Issue Number 396            June 30, 2003


  1. IAC's new "Immunization Registries" web page simplifies access to online resources
  2. Every Child By Two electronic newsletter makes it easy to keep up with federal immunization legislation
  3. North Carolina enacts meningococcal legislation for college attendance
  4. Routine immunization of children re-established across Iraq
  5. CDC publishes an update on current monkeypox outbreak
  6. Annual SIGN meeting to be held September 18-20 in Nairobi, back-to-back with the Africa AIDS Conference
  7. DHHS receives report of the National Advisory Committee on Children and Terrorism


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June 30, 2003

Recently, the Immunization Action Coalition (IAC) culled material about immunization registries from professional journals and government publications and used it to develop a new web page, "Immunization Registries." The national health goals for 2010 specify that 95 percent of children from birth up to age 6 years participate in a fully operational, population-based immunization registry. One of IAC's goals in developing the new web page is to provide those interested in registries with information that will speed the growth of registries and help attain the 2010 objectives.

The growth of registries is a recent and welcome occurrence. Health professionals who provide vaccinations know the frustration of trying to track down a new patient's shot record. Because of population mobility, changes in health plan rules, and changes in employment, patients, particularly children, often visit multiple providers to complete immunizations. When providers are not able to access previous records quickly, they may defer needed vaccines or give unnecessary doses.

Immunization registries, which are centralized repositories for immunization records, are the solution to this problem. Across the nation, many are functioning on the state and local level.

The new "Immunization Registries" web page is located in the Topics of Interest section in the right column of IAC's home page ( To access it, go to:

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June 30, 2003

Every other month, we at the Immunization Action Coalition are fortunate enough to receive an outstanding electronic newsletter published by Every Child By Two (ECBT), a nonprofit organization committed to promoting childhood immunization. Started in 1991 in response to the 1989-91 U.S. measles epidemic, the group is spearheaded by former United States First Lady Rosalynn Carter and former Arkansas First Lady Betty Bumpers.

Every newsletter issue includes "On the Hill," a column that describes and explains--in plain English--proposed legislation that has the potential to affect some aspect of childhood immunization on the national level. Subsequent newsletter issues inform readers of the status of the legislation. In addition, the column outlines steps readers can take to advocate for particular legislation. Several times a year, newsletter subscribers also receive stand-alone "On the Hill" columns that make them aware of particularly important immunization legislation.

Other newsletter articles concern various childhood immunization issues, such as immunization registries, pertinent articles published in the "Morbidity and Mortality Weekly Report," relevant events on the state level, and much more.

To access the May/June 2003 newsletter, including the "On the Hill" column, from the ECBT website, go to:

To access previous newsletters and stand-alone "On the Hill" columns, go to:

To subscribe to the newsletter and "On the Hill" column, email

For information about ECBT's myriad activities, visit the ECBT home page at There you'll find links to a host of web pages that describe the work the organization is involved in on behalf of childhood immunization.

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June 30, 2003

The General Assembly of North Carolina passed legislation requiring all educational institutions that offer a postsecondary degree and that have a residential campus to provide all students with (1) vaccination information on meningococcal disease and (2) forms on which students will indicate  whether they have received vaccination against the disease. The governor signed the legislation June 12; it went into effect immediately and will apply to students beginning in the 2003-2004 academic year.

The Immunization Action Coalition (IAC) has compiled information about all states that have meningococcal prevention mandates for colleges and universities. To access the information, go to:

We depend on our readers to help us stay informed and to ensure our website contains the most current and accurate information available. Please let us know when any changes occur in your state.

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June 30, 2003

On June 16, the United Nations International Children's Emergency Fund (UNICEF) issued a press release announcing the resumption of routine immunization of Iraqi children. Routine immunization was  halted for almost three months after the start of military action in March. Excerpts from the press release follow.


BAGHDAD, 16 June 2003 - With support from UNICEF, the Iraqi Ministry of Health has begun the process of immunizing the country's 4.2 million children under the age of five against preventable diseases such as polio, tetanus, diphtheria, pertussis, measles, and tuberculosis. The World Health Organization is also contributing to the reactivation of Iraq's Expanded Programme of Immunization by re-establishing the country's vital disease surveillance system.

According to UNICEF, no child in Iraq has been routinely immunized since the start of military action on 20 March 2003.

"In the past three months, approximately 210,000 children have been born in Iraq," said Carel de Rooy, UNICEF's Representative in Iraq. "Not one of these children has been vaccinated against the myriad of deadly and debilitating diseases young children are susceptible to."

"Parents know how important these immunizations are to their newborn and young children. An infant's immune system is very fragile and vulnerable to contracting disease without these vaccines, and given the current conditions in the country, children are at greater risk than ever if they are not vaccinated right away," added de Rooy.

With the fall of the former regime came the breakdown of much of Iraq's health system. The Ministry of Health stopped functioning, communication between the capital and the governorates became impossible, and vital services like routine immunization collapsed leaving children vulnerable to disease.

The war also affected the country's store of vaccines. The country's vaccines were kept in a building at the Vaccine and Serum Institute of Baghdad. The institute was struck by missiles during the war and all electricity to the store room was cut. . . .

To overcome this situation, UNICEF has been bringing millions of doses of vaccines into Iraq to restart the country's routine immunization programme in partnership with the reactivated Ministry of Health. The 25 million doses of vaccines were purchased through a $3.2 million grant from USAID. . . .

