Issue Number 607            July 3, 2006

CONTENTS OF THIS ISSUE

  1. New: CDC issues the latest ACIP influenza recommendations in an MMWR Early Release
  2. New: ACIP votes to recommend human papillomavirus vaccination for girls and women ages 9-26 years
  3. New: ACIP votes to recommend changes in varicella vaccination
  4. New: Influenza VISs for 2006-07 season now available on the CDC and IAC websites
  5. CDC website posts HPV vaccine fact sheet for healthcare professionals and updates fact sheet for public
  6. June 29 issue of Hep Express electronic newsletter now online
  7. New: Pediatric Dengue Vaccine Initiative launches newsletter

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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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July 3, 2006
NEW: CDC ISSUES THE LATEST ACIP INFLUENZA RECOMMENDATIONS IN AN MMWR EARLY RELEASE

On June 28, CDC issued "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" as an MMWR Early Release. CDC publishes the web-based MMWR Early Release only for the immediate release of important public health information. The article will be published in the standard MMWR format in the future.

Two sections of the recommendations are reprinted below: (1) the summary and (2) a portion of the introduction titled Primary Changes and Updates in the Recommendations.

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SUMMARY
This report updates the 2005 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine and antiviral agents (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2005;54[No. RR-8]:1-44). The 2006 recommendations include new and updated information. Principal changes include (1) recommending vaccination of children aged 24-59 months and their household contacts and out-of-home caregivers against influenza; (2) highlighting the importance of administering 2 doses of influenza vaccine for children aged 6 months-<9 years who were previously unvaccinated; (3) advising healthcare providers, those planning organized campaigns, and state and local public health agencies to (a) develop plans for expanding outreach and infrastructure to vaccinate more persons than [during] the previous year and (b) develop contingency plans for the timing and prioritization of administering influenza vaccine, if the supply of vaccine is delayed and/or reduced; (4) reminding providers that they should routinely offer influenza vaccine to patients throughout the influenza season; (5) recommending that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States until evidence of susceptibility to these antiviral medications has been re-established among circulating influenza A viruses; and (6) using the 2006-07 trivalent influenza vaccine virus strains: A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/ 67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus. A link to this report and other information can be accessed at http://www.cdc.gov/flu

[From the introduction]
PRIMARY CHANGES AND UPDATES IN THE RECOMMENDATIONS

The 2006 recommendations include six principal changes or updates:

  • ACIP recommends that healthy children aged 24-59 months and their household contacts and out-of-home caregivers be vaccinated against influenza (see Target Groups for Vaccination). This change extends the recommendations for vaccination of children so that all children aged 6-<=59 months receive annual vaccination.
     
  • ACIP emphasizes that all children aged 6 months-<9 years who have not been previously vaccinated at any time with either live, attenuated influenza vaccine (LAIV) or trivalent inactivated influenza vaccine (TIV) should receive 2 doses of vaccine. Those children aged 6 months-<9 years who receive TIV should have a booster dose of TIV administered >=1 month after the initial dose, before the onset of influenza season, if possible. Those children aged 5-<9 years who receive LAIV should have a second dose of LAIV 6-10 weeks after the initial dose, before the influenza season, if possible. If a child aged 6 months-<9 years received influenza vaccine for the first time during a previous season but did not receive a second dose of vaccine within the same season, only 1 dose of vaccine should be administered this season (see Efficacy and Effectiveness of Inactivated Influenza Vaccine, Children; TIV Dosage; and LAIV Dosage and Administration).
     
  • To ensure optimal use of available doses of influenza vaccine, projected to be approximately 100 million doses, healthcare providers, those planning organized campaigns, and state and local public health agencies should (1) develop plans for expanding outreach and infrastructure to vaccinate more persons than during the previous year and (2) develop contingency plans for the timing and prioritization of administering influenza vaccine, if the supply of vaccine is delayed and/or reduced because of the complexity of the production process (see Influenza Vaccine Supply and Timing of Annual Influenza Vaccination).
     
  • ACIP emphasizes that influenza vaccine should continue to be offered throughout the influenza season even after influenza activity has been documented in a community. In addition, ACIP encourages all community vaccinators and public health agencies to schedule clinics that serve target groups and to help extend the routine vaccination season by offering at least one vaccination clinic in December (see Influenza Vaccine Supply and Timing of Annual Influenza Vaccination).
     
  • ACIP recommends that neither amantadine nor rimantadine be used for the treatment or chemoprophylaxis of influenza A in the United States because of recent data indicating widespread resistance of influenza virus to these medications. Until susceptibility to adamantanes has been re-established among circulating influenza A viruses, oseltamivir or zanamivir may be prescribed if antiviral treatment or chemoprophylaxis of influenza is indicated (see Recommendations for Using Antiviral Agents for Influenza).
     
