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Issue Number 325            July 24, 2002


  1. "NEEDLE TIPS" summer 2002 issue is in the mail and on the web!
  2. CDC publishes findings from high-risk adolescent and adult hepatitis B vaccination program


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July 24, 2002

Look for your hard copy of the current "NEEDLE TIPS and the Hepatitis B Coalition News" in your mailbox soon--you can't miss the summery teal-green ink. Meanwhile, the entire summer 2002 issue is now available on IAC's website (

This mid-year issue of "NEEDLE TIPS" contains so much new information and material, you might want to preview and print individual pieces from it. For instance, we've produced a great new refrigerator temperature log for you to use on a daily basis in your clinic--why not download a copy and start logging temps properly today? And don't let another questioning patient leave your office without a copy of IAC's list of "Reliable Sources of Immunization Information." You will also want to read our special welcome to Diane Peterson, IAC's new associate director for immunization projects; she will be an important point person on many topics for the Coalition.

You can read more about the "NEEDLE TIPS" summer issue's features and departments below, with links to each article provided for your convenience. But it's easy to see already how valuable "NEEDLE  TIPS" is as a source of practical immunization information for health professionals. "NEEDLE TIPS" gathers the most important, up-to-date, expert-approved, clinical vaccination information in one 28-page publication. Every word in "NEEDLE TIPS" is reviewed for accuracy by immunization specialists at the federal Centers for Disease Control and Prevention (CDC).

In addition to being valuable, "NEEDLE TIPS" is accessible: it is offered to all public and private immunizers free of charge. However, this year IAC lost some of its traditional funding and had to cut back publication distribution, so please take a moment to read IAC Executive Director Deborah Wexler's request for financial support on the back page of "NEEDLE TIPS." If you are not already a contributor  to IAC, we hope that you will acknowledge the value of "NEEDLE TIPS" and all of IAC's work by sending in a tax-deductible contribution. We thank you for your help.


You can download the entire issue of "NEEDLE TIPS" from the web or view selected articles from the table of contents below.

To view the table of contents with links to individual articles, go to:

Please note: The PDF file of the entire summer 2002 issue, linked below, is large at 899,993 bytes. Some printers cannot print such a large file. For tips on downloading and printing PDF files, go to:

To download the entire PDF version of the summer 2002 issue of "NEEDLE TIPS," go to:

Here are direct links to some of the main "NEEDLE TIPS" pages following brief descriptions:

  1. "Ask the Experts"
    CDC immunization expert William Atkinson, M.D., M.P.H., answers general immunization questions. Hepatitis specialists Stephen C. Hadler, M.D., and Linda A. Moyer, R.N., answer hepatitis questions.

  2. "IAC Welcomes New Associate Director for IZ Projects" and "Welcome New Board Member!"
    Meet Diane Peterson, IAC's new associate director for immunization projects, and Thomas Stenvig, IAC's new board member representing the American Nurses Association.
  3. "Vaccine Highlights"
    Be sure to read this digest of recent recommendations and news about vaccine supply, influenza vaccine, smallpox, and more.
  4. "Unprotected People: Young Doctor Learns He Has Liver Cancer Too Late"
    This story about a young doctor's death from hepatitis B-related liver cancer is a tragic example of the consequence of inadequate medical attention to people with chronic hepatitis B.
  5. "Vaccines and Autism" by Dr. Paul Offit
    Here is a definitive article on the topic by a renowned physician who critically dissects the hypothesis--and the research investigating it--that MMR vaccine might be causally related to autism in children. By the end, you will understand why autism is not caused by MMR vaccine and why the issue must be put to rest.
  6. "Reliable Sources of Immunization Information"
    This is a list of IAC's top picks for books, websites, and other sources of information for patients with questions.
  7. "How to Administer IM and SC Injections"
    Two full-page charts show and tell how to give intramuscular (IM) and subcutaneous (SC) injections. They are a great training tool. Use these to make sure your staff vaccinators are giving shots correctly. Adapted from similar charts by the Minnesota Department of Health.
  8. "Protect Your Vaccines: Check Temperatures Twice a Day!"
    We have adapted this Fahrenheit temperature log from the Michigan Department of Community Health. Once you try using it, you'll make a habit of it--which is, of course, the point! This log makes recording temperatures easy.
  9. "The Truth about Using VISs"
    Too many doctors and nurses remain unsure about how and when to give vaccine recipients a Vaccine Information Statement (VIS). This sheet was created to answer the "to give, or not to give" question both simply and clearly.
  10. "Summary of Rules for Childhood Immunization"
    The revised two-sided table is about as concise as the official vaccination recommendations for children can get.
  11. "Labor and Delivery and Nursery Unit Guidelines to Prevent Hepatitis B Virus Transmission"
    The new birth dose of hepatitis B vaccine recommendation is now included in this updated piece along with other important information on preventing perinatal transmission of hepatitis B virus.
  12. "Immunization Resources"
    New books, booklets, websites, CD-ROMs, and organization contacts.
  13. "Need Help?"
    A list of immunization, hepatitis, and VFC coordinators in state health departments.
  14. "IAC Catalog"
    Order materials for patients and clinic staff here.
  15. "Letter from the Executive Director"
    Immunization Action Coalition Needs Your Support!


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July 24, 2002

On July 19, 2002, the Centers for Disease Control and Prevention (CDC) published "Hepatitis B Vaccination Among High-Risk Adolescents and Adults--San Diego, California, 1998-2001" in the  Morbidity and Mortality Weekly Report (MMWR). According to the Editorial Note to the article, the findings "suggest that a sustained vaccination program, when combined with a short counseling session, might achieve high levels of vaccine acceptance. . . .Achieving high rates of vaccination coverage requires that program managers set vaccination-coverage goals, train staff, review the  vaccination status of all clients routinely, and use appropriate health-education materials and counseling services."

The article reads in part as follows (excluding footnotes and a table):


The national strategy to eliminate hepatitis B virus (HBV) transmission is based on 1) screening all pregnant women for hepatitis B surface antigen and post-exposure vaccination of infants of infected mothers; 2) vaccinating all infants as part of the childhood vaccination schedule; 3) vaccinating children  and adolescents not vaccinated previously; and 4) vaccinating adolescents and adults in groups at increased risk for infection. These strategies have been implemented successfully in the United States except for the vaccination of adults and older adolescents at high risk. This report describes the initial findings of a hepatitis B vaccination program for potentially high-risk adolescents and adults conducted in areas of San Diego County, California. The findings indicate that high rates of hepatitis B vaccination  can be achieved in clinics and programs that serve persons at high risk for HBV infection through the  integration of hepatitis B vaccination into routine preventive health-care services. Improved efforts to vaccinate adolescents and adults at increased risk for HBV infection are critical to reduce disease incidence and prevent chronic HBV infection.

The San Diego Viral Hepatitis Prevention Project (VHPP) began in February 1998 with the selection of a convenience sample of sites located primarily in the central and southeast areas of San Diego County, where the incidences of gonorrhea and chlamydia are higher than in other parts of the county. The population of San Diego County is approximately 2.9 million persons, and the population of the  central and southeast areas is approximately 500,000 persons. Sites that serve both clients at high risk and those with a lower risk for HBV infection were selected. Hepatitis B vaccine was provided at no cost to participating sites, and project staff assisted site personnel in developing educational materials and administrative procedures and in monitoring vaccine coverage and completion. At sites that did not provide clinical services, the project provided a vaccination nurse on selected days.


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 read "Hepatitis B Immunization in an STD Clinic," the manual that was created in conjunction with the San Diego program, 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. 

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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