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Issue Number 228            February 16, 2001


  1. CDC releases report on effects of the 1999 AAP/USPHS Joint Statement on Thimerosal in Vaccines
  2. Express your support for "ER" measles episode
  3. New! Quick Links on IAC's website
  4. CDC notifies public on risk for meningococcal disease associated with the Hajj pilgrimage


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February 16, 2001

The Centers for Disease Control and Prevention (CDC) published "Impact of the 1999 AAP/USPHS Joint Statement on Thimerosal in Vaccines on Infant Hepatitis B Vaccination Practices" in the February 16, 2001, issue of Morbidity and Mortality Weekly Report (MMWR).

The article reports that the 1999 statements by the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (USPHS) that recommended reducing infant exposure to thimerosal led to rapid changes in routine perinatal hepatitis B virus infection prevention practices.

Public health officials in Wisconsin, Oklahoma, Oregon, and Michigan reviewed the effects of the policy recommendations. The MMWR article states that "many hospitals in Wisconsin have not reinstated policies to ensure routine administration of hepatitis B vaccine to newborns despite the availability of preservative-free hepatitis B vaccine, that the number of hepatitis B vaccine doses given to newborns in Oklahoma and Oregon has declined, and that an unvaccinated Michigan infant died from fulminant hepatitis B."

The Editorial Note reads in part:


AAP and PHS advocate the reintroduction of routine hepatitis B vaccination policies for all newborn infants born in hospitals in which this practice was discontinued because of concerns about thimerosal. After administering a dose at birth, providers may complete the series with either 2 more doses of single antigen hepatitis B vaccine or with 3 doses of combination Haemophilus influenzae type b/hepatitis B vaccine according to previously recommended schedules. All birthing hospitals should have hepatitis B vaccine available for use in infants born to HBsAg-positive and unscreened women. Hospitals should continue to vaccinate all infants at birth until procedures are in place to guarantee that 1) the HBsAg status of every pregnant woman is available and reviewed at delivery, 2) appropriate passive-active immunoprophylaxis (HBIG and hepatitis B vaccine) is provided for infants of HBsAg-positive women within 12 hours of birth, and 3) appropriate active immunoprophylaxis (hepatitis B vaccine) is provided for infants of women with an unknown HBsAg status. Pregnant women who are identified as HBsAg-positive should be reported to local or state health departments to ensure that their infants, family, and household contacts receive a full hepatitis B vaccination series.

Vaccination practices are influenced substantially by recommendations of professional and government advisory groups. The 1999 joint statement and the subsequent AAP guidelines were issued as a precautionary measure and were intended to apply only to infants born to HBsAg-negative women. The inadvertent effect in many hospitals was a persisting change in policies for administering hepatitis B vaccine to infants, most importantly to infants born to HBsAg-positive and unscreened women for whom no changes in vaccination practices had been recommended. Changes in established recommendations, especially if they occur without timely communication and education of health-care providers, may result in misinterpretation and unanticipated changes in vaccination practices.


For the complete text of the article online, including tables and references, go to:

For information on how to obtain a free electronic subscription to the MMWR, see the information following story four below.

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February 16, 2001

The February 15, 2001, episode of "ER" portrayed an unvaccinated four-year-old boy who died of measles complications after he contracted the disease in France.

Some groups opposed to vaccination have started a campaign to voice their disapproval with the storyline to NBC.

If you would like to express your appreciation for NBC's willingness to depict a look at the dangers of vaccine-preventable diseases, fill out the feedback form on the NBC website at:
You can also call NBC's viewer comment line at (212) 664-2333, or write a letter to NBC, Viewer Relations--ER, 30 Rockefeller Plaza, New York, NY 10112.

Additional information on measles can be found on the website of the National Immunization Program at

For information on the importance of vaccination, check out "What Would Happen If We Stopped Vaccinations?" on IAC's website:

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February 16, 2001

Find the information you want more easily on the website of the Immunization Action Coalition (IAC)! We've added "IAC Quick Links" to the left-hand navigation bar on our home page so that you can find quick and easy-to-remember links to our most popular features, including NEEDLE TIPS, VACCINATE ADULTS, IAC EXPRESS, VISs, and more. Visit:

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February 16, 2001

CDC published a Notice to Readers titled "Risk for Meningococcal Disease Associated With the Hajj 2001" in the February 16, 2001, issue of MMWR.

The report notes that during the March 2000 Hajj pilgrimage, Saudi Arabian health officials identified an outbreak of meningococcal disease. Four cases of meningococcal disease were subsequently identified among the estimated 15,000 pilgrims returning to the United States, their close contacts, and community.

The article notes that after a meningococcal outbreak in 1987, the Saudi government required all pilgrims to receive the meningococcal polysaccharide vaccine. CDC warns that the vaccine does not prevent people from carrying the bacteria asymptomatically. Because of this, CDC is planning to evaluate asymptomatic carriage of the bacteria among a set of pilgrims returning from the Hajj.

The results of this evaluation and any recommendations will be posted on CDC's website at when they become available. Information also will be available by telephone, (888) 232-3228.

For the complete text of the article online, go to:

HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR: To obtain a free electronic subscription to MMWR, visit CDC's MMWR website at: 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 arrive automatically by e-mail. 

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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