249 May 25, 2001
CONTENTS OF THIS ISSUE
- CDC seeks assistance from health professionals in
implementing ACIP recommendations for influenza vaccine
- CDC announces deferral of routine booster doses of
tetanus and diphtheria toxoids for adolescents and adults
- GAO issues report on flu vaccine and the need to ensure
access for those at high risk for influenza
- Abstract deadline for the ICC Symposium on Minorities,
the Medically Underserved, and Cancer is June 15
- CDC issues erratum to article on syringe exchange
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May 25, 2001
CDC SEEKS ASSISTANCE FROM HEALTH PROFESSIONALS IN IMPLEMENTING ACIP RECOMMENDATIONS FOR INFLUENZA VACCINE
On May 18, 2001, Walter A. Orenstein, MD, Assistant Surgeon General and Director of the National Immunization Program of
the Centers for Disease Control and Prevention (CDC), issued a letter seeking assistance from health
care providers in implementing the recommendations of the Advisory Committee
on Immunization Practices (ACIP) for the upcoming influenza season. His letter, along with its list of groups that
should be targeted for influenza vaccination, is reprinted here in its entirety.
May 18, 2001
Dear Health Care Provider:
The Centers for Disease Control and Prevention (CDC) is asking your assistance in implementing the recommendations
of the Advisory Committee on Immunization Practices (ACIP) for influenza vaccination. During the
2000-2001 influenza season, manufacturing problems resulted in a significant
delay of influenza vaccine availability. This delay was due to a combination of
factors including problems some manufacturers had in growing one of the virus strains used
in vaccine and problems two manufacturers had with good manufacturing practices. Ultimately, one manufacturer
withdrew from the market and did not distribute any vaccine. To make up for possible shortfalls
of influenza vaccine, CDC contracted with one manufacturer to extend their production
period and produce up to 9 million doses of additional influenza vaccine that was available in December 2000. As a
result, flu vaccine supplies were approximately what was distributed in prior years; however, a substantial
amount of vaccine reached providers much later than usual.
Because influenza vaccine is newly produced for each influenza season, numerous factors may affect the
manufacturers' vaccine production and distribution. If some manufacturers are delayed in getting their vaccine to the
providers, there will be uneven distribution of the vaccine with providers who
ordered from some manufacturers receiving vaccine later than providers who ordered from other
manufacturers. Further, providers who order late may receive vaccine late. Providers who order from third party
distributors will be dependent upon which manufacturer is supplying that distributor.
Manufacturers' current projections indicate that influenza vaccine supply should be
similar to prior seasons. However, we will not know for certain until substantially later this year as manufacturers
gain experience with production of this year's viral strains. Therefore, WE ASK YOU TO DEVELOP
CONTINGENCY PLANS NOW SO IMMUNIZATION EFFORTS ARE BETTER TARGETED TO IMMUNIZE
THOSE AT HIGHEST RISK FIRST, IN THE EVENT A DELAY OR SHORTAGE OCCURS.
In preparation for this year's influenza season, CDC STRONGLY ENCOURAGES THOSE OF YOU WITH HIGH-RISK PATIENTS TO
ORDER VACCINE NOW, rather than waiting to order later in the spring, summer, or
fall. Ordering now will help manufacturers and distributors gauge demand and
improve the opportunity to immunize high-risk individuals as early in the season as possible.
CDC published the ACIP recommendations, "Prevention and Control of Influenza," in the April 20, 2001, Morbidity and
Mortality Weekly Report (MMWR). (The MMWR can be found at www.cdc.gov.) Enclosed is a listing of
individuals recommended to receive influenza vaccine.
An important change in the ACIP recommendations is to extend the optimal time for vaccinating high-risk individuals from
mid-November to the end of November. In addition, ACIP recommends that efforts should continue to
vaccinate individuals through December and later, even if influenza is occurring in the community. During 19 influenza seasons from
1982 to 2000, influenza peaked in January or later in 15 seasons and in February or later in
10. This indicates administration of vaccine in December or even January should
have an impact in most influenza seasons.
