Issue
Number 321
July 1, 2002
CONTENTS OF THIS ISSUE
- CDC publishes 20-year history of
hepatitis B vaccine to mark the vaccine's
anniversary
- CDC clarifies groups that should
be vaccinated against influenza in the month of
October
- Revised! IAC's "Summary of
Recommendations for Adult Immunization"
- Dr. Harold Margolis to head CDC's
Division of Viral Hepatitis
- New! Measles, mumps, and rubella
information pages on IAC's website
- JAMA article examines, compares
antivaccine websites
- Europe is polio-free says World
Health Organization
- Group aims to increase
participation in immunization registries
- Long- and short-term overseas
immunization positions are now open
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July 1, 2002
CDC PUBLISHES 20-YEAR HISTORY OF HEPATITIS B VACCINE TO
MARK THE VACCINE'S ANNIVERSARY
On June 28, 2002, the Centers for Disease Control and
Prevention (CDC) published "Achievements in
Public Health: Hepatitis B Vaccination--United
States, 1982-2002" in Morbidity and Mortality
Weekly Report (MMWR). The article
includes a timeline of hepatitis B vaccination
recommendations by the Advisory
Committee on Immunization Practices (ACIP), from
the original high-risk-group recommendation to
this year's birth-dose recommendation.
"Substantial progress" has been made in reducing
hepatitis B virus transmission since 1982,
according to the article. Even so, after
summarizing strategies to prevent hepatitis
B, the article concludes that "unless efforts to vaccinate
adults at increased risk for HBV infection
are greatly expanded, complete elimination of HBV
transmission might take another 20 years to
achieve."
The introduction to the article reads as follows
(excluding footnotes):
********************************
This year marks the 20th anniversary of the implementation
in the United States of the world's first
vaccine against hepatitis B virus (HBV). In
addition to acute disease, persons infected with
HBV are at risk for chronic HBV
infection and severe morbidity and mortality from
cirrhosis and hepatocellular carcinoma.
Before 1982, an estimated 200,000-300,000 persons
in the United States were infected annually with
HBV, including approximately 20,000 children. No
practical method of pre-exposure prophylaxis for
HBV existed, and the only postexposure prophylaxis
available was injection with hepatitis B
immune globulin (HBIG).
Since 1982, substantial progress has been made toward
eliminating HBV transmission in children and
reducing the risk for HBV infection in
adults. During 1982-2002, an estimated 40 million
infants and children and 30 million
adults received hepatitis B vaccine. Because of
vaccination and changes in risk- eduction
behaviors among at-risk populations in response to
the HIV/AIDS epidemic, the number of
persons infected in the United States
declined to an estimated 79,000 in 2001. To eliminate HBV
transmission, high vaccine-coverage rates must be
sustained among infants, children, and adolescents,
and programs to vaccinate adults at high
risk for HBV infection must be expanded.
********************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5125.pdf
HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the "Morbidity
and Mortality Weekly Report" (MMWR), visit
CDC's MMWR website at:
http://www.cdc.gov/mmwr
Select "Free MMWR Subscription" from the
menu at the left of the screen. Once you
have submitted the required information, weekly
issues of the MMWR and all new ACIP statements
(published as MMWR's "Recommendations and
Reports") will arrive
automatically by email.
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July 1, 2002
CDC CLARIFIES GROUPS THAT SHOULD BE VACCINATED AGAINST
INFLUENZA IN THE MONTH OF OCTOBER
On June 28, 2002, the Centers for Disease Control and
Prevention (CDC) published "Erratum: Vol. 51,
No. RR-3" in Morbidity and Mortality Weekly
Report (MMWR). The Erratum concerns the MMWR
Recommendation and Report publication
titled "Prevention and Control of Influenza:
Recommendations of the Advisory Committee on
Immunization Practices," dated April 12, 2002.
