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Issue Number 294            February 4, 2002


  1. CDC publishes article on increase in pertussis cases
  2. It's not too late for flu shots!
  3. IAC launches Hepatitis B Information web page
  4. OSHA publishes Compliance Directive for revised Bloodborne Pathogens Standard
  5. Curriculum for nurses and self-paced course simplify immunization education
  6. February 14 is Immunize Georgia's Little Guys Conference
  7. National Pediatric Infectious Disease Seminar is set for April


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February 4, 2002

On February 1, 2002, the Centers for Disease Control and Prevention (CDC) published "Pertussis--United States, 1997-2000" in the Morbidity and Mortality Weekly Report (MMWR).

According to the article, after the widespread use of pertussis vaccine began in the late 1940s, incidence of reported pertussis declined and reached a historic low in 1976 at 1,010 cases. Since the early 1980s, incidence has increased in cycles, peaking every 3 to 4 years. Comparing surveillance data from 1997-2000 with data from 1994-1996, researchers found that reported incidence increased  60 percent among adults and 11 percent among infants. Continued high vaccination rates and outbreak management are suggested for prevention. The last sentence of the Editorial Note says:  "Studies among older children, adolescents, and adults examining pertussis disease burden and transmission of disease to infants might guide future policy decisions on the use of acellular pertussis vaccines among persons aged 7 or more years."

The CDC's synopsis of the article reads as follows:


Despite an effective vaccine, pertussis continues to occur in the United States in all age groups. There  has been an increase in the number of reported U.S. pertussis cases in the last two decades. This increase is primarily among infants too young to have received 3 pertussis-containing vaccine doses, and among adolescents and adults. . . . the increase in cases among infants <6 months of age suggests that a true increase in pertussis circulation has occurred. The number of cases of pertussis among children who are old enough to have received 3 or more pertussis vaccinations has remained stable.


To obtain the complete text of the article 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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February 4, 2002

So far, the U.S. has had a mild case of collective influenza this season, but that's no reason to skip the flu shot if you haven't had one already. There is no shortage of flu vaccine, so be sure to continue to give it to your patients, as well.

Although cases of influenza have been fewer than usual for this time of year, CDC's "Influenza Summary Update" for the week ending January 19 said that "forty-five states have reported laboratory- confirmed influenza" since September.

In the third week of January, four states reported widespread influenza activity: Colorado, New York, Utah, and Virginia. Forty-two other states reported regional or sporadic activity.

According to CDC epidemiologist Dr. Scott Harper, the flu season this year may peak later than expected. A CDC chart shows that in ten out of 18 recent years (1982-2000), the influenza rate peaked in February or March rather than in December or January. Therefore, it's important to remember that, whenever it peaks, the flu season generally lasts through March. We should not stop vaccinating until then.

In the February 1 issue of the Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) published "Update: Influenza Activity--United States, 2001-02 Season." The following is an excerpt from the Editorial Note to the article:


The best protection against influenza is vaccination, and approximately 10 million doses of 2001-02 influenza vaccine remain available. Health-care providers should continue to offer influenza vaccine during February because influenza activity is expected to increase, and unvaccinated persons can benefit from vaccination even after influenza has been detected in their communities. Influenza vaccine is strongly recommended for those at increased risk for serious complications from influenza (e.g., persons aged 6 months-64 years with certain chronic medical conditions and persons aged 65 years or older) and health-care providers. In addition, household contacts of high-risk persons, healthy persons aged 50-64 years, and any person who wants to reduce their risk for becoming ill with influenza should be vaccinated.


To obtain the complete text of the Update online, go to:

To obtain a camera-ready (PDF format) version of the entire MMWR issue, go to:

For more information on influenza and influenza vaccine, go to the CDC Flu web page at:

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February 4, 2002

The new Hepatitis B Information page on IAC's website directs (or links) you to 24 medical journal articles about hepatitis; CDC recommendations; state laws; case histories; photos; and a list of resources and organizations.

Visit this page often, because we will be updating it continually. Occasionally, we will announce major additions to the page here in IAC EXPRESS. Make it your first stop for . . . hepatitis B information! To see IAC's new Hepatitis B Information web page, go to:

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February 4, 2002

The Occupational Safety and Health Administration (OSHA) has issued a new Compliance Directive for enforcing the Bloodborne Pathogens Standard that was revised in January 2001 and that became effective in April. IAC has received many inquiries about the Standard's requirements for safer needle devices.

Directive no. CPL 2-2.69 is titled "Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens." The text is 93 pages long, not including five appendixes.

The OSHA trade news release about the Directive (dated November 28, 2001) reads in part as follows:


The compliance directive guides OSHA's safety and health inspection officers in enforcing the standard that covers occupational exposure to blood and other potentially infectious materials, and ensures consistent inspection procedures are followed. It updates an earlier directive issued in 1999 and incorporates changes mandated by the Needlestick Safety and Prevention Act passed in November 2000.

