Issue Number 353            December 9, 2002


  1. AAP publishes new policy statement on childhood influenza immunization
  2. AAP "Refusal to Vaccinate" form helps health professionals document a parent's refusal to accept vaccination
  3. CDC's diagnostic poster and worksheet, "Evaluating Patients for Smallpox," available online
  4. Updated! IAC's "State Mandates" web pages reflect new information from two states
  5. IAC responds to vaccine critics with two new web pages
  6. Register now for CDC's National Hepatitis Coordinators' January Conference
  7. TIDE's online childhood immunization curriculum now fully certified for CME/CEU/CNE credit
  8. New website supports the needs of survivors of vaccine associated paralytic polio
  9. CDC issues update on U.S. influenza activity for the 2002-03 season
  10. CMS decision to replace vaccine CPT codes with "Q" codes set to be implemented January 1, 2003


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December 9, 2002

The December 2002 issue of "Pediatrics," the journal of the American Academy of Pediatrics, contains the Academy's new policy statement on childhood influenza immunization: "Reduction of the  Influenza Burden in Children," as well as a technical report on the same topic. Following is the abstract from the new policy statement.


Epidemiologic studies indicate that children with certain chronic conditions, such as asthma, and otherwise healthy children younger than 24 months are hospitalized for influenza and its complications at high rates similar to those experienced by the elderly. Currently, annual influenza immunization is  recommended for all children 6 months and older with high-risk conditions. To protect these children more fully against the complications of influenza, increased efforts are needed to identify and recall high-risk children for annual influenza immunization. In addition, immunization of children 6 through 23 months of age and their household contacts and out-of-home caregivers is now encouraged to the extent feasible. The ultimate goal is a universal recommendation for influenza immunization. Issues that need to be addressed before institution of routine immunization of healthy young children include education of physicians and parents about the morbidity caused by influenza, adequate vaccine supply, and appropriate reimbursement of practitioners for influenza immunization.


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

To access the full text of the companion article, "Technical Report: Reduction of the Influenza Burden in Children," from "Pediatrics," December 2002, Vol.110(6):ppe80, go to:

For additional information about AAP, visit the AAP websites at and

To access links to 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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December 9, 2002

The American Academy of Pediatrics (AAP) recently posted a one-page "Refusal to Vaccinate" form on its website. The AAP website states that the form is intended for health care providers who "decide  it is in their best interest to formally document a parent's refusal to accept vaccination for a minor child."

A portion of the explanatory text describes why a health professional might consider using the form: "All parents and patients should be informed about the risks and benefits of preventive and therapeutic procedures, including vaccination. In the case of vaccination, federal law mandates this discussion. Despite the health care provider's best efforts to explain its importance, some families may refuse one or more vaccinations for their children. The use of this or a similar form may in some instances induce a wavering parent to accept your recommendations because it emphasizes the importance you place on being appropriately immunized."

To obtain a camera-ready copy (PDF format) of the form, go to:

To obtain copy of the AAP's "Refusal to Vaccinate" form, as well as the explanatory text, as a Word document, go to: Scroll down, looking on the right side of the screen for a paragraph with this heading: Documenting Parental Refusal to Accept Vaccination. At the bottom of the paragraph, click on (See Word doc)

To obtain the form by phone, call AAP at (888) 227-1770.

For an array of information on pediatric immunization go to AAP's Childhood Immunization Support Program website at

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December 9, 2002

The 11" x 17", full-color diagnostic poster, "Evaluating Patients for Smallpox" is available on the website  of Centers for Disease Control and Prevention (CDC). Intended for use with a worksheet of  the same title, the poster clearly outlines the protocol for distinguishing smallpox from varicella and other conditions that might be confused with smallpox and for evaluating risk.

The four-page companion worksheet aids health professionals in collecting information on cases of acute, generalized vesicular or pustular rash illness and in classifying risk of smallpox using the criteria outlined in the poster.

