Issue
Number 462
June 1, 2004
CONTENTS OF THIS ISSUE
- Errors discovered and corrected in footnotes of "Recommended Childhood
and Adolescent Immunization Schedule--United States, July-December 2004"
on the NIP website
- NIP releases Influenza Vaccine Bulletin #2 for the 2004-05 influenza
season
- CDC publishes hard copy of ACIP influenza recommendations
- NIP publishes new VISs for influenza and typhoid vaccines
- May issue of CDC's "Immunization Works!" electronic newsletter
available on the NIP website
- CDC reports on immunization registry progress
- May issue of IAC'S "HEP EXPRESS" electronic newsletter now available
online
- CDC reports on wild poliovirus importations in West and Central Africa
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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American
Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices;
CDC, Centers for Disease Control and Prevention; FDA, Food and Drug
Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and
Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine
Information Statement; VPD, vaccine-preventable disease; WHO, World Health
Organization.
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June 1, 2004
ERRORS DISCOVERED AND CORRECTED IN FOOTNOTES OF "RECOMMENDED CHILDHOOD AND
ADOLESCENT IMMUNIZATION SCHEDULE—UNITED STATES, JULY-DECEMBER 2004" ON THE
NIP WEBSITE
The National Immunization Program (NIP) has discovered several errors in the
footnotes of "Recommended Childhood and Adolescent Immunization
Schedule--United States, July-December 2004" as published on the NIP
website, primarily with the influenza vaccine footnote.
If you have downloaded the new schedule from the NIP website prior to May
28, you should not reproduce or distribute this version of the schedule. The
incorrect files have been removed, and corrected versions have been posted
on the NIP website.
To access the corrected and reposted "Recommended Childhood and Adolescent
Immunization Schedule--United States, July-December 2004," from the NIP
website, go to:
http://www.cdc.gov/nip/recs/child-schedule.htm#Printable Scroll down
to the section titled "July-December 2004 New!" and select the version you
want.
The version of the schedule printed in the April 30 issue of "MMWR Quick
Guide," in "Pediatrics," and on IAC's website is correct.
To access the correct "Recommended Childhood and Adolescent Immunization
Schedule--United States, July-December 2004" from IAC's website, go to:
http://www.immunize.org/cdc/child-schedule.pdf
To access the original April 30, 2004, MMWR article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5316-Immunizationa1.htm
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June 1, 2004
NIP RELEASES INFLUENZA VACCINE BULLETIN #2 FOR THE 2004-05 INFLUENZA SEASON
On May 20, NIP issued the second influenza vaccine bulletin designed to
update health professionals on the production, distribution, and
administration of influenza vaccine for the 2004-05 influenza season.
The bulletin is reprinted below with the exception of a section on
miscellaneous information.
********************
INFLUENZA VACCINE BULLETIN #2
May 20, 2004
Influenza Season 2004-05
The National Immunization Program (NIP) of the Centers for Disease Control
and Prevention (CDC) publishes and distributes periodic bulletins to update
partners about recent developments related to the production, distribution,
and administration of influenza vaccine. All recipients of this bulletin are
encouraged to distribute each issue widely to colleagues, members, and
constituents.
INFLUENZA VACCINE SUPPLY AND PRODUCTION
2004-2005 Influenza Vaccine Production
- Vaccine production is on schedule, and no
delays are anticipated, according to the Food and Drug Administration
(FDA) and vaccine manufacturers. However, it is still early in the
manufacturing process, and issues can arise. The Influenza Bulletin
provides regular updates on the status of vaccine production. The three
manufacturers of influenza vaccine anticipate total influenza vaccine
production of between 90 and 100 million doses. Between six and eight
million of those doses will include reduced amounts of thimerosal.
Place Orders for Influenza Vaccine!
- In order to ensure the availability of
influenza vaccine for administration in the fall of 2004, healthcare
providers should order supplies of influenza vaccine now if orders have
not been placed. Last year, cases of influenza began to appear in
October with widespread activity in November and December. Because
increased demand for vaccine is anticipated, healthcare providers who
care for Medicare beneficiaries and others at high risk for
complications from influenza must prepare for the upcoming influenza
season immediately.