The directive implements changes made to the standard that focus on the requirement that employers select safer needle devices as they become available and involve employees in identifying and choosing those devices. The standard now also requires most employers to maintain a log of injuries from contaminated sharps.

The directive highlights the major new requirements of the standard including: (1) evaluation and implementation of safer needle devices as part of the re-evaluation of appropriate engineering controls during an employer's annual exposure control plan; (2) documentation of the involvement of non-managerial, frontline employees in choosing safer devices; and (3) establishment and maintenance of a sharps injury log for recording injuries from contaminated sharps.

Compliance officers are reminded that no one safer medical device is appropriate for all situations; employers must consider and implement devices that are appropriate, commercially available and effective. The directive also includes detailed instructions on inspections of multi-employer worksites, including employment agencies, personnel services, home health services, physicians and healthcare professionals in independent practices, and independent contractors.

Also included in the directive are engineering control evaluation forms, a web site resource list, a model exposure control plan which incorporates the most current guidelines from the Centers for Disease Control regarding management of occupational exposure to the hepatitis B and C viruses, and the HIV virus.


Currently the Directive is available online only in PDF format. An HTML version is expected to be available soon.

To read or download the OSHA Directive, go to:

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February 4, 2002

The Association of Teachers of Preventive Medicine (ATPM) has created two highly useful educational products through the Project to Enhance Immunization Content in Nursing Education and Training.

"Teaching Immunization Practices (TIP) for Nurses" is a newly updated curriculum for nurse educators consisting of three modules: Basic Principles of Immunization; Basic Principles of Vaccine Use; and  Immunization Practice, Delivery, and Program Design. Student objectives are listed for each module, along with clearly defined lessons with figures and handouts to use. Challenging case studies make the information especially relevant and interesting. This thorough curriculum is designed to cover enough material for 13.5 hours of teaching time, but individual modules or parts of modules can also be used for single-topic lectures.

"TIP for Nurses" can be downloaded from the Internet or purchased as a CD-ROM for $25 by calling (800) 235-0882.

To download "TIP for Nurses" onto your computer free of charge, go to:

"Immunization: You Call the Shots" is a self-paced, interactive computer program for approximately 6 hours of independent learning. IAC's staff reviewers spent at least that much time exploring the two-part program and taking its instant-feedback competency tests.

In Part 1, students learn (or re-learn) the basics of vaccine-preventable diseases and vaccines, from the classification of vaccine types to details about the major vaccines and their use.

In Part 2, students get to "walk through" a virtual clinic, stopping in eight different rooms to learn about the entire immunization process. This "imm-sim show" makes learning fun. In the Reception Area, you can learn about reminder and recall systems. In the Waiting Room, hear a nurse explaining immunization to patients of different ages. In the Vaccine Administration Room, see a close-up of proper injection technique. Visit the Community Room to identify barriers to immunization and consider ways to overcome them.

According to the program's documentation, institutional users of "Immunization: You Call the Shots" may be able to award contact-hour credit using their organization's provider number; check with your state regulatory agency.

"Immunization: You Call the Shots" costs $295 (includes site and network license). Special pricing is available for federally funded public health clinics. Annual updates cost $25. For more information, or to request a free 30-day preview, call HealthSoft at (800) 235-0882.

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February 4, 2002

You can still attend the 9th Annual Immunize Georgia's Little Guys Conference next Thursday, February 14, at the Macon Centreplex Convention Centre in Macon, Georgia. The theme is "Back to Basics." Speakers include William Atkinson, M.D., M.P.H.; Walter Orenstein, M.D., M.P.H.; and Joanne Cono, M.D., S.C.M. from CDC; and Michael Chaney and others from Georgia Immunization Program.

The registration fee is $30 on or before February 7, 2002, and $60 thereafter. On-site registration is available.

Hotel accommodation has been arranged at the Crowne Plaza Macon near the Macon Centreplex Convention Center. Call (800) 227-6963 for reservations.

For registration or general conference information, contact Angie Moore, Conference Coordinator, by phone at (404) 929-8456 or email at

To access the conference brochure online, go to:

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February 4, 2002

The 22nd Annual National Pediatric Infectious Disease Seminar will be held April 3-6, 2002, at the Hyatt Regency New Orleans in Louisiana. The seminar will be "an intensive review designed for practicing clinicians and related health care workers who want to remain abreast of current issues and an update of the latest developments in pediatric infectious diseases."

The seminar is jointly sponsored by the University of Texas Southwestern Medical Center at Dallas and the National Pediatric Infectious Diseases Foundation. The registration fee is $525 for physicians and $375 for residents, fellows, physician assistants, nurses, and others.

For registration information, call the Synergy Medical Education Group at (972) 541-0973 or visit the NPIDS website at

You can register online through the above link, but don't be thrown off by the dialog box labeled "Certificate Name Check." Just click on "continue" and then hit "register online" again.

For hotel registration, call the Hyatt Regency New Orleans at (504) 561-1234. The early-bird rate deadline is March 2.

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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