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IAC Express 2008 |
| Issue number 731: May 19, 2008 |
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Contents
of this Issue
Select a title to jump to the article. |
- Today is
World Hepatitis Day!
- CDC
announces viral hepatitis awareness for May
- CDC
releases ACIP recommendations for preventing herpes zoster
- CDC
releases ACIP recommendations for preventing pertussis, tetanus, and
diphtheria among pregnant and postpartum women and their infants
- CDC
reports on acute hepatitis C virus infections attributed to unsafe
injection practices in Nevada endoscopy clinic
- CDC
offers new podcast on hepatitis B and Asian Pacific Islander Americans
- CDC
releases revised and expanded National Immunization Survey data on
hepatitis B birth dose
- CDC
experts review and update twelve of IAC's online "Ask the Experts" Q&A
sections
- Mark your
calendar: IZTA's May 21 conference call will present the latest research
on autism
- Enhanced
surveillance detects hepatitis C virus infection among injection drug
users in New York state
-
Multi-vaccine VIS and interim varicella vaccine VIS now in Thai
-
Important: Be sure to give influenza vaccine throughout the influenza
season--from now through spring
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| Abbreviations |
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AAFP, American Academy of Family Physicians; AAP,
American Academy of Pediatrics; ACIP, Advisory Committee on Immunization
Practices; AMA, American Medical Association; CDC, Centers for Disease
Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization
Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD,
National Center for Immunization and Respiratory Diseases; NIVS, National
Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD,
vaccine-preventable disease; WHO, World Health Organization. |
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Issue 731: May 19, 2008 |
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1. |
Today is World Hepatitis Day!
Today is World Hepatitis Day!
This new international, patient-led initiative was launched in response to the fact that one in
12 people worldwide is living with chronic hepatitis B virus
(HBV) or hepatitis C virus (HCV) infection, yet there is a lack
of awareness and political will to prevent and treat infection.
Did You Know?
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500 million people worldwide are currently infected with HBV
or HCV
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This number represents more than 10 times the number infected
with HIV/AIDS
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Between them, hepatitis B and C kill 1.5 million people a year
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One in every three people on the planet has been exposed to
either or both viruses
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Most of the 500 million infected
do not know
Today in Geneva, Switzerland, the World Hepatitis Alliance, a
newly formed nongovernmental organization, called on governments
around the world to do more to improve prevention, diagnosis,
and treatment for people living with chronic HBV and HCV.
Charles Gore, President of the World Hepatitis Alliance, said a
lack of data highlights the need for greater surveillance at
local, national, and international levels. To this end, World
Hepatitis Alliance has launched "The Hepatitis Atlas: Completing
the Data Map," a resource designed to become the first global
public compendium of statistics and information relating to
chronic HBV and HCV.
For more information, visit http://www.worldhepatitisday.com or
http://www.aminumber12.org (both addresses go to the same
website).
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2. |
CDC announces viral hepatitis awareness for May
CDC published "Viral Hepatitis Awareness--May
2008" in the May
16 issue of MMWR. The announcement is reprinted below in its
entirety, excluding one reference.
May 2008 marks the 13th anniversary of Hepatitis Awareness Month
in the United States. May 19 is World Hepatitis Day, which
recognizes the importance of global commitments to prevent liver
disease and cancer caused by viral hepatitis. This issue of MMWR
includes a report on an outbreak of acute hepatitis C associated
with unsafe injection practices at an endoscopy clinic and a
report on hepatitis C virus (HCV) infections among young
injection-drug users. Both reports highlight the role of viral
hepatitis surveillance in detecting outbreaks and populations at
risk. Development of effective state and local surveillance for
acute and chronic viral hepatitis is a public health priority.
HCV infection is the most common bloodborne illness, the leading
cause of chronic liver disease, and the primary indication for
liver transplantation in the United States. HCV is spread
primarily through exposure to infectious blood; injection-drug
use is the major contributor to HCV transmission in the United
States. Although HCV infection can result in acute illness, most
of its effects on the liver, including cirrhosis and liver
cancer, are not apparent until years after exposure. Many of the
estimated 3.2 million persons living with chronic HCV infection
in the United States are unaware of their infection status.
