ACIP vaccination strategy to eliminate HBV
transmission.
Several factors contribute to low hepatitis B vaccination coverage among
adults at high risk. In contrast to vaccination of children, national
programs that support vaccine purchase and infrastructure for vaccine
administration are not available for adults. As a result, adults at
increased risk often have missed opportunities to receive hepatitis B
vaccination. In a study of 483 adults with acute hepatitis B infection, 61%
reported a missed opportunity for vaccination during STD treatment,
incarceration, or drug treatment during 2001–2004. In primary care settings,
patients and providers might be reluctant to discuss risk behaviors, and
providers might not prioritize vaccination in the context of other clinical
care services.
Adult vaccination coverage can be increased through the use of provider
reminders and other interventions to increase access to vaccination.
Demonstration projects have determined that provision of comprehensive HIV,
viral hepatitis, and STD services increases vaccination coverage. In October
2005, ACIP provisionally recommended strategies to improve vaccination for
adults at risk for hepatitis B, emphasizing vaccination of all adults at
venues where a high proportion of persons are likely to have risk factors
for HBV infection (e.g., STD/HIV testing and treatment facilities,
correctional facilities, and drug-abuse treatment facilities) and the
adoption of practices that remove barriers to vaccination in primary care
settings. . . .
Hepatitis B vaccine is safe and effective and the only licensed vaccine that
prevents cancers. Despite these benefits, the majority of adults at risk for
HBV remain unvaccinated. To increase coverage, public health programs and
primary care providers should inform adults receiving preventive clinical
services of the potential benefits of hepatitis B vaccination for their
health, vaccinate all adults who seek protection from HBV, and adopt
strategies appropriate for the practice setting to ensure that all adults at
risk for HBV infection are offered hepatitis B 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/mm5518a3.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5518.pdf
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May 15, 2006
CDC REPORTS ON VACCINE-PREVENTABLE CHILD DEATHS AND ON GLOBAL IMMUNIZATION
VISION AND STRATEGY FOR 2006–15
CDC published "Vaccine Preventable Deaths and the Global Immunization Vision
and Strategy, 2006–2015" in the May 12 issue of MMWR. A portion of a summary
made available to the press is reprinted below.
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Immunization programs worldwide have made substantial progress since their
inception, preventing an estimated 2 million child deaths annually.
Nonetheless, as demonstrated by both global estimates of vaccine-preventable
disease mortality and DTP3 coverage [receipt of three doses of
diphtheria-tetanus-pertussis vaccine], currently available vaccines are not
yet used to their fullest potential. Challenges include sustaining current
immunization levels, extending immunizations to those currently unreached
and those beyond infancy, and introducing new vaccines and technologies. The
Global Immunization Vision and Strategy (GIVS), recently developed by WHO
and the United Nations Children's Fund (UNICEF) in collaboration with
partners, outlines their vision for immunizations from 2006–2015 and offers
a conceptual framework within which these challenges may be addressed. Full
implementation of GIVS will hopefully greatly reduce vaccine preventable
deaths during the next 10 years.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5518a4.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5518.pdf
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May 15, 2006
NEW: PROFESSIONAL-EDUCATION SHEET HELPS REDUCE CONFUSION ABOUT
SIMILAR-LOOKING VIALS OF Tdap, DTaP, AND Td VACCINES
Early in 2006, the Immunization Branch of the California Department of
Health Services, developed a full-color professional-education sheet "Check
Your Vials: Is it Tdap, DTaP, or Td?" Intended to reduce confusion, the
one-page sheet clearly pictures the vial and stopper of each of several
brands of tetanus-and-diphtheria-toxoid-containing vaccines licensed for use
in the United States.
To access this useful sheet, go to:
http://www.dhs.ca.gov/ps/dcdc/izgroup/pdf/IMM-508.pdf
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May 15, 2006
GOVERNMENT WEBSITE POSTS A VIEWER'S GUIDE AND Q&A SECTION ABOUT THE TV MOVIE
"FATAL CONTACT: BIRD FLU IN AMERICA"
Recently, the federal government's Pandemic Influenza website posted a
viewer's guide and Q&A section about the made-for-TV movie "Fatal Contact:
Bird Flu in America," which aired May 9 on ABC.