Because children aged 6 months through 8 years
receiving influenza vaccine for the first time
need a booster dose a month later, they should
get their first dose in October. This was not specified,
according to the Erratum, in the section on
"Timing of Organized Vaccination Campaigns."
The entire text of the Erratum follows (excluding one
footnote):
******************************
The MMWR Recommendations and Reports, "Prevention and
Control of Influenza: Recommendations of
the Advisory Committee on Immunization
Practices," published on April 12, 2002, contained
an inconsistency in the recommended
timing of vaccination of target groups. In the section,
"Vaccination in October and November,"
persons at increased risk for influenza-related
complications (e.g., persons
aged 65 years and older and persons aged 6 months-64 years with
high-risk medical conditions) and health-care
workers were recommended for vaccination in October.
In addition, children aged 6 months to <9
years receiving influenza vaccine for the first
time need a booster dose 1 month (or more) after
the first dose and, thus, also were
recommended to be vaccinated in October or earlier.
However, in the section, "Timing of
Organized Vaccination Campaigns," household
contacts of persons at high risk were also
included among those recommended to begin
vaccination in October, but children aged <9 years
receiving vaccine for the first time were not discussed.
To clarify, vaccination of the following groups should
begin in October, regardless of the setting in which
a person receives vaccination:
- persons at increased risk for
influenza-related complications (persons aged 65
years or older, persons
aged 6 months-64 years with certain medical conditions,
and healthy children aged 6-23
months);
- health-care workers;
- household contacts of persons at increased
risk for influenza-related complications
(including contacts of
infants aged <6 months who are not eligible for influenza
vaccine); and
- children aged 6 months to <9 years
receiving influenza vaccine for the first time.
The current projected distribution of U.S.
influenza vaccine for 2002-2003, on the basis of
aggregate manufacturer's estimates, is 92-97
million doses, with the majority of doses expected
to be distributed by the end of
October. This projection is based on early estimates and
might change as the season
progresses. Thus, supplies are expected to be
adequate for prioritization of persons at
increased risk for influenza complications,
their household contacts, and health-care workers
for vaccination in
October.
******************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a4.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5125.pdf
To read or print "Prevention and Control of Influenza:
Recommendations of the Advisory Committee on
Immunization Practices," go to:
HTML:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5103a1.htm
PDF:
http://www.cdc.gov/mmwr/pdf/rr/rr5103.pdf
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July 1, 2002
REVISED! IAC's "SUMMARY OF RECOMMENDATIONS FOR ADULT
IMMUNIZATION"
The Immunization Action Coalition (IAC) has incorporated
the most current guidelines for vaccinating
adults in the widely used two-sided chart,
"Summary of Rules for Adult Immunization."
Lyme disease vaccine information has been removed from the
chart. In addition, the meningococcal
vaccine recommendation to vaccinate people with
risk factors has been added at the beginning of
the meningococcal vaccine
text. A few other more minor clarifications in wording
have been made on such matters as
simultaneous administration of certain vaccines.
To obtain a copy of the revised "Summary of Recommendations
for Adult Immunization," go to:
HTML:
http://www.immunize.org/catg.d/p2011b.htm
PDF:
http://www.immunize.org/catg.d/p2011b.pdf
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July 1, 2002
DR. HAROLD MARGOLIS TO HEAD CDC'S DIVISION OF VIRAL HEPATITIS
The National Center for Infectious Diseases (NCID), within
the Centers for Disease Control and
Prevention (CDC), has announced the appointment of
Harold Margolis, M.D., to the position of
Director, Division of Viral Hepatitis.
The formal personnel announcement from NCID reads as
follows:
*******************************
I am very pleased to announce that Dr. Hal Margolis has
accepted the position of Director, Division of
Viral Hepatitis (DVH). Dr. Margolis was
named the Acting Director, DVH when it was
established in October 2001.
Most recently he has been on a detail to the CDC OD
[Office of the Director] as a Special
Assistant to the Deputy Director for Science and
Public Health to oversee and coordinate the
Agency's smallpox preparedness activities.
