749 | Immunize.org

IAC Express 2008
Issue number 749: August 25, 2008

Contents of this Issue Select a title to jump to the article.
CDC reports 131 measles cases in the U.S. during January-July 2008, the highest number of cases year-to-date since 1996 CDC Health Update: Limited rabies vaccine supply may affect near-term availability of vaccine for post-exposure prophylaxis Reporting that bacterial pneumonia caused the most deaths in the 1918 influenza pandemic, NIH authors call for stockpiling bacterial vaccines and antibiotics as part of preparing for a future pandemic CDC's 1918 Pandemic Influenza Storybook can help public health officials prepare for a possible influenza pandemic Two of IAC's revised viral-hepatitis screening questionnaires are now available in Spanish Book that helps parents evaluate vaccine safety concerns is available for order or electronically For coalitions: 168 immunization coalitions have posted information on www.izcoalitions.org--is yours one of them? August issue of CDC's Immunization Works electronic newsletter recently released For coalitions: August 26 is the new date for IZTA's teleconference on the upcoming influenza season MMWR includes summary of reported cases of notifiable diseases for 2007 Clinical Vaccinology Course scheduled for November 14-16 in Bethesda, MD International Conference on Rabies in the Americas planned for September 28-October 3 in Atlanta

Abbreviations

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.

Issue 749: August 25, 2008

CDC reports 131 measles cases in the U.S. during January-July 2008, the highest number of cases year-to-date since 1996

CDC published "Update: Measles--United States, January-July 2008" in the August 22 issue of MMWR. The article is reprinted below in its entirety, excluding one figure, one table, and references.

On August 21, CDC held a press conference featuring NCIRD Director Dr. Anne Schuchat and Dr. Jane Seward, deputy director, NCIRD's Division of Viral Diseases. Also on August 21, CDC issued (1) a press release titled "Most U.S. Measles Cases Reported Since 1996: Many unvaccinated because of philosophical beliefs" and (2) a fact sheet related to the topic. In addition, the Measles Initiative issued a statement on the topic. Links to the CDC press conference transcript, the CDC press release, the CDC fact sheet, and the Measles Initiative statement are given at the end of this IAC Express article.

Sporadic importations of measles into the United States have occurred since the disease was declared eliminated from the United States in 2000. During January-July 2008, 131 measles cases were reported to CDC, compared with an average of 63 cases per year during 2000-2007. This report updates an earlier report on measles in the United States during 2008 and summarizes two recent U.S. outbreaks among unvaccinated school-aged children. Among those measles cases reported during the first 7 months of 2008, 76% were in persons aged <20 years, and 91% were in persons who were unvaccinated or of unknown vaccination status. Of the 131 cases, 89% were imported from or associated with importations from other countries, particularly countries in Europe, where several outbreaks are ongoing. The findings demonstrate that measles outbreaks can occur in communities with a high number of unvaccinated persons and that maintaining high overall measles, mumps, and rubella (MMR) vaccination coverage rates in the United States is needed to continue to limit the spread of measles.

Measles cases in the United States are reported by state health departments to CDC using standard case definitions and case classifications. Cases acquired outside the United States are categorized as importations. Those acquired inside the United States are considered importation associated if they are linked epidemiologically via a chain of transmission to an importation or have virologic evidence of importation. Other cases are classified as having an unknown source. In the United States, recommendations for MMR vaccination include a single dose at age 12-15 months and a second dose at the time of school entry. Vaccination as early as age 6 months is recommended for U.S. children traveling abroad and is sometimes recommended within U.S. communities during outbreaks of measles.

During January 1-July 31, 2008, 131 measles cases were reported to CDC from 15 states and the District of Columbia (DC): Illinois (32 cases), New York (27), Washington (19), Arizona (14), California (14), Wisconsin (seven), Hawaii (five), Michigan (four), Arkansas (two), and DC, Georgia, Louisiana, Missouri, New Mexico, Pennsylvania, and Virginia (one each). Seven measles outbreaks (i.e., three or more cases linked in time or place) accounted for 106 (81%) of the cases. Fifteen of the patients (11%) were hospitalized, including four children aged <15 months. No deaths were reported.

