Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 602            June 5, 2006

CONTENTS OF THIS ISSUE

  1. MMWR issues an Early Release announcing updated ACIP recommendations for control and elimination of mumps
  2. NIP website posts provisional ACIP recommendations for rotavirus vaccine for infants
  3. NIP updates interim VIS for Tdap vaccine with information for adult vaccine recipients
  4. New: June 2006 issue of Vaccinate Adults is in the mail and on the Web
  5. New: IAC website posts chart and U.S. map showing which states have PCV mandates for daycare enrollees
  6. June Immunization Works electronic newsletter available on the NIP website
  7. MMWR dedicates June 2 issue to retrospectives on the AIDS epidemic, 1981–2006
  8. Reminder: All attendees to the June 29–30 ACIP meeting are required to register online
  9. Update: CDC website posts new HPV vaccine fact sheet for the public
  10. Free: Migrant Clinicians Network makes new Spanish-language immunization comic books available through June 16

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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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June 5, 2006
MMWR ISSUES AN EARLY RELEASE ANNOUNCING UPDATED ACIP RECOMMENDATIONS FOR CONTROL AND ELIMINATION OF MUMPS

On June 1, CDC published "Notice to readers: Updated recommendations of the Advisory Committee on Immunization Practices (ACIP) for the control and elimination of mumps" as an electronic MMWR Early Release. The article is reprinted below in its entirety, excluding references and a box.

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On May 17, 2006, the Advisory Committee on Immunization Practices (ACIP) updated criteria for mumps immunity and mumps vaccination recommendations. According to the 1998 ACIP recommendations for measles, mumps, and rubella (MMR) vaccine, for routine vaccination, a first dose of MMR vaccine is recommended at ages 12–15 months and a second dose at ages 4–6 years. Two doses of MMR vaccine also are recommended for students attending colleges and other post–high school institutions. However, documentation of mumps immunity through vaccination has consisted of only 1 dose of mumps-containing vaccine for all designated groups, including healthcare workers.

Live mumps virus vaccines (i.e., mumps and MMR vaccines) produced in the United States are derived from the Jeryl Lynn mumps vaccine strain. Postlicensure studies in the United States demonstrated that 1 dose of mumps vaccine was 78%–91% effective in preventing clinical mumps with parotitis. However, in the late 1980s and early 1990s, mumps outbreaks were observed in schools with extremely high ([greater than] 95%) vaccination coverage, suggesting that 1 dose of mumps vaccine or MMR vaccine was not sufficient to prevent mumps outbreaks in school settings.

In response to the resurgence of measles that began in 1989 and continued through 1991, a second dose of MMR vaccine for school-aged (i.e., grades K–12) and college students was recommended in 1989. Since implementation of the 2-dose MMR vaccination requirement, the incidence of mumps disease has decreased, and studies of vaccine effectiveness during outbreaks suggest substantially higher levels of protection with a second dose of MMR. For example, during a mumps outbreak at a Kansas high school during the 1988–89 school year, students who had received only 1 dose of MMR had five times the risk of contracting mumps compared with students who had received 2 doses. A study from the United Kingdom, which uses MMR vaccines that contain either the Jeryl Lynn mumps vaccine strain or the RIT 4385 strain (derived from the Jeryl Lynn strain), indicated a vaccine effectiveness of 88% for 2 doses of MMR vaccine compared with 64% for a single dose. In addition, elimination of mumps was declared in Finland through high and sustained coverage with 2 doses of MMR vaccine.

Infection-control failures resulting in nosocomial transmission have occurred during mumps outbreaks involving hospitals and long-term–care facilities that housed adolescent and young adult patients. Exposures to mumps in healthcare settings also can result in added economic costs associated with furlough or reassignment of staff members from patient-care duties or closure of wards.

During January 1–May 2, 2006, the current outbreak in the United States has resulted in reports of 2,597 cases of mumps in 11 states. The outbreak has underscored certain limitations in the 1998 recommendations relating to prevention of mumps transmission in healthcare and other settings with high risk for mumps transmission. After reviewing data from the current outbreak and previous evidence on mumps vaccine effectiveness and transmission, ACIP issued updated recommendations for mumps vaccination.

ACCEPTABLE PRESUMPTIVE EVIDENCE OF IMMUNITY TO MUMPS
Acceptable presumptive evidence of immunity to mumps includes one of the following: (1) documentation of adequate vaccination, (2) laboratory evidence of immunity, (3) birth before 1957, or (4) documentation of physician-diagnosed mumps. Evidence of immunity through documentation of adequate vaccination is now defined as 1 dose of a live mumps virus vaccine for preschool-aged children and adults not at high risk and 2 doses for school-aged children (i.e., grades K–12) and for adults at high risk (i.e., healthcare workers, international travelers, and students at post–high school educational institutions).