Previously Dr. Margolis has been Chief of the Hepatitis
Branch, Division of Viral and Rickettsial
Diseases, National Center for Infectious
Diseases, Centers for Disease Control and
Prevention, and Director of a World
Health Organization Collaborating Center for Research and
Reference in Viral Hepatitis since 1987. He
initially joined CDC in 1975 as an Epidemic
Intelligence Service (EIS) officer
following completion of his pediatric
residency at the University of Colorado. He subsequently
did a fellowship in immunology at the
National Jewish Center for Immunology Research in
Denver. He is a Fellow
of the American Academy of Pediatrics and the Infectious
Disease Society of America.
His interests include vaccine development and evaluation,
development and evaluation of strategies to
prevent viral hepatitis, and the molecular
pathogenesis of viral hepatitis. He has been a
leader in the development of
current recommendations for hepatitis B immunization
strategies in the United States and a
consultant to a number of countries in the
development of hepatitis B immunization and
prevention programs. He is the author or
coauthor of over 100 papers or chapters in the field of
viral hepatitis.
Jim Hughes
[Director, National Center for Infectious Diseases]
*******************************
Congratulations to Dr. Margolis, a long-time viral
hepatitis elimination visionary and immunization
champion. The Immunization Action Coalition is so
glad to have you back in viral hepatitis.
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July 1, 2002
NEW! MEASLES, MUMPS, AND RUBELLA INFORMATION PAGES ON
IAC'S WEBSITE
Next time you or your patients have questions about the
measles-mumps-rubella (MMR) vaccine or the
diseases themselves, you can find journal
articles, recommendations, state laws, case
histories, photos, and more on IAC's new
"MMR" web pages.
Resources pertaining to the trivalent vaccine are repeated
on all pages.
To view IAC's Measles Information web page, go to:
http://www.immunize.org/measles
To view IAC's Mumps Information page, go to:
http://www.immunize.org/mumps
To view IAC's Rubella Information web page, go to:
http://www.immunize.org/rubella
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July 1, 2002
JAMA ARTICLE EXAMINES, COMPARES ANTIVACCINE WEBSITES
The June 26 issue of JAMA, the Journal of the American
Medical Association, contains a feature article
titled "Content and Design Attributes of
Antivaccination Web Sites" (vol. 287, no. 24).
Written by Robert M. Wolfe,
M.D., Lisa K. Sharp, Ph.D., and Martin S. Lipsky, M.D.,
all from Northwestern University, the
article examines "the specific claims and concerns
expressed by antivaccination groups" on 22
websites.
Eleven common antivaccination claims are identified in the
websites and discussed in the article, as well
as ten website design features such as chat
rooms and links to similar sites.
According to the Comment section, "Our results show that
such sites express a variety of claims that are
largely unsupported by peer-reviewed
scientific literature. . . .While the majority of the public accepts
immunization, it appears that increasing
numbers of parents are seeking philosophical
exemptions from vaccination for their
children. . . . We believe our study findings can help
direct research aimed at more effectively
addressing the concerns of individuals opposing
childhood vaccination."
To read JAMA's "Brief Report" on the article, go to:
http://jama.ama-assn.org/issues/v287n24/abs/jbr20117.html
The entire article is available online at no charge only
to registered users or subscribers to JAMA. To
order the article online on a Pay Per View
basis ($9 fee), go to:
https://secure.edoc.com/PPV2.html
To order individual reprints, call the JAMA reprint office
at (312) 464-4594 or contact one of the
independent reprint vendors listed at:
http://pubs.ama-assn.org/docdelivery.html
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July 1, 2002
EUROPE IS POLIO-FREE SAYS WORLD HEALTH ORGANIZATION
On June 21, 2002, the World Health Organization (WHO)
announced that no indigenous cases of polio have been
detected in its European Region in the past three years.