Additional information on sources of vaccine can be found at
http://www.hidanetwork.com/govtrelations/flulinks.asp, a service
provided by the Health Industry Distributors Association.
Influenza Vaccine Contracts
- For 2004, CDC contracts have a maximum
quantity of 6.75 million doses, up from 4.8 million in 2003. These
figures represent vaccine purchased with VFC, 317, or state funds for
persons of all ages.
VFC Influenza Vaccine Stockpile
- Demand for influenza vaccine during
the 2003-2004 influenza season significantly exceeded supply.
Unfortunately, the current manufacturing process does not allow for
additional vaccine to be produced in a timely manner after supplies
are low. These factors highlight the need for a plan to ensure
availability of an adequate supply of influenza vaccine in the U.S.
In FY 2004 and FY 2005, CDC will purchase influenza vaccine for a
national stockpile. This purchase was authorized by the Omnibus
Reconciliation Act (OBRA) of 1993 which allows CDC to use Vaccines
for Children (VFC) program funds for stockpile purchases. This
stockpile, because it is funded through the VFC program, can only be
used to provide vaccine to VFC eligible children 18 years of age and
younger. Approximately 54 percent of U.S. children would be
eligible.
- In FY 2004, $40 million in VFC
program funds has been provided for the influenza stockpile. Based
on discussions with vaccine manufacturers, CDC estimates
purchasing approximately 4 to 4.5 million doses of influenza
vaccine for the stockpile.
- In FY 2005, $40 million in VFC
program funds was included in the President's Budget request. The
exact number of doses to be purchased in 2005 will ultimately
depend on manufacturers' production and timing capacity and will
not be known until they respond to the FY 2005 contract
solicitation in May, 2005.
- In the event that influenza
vaccine demand exceeds supply, the VFC-eligible children for whom
the vaccine is recommended will have priority access to the
stockpile. As determined by CDC, VFC stockpile vaccine may be made
available to state and local health departments and manufacturers
for distribution. If no influenza vaccine supply shortage occurs,
CDC will attempt to distribute the stockpiled vaccine in
consultation with the manufacturers.
INFLUENZA VACCINE DISTRIBUTION AND
ADMINISTRATION 2004 Influenza
Vaccination Recommendations of the Advisory Committee on
Immunization Practices (ACIP)
Recommendations have been broadened to protect more people from
influenza.
- The Centers for Disease Control
and Prevention (CDC) has adopted the following recommendations.
- Children 6 months to 23 months
of age should be vaccinated annually against influenza.
- Household contacts and
out-of-home caregivers of children 0 to 23 months of age should
be vaccinated annually to prevent these contacts from infecting
young children with influenza.
Other changes from last year's
recommendations include the composition of the influenza vaccine for the
2004-2005 season and clarification about the use of live, attenuated
influenza vaccine in healthcare workers and close contacts of severely
immunosuppressed persons.
Review the ACIP Recommendations at
http://www.cdc.gov/mmwr/pdf/rr/rr53e430.pdf
Changes to Recommendations for the 2004-05 Influenza Season
On February 24-25, 2004, the Advisory Committee on Immunization Practices (ACIP)
met in Atlanta to consider updates to its annual influenza vaccine
recommendations. The updated version for 2004-05 will be published in the
Morbidity Mortality Weekly Report in late April or early May 2004. Among the
changes are the following:
- Influenza vaccine is now
routinely recommended for all infants and children ages 6-23
months.
- Influenza vaccine has been
covered by the Vaccine for Children (VFC) Program since March
1, 2003. The following groups of VFC-eligible children can now
receive influenza vaccine through the VFC Program: all infants
and children ages 6-23 months and children and adolescents
2-18 years of age who have risk factors or are household
contacts of people with risk factors.
- All women who will be pregnant
at any time during influenza season should be vaccinated.
