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Issue Number 324            July 15, 2002


  1. CDC says increased DTaP, MMR vaccine supplies permit return to routine schedules
  2. National Immunization Program creates new "flu shot flyers" to give to patients in 2002-2003
  3. World Health Organization and UNICEF co-sponsor strategic plan to reduce measles mortality worldwide
  4. National Influenza Summit 2002 presentations and recommendations are now online
  5. Register now for CDC course in Minneapolis on August 28-29!
  6. New training module from Children's Vaccine Program: "Immunizing Children against Hepatitis B"
  7. World Vaccine Congress 2002 will convene in Lyon, France, on September 30-October 2


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July 15, 2002

On July 12, 2002, the Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Resumption of Routine Schedule for Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine and for Measles, Mumps, and Rubella Vaccine" in Morbidity and Mortality Weekly Report (MMWR).  This suspends the use of interim recommendations by the Advisory Committee on Immunization Practices (ACIP) developed in response to recent vaccine shortages.

Following is the entire Notice to Readers (excluding footnotes):


Please note: The text of this report [HTML] has been corrected and does not correspond to the official electronic PDF version [the version "of record"]. An erratum to the official version will be published in a subsequent issue. [In the PDF version, the word "insufficient" in the second paragraph of the DTaP  section has not yet been changed to "sufficient."]

Supplies of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine and measles, mumps, and rubella (MMR) vaccine in the United States have become sufficient to permit the resumption of the  routine schedule for DTaP and MMR use as recommended by the Advisory Committee on Immunization Practices (ACIP). However, health-care providers should be advised that, for the next 2 months, supply  might not be adequate for the initiation of ambitious recall or special initiative programs. With increases in national inventory, more comprehensive recall programs can be established. Child care and school attendance provisions requiring children to receive a DTaP booster and a second dose of MMR vaccine at age 4-6 years can be reinstituted.

DTaP Vaccine

Three DTaP vaccines are distributed currently in the United States: Tripedia[R] (Aventis Pasteur, Swiftwater, Pennsylvania), Infanrix[TM] (GlaxoSmithKline, Philadelphia, Pennsylvania), and DAPTACEL[TM] (Aventis Pasteur, Toronto, Ontario). The Food and Drug Administration (FDA)  approved DAPTACEL[TM] for use in the United States on May 14, 2002.

During the DTaP vaccine shortage beginning in 2000, ACIP recommended that health-care providers vaccinate infants with the initial 3 DTaP doses, if they did not have sufficient supply of DTaP to  vaccinate all children in their practice. ACIP also recommended deferral of the fourth and fifth DTaP doses if supplies were still inadequate. Supplies are now adequate to resume the full 5-dose schedule for DTaP vaccine.

MMR Vaccine

A temporary shortage of MMR vaccine in the United States resulted from a voluntary interruption of  manufacturing operations of Merck & Co., Inc., the only manufacturer of this vaccine in the United States. During the vaccine shortage, ACIP recommended deferral of the second dose of MMR vaccine  at age 4-6 years if health-care providers were unable to obtain sufficient amounts of vaccine. The first dose at age 12-15 months was not to be delayed because of the severity of measles in young children. Supplies are now adequate to resume the second dose of MMR vaccine.

Vaccine Supply

Health-care providers should review the vaccination status of their patients and administer DTaP and MMR vaccines, as appropriate. For at least the next 2 months, providers should order DTaP and MMR  vaccine in amounts sufficient for a 30-day or less supply to ensure that current supplies can meet requests. Recall or special initiative programs can be instituted when DTaP and MMR vaccine supply improves further but should be deferred during this transition period. However, if children who need these vaccines seek medical care for other reasons, they should be administered vaccine provided no contraindications exist. Furthermore, vaccine should be offered to children who need vaccination and whose parents requested vaccination. CDC will continue to monitor DTaP and MMR vaccine supply and,  if necessary, allocate vaccine. Updates regarding vaccine supply and shortages can be found at


To obtain the complete text of the 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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July 15, 2002

On July 3, 2002, CDC's National Immunization Program (NIP) published Influenza Vaccine Bulletin #3. In this bulletin, NIP estimates that influenza vaccine production for 2002-2003 will reach 92 to 97 million doses. The bulletin also summarizes CDC's recent erratum regarding influenza vaccine timing (see the  erratum at and provides the latest vaccine ordering information.

Of special note is the bulletin's announcement of new educational flyers about flu shots for patients now available on CDC's website. With all the changed recommendations for 2002-2003, these flyers will help vaccinators explain the recommendations to patients. Two of the three planned flyers are now ready for downloading.

"When Should You Get Your Flu Shot?" shows in simple chart form who should receive vaccine in October and who can wait until November, visually reminding people that if they missed it in those two  months it's "not too late" in December or later.

"Is It a Flu Shot Fact or a Myth?" lists eight statements about the flu and the flu shot and sets the record straight.