Among the 131 cases, 17 (13%) were importations: three each from Italy and Switzerland; two each from Belgium, India, and Israel; and one each from China, Germany, Pakistan, the Philippines, and Russia. This is the lowest percentage of imported measles cases since 1996. Nine of the importations were in U.S. residents who had traveled abroad, and eight were in foreign visitors. An additional 99 (76%) of the 131 cases were linked epidemiologically to importations or had virologic evidence of importation. The source of measles acquisition of 15 cases (11%) could not be determined.

Among the 131 measles patients, 123 were U.S. residents, of whom 99 (80%) were aged <20 years. Five (4%) of the 123 patients had received 1 dose of MMR vaccine, six (5%) had received 2 doses of MMR vaccine, and 112 (91%) were unvaccinated or had unknown vaccination status. Among these 112 patients, 95 (85%) were eligible for vaccination, and 63 (66%) of those were unvaccinated because of philosophical or religious beliefs.

Washington. On April 28, 2008, the Washington State Department of Health received a report of several suspected measles cases in a Grant County household. The index patient had rash onset on April 12. During April 18-21, the other seven children in the household became ill with fever and rash. Three of the children developed pneumonia and were evaluated by a healthcare provider who suspected measles; all three tested positive for measles-specific IgM antibody. Rash onset occurred during April 13-May 30 in 11 additional cases identified in Grant County. All of the 19 cases were linked epidemiologically, and all but one occurred in children and adolescents aged 9 months to 18 years. The 19 cases included 16 in school-aged children, among whom 11 were home schooled. Because of their parents' philosophical or religious beliefs, none of the 16 children had received measles-containing vaccine. Specimens from eight patients were submitted for virologic testing, and all contained genotype D5, which had been circulating in Japan and parts of Europe. A possible source of the outbreak was a church conference, held March 25-29 in King County, Washington, that was attended by four of the patients, including the index patient. The conference was attended by approximately 3,000 persons, primarily students from junior high through university age from 18 states, DC, and several foreign countries. None of these countries or states has since reported confirmed cases of measles among persons who attended this conference.

Illinois. On May 19, 2008, the Illinois Department of Public Health was notified by the DuPage County Health Department about a suspected case of measles. By May 27, four confirmed cases of measles had been reported to the county, three of which were laboratory confirmed. Among the four cases, rash onsets occurred during May 17-19, suggesting a common exposure. The four patients were unvaccinated girls aged 10-14 years; all had attended an event May 5 and might have attended a home gathering 2 days earlier. Both events were attended by a teenager who had recently returned from Italy and reportedly had developed fever and rash. Although attempts to obtain further information about the traveler were unsuccessful, viral isolation from one of the four patients yielded genotype D4, a strain circulating in Italy. Through July 31, 26 additional measles cases were reported, all with epidemiologic links to the first four cases. Among the 30 cases, 14 were confirmed in DuPage County, 11 in suburban Cook County, and five in Lake County. One case occurred in a person aged 43 years. The remaining 29 cases were in persons aged 8 months-17 years, including 25 (83%) school-aged children, all of whom were home schooled and not subject to school-entry vaccination requirements. Because of their parents' beliefs against vaccination, none of the 25 had received measles-containing vaccine.

Editorial Note:
The number of measles cases reported during January 1-July 31, 2008, is the highest year-to-date since 1996. This increase was not the result of a greater number of imported cases, but was the result of greater viral transmission after importation into the United States, leading to a greater number of importation-associated cases. These importation-associated cases have occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated. One study has suggested an increasing number of vaccine exemptions among children who attend school in states that allow philosophical exemptions. In addition, home-schooled children are not covered by school-entry vaccination requirements in many states. The increase in importation-associated cases this year is a concern and might herald a larger increase in measles morbidity, especially in communities with many unvaccinated residents.

