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Issue Number 73            May 4, 1999

CONTENTS OF THIS ISSUE

  1. CDC releases annual ACIP statement, "Prevention and Control of Influenza"
  2. CPT coding inadvertently causing serious delays in tests that diagnose acute hepatitis
  3. MMWR publishes article on outbreak of poliomyelitis in Angola
  4. MMWR publishes article on progress toward poliomyelitis eradication in Nigeria

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(1)
April 30, 1999
CDC RELEASES ANNUAL ACIP STATEMENT, "PREVENTION AND CONTROL OF INFLUENZA"

On April 30, 1999, the Advisory Committee on Immunization Practices released its updated statement, "Prevention and Control of Influenza," for the 1999-2000 influenza season.

This report updates the 1998 recommendations by the Advisory Committee on Immunization Practices on the use of influenza vaccine and antiviral agents (MMWR 1998;47{No.RR-6}:1-26).  The principal changes include a) information on the influenza virus strains included in the 1999-2000 trivalent vaccine; b) discussion of the potential expanded use of influenza vaccine; c) new background information on live-attenuated influenza vaccines, neuraminidase-inhibitor drugs, and  rapid diagnostic tests; d) new information on the epidemiology of influenza among travelers; and e) the addition of referenced citations.

In addition, this annually revised ACIP statement reviews recommendations for the use of influenza vaccine such as which children and adults should be given influenza vaccine, when it should be administered, who needs more than one dose, vaccine side effects, antiviral treatment for influenza, and more.

NOTE: Continuing education credits (CMEs, CEUs, CNEs) sponsored by CDC are available for reading this statement and completing the test which is printed at the end of the document.

To access the complete document in text format, click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00057028.htm

For the camera-ready copy (pdf format) of the document, click here: ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4804.pdf

TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR (delivered weekly), go to the MMWR website and sign up. When you sign up, you will also automatically begin to receive all new ACIP statements which are published as MMWR's "Recommendations and Reports." To get the MMWR website, click here: http://www.cdc.gov/epo/mmwr/mmwr.html
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(2)
April 30, 1999
CPT CODING INADVERTENTLY CAUSING SERIOUS DELAYS IN TESTS THAT DIAGNOSE ACUTE HEPATITIS

An article entitled "Changes in CPT Code for Hepatitis Panel Causing Delayed Reports of Acute Hepatitis" was reported in the April 30, 1999, issue of MMWR as a "Notice to Readers." CDC reports that these CPT (Current Procedural Terminology) changes are causing repercussions which include physicians not having sufficient time to provide postexposure prophylaxis to prevent transmission of HAV or HBV to susceptible contacts of the case-patient.

The entire notice reads as follows:

NOTICE TO READERS: CHANGES IN CPT CODE FOR HEPATITIS PANEL CAUSING DELAYED REPORTS OF ACUTE HEPATITIS
Current Procedural Terminology (CPT) codes are standardized codes developed and maintained by the CPT Board of the American Medical Association for reporting medical services. The Health Care Financing Administration requires use of these codes in the Common Procedure Coding System when services are reported to Medicare and Medicaid for reimbursement. Effective January 1, 1998, the CPT Board changed the hepatitis serology panel (CPT#80059) to exclude the tests for IgM antibody to hepatitis A virus (IgM anti-HAV) and IgM antibody to hepatitis B core antigen (IgM anti-HBc). These two tests specifically identify recent infection with HAV and HBV, respectively. Many providers may be unaware that these tests are not part of the standard hepatitis panel, and diagnoses of cases of acute viral hepatitis are likely to be delayed by the need to perform additional testing. As a result, reporting of cases to health departments may be delayed, and CDC has received reports of instances of insufficient time to provide  postexposure prophylaxis to prevent transmission of HAV or HBV to susceptible contacts of the case-patient.

The CPT Board has revised the hepatitis serology panel to include both IgM tests that were deleted. However, these modifications will not be implemented until the next CPT code manual is issued on January 1, 2000. Until this change takes effect, health departments should notify health-care practitioners and/or laboratories of the need to order individual tests for IgM anti-HAV (CPT#86709) and IgM anti-HBc (CPT#86705) for accurate determination of the cause of illness in patients with signs and/or symptoms of acute viral hepatitis and for timely prophylaxis of contacts.

If you would like to access a copy of this article directly from the MMWR's website, click here: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00057022.htm
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(3)
April 30, 1999
MMWR PUBLISHES ARTICLE ON OUTBREAK OF POLIOMYELITIS IN ANGOLA

An article entitled "Outbreak of Poliomyelitis - Angola, 1999" was published in the April 30, 1999, issue of the MMWR. This article describes one of the largest epidemics of poliovirus type 3 in the vaccine era.

On March 23, 1999, the Pediatric Hospital in Luanda, Angola, reported 21 cases (three deaths) of acute flaccid paralysis (AFP). By April 25, 1999, 634 AFP cases and 39 deaths had been reported. Preliminary data suggest that the outbreak primarily resulted from failure to vaccinate, with approximately 90% of the cases being unvaccinated or partially vaccinated. The civil war in Angola helped create conditions for the spread of poliovirus, with many displaced persons living in crowded and unsanitary conditions.

To read the complete MMWR article, which also includes advice to travelers, please click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056989.htm
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(4)
April 23, 1999
MMWR PUBLISHES ARTICLE ON PROGRESS TOWARD POLIOMYELITIS ERADICATION IN NIGERIA

An article entitled "Progress Toward Poliomyelitis Eradication -  Nigeria, 1996-1998" was published in the April 23, 1999, issue of the MMWR. The article describes how, despite much effort, NID (National Immunization Day) coverage has not been high enough to eradicate the wild poliovirus, which remains widespread in Nigeria.

The "Editorial Note" concludes that "Nigeria and West Africa are among the few remaining reservoirs of wild poliovirus transmission in the world. Interruption of wild poliovirus transmission will require 1) successful mopping-up in 15 states during April and May 1999; 2) high quality mopping-up in additional states guided by surveillance before the start of NIDs in November 1999; 3) house-to-house vaccination during the next two NIDs to assure high coverage; 4) statewide house-to-house mopping-up in any state with wild poliovirus transmission during 2000; and 5) maintenance and further strengthening of AFP surveillance. Nigeria's polio eradication efforts are supported by WHO, United Nations Children's Fund (UNICEF), Rotary International, U.S. Agency for International Development, and CDC.

To access the complete MMWR article, please click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056970.htm

 

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This page was updated on May 4, 1999