The last case of wild poliomyelitis occurred in eastern
Turkey in 1998 in a 2-year-old unvaccinated boy who was
paralyzed by the virus.
In a meeting of the European Regional Commission for
Certification of Poliomyelitis Eradication (RCC),
the European Region (51 countries) joined the Americas and
the Western Pacific in achieving "polio-free" certification. The Global Polio Eradication Initiative
aims to certify the world polio-free by the end
of the year 2005.
As RCC chairman Sir Joseph Smith stated in the WHO press
release about the certification, "Our work
does not stop here. Throughout the European Region, ongoing vaccination
and surveillance is vital. The risk of poliovirus being
imported into Europe will continue until we eradicate
polio globally."
To read the WHO press release, "Europe Achieves Historic
Milestone As Region Is Declared Polio-Free," go to:
http://www.who.int/inf/en/pr-EURO.2002-12.02.html
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July 1, 2002
GROUP AIMS TO INCREASE PARTICIPATION IN IMMUNIZATION
REGISTRIES
The following news report originally appeared in the June
Immunization Works Newsletter published by
the National Immunization Program (NIP) and distributed to NIP
grantees. The Immunization Action Coalition (IAC) is
reproducing it here as a service to IAC EXPRESS readers.
******************************
Currently, only 24% of children in the U.S. less than
6 years of age are participating in a population-based
immunization registry. One of the Healthy People 2010
immunization registry objectives is to increase the number
of children under 6 participating in an immunization
registry to 95%. In order to achieve this objective,
participation by health care professionals needs to
increase dramatically over the next 8 years. The CDC is
supporting activities to include the private sector in
this work. A Provider Participation Work Group has been
formed with representation from numerous organizations
with an immunization, registry or pediatric focus in their
mission. The purposes of a May 20 meeting were to
inform participants of the current status of immunization
registries, define the problem of provider non-participation
in registries, and initiate a discussion of the issues impacting
participation by health care professionals in community- and
state-based immunization registries. Future meetings will
continue to identify barriers and develop solutions of
increasing registry participation. If you or your organization
is interested in working with the Provider Participation Work
Group, please contact Karen Fowler, Work Group Chairman, at
kgf1@cdc.gov
<mailto:kgf1@cdc.gov> or (404) 639-8295.
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July 1, 2002
LONG- AND SHORT-TERM OVERSEAS IMMUNIZATION POSITIONS ARE
NOW OPEN
The following announcement originally appeared in the June
Immunization Works Newsletter published by the National
Immunization Program (NIP) and distributed to NIP
grantees. The Immunization Action Coalition (IAC) is
reproducing it here as a service to IAC EXPRESS readers.
******************************
The CDC's Global Immunization Division within the National
Immunization Program works to prevent and eliminate
vaccine preventable disease around the world. CDC, the
World Health Organization (WHO), UNICEF, Rotary
International and other partners are working toward the
global certification of polio eradication by 2005 and
developing measles mortality reduction activities. WHO and
UNICEF have asked CDC to assist them in filling critical
positions, both long and short term. Long-term, two-year
positions exist for Medical Epidemiologists and Technical
Officers in Africa, Asia and Europe for measles reduction
activities. Assignees will assist WHO, host governments
and partners in organizing National Immunization Days,
supplemental immunization activities, surveillance and
accelerated measles activities. Eligible applicants are
epidemiologists and technical officers with at least five
years of international public health, disease surveillance
and immunization program experience. More information is
available from Carla Lee at cel1@cdc.gov
<mailto:CEL1@cdc.gov> [or from Liz Bell at
eib6@cdc.gov]. Short term positions of
twelve weeks are available for polio eradication consultants.
Assignments include Africa, Asia and the Eastern Mediterranean.
The work focuses on disease surveillance and/or assisting with
planning, monitoring, and evaluating National Immunization
Days. More information may be obtained by visiting
www.cdc.gov/nip/global/
<http://www.cdc.gov/nip/global/>.
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