  • The 2006-07 trivalent vaccine virus strains are A/New Caledonia/20/1999 (H1N1)-like, A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens. For the A/Wisconsin/67/2005 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Hiroshima/52/2005 virus; for the B/Malaysia/2506/2004-like antigen, manufacturers may use the antigenically equivalent B/Ohio/1/2005 virus (see Influenza Vaccine Composition). . . .


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To access a ready-to-print (PDF) version of it, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr55e628.pdf

To access a web-text (HTML) version of the MMWR Early Release, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e628a1.htm
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July 3, 2006
NEW: ACIP VOTES TO RECOMMEND HUMAN PAPILLOMAVIRUS VACCINATION FOR GIRLS AND WOMEN AGES 9-26 YEARS

On June 29, CDC issued a media advisory announcing that ACIP has voted to recommend human papillomavirus vaccination for girls and women ages 9-26 years. Also on June 29, CDC posted on its website a transcript of a press briefing on the same subject. The speaker is Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases. A link to the transcript is given at the end of this IAC Express article.

The media advisory is reprinted below in its entirety.

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Media Advisory
For immediate release
June 29, 2006

CDC'S ADVISORY COMMITTEE RECOMMENDS HUMAN PAPILLOMAVIRUS VIRUS VACCINATION

CDC's Advisory Committee Recommends Human Papillomavirus Virus Vaccination Vaccine considered highly effective in preventing infections that are the cause of most cervical cancers.

The Advisory Committee on Immunization Practices (ACIP) voted Thursday to recommend that a newly licensed vaccine designed to protect against human papillomavirus virus (HPV) be routinely given to girls when they are 11-12 years old. The ACIP recommendation also allows for vaccination of girls beginning at nine years old as well as vaccination of girls and women 13-26 years old. HPV is the leading cause of cervical cancer in women.

According to the ACIP's recommendation, three doses of the new vaccine should be routinely given to girls when they are 11 or 12 years old. The advisory committee, however, noted that the vaccination series can be started as early as nine years old at the discretion of the physician or healthcare provider. The recommendation also includes girls and women 13-26 years old because they will benefit from getting the vaccine. The vaccine should be administered before onset of sexual activity (i.e., before women are exposed to the viruses), but females who are sexually active should still be vaccinated. . . .

"This vaccine represents an important medical breakthrough," said Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases. "As a result, these vaccine recommendations address a major health problem for women and represent a significant advance in women's health. It has been tested in thousands of women around the world and has been found to be safe and effective in providing protection against the two types of HPV that cause most cervical cancers."

Gardasil, manufactured by Merck, is the first vaccine developed to prevent cervical cancer, precancerous genital lesions, and genital warts due to HPV幽PV causes genital warts in men and women. The vaccine is highly effective against four types of the HPV virus, including two that cause about 70 percent of cervical cancer. Those who have not acquired HPV would get the full benefits of the vaccine. On average, there are 9,710 new cases and 3,700 deaths from cervical cancer in the United States each year.

HPV is the most common sexually transmitted infection in the United States. More than 20 million men and women in the United States are currently infected with HPV and there are 6.2 million new infections each year. HPV is most common in young women and men who are in their late teens and early 20s. By age 50, at least 80 percent of women will have acquired HPV infection.

"Although an effective vaccine is a major advance in the prevention of genital HPV and cervical cancer, it will not replace other prevention strategies, such as cervical cancer screening for women or protective sexual behaviors," said Dr. Schuchat. "Women should continue to get pap tests as a safeguard against cervical cancer."

The ACIP, consisting of 15 members appointed by the Secretary of the Department of Health and Human Services (HHS), advises the director of CDC and Secretary of HHS on control of vaccine-preventable disease and vaccine usage. Recommendations of the ACIP become CDC policy when they are accepted by the director of CDC and are published in CDC's Morbidity and Mortality Weekly Report (MMWR). There are no federal laws requiring the immunization of children. All school and daycare entry laws are state laws and vary from state to state.

For more information, visit www.cdc.gov

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To access the complete media advisory, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060629.htm

To access the transcript of the press briefing, go to:
http://www.cdc.gov/od/oc/media/transcripts/t060629.htm
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July 3, 2006
NEW: ACIP VOTES TO RECOMMEND CHANGES IN VARICELLA VACCINATION

On June 29, CDC issued a media advisory announcing that ACIP has voted to recommend a second dose of varicella vaccine for children ages 4-6 years, as well as other changes. Portions of the media advisory are reprinted below.

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Media Advisory
For immediate release
June 29, 2006

CDC'S ADVISORY COMMITTEE RECOMMENDS CHANGES IN VARICELLA VACCINATIONS

Second dose of varicella vaccine to offer more protection for children, adolescents, and adults

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 a second dose of varicella (chickenpox) vaccine for children four to six years old to further improve protection against the disease. The first dose of varicella vaccine is recommended at 12 to 15 months old.

