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Issue Number 96            July 15, 1999

CONTENTS OF THIS ISSUE

  1. CDC recommends postponing administration of rotavirus vaccine
  2. MMWR publishes article on intussusception among recipients of rotavirus vaccine
  3. OPV no longer recommended for routine childhood immunization against polio beginning January 1, 2000
  4. CDC publishes report on progress toward measles elimination in Southern Africa

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(1)
July 15, 1999
CDC RECOMMENDS POSTPONING ADMINISTRATION OF ROTAVIRUS VACCINE

The Centers for Disease Control and Prevention (CDC) announced today that health care providers and parents should postpone use of the rotavirus vaccine for infants. This decision was based on early surveillance reports of intussusception among some infants who received rotavirus vaccine. The official announcement to postpone rotavirus vaccine for infants as well as a link to CDC's "Rotavirus and Intussusception: Questions and Answers" follow:

CDC RECOMMENDS POSTPONING ADMINISTRATION OF ROTAVIRUS VACCINE
"CDC recommends that health care providers and parents postpone use of the rotavirus vaccine for infants, at least until November 1999, based on early surveillance reports of intussusception (a type of bowel obstruction that occurs when the bowel folds in on itself) among some infants who received rotavirus vaccine. Although intussusceptions occur among infants who have not received rotavirus vaccine, CDC will be collecting additional data in the next several months that may indicate more clearly whether the rotavirus vaccine increases the risk of  intussusception. The recommendation is being made with the  consideration that rotavirus season is still 4-6 months away in most parts of the United States.

"An estimated 1.5 million doses of rotavirus vaccine have been administered to infants since it was licensed on August 31, 1998. As of July 7, 1999, the Vaccine Adverse Event Reporting System (VAERS) has received 15 reports of intussusception. The rate of intussusception among children receiving the rotavirus vaccine appears to be increased in the first 2-3 weeks after vaccination. Parents and caretakers of infants should contact their health care provider if the child develops symptoms of intussusception (persistent vomiting, bloody stools, black stools, abdominal bloating or severe colic pain). Health care providers should be aware of the possible increased risk and consider this diagnosis among children presenting these symptoms. Parents and health care providers should report intussusception and other adverse events following vaccination to VAERS. VAERS reporting forms and information can be requested 24 hours a day by calling (800) 822-7967 or accessing the World Wide Web at: http://www.fda.gov/cber/vaers/vaers.htm

"In studies done before the Food and Drug Administration (FDA) licensed rotavirus vaccine for use in the United States, intussusception was noted among 5 of approximately 10,000 vaccine recipients. This number was not significantly higher than among placebo recipients in the studies. However, the Advisory Committee on Immunization Practices (ACIP), in its recommendation for routine rotavirus vaccination of infants, indicated that postlicensure surveillance was needed for intussusception and any other rare adverse events that might occur following receipt of the vaccine.

"Rotavirus is the most common cause of severe diarrhea in children in the United States. Virtually all children have one or more rotavirus infections in the first 5 years of life. Each year in the United States, rotavirus is responsible for approximately 500,000 physician visits and 50,000 hospitalizations. Severe diarrhea and dehydration occur primarily among children 3 months to 35 months of age. It is a seasonal   disease in the United States with the vast majority of the disease occurring in the winter and spring months."

For more detailed information, see article number two below regarding the July 16, 1999, MMWR article on rotavirus and intussusception.

CDC ANSWERS YOUR QUESTIONS ON ROTAVIRUS AND INTUSSUSCEPTION
What is intussusception? How frequently has intussusception occurred following rotavirus vaccination? What should be done if a child develops intussusception after receiving rotavirus vaccine? The answers to these questions and more are on the IAC's website:
http://www.cdc.gov/nip/issues/rota/
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(2)
July 15, 1999
MMWR PUBLISHES ARTICLE ON INTUSSUSCEPTION AMONG RECIPIENTS OF ROTAVIRUS VACCINE

The Centers for Disease Control and Prevention published the article, "Intussusception Among Recipients of Rotavirus Vaccine -- United States, 1998-1999," in the July 16, 1999, issue of the MMWR.

During September 1, 1999 - July 7, 1999, 15 cases of intussusception (a bowel obstruction in which one segment of bowel becomes enfolded within another segment) among infants who had received a tetravalent rhesus-based rotavirus vaccine (RRV-TV) were reported to the Vaccine Adverse Event Reporting System (VAERS). This article summarizes the clinical and epidemiologic features of these cases and preliminary data from ongoing studies of intussusception and rotavirus vaccine.

