Issue
Number 576
January 17, 2006
CONTENTS OF THIS ISSUE
- CDC issues official Health Advisory, recommending
against the use of Amantadine and Rimandatine for the treatment or
prophylaxis of influenza
- CDC issues interim VIS for hepatitis A vaccine
- CDC issues updated VIS for rabies vaccine
- Important information for those planning on attending
ACIP meetings
- HHS releases a pandemic influenza guide for individuals
and families
- AAFP publishes a pandemic influenza vaccine
prioritization guide for providers
- IAC adds web section of pandemic influenza resources
- IAC adds autism web section to its website for the
public and health professionals
- Influenza update: CDC reports on influenza activity
during December 25–31, 2005
- VIS translation: IAC posts Haitian Creole VIS for
meningococcal vaccine
- CDC updates its influenza web section
- January issue of CDC's Immunization Works electronic
newsletter now available on the NIP website
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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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January 17, 2006
CDC ISSUES OFFICIAL HEALTH ADVISORY, RECOMMENDING AGAINST THE USE OF
AMANTADINE AND RIMANDATINE FOR THE TREATMENT OR PROPHYLAXIS OF INFLUENZA
On January 14, CDC issued an official Health Advisory for healthcare
providers, recommending against the use of Amantadine and Rimandatine for
the treatment of influenza in the United States during the 2005–2006
influenza season. The Health Advisory is reprinted below in its entirety.
*******************
This is an official CDC Health Advisory
Distributed via Health Alert Network
Saturday, January 14, 2006, 15:30 EST (3:30 PM EST)
CDC Recommends against the Use of Amantadine and Rimandatine for the
Treatment or Prophylaxis of Influenza in the United States during the
2005–06 Influenza Season: Recent evidence indicates that a high proportion
of currently circulating Influenza A viruses in this country are resistant
to these medications
While the primary strategy for preventing complications of influenza
infections is annual vaccination, antiviral medications with activity
against influenza viruses can be effective for the prophylaxis and treatment
of influenza. Two classes of antivirals are currently available--the M2 ion
channel inhibitors (i.e., the two adamantanes amantadine and rimantadine)
and the neuraminidase inhibitors (i.e., oseltamivir and zanamivir). The
neuraminidase inhibitors are effective for the treatment and prophylaxis of
influenza A and B, while the adamantanes are only active against influenza A
viruses. This alert provides new information about the resistance of
influenza viruses currently circulating in the United States to the
adamantanes, and it makes an interim recommendation that these drugs not be
used during the 2005–06 influenza season. Amantadine is also used to treat
the symptoms of Parkinson's disease, and should continue to be used for this
indication.
Viral resistance to adamantanes can emerge rapidly during treatment because
a single point mutation at amino acid positions 26, 27, 30, 31, or 34 of the
M2 protein can confer cross-resistance to both amantadine and rimantadine.
The transmissibility of adamantane-resistant viruses is not impaired by any
of these amino acid changes. A recent report on the global prevalence of
adamantane-resistant influenza viruses showed a significant increase (from
1.9% to 12.3%) in drug resistance over the past 3 years. In the United
States, the frequency of drug resistance increased from 1.9% in 2004 to
14.5% during the first 6 months of the 2004–05 influenza season.
For the 2005–06 season, 120 influenza A (H3N2) viruses isolated from
patients in 23 states have been tested at CDC through January 12, 2006; 109
of the isolates (91%) contain an amino acid change at position 31 of the M2
protein, which confers resistance to amantadine and rimantadine. Three
influenza A(H1N1) viruses have been tested and demonstrated susceptibility
to these drugs. All influenza viruses from the United States that have been
screened for antiviral resistance at CDC have demonstrated susceptibility to
the neuraminidase inhibitors.
On the basis of available antiviral testing results, CDC is providing an
interim recommendation that neither amantadine nor rimandatine be used for
the treatment or prophylaxis of influenza A in the United States for the
remainder of the 2005–06 influenza season. During this period, oseltamivir
or zanamivir should be selected if an antiviral medication is used for the
treatment and prophylaxis of influenza. Testing of influenza isolates for
resistance to antivirals will continue throughout the 2005–06 influenza
season, and recommendations will be updated as needed. Annual influenza
vaccination remains the primary means of preventing morbidity and mortality
associated with influenza.
Additional information about the prevention and control of influenza is
available at http://www.cdc.gov/flu.
Specific information regarding the use of the neuraminidase inhibitors is
available at
http://www.cdc.gov/flu/protect/antiviral/index.htm. These websites will
be updated as new information becomes available.
*******************
To access the Health Alert from the archives of the Health Alert Network, go
to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00240
For a related press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060114.htm
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January 17, 2006
CDC ISSUES INTERIM VIS FOR HEPATITIS A VACCINE
On January 9, CDC posted an interim VIS for the hepatitis A vaccine. The
interim VIS takes into account the licensing of hepatitis A vaccines for
children 12 months and older. CDC will issue the final VIS for hepatitis A
vaccine after MMWR publishes the ACIP recommendations. Until then,
healthcare providers should give patients the interim VIS before
administering the vaccine.