In the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s. Through a successful measles vaccination program, the United States eliminated endemic measles transmission. Sustaining elimination requires maintaining high MMR vaccine coverage rates, particularly among preschool (>90% 1-dose coverage) and school-aged children (>95% 2-dose coverage). High coverage levels provide herd immunity, decreasing everyone's risk for measles exposure and affording protection to persons who cannot be vaccinated. However, herd immunity does not provide 100% protection, especially in communities with large numbers of unvaccinated persons. For the foreseeable future, measles importations into the United States will continue to occur because measles is still common in Europe and other regions of the world. Within the United States, the current national MMR vaccine coverage rate is adequate to prevent the sustained spread of measles. However, importations of measles likely will continue to cause outbreaks in communities that have sizeable clusters of unvaccinated persons.

Measles is one of the first diseases to reappear when vaccination coverage rates fall. Ongoing outbreaks are occurring in European countries where rates of vaccination coverage are lower than those in the United States, including Austria, Italy, and Switzerland. In June 2008, the United Kingdom's Health Protection Agency declared that, because of a drop in vaccination coverage levels (to 80%-85% among children aged 2 years), measles was again endemic in the United Kingdom, 14 years after it had been eliminated. Since April 2008, two measles-related deaths have been reported in Europe, both in children ineligible to receive MMR vaccine because of congenital immunologic compromise. Such children depend on herd immunity for protection from the disease, as do children aged <12 months, who normally are too young to receive the vaccine. Otherwise healthy children with measles also are at risk for severe complications, including encephalitis and pneumonia, which can lead to permanent disability or death.

The measles outbreaks in Illinois and Washington demonstrate that measles remains a risk for unvaccinated persons and those who come in contact with them. Each school year, parents should ensure that their children's vaccinations are current, regardless of whether the children are returning to school, attending day care, or being schooled at home. Adults without evidence of measles immunity should receive at least 1 dose of MMR vaccine. All persons who travel internationally also should be up-to-date on their measles vaccination and other vaccinations recommended for countries they might visit. These recommendations include a single dose of MMR vaccine for infant travelers aged 6-11 months and 2 doses, administered at least 28 days apart, for children aged >=12 months.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5733.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

Links to related resources:
To access the August 21 press conference transcript, go to:
http://www.cdc.gov/media/transcripts/2008/t080808.htm

To access the CDC press release, go to:
http://www.cdc.gov/media/pressrel/2008/r080821.htm

To access the CDC fact sheet, go to:
http://www.immunize.org/cdc/MMWR_Measles_Fact_Sheet.pdf

To access the Measles Initiative statement, go to:
http://www.redcross.org/pressrelease/0,1077,0_314_8049,00.html

CDC Health Update: Limited rabies vaccine supply may affect near-term availability of vaccine for post-exposure prophylaxis

On August 22, CDC issued an official CDC Health Update alerting public health authorities, healthcare providers, veterinarians, and the public that the supply of human rabies vaccine is limited. The update is reprinted below in its entirety.

RABIES VACCINE SUPPLY IS LIMITED--UPDATE AS OF AUGUST 22, 2008

The Centers for Disease Control and Prevention (CDC) has been notified by Novartis, maker of RabAvert (Rabies Vaccine), that the supply of human rabies vaccine is being used at a higher rate than expected, which may affect the near-term availability of vaccine for rabies post-exposure prophylaxis (PEP). This development follows the August 14 news release by sanofi pasteur, which announced the unavailability of the IMOVAX vaccine until late September-early October. Because of limited existing supplies, the CDC strongly recommends that healthcare providers, state and local public health authorities, animal control officials, and the public take immediate steps to ensure appropriate use of human rabies biologics. The Advisory Committee on Immunization Practices (ACIP) human rabies prevention recommendations outline animal exposures associated with the risk of rabies (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm). Judicious and appropriate use of rabies vaccines is crucial to avert a situation in which persons exposed to rabies are put at increased risk due to depleted vaccine supplies.