The ACIP recommendations also suggest that persons planning substantial organized vaccination campaigns consider
scheduling these events after mid-October, to minimize the need for cancellations because vaccine is
unavailable. We would also ask that employee-based campaigns, which primarily immunize a healthy, younger population, consider
postponing their campaigns even later, particularly if there is a significant delay or shortage of
vaccine, so that high-risk individuals may be immunized first.
CDC will continue to work closely with the FDA, vaccine manufacturers, State
and local health officials, and other partners to share information regarding
the influenza vaccine supply as it becomes available. We appreciate your efforts to maximize influenza vaccine to prevent influenza
Walter A. Orenstein, MD
Assistant Surgeon General
National Immunization Program
[ACIP RECOMMENDS THE FOLLOWING TARGETING STRATEGY FOR THE
2001-2002 INFLUENZA SEASON]
TARGET GROUPS FOR VACCINATION
Persons at Increased Risk For Complications
- persons aged > 65 years;
- residents of nursing homes and other chronic-care
facilities that house persons of any age who have chronic medical conditions;
- adults and children who have chronic disorders of the
pulmonary or cardiovascular systems, including asthma;
- adults and children who have required medical follow-up or
hospitalization during the preceding year because of chronic metabolic
diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression
(including immunosuppression caused by medications or by human immunodeficiency virus);
- children and teenagers (aged 6 months to 18 years) who are
receiving long-term aspirin therapy and therefore might be at risk for developing
Reyes syndrome after influenza infection; and
- women who will be in the second or third trimester of
pregnancy during the influenza season.
Persons Aged 50-64 Years
Vaccination is recommended for persons aged 50-64 years because this group has an increased prevalence of persons
with high-risk conditions. Persons aged 50-64 years without high-risk conditions also receive benefit
from vaccination in the form of decreased rates of influenza illness, decreased work absenteeism, and decreased need for medical
visits and medication, including antibiotics.
Persons Who Can Transmit Influenza to Those at High Risk
- physicians, nurses, and other personnel in both hospital
and outpatient-care settings, including emergency response workers
- employees of nursing homes and chronic-care facilities who
have contact with patients or residents
- employees of assisted living and other residences for
persons in groups at risk
- persons who provide home care to persons in groups at high
- household members (including children) of persons in
groups at high risk
To read this letter and the list of groups to target for vaccination online in
camera-ready (PDF format), go to: http://www.immunize.org/news.d/flulettr.pdf
To obtain the April 20, 2001, ACIP statement for influenza, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5004a1.htm
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May 25, 2001
CDC ANNOUNCES DEFERRAL OF ROUTINE BOOSTER DOSES OF TETANUS AND DIPHTHERIA TOXOIDS FOR ADOLESCENTS AND ADULTS
CDC published a Notice to Readers titled "Deferral of Routine Booster Doses of Tetanus and Diphtheria Toxoids for
Adolescents and Adults" in the May 25, 2001, issue of Morbidity and Mortality Weekly Report (MMWR). The complete
notice is reprinted below:
A shortage of tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT) in
the United States has resulted because one of two manufacturers discontinued production of
tetanus toxoid-containing products. Aventis Pasteur (Swiftwater, Pennsylvania) is the only major manufacturer of
tetanus and Td in the United States. In response to the shortage, Aventis Pasteur has
increased production of Td to meet national needs; however, because 11 months are required
for vaccine production, the shortage is expected to last for the remainder of 2001. To assure vaccine availability for
priority indications, all routine Td boosters in adolescents and adults should be
delayed until 2002. Td use should follow existing recommendations for all other
indications, which include 1) persons traveling to a country where the risk for
diphtheria is high; 2) persons requiring tetanus vaccination for prophylaxis in
wound management; 3) persons who have received fewer than 3 doses of any vaccine
containing Td; and 4) pregnant women who have not been vaccinated with Td during the preceding 10 years.
CDC recommends that health-care providers, including clinic personnel, record the names of patients whose booster dose
is delayed during the shortage. When Td supplies are restored, these patients should be notified to
return to their health-care provider for vaccination. According to Aventis Pasteur, sufficient vaccine will be available in
early 2002 to supply the national demand.