OBTAINING THE INTERIM VIS FOR HEPATITIS A VACCINE
Please note that the interim VIS (dated 1/9/06) is currently available only
in English.
To obtain a ready-to-copy (PDF) version of the interim VIS for hepatitis A
vaccine from the NIP website, go to:
http://www.cdc.gov/nip/publications/vis/vis-hep-a.pdf
To obtain it from the IAC website, go to:
http://www.immunize.org/vis/v-hepa.pdf
For VISs in a total of 33 languages, and for information about the use of
VISs, visit IAC's VIS web section at
http://www.immunize.org/vis
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January 17, 2006
CDC ISSUES UPDATED VIS FOR RABIES VACCINE
On January 12, CDC posted an updated VIS for rabies vaccine. A small change
has been made in the rabies VIS. In Section 4 ("Tell your doctor if . . ."),
a statement regarding anti-malarial drugs has been removed. This is because
intradermal rabies vaccine is no longer available in the U.S., and this
precaution applied only to the intradermal formulation. The revised VIS is
dated 1/12/06. Stocks of the earlier version of the VIS may be used up, but
patients should be made aware that use of anti-malarial drugs is no longer a
precaution for rabies vaccination.
OBTAINING THE UPDATED VIS FOR RABIES VACCINE
Please note that the updated VIS is currently available only in English.
To obtain a ready-to-copy (PDF) version of the VIS for rabies vaccine from
the NIP website, go to:
http://www.cdc.gov/nip/publications/vis/vis-rabies.pdf
To obtain it from the IAC website, go to:
http://www.immunize.org/vis/rabies06.pdf
For VISs in a total of 33 languages, and for information about the use of
VISs, visit IAC's VIS web section at
http://www.immunize.org/vis
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January 17, 2006
IMPORTANT INFORMATION FOR THOSE PLANNING ON ATTENDING ACIP MEETINGS
In order to expedite the security clearance process at the CDC Clifton Road
campus, all Advisory Committee on Immunization Practices (ACIP) attendees
must now register online. This rule includes all CDC participants as well as
all visitors. The registration forms for upcoming meetings can be accessed
at
http://www.cdc.gov/nip/ACIP/dates.htm
All non-U.S. citizens are required to register at least three weeks in
advance of an ACIP meeting (e.g., for the February 21–22 meeting, the latest
registration date allowed would be January 25, 2006). Non-U.S. citizens will
not be allowed to register on site. In addition to registering online,
foreign attendees must also complete an additional document. To obtain this
form, email Dee Gardner at
dgardner@cdc.gov or call (404) 639-8836.
As a reminder, the next ACIP meeting will be held Tuesday, February 21 and
Wednesday, February 22, 2006. For more information, go to:
http://www.cdc.gov/nip/acip
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January 17, 2006
HHS RELEASES A PANDEMIC INFLUENZA GUIDE FOR INDIVIDUALS AND FAMILIES
On January 6, the U.S. Department of Health and Human Services (HHS)
released a new tool to help Americans understand the threat of pandemic
influenza and learn specific actions they can take to protect themselves and
their families.
"Pandemic Influenza Planning: A Guide for Individuals and Families" includes
a planning checklist intended to help individuals gather the information and
resources they may need. The checklist breaks activities into three
categories: "To plan for a pandemic," "To limit the spread of germs and
prevent infection," and "Items to have on hand for an extended stay at
home."
To access this new resource, go to:
http://www.pandemicflu.gov/plan/pdf/guide.pdf
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January 17, 1006
AAFP PUBLISHES A PANDEMIC INFLUENZA VACCINE PRIORITIZATION GUIDE FOR
PROVIDERS
The American Academy of Family Physicians (AAFP) published "Preparing for an
Influenza Pandemic: Vaccine Prioritization" by Jonathan L. Temte, MD, PhD,
in the January 2006 issue of Family Practice Management. The article details
how to determine which patients and employees in a medical practice should
receive the influenza vaccine if a pandemic occurs.
To read this article online, go to:
http://www.aafp.org/fpm/20060100/32prep.html
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January 17, 2006
IAC ADDS WEB SECTION OF PANDEMIC INFLUENZA RESOURCES
IAC recently added a link to the home page of
http://www.immunize.org to make it
easier for visitors to access pandemic influenza information. Individuals
can click on the "Pandemic influenza" link in the top right corner of the
website, or go directly to the pandemic influenza index page at
http://www.immunize.org/pandemic
This page features links to resources from the U.S. Department of Health and
Human Services, the American Academy of Family Physicians, WHO, and CDC,
including links to CDC's new newsletter, Pandemic Influenza Update. To read
the January 5, 2006 issue of this newsletter, go to:
http://www.immunize.org/pandemic/panflu010506.pdf
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January 17, 2006
IAC ADDS AUTISM WEB SECTION TO ITS WEBSITE FOR THE PUBLIC AND HEALTH
PROFESSIONALS
To help parents searching for reliable information about vaccines and
autism, IAC has added a new section of information to its website for the
public and health professionals. Visitors can click on the "Vaccines and
Autism" link on the home page of
http://www.vaccineinformation.org, or go directly to
http://www.vaccineinformation.org/autism.asp The page includes
information from the U.S. Department of Health and Human Services, CDC, the
Institute of Medicine, the American Academy of Pediatrics, and IAC.
