Issue Number 451            March 22, 2004


  1. AAP releases its latest immunization policy statement, "Recommendations for Influenza Immunization of Children"
  2. Official CDC Health Advisory reports on a measles case imported to the United States on March 12
  3. CDC reports on a school-associated outbreak of pertussis in Arizona in 2002-03
  4. Free: Bulk copies of the latest issue of "NEEDLE TIPS" (January 2004) are available--place your order now
  5. Read the March issue of CDC's "Immunization Works!" electronic newsletter on the NIP website
  6. New: AAP makes four print resources available at no charge
  7. CDC releases "Dear Colleague" letter on recommended STD prevention services for MSM
  8. HBF adds a National Library of Medicine tutorial to its website
  9. CDC workbook on sharps injury prevention programs available online
  10. AASLD practice guidelines published online
  11. Two new issues of "Viral Hepatitis" available on VHPB website
  12. WHO publishes injection safety documents


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ABBREVIATIONS: AAFP, American Academy of Family Physicians; 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; VPD, vaccine-preventable disease; WHO, World Health Organization.

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March 22, 2004

On March 10, AAP released "Recommendations for Influenza Immunization of Children," its most recent immunization policy statement. The abstract is reprinted below in its entirety.


ABSTRACT. Epidemiologic studies indicate that children of all ages with certain chronic conditions and otherwise healthy children younger than 24 months of age are hospitalized for influenza infection and its complications at high rates similar to those experienced by the elderly. Annual influenza immunization is recommended for all children with high-risk conditions who are 6 months of age and older. Young, healthy children are at high risk of hospitalization for influenza infection; therefore, the American Academy of Pediatrics recommends influenza immunization for healthy children between 6 and 24 months of age, for household contacts and out-of-home caregivers of all children younger than 24 months of age, and for health care professionals. To protect these children more fully against the complications of influenza, increased efforts are needed to identify all high-risk children and inform their parents when annual immunization is due. The purposes of this statement are to update recommendations for routine use of influenza vaccine in children and to review the indications for use of trivalent inactivated influenza vaccine and live-attenuated influenza vaccine.


To access a ready-to-copy (PDF) version of the complete statement from the AAP website, go to:

To access AAP immunization policy statements through links on the IAC website, go to the web section titled "Immunization Policy Statements from the American Academy of Pediatrics" at

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March 22, 2004

On March 18, an official CDC Health Advisory, "Imported Case of Measles Identified on Airline Flight into Detroit and Cedar Rapids," was issued. It is reprinted below in its entirety.


This is an official CDC Health Advisory
Distributed via Health Alert Network
March 18, 2004, 12:46 EST


On March 13, 2004, the Iowa Department of Health reported to CDC a case of measles in the infectious stage in Cedar Rapids, Iowa. The index case flew from New Delhi through the Detroit Metro Airport to Cedar Rapids, Iowa, on March 12th. Flight numbers: Northwest 039 from Amsterdam to Detroit, MI, and Northwest 3786 from Detroit to Cedar Rapids. The Iowa Department of Health and the Michigan Department of Health have been contacting passengers to alert them to the possible exposure. On March 15, the Wayne County Health Department visited the Detroit Metro Airport to vaccinate the Customs and Border Protection personnel, airline personnel, and anyone else who was exposed.

CDC estimates that exposures to measles in a commercial aircraft occur an average 10-12 times per year in the United States. Over the past ten years, CDC has identified only three cases of measles, which apparently resulted from exposure in a commercial aircraft.

The case, which is now laboratory confirmed, occurred in a 19-year-old male who is a U.S. resident returning from travel to India where measles is endemic. The student [had] not been vaccinated against measles.

Persons who might have been exposed, or who are at high risk of exposure to measles, should be evaluated to assure they are immune to measles. Persons generally can be presumed immune to measles if they have documentation of 2 doses of measles vaccine, laboratory evidence of immunity to measles, documentation of physician-diagnosed measles, or were born before 1957. Persons who are not immune should be given MMR vaccine or immune globulin according to ACIP recommendations.

State public health departments should be alert to possible cases of measles in persons who traveled on Northwest # 039 and 3786 or their contacts. Measles is an acute disease characterized by fever, cough, coryza, an erythematous maculopapular rash, and a pathognomonic enanthem (Koplik's spots). Measles has an incubation period of 7-21 days and infected people are considered contagious from 4 days before to 4 days after the appearance of rash. Serologic (Measles IgM) testing is required to confirm the diagnosis. In addition to serologic specimens, programs should collect throat swabs or urine for viral isolation.