To ensure that thorough risk assessments are conducted, Novartis is now requiring that healthcare providers confer with public health officials, and obtain a confirmation code from a state health department before ordering vaccine doses for post-exposure prophylaxis. Confirmation codes will be updated at a frequent interval. These codes should only be released by a state/local health authority that has reviewed the known facts of a given exposure and determined they indicate a sufficient level of exposure risk as outlined in the ACIP human rabies prevention recommendations (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm).

Public health authorities, healthcare providers, and veterinarians are encouraged to educate the public regarding precautions to avoid rabies exposure and actions to take if an exposure occurs. These precautions include vaccinating pets and livestock that have close human contact, avoiding stray and wild animals, and safely capturing or detaining biting animals (preferably using animal control officials), or obtaining owner contact information for follow up. For specific guidance, please see www.cdc.gov/rabies. Persons with possible rabies exposure should be evaluated as soon as possible by a healthcare provider. Since PEP is an urgent medical issue but not an emergency, it can be delayed until animal rabies testing or clinical observation is completed. This approach not only limits administration of PEP to persons with confirmed rabies exposure, but it is also cost-saving and conserves limited resources.

Until vaccine supply levels are restored, distribution of vaccine for pre-exposure prophylaxis (PreP) will continue to require approval by state and federal public health authorities. Priority will be given to those individuals with occupational rabies exposure risk (e.g., rabies laboratory workers, animal control officers, veterinary staff, wildlife workers).

Discussions among federal, state, and local public health officials are ongoing to review additional strategies to manage this situation. A national working group has been convened to monitor the ongoing supply situation and provide updated recommendations as the situation evolves. For more information about rabies and its prevention, and updates regarding vaccine supply, contact your state or local public health official or CDC at 1-800-CDC-INFO [(800) 232-4636] or visit www.cdc.gov/rabies.

To access the CDC Health Update, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00277

Reporting that bacterial pneumonia caused the most deaths in the 1918 influenza pandemic, NIH authors call for stockpiling bacterial vaccines and antibiotics as part of preparing for a future pandemic

On August 19, the National Institutes of Health (NIH) issued a press release titled "Bacterial Pneumonia Caused Most Deaths in 1918 Influenza Pandemic: Implications for future pandemic planning." Portions of it are reprinted below.

The majority of deaths during the influenza pandemic of 1918-1919 were not caused by the influenza virus acting alone, report researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Instead, most victims succumbed to bacterial pneumonia following influenza virus infection. The pneumonia was caused when bacteria that normally inhabit the nose and throat invaded the lungs along a pathway created when the virus destroyed the cells that line the bronchial tubes and lungs.

A future influenza pandemic may unfold in a similar manner, say the NIAID authors, whose paper in the Oct. 1 issue of The Journal of Infectious Diseases is now available online. Therefore, the authors conclude, comprehensive pandemic preparations should include not only efforts to produce new or improved influenza vaccines and antiviral drugs but also provisions to stockpile antibiotics and bacterial vaccines as well.

The work presents complementary lines of evidence from the fields of pathology and history of medicine to support this conclusion. "The weight of evidence we examined from both historical and modern analyses of the 1918 influenza pandemic favors a scenario in which viral damage followed by bacterial pneumonia led to the vast majority of deaths," says co-author NIAID Director Anthony S. Fauci, MD. "In essence, the virus landed the first blow while bacteria delivered the knockout punch."

NIAID co-author and pathologist Jeffery Taubenberger, MD, PhD, examined lung tissue samples from 58 soldiers who died of influenza at various U. S. military bases in 1918 and 1919. The samples, preserved in paraffin blocks, were re-cut and stained to allow microscopic evaluation. Examination revealed a spectrum of tissue damage "ranging from changes characteristic of the primary viral pneumonia and evidence of tissue repair to evidence of severe, acute, secondary bacterial pneumonia," says Dr. Taubenberger. In most cases, he adds, the predominant disease at the time of death appeared to have been bacterial pneumonia. There also was evidence that the virus destroyed the cells lining the bronchial tubes, including cells with protective hair-like projections, or cilia. This loss made other kinds of cells throughout the entire respiratory tract--including cells deep in the lungs--vulnerable to attack by bacteria that migrated down the newly created pathway from the nose and throat.

