Issue
Number 602
June 5, 2006
CONTENTS OF THIS ISSUE
- MMWR issues an Early Release announcing updated ACIP
recommendations for control and elimination of mumps
- NIP website posts provisional ACIP recommendations for
rotavirus vaccine for infants
- NIP updates interim VIS for Tdap vaccine with
information for adult vaccine recipients
- New: June 2006 issue of Vaccinate Adults is in the mail
and on the Web
- New: IAC website posts chart and U.S. map showing which
states have PCV mandates for daycare enrollees
- June Immunization Works electronic newsletter available
on the NIP website
- MMWR dedicates June 2 issue to retrospectives on the
AIDS epidemic, 1981–2006
- Reminder: All attendees to the June 29–30 ACIP meeting
are required to register online
- Update: CDC website posts new HPV vaccine fact sheet for
the public
- 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.
***********************
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.
***********************
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.
*********************
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. . .
.
*********************
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.
***********************
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.
***********************
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 |