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January 17, 2006
INFLUENZA UPDATE: CDC REPORTS ON INFLUENZA ACTIVITY DURING DECEMBER 25–31,
2005
CDC published "Update: Influenza Activity--United States, December 25-31,
2005" in the January 13 issue of MMWR. The article's first paragraph is
reprinted below.
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During December 25–31, 2005, the number of states reporting widespread
influenza activity increased to seven. Three states reported regional
activity, nine reported local activity, and 27 reported sporadic activity.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5501a4.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5501.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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January 17, 2006
VIS TRANSLATION: IAC POSTS HAITIAN CREOLE VIS FOR MENINGOCOCCAL VACCINE
The current interim version of the VIS for meningococcal vaccine is now
available on the IAC website in Haitian Creole. IAC gratefully acknowledges
the Massachusetts Department of Public Health for the translation.
MENINGOCOCCAL VACCINE VIS (dated 10/7/05)
To obtain a ready-to-print (PDF) version of the interim VIS for
meningococcal vaccine in Haitian Creole, go to:
http://www.immunize.org/vis/ha_men05.pdf
To obtain it in English, go to:
http://www.immunize.org/vis/menin05.pdf
For VISs in a total of 33 languages, and for information about the use of
VISs, visit IAC's VIS web section at
http://www.immunize.org/vis
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January 17, 2006
CDC UPDATES ITS INFLUENZA WEB SECTION
CDC recently updated two pages on its Influenza web section:
-
"Recent Avian Influenza Outbreaks in Asia and Europe" (1/10/06)
-
"Key Facts: Information about Avian Influenza (Bird Flu) and Avian
Influenza A (H5N1) Virus" (1/10/06)
To access these resources, go to:
http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent
link.
To access a broad range of continually updated information on seasonal
influenza, avian influenza, and pandemic influenza, go to:
http://www.cdc.gov/flu
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January 17, 2006
JANUARY ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER NOW
AVAILABLE ON THE NIP WEBSITE
The January 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.
Some of the information in the January issue has already appeared in
previous issues of IAC Express. Following is the text of two articles we
have not covered.
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OTHER IMMUNIZATION NEWS
CDC INFLUENZA LEAD ANNOUNCED: National Center for Infectious Diseases (NCID)
and National Immunization Program (NIP) leadership announced that Jim
LeDuc will serve as influenza lead and interim influenza goal team leader
for CDC. Dr. LeDuc has been the Director of the Division of Viral and
Rickettsial Diseases (DVRD) in NCID since 2000. Previously, he was the
Associate Director for Global Health, NCID, and prior to that, he was
technical advisor for arboviruses and hemorrhagic fevers at the World
Health Organization (WHO) in Geneva, Switzerland. For over 20 years, Dr.
LeDuc also served as an officer and research scientist in the U.S. Army
Medical Research and Development Command, where he conducted field and
laboratory investigations into the epidemiology of virus diseases,
developed diagnostic tests, and participated in vaccine development
efforts. Dr. LeDuc received his bachelor's degree from California State
University at Long Beach, and his Masters of Science and Doctor of
Philosophy degrees from the University of California at Los Angeles. He is
the author of nearly 200 scientific papers and book chapters on infectious
diseases and global health.
PROVIDER REMINDERS AT VISIT IMPROVE IMMUNIZATION COVERAGE:
A recently published study offers strong support for provider reminders
about the child's next immunization visit at the time of the immunization
visit. The study compared 4:3:1:3:3 (4+ doses of diphtheria and tetanus
toxoids and pertussis vaccine, 3+ doses of poliovirus vaccine, 1+ doses of
measles-containing vaccine, 3+ doses of Haemophilus influenzae type b
vaccine, and 3+ doses of hepatitis B vaccine) coverage among children
19-35 months whose caregivers learned by different methods when their
child's most recent immunization was needed. Methods included provider
reminders during an immunization visit (of the next scheduled immunization
visit); use of a shot card/record; use of reminder/recall systems; and
informal methods such as reminders from relatives, friends, or daycare
providers.
Of all methods, provider reminders during an immunization visit (of the
next scheduled immunization visit) were found to be the most effective.
Coverage rates for children of "reminded" caregivers were significantly
higher than [for] children of "un-reminded" caregivers (77% vs. 70%). To
access the complete article, published in BMC [BioMed Central] Pediatrics,
please visit
http://www.biomedcentral.com/1471-2431/5/44.
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To access the complete January issue of Immunization Works from the NIP
website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200601.htm
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