Issue
Number 591
April 10, 2006
CONTENTS OF THIS ISSUE
- IAC posts three thimerosal resources to its website
- CDC issues an update on Guillain-Barre Syndrome and
receipt of Menactra vaccine
- Handouts and recordings of NIC sessions now available
online
- April issue of Immunization Works summarizes information
about NIP reorganization and name change
- New: April issue of CDC's Immunization Works electronic
newsletter now available online
- MMWR publishes report on the current mumps epidemic in
Iowa
- Avian influenza covered extensively on the websites of
CDC, NIAID, and WHO
- Reminder: Register soon for the April 20 Rotavirus net
conference
- Public Health and the Law in the 21st Century conference
scheduled for June 12-14 in Atlanta
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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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April 10, 2006
IAC POSTS THREE THIMEROSAL RESOURCES TO ITS WEBSITE
IAC recently added three resources to the homepage of its website at
http://www.immunize.org Links to these
resources are in the upper right corner of the homepage.
The first is a joint letter to the U.S. Congress signed by 22 national
organizations that oppose legislative efforts to restrict access to vaccines
that contain thimerosal. To access the letter, go to:
http://www.immunize.org/thimerosalletter.pdf
The second is a summary for parents of the evidence explaining that
thimerosal is not a cause of autism. It was written by Paul A. Offit, MD. An
immunization expert, Dr. Offit is chief, Division of Infectious Diseases,
Children's Hospital of Philadelphia, and professor of pediatrics and Maurice
R. Hilleman Professor of Vaccinology, University of Pennsylvania School of
Medicine. To access the summary, go to:
http://www.immunize.org/catg.d/p2066.pdf
The third is a press release CDC issued in response to an advertisement
attacking CDC that appeared in the April 6 issue of USA Today. Titled "CDC
statement regarding autism-related advertisement in USA Today," the press
release states the ad "mischaracterizes the efforts of CDC, the American
Academy of Pediatrics, the Institute of Medicine, and others to protect the
health and well-being of the nation's children." To access the press
release, go to:
http://www.cdc.gov/od/oc/media/pressrel/s060406.htm
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April 10, 2006
CDC ISSUES AN UPDATE ON GUILLAIN-BARRE SYNDROME AND RECEIPT OF MENACTRA
VACCINE
CDC published "Update: Guillain-Barre Syndrome Among Recipients of Menactra
Meningococcal Conjugate Vaccine—United States, October 2005–February 2006"
in the April 7 issue of MMWR. Portions of the article are reprinted below.
***********************
In October 2005, a possible association between Guillain-Barre Syndrome (GBS)
and receipt of meningococcal conjugate vaccine (i.e., meningococcal
polysaccharide diphtheria toxoid conjugate vaccine [Menactra])(MCV4) was
reported. GBS is a serious neurologic disorder involving inflammatory
demyelination of the peripheral nerves. At the time of the first report,
five confirmed cases of GBS after receipt of MCV4 had been reported to the
Vaccine Adverse Events Reporting System (VAERS). During the 4 months since,
three additional confirmed cases of GBS have been reported. This report
describes two of these recent cases and provides additional data collected
through February 2006. Because available evidence neither proves nor
disproves a causal relation between MCV4 and GBS, further monitoring and
studies are ongoing within VAERS and the Vaccine Safety Datalink (VSD). CDC
continues to recommend use of MCV4 for persons for whom vaccination is
indicated; the additional reported cases have not resulted in any change to
that recommendation.
Case Reports
Brief clinical and epidemiologic descriptions of two of the newly reported
cases follow. The third case is undergoing detailed clinical investigation
but meets the provisional case definition for GBS.
Case 1. On August 8, 2005, a male aged 19 years from Arizona was vaccinated
with MCV4. Approximately 25 days later, he experienced numbness and tingling
in his hands and feet, followed by weakness in his legs, difficulty running,
and decreased dexterity in his hands. In the month before neurologic symptom
onset, he had no defined episode of respiratory or gastrointestinal illness.