The editorial note includes information on the CDC recommendation to postpone administration of RRV-TV to children scheduled to receive the vaccine before November 1999, including those who already have begun the RRV-TV series. It also includes information for health professionals who have administered rotavirus vaccine and a message to parents or caregivers of children who have recently received rotavirus vaccine to promptly contact their health care provider if their infant develops symptoms consistent with intussusception (e.g., persistent vomiting, bloody stools, black stools, abdominal distention, and/or severe colic pain).

To obtain a text version of this MMWR article, click here: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827a1.htm

For information on how to get a free electronic subscription to the MMWR, see the instructions that follow article four below.
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(3)
July 15, 1999
OPV NO LONGER RECOMMENDED FOR ROUTINE CHILDHOOD IMMUNIZATION AGAINST POLIO BEGINNING JANUARY 1, 2000

The June 17, 1999, Advisory Committee on Immunization Practices (ACIP) recommendation to begin using an all-IPV schedule for routine childhood polio vaccination in the United States on January 1, 2000, was published as a "Notice to Readers" in the July 15, 1999, issue of the MMWR. The notice reads as follows:

RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES: REVISED RECOMMENDATIONS FOR ROUTINE POLIOMYELITIS VACCINATION
"Since 1979, the only indigenous cases of poliomyelitis reported in the United States (n=144) have been associated with use of the live oral poliovirus vaccine (OPV) (an additional six imported cases have been reported since 1979, the last of which occurred in 1993). Until recently, the benefits of OPV use (i.e., intestinal immunity, secondary spread) outweighed the risk for vaccine-associated paralytic polio (VAPP) (one case per 2.4 million doses distributed). In 1997, to decrease the risk for VAPP while maintaining the benefits of OPV, the Advisory Committee on Immunization Practices (ACIP) recommended a sequential schedule of inactivated poliovirus vaccine (IPV) followed by OPV. Since 1997, the global polio eradication initiative has progressed rapidly, and the likelihood of poliovirus importation into the United States has decreased substantially. In addition, since 1997, the sequential schedule has been well accepted. No declines in childhood vaccination coverage were observed, despite the need for additional injections.

"On the basis of these data, on June 17, 1999, to eliminate the risk for VAPP, the ACIP recommended an all-IPV schedule for routine childhood polio vaccination in the United States. As of January 1, 2000, all children should receive four doses of IPV at ages 2 months, 4 months, 6-18 months, and 4-6 years.

"OPV should be used only for the following special circumstances:

  1. Mass vaccination campaigns to control outbreaks of paralytic polio.
  2. Unvaccinated children who will be traveling in <4 weeks to areas where polio is endemic.
  3. Children of parents who do not accept the recommended number of vaccine injections. These children may receive OPV only for the third or fourth dose or both; in this situation, health-care providers should administer OPV only after discussing the risk for VAPP with parents or caregivers.

"Availability of OPV is expected to be limited in the future in the United States. ACIP reaffirms its support for the global polio eradication initiative and use of OPV as the vaccine of choice to eradicate polio from the remaining countries where polio is endemic."

To obtain a text version of this MMWR "Notice to Readers," click here: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827a4.htm

For information on how to get a free electronic subscription to the MMWR, see the instructions that follow article four below.
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(4)
July 15, 1999
CDC PUBLISHES REPORT ON PROGRESS TOWARD MEASLES ELIMINATION IN SOUTHERN AFRICA

The Centers for Disease Control and Prevention published an article entitled "Progress Toward Measles Elimination -- Southern Africa, 1996-1998," in the July 16, 1999, issue of the MMWR.

Since 1995 the six southern Africa countries of Botswana, Malawi, Namibia, South Africa, Swaziland, and Zimbabwe have launched measles-elimination initiatives in accordance with the recommendations of the World Health Organization (WHO) African Regional Office.

This article presents preliminary data about these countries' progress toward measles elimination, describes the campaigns, and reports that the initiatives have been highly effective in reducing morbidity and mortality resulting from measles.

The article concludes: "to sustain progress toward measles elimination in southern Africa, continued national commitment to support and implement WHO strategies is needed to prevent the re-establishment of measles transmission, and possibly to avoid large outbreaks, in counties where elimination has been achieved."

To obtain a text version of this MMWR article, click here:  http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827a3.htm

HOW TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR
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 to the MMWR website, click here: http://www2.cdc.gov/mmwr/

 

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This page was updated on February 15, 2002