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Issue 1050: April 9, 2013








CDC provides information regarding human infection with novel avian influenza A(H7N9) virus in China
On April 5, CDC's Health Alert Network (HAN) issued an official CDC Health Advisory titled Human Infections with Novel Influenza A(H7N9) Viruses. The advisory provides interim recommendations for state and local health departments and clinician guidance for case investigation and testing, infection control, and treatment.

Also on April 5, CDC held a media telebriefing titled H7N9 Influenza Cases. The presenters were CDC Director Thomas Frieden, MD, MPH, and Joseph Bresee, MD, chief, Epidemiology and Prevention Branch, Influenza Division, NCIRD. Three paragraphs of Dr. Frieden's remarks are reprinted below.

As of April 5th, 2013, Chinese public health officials have reported 16 cases of human infection with a novel avian influenza A, which is called the H7N9 virus, from four different provinces in China. Patients were hospitalized and six of them have died. These are the first human infections with this particular strain of H7N9 that have been identified. 15 of the cases are among adults ages 27 to 87. The one child is age 4 and apparently had mild illness. All cases had onset between February 19th and March 31st, 2013. There has been no person-to-person transmission and no epidemiologic link between any of the cases so far. There are two families where there was illness in a family around the time of a confirmed case and those two family situations are being investigated by Chinese authorities to see if there was person-to-person transmission in those cases. I would say that with other avian influenza strains we sometimes see limited person-to-person transmission within the close contact of a family or health care but only one generation of spread or two generations of spread, not multiple generations of spread. So when we speak of person-to-person transmission, we really are looking at whether it's spreading widely. 

Now, at this point, we are—there are several things that give us some confidence that it's not spreading widely from person to person. One is that more than 100 contacts have been assessed and monitored by Chinese public health authorities and none of them have developed illness. In contrast, in influenza, you would expect at least 20 to 30 percent of family members to develop illness. So the fact that there are that many contacts and no illness has been identified is encouraging. In addition, many or perhaps most of the cases in the investigations are still ongoing have direct contact with live poultry. We also have reports from the Chinese Agricultural Authority that there are positive cultures for a similar strain of H7N9 from both chickens and pigeons and that further testing is under way. At this time, no cases of human infection with avian influenza A H7N9 have been detected in the United States. 

CDC is working to address this situation as part of a coordinated international effort. First, today we issued a health advisory to inform clinicians and public health specialists throughout the U.S. of what is happening and what they should do if they have a suspected case in a traveler who is returning from China, what they should do in terms of testing, infection control, and care. We also have developed a test currently being used at CDC so that we can test specimens from travelers returning from China who have severe illness that might be this influenza and determine whether or not they have it. We will be taking further steps to develop a diagnostic test kit that we can send to states throughout the U.S. and to China so that we can have rapid diagnosis of infections going forward. The information coming out of China suggests that the virus is susceptible to two of the main antiviral agents we use, Oseltamivir and Zanamivir and we will be confirming that in the coming days, but that's what it looks like. Throughout the U.S. government and with pharmaceutical companies, the vaccine manufacturers out of an abundance of caution were developing a candidate virus that could be used to produce a vaccine if one is needed. This would only be produced if there were evidence of widespread transmission from person-to-person. That's not something that we are seeing at this time. We are not issuing any formal travel advisories. As I said earlier, a source for these infections has not been identified but we do know that the Chinese health authorities are starting to cull birds in live markets as a precautionary step and for about a decade we've already recommended to people in China to Americans traveling in China to avoid contact with birds and other animals. That's been in place since both SARS and the spread of another strain of influenza called H5 nearly a decade ago.

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IAC Spotlight! Reminder to consider using IAC’s newest educational materials for patients and staff
To help healthcare professionals carry out their immunization activities, IAC wants to remind you that in the past year we have created several handouts for patients and educational materials for staff. Please review them to see if they might be of help to you in your clinic setting.
  1. Pneumococcal Vaccination Recommendations for Children and Adults by Age and/or Risk Factor
  2. Vaccinations for Adults with Diabetes
  3. Vaccinations for infants and Children, Age 0-10 Years
  4. Vaccinations for Preteens and Teens, Age 11-19 Years
  5. Cocooning Protects Babies
  6. Influenza Vaccination of People with a History of Egg Allergy
  7. Meningococcal Vaccination Recommendations by Age and/or Risk Factor
  8. Current Dates of Vaccine Information Statements (VISs)
  9. Tips for Locating Old Immunization Records
  10. Decision to Not Vaccinate My Child
  11. How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines
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CDC publishes two corrections to the U.S. immunization schedule for children and teens age 0 through 18 years
CDC published Errata: Vol. 62, Suppl 1 in the April 5 issue of MMWR (page 256). The correction is reprinted below.

In the MMWR supplement, "Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 Years and Adults Aged 19 Years and Older—United States, 2013," on page 7, in the third bulleted item under footnote 13, the text should read, "For children aged 2 months through 10 years with high-risk conditions, see below." On page 8, under Additional Vaccine Information, in the fourth bulleted item, the last reference should read, "American Academy of Pediatrics. Immunization in Special Clinical Circumstances. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red book: 2012 report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics."

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Coming later in April: National Infant Immunization Week and World Immunization Week
The following article is cross posted from the March issue of CDC's monthly newsletter Immunization Works.

