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Issue Number 398            July 7, 2003


  1. June issue of CDC's "Immunization Works!" electronic newsletter is packed with timely news
  2. Article about hepatitis B vaccination of high-risk adults makes case for federal funding
  3. NNii combs national and international press to generate content for "Immunization Newsbriefs"
  4. New website for MSM lists clinics providing free or low-cost hepatitis A and B vaccination
  5. Wisconsin Hepatitis Conference set for September 5
  6. CDC updates interim guidance for use of smallpox vaccine, cidofovir, and vaccinia immune globulin for prevention and treatment of monkeypox infections
  7. CDC publishes an update on current monkeypox outbreak


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July 7, 2003

"Immunization Works!" a monthly email newsletter published by the Centers for Disease Control and  Prevention, offers a number of articles pertinent to persons in the immunization community. Some of the information in the June issue has already appeared in previous issues of "IAC EXPRESS." Following is the text of six articles we have not covered.


FIRST NASAL VACCINE APPROVED FOR USE: On June 17, 2003, the Food and Drug Administration (FDA) approved the use of FluMist, an influenza vaccine that is the first nasally administered vaccine to be marketed in the United States. It is also the first live virus influenza vaccine approved in the U.S.

FluMist is approved to prevent influenza illness due to influenza A and B viruses in healthy children and adolescents, ages 5-17 years, and healthy adults, ages 18-49.

In clinical trials, FluMist was evaluated in 20,228 individuals, including over 10,000 healthy children 5-7 years old. The efficacy of the vaccine in preventing influenza was approximately 87 percent among children included in the trial. In healthy adults ages 18-49 years, FluMist was effective in reducing  severe illnesses with fever, and upper respiratory problems which may be caused by influenza infection.

As with any live virus vaccines, FluMist should not be given for any reason to people with immune suppression, including those with immune deficiency diseases, such as AIDS or cancer, and people  who are being treated with drugs that cause immunosuppression.

The safety of FluMist in people with asthma or other reactive airway diseases has not been established; FluMist should not be given to people with a history of these problems. In a large safety study, children under five years of age were found to have increased rate of asthma and wheezing within 42 days of vaccination compared to placebo recipients, and thus FluMist is not recommended for young children.  For people age 50 years and over, the safe and effective use of FluMist has also not been established.

The vaccine should also not be administered to those with therapies including aspirin, a history of Guillain-Barre syndrome, chronic diseases, allergies to eggs or those who are pregnant.

The most common adverse events associated with the vaccine were nasal congestion, runny nose, sore throat, and cough.

FluMist is produced by MedImmune Vaccines and will be distributed by Wyeth. Both companies will  market the product.For more information visit or


ACIP HIGHLIGHTS: The Advisory Committee on Immunization Practices (ACIP) met earlier this month in Atlanta. Besides offering unanimous support for the new influenza vaccine, FluMist, as outlined  above, the ACIP also took the following actions:

  • Smallpox: The committee unanimously passed a draft statement that states "ACIP feels it is  unwise to expand beyond the current, ACIP pre-event smallpox vaccination recommendations. ACIP is concerned about a new and unanticipated safety concern, i.e., myo/pericarditis, whose extent and severity, particularly of long term sequelae, are not yet known." The statement does encourage the continued activities related to smallpox preparedness as well as continued vaccination of established response teams.
  • Pneumococcal Vaccine for Individuals with Cochlear Implants: ACIP unanimously extended pneumoccocal vaccination recommendation to include individuals who have or are scheduled to receive cochlear implants.


OTHER ACIP NEWS: The Committee also discussed education for parents about meningococcal vaccine, thimerosal, research and development of safe, disposable cartridge jet injectors for mass immunization campaigns as well as other issues. More information regarding ACIP actions can be found at


INTERNATIONAL IMMUNIZATION OPPORTUNITIES: The Global Immunization Division at the National Immunization Program at CDC is currently accepting applications for the September '03 and January  '04 Stop Transmission of Polio (STOP) teams. CDC is recruiting candidates to work both in field surveillance assignments, as well as data management assignments. In order to qualify for consideration, candidates must either have obtained a graduate degree or licensure in health and have three years of relevant work experience (for example, MD, PA, RN, DVM, MPH) OR have five years of  relevant work experience. Particularly desirable is field surveillance and/or immunization program experience, especially in developing countries, in addition to a demonstrated ability to work in French, Portuguese, or Arabic. For more information and application procedures, please visit

Also, CDC periodically recruits Medical Officers and Epidemiologists to work on measles, polio, and  other activities in Atlanta-based positions as well as long-term assignments (2 yrs. minimum) in various overseas locations. We are especially interested in mid-career professionals with at least five years of  international public health management, disease surveillance and/or immunization program experience, and excellent interpersonal skills. Please contact Liz Bell at or Carla Lee at for further information.


EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES COURSE: The Epidemiology and Prevention of Vaccine-Preventable Diseases two-day course will be offered this fall in Indiana and California. The courses will be held in Indianapolis, Indiana, September 9-10, 2003, Torrance, California, November 17-18, 2003, and Sacramento, California, November 20-21, 2003. This course provides the latest information for providers on immunizations and the diseases they can prevent. Continuing education credits will be offered for various professions based on 15 hours of  instruction. For Indiana information, contact Susan Meece-Hinh at or (317) 274-3178. For California information, contact Melissa Dahlke at or (510) 540-2379.