Fifteen to 20 percent of children who have received one dose of the vaccine are not fully protected and may develop chickenpox after coming in contact with varicella zoster virus. Additionally, one dose of the vaccine may not continue to provide protection into adulthood when chickenpox is more severe. A second dose of varicella vaccine provides increased protection against varicella disease compared [with] one dose. The ACIP also recommended that children, adolescents, and adults who previously received one dose should receive a second dose.

"We have made great progress in reducing chickenpox during the past ten years," said Dr. Anne Schuchat, director of CDC's National Center for Immunization and Respiratory Diseases. "This recommendation will further reduce outbreaks of chickenpox and provide better individual protection."

Before licensure of the varicella vaccine in 1995, each year there were about four million cases of varicella, 13,500 hospitalizations, and 150 deaths. Cases of varicella have steadily declined 80 to 85 percent in surveillance sites since the licensure. From 1995 to 2001, varicella hospitalizations declined by 72 percent and deaths, among those 50 years old and younger, decreased by 75% or more.

However, in recent years varicella outbreaks have continued to occur among vaccinated school children. During these chickenpox outbreaks, between 11 and 17 percent of vaccinated children developed varicella. Varicella in vaccinated children is usually mild, but the children are contagious and can transmit the virus to others including their parents who are at higher risk of severe disease. . . .

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To access the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060629-b.htm
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July 3, 2006
NEW: INFLUENZA VISs FOR 2006-07 SEASON NOW AVAILABLE ON THE CDC AND IAC WEBSITES

On June 30, CDC issued new VISs for the two influenza vaccines: trivalent inactivated influenza vaccine (TIV; injectable) and live attenuated influenza vaccine (LAIV; nasal spray). Both are available on the CDC and IAC websites. At this time, these VISs are available in English only.

TIV VACCINE VIS (dated 6/30/06)
To obtain a ready-to-print (PDF) version of the VIS for TIV in English from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf

To obtain it from the IAC website, go to:
http://www.immunize.org/vis/2flu.pdf

LAIV VACCINE VIS (dated 6/30/06)
To obtain a ready-to-print (PDF) version of the VIS for LAIV in English from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf

To obtain it from the IAC website, go to:
http://www.immunize.org/vis/liveflu.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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July 3, 2006
NEW: CDC WEBSITE POSTS HPV VACCINE FACT SHEET FOR HEALTHCARE PROFESSIONALS AND UPDATES FACT SHEET FOR PUBLIC

CDC's Sexually Transmitted Diseases web section recently posted a fact sheet on human papillomavirus (HPV) infection and vaccine for healthcare professionals and updated the existing fact sheet for the public.

To access the fact sheet for healthcare professionals, go to:
http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine-hcp.htm

To access the fact sheet for the public, go to:
http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm
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July 3, 2006
JUNE 29 ISSUE OF HEP EXPRESS ELECTRONIC NEWSLETTER NOW ONLINE

The June 29 issue of Hep Express, an electronic newsletter published by IAC, is now available online. It is intended for health and social service professionals involved in the prevention and treatment of viral hepatitis.

Six articles in the June 29 issue are of particular note; these are their titles:

  • Free and now available: Asian Liver Center's new brochure, "Hepatitis B and Moms-to-Be," in English and Chinese
  • Review the key issues of HBV treatment options as presented at Digestive Disease Week 2006
  • Hepatitis B Foundation updates English chapters
  • Viral Hepatitis Prevention Board website features presentations from a meeting on hepatitis B, hepatitis C, and other bloodborne infections in healthcare workers
  • Asian Liver Center releases unique documentary on HBV: "Another Life: The Untold Story of an Asian Epidemic"
  • Viral hepatitis integration brochure and other educational materials available free from CDC

Titles of additional articles from the June 29 Hep Express include the following:

  • Hepatitis B Congressional briefing raises awareness about hepatitis B
  • Hepatitis C awareness event called Hep Fest coming to Florida on September 1-4
  • Conference on hepatitis C, HIV, and other bloodborne pathogens planned for Chicago on October 26-27

To access the June 29 issue, go to:
http://www.hepprograms.org/hepexpress/issue45.asp

To sign up for a free subscription to Hep Express, go to:
http://www.hepprograms.org/hepexpress/signup.asp

To access previous issues of Hep Express, go to:
http://www.hepprograms.org/hepexpress
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July 3, 2006
NEW: PEDIATRIC DENGUE VACCINE INITIATIVE LAUNCHES NEWSLETTER

The Pediatric Dengue Vaccine Initiative (PDVI), housed at the International Vaccine Institute in Seoul, Korea, has launched a newsletter猶DVI News. PDVI is funded by the Bill and Melinda Gates Foundation and the Rockefeller Foundation. It promotes the development, evaluation, and introduction of dengue vaccines for developing countries.

The newsletter may be accessed at
http://www.pdvi.org/Newsletter.htm

Subscription requests should be send to Ms. Nam Hee Kim at nhkim@pdvi.org

About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of Immunize.org and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
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    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
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    Kayla Ohlde

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