Issue Number 286            December 17, 2001


  1. CDC publishes notice: ACIP approves shorter pregnancy wait after receipt of rubella-containing vaccine
  2. Merck recalls some lots of VAQTA in prefilled syringes
  3. Complete smallpox plan now available on CDC website
  4. New staff appointments at CDC announced
  5. Reminder! Fourth National Conference on Immunization Coalitions registration deadline extended
  6. Standing Orders Project publishes quarterly "Partner Newsbrief"
  7. If your patients ask: New study confirms safety of influenza vaccine for people with asthma


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December 17, 2001

On December 14, 2001, CDC published "Notice to Readers: Revised ACIP Recommendation for Avoiding Pregnancy After Receiving a Rubella-Containing Vaccine" in the Morbidity and Mortality Weekly Report (MMWR).

The complete notice, excluding references, reads as follows:


On October 18, 2001, the Advisory Committee on Immunization Practices (ACIP) reviewed data from several sources indicating that no cases of congenital rubella syndrome (CRS) had been identified among infants born to women who were vaccinated inadvertently against rubella within 3 months or early in pregnancy. On the basis of these data, ACIP shortened its recommended period to avoid pregnancy after receipt of rubella-containing vaccine from 3 months to 28 days.

Data were available from the U.S. Rubella Vaccine in Pregnancy Registry, the U.K. National Congenital Rubella Surveillance Programme (National Congenital Registry Surveillance Programme, unpublished data, 2001; P. Tookey, Ph.D., Center of Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, personal communication, April 2001), and Sweden and Germany (G. Enders, M.D., Laboratory of Enders and Partners, and Institute for Virology, Infectology, and Epidemiology, personnel communication, September 2001) on 680 live births to  susceptible women who were inadvertently vaccinated 3 months before or during pregnancy with one of three rubella vaccines (HPV-77, Cendehill, or RA 27/3). None of the infants was born with CRS. However, a small theoretical risk of 0.5 percent  (upper bound of 95 percent confidence limit=0.05 percent) cannot be ruled out. Limiting the analysis to the 293 infants born to susceptible mothers vaccinated 1-2  weeks before to 4-6 weeks after conception, the maximum theoretical risk is 1.3 percent. This risk is substantially less than the >20 percent risk for CRS associated with maternal infection during the first 20 weeks of pregnancy.

Measles-mumps-rubella (MMR) vaccine and its component vaccines should not be administered to women known to be pregnant. Because a risk to the fetus from administration of these live virus vaccines cannot be excluded for theoretical  reasons, women should be counseled to avoid becoming pregnant for 28 days after vaccination with measles or mumps vaccines or MMR or other rubella-containing vaccines.

The goal of the U.S. rubella vaccination program is to prevent congenital rubella infection. ACIP recommended that MMR vaccine should be offered to all women of childbearing age (i.e., adolescent girls and premenopausal women) who do not have  acceptable evidence of rubella immunity.

Most rubella cases in the United States occur among young Hispanic adults born outside the United States, and most infants with CRS are born to foreign-born  mothers.Ensuring immunity in women of childbearing age, especially those at highest risk for exposure, will help to prevent CRS.


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

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

To obtain a free electronic subscription to the "Morbidity and Mortality Weekly Report" (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 email.

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December 17, 2001

On December 10, Merck Vaccine Division issued an urgent recall of selected lots of VAQTA (hepatitis A vaccine, inactivated) in prefilled syringes. According to the recall notice, "Recent investigation indicates that some syringes within the [specified] lots may have antigen levels below the product specification limit. Persons vaccinated with VAQTA in prefilled syringes from the indicated lots may be insufficiently protected against hepatitis A."

Not affected by the recall are VAQTA in vials and prefilled syringes from lots not specified.

To see the Merck Product Recall notice with recalled VAQTA lot numbers, go to:

A list of recalled VAQTA lots is also available on the website of the Food and Drug Administration at:

Questions about returns will be taken by the Merck Order Management Center at (800) 637-2579.

Questions about free hepatitis A antibody testing of patients who may have been vaccinated with affected lots of VAQTA will be taken by the Merck Product Assistance Line at (800) 439-4958.

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December 17, 2001

The Centers for Disease Control and Prevention (CDC) has posted its "Interim Smallpox Response Plan and Guidelines" and other smallpox-related documents on its website. The new Smallpox page features agent information for health care providers--including details about the disease, recommended treatment, and recognizing smallpox in emergency departments--and lab protocol so that laboratories will have techniques to identify microorganisms to help clinicians with diagnosis.

