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Issue Number 284            December 4, 2001


  1. CDC publishes findings on importance of proper timing of varicella vaccination
  2. CDC's National Immunization Program releases influenza bulletin #10
  3. CDC releases "Interim Smallpox Response Plan and Guidelines"
  4. Hearing on National Immunization Program (NIP) held in Washington
  5. Comments invited on proposed changes to reporting form for VAERS (Vaccine Adverse Event Reporting System)
  6. Expanding! Hepatitis Prevention Programs website seeks new program profiles


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December 4, 2001

On November 30, 2001, the Centers for Disease Control (CDC) published "Simultaneous Administration of Varicella Vaccine and Other Recommended Childhood Vaccines--United States, 1995-1999" in the Morbidity and Mortality Weekly Report (MMWR).

The effectiveness of varicella vaccine (Var) was assessed when administered to children simultaneously with or fewer than 30 days later than several routine childhood vaccines in a retrospective cohort study. Effectiveness was measured by looking at rates of "breakthrough" varicella disease, meaning cases that occurred following exposure to wild-type virus more than 42 days  after children's varicella vaccination. The incidence of breakthrough varicella disease was compared for each vaccine in three groups: children who received Var simultaneously with the other vaccines, children who received Var fewer than 30 days after the other vaccines, and control children who received Var 30 or more days after the other vaccines.

While the study found no increased risk of breakthrough varicella disease  among children who received Var simultaneously with any of the vaccines, a  significant 2.5-fold increase in breakthrough varicella disease was found when Var was given 1-29 days after measles-mumps-rubella (MMR) vaccine.

This finding supports the recommendation by the Advisory Committee on Immunization Practices (ACIP) that Var be administered either on the same day as MMR or 30 or more days after MMR.

The first paragraph of the article reads: "[A] decrease in Var effectiveness occurred when Var was administered less than 30 days after MMR; therefore,  as currently recommended, physicians should administer Var simultaneously with MMR or wait at least 30 days if the vaccines are administered separately."

To obtain the complete text of this article online, go to:

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:

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December 4, 2001

On November 27, 2001, the National Immunization Program (NIP) issued the  tenth in a series of influenza bulletins designed to update health professionals on the production, distribution, and administration of influenza vaccine for the 2001-2002 season.

Of special note are three items: "Influenza vaccine is still available for purchase," "CDC has developed a flyer to help clinicians determine differences in signs and symptoms caused by influenza, inhalational anthrax and influenza-like illness from other causes," and "The Centers for Medicare and Medicaid Services (CMS) is ensuring that payment rates for influenza vaccine are determined in accordance with Medicare's payment methodology."

To obtain a camera-ready (PDF format) copy of Influenza Bulletin #10, go to:

For previous influenza vaccine bulletins, go to:

The latest information regarding influenza vaccine, as well as patient education materials to print and use, is available on CDC's website:

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December 4, 2001

On Monday, November 26, 2001, the Centers for Disease Control (CDC) released "Interim Smallpox Response Plan and Guidelines," which outlines CDC's strategies for responding to a smallpox emergency. The plan identifies pre- and post-event activities that would need to be taken by various federal, state, and local agencies. These include identification and notification of suspected cases, quarantine-related activities, and vaccine and personnel mobilization.

The plan does not call for mass vaccination in advance of a smallpox outbreak because the risk of side effects from the vaccine outweigh the risks of  someone actually being exposed to the smallpox virus.

To view a summary of "Interim Smallpox Response Plan and Guidelines," go to:

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December 4, 2001

On Tuesday, November 27, "Hearing on the National Immunization Program: Is It Prepared for the Public Health Challenges of the 21st Century?" was held before the Senate Health, Education, Labor, and Pensions Committee in Washington, D.C. The Committee is chaired by Sen. Edward Kennedy, D-Mass. The Hearing was chaired by Sen. Jack Reed, D-R.I.

Two panels addressed questions raised by the Committee. Panel One consisted of Walter Orenstein, director, National Immunization Program, Centers for Disease Control; and Anthony Fauci, director, National Institute of  Allergy and Infectious Diseases, National Institutes of Health. Panel Two consisted of Betty Bumpers, cofounder and vice president, Every Child by Two; Ed Thompson, state health officer of Mississippi, past president, Association of State and Territorial Health Officials; and John Calfee, resident scholar, American Enterprise Institute.

Following is an excerpt from Sen. Reed's opening statement:

The purpose of today's hearing is to provide a broad overview of the status of our nation's immunization campaign. This initiative has resulted in record coverage levels and low numbers of outbreaks of vaccine preventable diseases. In fact, immunizations have reduced nine childhood diseases more than 95 to 99 percent. This initiative has not only had a tremendous impact on improving the health of children in this country, it has also produced economic benefits.

