Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 621            September 18, 2006

CONTENTS OF THIS ISSUE

  1. New: CDC releases interim VIS for shingles (herpes zoster) vaccine
  2. Survey of 2005 vaccination rates of U.S. children ages 19-35 months shows similar rates across racial and ethnic lines
  3. CDC reports on state and local health departments' response to U.S. varicella outbreaks during 2003-04
  4. 2006 National Adult Immunization Week scheduled for September 24-30; promotional materials available
  5. IAC updates its two summaries of immunization recommendations and other materials for healthcare professionals
  6. National Influenza Vaccine Summit web section posts materials on influenza vaccination of healthcare professionals
  7. Massachusetts Medical Society website posts the 2006 Employee Flu Immunization Campaign Kit
  8. Promote healthcare worker vaccination with CDC's updated posters and flyers
  9. Don't delay: Add your influenza clinic to the American Lung Association's popular Flu Clinic Locator website
  10. Article in FDA Consumer magazine explains the basics of influenza vaccine selection and recommendations
  11. CDC's Influenza web section posts an assortment of influenza information sheets for healthcare professionals
  12. September issue of CDC's Immunization Works electronic newsletter focuses on influenza vaccine
  13. Women in Government recommends HPV vaccination for girls entering middle school
  14. MMWR issues corrections to the STD treatment guidelines it published on August 4

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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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September 18, 2006
NEW: CDC RELEASES INTERIM VIS FOR SHINGLES (HERPES ZOSTER) VACCINE

On September 11, CDC released an interim VIS for shingles (herpes zoster) vaccine. ACIP has not yet voted on recommendations for zoster vaccine. The interim VIS is based primarily on information from the manufacturer's package insert. The final VIS will be produced after the ACIP recommendations have been published in MMWR. The final VIS could differ from the interim version.

To obtain a ready-to-print (PDF) version of the interim VIS from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-shingles.pdf

To obtain it from the IAC website, go to:
http://www.immunize.org/vis/shingles.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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September 18, 2006
SURVEY OF 2005 VACCINATION RATES OF U.S. CHILDREN AGES 19-35 MONTHS SHOWS SIMILAR RATES ACROSS RACIAL AND ETHNIC LINES

CDC published "National, State, and Urban Area Vaccination Coverage Among Children Aged 19-35 Months—United States, 2005" in the September 15 issue of MMWR. A link to tables describing data collected during the 2005 National Immunization Survey (NIS) appears at the end of this IAC Express article, as do links to a CDC press release relating to the 2005 survey and to the full transcript of a CDC press briefing on the topic.

Portions of the MMWR article are reprinted below.

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The National Immunization Survey (NIS) provides vaccination coverage estimates among children aged 19-35 months for each of the 50 states and selected urban areas. Findings from the 2005 NIS include nationwide increases in coverage with >=3 and >=4 doses of pneumococcal conjugate vaccine (PCV) and continued high levels of coverage for the other recommended vaccines and vaccine series. In addition, no racial/ethnic disparities in coverage estimates were observed in the 4:3:1:3:3:1 vaccine series, the recommended series for children aged 19-35 months that includes DTP/DT/DTaP; poliovirus vaccine; measles, mumps, and rubella vaccine (MMR); Haemophilus influenzae type b vaccine; hepatitis B vaccine; and varicella vaccine. An important accomplishment indicated by the 2005 NIS data is the achievement of >50% coverage for the full series of PCV (>=4 doses) and >80% coverage for >=3 doses within 5 years after being added to the U.S.-recommended childhood immunization schedule in 2000. This occurred despite shortages of this vaccine during 2001-2004, which might have affected accessibility to PCV. . . .

National vaccination coverage estimates increased from 2004 to 2005 for PCV, from 73.2% to 82.8% for >=3 doses and from 43.4% to 53.7% for >=4 doses. Coverage for >=1 dose of MMR vaccine decreased from 93.0% to 91.5%. Coverage estimates for all other vaccines and vaccine series in 2005 were not significantly different (by t test) from 2004 estimates.