ROUTINE VACCINATION FOR HEALTHCARE WORKERS
All persons who work in healthcare facilities should be immune to mumps. Adequate mumps vaccination for healthcare workers born during or after 1957 consists of 2 doses of a live mumps virus vaccine. Healthcare workers with no history of mumps vaccination and no other evidence of immunity should receive 2 doses (at a minimum interval of 28 days between doses). Healthcare workers who have received only 1 dose previously should receive a second dose. Because birth before 1957 is only presumptive evidence of immunity, healthcare facilities should consider recommending 1 dose of a live mumps virus vaccine for unvaccinated workers born before 1957 who do not have a history of physician-diagnosed mumps or laboratory evidence of mumps immunity.

MUMPS OUTBREAK CONTROL
Depending on the epidemiology of the outbreak (e.g., the age groups and/or institutions involved), a second dose of mumps vaccine should be considered for children aged 1–4 years and adults who have received 1 dose. In healthcare settings, an effective routine MMR vaccination program for healthcare workers is the best approach to prevent nosocomial transmission. During an outbreak, healthcare facilities should strongly consider recommending 2 doses of a live mumps virus vaccine to unvaccinated workers born before 1957 who do not have evidence of mumps immunity.

These new recommendations for healthcare workers are intended to offer increased protection during a recognized outbreak of mumps. However, reviewing healthcare worker immune status for mumps and providing vaccine during an outbreak might be impractical or inefficient. Therefore, facilities might consider reviewing the immune status of healthcare workers routinely and providing appropriate vaccinations, including a second dose of mumps vaccine, in conjunction with routine annual disease-prevention measures such as influenza vaccination or tuberculin testing.

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To access a ready-to-print (PDF) version of the MMWR Early Release, go to: http://www.cdc.gov/mmwr/pdf/wk/mm55e601.pdf

To access a web-text (HTML) version, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55e601a1.htm

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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June 5, 2006
NIP WEBSITE POSTS PROVISIONAL ACIP RECOMMENDATIONS FOR ROTAVIRUS VACCINE FOR INFANTS

NIP's web section Provisional ACIP Recommendations recently added provisional recommendations for use of rotavirus vaccine in infants. The first three paragraphs of the provisional recommendations are reprinted below.

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On February 3, 2006, the U.S. Food and Drug Administration licensed a rotavirus vaccine (RV) [RotaTeq, Merck and Co.] for use among U.S. infants. On February 21, 2006, the Advisory Committee on Immunization Practices (ACIP) recommended routine immunization of all U.S. infants with RV. The provisional ACIP recommendations are summarized below. These recommendations are under review by the director of the Centers for Disease Control and Prevention (CDC) and the Department of Health and Human Services and will be official when published in the CDC's Morbidity and Mortality Weekly Report.

PROVISIONAL RECOMMENDATIONS FOR USE OF ROTAVIRUS VACCINE (RV)

  • Routine: All infants should be immunized with 3 doses of RV (RotaTeq) administered orally at 2, 4, and 6 months of age. The first dose should be administered between 6–12 weeks of age. Subsequent doses should be administered at 4- to 10-week intervals, and all 3 doses of vaccine should be administered by 32 weeks of age.
     
  • Simultaneous administration: RV can be administered together with other childhood vaccines indicated at the same visits, including Haemophilus influenzae type b conjugate (Hib) vaccine, inactivated poliovirus vaccine (IPV), hepatitis B (HepB) vaccine, pneumococcal conjugate vaccine (PCV), and the diphtheria, tetanus, and acellular pertussis (DTaP) vaccines. . . .

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The provisional recommendations also include information about special situations, contraindications, and precautions.

To access the provisional rotavirus vaccine recommendations for infants, go to:
http://www.cdc.gov/nip/recs/provisional_recs/rotavirus-child.pdf

To access all provisional recommendations, which include those for Tdap vaccination for adults, hepatitis B vaccination for adults, and expanded recommendations for varicella vaccine, go to: http://www.cdc.gov/nip/recs/provisional_recs
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June 5, 2006
NIP UPDATES INTERIM VIS FOR Tdap VACCINE WITH INFORMATION FOR ADULT VACCINE RECIPIENTS

NIP recently posted an updated interim VIS for Tdap (tetanus, diphtheria, acellular pertussis) vaccine. Dated 5/31/06, the newly revised interim VIS now contains information for adults getting the vaccine, as well as for adolescents. A final VIS will be developed after ACIP issues its final recommendations and MMWR publishes them. Note: The 5/31/06 interim VIS is currently available in English only.