- The guidance for use of the
live attenuated influenza vaccine (FluMist) versus inactivated
vaccine among healthcare workers and other contacts of high
risk persons will be narrowed to recommend that the
inactivated influenza vaccine is preferred only for persons
who have close contact with severely immunosuppressed persons
(e.g., patients with hematopoietic stem cell transplants)
during those periods in which the immunosuppressed person
requires care in a protective environment. There is no
preference for inactivated influenza vaccine use by contacts
of persons with lesser degrees of immunosuppression or other
high risk conditions (e.g., persons with diabetes mellitus,
persons with asthma taking corticosteroids, or persons
infected with human immunodeficiency virus).
The length of time that persons vaccinated
with live attenuated vaccine are recommended to avoid contact with severely
immunosuppressed persons is changed to 7 days from 21 days after
vaccination.
Update on Medicare Payment for Influenza Vaccine Purchase and Administration
- The basis for Medicare
payment of influenza vaccine will continue to be 95% of the
average wholesale price, as stated by the Centers for
Medicare and Medicaid Services (CMS) at
http://www.cms.hhs.gov/medlearn/refimmu.asp
MedImmune Reacquires Rights to FluMist from
Wyeth
- On April 26, 2004,
MedImmune, Inc. and Wyeth announced the dissolution of
their collaboration for the nasal influenza vaccine,
FluMist (Influenza Virus Vaccine Live, Intranasal) and an
investigational second-generation liquid formulation, Cold
Adapted Influenza Vaccine-Trivalent (CAIV-T). As a result
of the dissolution, subject to obtaining necessary
government approval, MedImmune will have worldwide rights
to these products and will assume full responsibility for
the manufacturing, marketing, and selling of FluMist.
As part of the dissolution process, MedImmune
will acquire Wyeth's distribution facility in Louisville, Kentucky. Wyeth is
providing bulk manufacturing materials and will transfer clinical trial
data, as well as provide manufacturing services, during a transition that
the companies expect to complete in large part by fourth quarter 2004.
INFLUENZA VACCINE COMMUNICATIONS AND RESOURCES
38th National Immunization Conference
The objective of the conference, held on May 11-14, 2004, in Nashville,
Tennessee, was to bring together a wide variety of local, state, federal,
and private-sector immunization partners to explore science, policy,
education, and planning issues related to immunization in general and
vaccine-preventable disease. The conference featured plenary sessions on
influenza and adult immunization, as well as a total of 14 workshops
dedicated to the two topics. Over 1300 persons were pre-registered for the
conference. For additional information, please visit
http://www.cdc.gov/nip/NIC/default.htm
2004 National Influenza Vaccine Summit
The National Influenza Summit is acknowledged as an informal partnership of
stakeholders who advise on and respond to issues of influenza vaccination
all year round. This year, the Summit moved away from the workgroup-oriented
approach of the previous summits and towards a topical/ thematic approach.
This topical approach allowed relevant and current background material to be
presented at the plenary session for each theme. The plenary sessions were
then followed by moderated breakout sessions on a variety of topics
pertinent to that theme allowing all Summit participants an opportunity to
contribute to all themes. To view individual presentations and additional
information from the Summit, visit
http://www.ama-assn.org/ama/pub/article/1826-8377.html
Resource Materials
- "Influenza Immunization
Among Health Care Workers"
A call for action, published by The National Foundation
for Infectious Diseases, suggests that a comprehensive
approach is essential to improve influenza vaccination
rates among health care workers. Since influenza vaccine
coverage for health care professionals is estimated
nationally at 38 percent, additional efforts are needed
to reach a greater percentage of this important
subpopulation.
You may download the entire Call to Action at
http://www.nfid.org/publications/calltoaction.pdf
- An article in Volume 26,
Number 4 of the 2004 American Journal of Preventive
Medicine, "Operational Conditions Affecting the
Vaccination of Older Adults", by John Fontanesi and
colleagues, suggests that adequate description has not
been provided on the content and context of the process
for vaccinating older adults against influenza in
outpatient settings. While patient and provider beliefs
and characteristics may affect the likelihood that a
provider recommends influenza immunization, other
factors may present as much or even greater influence.