CDC recommends HCV testing for persons at risk. Persons with HCV
infection also should be assessed regularly for severity of
liver disease, onset of liver cancer, and the need for
treatment. Additional information about viral hepatitis is
available at http://www.cdc.gov/hepatitis
To access a web-text (HTML) version of the complete
announcement, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5719a1.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5719.pdf
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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3. |
CDC releases ACIP recommendations for preventing herpes zoster
On May 15, CDC published "Prevention of Herpes
Zoster:
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 announcement
of important public health information. The recommendations will
be published in the standard MMWR format in the future. The
recommendations' summary section is reprinted below.
Note: A Continuing Education (CE) activity has been approved for
the recommendations and will be included when the
recommendations are published in the standard MMWR format on
June 6. IAC Express will notify readers at that time.
Also on May 15, CDC issued a related press release, "CDC
Recommends Shingles Vaccine: People age 60 and older should be
vaccinated against shingles, or herpes zoster, a condition often
marked by debilitating chronic pain, the Centers for Disease
control and Prevention (CDC) recommended today." A link to the
press release is given at the end of this IAC Express article.
These recommendations represent the first statement by the
Advisory Committee on Immunization Practices (ACIP) on the use
of a live attenuated vaccine for the prevention of herpes zoster
(zoster) (i.e., shingles) and its sequelae, which was licensed
by the U.S. Food and Drug Administration (FDA) on May 25, 2006.
This report summarizes the epidemiology of zoster and its
sequelae, describes the zoster vaccine, and provides
recommendations for its use among adults aged >=60 years in the
United States.
Zoster is a localized, generally painful cutaneous eruption that
occurs most frequently among older adults and immunocompromised
persons. It is caused by reactivation of latent varicella zoster
virus (VZV) decades after initial VZV infection is established.
Approximately one in three persons will develop zoster during
their lifetime, resulting in an estimated 1 million episodes in
the United States annually. A common complication of zoster is
postherpetic neuralgia (PHN), a chronic, often debilitating pain
condition that can last months or even years. The risk for PHN
in patients with zoster is 10%-18%. Another complication of
zoster is eye involvement, which occurs in 10%-25% of zoster
episodes and can result in prolonged or permanent pain, facial
scarring, and loss of vision. Approximately 3% of patients with
zoster are hospitalized; many of these episodes involved persons
with one or more immunocompromising conditions. Deaths
attributable to zoster are uncommon among persons who are not
immunocompromised.
Prompt treatment with the oral antiviral agents acyclovir,
valacyclovir, and famciclovir decreases the severity and
duration of acute pain from zoster. Additional pain control can
be achieved in certain patients by supplementing antiviral
agents with corticosteroids and with analgesics. Established PHN
can be managed in certain patients with analgesics, tricyclic
antidepressants, and other agents.
Licensed zoster vaccine is a lyophilized preparation of a live,
attenuated strain of VZV, the same strain used in the varicella
vaccines. However, its minimum potency is at least 14 times the
potency of single-antigen varicella vaccine. In a large clinical
trial, zoster vaccine was partially efficacious at preventing
zoster. It also was partially efficacious at reducing the
severity and duration of pain and at preventing PHN among those
developing zoster.
Zoster vaccine is recommended for all persons aged >=60 years
who have no contraindications, including persons who report a
previous episode of zoster or who have chronic medical
conditions. The vaccine should be offered at the patient's first
clinical encounter with his or her healthcare provider. It is
administered as a single 0.65 mL dose subcutaneously in the
deltoid region of the arm. A booster dose is not licensed for
the vaccine. Zoster vaccination is not indicated to treat acute
zoster, to prevent persons with acute zoster from developing
PHN, or to treat ongoing PHN. Before administration of zoster
vaccine, patients do not need to be asked about their history of
varicella (chickenpox) or to have serologic testing conducted to
determine varicella immunity. . . .
To access a ready-to-print (PDF) version of MMWR Early Release
of the recommendations, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr57e0515.pdf
To access a web-text (HTML) version of the MMWR Early Release of
the recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0515a1.htm
To access the related CDC press release, go to:
http://www.cdc.gov/media/pressrel/2008/r080515.htm
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4. |
CDC releases ACIP recommendations for preventing pertussis, tetanus, and
diphtheria among pregnant and postpartum women and their infants
On May 14, CDC published "Prevention of
Pertussis, Tetanus, and
Diphtheria Among Pregnant and Postpartum Women and Their
Infants: 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
recommendations will be published in the standard MMWR format in
the future.