As in previous years, estimated vaccination coverage levels varied substantially among states. Estimated coverage with the 4:3:1:3:3:1 vaccine series ranged from 90.7% (95% confidence interval [CI] = +/-3.8) in Massachusetts to 62.9% (CI = +/-8.1) in Vermont. Coverage also varied substantially among the 27 urban areas. The highest estimated coverage among the urban areas for the 4:3:1:3:3:1 series was 84.5% (CI = +/-6.0) for Jefferson County, Alabama, and the lowest was 58.8% (CI = +/-7.9) for Clark County, Nevada. . . .

Editorial Note:

The findings in this report indicate that among U.S. children aged 19-35 months, coverage with the recommended vaccines in 2005 remained at or near all-time—high levels, with substantial increases in PCV coverage. The 2005 NIS survey cohort included children born during February 2002-July 2004; all of these children might have been affected by the shortages of PCV during February-September 2004, when recommendations to defer the 4th dose or the 3rd and 4th doses were in effect. Despite these shortages, coverage with the full series (>=4 doses) exceeded 50% and coverage with >=3 doses of PCV exceeded 80% in this survey cohort. Surveillance data from 1998-2003 have indicated substantial reductions in the incidence of vaccine-type and overall invasive pneumococcal disease in children and adults, attributable to routine use of PCV in young children. . . .

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5536a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5536.pdf

To access NIS 2005 data tables from the CDC website, go to:
http://www.cdc.gov/nip/coverage/NIS/05/toc-05.htm

To access a CDC press release titled "Racial disparities in childhood immunization coverage rates closing," go to:
http://www.cdc.gov/od/oc/media/pressrel/r060914.htm

To access the full transcript of the CDC press briefing, go to:
http://www.cdc.gov/od/oc/media/transcripts/t060914.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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September 18, 2006
CDC REPORTS ON STATE AND LOCAL HEALTH DEPARTMENTS' RESPONSE TO U.S. VARICELLA OUTBREAKS DURING 2003-04

CDC published "Public Health Response to Varicella Outbreaks—United States, 2003-2004" in the September 15 issue of MMWR. Portions of a summary made available to the press are reprinted below, as are two paragraphs from the article's Editorial Note.

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FROM THE PRESS SUMMARY
Although varicella disease has decreased as vaccination coverage has increased, varicella outbreaks are continuing to occur and are being reported and responded to by state and local health departments. . . .

A national survey was conducted to obtain an estimate of the extent of varicella outbreaks that occurred in 2003-2004 and to learn more about public health response to these outbreaks. The survey highlighted that a large number of varicella outbreaks continue to occur; most health jurisdictions reported that they were notified about at least one varicella outbreak in 2003 and 2004. Many health jurisdictions respond to varicella outbreaks that they are notified about and have a definition for varicella outbreaks, although their response and definition varies by jurisdiction. Almost half of health jurisdictions have varicella outbreak management guidelines. CDC will continue to work with state and local health jurisdictions to develop and publish a standard varicella outbreak definition and national outbreak management guidelines and will continue to provide assistance to health departments on managing outbreaks as these guidelines are being developed. The recent recommendation by the Advisory Committee on Immunization Practices for a routine 2-dose varicella vaccination should help to improve varicella disease control, including prevention of varicella outbreaks, alleviating the challenges and costs for health departments to respond to these outbreaks.

FROM THE EDITORIAL NOTE
In June 2005, the Advisory Committee on Immunization Practices (ACIP) provisionally recommended a second dose of varicella vaccine in outbreak settings for persons who have had only 1 dose of varicella vaccine and no disease history (provided that an appropriate interval has elapsed since the first dose). On the basis of a 10-year follow-up prelicensure study of the vaccine, a 2-dose vaccination regimen has been determined more effective than a 1-dose regimen.

In a 2006 position statement, the Council of State and Territorial Epidemiologists (CSTE) supported a routine 2-dose varicella vaccination policy to improve varicella control and outbreak prevention. In June 2006, ACIP approved a routine 2-dose varicella vaccination policy for children (first dose at 12-15 months, second dose at 4-6 years) and catch-up vaccinations for children, adolescents, and adults who had previously received only 1 dose. Establishing a routine 2-dose vaccination regimen might make the 2-dose outbreak response for susceptible populations more feasible to implement. . . .


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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5536a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5536.pdf
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September 18, 2006
2006 NATIONAL ADULT IMMUNIZATION WEEK SCHEDULED FOR SEPTEMBER 24-30; PROMOTIONAL MATERIALS AVAILABLE

The NIP website recently posted information about the 2006 National Adult Immunization Awareness Week (NAIAW), which is scheduled for September 24-30. This year marks the 19th consecutive observance of NAIAW; it is a great opportunity for individuals and organizations to promote the importance of adult and adolescent immunization.

