Issue Number 285            December 11, 2001


  1. Fall/Winter issue of NEEDLE TIPS is in the mail--and up on the web
  2. ACIP votes on pneumococcal conjugate and DTaP vaccine recommendations
  3. Letter on influenza vaccine from National Immunization Program Director Walter Orenstein, M.D.
  4. Reminder for this Thursday, December 13: CDC satellite broadcast about smallpox for clinicians
  5. CDC announces 7th edition of "The Pink Book" and December discount on advance orders
  6. Register early for the National Immunization Conference
  7. New on IAC's website: "Skills Checklist for Immunization"


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December 11, 2001

Look for your "golden-ink" copy of the Fall/Winter 2001-2002 issue of NEEDLE TIPS and the Hepatitis B Coalition News in the mail! It's also now available on IAC's website (see links below).

The Fall/Winter 2001-2002 issue is filled with new and practical immunization information for you to use and distribute to colleagues and patients. All of the items are reviewed for technical accuracy by the Centers for Disease Control and Prevention (CDC) with the exception of opinion pieces.

Once again NEEDLE TIPS features "Ask the Experts," with authoritative answers to immunization questions provided by William Atkinson, M.D., M.P.H., and to hepatitis A and B questions by Harold Margolis, M.D., and Linda Moyer, R.N. All three experts are, indeed, highly regarded specialists with CDC. Whether it's a question about dosage or postexposure prophylaxis, they let you know what needs to be done.

We are also excited to bring you two new educational pieces and two clinical "tools" in NEEDLE TIPS. Because talking about hepatitis with patients can be confusing for them, we've created a one-page chart that clarifies the issues called "Hepatitis A, B, and C: Learn the Differences." Whether you give patients this chart to take home or use it as a teaching tool, we hope you find it as helpful as our own staff does! For immunization providers, we offer the up-to-date "Vaccine Products Licensed for Use in the United States, 2001."

Everybody is looking for better ways to get adult patients' immunization histories. Our new self-assessment questionnaire for adults, simply titled "Do I  Need Any Vaccinations Today?" is intended to make the adult history-taking process both easy and timesaving for health professionals by allowing patients  to fill out the form before the history-taking process even begins.

Likewise, our new "Checklist for Safe Vaccine Handling and Storage" is intended to clarify the process of safeguarding, monitoring, and documenting vaccine inventory. We hope this checklist will help establish--or maintain--proper vaccine management protocol in clinics, hospitals, and other practices with immunization services! Whether you keep it in a file or on a clipboard or post it on your vaccine refrigerator, it can serve as a convenient reminder of the basic storage and handling requirements for vaccines.

Don't forget to copy and distribute the newly revised "Summary of Recommendations for Adult Immunization." This chart summarizes the most  current recommendations from the Advisory Committee on Immunization Practices (ACIP) on everything from schedules and routes of administration to contraindications. Some practices laminate or make cardstock copies of this document for each examination room and hand them out to immunization staff as a ready-reference guide.

Finally, IAC Executive Director Deborah L. Wexler, M.D., has written a powerful piece for anyone interested in infant health or hepatitis B prevention.  Please read her "Unprotected Babies: Hepatitis B Vaccine at Birth Saves Lives." You may be moved to reexamine or change your current infant hepatitis B vaccination practices (if you haven't already). Although the "B" in hepatitis B doesn't stand for "birth dose," maybe you will agree after reading this piece that we should all act as if it does.

Following are links to individual pages of NEEDLE TIPS and to the entire issue. Most pages are available in both PDF and HTML formats, but a few are  available only as PDF files.

  1. "Ask the Experts"
  2. "Letters to the Editor"
  3. "Vaccine Highlights"
  4. "Unprotected Babies: Hepatitis B at Birth Saves Lives!"
  5. "Checklist for Safe Vaccine Handling and Storage"
  6. "Hepatitis A, B, and C: Learn the Differences"
  7. "Do I Need Any Vaccinations Today?"
  8. "Vaccine Products Licensed for Use in the United States, 2001"
  9. "How's Your State Doing? Current Immunization Rates and Hep B Mandates by State"
  10. "Summary of Recommendations for Adult Immunization"
  11. "Pneumococcal Congugate Vaccine: What You Need to Know" (VIS)
  12. "National Resources"
  13. "Need Help? Call Your Immunization, Hepatitis, and VFC Coordinators"
  14. "Coalition Catalog: Publications and Resources"

To view the NEEDLE TIPS table of contents with links to both the text (HTML format) and camera-ready (PDF format) versions of individual pages, go to:

WARNING: The PDF format version of the entire issue below is a large file, and some printers cannot print a file of this size. For some helpful tips on downloading and printing PDF files, go to:

To download a camera-ready (PDF format) copy of the entire issue, go to:

If you are a health professional and would like to receive a hard copy of NEEDLE TIPS or be added to our mailing list, please contact us by e-mail at

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December 11, 2001

On December 7, 2001, the Advisory Committee on Immunization Practices (ACIP) voted to temporarily revise recommendations for pneumococcal conjugate vaccine and to continue previously issued DTaP recommendations.

