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Issue Number 342            October 14, 2002


  1. Ample vaccine supply is reason to celebrate this year's National Adult Immunization Awareness Week
  2. MMWR notifies readers that the long-awaited harmonized Adult Immunization Schedule is now available!
  3. HHS rule expands use of standing orders to make it easier for Medicare and Medicaid beneficiaries to get flu and pneumococcal vaccines
  4. AAP issues policy statement on smallpox vaccine
  5. Order now! Popular "Immunization Techniques" video is going fast, but there's still time to get yours
  6. New! CDC's National Immunization Program releases Influenza Bulletin #5
  7. New! WHO issues position paper on meningococcal vaccines
  8. Meeting of Immunization Safety Review Committee set for October 28-29


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October 14, 2002

Health care providers have a lot to cheer about during National Adult Immunization Awareness Week, October 13-19. For one thing, there's an abundance of two vaccines for adults that were scarce last year: influenza vaccine and adult tetanus and diphtheria toxoids (Td). For another, immunization resources abound.

Vaccine supply

The big news is that a record-setting amount of influenza vaccine is available for the 2002-2003 flu season. The Centers for Disease Control and Prevention (CDC) reported the following in the October 4  issue of the "Morbidity and Mortality Weekly Report" (MMWR): "The three manufacturers distributing  influenza vaccine in the United States are expected to produce approximately 94 million doses combined, the largest number of trivalent influenza vaccine doses ever projected for a single season. Vaccine manufacturers estimate that approximately 80% of the 94 million doses of influenza vaccine will be distributed by the end of October."

Also, according to "Influenza Vaccine Bulletin #5" of CDC's National Immunization Program (NIP),  which was released October 9, several million doses of influenza vaccine remain available for purchase. Interested providers should contact their regular sources of influenza vaccine for supplies.

According to MMWR's June 21 issue, the supply of Td vaccine is also plentiful. CDC urges adults and adolescents who were prevented from getting routine booster doses because of previous vaccine shortages to get them now.

Likewise, there is no reported shortage of other vaccines given to adults, such as pneumococcal polysaccharide vaccine (PPV23), hepatitis A vaccine, and hepatitis B vaccine.

Immunization resources

A wealth of continually updated influenza information exists on NIP's "Flu Season 2002-03" web page. NIP encourages providers to check the page often throughout flu season.

To access NIP's flu page, go to:

The website of the Immunization Action Coalition (IAC) offers providers "Give These People Flu Vaccine," a one-page professional education piece.

For an HTML copy, go to:

For a camera-ready (PDF) copy, go to:

IAC's site also posts CDC's influenza Vaccine Information Statement (VIS), as well as VISs for 14 other vaccines (available in up to 28 languages).

For camera-ready (PDF) copies of all VISs, go to:

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October 14, 2002

The Centers for Disease Control and Prevention (CDC) published a Notice to Readers "Recommended Adult Immunization Schedule--United States, 2002-2003" in the October 11 issue of Morbidity and Mortality Weekly Report (MMWR).

According to the MMWR, the schedule is an up-to-date tool that will help health professionals assess an adult patient's need for vaccination during the office visit. It is anticipated to reduce missed vaccination opportunities.

The article announced the new harmonized Adult Immunization Schedule, printed it, explained it, and encouraged immunization providers to use it. Following are the first two paragraphs of the article (excluding reference numbers).


Although the childhood immunization program in the United States has reduced the burden of vaccine-preventable disease substantially among children, substantial vaccine-preventable morbidity and mortality from diseases such as hepatitis A, hepatitis B, influenza, and pneumococcal infections continue to occur among adults. In February 2002, the Advisory Committee on Immunization Practices (ACIP) approved for the first time a schedule for the routine vaccination of persons aged 19 years and older. The Adult Immunization Schedule has been accepted by the American Academy of Family Physicians (AAFP) and the American College of Obstetricians and Gynecologists (ACOG). ACIP will  review and approve annually both the recommended adult and childhood immunization schedules. Together, these schedules provide a comprehensive summary of recommendations for prevention of vaccine-preventable diseases during the life span of persons in the United States.