To access these resources, go to:
http://www.pandemicflu.gov/news/birdfluinamerica.html
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May 15, 2006
REMINDER: DEADLINE FOR EARLY-BIRD REGISTRATION FOR PUBLIC HEALTH AND THE LAW
CONFERENCE IS MAY 20
The conference Public Health and the Law in the 21st Century will take place
June 12–14 in Atlanta. Save $50 (pay $245 instead of $295) when you register
by May 20, the early-bird deadline.
Speakers confirmed for the conference include U.S. Surgeon General Richard
H. Carmona, MD, MPH; John O. Agwunobi, MD, MPH, assistant secretary for
health, Department of Health and Human Services; and Michael R. Bloomberg,
mayor of New York City.
Conference attendees involved in immunization and infectious diseases
programs may benefit from the following conference sessions:
-
The Public Health Law Year in Review: Implications of Major Legal
Developments, Trends, and Court Rulings
-
Vaccine Law 101
-
New Adolescent Vaccines: Legal and Legislative Issues
-
Incident at Airport X: Quarantine Enforcement: Law and Limits
-
Health Departments, Hospitals, and the Pandemic Flu: Overlapping Ethical
and Legal Questions
-
Pandemic Flu: The Threat, Health System Implications, and Legal
Preparedness
-
Closing the Gap between Science and Law
-
Training and Tools for a Legally Prepared Public Health Workforce
For comprehensive information and to register, go to:
http://www2a.cdc.gov/phlp/conference2006.asp For registration
information, email Katie Johnson at
kjohnson@aslme.org or phone her at (617) 262-4990.
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May 15, 2006
CDC ADDS TO AND UPDATES ITS INFLUENZA WEB SECTION WITH INFORMATION ABOUT
AVIAN INFLUENZA
CDC recently added one page to and updated two pages of its Influenza web
section:
NEW
(1) "Avian influenza update: Djibouti" describes a confirmed case of avian
influenza in a toddler in Djibouti (posted 5/12/05)
To access this resource, go to:
http://www.cdc.gov/flu/whatsnew.htm#new and click on the pertinent
link.
UPDATED
(2) "Questions and answers about avian influenza (bird flu) & avian
influenza virus" now has information about a confirmed case of human avian
influenza in Djibouti and about food safety (updated 5/12/06 and 5/9/06)
(3) "Key facts: Information about avian influenza (bird flu) and avian
influenza A (H5N1) virus" (updated 5/5/06)
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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May 15, 2006
NEW: CDC REPORTS ON 13-MONTH DELAY BETWEEN EVALUATION AND DIAGNOSIS OF
AUTISM IN CHILDREN
On May 10, CDC issued a press release reporting on study findings that
show that children who were evaluated for developmental delays were not
diagnosed with autism until 13 months after the initial assessment.
Portions of the press release are reprinted below.
********************
For immediate release
May 10, 2006
THIRTEEN-MONTH DELAY BETWEEN EVALUATION AND AUTISM DIAGNOSIS IN CHILDREN
Children with autism spectrum disorders (ASDs) may experience a 13-month
delay before they are diagnosed. A study in the April autism supplement of
the Journal of Developmental and Behavioral Pediatrics released today,
found that children diagnosed in metropolitan Atlanta were initially
evaluated at an average of 4 years of age but were not diagnosed with an
ASD until an average of 5 years 1 month. . . .
"Although this study draws upon data from the metro Atlanta area, it
serves as an important indicator of the nationwide challenges of
diagnosing autism, particularly more mild cases," said Dr. Jose Cordero,
director of CDC's National Center on Birth Defects and Developmental
Disabilities. "The real public health challenge is to educate doctors on
the signs of autism and to encourage use of standardized diagnostic
instruments that better identify symptoms relevant to ASD and help
distinguish ASD from other developmental delays or disorders. . . ."
********************
To access the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060510.htm |
