Issue Number 437            January 20, 2004


  1. CDC, AAP, and AAFP publish "Recommended Childhood and Adolescent Immunization Schedule--United States, January-June 2004"
  2. New: Freeware puts 2004 childhood immunization schedule in the palm of your hand
  3. CDC issues an update of U.S. influenza activity for January 4-10
  4. CDC reports on a preliminary assessment of the effectiveness of the 2003-04 inactivated influenza vaccine
  5. CDC updates its influenza web section with interim guidance for schools and other school-related resources
  6. 1st International Neonatal Vaccination Workshop scheduled for March 2-4 in McLean, VA
  7. International Conference on Emerging and Infectious Diseases to be held in Atlanta February 29-March 3
  8. New: Japanese Encephalitis Project at PATH adds links to resources to its website
  9. IOM meeting on vaccines and autism scheduled for February 9


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ABBREVIATIONS: AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR Morbidity and Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine Information Statement; WHO, World Health Organization.

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January 20, 2004

CDC, AAP, and the American Academy of Family Physicians (AAFP) published "Recommended Childhood and Adolescent Immunization Schedule--United States, January-June 2004." The schedule appears in the January 16 issue of the "MMWR QuickGuide," the January issue of "Pediatrics," an AAP journal, and the January issue of "American Family Physician," an AAFP journal. The schedule was approved by ACIP, AAP, and AAFP.

As was the case in 2003, the 2004 schedule includes a catch-up schedule for children who fall behind or start their immunizations late. In addition, this year, a mid-year schedule will be released describing new additional recommendations.

MMWR prefaced the 2004 schedule with several introductory paragraphs; AAP accompanied the schedule with a policy statement, and AAFP with practice guidelines. Immediately following is the MMWR preface, reprinted in its entirety with the exception of references. Links to the AAP policy statement and the AAFP practice guidelines appear at the end of this article.


Each year, CDC's Advisory Committee on Immunization Practices (ACIP) reviews the recommended childhood and adolescent immunization schedule to ensure that it is current with changes in manufacturers' vaccine formulations and reflects revised recommendations for the use of licensed vaccines, including those newly licensed. The recommended childhood and adolescent immunization schedule for January-June 2004, recommendations, and format have been approved by ACIP, the American Academy of Family Physicians, and the American Academy of Pediatrics.

Catch-Up Childhood and Adolescent Immunization Schedule
A catch-up immunization schedule for children and adolescents who start late or who are >1 month behind was introduced in 2003 and remains the same. Minimum ages and minimum intervals between doses are provided for each of the routinely recommended childhood and adolescent vaccines. The schedule is divided into two age groups: children aged 4 months-6 years and children/adolescents aged 7-18 years.

Hepatitis B Vaccine
The schedule indicates a change in the recommendation for the minimum age for the last dose in the hepatitis B vaccination schedule. The last dose in the vaccination series should not be administered before age 24 weeks (updating the previous recommendation not to administer the last dose before age 6 months).

Adolescent Tetanus and Diphtheria Toxoids (Td) Vaccine
The range of recommended ages for the adolescent Td vaccine dose has been updated to emphasize a preference for vaccinating at ages 11-12 years with ages 13-18 years to serve as a catch-up interval.

Clarification Regarding Certain Final Doses
Clarification was added to the footnotes regarding the timing of the final vaccine doses in the series for diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, Haemophilus influenzae type b (Hib) conjugate vaccine, and pneumococcal conjugate vaccine (PCV). The final dose in the DTaP series should be given at age >=4 years. The final doses in the Hib and PCV series should be given at age >=12 months.

Influenza Vaccine
Healthy children aged 6-23 months are encouraged to receive influenza vaccine when feasible during the 2003-2004 influenza season. Children in this age group are at substantially increased risk for influenza-related hospitalizations. ACIP has indicated further that beginning in fall 2004, children aged 6-23 months will be recommended to receive annual influenza vaccine. An updated childhood and adolescent immunization schedule for July-December 2004 will be released to reflect this change.

An intranasally administered, live, attenuated influenza vaccine (LAIV) was approved for use in the United States in June 2003. For healthy persons aged 5-49 years, LAIV is an acceptable alternative to the intramuscular trivalent inactivated influenza vaccine (TIV).

Vaccine Information Statements
The National Childhood Vaccine Injury Act requires that all health-care providers give parents or patients copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedule. Additional information is available from state health departments and at Detailed recommendations for using vaccines are available from the manufacturers' package inserts, ACIP statements on specific vaccines, and the 2003 Red Book. ACIP statements for each recommended childhood vaccine can be viewed, downloaded, and printed from CDC's National Immunization Program website at Instructions on the use of the Vaccine Information Statements are available at In addition, guidance on how to obtain and complete a Vaccine Adverse Event Reporting System (VAERS) form is available at or by telephone, (800) 822-7967.