The Adult Immunization Schedule is based on published recommendations of ACIP, AAFP, ACOG,  and the American College of Physicians--American Society of Internal Medicine (ACP-ASIM) with the Infectious Diseases Society of America and was developed by members of these organizations and CDC. The schedule presents a tabular, color-coded summary of vaccine indications by age group and medical condition. Footnotes included in Figure 1 are summaries of the ACIP recommendations for specific vaccines since 1991. Figure 2 includes special considerations or contraindications for vaccinating persons with specific medical conditions. Licensed combination vaccines can be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult manufacturers' package inserts for detailed recommendations. CDC and ACIP will update the schedule annually through collaboration with members of AAFP, ACOG, and ACP-ASIM.


A printable, annotated, color version of the schedule is available; it can also be printed in black and white. For a camera-ready (PDF) version, go to:

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 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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October 14, 2002

On October 1, Department of Health and Human Services (HHS) secretary, Tommy G. Thompson, announced a change in federal rules that will make it easier and faster to give flu and pneumococcal vaccinations in hospitals, long-term care facilities, and home health agencies that serve Medicare and Medicaid beneficiaries.

In "Influenza Vaccine Bulletin #5," dated October 9, the National Immunization Program of the Centers for Disease Control and Prevention described the crux of the change as follows:


On October 2, 2002, the Centers for Medicare and Medicaid Services (CMS) published an interim final rule in the Federal Register which removes from the Conditions of Participation the physician signature requirement for influenza and pneumococcal vaccinations in Medicare and Medicaid participating hospitals, long-term care facilities, and home health agencies.

To the extent allowed by state law, these facilities and agencies may now implement standing orders for influenza and pneumococcal vaccination of Medicare- and Medicaid-eligible patients.


Before the change, a physician's order was required for vaccinations given in Medicare- or Medicaid-participating hospitals, nursing homes, and home health agencies, even though vaccinations could be given using standing orders in other settings, such as clinics and doctors' offices.

To read the complete press release from HHS, go to:

To learn more about using standing orders in your health care setting, contact your local or state health department.

To access a camera-ready (PDF) copy of the complete text of the interim final rule from the Federal Register, go to:

The Immunization Action Coalition (IAC) is developing a web page on the use of standing orders for immunization. Look for an announcement about it in an up-coming issue of IAC EXPRESS.

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October 14, 2002

The October 2002 issue of "Pediatrics," the journal of the American Academy of Pediatrics, contains the Academy's new policy statement on smallpox vaccine. Following is the abstract.


After an extensive worldwide eradication program, the last nonlaboratory case of smallpox occurred in 1977 in Somalia. In 1972, routine smallpox immunization was discontinued in the United States, and since 1983, vaccine production has been halted. Stockpiled vaccine has been used only for laboratory researchers working on orthopoxviruses. In recent years, there has been concern that smallpox virus stocks may be in the hands of bioterrorists, and this concern has been heightened by the terrorist attack on the World Trade Center and the Pentagon on September 11, 2001. Because most of the population is considered to be nonimmune, there is debate as to whether smallpox immunization should be resumed. This statement reviews the current status of smallpox vaccine, the adverse effects that were associated with smallpox vaccine in the past, and the major proposals for vaccine use. The statement provides the rationale for a policy based on the so-called ring vaccination strategy recommended by the Centers for Disease Control and Prevention, in which cases of smallpox are rapidly identified, infected individuals are isolated, and contacts of the infected individuals as well as their contacts are immunized immediately.


To access the text of the complete smallpox policy statement from the AAP website, go to:

To access the abstract from "Pediatrics," October 2002, Vol.110(4):841-45, go to:

For additional information about the AAP, visit the AAP website at

To access many other AAP vaccine policy statements, go to the Immunization Action Coalition's web page "Immunization Policy Statements from the American Academy of Pediatrics," at

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October 14, 2002

Since we first offered the video "Immunization Techniques: Safe, Effective, Caring" in IAC EXPRESS #273 in September 2001, IAC has sold more than 6,300 videotapes! More than a third of those orders were placed in the last three months.

One reason for the recent high sales volume is that some organizations have found the video to be such a powerful staff-training tool that they have placed large orders. For example, the Pennsylvania VFC Program ordered 1,800 videos, the Georgia Chapter of the American Academy of Pediatrics ordered 105, and the Connecticut Department of Public Health ordered 101.