To obtain the complete 11" x 17" poster, go to:

To obtain one half of the poster as an 8-1/2" x 11" document, go to:

To obtain the other half of the poster as an 8-1/2" x 11" document, go to:

For a copy of the companion worksheet, "Evaluating Patients for Smallpox," go to:

For an array of useful information on all aspects of smallpox disease and vaccine, go to CDC's website at

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December 9, 2002

The Immunization Action Coalition (IAC) recently updated its "State Mandates on Immunization and Vaccine-Preventable Disease" web pages to reflect the following changes made in two states:

Varicella vaccination mandates went into effect for all children twelve months of age and older in day care in Delaware in September 2002 and will go into effect for new enrollees in elementary and middle school in September 2003. Indiana will require varicella vaccination starting January 2003 for all  children age 19 months to six years in day care.

Pneumococcal conjugate vaccine (PCV7) will be required in January 2003 for all children age two months through five years attending day care in Indiana.

To access IAC's updated state mandates web pages, go to:

Please be sure to let us know of any new immunization mandates in your state. Although we follow state activities, we also rely on readers to keep us informed. Send emails with your updates to

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December 9, 2002

The Immunization Action Coalition (IAC) recently launched two web pages of solid, scientific resources that counter arguments of vaccine critics. The new web page "Answering Immunization Critics" is intended for health professionals; the web page titled "Concerned About Vaccines?" is designed for patients and parents.

"Answering Immunization Critics"

This web page is designed to help health professionals talk to patients and parents who have concerns about the safety, efficacy, or ethics of vaccination. The Internet is fast becoming parents' and patients' source for vaccination information. Though some Internet information is based on science, much is based, unfortunately, on misinformation. This makes it imperative that health professionals know about the latest arguments and rumors on the Internet so they can counter misinformation with facts. This page was developed to be a "one stop" source for health professionals interested in educating themselves about such issues.

Since not all patients question immunization for the same reasons, "Answering Immunization Critics" is divided into six sections that cover a range of vaccine concerns: vaccine safety, continuing importance of vaccines, chiropractors and immunization, immunization and "alternative medicine," religious and ethical concerns about vaccination, and issues of civil liberties.

To view the web page for health care providers, go to:

"Concerned About Vaccines?"

On IAC's new public website,, you will find a web page of excerpts of some of the information from "Answering Immunization Critics." Titled "Concerned About Vaccines?" this web page addresses parents' and patients' questions about vaccination and responds to the arguments of vaccine critics. Please encourage your web-savvy patients to consult this page in the course of their research on immunization.

Visit and refer your patients to "Concerned About Vaccines?" at

IAC's new public website, is a comprehensive resource for parents, patients, and members of the media. It has information about vaccine-preventable diseases and their vaccines, vaccine safety, and topics of special interest to non-medical audiences. To increase its availability and usefulness, IAC requests that you add it as a link on your website.

We hope you find these collections of resources useful in your health care setting. We'd appreciate your feedback. Please email your thoughts about these new web pages and the new website to us at

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December 9, 2002

The Centers for Disease Control and Prevention's National Hepatitis Coordinators' Conference: Integration of Services for the Prevention of Viral Hepatitis, is scheduled for January 26-30 in San Antonio, TX.

The conference program will include plenary sessions, workshop sessions, poster presentations, and plenty of opportunities to network with public health professionals working in viral hepatitis. Conference topics include viral hepatitis prevention, treatment, counseling, and testing.

The plenary sessions and workshops will appeal to a broad audience including public health professionals, administrators, educators, and others interested in the prevention and control of viral hepatitis. Attendees will also include health professionals working with HIV, STD, immunizations, and hepatitis, as well as those working in substance abuse and correctional health settings. Counselors and social workers working with individuals at increased risk for viral hepatitis should also consider attending.

The conference is co-sponsored by the Centers for Disease Control and Prevention, the Immunization Action Coalition, and the University of Minnesota Office of Continuing Medical Education.

For a brief overview of the conference and for registration information, go to:

For an online copy of the conference brochure, including complete information on continuing medical education credits, registration, meeting venue and accommodations, conference materials, pre- and post-conference sessions, and the conference program, go to:

To access the online registration form, go to:

For additional information, call the conference planner, the University of Minnesota Office of Continuing Medical Education, at (800) 776-8636.

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December 9, 2002

After pilot testing and evaluation, all four modules of the curriculum for "TIDE (Teaching Immunization Delivery and Evaluation): An Online Interactive Education Program" have been certified for CME/CEU/CNE credit.