"UNICEF and the Ministry of Health have been focusing our health initiatives on re-establishing the country's routine immunization system. It is our main priority for protecting the health of Iraqi children,"  said de Rooy. "The size and importance of this endeavour can not be underestimated, and we are extremely pleased that immunization will begin across Iraq today."

With support from UNICEF and WHO, Iraq has been certified polio-free, measles has been brought under control, and maternal and neonatal tetanus eliminated.

However, according to UNICEF all of these gains would be lost if routine immunization were not restarted quickly. The re-emergence of polio in Iraq would also risk transmission to neighbouring countries, thereby threatening the region.


To access the press release from the UNICEF website, go to:

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June 30, 2003

The Centers for Disease Control and Prevention (CDC) published "Update: Multistate Outbreak of Monkeypox--Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003" in the June 27 issue of the "Morbidity and Mortality Weekly Report" (MMWR).

The article reports the number of confirmed cases has been revised, based on the updated case definition, issued June 17. In addition, the article reports on the use of smallpox vaccine to prevent further transmission of monkeypox and refers readers to an updated interim guidance on the use of smallpox vaccine, cidofovir, and vaccinia immune globulin, issued June 25. Excerpts of the article are reprinted below.


CDC and state and local health departments continue to investigate cases of monkeypox among persons who had contact with wild or exotic mammalian pets or persons with monkeypox. This report updates epidemiologic, laboratory, and smallpox vaccine use data for U.S. cases.

As of June 25, a total of 79 cases of monkeypox had been reported to CDC from Wisconsin (39), Indiana (20), Illinois (16), Missouri (two), Kansas (one), and Ohio (one); these include 29 cases laboratory-confirmed at CDC and 51 cases under investigation by state and local health departments. A total of 19 cases were excluded from those reported in the previous update because they met the exclusion criteria outlined in the updated case definition, and 11 were added. . . .

To prevent further transmission of monkeypox, 26 residents of five states have received smallpox vaccine since June 13; recipients included 24 adults and two children. Vaccine was administered to two laboratory workers pre-exposure and to 24 persons post-exposure (11 health-care workers, seven household contacts, three laboratory workers, two public health veterinarians, and one work contact). One adult who was vaccinated as a child did not have a major vaccine reaction or "take" 7 days after vaccination and required revaccination.

CDC has issued updated interim guidance on the use of smallpox vaccine, cidofovir, and vaccinia immune globulin for prevention and treatment in the setting of an outbreak of monkeypox. Principal changes in the updated guidance include a revision of the definition of close contact with an ill animal, recommendations for vaccination of clinical laboratory workers handling specimens from ill animals and persons infected with monkeypox virus, and instructions for reporting smallpox vaccine-related  serious adverse events to the Vaccine Adverse Event Reporting System (VAERS).

["IAC EXPRESS" editor's note: To access the updated interim guidance from CDC's monkeypox web page, go to:]

Health-care providers, veterinarians, and public health officials who suspect monkeypox in animals or humans should report such cases to their state and local health departments. State health departments  should report suspect cases to CDC, telephone (770) 488-7100. Clinical specimens should be submitted for testing after consultation with the state and local health department. Interpretation of  laboratory results requires completion of specimen submission forms, which are available at Additional information about monkeypox is available at


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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June 30, 2003

The 2003 annual meeting of SIGN (Safe Injection Global Network) will be held September 18-20 in Nairobi, Kenya, as a satellite symposium of the 13th International Conference on AIDS and STIs in Africa (ICASA). The AIDS conference follows on September 21-26.

SIGN meets annually to aid collaboration and synergy among its participants worldwide. Specific objectives include (1) reviewing progress achieved; (2) exchanging information and ideas; (3) identifying upcoming key issues and future challenges. Online information on the upcoming SIGN meeting is currently under construction. To check its progress, go to:

For further information about the meeting, contact the SIGN secretariat by email at, by phone in Switzerland at +41 22 791 1275, or by fax in Switzerland at +41 22 791 4836.

To subscribe to "SIGNpost," SIGN's weekly electronic newsletter, go to:

For an array of information about the Africa AIDS Conference, go to: or email the conference secretariat at

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June 30, 2003

On June 12, Tommy G. Thompson, Secretary of the Department of Health and Human Services (DHHS), received the report of the National Advisory Committee on Children and Terrorism (NACCT). The advisory committee was established a year ago for the purpose of making consensus recommendations to the DHHS secretary on matters related to terrorism and its impact on children.

A paragraph from the report's executive summary outlining the committee's conclusions is reprinted below in its entirety, excluding references.


The NACCT has reached remarkable consensus that (1) a comprehensive public health strategy to meet the needs of children in planning and responding to terrorism will require review of all current DHHS programs and guidance to assertively require that a specific focus be placed on meeting the needs of children and families, (2) funding decisions for terrorism-related programs and initiatives should be linked to confirmation that children's needs have been specifically accounted for, (3) structures within DHHS should be created to ensure continued oversight and adequate response to the needs of children and families in DHHS programs and initiatives, (4) significant new pediatric and psychosocial initiatives are needed to address the needs of the nation's children and families in light of the continued threat of terror events, and (5) addressing the needs of children and families in the face of terrorism should be recognized to be an essential part of America's national security response to terrorism.


To access an online copy of the 38-page report from the Centers for Disease Control and Prevention (CDC) bioterrorism website, go to:

To access a camera-ready (PDF) copy of the report, go to:

To access DHHS's June 16 press release about the report, go to:

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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