The 35-minute video, titled "Immunization Techniques: Safe, Effective, Caring," was developed by the California Department of Health Services Immunization Branch in collaboration with a team of national experts. Designed for use as a "hands-on" instructional program, the video is intended to train new  staff and provide a refresher course for experienced staff who administer vaccines.

It teaches best practices for administering intramuscular (IM) and subcutaneous (SC) vaccines to infants, children, and adults and discusses the following:

Anatomic sites
Choice of needle size
Vaccines and routes of administration
How to "draw up" doses of vaccine from a vial

People of various ages--from infants to adults--are vaccinated in the video to demonstrate these techniques.

The video comes with presenter's notes that include instructional objectives, pre- and post-tests, photos showing vaccination sites appropriate for vaccinating people of different ages, and a skills checklist to help you document that your staff is well trained.

IAC distributes the video and presenter's notes at $15 per set (to U.S. addresses). California Distance Learning Health Network (CDLHN) offers it at $25 per set. The versions are the same except that IAC's video comes in a plain cardboard sleeve and the presenter's notes are printed in black and white, while CDLHN's video box and presenter's notes are printed in color. The videotape and text of presenter's  notes are identical. CDLHN also has a Spanish version available.

If you wish to order online (U.S. addresses only), go to:

To order by mail or fax, print an IAC order form, available at

Send your order payment (check, credit card information, or purchase order) to Immunization Action Coalition, 1573 Selby Ave., Ste. 234, St. Paul, MN 55104, and include your complete mailing information and phone number. You can fax your order form with payment information to IAC at (651) 647-9131. If you are placing an order from outside the United States, please call IAC at (651) 647-9009 for shipping cost information.

To order through CDLHN, call (619) 594-3348, email, or visit CDLHN online at

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October 14, 2002

On October 9, the National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) issued the fifth in a series of influenza vaccine bulletins designed to update health professionals on the production, distribution, and administration of influenza vaccine for the 2002-2003 influenza season. Following is a summary of Influenza Bulletin #5.

Influenza vaccine supply and production

Several million doses of influenza vaccine remain available for the 2002-2003 flu season; providers are encouraged to contact their regular sources of influenza vaccine to make purchases.

Influenza vaccine distribution

Effective October 2, the Department of Health and Human Services changed the rule for administering influenza and pneumonia vaccines in hospitals, long-term care facilities and home health agencies that serve Medicare and Medicaid beneficiaries. The change allows these facilities and agencies to use standing orders, rather than physicians' signed orders, when giving flu and pneumonia vaccines. For more information, see article #3 in this week's issue of "IAC EXPRESS."

Effective October 16, the Health Insurance Portability and Accountability Act (HIPAA) requires providers to use standard formats for electronic transmission of health care claims. However, HIPAA  legislation allows providers not in compliance with the act to file for a one-year extension before  October 16. To find out more about HIPAA and the extension, go to:

Influenza vaccine communications

The Centers for Disease Control and Prevention (CDC) has new education materials for this season, including the chart "Pediatric Influenza Vaccine Dosages." CDC warns providers that another pediatric  influenza vaccine dosage chart--WITH INCORRECT INFORMATION--is circulating. To avoid confusion, providers should use only the chart that displays the CDC logo. To view new materials, go to the CDC's web page "Patient Education Materials for the 2002-03 Season" at

To view or obtain a complete copy of the bulletin, go to:

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October 14, 2002

The World Health Organization (WHO) published a new position paper, "Meningococcal Vaccines: Polysaccharide and Polysaccharide Conjugate Vaccines," in the October 4 issue of the "Weekly Epidemiological Record."

The paper is the latest in a series on vaccines and vaccine combinations against diseases that have an international public health impact. The papers are primarily intended for national public health officials and program managers of large-scale immunization programs.

A link to the new position paper is included on the website of the Immunization Action Coalition (IAC), along with links to all WHO position papers on vaccines and other WHO vaccination resources.

For links to IAC's "WHO Immunization Information" web page, go to:

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October 14, 2002

The seventh meeting of the Institute of Medicine's Immunization Safety Review Committee will be held October 28-29 at Beckman Center on the campus of the University of California, Irvine. The meeting  topic is the potential role of vaccination in sudden, unexpected infant death.

For information about the meeting and to register online, go to:

For additional information, call (202) 334-1342 or 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.

IZ Express Disclaimer
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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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