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IAC Express 2009
Issue number 814: August 3, 2009

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Contents of this Issue Select a title to jump to the article.
ACIP makes recommendations for use of novel influenza A (H1N1) vaccine Study indicates pregnant women have higher rates of hospitalization and death from infection with H1N1 influenza virus; prompt antiviral treatment urged CDC's 2009 recommendations for prevention and control of seasonal influenza now published as an MMWR Recommendations and Reports AAP issues early release of a policy statement on recommendations for prevention and control of seasonal influenza in children IAC's Videos of the Week promote immunization across the lifespan during National Immunization Awareness Month Order IAC's laminated U.S. immunization schedules today! New: 2010 edition of the Yellow Book--CDC's travel-health guide--now available online CDC's H1N1 influenza web section updated with planning information for healthcare professionals, Q&As for the public on H1N1 influenza vaccine, and more FDA authorizes emergency use of another diagnostic test for H1N1 influenza Tuesday--August 4--is the date for IZTA's teleconference on influenza communication "CDC Features" tells parents how to protect their family from rabies1 For coalitions: August 18 is the date for IZTA's hepatitis B update MMWR publishes a report on a case of laboratory-confirmed vaccinia virus in Virginia in 2008

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 814: August 3, 2009

ACIP makes recommendations for use of novel influenza A (H1N1) vaccine

On July 29, the CDC website posted the novel H1N1 vaccination recommendations made by ACIP. It is reprinted below in its entirety.

NOVEL H1N1 VACCINATION RECOMMENDATIONS

With the new H1N1 virus continuing to cause illness, hospitalizations and deaths in the U.S. during the normally flu-free summer months and some uncertainty about what the upcoming flu season might bring, CDC's Advisory Committee on Immunization Practices has taken an important step in preparations for a voluntary novel H1N1 vaccination effort to counter a possibly severe upcoming flu season. On July 29, ACIP met to consider who should receive novel H1N1 vaccine when it becomes available.

Novel H1N1 Vaccine

Every flu season has the potential to cause a lot of illness, doctor's visits, hospitalizations, and deaths. CDC is concerned that the new H1N1 flu virus could result in a particularly severe flu season this year. Vaccines are the best tool we have to prevent influenza. CDC hopes that people will start to go out and get vaccinated against seasonal influenza as soon as vaccines become available at their doctor's offices and in their communities (this may be as early as August for some). The seasonal flu vaccine is unlikely to provide protection against novel H1N1 influenza. However a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine--it is intended to be used alongside seasonal flu vaccine.

CDC's Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the new H1N1 vaccine when it becomes available. While some issues are still unknown, such as how severe the virus will be during the fall and winter months, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations, and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.

The groups recommended to receive the novel H1N1 influenza vaccine include

PREGNANT WOMEN because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
HOUSEHOLD CONTACTS AND CAREGIVERS FOR CHILDREN YOUNGER THAN 6 MONTHS OF AGE because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by "cocooning" them from the virus;
HEALTHCARE AND EMERGENCY MEDICAL SERVICES PERSONNEL because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
ALL PEOPLE FROM 6 MONTHS THROUGH 24 YEARS OF AGE
- CHILDREN FROM 6 MONTHS THROUGH 18 YEARS OF AGE because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
- YOUNG ADULTS 19 THROUGH 24 YEARS OF AGE because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
PERSONS AGED 25 THROUGH 64 YEARS who have health conditions associated with higher risk of medical complications from influenza.

We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1 (http://www.cdc.gov/media/pressrel/2009/r090729b.htm).

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

To access the recommendations, go to:
http://www.cdc.gov/h1n1flu/vaccination/acip.htm

Study indicates pregnant women have higher rates of hospitalization and death from infection with H1N1 influenza virus; prompt antiviral treatment urged

On July 29, the British medical journal The Lancet issued a press release titled "Pregnant Women with H1N1 Flu Should Start Antiviral Treatment As Soon As Possible, While Those Who Are Well Should Be Vaccinated." The press release concerns an article published in an online issue of The Lancet. Portions of the press release are reprinted below. A link to the full text of the article is given at the end of this IAC Express article, as is a link to CDC's clinical guidance for treatment and prophylaxis of pregnant women with suspected or confirmed pandemic H1N1 influenza.