Further information on measles can be found at


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March 22, 2004

CDC published "School-Associated Pertussis Outbreak--Yavapai County, Arizona, September 2002-February 2003" in the March 19 issue of MMWR. According to the article's opening paragraph, the report " . . . summarizes the epidemiology of the outbreak and the control measures used to contain it. Health care providers should consider pertussis in persons of any age with acute cough illnesses and consider obtaining nasopharyngeal (NP) specimens for B. pertussis culture."

Portions of a summary made available to the press and of the article's Editorial Note are reprinted below.


[From the press summary]
In adolescents or adults, pertussis should be considered as the cause of cough illness lasting >=2 weeks, especially if the coughing is accompanied by a "whoop" sound, or if the person experiences spasms of coughing or vomiting after coughing.

Public health authorities in Arizona successfully implemented measures to control an outbreak of pertussis, which began in a middle school in Yavapai County and spread to others in the community. Pertussis, or "whooping cough," is a serious bacterial respiratory infection characterized by severe spasms of cough that can last for a few weeks to several months. Infants (aged <1 year) are at greatest risk from pertussis; infants have the highest incidence of the disease and account for the overwhelming majority of pertussis-related hospitalizations, serious complications, and deaths. DTaP vaccine prevents the complications of pertussis and is recommended for all infants. However, vaccine protection against pertussis wanes over time. Among older children and adults whose protection has waned, pertussis can cause a range of symptoms from mild to severe cough. Middle and high school-associated pertussis outbreaks are increasingly recognized and reported. Such outbreaks often result in a large number of cases among adolescents and subsequent spread to the community with cases among infants aged <1 year. This was the situation in the Yavapai County outbreak, which began in a middle school in September 2002 and resulted in 485 pertussis cases (113 cases in students).

[From the article's Editorial Note]
Although infants with pertussis can become severely ill and die, no pertussis-associated hospitalizations or deaths were reported during this outbreak. In contrast to disease severity observed commonly among infants, older persons with pertussis often have a mild illness. As a result, older persons might not visit a health-care provider until several weeks after cough onset, when recovery of the fastidious B. pertussis bacterium is unlikely and diagnosis might not be confirmed. Recognizing pertussis outbreaks in schools is challenging for several reasons, including (1) patients usually do not seek medical care early, (2) a diagnosis of pertussis might be delayed or not considered, and (3) the sensitivity and specificity of diagnostic tests will be low if NP specimens are not obtained and transported to the laboratory under optimal conditions. Health-care providers should consider pertussis in persons of any age with an acute cough illness and consider obtaining NP specimens for B. pertussis culture. Early recognition, treatment, and chemoprophylaxis can help prevent transmission to others; because of its severity in young unvaccinated infants, preventing pertussis in this population is of greatest importance.


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 receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:

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March 22, 2004

The Immunization Action Coalition (IAC) is giving away bulk copies (up to 100 per request) of the January 2004 issue of "NEEDLE TIPS."

If you have an immunization conference or an educational program coming up for physicians, residents, or nurses who specialize in pediatrics or family practice, this 24-page publication is an excellent item to distribute. The January issue includes the "Recommended Childhood and Adolescent Immunization Schedule--United States, January-June 2004," several practical pieces on storing and administering vaccines, and hepatitis resources.

Because supplies are limited, it's best to make your request right away. Free copies go quickly. Sorry, we can mail orders only to addresses within the United States.

To request copies, fill out the online form on IAC's website:

You will be asked to supply the following information:

  • The number of copies you want (maximum 100)
  • A description of how you plan to use the copies
  • Your name and complete contact information, including mailing address, telephone number, and email address

For further information, please contact Robin VanOss by email at

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March 22, 2004

The March issue of "Immunization Works!" a monthly email newsletter published by CDC, is available on the NIP website. The newsletter offers members of the immunization community non-proprietary information about current topics. CDC encourages its wide dissemination.

Some of the information in the March issue has already appeared in previous issues of "IAC EXPRESS." Following is the text of six articles we have not covered.