In addition, NIP posted a link to the printable version of the NAIAW 2006 Campaign Kit, which was created by the National Foundation for Infectious Diseases (NFID). To access the kit from the NFID website, go to: http://www.nfid.org/pdf/publications/naiaw06.pdf

NOTE: The kit is a very large file. For help on downloading and printing large PDF files, go to:
http://www.immunize.org/nslt.d/tips.htm
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September 18, 2006
IAC UPDATES ITS TWO SUMMARIES OF IMMUNIZATION RECOMMENDATIONS AND OTHER MATERIALS FOR HEALTHCARE PROFESSIONALS

IAC recently updated its two summaries of immunization recommendations, as well as three information sheets for healthcare professionals. Following are explanations of the revisions and links to the updated documents.

(1) Summary of Recommendations for Childhood and Adolescent Immunization (three pages, updated September 2006): Information was added about the new vaccines for human papillomavirus (HPV) and rotavirus. In addition, the sections on the following vaccines were extensively revised: hepatitis B, Td/Tdap, varicella, MMR, influenza, pneumococcal polysaccharide (PPV), and hepatitis A.

To access a ready-to-print version of the childhood/adolescent summary, go to: http://www.immunize.org/catg.d/rules1.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n17/rules1.htm

(2) Summary of Recommendations for Adult Immunization (three pages, updated September 2006): Information on using Td/Tdap vaccines during pregnancy was revised, as was information about the evidence of immunity to varicella.

To access a ready-to-print version of the adult summary, 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

(3) How to Administer Intramuscular (IM) and Subcutaneous (SC) Injections (two pages, updated September 2006): Information on the site for administering IM injections to children ages 12 months to 10 years was changed.

To access a ready-to-print version of this piece, go to:
http://www.immunize.org/catg.d/p2020.pdf

(4) Screening Questionnaire for Child and Teen Immunization (two pages; updated September 2006): Minor revisions were made.

To access a ready-to-print version of this piece, go to:
http://www.immunize.org/catg.d/p4060scr.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4060scr.htm

(5) Screening Questionnaire for Adult Immunization (two pages; updated September 2006): Minor revisions were made.

To access a ready-to-print version of this piece, go to:
http://www.immunize.org/catg.d/p4065scr.pdf

To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4065scr.htm
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September 18, 2006
NATIONAL INFLUENZA VACCINE SUMMIT WEB SECTION POSTS MATERIALS ON INFLUENZA VACCINATION OF HEALTHCARE PROFESSIONALS

The National Influenza Vaccine Summit recently posted an array of resources on its Health Care Worker Influenza Immunization Home Page. To access the home page, go to: www.ama-assn.org/go/HCWfluimmunization
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September 18, 2006
MASSACHUSETTS MEDICAL SOCIETY WEBSITE POSTS THE 2006 EMPLOYEE FLU IMMUNIZATION CAMPAIGN KIT

The website of the Massachusetts Medical Society (MMS) recently posted the Employee Flu Immunization Campaign Kit for 2006. Produced by MMS, Masspro, and the Massachusetts Department of Public Health, the kit is available online by clicking here
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September 18, 2006
PROMOTE HEALTHCARE WORKER VACCINATION WITH CDC'S UPDATED POSTERS
AND FLYERS

[The following is cross posted from CDC's Immunization Works electronic newsletter, September 2006.]

PROMOTE HCW VACCINATION: CDC has recently updated posters and flyers for healthcare worker (HCW) vaccinations, "Healthcare Workers! Are your vaccinations up-to-date?" The updated materials reflect the Advisory Committee on Immunization Practices' (ACIP's) new pertussis vaccine recommendations. They can be downloaded and printed in black and white or commercial-quality color from www.cdc.gov/nip/publications/#healthcare (scroll down to Healthcare Worker Immunizations).
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September 18, 2006
DON'T DELAY: ADD YOUR INFLUENZA CLINIC TO THE AMERICAN LUNG ASSOCIATION'S POPULAR FLU CLINIC LOCATOR WEBSITE

The American Lung Association recently updated the Professional Resources section of its popular Flu Clinic Locator website with information for providers interested in adding their clinics to the website and promoting them.