An article published Online First [The Lancet online](http://www.thelancet.com) and in an upcoming edition of The Lancet shows that pregnant women could be at increased risk for complications from H1N1 flu. Furthermore, the study, from the USA, shows that the rate of hospitalisation for pregnant women is more than four times that of the general population. Pregnant women with H1N1 flu should start antiviral treatment as soon as possible, while those who are well should be vaccinated once a vaccine becomes available. The article is written by Dr. Denise J. Jamieson, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA, and colleagues. . . .

Between April 15 and June 16, 2009, six deaths in pregnant women were reported to the CDC; all were in women who had developed pneumonia and subsequent acute respiratory distress syndrome requiring mechanical ventilation. . . .

[The authors wrote]: "CDC recommendations for pregnant patients are that antiviral drugs be started as soon as possible after the onset of influenza symptoms. The benefit is expected to be greatest if started within 48 [hours] of onset. . . . However, many pregnant women in our series were not treated with either of these drugs at the time of their presentation with influenza-like illness. Furthermore, none of those who died were treated within 48 [hours] of illness onset." . . . .

To access the complete press release, go to:
http://www.eurekalert.org/pub_releases/2009-07/l-pww072909.php

To access the full text of The Lancet article, go to:
http://press.thelancet.com/h1n1pregart.pdf

To access Pregnant Women and Novel Influenza A (H1N1) Virus: Considerations for Clinicians, go to:
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm

CDC's 2009 recommendations for prevention and control of seasonal influenza now published as an MMWR Recommendations and Reports

On July 31, CDC published "Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009" as an MMWR Recommendations and Reports. Previously, the recommendations were available only in electronic format as an MMWR Early Release (published July 24).

To access a ready-to-print (PDF) version of the recommendations, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr5808.pdf

To access a web-text (HTML) version of the recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5808a1.htm

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

AAP issues early release of a policy statement on recommendations for prevention and control of seasonal influenza in children

On July 16, the American Academy of Pediatrics (AAP) issued an online early release of a policy statement made by AAP's Committee on Infectious Diseases. Titled "Recommendations for Prevention and Control of Influenza in Children, 2009–2010," the statement updates recommendations for routine use of trivalent seasonal influenza vaccines and antiviral medications for the prevention and treatment of influenza in children.

To access a ready-to-print (PDF) version of the early release of the policy statement, go to:
http://www.cispimmunize.org/ill/Flu/Influenza%20Recommendations.pdf

IAC's Videos of the Week promote immunization across the lifespan during National Immunization Awareness Month

This week, to mark the August observation of National Immunization Awareness Month (NIAM), IAC is providing a mix of videos as its Video of the Week. They encourage immunization for different age groups--children, teens, and adults. This is in keeping with the goal of NIAM, which is to increase awareness about immunizations across the life span. "Vaccinate Your Baby: Facts" and "Vaccinate Your Baby: Protect" are two 30-second public service announcements (PSAs) that feature actress Amanda Peet; "Vaccines for Teens" is a video with a run time of 3 minutes; and "Immunization for Adults" is a 30-second PSA.

They will be available on the home page of IAC's website through August 9. To access them, go to: http://www.immunize.org and click on the image under the words Video of the Week. It may take a few moments for the video or PSA you have selected to begin playing; please be patient!

Remember to bookmark IAC's home page to view a new video every Monday. To access an IAC Video of the Week selection from the past, go to the video archive at http://www.immunize.org/votw/jul09.asp

Order IAC's laminated U.S. immunization schedules today!