He had traveled to Mexico twice during the preceding 3 months.
Electrophysiology studies revealed a diffuse neuropathic process with both
demyelinating and axonal features, consistent with GBS. Testing for
Epstein-Barr virus capsid IgG and IgM antibodies was negative. Testing for
cytomegalovirus IgG and IgM antibodies also was negative, as were serologic
studies for hepatitis A, B, and C to rule out other probable causes of GBS.
The patient was treated with intravenous immunoglobulin. At follow-up
examination 8 weeks after onset, he had fully recovered.
Case 2. On November 4, 2005, a male aged 17 years from Ohio received MCV4.
Eleven days later, he experienced numbness and tingling in his right foot,
followed by the same symptoms in the left foot, which progressed proximally
during the next 5 days. He also described a neck hyperextension injury
sustained while playing sports 2 days before the start of sensory symptoms
and sore throat and congestion 1 day before sensory symptoms. He had no
gastrointestinal illness during the 6 weeks before hospital admission, which
occurred 6 days after symptom onset. Cervical spine radiographs revealed no
fractures; magnetic resonance imaging (MRI) of the spine revealed mild
enhancement along the surface of distal cord and lumbar nerve roots,
consistent with GBS. Nerve conduction studies also were consistent with GBS.
Polymerase chain reaction (PCR) assays for enterovirus were negative, as
were tests for Mycoplasma pneumoniae IgG and IgM. The patient was treated
with intravenous immunoglobulin. At follow-up examination 2 weeks after
admission, he had completely recovered.
In the two cases described in this report, the period from MCV4 vaccination
to symptom onset was less than 6 weeks. This is the time window of elevated
risk noted for GBS after administration of certain other vaccines.
To determine whether the reporting rate of GBS after MCV4 vaccination was
higher than the expected incidence rate of GBS for the appropriate age group
population, the reporting rate was calculated by dividing the eight
confirmed GBS cases with onset within 6 weeks of vaccination by the number
of vaccine doses distributed as provided by the manufacturer (approximately
3.77 million doses of MCV4 were distributed during March 2005–February
2006). The eight cases were divided by the 3.77 million distributed
doses to provide the reporting rate for GBS after MCV4. The expected
incidence rate of GBS was estimated from a multistate hospital discharge
database (Health Care Utilization Project). For the years 2000–2003, the
incidence rate of GBS among persons aged 11–19 years was estimated to be 1.4
per 100,000 population per year or 0.17 per 100,000 population during a
6-week period. Therefore, the ratio of the reporting rate of GBS after MCV4
vaccination to the expected incidence rate was 1.4 (95% confidence interval
= 0.7–2.8), suggesting that the occurrence of eight cases of GBS within 6
weeks of MCV4 administration is similar to what might be expected to occur
by chance alone. . . .
Editorial Note:
In October 2005, CDC and the Food and Drug Administration (FDA) alerted
healthcare providers about a possible association between GBS and MCV4 and
encouraged reporting of adverse events to VAERS. Since that time, three
additional confirmed cases of GBS with onset within 6 weeks of MCV4
vaccination have been reported. However, even with these reported cases, the
reported incidence remains similar to the expected incidence. In addition,
three other cases of GBS have been reported, with symptom onsets at [more
than] 6 weeks (107 days, 116 days, and 125 days) after vaccination with
MCV4; these three cases were not included in calculation of GBS rates.
Because VAERS is a voluntary reporting system, the completeness of reporting
of GBS remains unknown. Only three cases were reported since October 2005,
suggesting that MCV4 might not be causally related to GBS. The background
incidence rate of GBS is one to two cases per 100,000 population. However,
the timing of onset of neurologic symptoms within 2–5 weeks of vaccination
is still a concern.
Additional preliminary data from VSD, a collaborative project between CDC
and eight managed care organizations in the United States, have not
identified GBS cases in MCV4 recipients. However, VSD has a limited ability
to detect rare health events such as GBS. To further evaluate any potential
risk, additional controlled studies of GBS after MCV4 are being planned.