Health-care providers using Td for wound management should follow recommendations from the Advisory Committee on
Immunization Practices for wound management. All wound patients should receive Td if they have
received fewer than 3 tetanus-containing vaccines or if vaccination history is
uncertain. These patients also should receive tetanus immune globulin for wounds that are contaminated with dirt, feces,
soil or saliva, puncture wounds, and avulsions and wounds resulting from missiles, crushing, burns or frostbite.
For persons with more than 3 doses of TT-containing vaccine and severe or contaminated wounds, Td should be given only if
more than 5 years have passed since the last dose of tetanus-containing vaccine. For clean and minor
wounds, Td should be given only if the patient has not received a tetanus-containing vaccine during the preceding 10 years.
Health-care providers should inquire from patients presenting for wound management
about the timing of their last tetanus-containing vaccine to avoid unnecessary
Pediatric formulations of diphtheria and tetanus toxoids (DT) and diphtheria
and tetanus toxoids and acellular pertussis vaccine (DTaP) should not be used
for persons aged 7 years or older. Although TT might be considered a substitute for Td in wound management when Td is not
available, TT is not available for national distribution. Existing stocks of TT are extremely limited
and are mainly reserved for production of tetanus immune globulin and other special circumstances.
Health-care providers and institutions requiring Td for priority indications
should contact Aventis Pasteur, telephone (800) 822-2463 or (800) VACCINE. Institutions
should place orders for their anticipated needs for priority indications only. Limiting quantities of vaccine in each
order is necessary to assure the widest possible distribution of available vaccine. For emergency
situations (e.g., natural disasters) requiring increased use of Td, Aventis Pasteur can provide vaccine within 24 hours.
To read the complete text of this notice online, go to: http://www.cdc.gov/mmwr//preview/mmwrhtml/mm5020a8.htm
To obtain a free email subscription to the MMWR, see the information following story five below.
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May 25, 2001
GAO ISSUES REPORT ON FLU VACCINE AND THE NEED TO ENSURE ACCESS FOR THOSE AT HIGH RISK FOR INFLUENZA
On May 15, 2001, the United States General Accounting Office (GAO) issued a report titled, "Flu Vaccine: Supply Problems
Heighten Need to Ensure Access for High-Risk People." At the request of Congress, GAO looked at the
production and distribution difficulties of influenza vaccine during the 2000-2001 flu season. The report explains how manufacturing
problems caused temporary shortages and spikes in price, how current distribution of
vaccine does not ensure priority to individuals at high risk for influenza, and
what initiatives the U.S. Department of Health and Human Services has underway to prepare for future vaccine delays and shortages.
To obtain a copy of the report, go to: http://www.gao.gov/cgi-bin/getrpt?rptno=GAO-01-624
or call GAO's Document Distribution Center at (202) 512-6000 and request a copy of report
number GAO-01-624 by mail.
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May 25, 2001
ABSTRACT DEADLINE FOR THE ICC SYMPOSIUM ON MINORITIES, THE MEDICALLY UNDERSERVED, AND CANCER IS JUNE 15
The Intercultural Cancer Council has issued a call for abstracts for its Biennial
Symposium on Minorities, the Medically Underserved, and Cancer. The abstract deadline is
June 15, and the symposium will take place February 6 to 10, 2002, at the Omni Shoreham Hotel in Washington, D.C.
Abstract and registration forms are available online at: http://iccnetwork.org/symposium
or call (713) 798-5383.
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May 25, 2001
CDC ISSUES ERRATUM TO ARTICLE ON SYRINGE EXCHANGE PROGRAMS
CDC published the following erratum in the May 25, 2001, issue of MMWR:
Vol. 50, No. 19
In the article, "Update: Syringe Exchange Programs--United States, 1998," on
page 387, an error occurred in the fourth sentence of the last paragraph. It
should read, "Assuring availability of sterile syringes for IDUs who continue to
inject is only one component of a comprehensive approach to HIV prevention for IDUs."
To read the complete text of this erratum online, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5020a9.htm
HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the "Morbidity and Mortality Weekly
Report" (MMWR), visit CDC's MMWR website at: http://www.cdc.gov/mmwr
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.