IAC has two laminated immunization schedules for 2009--one for children/teens ages 0 through 18 years and one for adults. Based on CDC's 2009 immunization schedules, the laminated schedules offer two significant advantages over paper schedules:

(1) They are covered with a tough, washable coating that lets them stand up to a year's worth of use as guides to immunization and as teaching tools you can use to give patients and parents authoritative immunization information.

(2) Each schedule includes a guide to vaccine contraindications and precautions, a feature that will help you make on-the-spot determinations about vaccinating patients of any age.

IAC's laminated schedules come complete with essential footnotes and are printed in color for easy reading. Each schedule has six pages (i.e., three double-sided pages), and when folded, measures 8.5" x 11".

An image of each schedule is available, as is specific information about each, and a downloadable order form and online ordering information.

To access an image of the child/teen schedule and related information, go to:
http://www.immunize.org/shop/schedule_child.asp

To access an image of the adult schedule and related information, go to:
http://www.immunize.org/shop/schedule_adult.asp

Prices start at $10 each for 1-4 copies and drop to $6.50 each for 5-19 copies. Discount pricing is available for 20 or more copies. For quotes on customizing or placing orders in excess of 999 schedules, call (651) 647-9009 or email admininfo@immunize.org

IAC's offers other products for sale, including educational videos and personal immunization record cards, at http://www.immunize.org/shop

New: 2010 edition of the Yellow Book--CDC's travel-health guide--now available online

The 2010 edition of Health Information for International Travel (also known as the Yellow Book), is now available online at http://wwwn.cdc.gov/travel/content/yellowbook/home-2010.aspx It is published every two years by CDC as a reference forthose who advise international travelers of health risks,as well as others who might find it useful.

The 2010 edition features extensive sections on travel-related vaccine-preventable diseases (VPDs) and routine VPDs. For the first time, the book includes information on medical tourism, the growing practice of combining international travel for medical procedures with leisure travel. It also offers vaccination and medication information for disease risks by destination, as well as helpful hints for healthy travel and information on a wide range of common travel problems such as motion sickness.

You can also access the Yellow Book from CDC's Travelers' Health home page at http://www.cdc.gov/travel

The book is available at bookstores. The cost is $29.95.

To order a copy from the publisher, go to:
http://www.us.elsevierhealth.com/product.jsp?isbn=9780702034817
You can also call (800) 545-2522 and ask for ISBN# 978-0-7020-3481-7.

CDC's H1N1 influenza web section updated with planning information for healthcare professionals, Q&As for the public on H1N1 influenza vaccine, and more

CDC recently posted new or updated information to various sub-sections of its H1N1 Flu web section. Following are the titles and URLs of documents that have been posted since the July 27 issue of IAC Express:

Planning and Preparing for Novel H1N1 Vaccination [for healthcare professionals]
http://www.cdc.gov/h1n1flu/vaccination/provider/preparing.htm

Updated: Questions & Answers: Novel H1N1 Influenza Vaccine [for the public]
http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm

Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests
http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm

Managing Calls and Call Centers during a Large-Scale Influenza Outbreak: Implementation Tool
http://www.cdc.gov/h1n1flu/callcenters.htm

FOR MORE INFORMATION
The home page of CDC's H1N1 Flu web section can be accessed from http://www.cdc.gov/h1n1flu

IAC has gathered information related to H1N1 influenza in a single web section at http://www.immunize.org/h1n1

FDA authorizes emergency use of another diagnostic test for H1N1 influenza

On July 24, FDA issued a press release titled "FDA Authorizes Emergency Use of Another Test for 2009 H1N1 Influenza Virus." A portion of the press release is reprinted below.

The U.S. Food and Drug Administration today announced it has issued an Emergency Use Authorization (EUA) for a another diagnostic test for the 2009 H1N1 influenza virus, whose spread has caused the virus to be characterized as a pandemic by the World Health Organization.