The case definition developed for the initial investigation has been refined
by an extended working group of the Brighton Collaboration, an international
voluntary collaboration of scientists. The Clinical Immunization Safety
Assessment Network, in collaboration with CDC, continues to research and
conduct standardized clinical evaluation of affected vaccinees to better
understand the pathophysiology of select adverse events after vaccination,
such as GBS. In response to the evaluation of the reported cases to VAERS,
Sanofi Pasteur and FDA updated the Menactra vaccine package insert to list
previous GBS as a contraindication and provide a warning of the temporal
relation between GBS and MCV4.
In October 2005, CDC recommended continuing use of MCV4 for persons for whom
vaccination is recommended; the additional cases reported in this update do
not affect that recommendation. In December 2005, the Global Advisory
Committee on Vaccine Safety also recommended no change in MCV4 vaccination
policies.
The Advisory Committee on Immunization Practices has recommended that
persons with a history of GBS should not be vaccinated with MCV4 unless they
are at elevated risk for meningococcal disease. Persons at elevated
risk for meningococcal disease include first-year college students living in
dormitories, military recruits, travelers to areas in which meningococcal
disease is hyperendemic or epidemic, microbiologists who are routinely
exposed to isolates of Neisseria meningitidis, patients with anatomic or
functional asplenia, and patients with terminal complement deficiency.
Information regarding the current investigation should be shared with
adolescents and caregivers before MCV4 vaccination. A Vaccine Information
Statement and fact sheet noting the information on the reported GBS cases is
available at
http://www.cdc.gov/nip/publications/vis/default.htm An updated fact
sheet for healthcare workers is available at
http://www.cdc.gov/nip/vacsafe/concerns/gbs/menactra.htm CDC continues
to recommend that healthcare workers and any other persons aware of adverse
events associated with MCV4 or any other vaccination report to VAERS cases
of GBS or any other clinically significant adverse events. Reports may be
submitted securely online at
http://www.vaers.hhs.gov or by fax at (877) 721-0366. Reporting forms
and additional information [are] available [by] telephone, (800) 822-7967.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5513.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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April 10, 2006
HANDOUTS AND RECORDINGS OF NIC SESSIONS NOW AVAILABLE ONLINE
[The following is cross posted with thanks from the April 2006 issue of
CDC's Immunization Works electronic newsletter. It is a portion of the
article titled "Record Attendance at 40th NIC." To access the complete
article, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200604.htm#other]
Handouts and audio/video recordings from the 40th NIC are now available
online. To obtain handouts and audio/video recordings, please visit the NIC
website http://www.cdc.gov/nip/NIC,
scroll down to "Conference Recordings and Slides," and click "Go." Handouts
and audio/video recordings can be accessed by searching with key words or by
scrolling through the NIC program and selecting a specific plenary or
workshop session. If available, the audio and/or handout for a specific
presentation can then be selected. Also, conference participants can receive
Continuing Education (CE) credits for participation until April 13, 2006.
Please visit
http://www.cdc.gov/nip/NIC/40th/cestatements.htm for CE information. . .
.
[IAC editor's note: Following are direct links to recordings of three
notable presentations:
"Maurice Hilleman: His Extraordinary Life and Work," the Jeryl Lynn Hilleman
Endowed Lecture delivered by Paul A. Offit, MD, chief, Division of
Infectious Diseases, Children's Hospital of Philadelphia, and professor of
pediatrics and Maurice R. Hilleman Professor of Vaccinology, University of
Pennsylvania School of Medicine. To access this presentation, go to:
http://cdc.confex.com/cdc/nic2006/techprogram/P12005.HTM
"Fifteen Years of Successful Immunization Partnerships, the Successes and
the Challenges that Remain," a speech at the closing plenary session
delivered by Rosalynn Carter, former First Lady of the United States. To
access this presentation, go to:
http://cdc.confex.com/cdc/nic2006/techprogram/P12037.HTM
"Fifteen Years of Successful Immunization Partnerships, the Successes and
the Challenges that Remain: Comments," a speech at the closing plenary
session delivered by Betty Bumpers, former First Lady of Arkansas. To access
this presentation, go to:
http://cdc.confex.com/cdc/nic2006/techprogram/P11758.HTM]
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April 10, 2006
APRIL ISSUE OF IMMUNIZATION WORKS SUMMARIZES INFORMATION ABOUT NIP
REORGANIZATION AND NAME CHANGE
[The following is cross posted with thanks from the April 2006 issue of
CDC's Immunization Works electronic newsletter.]