To access the 5/31/06 interim VIS from the NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-tdap.pdf

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

For information about the use of VISs, and for VISs in more than 30 languages, visit IAC's VIS web section at http://www.immunize.org/vis
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June 5, 2006
NEW: JUNE 2006 ISSUE OF VACCINATE ADULTS IS IN THE MAIL AND ON THE WEB

IAC recently mailed the latest issue of Vaccinate Adults (June 2006) to 130,000 adult medicine specialists and others who work in the field of immunization. Packed with immunization resources for health professionals and patients, the 12-page issue is well worth downloading. All articles and education pieces, except editorials, have been thoroughly reviewed by immunization and hepatitis experts at CDC.

HOW TO READ VACCINATE ADULTS ON THE WEB
You can view selected articles from the table of contents below or download the entire issue from the Web.

To view the table of contents with links to individual articles, go to: http://www.immunize.org/va

The PDF file of the entire issue, linked below, is 1.01 megabytes. For tips on downloading and printing PDF files, go to: http://www.immunize.org/nslt.d/tips.htm

To download a ready-to-print (PDF) version of the June issue, go to: http://www.immunize.org/va/va17.pdf

Below are descriptions of articles published in the June issue, followed by links:


GENERAL IMMUNIZATION (three resources)
(1) In "Ask the Experts," CDC immunization experts answer questions about vaccines and their recommended use.

To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/va/va17exprt.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/va/va17exprt.htm

(2) "Vaccine highlights" presents information on recently published ACIP recommendations on influenza vaccination of healthcare personnel, ACIP's provisional recommendations for adult vaccination with the Tdap and hepatitis B vaccines, and new CDC immunization resources.

To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/va/va17vacc.pdf

(3) "Standing orders for administering vaccines to adults and children" gives health professionals general information about the many standing orders IAC has developed.

To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/va/standingorders.pdf


ADULT IMMUNIZATION (two resources)
(1) Updated in February, "Vaccinations for adults: You're NEVER too old to get immunized!" now includes information on the newly licensed Tdap vaccine.

To access a ready-to-print (PDF) version, 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

(2) Updated in May, "Summary of recommendations for adult immunization," now offers current information about the target populations for hepatitis B vaccine and Tdap vaccine.

To access a ready-to-print (PDF) version, go to:
http://www.immunize.org/catg.d/p2011b.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p2011b.htm


VIRAL HEPATITIS (two resources)
(1 & 2) Updated in February, the patient-education pieces "If you have hepatitis C, which vaccinations do you need?" and "If you have HIV infection, which vaccinations do you need?" make it easy for patients infected with hepatitis C virus and/or HIV to learn about the vaccines they need.

To access a ready-to-print (PDF) version of the Vaccinate Adult page, go to: http://www.immunize.org/va/hivhepc.pdf

To access a ready-to-print version of "If you have hepatitis C, which vaccinations do you need?" go to:
http://www.immunize.org/catg.d/4042hepc.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/4042hepc.htm

To access a ready-to-print version of "If you have HIV infection, which vaccinations do you need?" go to:
http://www.immunize.org/catg.d/p4041hiv.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4041hiv.htm
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June 5, 2006
NEW: IAC WEBSITE POSTS CHART AND U.S. MAP SHOWING WHICH STATES HAVE PCV MANDATES FOR DAYCARE ENROLLEES

IAC recently compiled information about all states that have pneumococcal conjugate vaccine (PCV) mandates for daycare enrollees. To access the information, go to:
http://www.immunize.org/laws/pneuconj.htm

The information is also depicted visually on a map of the United States. To access the map, go to:
http://www.immunize.org/laws/pneuconjmap.pdf

For information about state mandates for other vaccines, go to:
http://www.immunize.org/laws

We depend on our readers to help us stay informed and ensure our website contains the most current and accurate information available. Please let us know when any changes occur in your state by emailing us at admin@immunize.org
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June 5, 2006
JUNE IMMUNIZATION WORKS ELECTRONIC NEWSLETTER AVAILABLE ON THE NIP WEBSITE

The June 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.

The lead story in the June issue concerns the current multi-state mumps outbreak and ACIP's updated recommendations for controlling and eliminating mumps. IAC Express covered the multi-state outbreak in previous issues, and has reprinted a substantial portion of the updated recommendations in story #1 of this issue. Information from all other articles in the June issue of Immunization Works have appeared in previous issues of IAC Express.