REQUEST FOR PROPOSAL (RFP) REGARDING VACCINE ADVERSE EVENTS: The CDC, working with the Food and Drug Administration (FDA), is seeking proposals to provide a single nationwide mechanism by which vaccine adverse events (VAEs) occurring after receipt of vaccines can be collected and analyzed. The project is required by the National Childhood Vaccine Injury Act (NCVIA), P.L. 99-660. The contractor will be responsible for all the day-to-day aspects of the Vaccine Adverse Events Reporting System (VAERS) operations, including (1) promoting reporting, (2) data collection and entry into a database using standard quality control and quality assurance measures, (3) follow-up of serious and selected other reports, (4) data security, integrity, authenticity, and confidentiality, (5) providing support for CDC and FDA researchers in conducting epidemiologic and other scientific studies of VAERS data, and (6) complete detailed up-to-date documentation for all business processes and IT systems. For more information, visit


REQUEST FOR PROPOSAL FOR IMMUNIZATION COALITION TECHNICAL ASSISTANCE AND TRAINING: The CDC announces the availability of fiscal year 2004 funds for a cooperative agreement program for technical assistance and training for immunization coalitions and immunization information dissemination. The purpose of the program is to provide support for immunization coalitions and for the dissemination of immunization information to enhance the effectiveness of disease prevention programs that reduce the annual burden of vaccine preventable diseases. The complete program announcement was published in the Federal Register, March 4, 2004, Volume 69, No. 43, Page 10,233. It can also be accessed at Click on Thursday, March 4, scroll down to CDC, and select TEXT or PDF version. Application materials can be found on CDC's funding web site at The application deadline is May 3.


SEVENTH ANNUAL CONFERENCE ON VACCINE RESEARCH: The 7th Annual Conference on Vaccine Research will be held May 24-26, 2004, at the Crystal Gateway Marriott in Arlington, Virginia. This conference provides current reports of scientific progress featured in both invited presentations and submitted abstracts. International experts will lead seminars and panel discussions on topical areas of basic immunology, product development, clinical testing, regulation, and other aspects of vaccine research. For more information, visit or e-mail


NEW VACCINE ADVERSE EVENT REPORTING SYSTEM BROCHURE AVAILABLE: A new Vaccine Adverse Event Reporting System (VAERS) brochure is available for printing from the Web at This colorful brochure provides clear and concise information for providers and the public on the VAERS system and vaccine adverse event reporting.


FREE CME'S AVAILABLE RELATED TO THE VACCINE ADVERSE EVENT REPORTING SYSTEM (VAERS): Health care providers may access the "Vaccine Safety Post-Marketing Surveillance: The Vaccine Adverse Event Reporting System" with free CMEs through September 19, 2004. To access the CME article, visit Additional information related to VAERS is available at


JOB OPENINGS WITHIN THE NATIONAL IMMUNIZATION PROGRAM: NIP is committed to recruiting and hiring qualified candidates for a wide range of positions. Researchers, Medical Officers, and Epidemiologists, as well as other specialties are often needed to fill positions within NIP. We encourage all interested parties to apply for these jobs. For a current listing of positions available at NIP, please visit Once at the site, conduct a search for "National Immunization Program."


To access the complete March issue from the NIP website, go to:

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March 22, 2004

AAP is making four print resources available free of charge on a first-come first-served basis. If you are interested in obtaining any of the following resources, contact Jill Ackermann by email at In your message, include your complete mailing address and the number of copies you require of each resource. The maximum number of copies you can order of any resource is 50.

  1. AAP Policy Statement: "Increasing Immunization Coverage" (Committee on Community Health Services and Committee on Practice and Ambulatory Medicine). "Pediatrics," October 2003, Vol.112(4):993-996.
  2. Special Article: "Standards for Child and Adolescent Immunization Practices" (National Vaccine Advisory Committee). "Pediatrics," October 2003, Vol. 112(4):958-963.
  3. Commentary: "Child and Adolescent Immunizations: New Recommendations, New Standards, New Opportunities" (Alan E. Kohrt, MD, Department of Pediatrics, Children's Hospital of Philadelphia). "Pediatrics," October 2003, Vol. 112 (4):978-981.
  4. AAP Patient Education Brochure: "Immunizations: What You Need to Know."


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March 22, 2004

[The following is cross posted from IAC's "HEP EXPRESS" electronic newsletter, 3/18/04.]