NIP HAS NEW NAME, NEW MISSION
In April 2006, the National Immunization Program (NIP) will become the
proposed National Center for Immunization and Respiratory Diseases (NCIRD),
to be housed in CDC's Coordinating Center for Infectious Diseases (CCID).
NCIRD will be led by Anne Schuchat, MD, who currently serves as NIP's
Director. NCIRD's proposed mission will be to prevent disease, disability,
and death through immunization and by control of respiratory and related
diseases. The new center will support both domestic and global immunization
and respiratory disease prevention and control priorities, and will link
epidemiology and laboratory science around vaccine-preventable diseases and
acute respiratory infections with prevention and control programs and strong
communication science.
As shown here (http://www.cdc.gov/nip/webutil/about/divisions/NCIRDorg.htm),
NCIRD will contain five divisions:
-
Immunization Services Division (ISD)
-
Global Immunization Division (GID)
-
Division of Bacterial Diseases (DBD)
-
Division of Viral Diseases (DVD)
-
Influenza Division (ID)
ISD and GID will retain similar structures and functions in NCIRD as they
had in NIP. Functions from NIP's Epidemiology and Surveillance Division (ESD)
will be relocated into NCIRD's three new divisions: ID, DVD, and DBD.
NCIRD will strive to work closely with partners to provide a key focus for
vaccine-preventable disease and immunization program issues. NCIRD will also
work within CDC to synthesize vaccine-related information from other parts
of CDC with immunization expertise.
NCIRD will not be responsible for all vaccine-preventable disease functions
nor all respiratory infectious disease functions. For example, the Division
of Viral Hepatitis (DVH)— which is now part of CDC's National Center for
Infectious Diseases (NCID)— will be moved into the National Center for HIV,
Viral Hepatitis, STDs, and Tuberculosis Prevention (NCHHSTP). Like NCIRD,
NCHHSTP will be housed in CDC's Coordinating Center for Infectious Diseases
(CCID). DVH will have primary responsibilities concerning hepatitis A and
hepatitis B, and will retain subject matter experts for these diseases.
However, DVH will work in collaboration with ISD to provide program support
to state immunization partners on issues concerning hepatitis A and
hepatitis B.
As always, working with partners will remain a high priority for
immunization staff at CDC. Future updates about NCIRD and other CDC
organizational changes will continue to be shared with immunization partners
through this publication.
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April 10, 2006
NEW: APRIL ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER NOW
AVAILABLE ONLINE
The April 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 April issue has already appeared in
previous issues of IAC Express or is covered separately in this issue.
Following is the text of two articles we have not covered.
************************
Meetings, Conferences, and Resources
NIP 2006 ANNUAL REPORT: The 2006 National Immunization Program (NIP)
Annual Report, entitled A Global Commitment to Lifelong Protection through
Immunization, has been posted to the CDC website. The report can be viewed
or printed from
http://www.cdc.gov/nip/webutil/about/annual-rpts/ar2006/2006annual-rpt.htm
A hard copy of the report can be ordered from the NIP Immunization
Educational and Training Materials order form, which can be found at
https://www2.cdc.gov/nchstp_od/PIWeb/niporderform.asp The 2006 NIP
Annual Report is listed under "Publications for Healthcare Providers."
************************
CDC NEEDS PILOT TESTERS: CDC has an ongoing need for volunteers to pilot
test immunization training courses. Volunteers are particularly needed in
the following occupations: physicians, pharmacists, health educators,
medical assistants, and nurses. To learn more about becoming a pilot
tester, please send an email to
nippilot@cdc.gov
************************
To access the complete April issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200604.htm
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April 10, 2006
MMWR PUBLISHES REPORT ON THE CURRENT MUMPS EPIDEMIC IN IOWA
CDC published "Mumps Epidemic—Iowa, 2006" in the April 7 issue of MMWR.