The Centers for Disease Control (CDC) released the following message about the votes:



The Advisory Committee on Immunization Practices (ACIP) voted today to temporarily revise recommendations for the pneumococcal conjugate vaccine due to continued shortages of the vaccine that are insufficient to allow full implementation of the 4-dose schedule for infants. 

Pneumococcal conjugate vaccine is highly effective in preventing invasive pneumococcal disease in young children. Prior to the introduction of PCV-7, pneumococcal infections caused approximately 700 cases of meningitis, 17,000 cases of bacteremia--blood stream infections--and 200 deaths each year in children under age five. Meningitis is the most severe type of pneumococcal disease. About 5 percent of children under 5 years old with pneumococcal meningitis will die of their infections.

The ACIP had previously revised recommendations for the vaccine on  September 14, 2001, for shortages which at the time were anticipated to be brief. However, according to manufacturer estimates, about 1.2 million doses of vaccine will be distributed per month through March 2002, less than the 1.5 million doses per month needed, based on current demand.

The shortage of the vaccine is due to a rapid increase in demand and manufacturing problems that have prevented the manufacturer from producing at full capacity. The shortage is expected to continue until mid-2002, depending on adherence [to] the revised recommendations.

The ACIP is making revised recommendations to limit pneumococcal conjugate vaccine use until supplies are adequate. Two key principles underlie the revised recommendations. First, providers should conserve vaccine supply by decreasing the number of doses administered to healthy infants, rather  than leaving some children in the group recommended for vaccination completely unprotected.

Second, changes in pneumococcal conjugate vaccine use and ordering should be made by all providers, regardless of the current vaccine supply in their own practice. 

The ACIP revised recommendations are as follows:

  1. High risk children less than 5 years of age should continue to be vaccinated as recommended by the ACIP in October 2000.
  2. Healthy infants and children less than 24 months old should receive a decreased number of pneumococcal conjugate doses based on the age at which vaccination is initiated and the provider's estimate of vaccine supply in their practice. All providers should defer the 4th dose for infants who are vaccinated beginning at less than 6 months of age.  Additional recommendations to decrease vaccine use are included in the specific recommendations adopted by the Committee. (Guidelines will be given when the recommendations are published in CDC's Morbidity and Mortality Weekly Report.)
  3. Further studies should be done to evaluate the immune response to a pneumococcal polysaccharide vaccine booster dose among children  12-15 months of age. Polysaccharide vaccine is recommended for children more than 2 years old who are at increased risk of invasive  pneumococcal infection. It is not licensed for use in children less than 2 years old.
  4. Providers should maintain a list of children for whom PCV-7 has been deferred so that it can be administered when the supply situation improves.


The ACIP voted to continue prior CDC recommendations (published March 16, 2001) for providers who had insufficient quantities of DTaP vaccine due to spot shortages of the vaccine. The recommendation applies only to providers  with insufficient quantities of DTaP vaccine and recommends that they prioritize vaccinating infants with the initial 3 DTaP doses, and if necessary, to defer the 4th DTaP dose. The ACIP also added that if deferring the 4th DTaP  dose still does not provide enough vaccine to vaccinate infants with 3 DTaP doses, then the 5th DTaP dose can be deferred. When adequate DTaP vaccine becomes available, steps should be taken to recall all children who did not receive a DTaP dose for remedial immunization. Children should be  vaccinated in accordance with existing ACIP recommendations to assure immunity to pertussis, diphtheria, and tetanus during the elementary school years.

The vaccine protects against diphtheria, tetanus, and pertussis or whooping cough. Diphtheria, tetanus, and pertussis are serious diseases caused by bacteria. Diphtheria and pertussis are spread from person to person. Tetanus enters the body through cuts or wounds.


For more information on the revised ACIP recommendations and the vaccines addressed, go to the website of CDC's National Immunization Program at:


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December 11, 2001

On December 4, 2001, a letter to colleagues in medicine and public health  was issued by the office of Walt Orenstein, M.D., director, National Immunization Program, Centers for Disease Control and Prevention. The letter urges continued administration of influenza vaccine for high-risk people and assures an adequate and available supply.

The text of the letter reads as follows:


Dear Colleague:

If you are seeing patients who need or want influenza vaccine, I urge you to continue to offer influenza vaccine throughout the month of December and beyond for as long as vaccine is available. As you know, distribution of a portion of this year's influenza vaccine was delayed, and insufficient quantities were available to meet all the demand during the optimal period for vaccination, October and November. Thus, MANY INDIVIDUALS 65 AND ABOVE AND THOSE WITH MEDICAL CONDITIONS PLACING THEM AT HIGH RISK FOR COMPLICATIONS FROM INFLUENZA REMAIN UNVACCINATED. In addition, other young, healthy persons who wish to reduce their risk from influenza this year were not vaccinated. And finally, many work-site clinics were cancelled due to unavailability of vaccine.