The recommendations' summary section is reprinted below. In
addition, links to Appendix A and Appendix B are given at the
end of this IAC Express article. Appendix A summarizes the
salient points of the recommendations.
In 2005, two tetanus toxoid, reduced diphtheria toxoid, and
acellular pertussis (Tdap) vaccines were licensed and
recommended for use in adults and adolescents in the United
States: ADACEL (sanofi pasteur, Swiftwater, Pennsylvania), which
is licensed for use in persons aged 11-64 years, and BOOSTRIX
(GlaxoSmithKline Biologicals, Rixensart, Belgium), which is
licensed for use in persons aged 10-18 years. Both Tdap vaccines
are licensed for single-dose use to add protection against
pertussis and to replace the next dose of tetanus and diphtheria
toxoids vaccine (Td). Available evidence does not address the
safety of Tdap for pregnant women, their fetuses, or pregnancy
outcomes sufficiently. Available data also do not indicate
whether Tdap-induced transplacental maternal antibodies provide
early protection against pertussis to infants or interfere with
an infant's immune responses to routinely administered pediatric
vaccines. Until additional information is available, CDC's
Advisory Committee on Immunization Practices recommends that
pregnant women who were not vaccinated previously with Tdap: (1)
receive Tdap in the immediate postpartum period before discharge
from a hospital or birthing center, (2) may receive Tdap at an
interval as short as 2 years since the most recent Td vaccine,
(3) receive Td during pregnancy for tetanus and diphtheria
protection when indicated, or (4) defer the Td vaccine indicated
during pregnancy to substitute Tdap vaccine in the immediate
postpartum period if the woman is likely to have sufficient
protection against tetanus and diphtheria. Although pregnancy is
not a contraindication for receiving Tdap vaccine, healthcare
providers should weigh the theoretical risks and benefits before
choosing to administer Tdap vaccine to a pregnant woman. This
report (1) describes the clinical features of pertussis,
tetanus, and diphtheria among pregnant and postpartum women and
their infants, (2) reviews available evidence of pertussis
vaccination during pregnancy as a strategy to prevent infant
pertussis, (3) summarizes Tdap vaccination policy in the United
States, and (4) presents recommendations for use of Td and Tdap
vaccines among pregnant and postpartum women. . . .
To access a ready-to-print (PDF) version of MMWR Early Release
of the recommendations (which includes Appendix A and Appendix
B), go to:
http://www.cdc.gov/mmwr/pdf/rr/rr57e0514.pdf
To access a web-text (HTML) version of the MMWR Early Release of
the recommendations (links to Appendix A and Appendix B are
listed below), go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0514a1.htm
Please note: If you are using the HTML version of the
recommendations, be sure to access the two links below to get
the recommendations' complete content:
To access the web-text (HTML) version of Appendix A, "Summary of
ACIP Recommendations for Prevention of Pertussis, Tetanus and
Diphtheria Among Pregnant and Postpartum Women and Their
Infants," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0514a2.htm
To access the web-text (HTML) version of Appendix B,
"Abbreviations Used in This Report," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e0514a3.htm
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5. |
CDC reports on acute hepatitis C virus infections attributed to unsafe
injection practices in Nevada endoscopy clinic
CDC published "Acute Hepatitis C Virus Infections
Attributed to
Unsafe Injection Practices at an Endoscopy Clinic--Nevada, 2007"
in the May 16 issue of MMWR. Portions of the article are
reprinted below, including the complete text of a box titled
"Injection safety recommendations."