To obtain a camera-ready (PDF format) copy of "When Should You Get Your Flu Shot?" go to:

To obtain a camera-ready (PDF format) copy of "Is It a Flu Shot Fact or a Myth?" go to:

To read Influenza Vaccine Bulletin #3, go to:

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July 15, 2002

On July 5, 2002, "WHO-UNICEF Joint Statement on Strategies to Reduce Measles Mortality Worldwide" was published in the World Health Organization (WHO) news journal "Weekly Epidemiological Record" (vol. 77., no. 27). The statement outlines a Global Measles Strategic Plan with the main goal of halving the current number of measles deaths by the year 2005.

The statement reads in part as follows (excluding one figure reference):


There were an estimated 30 million to 40 million cases of measles in 2000, causing some 777,000 deaths. Measles thus accounts for nearly half of the 1.7 million annual deaths due to childhood vaccine-preventable diseases. . . .

Failure to deliver at least one dose of measles vaccine to all infants remains the primary reason for high measles morbidity and mortality. Many of the deaths can be prevented by more efficient use of existing immunization services and by ensuring the availability of resources for implementing all recommended strategies in each country. . . .

Of all health interventions, measles immunization carries the highest health return for the money spent, saving more lives per unit cost. The vaccine, which has been available for more than 30 years, costs US$0.26 per dose, which includes safe injection equipment. . . .

[The four strategies to reduce measles mortality are:]

(1) Provide the first dose of measles vaccine to successive groups of children at the age of 9 months or shortly after [IAC editorial note: the current recommendation for the United States is to give the first dose at 12-15 months of age];

(2) Guarantee a "second opportunity" for measles vaccination either through campaigns or routine immunization. The second opportunity is needed both to increase the chance that every child receives at least one dose of measles vaccine and to increase the proportion of the population that is fully immunized. When the first dose is given at 9 months, not all children will develop a protective response. The second dose, given later, will increase the protective response and the likelihood of immunity. . . ;

(3) Establish an effective system to monitor coverage and conduct measles surveillance. . . ;

(4) Improve management of every measles case. . . .


To read the entire text of "WHO-UNICEF Joint Statement on Strategies to Reduce Measles Mortality Worldwide," see the July 5 issue of "Weekly Epidemiological Record" at:

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July 15, 2002

Co-sponsored by the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC), the National Influenza Summit 2002 was held in Atlanta, Georgia, May 22-23, with more than 65 invited participants who are involved in vaccine production, delivery, and administration.  Working groups discussed communications, payment for vaccine and its administration, vaccine distribution, mass vaccination, and occupational health and business.

The AMA has now posted much of the Summit discussion and conclusions on its website in both PDF format and Microsoft Word files. The Summit agenda, list of participants, presentations, and final recommendations all can be accessed from the Summit page.

To read the National Influenza Summit 2002 introductory text and link to specific documents, go to:

To read only the Summary of Recommendations, go to:

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July 15, 2002

A live, two-day course on vaccine-preventable diseases (VPDs) will be held in Minneapolis on August 28 and 29 at the downtown Minneapolis Marriott Hotel. "Epidemiology and Prevention of Vaccine- Preventable Diseases" will cover the latest information for providers on schedules, contraindications, standard immunization practices, and vaccine management and safety.

The course is based on the book by the same name, also known as "The Pink Book." Attending this course is a great way to learn about what's new in "The Pink Book"--and in the world of VPDs--in a short period of time. With so many changes in vaccine supply and recommendations, now is a good time to get staff updated.

Featured speakers at "Epidemiology and Prevention of Vaccine-Preventable Diseases" are CDC experts William L. Atkinson, M.D., M.P.H.; Donna L. Weaver, M.N., R.N.; Judy V. Schmidt, Ed.D., R.N.C.; and IAC Executive Director Deborah L. Wexler, M.D.

The registration fee for the course is $69. The Immunization Action Coalition is offering a free set of VPD slides to the 101st registrant. This VPD slide set consists of 30 slides to present with an English or Spanish script.

To print a course brochure, go to:

To register for the course online, go to:

If you have questions, contact Judy Schmidt at or Patti Storti at

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July 15, 2002

The Children's Vaccine Program at Path (CVP) has developed a 46-page international training module for doctors, nurses, and other immunization providers titled "Immunizing Children against Hepatitis B."  This training module can be downloaded from the CVP website and printed free of charge.

The user-friendly module comes with a thorough introduction, including information on training preparation and objectives, and clear instructions for adapting content for use in different countries or regions. The estimated time needed to present the material in the module "can vary from approximately 2 hours to one full day," according to the introduction, depending on how much time for discussion is allowed and how much time is devoted to student practice giving injections, doing role-plays, and filling out forms.

Attachments to the module include the very helpful "Has This Vaccine Been Frozen? Doing the `Shake Test'" with pictures of sediment-laden vaccine in a vial to show how hepatitis vaccine should NOT look.

To print "Immunizing Children against Hepatitis B," go to:

For other training materials and clinical information from CVP, go to:

For more information, email

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July 15, 2002

The fourth annual World Vaccine Congress will be held at the Palais de Congres de Lyon in Lyon, France, on September 30 through October 2, 2002. The theme of the Congress is "Bringing Vaccines to Life--from Conception to Delivery."

For more information on the World Vaccine Congress 2002, call +44 (0) 20-7242-2324, fax +44 (0) 20-7242-2320, or visit

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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
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    Laurel H. Wood, MPA
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    Kayla Ohlde

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