In a quest to obtain all scientific publications reporting on the pathology and bacteriology of the 1918-1919 influenza pandemic, Dr. Taubenberger and NIAID co-author David Morens, MD, searched bibliography sources for papers in any language. They also reviewed scientific and medical journals published in English, French, and German, and located all papers reporting on autopsies conducted on influenza victims. From a pool of more than 2,000 publications that appeared between 1919 and 1929, the researchers identified 118 key autopsy series reports. In total, the autopsy series they reviewed represented 8,398 individual autopsies conducted in 15 countries.

The published reports "clearly and consistently implicated secondary bacterial pneumonia caused by common upper respiratory flora in most influenza fatalities," says Dr. Morens. Pathologists of the time, he adds, were nearly unanimous in the conviction that deaths were not caused directly by the then-unidentified influenza virus, but rather resulted from severe secondary pneumonia caused by various bacteria. Absent the secondary bacterial infections, many patients might have survived, experts at the time believed. Indeed, the availability of antibiotics during the other influenza pandemics of the 20th century, specifically those of 1957 and 1968, was probably a key factor in the lower number of worldwide deaths during those outbreaks, notes Dr. Morens.

The cause and timing of the next influenza pandemic cannot be predicted with certainty, the authors acknowledge, nor can the virulence of the pandemic influenza virus strain. However, it is possible that--as in 1918--a similar pattern of viral damage followed by bacterial invasion could unfold, say the authors. Preparations for diagnosing, treating and preventing bacterial pneumonia should be among highest priorities in influenza pandemic planning, they write. "We are encouraged by the fact that pandemic planners are already considering and implementing some of these actions," says Dr. Fauci. . . .

To access the complete press release, go to:
http://www.nih.gov/news/health/aug2008/niaid-19.htm

To access the full text of the Journal of Infectious Diseases article, go to:
http://www.journals.uchicago.edu/doi/full/10.1086/591708

The PandemicFlu website offers users one-stop access to U.S. government information on avian and pandemic influenza. To access it, go to: http://www.pandemicflu.gov

CDC's 1918 Pandemic Influenza Storybook can help public health officials prepare for a possible influenza pandemic

On August 21, CDC issued a press release titled "CDC Releases 1918 Pandemic Flu Storybook." The press release is reprinted below in its entirety.

The Centers for Disease Control and Prevention (CDC) released today an online storybook containing narratives from survivors, families, and friends about one of the largest scourges ever on human kind--the 1918 influenza pandemic that killed millions of people around the world. The storybook provides valuable insight for public health officials preparing for the possibility of another pandemic sometime in our future.

This year marks the 90th anniversary of the 1918 influenza pandemic. The internet storybook contains about 50 stories from individuals from 24 states around the country as well as photos and narrative videos from the storytellers.

"Complacency is enemy number one when it comes to preparing for another influenza pandemic," said CDC Director Dr. Julie Gerberding. "These stories, told so eloquently by survivors, family members, and friends from past pandemics, serve as a sobering reminder of the devastating impact that influenza can have and reading them is a must for anyone involved in public health preparedness."

The idea for such a storybook emerged during crisis and emergency risk communication (CERC) training CDC has been conducting with health professionals over the past few years. The online storybook contains narratives from survivors, families, and friends who lived through the 1918 and 1957 pandemics. The agency welcomes new submissions and plans to update the book each quarter. Narratives from the 1968 pandemic are also welcome.

"It's an excellent resource, not only for public health professionals, but for people of all ages," said Sharon KD Hoskins, a public affairs officer who coordinated the project for CDC. "It's probably the closest to experiencing the real thing that many of us can imagine."