For information on how the website works and how to participate, go to: http://www.flucliniclocator.org Click on Professional Resources in the left column, and you will be taken to the Professional Resources web section. Once there, click on All About the Flu Clinic Locator and then on pertinent links listed under the heading Helpful, Related Resources.

For additional information, email flucliniclocator@lungusa.org
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September 18, 2006
ARTICLE IN FDA CONSUMER MAGAZINE EXPLAINS THE BASICS OF INFLUENZA VACCINE SELECTION AND RECOMMENDATIONS

The website of the U.S. Food and Drug Administration recently posted an article that appeared in the July-August 2006 issue of the magazine FDA Consumer. The article, "Getting Ready for Another Flu Season," presents basic information about the disease and the yearly processes of selecting vaccine strains and updating the ACIP influenza recommendations. It concludes with an overview of the recommendations for the 2006-07 influenza season.

To access the article, go to:
http://www.fda.gov/fdac/features/2006/406_flu.html
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September 18, 2006
CDC'S INFLUENZA WEB SECTION POSTS AN ASSORTMENT OF INFLUENZA INFORMATION SHEETS FOR HEALTHCARE PROFESSIONALS

On September 8, CDC added four new information sheets to its Influenza web section and updated 14 more. The new and updated information sheets are based on information contained in the ACIP influenza recommendations for 2006-07.

NEW

  1. "Recommendations for Using Inactivated and Live, Attenuated Influenza Vaccine"
  2. "Influenza Vaccine Supply and Timing of Annual Influenza Vaccination"
  3. "Efficacy and Effectiveness of Live, Attenuated Influenza Vaccine (LAIV)"
  4. "Vaccination of Close Contacts of Persons at High Risk for Complications of Influenza"

To access these materials, go to: http://www.cdc.gov/flu/whatsnew.htm and click on the pertinent links.

UPDATED
To access any of the 14 newly undated information sheets, go to http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent links.

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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September 18, 2006
SEPTEMBER ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER FOCUSES ON INFLUENZA VACCINE

The September 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 article, "100 Million Doses of Influenza Vaccine Expected This Year," is reprinted below in its entirety. Other articles in the September issue have previously been covered in IAC Express. Following is the text of articles we have not covered.

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100 MILLION DOSES OF INFLUENZA VACCINE EXPECTED THIS YEAR

The Centers for Disease Control and Prevention (CDC) announced this week that influenza vaccine manufacturers are expecting to produce and distribute more than 100 million doses of influenza vaccines in the United States between now and early January 2007. Manufacturers have already begun to ship this season's influenza vaccine, with almost all of the vaccine expected to be shipped and distributed in October and November. The influenza manufacturers and major distributors are implementing policies designed to provide some influenza vaccine by the end of October to all providers who ordered it.

The more than 100 million doses is at least 17 million more doses of influenza vaccine than has ever been distributed in the past and about 19 million more doses than were distributed last year. According to the information from manufacturers, about 75 million doses will be distributed by the end of October.

CDC encourages anyone who wants to be protected against influenza to seek vaccination, especially those at increased risk for influenza-related complications as well as those who live with or care for people at high risk—including healthcare providers, children between 6 months and up to 5 years of age, and people with chronic diseases such as diabetes, asthma, and heart disease, as well as people 50 years old and older.

While the best time for vaccination is October and November before the influenza season typically begins, vaccination can still provide protection in December and later because during most years influenza does not peak until February or later. Since influenza is unpredictable, and different types and strains of influenza circulate throughout the flu season, the CDC's Advisory Committee on Immunization Practices (ACIP) recommends that influenza vaccine be offered throughout the influenza season—even after influenza has appeared or begun appearing in a community.

To assist in the promotion of the flu vaccine, CDC's Flu Gallery contains educational materials for use during the influenza immunization season. These materials reflect CDC's vaccination recommendations and highlight the benefits of influenza vaccination. The Gallery contains print materials such as flyers, posters, and brochures, in color and black and white, English and Spanish. Many of the materials can be reproduced on an office printer. You can also have the materials printed by a professional (offset) printer.

