Issue Number 37
December 18, 1998
CONTENTS OF THIS ISSUE
- AAP now recommends IPV for the first
two doses of the primary series for polio vaccine
- MMWR publishes announcement on FDA
approval of a fourth acellular pertussis vaccine for use among infants and young children
- MMWR publishes article on the progress
toward global measles control and regional elimination
- "Immunization Gateway" is a
major immunization resource center on the web
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(1)
December 18, 1998
AAP NOW RECOMMENDS IPV FOR THE FIRST TWO DOSES OF THE PRIMARY SERIES FOR POLIO VACCINE
In order to reduce the risk of vaccine-associated paralytic poliomyelitis (VAPP), the
American Academy of Pediatrics (AAP) now recommends that most children in the United
States receive the inactivated poliovirus vaccine (IPV) for the first two doses of the
primary series and either IPV or oral poliovirus vaccine (OPV) for the third and fourth
doses.
This new polio vaccine recommendation is one of several polio vaccine guidelines that have
been revised by the AAP. The complete statement, "Poliomyelitis Prevention: Revised
Recommendations for Use of Inactivated and Live Oral Poliovirus Vaccines," is now
available on AAP's website http://www.aap.org/policy/re9853.html
and will be published in the January 1999 issue of "Pediatrics."
The AAP's revised polio vaccine guidelines are summarized in the following press release
that was issued by the AAP on December 9:
AAP REVISES GUIDELINES ON THE USE OF POLIO VACCINES
CHICAGO-The American Academy of Pediatrics (AAP) issued a statement to its 55,000 member
pediatricians offering new vaccine recommendations for the four dose immunization series
to prevent polio in children. The policy recommendations appear in the December 1998 issue
of AAP News, the official newsmagazine of the American Academy of Pediatrics.
The AAP now recommends that most children in the United States receive the inactivated
poliovirus vaccine (IPV), which is received as an injection at 2 and 4 months of age for
the first two doses. Either the IPV or the oral poliovirus vaccine (OPV) is recommended
for the third dose at 6 to 18 months and the fourth dose at 4 to 6 years. Depending on the
child's medical history, pediatricians also may choose to give IPV for the entire four
dose schedule. This new recommendation also is aimed at reducing the rare instance of
vaccine-associated paralytic poliomyelitis (VAPP), which is associated with the live virus
within OPV.
In 1997, the AAP recommended that pediatricians could choose either an IPV-only, OPV-only
or a schedule utilizing both vaccines sequentially for the complete four dose regimen
against polio. However, the AAP states that since these 1997 guidelines were issued,
"substantial progress in global eradication of poliomyelitis has occurred and the use
of inactivated poliovirus vaccine has increased considerably in the United States with a
corresponding decrease in the use of oral poliovirus vaccine (OPV)." Surveys indicate
that the majority of physicians now
routinely immunize children with the sequential IPV-OPV schedule or the IPV-only schedule.
Some of the other recommendations from today's AAP statement are as follows:
OPV is acceptable when parents refuse either IPV or the number of injections needed to
administer the other recommended vaccines for infants.
The IPV-only schedule is recommended for immunocompromised persons and their household
contacts because OPV may pose possible side effects.
An OPV schedule is acceptable in infants and children in whom routine immunization is not
initiated until after 6 months of age.
OPV continues to be the vaccine of choice for control of outbreaks of the wild-type polio
virus in the United States, and the AAP supports the need for federal resources to ensure
that there is an adequate supply of OPV for outbreak control.
Parents should speak with their child's pediatrician about the advantages and
disadvantages of each vaccine and the medical history of their child. The AAP continues to
support the World Health Organization recommendation for the use of OPV to achieve global
eradication of poliomyelitis, especially in countries with continued or recent circulation
of wild-type poliovirus.
[End of press release information]
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(2)
November 6, 1998
MMWR PUBLISHES ANNOUNCEMENT ON FDA APPROVAL OF A FOURTH ACELLULAR PERTUSSIS VACCINE FOR
USE AMONG INFANTS AND YOUNG CHILDREN
A "Notice to Readers" on the FDA licensure of Certiva, a combined diphtheria and
tetanus toxoids and acellular pertussis vaccine (DTaP) manufactured by North American
Vaccine, was published in the November 6, 1998, issue of the MMWR.
Certiva, which was licensed by the FDA on July 29, 1998, is approved for the first four
doses of the diphtheria and tetanus toxoids and pertussis vaccination series administered
to infants and children who are 6 weeks to 6 years of age. There are three other DTaP
vaccines licensed for use in infants and young children in the United States. They are
Acel-Imune, manufactured by Lederle Labs; Infanrix, manufactured by SmithKline Beecham;
and Tripedia, manufactured by Pasteur Merieux Connaught.
NOTICE TO THOSE STILL USING DTP VACCINE INSTEAD OF DTaP: The "Notice to Readers"
also reminds the reader of the ACIP recommendation to use a licensed DTaP vaccine for all
five doses of the routine diphtheria, tetanus, and pertussis vaccination series as well as
for the remaining doses in the series for children who have started the vaccination series
with whole-cell DTP vaccine. The "Notice to Readers" states that the ACIP
recommendation to use DTaP for all five doses was made because of the reduced frequency of
adverse reactions and demonstrated efficacy of DTaP.
To access the complete text of this "Notice to Readers," click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055598.htm
TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR (delivered weekly), go to the MMWR
website and sign up. When you sign up, you will also receive all new ACIP statements which
are published as MMWR's "Recommendations and Reports." To get to the MMWR
website, click here: http://www.cdc.gov/epo/mmwr/mmwr.html
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(3)
December 11, 1998
MMWR PUBLISHES ARTICLE ON THE PROGRESS TOWARD GLOBAL MEASLES CONTROL AND REGIONAL
ELIMINATION
An article entitled, "Progress Toward Global Measles Control and Regional
Elimination, 1990-1997" was published in the MMWR on December 11, 1998. This report
updates progress toward global measles control and regional elimination. It also presents
measles vaccination coverage and incidence for 1997 and World Health Organization (WHO)
estimates of global measles morbidity and mortality in 1997 compared with the prevaccine
era.
The article states that by the end of 1997, global measles morbidity and mortality had
decreased 74% and 85%, respectively, compared with the annual morbidity and mortality
during the prevaccine era.
The report also has WHO region-specific information on measles cases and vaccine coverage
as well as information on which countries have conducted measles catch-up and/or follow up
vaccination campaigns.
To access the complete text of this "Notice to Readers," click here:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00055965.htm
TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR (delivered weekly), go to the MMWR
website and sign up. When you sign up, you will also receive all new ACIP statements which
are published as MMWR's "Recommendations and Reports." To get to the MMWR
website, click here: http://www.cdc.gov/epo/mmwr/mmwr.html
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(4)
December 18, 1998
"IMMUNIZATION GATEWAY" IS A MAJOR IMMUNIZATION RESOURCE CENTER ON THE WEB
"Immunization Gateway: Your Vaccine Fact-Finder" is a major immunization
resource center on the web. Visitors are offered hyperlinks to the best immunization
resources on the web. This is a great place to get electronically connected to all the
current ACIP recommendations on immunization, new immunization resources, information on
clinical trials and vaccine research, and more, more, more.
The author of the Immunization Gateway is John D. Grabenstein, MSPharm, EdM, FASHP. He is
also the author of "ImmunoFacts," an up-to-date, comprehensive reference book on
vaccines and immunologic drugs. (Ordering information is at this website.)
To follow a quick electronic pathway to great vaccine information, visit
"Immunization Gateway" at: http://www.immunofacts.com/ |