To access a web-text (HTML) version of this "MMWR QuickGuide" article, go to:

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:

Receive a FREE electronic subscription to MMWR (which includes new ACIP statements) by going to

To access a ready-to-copy (PDF) version of the 2004 schedule and catch-up schedule from the CDC website, go to: and select the format you want.

To access the AAP policy statement, go to:

To access the AAFP practice guidelines, which includes a link to the 2004 schedule, go to:

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January 20, 2004

"Shots 2004" is a quick, portable reference guide to the newly released "Recommended Childhood and Adolescent Immunization Schedule--United States, January-June 2004." Produced by the Group on Immunization Education of the Society of Teachers of Family Medicine (STFM), this freeware for the Palm OS 3.1 provides detailed information on vaccines. All you have to do is click on them by name.

The program requires Palm OS 3.1 or higher and approximately 379KB of memory. It runs on color and non-color handhelds.

To download "Shots 2004," go to:

For more information, contact STFM by email at

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January 20, 2004

The CDC published "Update: Influenza Activity--United States, January 4-10, 2004" in the January 16 issue of MMWR. Portions of it are reprinted below.


The number of states reporting widespread influenza activity continued to decrease during the reporting week of January 4-10, 2004. Health departments in 20 states and New York City reported widespread influenza activity. A total of 24 states reported regional activity, three states reported local activity, and sporadic activity was reported by two states, the District of Columbia, Guam, and Puerto Rico. The percentage of outpatient visits for influenza-like illness (ILI) continued to decrease in all surveillance regions during the week ending January 10, with an overall national percentage of 2.8%. This percentage is above the national baseline of 2.5%. The percentage of specimens testing positive for influenza also decreased; however, the percentage of deaths attributed to pneumonia and influenza (P&I) continued to increase. . . .

Antigenic Characterization
Of the 518 influenza viruses collected by U.S. laboratories since October 1, 2003, and characterized antigenically by CDC, 511 were influenza A (H3N2) viruses, two were influenza A (H1) viruses, and five were influenza B viruses. The hemagglutinin proteins of the influenza A (H1) viruses were similar antigenically to the hemagglutinin of the vaccine strain A/New Caledonia/20/99. Of the 511 influenza A (H3N2) isolates that have been characterized, 98 (19.2%) were similar antigenically to the vaccine strain A/Panama/2007/99 (H3N2), and 413 (80.8%) were similar to a drift variant, A/Fujian/411/2002 (H3N2). Four influenza B viruses characterized were similar antigenically to B/Sichuan/379/99, and one was similar antigenically to B/Hong Kong/330/2001.

P&I Mortality Surveillance
During the week ending January 10, P&I accounted for 10.2% of all deaths reported through the 122 Cities Mortality Reporting System. This percentage is again above the epidemic threshold of 8.1% for that reporting week. . . .

Weekly updates on influenza activity will be published in MMWR during the influenza season. Additional information about influenza activity is available from CDC at


To access a web-text (HTML) version of the complete article, go to:

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:

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January 20, 2004

The CDC published "Preliminary Assessment of the Effectiveness of the 2003-04 Inactivated Influenza Vaccine--Colorado, December 2003" in the January 16 issue of MMWR. The MMWR article's editorial note is reprinted below. In addition, links to a series of questions and answers about the MMWR article and to a fact sheet about it are given at the end of this article.


Editorial Note:
The preliminary findings presented in this report demonstrated no or very low effectiveness of TIV against ILI. However, these findings do not provide a basis for assessing the effectiveness of TIV against more severe illness outcomes or against influenza B or influenza A (H1N1), nor do they assess the effectiveness of live attenuated influenza vaccine (LAIV). Despite a suboptimal antigenic match, TIV can still provide protection against influenza complications. In a study conducted among patients aged >=65 years, TIV was effective in preventing 61% of influenza-related deaths when the vaccine and circulating strains were well matched and 35% when they were not well matched.

Estimates of vaccine effectiveness generally are lower against ILI than against laboratory-confirmed influenza. During the 1998-99 season, when the vaccine and circulating strains were well matched, TIV effectiveness among healthy adults was 86% against laboratory-confirmed influenza and 34% against ILI; during the 1997-98 season, when the vaccine and circulating strains were not well matched, TIV effectiveness was 50% against laboratory-confirmed influenza and zero against ILI. Further studies are under way or planned to estimate the effectiveness of the 2003-04 influenza vaccine against laboratory-confirmed influenza and influenza-related complications.