For example, in the case of polio, every dollar spent to administer the vaccine yielded savings of $3.40 in direct medical costs and $2.74 in the indirect social cost.

While the success has been significant and has been achieved through immunization, we face a number of challenges. In fact, the June 2000 Institute of Medicine Report entitled "Calling the Shots" noted that despite record high vaccination rates, pockets of underimmunized children still exist in all corners of the United States risking dangerous disease outbreaks. In some parts of the country, vaccination rates are actually declining.

[The] IOM Report, which was requested by former Senator Bumpers, presented a disturbing picture of states struggling to maintain and improve vaccine coverage rates, while being forced to cut back on key functions due to federal funding shortfalls. Many have reduced clinic hours, canceled provider contracts, suspended registry development and implementation, limited outreach, and discontinued performance monitoring. . . .

Moreover, vaccine preventable diseases continue to take a toll on the lives and  health of adolescents and adults in this nation. While vaccination levels for adults are at an all-time high, 63 percent for influenza and 46 percent for pneumococcal, which causes pneumonia, over 30,000 adults still die each  year from vaccine preventable diseases costing our society $10 billion each year in additional healthcare costs. . . .

Lastly, recent concerns about the growing threat of bioterrorism and the need to direct federal resources for the development of vaccines against potential bioterrorist agents, also has potential implications for our existing portfolio of vaccine research and our traditional methods of vaccine delivery. I would only  hope that as we work to combat terrorism that we do not lose sight of the need to adequately fund our equally important elements of our immunization program.

Frequently recurring topics in the wide-ranging Hearing were vaccine costs and funding, vaccine supply issues, the need to increase adult vaccination rates, public- and private-sector roles, proposed legislation to mandate vaccination coverage by insurers, and recent demands on the vaccine infrastructure because of bioterrorist attacks.

To obtain a transcript of the Hearing, go to:

An official Senate transcript will soon be available at:

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December 4, 2001

The Food and Drug Administration (FDA) and Centers for Disease Control  (CDC) have proposed changes to the VAERS reporting form that are intended to facilitate online reporting. Data fields would be changed to increase clarity and eliminate redundancy.

Notification of the proposed revised form was posted in the Federal Register (November 20, 2001, vol. 66, no. 224) for 60-day public comment. A copy of the Notice can be found at:

The draft of the proposed revised form (DRAFT VAERS-2) can be found at:

The Notification and DRAFT VAERS-2 may also be obtained by calling the FDA Center for Biologics Evaluation and Research at (800) 835-4709.

Interested parties are encouraged to review the proposed revised form and submit comments to the FDA by January 22, 2002. Comments may be submitted by mail (see address below) or online at:

The mailing address is:

Dockets Management Branch (HFA-305)
Food and Drug Administration
5630 Fishers Lane, Room 1061
Rockville, MD 20852

Please refer to Docket Number 01N-0464 when submitting comments.

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December 4, 2001

In November, four new program profiles were added to IAC's Hepatitis Prevention Programs website, and two other programs updated their profiles' activities listing. Thanks to the staff members of these programs who contacted us with information! (See direct program links at the end of this article.)

The Hepatitis Prevention Programs website now provides names and links to 59 programs from around the nation, as well as a wealth of background information and resources.

When the "hepprograms" site originally was launched by IAC in March 2001, as part of a cooperative agreement with CDC's Division of Viral Hepatitis, it featured 32 programs that were successfully preventing hepatitis A, B, or C in adolescent and adult populations at risk. The site now covers a wide range of program categories, including programs for men who have sex with men, family planning clinics, programs in correctional facilities, and drug treatment and needle exchange programs.

To visit IAC's Hepatitis Prevention Programs website home page, go to:

Following are direct links to the four new programs that were added to the website in November:

Michigan Department of Community Health, Detroit Hmong Vaccination Program

Louisiana State University Health Sciences Center, School-Based Vaccination Program

Health Care for the Homeless, Baltimore, Md.

Texas Department of Health Hepatitis C Initiative

Following are direct links to the two programs that updated IAC on their activities in November:

AIDS Project Rhode Island, which has begun offering both hepatitis A and B vaccination in their "cozy little" bathhouse clinic decorated with art and antiques:

Macon County Health Department Hepatitis Pilot Project, which has ads targeted to drug users, sex partners of drug users, men who have sex with men, females with high-risk partners, and persons infected with hepatitis C:

Recently we have added a link to information on 11 partner organizations in the viral hepatitis cooperative agreement. To see the Viral Hepatitis Grant Partners page on the Hepatitis Prevention Programs website, go to:

Remember: we rely on readers for current, accurate information about new or already existing programs. To help make this site the most comprehensive  compendium of adult and adolescent hepatitis prevention programs on the Internet, please keep us informed of any other programs that should be included on the Hepatitis Prevention Programs website. You can do this when visiting the website or 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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    Courtnay Londo, MA
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