The storybook can be found at
http://www.pandemicflu.gov/storybook

To access the press release, go to:
http://www.cdc.gov/media/pressrel/2008/r080821a.htm

Two of IAC's revised viral-hepatitis screening questionnaires are now available in Spanish

The screening questionnaires "Should You Be Vaccinated Against Hepatitis B? A screening questionnaire for adults" and "Should You Be Vaccinated Against Hepatitis A? A screening questionnaire for adults" were updated in June 2008. The updated versions are now available Spanish.

To access the Spanish version of "Should You Be Vaccinated Against Hepatitis B? A screening questionnaire for adults," go to:
http://www.immunize.org/catg.d/p2191-01.pdf

To access the English version of "Should You Be Vaccinated Against Hepatitis B? A screening questionnaire for adults," go to:
http://www.immunize.org/catg.d/p2191.pdf

To access the Spanish version of "Should You Be Vaccinated Against Hepatitis A? A screening questionnaire for adults," go to:
http://www.immunize.org/catg.d/p2190-01.pdf

To access the English version of "Should You Be Vaccinated Against Hepatitis A? A screening questionnaire for adults," go to:
http://www.immunize.org/catg.d/p2190.pdf

IAC's Print Materials web section has more than 175 FREE, ready-to-print English-language materials for healthcare professionals and the public--as well as many in translation. To access all of IAC's print materials, go to: http://www.immunize.org/printmaterials

Book that helps parents evaluate vaccine safety concerns is available for order or electronically

If you are looking for a clearly written and well researched book to recommend to parents about the issues that underlie the current debate about vaccine safety, consider "Do Vaccines Cause That?! A Guide for Evaluating Vaccine Safety Concerns." It is written by Martin G. Myers, MD, an internationally recognized vaccine expert and former director of the National Vaccine Program Office, and science writer Diego Pineda. Both are with the National Network for Immunization Information (NNii).

The 272-page book is divided in two sections. The first section tells parents how best to weigh and evaluate what they read or hear about vaccine safety, emphasizing how scientists determine whether a vaccine actually causes a specific effect. The second section deals specifically with vaccine safety concerns such as asthma, autism, and autoimmune diseases, among others. The overall theme is to help parents arrive at conclusions based on science.

"Do Vaccines Cause That?!" is available for $14.95 at Amazon.com (http://www.amazon.com) and DoVaccinesCauseThat.com (http://www.dovaccinescausethat.com), where the electronic version is also available for just $12.95.

For additional information, go to:
http://www.dovaccinescausethat.com

For coalitions: 168 immunization coalitions have posted information on www.izcoalitions.org--is yours one of them?

Since its 2002 launch date, IAC's izcoalitions.org website (http://www.izcoalitions.org) has posted information from 168 immunization coalitions. The site includes data from coalitions at all levels (local, state, regional, and national) and of all types, vaccine-specific as well as age-specific (childhood, adult, senior).

This online database allows health professionals, immunization advocates, parents, and others to contact specific coalitions to find resources, share ideas, and form strategic partnerships. Searches can be done by coalition name or geographic area.

Be sure your coalition is part of this powerful web-based networking tool by checking for your coalition's listing. If your coalition is not listed, sign up today. If your coalition is already displayed but information about your coalition has changed, be sure to update your listing to help us keep izcoalitions.org current and accurate.

To look for your coalition on the izcoalitions.org website, go to: http://www.izcoalitions.org

If you have questions or difficulties updating your coalition's information or anything else, send an email to Janelle at janelle@immunize.org or call her at (651) 647-9009.

August issue of CDC's Immunization Works electronic newsletter recently released

CDC recently released the August issue of its monthly newsletter Immunization Works; it will soon be posted on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

Some of the information in the August issue has already appeared in previous issues of IAC Express. Following are titles of articles IAC Express has already covered:

Most U.S. Measles Cases Reported Since 1996
Advisory Committee on Immunization Practices [on the] Prevention and Control and Influenza Recommendations
Immunization Scheduler Makes It Simple for Parents and Providers to Catch Up on Kids' Immunizations
Announcing: Annual Immunization Update Program Now Offered as a Webcast Only
Clinical Vaccinology Course
Perinatal Hepatitis B Prevention Training Series
Epidemiology and Prevention of Vaccine-Preventable Diseases 2008
Pink Book, New Printing

Following is the text of two articles we have not covered.