The person-time analysis included all persons in the cohort regardless of when they were vaccinated. These estimates probably are more precise than those obtained in the categorical analysis. Some negative effectiveness estimates (i.e., estimates lower than zero) were obtained in this analysis; because vaccine effectiveness cannot be lower than zero, such estimates should be considered zero. These results suggest that the study had unknown or uncorrected disparities between the vaccinated and unvaccinated groups in terms of risk for disease or other factors.

The findings in this report are subject to at least five limitations. First, study participants were not selected at random to receive influenza vaccination, and persons with greater patient exposure and possibly greater exposure to influenza viruses were more likely to be vaccinated. Second, a greater percentage of persons aged >=50 years and persons with one or more conditions associated with increased risk for influenza-related complications were vaccinated. Third, other biases, including participation in the study and reporting illness based on vaccination, might have occurred. Such biases and other differences between the vaccinated and unvaccinated groups are very likely to have occurred, given the disparities noted. For example, persons who were vaccinated and became ill might have been more likely to complete the questionnaire, biasing the study to indicate lower effectiveness. Fourth, influenza vaccination and illnesses were self-reported. Finally, the sample size might not have been large enough to detect vaccine effectiveness against ILI, particularly because a large proportion of the respondents were vaccinated. Many of these limitations can be avoided by using a prospective cohort study design with laboratory-confirmed disease as an outcome. Conducting annual prospective studies would provide consistent and comparable vaccine effectiveness data to assist with public health decision making.

This study does not provide data that permits an assessment of the effectiveness of TIV against laboratory-confirmed influenza and its complications. Additional studies to provide such data are under way. Because TIV was effective against laboratory-confirmed influenza and influenza-related complications in previous years in which it was not effective against ILI, and because influenza B and influenza A (H1N1) viruses might cause serious illness later this season, influenza vaccine continues to be recommended for persons at increased risk for influenza-related complications, their household contacts, and health-care personnel.


To access a web-text (HTML) version of the complete article, go to:

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:

To access "Questions and Answers about the Colorado Healthcare Workers Study of the Effectiveness of the Inactivated Influenza Vaccine Against Influenza-like Illness" from the CDC website, go to:

To access a fact sheet on the Influenza Vaccine Effectiveness Studies from the CDC website, go to:

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January 20, 2004

On January 12, CDC added "Stop the Spread of Germs: Actions for Schools" to its influenza web section. School resources include the following:

To access additional materials for schools--including the "Be a Germ Stopper" poster and "It's a SNAP" absenteeism-reduction toolkit--go to:

To access an array of influenza information for the public and health professionals, go to:


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January 20, 2004

The U.S. Department of Health and Human Services (DHHS) is sponsoring the 1st International Neonatal Vaccination Workshop. It will be held on March 2-4 at the Hilton McLean Tysons Corner Hotel in McLean, VA. The pre-registration deadline is February 13.

The workshop will explore the feasibility and safety of strategies to protect neonates from a variety of bacterial, viral, and parasitic agents. Sessions will focus on the science of neonatal vaccination and will cover the following: immune responses of the neonate to vaccine antigens, clinical experience with vaccines administered to neonates, the industry and regulatory perspectives on the expanded use of vaccines in the neonate, and alternative strategies to protect neonates, such as maternal immunization.

The workshop is coordinated by the National Vaccine Advisory Committee's Future Vaccines Subcommittee, CDC, FDA, the National Institutes of Health, and the Task Force for Child Survival and Development (TFCSD). It is supported by a grant from the DHHS National Vaccine Program Office.

For comprehensive information about the workshop, including registration information, go to:

For additional information, email or call Beverly Fowler at TFCSD at (404) 592-1425.

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January 20, 2004

Scheduled for February 29-March 3 in Atlanta, the International Conference on Emerging Infectious Diseases will bring together health professionals in an exchange of scientific and public health information on global emerging infections. Major topics include current work on surveillance, epidemiology, research, communication and training, bioterrorism, and prevention and control of emerging infectious diseases, in the United States and abroad.

For a comprehensive overview of the conference, including registration and program information, go to:

For additional information, contact the American Society for Microbiology by phone at (202) 942-9330 or by email at

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January 20, 2004

The Japanese Encephalitis Project at PATH (Program for Appropriate Technology in Health) recently announced that its website now offers links to Japanese Encephalitis resources developed by several organizations, including CDC and WHO.

To access the section on resources, go to:

To access an array of information on Japanese Encephalitis, go to: The right column offers links to topics.

A press release issued on December 9, 2003, offers more information about PATH's Japanese Encephalitis Project. To access it, go to:

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January 20, 2004

The Immunization Safety Review Committee of the Institute of Medicine (IOM) will hold a meeting on vaccines and autism on February 9 in Washington, D.C. The meeting, part of the committee's information-gathering process, is open to the public. Registration is open until February 2.

To register online, go to:

For additional information, call Amy Grossman at (202) 334-1342 or go to:

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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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