Issue Number 124            November 1, 1999


  1. CDC publishes progress report on influenza and pneumococcal vaccination rates among persons with diabetes mellitus
  2. CDC publishes report on public health response to a potentially rabid bear cub
  3. CDC publishes article on polio eradication efforts in Myanmar
  4. Discount starts today! Order the 6th edition of the "Pink Book" at a reduced price until December 31, 1999


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October 29,1999

The Centers for Disease Control and Prevention (CDC) published an article titled "Influenza and Pneumococcal Vaccination Rates Among Persons with Diabetes Mellitus -- United States, 1997" in the October 29, 1999, issue of the  MMWR.

According to this article's introductory paragraph, "A national health objective for 2000 is to increase influenza and pneumococcal vaccination rates to greater than or equal to 60% among persons at high risk for complications from influenza and pneumonia, including persons with diabetes." This MMWR article reports on data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS) which indicates "most states did not reach the national health objectives for influenza and pneumococcal vaccination in their  populations with diabetes." 

The "Editorial Note" states in part: "The findings indicate that many patients and providers may not be aware of the ACIP (Advisory Committee on Immunization Practices) guidelines for persons with diabetes. Increased efforts are necessary to heighten awareness of the need for increased vaccination and to improve routine use of vaccination among persons of all  ages with diabetes. These efforts should include incorporating recommendations for influenza and pneumococcal vaccinations into standard-of-care guidelines for persons with diabetes."

"...Among adults with diabetes, 52.1% reported receiving influenza vaccine during the previous 12 months, and 33.2% reported ever receiving pneumococcal vaccine. Non-Hispanic whites were significantly more likely to report receiving influenza and pneumococcal vaccines (56.6% and 38.8%,  respectively) than non-Hispanic blacks (48.1% and 24.9%, respectively) and Hispanics (41.0% and 20.9%, respectively)."

"...The findings that Hispanics and non-Hispanic blacks had lower vaccination rates than non-Hispanic whites are consistent with the 1993 examination of vaccination rates among persons with diabetes. These disparities may result  from differences in access to vaccination services across these groups, differences in the quality of care received by different racial/ethnic groups, or social and cultural factors that impact vaccine acceptance. These disparities  must be investigated further to improve vaccination rates in these populations."

"...In 1998, to improve vaccination rates among persons with diabetes, CDC implemented the Diabetes Flu/Pneumococcal Campaign entitled 'Diabetes. One Disease. Many Risks.' Through state-based diabetes-control programs, the campaign encourages persons with diabetes to receive influenza and pneumococcal vaccinations... Because persons with diabetes report a high rate of routine medical care, these interventions can have a large impact on improving vaccination rates. Interventions that include standing orders for vaccination, using provider and patient recalls and reminders, and feedback on vaccination levels have been shown to be effective in increasing vaccination rates. In addition, opportunities for vaccination outside of traditional health-care settings should be extended to persons with diabetes who routinely do not have access to traditional health-care facilities. Additional information about the Diabetes Flu/Pneumococcal Campaign is available from the  World-Wide Web at (link discontinued) and ."

To obtain the text version (HTML format) of this MMWR article which includes a table of state-by-state immunization data, go to:

For more information on the "racial/ethnic disparities initiative" organized by CDC and other federal agencies which includes elimination of racial/ethnic health disparities in vaccination rates by 2010, visit: (link discontinued) and

To read the April 1999 ACIP statement on influenza (in HTML format), go to:

To obtain the April 1997 ACIP statement on pneumococcal (in HTML format), go to:

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article three below.

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October 29, 1999

The Centers for Disease Control and Prevention (CDC) published an article titled "Public Health Response to a Potentially Rabid Bear Cub -- Iowa, 1999" in the October 29, 1999, issue of the MMWR. The article begins:

"On August 27, 1999, a 5-6 month-old black bear cub in a petting zoo in Clermont, Iowa, died after developing acute central nervous system signs; the initial direct fluorescent-antibody (DFA) test results available on August 28 indicated the bear had rabies. On August 29, in response to the positive laboratory report, the Iowa Department of Public Health (IDPH) initiated a campaign to identify and inform persons potentially exposed to the bear's saliva. Within 72 hours, IDPH staff verified contact and exposure information for approximately 350 persons. Subsequent testing found no evidence of rabies virus in brain or spinal cord tissues."

The "Editorial Note" includes the following information: "The false-positive test result for rabies in a bear in Iowa affords an opportunity to review testing procedures and protocols for rabies virus infection, the public health record in the United States resulting from these procedures and protocols, and recommendations for handling inconsistent test results."

To obtain the complete text version (HTML format) of this MMWR article, go to:

For information on how to obtain a free electronic subscription to the MMWR, see the instructions that follow article three below.

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October 29, 1999

The Centers for Disease Control and Prevention (CDC) published an article titled "Progress Toward Poliomyelitis Eradication -- Myanmar, 1996-1999" in the October 29, 1999, issue of the MMWR. The "Editorial note" reads in part:

"In 1999, Myanmar, situated between countries with endemic polio (India and Bangladesh) and polio-free countries (China, Laos, and Thailand), has confirmed four cases of polio based on isolation of wild poliovirus type 1. This is the first evidence of ongoing transmission of wild poliovirus since 1996. All AFP (acute flaccid paralysis) cases with wild poliovirus isolation occurred  in persons who resided in areas adjacent to the Bangladesh border, illustrating the importance of border areas in polio eradication activities and the  continuing vulnerability of countries to a resurgence of polio unless eradication strategies are fully implemented and sustained."

To obtain the full text version (HTML format) of this MMWR article, go to:

HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR To obtain a free electronic subscription to the MMWR (delivered weekly), visit CDC's MMWR website listed below. 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 automatically arrive in your e-mail box. To go to the MMWR website, visit:

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November 1, 1999

The 6th edition of "Epidemiology and Prevention of Vaccine-Preventable Diseases" (also referred to as the "Pink Book") from the Centers for Disease Control and Prevention (CDC) will be available in mid-March 2000. Cost of the "Pink Book" is $25, but place an early order before December 31, 1999, and  pay only $20 per copy!

The Public Health Foundation (PHF) will begin taking pre-publication orders on November 1, 1999. CDC's definitive written guide to vaccines and immunization information, the "Pink Book" is an easy-to-read, quick reference for busy clinics and health care offices. The book is also used to support the National Immunization Program's training courses on epidemiology and prevention of vaccine-preventable diseases via satellite.

In addition to the discounted price described above, large-quantity orders of 250 copies or more will be further discounted by 25%. With the double discount, state and local health agencies (and anyone else who wishes to order in bulk) can pre-order copies of the "Pink Book" for just $15 per copy.

To order the "Pink Book," call PHF at (877) 252-1200 or (800) 41-TRAIN between 9:00 am - 5:00 pm ET. You can also fax purchase orders and credit card orders to (301) 843-0159 or send an e-mail with payment information to:

Individuals calling from outside the United States should call (301) 645-7773.

If you are not familiar with the "Pink Book," then check it out! The 5th edition is not available online, but chapters from the 4th edition are easily accessible at:

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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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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