The EUA for the Focus Diagnostics Influenza H1N1 (2009) Real-Time Reverse Transcription Polymerase Chain Reaction (RT-PCR) diagnostic test is the third diagnostic test authorized under an EUA by the FDA since the public health emergency involving the 2009 H1N1 influenza virus was declared on April 26, 2009.

The EUA allows Focus Diagnostics to distribute the test to laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity tests. This test is not typically utilized in a doctor's office--it is a complex laboratory test performed in an environment that has the necessary equipment. These tests are intended for use in the detection of the 2009 H1N1 influenza virus in patients with symptoms of respiratory infection. . . .

To access the complete press release, go to:
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm173543.htm

10.

Tuesday--August 4--is the date for IZTA's teleconference on influenza communication

Tuesday, August 4, is the date for the Immunization Coalitions Technical Assistance Network (IZTA) conference call on influenza communication. The presenter is CDC's Alan Janssen, MSPH.

The call will provide an overview of CDC's influenza messages and explain how the H1N1 virus will affect this year's outreach campaign. Mr. Janssen will also discuss educational materials that are available to assist you in promoting influenza vaccination in your community.

The August 4 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."

IZTA is a program of the Center for Health Communication, Academy for Educational Development. To access earlier IZTA programs, go to:
http://www.izta.org/confcall.cfm

11.

"CDC Features" tells parents how to protect their family from rabies

The "CDC Features" web section includes information for parents about rabies. "Protect Your Family from Rabies" cautions families to avoid wild animals, to take steps to reduce the possibility of family pets contracting rabies, to be cautious on hikes and other outdoor activities, and to take action if bitten by an animal.

To access "Protect Your Family from Rabies," go to:
http://www.cdc.gov/Features/RabiesSafeFamily

To access an alphabetical index of all "CDC Features," go to:
http://www.cdc.gov/az

12.

For coalitions: August 18 is the date for IZTA's hepatitis B update

August 18 is the date for the Immunization Coalitions Technical Assistance Network (IZTA) conference call featuring an update on hepatitis B. The presenter is Kim Nguyen, program manager, Hepatitis B Coalition of WA [Washington state]. Ms. Nguyen will discuss what the coalition has done and what it has learned from its work on hepatitis B.

The August 18 call will be held at 1PM, ET. To register, send an email to izta@aed.org Include this message: "Sign me up for the hepatitis update."

IZTA is a program of the Center for Health Communication, Academy for Educational Development. To access earlier IZTA programs, go to:
http://www.izta.org/confcall.cfm

13.

MMWR publishes a report on a case of laboratory-confirmed vaccinia virus in Virginia in 2008

CDC published "Laboratory-Acquired Vaccinia Virus Infection--Virginia, 2008" in the July 31 issue of MMWR. The article's opening paragraph is reprinted below.

Vaccinia virus (VACV) is the live viral component of smallpox vaccine. Inadvertent exposure to VACV can result in infection, and severe complications can occur in persons with underlying risk factors (e.g., pregnancy, immunodeficiencies, or dermatologic conditions). The Advisory Committee on Immunization Practices (ACIP) recommends smallpox vaccination for laboratory workers who handle nonhighly attenuated VACV strains or other orthopoxviruses (e.g., monkeypox, cowpox, or variola). On July 8, 2008, CDC was notified by a Virginia physician of a suspected case of inadvertent autoinoculation and VACV infection in an unvaccinated laboratory worker. This report describes the subsequent investigations conducted by the Virginia Department of Health and CDC to identify the source of infection and any cases of contact transmission. Of the patient's 102 possible contacts, seven had underlying risk factors for developing serious vaccinia infection. Investigators found no evidence of contact transmission and, based on the results of molecular typing, further concluded that the patient had been exposed to a VACV strain that had contaminated the seed stock from the laboratory where the patient worked. This case underscores the importance of adherence to ACIP vaccination recommendations for laboratory workers and use of safety precautions when working with nonhighly attenuated VACV. . . .

To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5829a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5829.pdf

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