MEETINGS, CONFERENCES & RESOURCES

FIRST IMMUNIZATION COALITION ESTABLISHED IN WESTERN AUSTRALIA:
The Western Australia Immunization Alliance (WAIA), less than a year old, is already making impressive progress in its campaign to tackle immunization issues in their region, traditionally the worst performing state in Australia. While the country as a whole can point to an overall coverage of 90%, this rate masks a number of problems, including regional and ethnic inequities. When the Australian CDC suggested forming a citizens' coalition to deal with vaccine issues in Western Australia (WA), local representatives began by searching the internet for resources. The search led to Moms on Meningitis (MOMs), an organization of parents of children who have died or suffered from meningitis. MOMs provided inspiration and information, describing how the coalition was started, how to put a face on the issues and get parents involved, and what other groups should be recruited.

MOMs referred the WA organizers to the Texas Immunization Stakeholders Working Group. Their coordinator shared Texas's experience and resources with the Australians and, working entirely via email, provided them with templates of by-laws, minutes of meetings, notes on establishing a mission, and other useful information. When they announced, only a couple of months later, "We've done it--we have established a coalition," they were invited to attend the 8th National Conference on Immunization and Health Coalitions in San Francisco in May, 2008. Three members of the WAIA attended the conference, and Dr. Michael Wise, one of the WAIA representatives, stated "I very much appreciate the opportunity to attend the conference to learn best practice from a group of dedicated public health advocates." He added that attending had given him a far better understanding of the "big picture" regarding immunization.

SOUTH CAROLINA IMMUNIZATION CONFERENCE: The 2008 South Carolina Immunization Conference is open to all interested healthcare providers, including interested individuals from other states. The conference will focus on the latest information on vaccines and will feature Dr. Sharon Humiston, author of "Vaccinating Your Child: Questions and Answers for the Concerned Parent." Nursing and pharmacology contact hours will be offered. The conference will be held Friday, November 7, 2008, in Columbia, South Carolina, at the Radisson Hotel Columbia and Conference Center. For more information contact the South Carolina DHEC Immunization Division at (803) 898-0460.

Issues of Immunization Works are posted on CDC's Vaccines & Immunizations website a few days after publication. To access the August issue, go to: http://www.cdc.gov/vaccines/news/newsltrs/imwrks Click on the link titled "Aug" under the banner titled "2008 Newsletters Available Online."

For coalitions: August 26 is the new date for IZTA's teleconference on the upcoming influenza season

Originally scheduled for August 19, The Immunization Coalitions Technical Assistance Network (IZTA) conference call on influenza communication has been rescheduled for August 26. IZTA is a program of the Center for Health Communication, Academy for Educational Development.

The call will provide an overview of CDC's plans for communicating about influenza vaccine in the 2008-09 influenza season. It will also include a discussion of the CDC educational materials that will be available to assist U.S. communities in promoting influenza vaccination. The presenter is CDC's Alan Janssen, MSPH.

The August 26 call will be held at 1PM, ET. To register, send an email to izta@aed.org Include this message: "Sign me up for the influenza communications update."

To access earlier programs, go to:
http://www.izta.org/confcall.cfm

10.

MMWR includes summary of reported cases of notifiable diseases for 2007

CDC published "Notice to Readers: Final 2007 Reports of Nationally Notifiable Infectious Diseases" in the August 22 issue of MMWR. The notice is reprinted below in its entirety, excluding references.