On March 8, 2004, CDC released a "Dear Colleague" letter targeted to public health programs and private providers who serve MSM [men who have sex with men]. The letter is intended to encourage and facilitate efforts to deliver integrated and appropriate services to populations at risk.

The letter recommends that clinicians routinely identify sexually active MSM and provide

HIV counseling and testing at least annually; Testing for syphilis, gonorrhea, and chlamydia at least annually; and Hepatitis A and hepatitis B vaccination.

The continued high rates of multiple STDs among MSM underscore the importance and need for the delivery of comprehensive STD-prevention services in both the public and private sectors. Studies suggest that most (65%-85%) MSM receive primary health care from private providers; fewer (2%-5%) receive primary health care from public health clinics or community clinics.

The "Dear Colleague" letter was signed by the directors of CDC's Division of Viral Hepatitis, Division of Sexually Transmitted Diseases, Division of Immunization Services, and Division of HIV/AIDS Prevention. The letter can be accessed at

The recommendations discussed in this letter can be studied in more detail in CDC's 2002 "Sexually Transmitted Diseases Treatment Guidelines" at

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March 22, 2004

[The following is cross posted from IAC's "HEP EXPRESS" electronic newsletter, 3/18/04.]

The Hepatitis B Foundation (HBF) announces the addition of a new National Library of Medicine (NLM) tutorial to its website. The tutorial teaches the viewer, through a step-by-step approach, how to search the MEDLINE, MEDLINEplus, and databases. The tutorial was made possible through a grant from NLM to expand hepatitis B information and education delivery on the Internet.

To access this resource, go to:

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March 22, 2004

[The following is cross posted from IAC's "HEP EXPRESS" electronic newsletter, 3/18/04.]

CDC has released a new resource on sharps injury prevention programs, "Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program."

Occupational exposure to bloodborne pathogens from needlesticks and other sharps injuries is a serious problem, but it is often preventable. CDC estimates that each year 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based health care personnel. Similar injuries occur in other health care settings, such as nursing homes, clinics, emergency care services, and private homes. Sharps injuries are primarily associated with occupational transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), but they may be implicated in the transmission of more than 20 other pathogens.

The workbook's goal is to help programs

Assess the facility's sharps injury prevention program; Document the development and implementation of planning and prevention activities; and Evaluate the impact of prevention interventions.

The home page for the workbook can be accessed at

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March 22, 2004

[The following is cross posted from IAC's "HEP EXPRESS" electronic newsletter, 3/18/04.]

Practice guidelines for the diagnosis, management, and treatment of hepatitis B and hepatitis C are available on the American Association for the Study of Liver Diseases (AASLD) website.

"Diagnosis Management and Treatment of Hepatitis C"

"Chronic Hepatitis B"

"Chronic Hepatitis B: Update of Recommendations"

AASLD represents more than 2,400 physicians, researchers, and allied hepatology health professionals. To visit the AASLD website, go to:

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March 22, 2004

[The following is cross posted from IAC's "HEP EXPRESS" electronic newsletter, 3/18/04.]

The Viral Hepatitis Prevention Board (VHPB) website has been updated and includes two new issues of the publication "Viral Hepatitis."

"Viral Hepatitis," Volume 12, Number 1, is prepared from material presented at the VHPB meeting on March 13-24, 2004, in Geneva, Switzerland.

"Viral Hepatitis," Volume 12, Number 2, is a special edition that includes the most recent updates of recommendations, consensus statements, and meeting conclusions produced by, or in collaboration with, VHPB during 1996-2003.

To access the ready-to-copy (PDF) versions of these issues, go to:

To access the home page of the VHPB website, go to:

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March 22, 2004

[The following is cross posted from IAC's "HEP EXPRESS" electronic newsletter, 3/18/04.]

The World Health Organization (WHO) reports that in some countries nearly 50% of the injections may be given with used, contaminated injection equipment. WHO also estimates that annually, unsafe injections account for 33% of new HBV infections, 40% of new HCV infections, and 5% of new HIV infections. This means that improvements in injection safety could prevent 22 million people from acquiring HBV infections, two million people from HCV infections, and 260,000 from HIV infection each year.

WHO recently released the following documents related to injection safety:

"A Guide for Supervising Injections" (Developed in collaboration with the International Council of Nurses)

"Safety of Injections: Questions & Answers"

"Safety of Injections: A Glossary"

"Safety of Injections: Global Facts & Figures"

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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