NIIW 2013: National Infant Immunization Week (NIIW) is set for April 20–27, 2013. NIIW is an annual observance to promote the benefits of immunizations and to improve the health of children younger than two years old. Since 1994, local and state health departments, national immunization partners, health care professionals, community leaders from across the United States, and CDC have worked together through NIIW to highlight the positive impact of vaccination on the lives of infants and children, and to call attention to immunization achievements. NIIW will be celebrated as part of World Immunization Week (WIW), an initiative of the World Health Organization (WHO) scheduled for April 24–30, 2013. During WIW, all six WHO regions, including more than 180 Member States, territories, and areas, will simultaneously promote immunization, advance equity in the use of vaccines and universal access to vaccination services, and enable cooperation on cross-border immunization activities. Please visit the NIIW website for additional information.

With NIIW right around the corner, you can access CDC’s newest materials to help you promote infant immunizations in your communities. While these pieces are designed to be “evergreen” so that you can use them throughout the year, consider utilizing them during NIIW by asking your local newspapers to publish the print ads and drop-in articles, or your partners to use the materials in their newsletters. You can view and download the new video PSAs, print ads, web buttons, and more from the NIIW website.

Also, see what others are planning for NIIW, and share your activities through the NIIW activity registry.

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April is STD Awareness Month
CDC published Announcement: STD Awareness Month—April 2013 in the April 5 issue of MMWR (page 256). The first paragraph of the article is reprinted below.

April is STD Awareness Month, an annual event calling attention to the impact of sexually transmitted diseases (STDs) in the United States. This month-long observance provides individuals, doctors, and community-based organizations an opportunity to address ways to prevent some of nearly 20 million new cases of STDs that occur in the United States each year, costing the U.S. health-care system nearly $16 billion in direct medical costs, and placing a substantial human and economic burden on the nation.

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IAC updates "It's Federal Law!" and "Current Dates of Vaccine Information Statements (VISs)"
IAC recently updated It's Federal Law! You must give your patients current Vaccine Information Statement (VISs) and Current Dates of Vaccine Information Statements (VISs). They  now include the issue date of the most recent version of the VIS for pneumococcal conjugate vaccine (PCV13), which CDC issued on February 27.

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IAC updates "Immunizations for Babies"; Spanish, French, and Turkish translations are available
IAC recently reviewed the patient schedule titled Immunizations for Babies: A Guide for Parents—These are the vaccinations your baby needs! IAC made minor changes to the piece.

The current version of this patient schedule is available in Spanish, in French, and in Turkish. IAC thanks Mustafa Kozanoglu, MD, for the Turkish translation.

IAC offers patient schedules for people of all ages in many additional languages, including Arabic, Chinese, Korean, Russian, and Vietnamese.

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VIS for PCV13 now available in Armenian, Cambodian, Farsi, Hmong, Korean, and Tagalog
IAC recently posted translations of CDC's newly released VIS for pneumococcal conjugate vaccine (PCV13) in Armenian, Cambodian, Farsi (spoken in Bahrain, United Arab Emirates, Iran), Hmong, Korean, and Tagalog. IAC thanks the Immunization Branch of the California Department of Health for the translations.

Important note: CDC's Note to Providers has additional information about the PCV13 vaccine, including guidance on precautions and contraindications and links to appropriate ACIP recommendations.
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HPV articles educate minority women and parents of preteens about cervical cancer and importance of HPV vaccination
CDC recently posted formatted articles about preventing cervical cancer and increasing the human papillomavirus (HPV) vaccination rate in African-American and Hispanic women. An additional formatted article is available for the parents of preteens.

The articles discuss diseases associated with HPV infection, including cervical cancer, and encourage HPV vaccination. The need for these formatted articles is substantial. Hispanic women have the highest rate of cervical cancer in the United States, and cervical cancer rates are higher among African-American women than among their white counterparts. Data from the 2011 National Immunization Survey of teen vaccination show that only 34.8 percent of teenage girls age 13–17 have received the complete 3-dose series of HPV vaccinations. Only 1 percent of boys have. 

CDC's formatted articles are free and ready-to-print. They can be easily dropped into newsletters, handed out at health fairs, and posted on websites. CDC encourages their wide distribution.

Links to HPV formatted articles
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Influenza is serious; vaccination is recommended for nearly everyone, so please keep vaccinating your patients
Vaccination remains the single most effective means of preventing influenza. Vaccination is recommended for everyone age 6 months and older, so please continue to vaccinate your patients. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

If you are seeking influenza vaccine for your clinic, check the Influenza Vaccine Availability Tracking System (IVATS), which is a resource for healthcare settings looking to purchase influenza vaccine. The IVATS chart contains information from approved, enrolled, and participating wholesale vaccine distributors or manufacturers of U.S. licensed influenza vaccine. Information is updated on an ongoing basis.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public.
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March issue of CDC's Immunization Works newsletter now available
CDC recently released the March issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

The March issue contains a great deal of useful, timely information. Be sure to read through all four sections: Top Stories, Influenza Information, Meetings and Conferences, and Resources and Information.
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Epidemiology & Prevention of Vaccine-Preventable Diseases course planned for June 12–13 in Omaha
In celebration of the tenth anniversary of the Immunize Nebraska conference, conference organizers have arranged to bring CDC's Epidemiology and Prevention of Vaccine-Preventable Diseases course to Omaha on June 12–13. The conference will also include an update on information specific to Nebraska.

Presented by the Centers for Disease Control and Prevention, this live two-day course provides a comprehensive review of immunizations and of vaccine-preventable diseases and their respective vaccines. Physicians, nurses, pharmacists, medical assistants, students, and other health professionals will learn the most up-to-date immunization information from ACIP. Continuing education credits are available.

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Archived video broadcast and slide sets from the February 2013 ACIP meeting now available
ACIP recently posted the archived video broadcast and the slide sets presented at the ACIP meeting held on February 20–21, 2013.

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About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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