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Issue Number 317            June 3, 2002


  1. New England Journal of Medicine article describes how to recognize and manage smallpox
  2. WHO presents new "Global Agenda on Influenza"
  3. IOM study finds no link between hepatitis B vaccine and demyelinating neurological disorders
  4. Download "The ABCs of Childhood Vaccines" presentation from CDC's website
  5. Rotary Foundation receives 2002 Gates Award for Global Health


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June 3, 2002

The New England Journal of Medicine (NEJM) featured articles on smallpox in its April 25, 2002, issue (vol. 346, no. 17) in response to national concerns about a possible release of smallpox (variola) virus by terrorists. New research on the efficacy of and reactions to diluted smallpox vaccine was presented.

Because smallpox was eradicated as a naturally occurring disease over 20 years ago, few physicians know how to diagnose it now for purposes of treatment and post-exposure vaccination of known contacts. For that reason, as noted in the editorial statement to the issue, a review article was included "to help medical  professionals recognize and treat [smallpox] if and when it occurs."

"Current Concepts: Diagnosis and Management of Smallpox," written by Joel G. Breman, M.D., D.T.P.H., and D. A. Henderson, M.D., M.P.H., includes a thorough discussion of the disease's pathogenesis, transmission, clinical manifestations, and diagnosis as well as vaccination. Figure 1 shows clinical  manifestations and immune response along a timeline. Tables outline (1) other eruptive illness that can be misdiagnosed as smallpox and (2) important differences between severe chickenpox and smallpox.

The section on Emergency Reporting reads in part as follows (excluding footnotes):


A possible case of smallpox is a public health emergency and of utmost international concern. State health officials should be contacted immediately, and the diagnosis confirmed in a Biological Safety Level 4 laboratory where staff members have been vaccinated. The state officials should contact the CDC at any time of the day or night (telephone number, 770-488-7100). The CDC, in turn, will inform the WHO [World  Health Organization] Department of Communicable Diseases Surveillance and Response Unit in Geneva, Switzerland.

After the patient has been isolated, interviews should be conducted to identify contacts. The contacts should be vaccinated as soon as possible and not more than two or three days after exposure. Smallpox vaccination within this period offers substantial protection, which is the rationale, in part, for the current  policy of not launching a program of widespread vaccination of health care personnel before an outbreak has occurred.


The "ring vaccination and containment strategy" of managing a possible international release of smallpox is also discussed, followed by information on current and projected vaccine supply.

To obtain a camera-ready (PDF format) copy of "Diagnosis and Management of Smallpox," go to:

To see the contents of the entire issue of NEJM, go to:

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June 3, 2002

On May 31, 2002, the World Health Organization (WHO) published the full text of the "Global Agenda on Influenza Surveillance and Control" in the Weekly Epidemiological Record (WER; vol. 77, no. 22). The  Global Agenda was developed during 2001 and was finalized by the 65 participants of the WHO Consultation on Global Priorities in Influenza that was held in Geneva, Switzerland, on May 6 and 7 of this year.

Major themes in the Global Agenda include: improvement in influenza surveillance; improvement in understanding the burden of influenza and the benefits of epidemic and pandemic preparedness;  expansion of the use of existing vaccines, particularly in developing countries and in high-risk groups; and acceleration of introduction of new vaccines.

To read the Global Agenda in WER, go to:

To read the Global Agenda and learn about its background, go to:

To read WHO's Influenza Fact Sheet, go to:

If you have questions about the Global Agenda, contact WHO by email at

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June 3, 2002

On May 30, 2002, the Institute of Medicine (IOM) released the latest report of the Immunization Safety  Review Committee. "Hepatitis B Vaccine and Demyelinating Neurological Disorders" examines the hypothesis that hepatitis B vaccine could cause multiple sclerosis (MS), Guillain-Barre syndrome, and four other diseases that damage or destroy the myelin that surrounds the body's nerve fibers. The committee  determined that hepatitis B vaccine does not lead to MS in adults and that existing evidence is insufficient for the other diseases.

The abstract to the Executive Summary states: "[T]he committee found that the epidemiological evidence (i.e., from studies of vaccine-exposed populations and their control groups or of patients with these diseases and their control groups) favors rejection of a causal relationship between the hepatitis B vaccine  in adults and multiple sclerosis. The evidence was inadequate to accept or reject a causal relationship  between the hepatitis B vaccine and all other demyelinating conditions."

The report will soon be published by the National Academy Press (NAP) in book form. The approximately 95-page book will cost $18.00 (14.40 if purchased on the NAP website). Prepublication proofs are not available for general  purchase for this title.

A camera-ready (PDF format) version of the report's  Executive Summary is available at:$file/HepatitisB_ExecSummary.PDF

To read all or part of the report online, go to:

For more information, call the National Academy Press at (800) 624-6242.

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June 3, 2002

The Centers for Disease Control and Prevention (CDC) now offers an "ABCs of Childhood Vaccines"  PowerPoint slide series for parents and others who have a special interest in childhood vaccines. All ready to be downloaded from the CDC website, the five parts of the presentation can be used together or independently.

The five parts of the colorful presentation are: Vaccine Safety, Risks of Not Vaccinating, How Vaccines Work, Natural Immunity, and Primary Vaccinations.

Easy downloading instructions accompany the description of the presentation on the main page. Also offered are instructions for printing slides in black and white, text-only files, and a flyer to promote the  presentation as a teaching tool.

To access the "ABCs of Childhood Vaccines" main page, go to:

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June 3, 2002

In recognition of its contributions toward polio eradication and other public health issues, the Rotary Foundation of Rotary International has been granted the 2002 Gates Award for Global Health. The Global Health Council, which administers the award, chose from a large field of nominated organizations. Bill Gates, Sr., was scheduled to present the award to Rotary Foundation Trustee Chairman Luis Vicente Giay at a May 30 dinner as part of the Global Health Council's 29th annual conference.

According to the Global Health Council, "Rotary has contributed over US$462 million toward polio eradication, and has mobilized over one million Rotary members to help immunize more than 2 billion children in 122 countries." Other Rotary activities include a revolving loan program for women in Uganda to break the link between AIDS and chronic poverty and a project in the Philippines to provide free tuberculosis screening and treatment for children of pre-school or elementary age.

To learn more about Rotary International, 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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