- Review recently
published Morbidity and Mortality Weekly Reports (MMWRs)
related to influenza by clicking on the following links.
"Prevention and Control of Influenza: Recommendations of
the Advisory Committee on Immunization Practices (ACIP)"
MMWR April 30, 2004; 53 (Early Release),
http://www.cdc.gov/mmwr/pdf/rr/rr53e430.pdf
"Update: Influenza Activity—United States, 2003-04
Season"
MMWR April 9, 2004; 53(13):284-287 ,
http://www.cdc.gov/mmwr/PDF/wk/mm5313.pdf
"Preliminary Assessment of the Effectiveness of the
2003-04 Inactivated Influenza Vaccine -Colorado,
December 2003" MMWR January 16, 2004; 53(1):8-11,
http://www.cdc.gov/mmwr/pdf/wk/mm5301.pdf
"Recommended Childhood and Adolescent Immunization
Schedule—United States, January-June 2004" MMWR January
16, 2004; 53(1):Q1-4
http://www.cdc.gov/mmwr/pdf/wk/mm5301-Immunization.pdf
"Update: Influenza-Associated Deaths Reported Among
Children Aged <18 Years—United States, 2003-04 Season"
MMWR January 9, 2004; 52(53):1286-1288
http://www.cdc.gov/mmwr/PDF/wk/mm5253.pdf
- Reference previous
bulletins at
http://www.cdc.gov/flu/professionals/flubulletin.htm
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For a ready-to-copy (PDF) version of Influenza Vaccine Bulletin #2, go to:
http://www.cdc.gov/nip/flu/bulletins-flu/2004-05/bulletin2_052004.pdf
For a text version of Influenza Vaccine Bulletin #2, go to:
http://www.cdc.gov/nip/flu/bulletins-flu/2004-05/bulletin2_052004.htm#admin
For more influenza information from CDC's influenza web section, go to:
http://www.cdc.gov/flu
For influenza information from the IAC website, go to:
http://www.immunize.org/influenza
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June 1, 2004
CDC PUBLISHES HARD COPY OF ACIP'S INFLUENZA RECOMMENDATIONS
On April 30, CDC issued "Prevention and Control of Influenza:
Recommendations of the Advisory Committee on Immunization Practices (ACIP)"
as an electronic "MMWR Early Release." On May 28, CDC published a hard copy
of the same document in "MMWR Recommendations and Reports" (RR-6). The
content is the same in both versions.
To access the ready-to-copy (PDF) version of this recommendation, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5306.pdf
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June 1, 2004
NIP PUBLISHES NEW VISs FOR INFLUENZA AND TYPHOID VACCINES
On May 24, the National Immunization Program (NIP) posted Vaccine
Information Statements (VISs) for the inactivated influenza vaccine and the
live, intranasal influenza vaccine for the 2004-05 influenza season.
To access a ready-to-copy (PDF) version of the inactivated influenza vaccine
VIS from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf
To access a ready-to-copy (PDF) version of the live, intranasal influenza
vaccine VIS from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf
On May 19, NIP posted a new typhoid vaccine VIS on their website.
To access a ready-to-copy (PDF) version of the typhoid vaccine VIS, go to:
http://www.cdc.gov/nip/publications/VIS/vis-typhoid.pdf
You can access all current VISs in English from NIP at
http://www.cdc.gov/nip/publications/VIS
The three VISs are also posted on the IAC website. For information about the
use of VISs, as well as VISs in up to 30 translations and alternative
formats, visit IAC's VIS web section at
http://www.immunize.org/vis
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June 1, 2004
MAY ISSUE OF CDC'S "IMMUNIZATION WORKS!" ELECTRONIC NEWSLETTER
AVAILABLE ON THE NIP WEBSITE
The May issue of "Immunization Works!" a monthly email
newsletter published by CDC, is available on NIP's website. The
newsletter offers members of the immunization community
non-proprietary information about current topics. CDC encourages
its wide dissemination.