Now that vaccine production is complete, plentiful amounts of influenza vaccine are available for immediate shipment from the three primary suppliers of vaccine in the United States: Aventis Pasteur, Wyeth-Lederle, and Henry Schein (and its GIV and Caligor divisions) at current market prices. Other marketers may also have product available. I urge you to take advantage of this situation and continue to vaccinate until all persons who want or need influenza vaccine are vaccinated or the available supply is exhausted.

To date, influenza activity in the United States remains quite limited with only a couple of small outbreaks and a relatively small number of isolated outbreaks reported. Influenza disease has peaked in January or later in 15 of the past 19 influenza seasons. BUT EVEN WHEN INFLUENZA IS OCCURRING IN A COMMUNITY, INDIVIDUAL PATIENTS WHO HAVE NOT YET BEEN EXPOSED, ESPECIALLY THE ELDERLY AND THOSE WITH RISK CONDITIONS, CAN BENEFIT FROM VACCINATION. For businesses that  want to protect their work forces and minimize absenteeism caused by influenza, work-site clinics in December or later can still help meet that objective. And the many young, healthy individuals who deferred vaccination earlier in the year can now be vaccinated.

The medical literature has documented that when health care providers recommend vaccination to patients, those patients almost always agree to be vaccinated. I hope that you will continue to offer influenza vaccine to your patients. If you require additional vaccine, I encourage you to contact a supplier and obtain the needed quantities. For those of you concerned about this year's Medicare payment rate for influenza vaccine, all Medicare carriers are now paying $7.12 per dose of vaccine (which exceeds the prices being offered by the three primary suppliers) plus an administrative fee that ranges  from $3.00 to $5.79 depending upon locale.

Thank you for your continued effort to provide influenza vaccine to high-risk individuals and others who seek it, especially in light of the delays in distribution we have experienced these past two years. Please continue your efforts to help ensure that in 2001/2002, we achieve the highest influenza vaccine coverage levels ever and protect more individuals, especially the most vulnerable, against the ravages of influenza.

Walter A. Orenstein, M.D.
Assistant Surgeon General
National Immunization Program


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December 11, 2001

The Centers for Disease Control (CDC) will present a live satellite and web broadcast, "Smallpox: What Every Clinician Should Know," on Thursday, December 13, 12:00-2:00 p.m. Eastern Time. The program will be rebroadcast on Monday, December 17, 5:00-7:00 p.m. Eastern Time.

A panel of experts from CDC will present information on virology, epidemiology, clinical features and diagnosis of smallpox, and the characteristics and use of smallpox vaccine.

For program details, registration, continuing education credit information, and satellite specifications, go to:

If you are unable to view the live broadcast, CDC will provide a single VHS  videotape of the program free of charge. Videotapes will be available after January 9, 2002. 

To order a videotape, contact the Public Health Foundation by phone at 1-877-252-1200 or email at

Or order online at:

Additional copies may be purchased in packages of five copies for $35, with a 15% discount on orders of 20 or more five-packs.

Webcast links for the entire series of bioterrorism broadcasts since October 18 can be found at:

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December 11, 2001

The Centers for Disease Control and Prevention (CDC) has announced that the 7th edition of EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES, also known as THE PINK BOOK, will be available in February 2002. THE PINK BOOK provides physicians, nurse  practitioners, physician assistants, nurses, pharmacists, and others with:

  • comprehensive information on vaccine-preventable diseases
  • general recommendations on immunizations
  • immunization strategies for health care practices and providers
  • strategies to increase vaccination
  • revised vaccine recommendations

Order by mail, telephone, or online as instructed below. Until December 31, 2001, the cost is $22 per copy plus $5.50 each shipping and handling; for bulk orders of 250 or more, the cost is $16.50 each plus shipping and handling. Starting January 1, 2002, the cost increases to $25 per copy plus $5.50 each shipping and handling; $18.75 each for bulk orders of 250 or more.

Send your prepaid order to:
Public Health Foundation
Publication Sales
P.O. Box 753
Waldorf, MD 20604

To order by phone, call (877) 252-1200.

To order online, go to:

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December 11, 2001

The 36th National Immunization Conference (NIC) will be held April 29-May 2, 2002 in Denver, Colorado. The theme is "Reaching for New Heights in Immunization."

You may register online now for an "early bird" discount!

To register online, go to:

Also, remember that the deadline for abstracts is December 14, 2001. Abstracts should be submitted online at:

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December 11, 2001

This self-assessment tool for health care staff who administer vaccines is now available on IAC's website. Originally, this checklist was designed to  accompany the popular video "Immunization Techniques: Safe, Effective, Caring" that IAC promoted in the fall and continues to offer for sale. However,  because the checklist is also useful on its own, we decided to make it available for direct downloading. It's a great way to assure all staff members' competency in all stages of the immunization process.

To obtain a camera-ready (PDF format) copy of the "Skills Checklist," go to:

To read more about the video, go to:

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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