EARN FREE CONTINUING EDUCATION CREDITS: Continuing Education Credits, including CME,  CNE, CEU, and CECH, are available for the 4-part series "Epidemiology and Prevention of Vaccine Preventable Diseases 2003." The series is available on 4 VHS videotapes available individually or as a set. The videotapes can be requested using an online order form at The series is also available through archived webcast at Also, there will be an Immunization Update satellite broadcast on August 21, 2003. Please click on this link for more information


To access the complete June issue from the website of the Immunization Action Coalition, go to:

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July 7, 2003

[The following is cross posted from the Immunization Action Coalition's "HEP EXPRESS" electronic newsletter, 7/2/03.]

"A Review of the Case for Hepatitis B Vaccination of High-Risk Adults" examines the history of providing hepatitis B vaccine to high-risk adults in the United States, and illustrates the need for a clear national objective and federal funding in this area.

The article describes how the hepatitis B vaccine continues to be underutilized in high-risk adults. For example, a survey of 65 federally funded STD projects in 1997 found that only 24 percent offered the  hepatitis B vaccine in some or all of their clinics. In another national survey, only three of 36 responding state and federal correctional systems reported offering the vaccine to all inmates. In another study, only 13 to 25 percent of injection drug users reported being offered vaccination.

Although targeting high-risk adults for hepatitis B vaccination is likely to be cost-effective, most programs providing services to such clients--such as STD clinics, drug treatment centers, mental health facilities, prisons, and homeless shelters--will not be able to add hepatitis B vaccination without additional funding.

The article concludes, "Beyond the issue of feasibility and cost-effectiveness, however, lies the reality of politics and public consciousness. Hepatitis B is prevalent in prisoners, injection drug users, commercial sex workers, and men who have sex with men, and current political agendas are not likely to increase funding to these marginalized groups for preventative health. What is needed is a clear  national objective and federal funding for vaccinating high-risk adults."

The full citation for this article follows:

"A Review of the Case for Hepatitis B Vaccination of High-Risk Adults"
Authors: Rich JD, Ching CG, Lally MA, Gaitanis MM,
Schwartzapfel B, Charuvastra A, Beckwith CG, Flanigan TP
Source: The American Journal of Medicine, March 2003, Vol. 114(4):316-8

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July 7, 2003

Each Monday, Wednesday, and Friday, subscribers to the electronic newsletter "Immunization Newsbriefs" receive up-to-the-minute U.S. and international immunization news. A service of the National Network for Immunization Information (NNii), the newsletter is published by Information, Inc., Bethesda, MD.

Culled from news sources worldwide, the newsletter's content consists of summaries of articles from  newspapers and occasional medical publications. A link to the source publication accompanies each summary.

To access the current issue of "Immunization Newsbriefs" from the NNii website, go to:

To subscribe, go to:

To access the NNii home page, go to:

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July 7, 2003

[The following is cross posted from the Immunization Action Coalition's "HEP EXPRESS" electronic newsletter, 7/2/03.]

Men who have sex with men (MSM) should be vaccinated against both hepatitis A and hepatitis B, yet many remain unprotected. recently compiled a list of clinics nationwide providing free or low-cost hepatitis A and hepatitis B vaccines to MSM.

The list of clinics is available as part of's new website,, which also provides links to other viral hepatitis information of interest to persons at high risk of infection; not only MSM, but also persons with multiple sex partners, users of intravenous drugs, travelers to endemic areas, and others.

Visit this new website at The editors are always looking for more clinics to add, so if you work for a clinic offering free or low-cost hepatitis A and hepatitis B vaccines to high-risk adolescents and adults, and your clinic isn't listed, please inform by writing to

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July 7, 2003

The Wisconsin Hepatitis Conference will be held September 5 in Madison. The Wisconsin Department of Health and Family Services and the Office of Continuing Medical Education, University of Wisconsin Medical School are joint sponsors.

The conference is intended for health care providers, local health departments, family practitioners, nurse practitioners, physician assistants, tribal health clinics, and community health clinics. Featured speakers are Joanna Buffington, MD, MPH, Medical Epidemiologist, Centers for Disease Control and Prevention and Michael R. Lucey, MD, Professor of Medicine, Chief of Gastroenterology and Hepatology, University of Wisconsin Medical School.

For additional information, including registration information, contact Cathy Means at (608) 263-6637.

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July 7, 2003

On June 25, the Centers for Disease Control and Prevention (CDC) issued "Updated Interim CDC Guidance for Use of Smallpox Vaccine, Cidofovir, and Vaccinia Immune Globulin (VIG) for Prevention and Treatment in the Setting of an Outbreak of Monkeypox Infections."

To access a copy of updated interim guidance from the CDC website, go to:

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

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July 7, 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 July 4 issue of the "Morbidity and Mortality Weekly Report" (MMWR). The opening paragraph is reprinted below in its entirety, excluding references.


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, and summarizes laboratory-based evidence implicating imported African rodents as the probable source of the outbreak.


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.

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
ISSN 2771-8085

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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