The May issue summarizes the April 30, 2004 document,
"Prevention and Control of Influenza: Recommendations of the
Advisory Committee on Immunization Practices (ACIP)," and
reports on several conferences and resources.
To access the complete May issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2004/200405.htm
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June 1, 2004
CDC REPORTS ON IMMUNIZATION REGISTRY PROGRESS
CDC published "Immunization Registry Progress—United States,
January-December 2002" in the May 28 issue of MMWR. The first
paragraph of this article is reprinted below, excluding
references.
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Immunization registries are confidential, computerized
information systems that collect vaccination data within a
geographic area. By consolidating vaccination records from
multiple health-care providers, generating reminder and recall
notifications, and assessing clinic and vaccination coverage,
registries serve as key tools to increase and sustain high
vaccination coverage. One of the national health objectives for
2010 is to increase to 95% the proportion of children aged less
than 6 years who participate (i.e., have two or more
vaccinations recorded) in fully operational, population-based
immunization registries (objective 14.26). This report
summarizes data from CDC's 2002 Immunization Registry Annual
Report (2002 IRAR), a survey of registry activity among
immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under section 317b of
the Public Health Service Act. These data indicate that
approximately 43% of children aged less than 6 years are
enrolled in a registry; achieving the national health objective
will require increased implementation of functional standards to
improve data quality.
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To access a web-text (HTML) version of the complete article, go
to:
http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5320a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/MMWR/PDF/wk/mm5320.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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June 1, 2004
MAY ISSUE OF IAC'S "HEP EXPRESS" ELECTRONIC NEWSLETTER NOW
AVAILABLE ONLINE
The May 20 issue of "HEP EXPRESS," an electronic newsletter published by IAC, is available online.
"HEP EXPRESS" is intended
for health and social service professionals involved in the
prevention and treatment of viral hepatitis. The May 20 issue
includes articles on the following:
- CDC's new web section on preventing STDs among MSM
- CDC's "Top 11" FAQ page about viral hepatitis
- Free CME courses for physicians on viral hepatitis
available through Medscape
- Hepatitis B Foundation's online expert speaker forum
- Links to recent journal article abstracts about viral
hepatitis
To access the May 20 issue, go to:
http://www.hepprograms.org/hepexpress/issue17.asp
To sign up for a free subscription to "HEP EXPRESS," go to:
http://www.hepprograms.org/hepexpress/signup.asp
To access previous issues of "HEP EXPRESS," go to:
http://www.hepprograms.org/hepexpress/index.asp
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June 1, 2004
CDC REPORTS ON WILD POLIOVIRUS IMPORTATIONS IN WEST AND CENTRAL
AFRICA
CDC published "Wild Poliovirus Importations—West and Central
Africa, January 2003-March 2004" in the May 28 issue of MMWR.
A summary made available to the press is reprinted below in
its entirety.
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To restore gains made in polio eradication in West and Central
Africa, wild poliovirus transmission must be interrupted in
Nigeria and Niger. Until then, immunization activities must be
of high enough quality to provide an immunity barrier to keep
poliovirus from re-establishing and causing disease in these
neighboring polio-free countries.
During 2003 and the first quarter of 2004, 8 previously polio-free West and Central African countries reported wild poliovirus
importations resulting in 63 polio cases. All importations can
be traced to ancestral strains that circulate in northern
Nigeria and southern Niger. Many of these 8 countries had
continued transmission after importation because of low
vaccination coverage and decreased frequency or quality of
immunization activities. Until the major Nigeria/Niger PV
reservoir has been eliminated, neighboring countries must create
a population immunity barrier by implementing quality
immunization activities (routine and especially supplementary
activities). The quality of recent campaigns in these countries
has improved by increasing the level of political commitment and
a strengthening in the monitoring and supervision of activities.
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To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5320a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/MMWR/PDF/wk/mm5320.pdf |