A project of the Centers for Disease Control and Prevention, the Ambulatory Pediatric Association, and the Society for Adolescent Medicine, TIDE is offered through the Medical University of South Carolina. It is designed to "improve knowledge, attitudes, and skills" in clinical settings, leading to increased rates of childhood immunization. It is currently available at no charge.

The four self-contained modules are Childhood Immunization, Assessing Immunization Rates, Improving Immunization Rates in Your Practice, and Adolescent Immunization. Learners consider sample pediatric cases, walk through a chart audit, and use adolescent patient information to make correct immunization decisions.

To learn more about TIDE, go to:

To register on line to use the TIDE modules, go to:

If you have questions about TIDE, contact Patti Holsclaw, TIDE coordinator, by phone at (843) 876-1217 or email at

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December 9, 2002

The Vaccine Associated Polio Society (VAPS) has launched a website that offers information, education, and resources to the survivors of vaccine associated paralytic polio (VAPP) and their families. The society, which has the motto "Pro-Immunization--Pro-Safe Polio Vaccines," is dedicated to ensuring continued medical care and sound public policy for people living with VAPP through education, advocacy, and research.

A predecessor organization, Informed Parents Against VAPP, helped lead a successful campaign to change federal vaccine policy from oral polio vaccine, which can cause VAPP, to inactivated polio vaccine, which cannot.

For additional information about VAPS, visit the website at or call (888) 363-VAPP (8277).

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December 9, 2002

The Centers for Disease Control and Prevention (CDC) published "Update: Influenza Activity--United States, 2002-03 Season" in the December 6 issue of "Morbidity and Mortality Weekly Report" (MMWR). The Editorial Note, excluding four footnoted references, reads as follows.


All four national influenza surveillance system components indicated that levels of influenza activity were low in the United States during the weeks ending October 5-November 23. Both influenza A and B viruses have been identified this season, but it is too early to determine which strain(s) will predominate. Influenza activity is expected to increase during the coming weeks and months.

The best prevention against influenza is annual vaccination. Although the optimal time to receive influenza vaccination is during October-November, CDC encourages continuing vaccination efforts in December and throughout the influenza season. The American Medical Association, with support from CDC, has declared December 2-13 as "National Influenza Vaccination Catch-up Fortnight" because millions of persons at high risk for complications from influenza remain unvaccinated each year. It is particularly important to vaccinate those at high risk for serious complications from influenza (including persons 65 years of age and over and those with certain underlying medical conditions), and health-care providers. Such persons might benefit from vaccination even after influenza has been detected in their community. Vaccine supplies continue to be plentiful. The manufacturers estimate that approximately 93 million doses of influenza vaccine were produced this year, compared with  approximately 87 million doses produced during the 2001-02 season.

On November 19, Wyeth Vaccines announced that it will no longer produce inactivated influenza vaccine after the 2002-03 influenza season. This development will not jeopardize this year's vaccination programs or vaccine availability. The two remaining influenza vaccine manufacturers in the U.S. market, Aventis Pasteur, Inc. and Evans Vaccines, Ltd., have indicated that they plan to increase influenza vaccine production for the 2003-04 season to make up for the loss of the Wyeth Vaccines product.

Influenza surveillance reports for the United States are published weekly during October-May and are available at or through CDC's voice [(888) 232-3228] and fax [(888) 232-3299, document number 361100] information systems.


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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December 9, 2002

Earlier this fall, the Center for Medicare and Medicaid Services (CMS) issued instructions to its contractors to replace hepatitis B vaccine CPT codes with "Q" codes, effective January 1, 2003.

The decision has raised concern among some in the health community, particularly physician and non-physician health care professionals involved in hepatitis B immunization, from both a clinical and payment policy perspective. Currently, health professionals have five CPT codes available to them for billing for hepatitis B immunization. When "Q" codes become effective, only three codes will be available. Health professionals are concerned that the reduction from five codes to three will result in the loss of detailed information useful to clinicians and public health professionals.

The possibility exists to defer implementation of new "Q" codes until the concerns of various groups in the health community have been discussed further.

For a more detailed discussion of the topic, and of steps being taken to possibly defer implementation, go to the websites of the American Immunization Registry Association at or of the American College of Physicians- American Society of Internal Medicine at

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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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