The tables listed in this report on pages 903-913 summarize finalized 2007 data, as of June 30, 2008, from the National Notifiable Diseases Surveillance System (NNDSS). These data will be published in more detail in the Summary of Notifiable Diseases, United States, 2007. Because no cases of diphtheria, neuroinvasive or non-neuroinvasive western equine encephalitis virus disease, paralytic poliomyelitis, nonparalytic poliovirus infection, congenital rubella, severe acute respiratory syndrome-associated coronavirus syndrome, smallpox, or yellow fever were reported in the United States during 2007, these diseases do not appear in these early release tables. Policies for reporting NNDSS data to CDC can vary by disease or reporting jurisdiction, depending on case status classification (i.e., confirmed, probable, or suspected).

The publication criteria used for the 2007 finalized tables are listed in the "Print Criteria" column of the NNDSS event code list, available at http://www.cdc.gov/ncphi/disss/nndss/phs/infdis.htm The NNDSS website is updated annually to include the latest national surveillance case definitions approved by the Council of State and Territorial Epidemiologists for enumerating data on nationally notifiable infectious diseases.

Population estimates for the states are from the National Center for Health Statistics. Estimates of the July 1, 2000-July 1, 2006, United States resident population are from the Vintage 2006 postcensal series by year, county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau, and available at http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm Population estimates for territories are 2006 estimates from the U.S. Census Bureau.

To access a web-text (HTML) version of the complete notice, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a6.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5733.pdf

11.

Clinical Vaccinology Course scheduled for November 14-16 in Bethesda, MD

CDC published "Notice to Readers: Clinical Vaccinology Course--November 14-16, 2008" in the August 22 issue of MMWR. The notice is reprinted below in its entirety.

CDC and five other national organizations are collaborating with the National Foundation for Infectious Diseases (NFID), Emory University School of Medicine, and the Emory Vaccine Center to sponsor a Clinical Vaccinology Course to be held November 14-16, 2008, at the Hyatt Regency Bethesda Hotel in Bethesda, Maryland. Through lectures and interactive case presentations, the course will focus on new developments and concerns related to the use of vaccines in pediatric, adolescent, and adult populations. Leading infectious disease experts, including pediatricians, internists, and family physicians will present the latest information on newly available vaccines and vaccines in the pipeline, as well as established vaccines whose continued administration is essential to improving disease prevention efforts.

This course is specifically designed for physicians, nurses, nurse practitioners, physician assistants, pharmacists, vaccine program administrators, and other healthcare professionals interested in clinical aspects of vaccinology. The course also might be useful for healthcare professionals involved in prevention and control of infectious diseases, including federal, state, and local public health officials.

Continuing education credits will be offered. Information regarding the preliminary program, registration, and hotel accommodations is available at http://www.nfid.org, or by email (idcourse@nfid.org), fax ([301] 907-0878), telephone ([301] 656-0003, ext. 19), or mail (NFID, 4733 Bethesda Avenue, Suite 750, Bethesda, MD 20814-5228).

To access a web-text (HTML) version of the complete notice, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a4.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5733.pdf

12.

International Conference on Rabies in the Americas planned for September 28-October 3 in Atlanta

CDC published "Notice to Readers: International Conference on Rabies in the Americas--September 28-October 3, 2008" in the August 22 issue of MMWR. The notice is reprinted below in its entirety.

The 19th International Conference on Rabies in the Americas (RITA) will be held at CDC's Tom Harkin Global Communications Center in Atlanta, Georgia, September 28-October 3, 2008. September 28 also marks World Rabies Day. The conference attracts international participation from scientists, epidemiologists, laboratorians, and public health professionals with an interest in rabies surveillance, control, and prevention. Presentations will feature the latest findings in rabies research. Scheduled activities include the signing of the North American Rabies Management Plan by U.S., Canadian, and Mexican federal authorities and a World Rabies Day Run/Walk.

The deadline for RITA registration is September 5. Continuing education credits will be offered. Additional information regarding the agenda, registration, the World Rabies Day Run/Walk, and lodging, is available at http://www.rabiesintheamericas.org

To access a web-text (HTML) version of the complete notice, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5733.pdf

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