More information about influenza and influenza vaccine can be found at http://www.cdc.gov/flu and the Flu Gallery can be found at http://www.cdc.gov/flu/gallery

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OTHER NEWS AND SUMMARIES

INFLUENZA VACCINE DISTRIBUTION DATA IS BEING MADE AVAILABLE TO STATE AND LOCAL PUBLIC HEALTH OFFICIALS: To aid the visibility of influenza vaccine distribution, the CDC is making available jurisdiction-specific summary reports of influenza vaccine distribution data to state and local public health officials. The CDC is working closely with the licensed manufacturers of influenza vaccine and seven major influenza vaccine distributors to provide distribution information on a weekly basis throughout the influenza season, beginning this month. Distribution data elements will include the zip code of end recipient, product type, number of doses, and provider type. A limited amount of jurisdiction-specific order information ("pre-booking" data) will be available as well.

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MEETINGS, CONFERENCES, AND RESOURCES

NEXT ACIP MEETING: The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on October, 25-26, 2006, at the CDC in Atlanta, Georgia. The draft agenda will be available in early October on ACIP's meetings page. Participants can also register for the October meeting at ACIP's website. This meeting is open to the general public, but advanced registration is required.

MMWR NEEDS PILOT TESTERS: CDC's MMWR (Morbidity and Mortality Weekly Report) has a need for volunteers to pilot test upcoming articles that are to be published in this journal. MMWR will soon publish articles on the new General Recommendations and on Tdap vaccination for adults. If you are interested in pilot testing these articles, contact Barbara Stallworth at BStallworth@cdc.gov Volunteers are particularly needed in the following occupations: physicians, pharmacists, health educators, medical assistants, and nurses. For those who are already on NIP's pilot testing list: Please note that this is a separate pool of volunteers. You can volunteer to be included in both groups if you wish.

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To access the complete September issue from the NIP website, go to: http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200609.htm
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September 18, 2006
WOMEN IN GOVERNMENT RECOMMENDS HPV VACCINATION FOR GIRLS ENTERING MIDDLE SCHOOL

On September 12, Women In Government, a bi-partisan organization of women state legislators, issued a press release recommending that girls entering middle school receive human papillomavirus (HPV) vaccine. Portions of the press release are reprinted below.

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WOMEN IN GOVERNMENT ISSUES STATE POLICY RECOMMENDATIONS FOR CERVICAL CANCER VACCINE
Recommendations Support Middle School Entry Requirements

Following the recent Food and Drug Administration (FDA) approval of a vaccine targeting cervical cancer, Women in Government, a national, bi-partisan, non-profit organization representing women state legislators, today recommended that all girls entering middle school be vaccinated against the human papillomavirus (HPV), the cause of cervical cancer. The recommendation is part of the group's new policy recommendations for the HPV vaccine's implementation in the states. The group also supports parental exemptions to the HPV vaccine, based on existing state immunization exemptions. . . .

The new HPV vaccine policy recommendations are part of Women in Government's "Challenge to Eliminate Cervical Cancer Campaign," which mobilizes state legislators to help eradicate cervical cancer through education and policy initiatives. Since 2004, 45 states have introduced legislation or resolutions tackling this issue. . . .

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To access the complete press release, click here

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September 18, 2006
MMWR ISSUES CORRECTIONS TO THE STD TREATMENT GUIDELINES IT PUBLISHED ON AUGUST 4

CDC published a brief article, "Errata: Vol. 55, No. RR-ll," in the September 15 issue of MMWR. It concerns errors that appeared in "Sexually Transmitted Diseases Treatment Guidelines, 2006," published August 4 in MMWR Recommendations and Reports. The September 15 article is reprinted below in its entirety.

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In the MMWR Recommendations and Reports, "Sexually Transmitted Diseases Treatment Guidelines, 2006," the following errors occurred:

On page 42, in the section "Chlamydial Infections Among Children" under "Diagnostic Considerations," the second recommended regimen should read: Recommended Regimen for Children Who Weigh >=45 kg but Who Are Aged <8 Years.

On page 48, in the section "Gonococcal Infections Among Children" under "Diagnostic Considerations," the first recommended regimen should read: Recommended Regimens for Children Who Weigh >45 kg.

On page 59, under "Recommended Regimen A," the daily dosage for Ofloxacin was incorrect. It should read: Ofloxacin 400 mg orally twice daily for 14 days*.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5536a7.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5536.pdf

 

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 September 18, 2006