To access the June issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200606.htm
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June 5, 2006
MMWR DEDICATES JUNE 2 ISSUE TO RETROSPECTIVES ON THE AIDS EPIDEMIC, 1981–2006

In its June 2 issue, MMWR gives extensive coverage to the 25-year epidemic of HIV/AIDS in the United States, devoting four articles to the topic. Portions of the lead article, "Twenty-five years of HIV/AIDS—United States, 1981–2006," are reprinted below.

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On June 5, 1981, MMWR published a report of Pneumocystis carinii pneumonia in five previously healthy young men in Los Angeles, California. These cases were later recognized as the first reported cases of acquired immunodeficiency syndrome (AIDS) in the United States. Since that time, this disease has become one of the greatest public health challenges both nationally and globally. Human immunodeficiency virus (HIV) and AIDS have claimed the lives of more than 22 million persons worldwide, including more than 500,000 persons in the United States. . . .

HIV/AIDS remains a potentially deadly chronic disease. Prevention of HIV infection requires a continued commitment from persons at risk, persons infected, and society as a whole. Prevention efforts need to keep pace with a changing epidemic. Most importantly, younger generations, who might not remember the deadlier, early days of the epidemic, continually need to receive basic HIV-prevention messages. Twenty-five years after first reporting on AIDS, MMWR dedicates this issue to retrospectives on the epidemic, including the changing epidemiology of HIV/AIDS, the public health achievement in reducing perinatal transmission of HIV, and the evolution of measures to prevent HIV/AIDS.

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To access a web-text (HTML) version of the article "Twenty-five years of HIV/AIDS—United States, 1981–2006," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a1.htm

To access a web-text (HTML) version of the article "Epidemiology of HIV/AIDS—United States, 1981–2005," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a2.htm

To access a web-text (HTML) version of the article "Reduction in perinatal transmission of HIV—United States, 1985–2005," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a3.htm

To access a web-text (HTML) version of the article "Evolution of HIV/AIDS prevention programs—United States, 1981–2006," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5521a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5521.pdf
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June 5, 2006
REMINDER: ALL ATTENDEES TO THE JUNE 29–30 ACIP MEETING ARE REQUIRED TO REGISTER ONLINE

CDC has asked IAC to remind readers that all attendees (participants and visitors) to the summer ACIP meeting (scheduled for Thursday–Friday, June 29–30) are required to register online. The meeting will be held at CDC's Clifton Road campus in Atlanta. Online registration will speed the security clearance process.

To register, go to:
http://www2.cdc.gov/nip/ACIP/JuneRegistration.asp

All non–U.S. citizens are required to register at least three weeks in advance of an ACIP meeting. 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 fall ACIP meeting will be held Wednesday–Thursday, October 25–26. For more information, go to: http://www.cdc.gov/nip/acip
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June 5, 2006
UPDATE: CDC WEBSITE POSTS NEW HPV VACCINE FACT SHEET FOR THE PUBLIC

The CDC website posted a new HPV (human papillomavirus) Vaccine fact sheet for members of the general public. To access it, go to: www.cdc.gov/std/HPV/STDFact-HPV-vaccine.htm

CDC will continue to update the HPV resource page as new information becomes available. The page includes resources in English and Spanish. To access it, go to:
http://www.cdc.gov/std/HPV

In the coming weeks, a HPV vaccine fact sheet for healthcare providers will be posted on the website. IAC Express will alert readers when it becomes available.
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June 5, 2006
FREE: MIGRANT CLINICIANS NETWORK MAKES THREE NEW SPANISH-LANGUAGE IMMUNIZATION COMIC BOOKS AVAILABLE THROUGH JUNE 16

The Migrant Clinicians Network (MCN) recently announced three new immunization comic books. Available through June 16, the comic books are free of charge. In addition, postage is free to U.S. addresses.

Using the character Pepin, the series educates migrant, mobile underserved populations about vaccinations for their children, adolescents, and themselves. The new titles include "What to do after the shot," "Tetanus/diphtheria vaccine," and "Hepatitis A vaccine." The materials were developed in collaboration with Texas Tech University Health Science Center at El Paso.

Please note that these resources are a supplement to the vaccination information statements (VISs), and that providers are still required to distribute the VISs.

To order the comic books online, go to: http://www.migrantclinician.org/surveys/vacunas_orderform.php You can also download the order form, complete it, and fax it to MCN at (512) 327-0719.

For additional information, go to: http://www.migrantclinician.org/excellence/immunizations

 

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 June 5, 2006