To view the new Smallpox page on CDC’s website, go to:

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December 17, 2001

The Centers for Disease Control and Prevention (CDC) has temporarily reassigned Dr. Harold Margolis, Director of the Division of Viral Hepatitis, to the position of CDC Coordinator of Smallpox Preparedness Activities. This 6-month assignment began November 26, 2001.

While Dr. Margolis is serving in this new capacity, Dr. Steve Hadler, Chief of the Global Alliance for Vaccines and Immunization, will be the Acting Director of the Division of Viral Hepatitis. This assignment began on December 3, 2001.

The CDC has also formed a new Smallpox Preparedness and Response Activity that will report to the Office of the Director of the National Immunization Program. The Director of the new Activity is Dr. Joel Kuritsky.

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December 17, 2001

As previously announced, the Fourth National Conference on Immunization Coalitions, with the theme "Building Healthy Immunized Communities: Yours, Mine and Ours," will be held January 9-11, 2002, at the San Antonio Marriott Rivercenter, San Antonio, Texas. (The opening reception will be held in the evening on January 9.) The conference is hosted by Children’s Healthcare of Atlanta and Immunize Georgia’s Little Guys.

This conference offers information, resources, and skill building sessions to help local, state, and national organizations create and sustain coalitions and partnerships. Continuing education credits (CMEs, CNEs, and CECHs) are available for attendees.

The new registration deadline is Monday, December 24. The registration fee is $125 through that date and increases to $250 thereafter. Note: The early hotel registration deadline was Monday, December 10. Call the San Antonio Rivercenter Marriott for the regular rates.

For more information on the conference or to obtain a registration form, contact Dena Stansbury, conference coordinator, by phone at (404) 929-8684, fax at (404) 929-8481, or email at

To view the conference brochure online, go to:

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December 17, 2001

The Standing Orders Project (SOP), a collaboration of the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS), has published the third issue of its quarterly newsletter, "Partner Newsbrief."

The mission of the pilot Standing Orders Project is to increase coverage rates for pneumococcal and influenza vaccines in long-term care facilities. Nine states are currently involved in recruiting long-term care facilities.

To subscribe to "Partner Newsbrief," contact Jennifer O’Hagan, SOP Project Coordinator, by phone at (405) 840-2891 (ext. 205) or by email at

To see "Partner Newsbrief" online, go to:

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December 17, 2001

According to an article in the November 22, 2001, issue of the New England Journal of Medicine (vol. 345, no. 21, pp. 1529-1536), less than 10 percent of patients with asthma become vaccinated against influenza. Some patients with asthma believe that influenza vaccination will exacerbate their symptoms and therefore avoid the annual vaccine. Previous studies on the issue have been inconclusive, according to the article, leaving health care providers with little concrete information to allay their asthma patients’ concerns. Because there  are "substantial effects of influenza in patients with asthma" and "influenza is a common reason for hospitalization in children with asthma," a large clinical study of flu vaccination of asthma patients was undertaken.

"The Safety of Inactivated Influenza Vaccine in Adults and Children with Asthma" was authored by the Writing Committee of the American Lung Association Asthma Clinical Research Centers. In the study, led by Mario Castro, M.D., assistant professor of medicine at Washington University School of Medicine in St. Louis, 2,032 asthma patients (aged 3-64 years) received both a placebo injection and a flu vaccine injection, but in different orders, and separated by a mean of 22 days. After each injection, records of symptoms were kept, including increased frequency of use of bronchodilator medications and decreases in daily peak expiratory flow rate.

The researchers found that "the frequency of exacerbations of asthma was similar in the two weeks after the influenza vaccination and after placebo  injection . . . only body aches were more frequent after the vaccine injection than after placebo injection."

The Discussion section states: "The main finding of this controlled study is that influenza vaccination does not worsen asthma. This finding should be reassuring to patients and to their physicians, and it provides evidence that the current guidelines for the immunization of patients with asthma are safe."

To see the abstract of this article, go to:

The entire article is currently available only in print and is not available online. For original articles, the full text becomes available 6 months after print publication to all registered users of the New England Journal of Medicine website at

To order individual reprints, call the New England Journal of Medicine customer service desk at (800) 843-6356. The cost for an emailed or faxed copy of the article is $12; the cost to have a copy sent via U.S. mail is $10.

Bulk reprint orders (100 or more copies) may be made online at: 

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