Previously, the article was available only in electronic format as an "MMWR
Dispatch."
To access a web-text (HTML) version of the MMWR article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5513a3.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5513.pdf
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April 10, 2006
AVIAN INFLUENZA COVERED EXTENSIVELY ON THE WEBSITES OF CDC, NIAID, AND WHO
Recently, CDC, NIAID (National Institute of Allergy and Infectious
Diseases), and WHO have updated their websites with information pertinent
to the current worldwide avian influenza situation.
1. CDC
CDC posted new information to its Influenza web section about the status
of human cases reported in Egypt and animal cases reported in the United
Kingdom and Czech Republic.
New
* Avian influenza update: Egypt (posted 4/4/06)
To access this resource, go to:
http://www.cdc.gov/flu/whatsnew.htm#new and click on the pertinent
link.
Updated
* Avian influenza: Current Situation [United Kingdom] (posted 4/7/06)
* Questions & answers about avian influenza (bird flu) & avian influenza
virus (posted 4/7/06)
* Recommendations for using antiviral agents for influenza (posted 4/4/06)
* Avian influenza: Current situation [Czech Republic] (posted 4/4/06)
* Avian influenza: Current situation [Egypt] (posted 4/3/06)
To access these resources, go to:
http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent
links.
To access a broad range of continually updated information on seasonal
influenza, avian influenza, and pandemic influenza, go to:
http://www.cdc.gov/flu
2. NIAID
On March 29, NIAID issued a press release, "H5N1 avian flu virus vaccine
induces immune responses in healthy adults." To access the press release,
go to:
http://www3.niaid.nih.gov/news/newsreleases/2006/avianvax3_06.htm
3. WHO
The April 7 issue of the WHO publication Weekly Epidemiological Record
included a comprehensive article titled "Avian influenza fact sheet." The
article discusses the following: (1) the disease in birds, (2) the role of
migratory birds, (3) countries affected by outbreaks in birds, (4) the
disease in humans, and (5) countries with human cases in the current
outbreak. To access the April 7 issue, go to:
http://www.who.int/wer/2006/wer8114/en/index.html
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April 10, 2006
REMINDER: REGISTER SOON FOR THE APRIL 20 ROTAVIRUS NET CONFERENCE
[The following is cross posted with thanks from the April 2006 issue of
CDC's Immunization Works electronic newsletter.]
ROTAVIRUS NET CONFERENCE: CDC will present a live net conference on April
20 from noon to 1:00 PM ET concerning (1) rotavirus general
recommendations (timing and spacing of immunobiologics and altered
immunocompetence) and (2) rotavirus vaccine recommendations. Part of the
Current Issues in Immunization series, this net conference is designed to
provide clinicians with the most up-to-date information on immunization
issues. It will combine a telephone audio conference and simultaneous
online visual content, and participants can join the Q&A session by
telephone or Internet. Instructions and system requirements can be found
at
http://www.cdc.gov/nip/ed/ciinc/instructions.htm Please note that
space is limited, and registration is required. Registration will close
when the course is full or on April 17 (midnight ET). To register, please
visit
http://www2.cdc.gov/nip/isd/ciinc
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April 10, 2006
PUBLIC HEALTH AND THE LAW IN THE 21ST CENTURY CONFERENCE SCHEDULED FOR
JUNE 12-14 IN ATLANTA
Scheduled for June 12-14, the conference the Public Health and the Law in
the 21st Century will be held in Atlanta. The conference will offer
sessions on (1) legal preparedness for avian influenza and natural
disasters and (2) the policy issues and legal frameworks surrounding
vaccine safety.
The early-bird registration deadline is May 20. For comprehensive
information on the conference, go to:
http://www2a.cdc.gov/phlp/conference2006.asp |