On January 2, 2008, the Nevada State Health Division (NSHD)
contacted CDC concerning surveillance reports received by the
Southern Nevada Health District (SNHD) regarding two persons
recently diagnosed with acute hepatitis C. A third person with
acute hepatitis C was reported the following day. This raised
concerns about an outbreak because SNHD typically confirms four
or fewer cases of acute hepatitis C per year. Initial inquiries
found that all three persons with acute hepatitis C underwent
procedures at the same endoscopy clinic (clinic A) within 35-90
days of illness onset. A joint investigation by SNHD, NSHD, and
CDC was initiated on January 9, 2008. The epidemiologic and
laboratory investigation revealed that hepatitis C virus (HCV)
transmission likely resulted from reuse of syringes on
individual patients and use of single-use medication vials on
multiple patients at the clinic. Health officials advised clinic
A to stop unsafe injection practices immediately, and
approximately 40,000 patients of the clinic were notified about
their potential risk for exposure to HCV and other bloodborne
pathogens. This report focuses on the six cases of acute
hepatitis C identified during the initial investigation, which
is ongoing; additional cases of acute hepatitis C associated
with exposures at clinic A might be identified. Comprehensive
measures involving viral hepatitis surveillance, healthcare
provider education, public awareness, professional oversight,
licensing, and improvements in medical devices can help detect
and prevent transmission of HCV and other bloodborne pathogens
in healthcare settings. . . .
BOX. Injection safety recommendations
- Never administer medications from the same syringe for more
than one patient, even if the needle is changed.
- Consider a syringe or needle contaminated after it has been
used to enter or connect to a patient's intravenous infusion
bag or administration set.
- Do not enter a vial with a used syringe or needle.
- Never use medications packaged as single-use vials for more
than one patient.
- Assign medications packaged as multi-use vials to a single
patient whenever possible.
- Do not use bags or bottles of intravenous solution as a common
source of supply for more than one patient.
- Follow proper infection-control practices during the
preparation and administration of injected medications.
. . . .
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5719a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5719.pdf
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6. |
CDC offers new podcast on hepatitis B and Asian Pacific Islander Americans
[The following is cross posted from IAC's Hep
Express electronic
newsletter, 5/15/08.]
CDC recently posted a podcast titled "Stopping the Silent
Killer: Hepatitis B Among Asian Americans" on its website. This
resource features Dr. John Ward, director of CDC's Division of
Viral Hepatitis, and Dr. Sam So, founder of the Asian Liver
Center at Stanford University, discussing the health threat of
chronic HBV infection to many Asians and Pacific Islanders in
the United States and the importance of testing, vaccination,
and care.
To access this podcast, go to:
http://www2a.cdc.gov/podcasts/player.asp?f=8908
All CDC podcasts can be found at http://www2a.cdc.gov/podcasts
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7. |
CDC releases revised and expanded National Immunization Survey data on
hepatitis B birth dose
CDC recently released revised 2006 National
Immunization Survey
(NIS) data about hepatitis B vaccination coverage rates within
two days of life, as well as new information about hepatitis B
vaccination coverage rates within one and three days of life.
To access this table directly in Excel format, click
here.
You can also access NIS birth dose data from 2003-2006 on the
Perinatal Hepatitis B Coordinator Resource Center web page at
http://www.cdc.gov/ncidod/diseases/hepatitis/resource/perinatalhepB.htm
Those interested in the specifics of the revision of the data
can read "A Special Note for the April 2008 Revision" at
http://www.cdc.gov/vaccines/stats-surv/nis/data/april2008revision.doc
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8. |
CDC
experts review and update twelve of IAC's online "Ask the Experts" Q&A sections
Vaccination experts at CDC recently reviewed and
updated
information on twelve of IAC's online "Ask the Experts" Q&A
sections. All of IAC's "Ask the Experts" Q&As are reviewed and
updated annually. The process is ongoing; IAC Express will
inform readers as sections are reviewed and revised.
Here are the twelve most recently revised Q&A sections:
To access the revised Q&As on diphtheria, go to:
http://www.immunize.org/askexperts/experts_diph.asp
To access the revised Q&As on Haemophilus influenzae type b
(Hib), go to: http://www.immunize.org/askexperts/experts_hib.asp
To access the revised Q&As on human papillomavirus (HPV), go to:
http://www.immunize.org/askexperts/experts_hpv.asp
To access the revised Q&As on influenza, go to:
http://www.immunize.org/askexperts/experts_inf.asp
To access the revised Q&As on measles-mumps-rubella (MMR), go
to: http://www.immunize.org/askexperts/experts_mmr.asp
To access the revised Q&As on meningococcal disease, go to:
http://www.immunize.org/askexperts/experts_men.asp
To access the revised Q&As on pertussis, go to:
http://www.immunize.org/askexperts/experts_per.asp
To access the revised Q&As on pediatric pneumococcal conjugate
vaccine (PCV7), go to:
http://www.immunize.org/askexperts/experts_pcv.asp
To access the revised Q&As on rotavirus, go to:
http://www.immunize.org/askexperts/experts_rota.asp
To access the revised Q&As on tetanus, go to:
http://www.immunize.org/askexperts/experts_tet.asp
To access the revised Q&As on varicella, go to:
http://www.immunize.org/askexperts/experts_var.asp
To access the revised Q&As on zoster, go to:
http://www.immunize.org/askexperts/experts_zos.asp
To access the index of "Ask the Experts" sections, go to:
http://www.immunize.org/askexperts
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9. |
Mark
your calendar: IZTA's May 21 conference call will present the latest research on
autism
The Immunization Coalitions Technical Assistance
Network (IZTA)
conference call on May 21 will present two CDC autism experts in
a discussion about autism. The goal of the call is to address
misconceptions about autism that have appeared in the media in
the recent past. The call will not address the recent vaccine
injury compensation case or the alleged relationship between
vaccines and autism. Rather, it will be a discussion of the
disorder itself. IZTA is a program of the Center for Health
Communication, Academy for Educational Development.
The presenters are Georgina Peacock, MD, and Catherine Rice,
PhD. Both are with CDC's National Center on Birth Defects and
Developmental Disabilities. The mother of a young autistic
child will also present.
The May 21 call will be held at 2PM, ET. To register, send an
email to izta@aed.org Include this message: "Sign me up for the
"Understanding Autism Call."
For additional information, or to access earlier programs, go
to: http://www.izta.org/confcall.cfm
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10. |
Enhanced surveillance detects hepatitis C virus infection among injection
drug users in New York state
CDC published "Use of Enhanced Surveillance for
Hepatitis C
Virus Infection to Detect a Cluster Among Young Injection-Drug
Users--New York, November 2004-April 2007" in the May 16 issue
of MMWR. A press summary of the article is reprinted below in
its entirety.
Establishing effective systems that reliably detect hepatitis C
virus (HCV) infections among all populations could have a
lasting effect on HCV disease control.
Surveillance for hepatitis C is challenging due to the nature of
the disease and the effort required to collect complete
information. When resources are limited, algorithms to
prioritize cases for investigation can guide targeted response
initiatives to get affected people needed help and prevent
additional hepatitis C infections. During the summer of 2007,
the New York State and Erie County departments of health
investigated a cluster of hepatitis C among adolescents and
young adults in Erie County. The major risk factor reported was
intravenous drug use. The departments cooperated to investigate
the cluster and implement interventions that included education,
testing, and referral to medical, mental health, and addiction
therapy. This demonstrates the utility of enhanced surveillance
to guide effective resource deployment.
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5719a3.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5719.pdf
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11. |
Multi-vaccine VIS and interim varicella vaccine VIS now in Thai
The multi-vaccine VIS and the interim varicella
vaccine VIS are
now available in Thai. IAC gratefully acknowledges Asian Pacific
Health Care Venture of Los Angeles for the translations.
Multi-vaccine VIS (dated 1/30/08)
To access the Thai version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/th_multi.pdf
To access the English version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/vis_multi1.pdf
NOTE: The multi-vaccine VIS comes in additional languages,
including Spanish. To access them, go to:
http://www.immunize.org/vis/vis_multi1.asp Click on the link to
the pertinent language.
Interim varicella vaccine VIS (dated 3/13/08)
To access the Thai version of the interim varicella VIS, go to:
http://www.immunize.org/vis/th_var98.pdf
To access the English version of the interim varicella VIS, go
to: http://www.immunize.org/vis/varic07.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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12. |
Important: Be sure to give influenza vaccine throughout the influenza
season--from now through spring
Influenza is currently circulating, and
vaccination should
continue from now until May. Visit the following websites often
to find the information you need to keep vaccinating. Both are
continually updated with the latest resources.
The National Influenza Vaccine Summit website at
http://www.preventinfluenza.org
CDC's Seasonal Flu web section at http://www.cdc.gov/flu
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