Issue Number 453            March 29, 2004


  1. New: NIP releases Influenza Vaccine Bulletin #1 for the 2004-05 influenza season
  2. New: CDC publishes guidelines for preventing health-care-associated pneumonia
  3. CDC publishes report on recent Iowa measles case associated with nonmedical vaccination exemption
  4. CDC issues report on polio eradication in India


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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 29, 2004

On March 26, NIP issued the first influenza vaccine bulletin designed to update health professionals on the production, distribution, and administration of influenza vaccine for the 2004-05 influenza season.

The bulletin is reprinted below with the exception of a section on miscellaneous information.


March 26, 2004
Influenza Season 2004-05

The National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) publishes and distributes periodic bulletins to update partners about recent developments related to the production, distribution, and administration of influenza vaccine. All recipients of this bulletin are encouraged to distribute each issue widely to colleagues, members, and constituents.


2004-2005 Influenza Vaccine Strains

  • The Vaccines and Related Biological Products Advisory Committee (VRBPAC) of the Food and Drug Administration (FDA) met on February 18-19, and March 17, 2004, to determine the influenza vaccine formulation for the United States during the upcoming season. The formulation includes one virus from last year's vaccine [A/New Caledonia/20/99 (H1N1)-like] and two new viruses [A/Fujian/411/2002 (H3N2-like) and B/Shanghai/361/2002-like]. For the A/Fujian component, manufacturers may use A/Wyoming/3/2003 (H3N2) or A/Kumamoto/102/2002 (H3N2). An available alternate for the B/Shanghai component is B/Jilin/20/2003.

Projection for 2004-2005 Influenza Vaccine Supply

  • Based on early projections, the three manufacturers anticipate total influenza vaccine production of between 90 and 100 million doses. A more precise estimate will be available later in the production cycle once the companies have some experience working with the new viruses and can begin to quantify yields. Total production in 2003 was 86.9 million doses.

Place orders for influenza vaccine

  • Healthcare providers should place influenza vaccine orders now if they have not already done so. Distributors began taking orders in December of 2003.
  • Additional information on sources of vaccine can be found at a service provided by the Health Industry Distributors Association.


Distribution Totals for the 2003-04 Influenza Season

  • During the 2003-04 influenza vaccination campaign, manufacturers distributed approximately 83.1 million doses of vaccine, about the same as in 2002-03.

Changes to Recommendations for the 2004-05 Influenza Season

  • On February 24-25, 2004, the Advisory Committee on Immunization Practices (ACIP) met in Atlanta to consider updates to its annual influenza vaccine recommendations. The updated version for 2004-05 will be published in the "Morbidity and Mortality Weekly Report" in late April or early May 2004. Among the changes are the following:
  • Influenza vaccine is now routinely recommended for all infants and children ages 6-23 months.
  • Influenza vaccine has been covered by the VFC Program since March 1, 2003. The following groups of VFC-eligible children can now receive influenza vaccine through the VFC Program: all infants and children ages 6-23 months and children and adolescents 2-18 years of age who have risk factors or are household contacts of people with risk factors.
  • All women who will be pregnant at any time during influenza season should be vaccinated.
  • The guidance for use of the live attenuated influenza vaccine (FluMist) versus inactivated vaccine among health care workers and other contacts of high risk persons will be narrowed to recommend that the inactivated influenza vaccine is preferred only for persons who have close contact with severely immunosuppressed persons (e.g., patients with hematopoietic stem cell transplants) during those periods in which the immunosuppressed person requires care in a protective environment. There is no preference for inactivated influenza vaccine use by contacts of persons with lesser degrees of immunosuppression or other high risk conditions (e.g., persons with diabetes mellitus, persons with asthma taking corticosteroids, or persons infected with human immunodeficiency virus).
  • The length of time that persons vaccinated with live attenuated vaccine are recommended to avoid contact with severely immunosuppressed persons is changed to 7 days from 21 days after vaccination.

Update on Medicare Payment for Influenza Vaccine Purchase and Administration

  • Based on Medicare's 2004 Physician Fee Schedule, the average payment rate for administration of influenza vaccine to Medicare beneficiaries has increased from $7.72 to $8.21 per dose. Rates vary by locale and range from $5.68 to $13.72. Once these rates are posted on the CMS website, the Influenza Vaccine Bulletin will provide a link to the information so that people wishing to determine payment rates for their respective locales may do so.
  • The Medicare payment rate for influenza vaccine has not yet been determined but is expected to be similar to last year's $9.95 per dose. (The payment for vaccine is in addition to payment for its administration.)

Cost for Influenza Vaccine

  • The prices for influenza vaccine this year are expected to be similar to, if not the same as, last year. Purchasers should check with their regular sources of vaccine to determine exact prices. The least expensive price per dose will be for the 10-dose vial presentation while product packaged in pre-filled syringes will be more expensive.

Latest Influenza Vaccine Coverage Data

  • From the 2002 National Health Interview Survey, coverage level data for selected groups targeted for influenza vaccine are as shown below.
    Group: Ages 18-49, high risk; 23% coverage. Group: Ages 50-64, high risk; 44% coverage. Group: Ages 50-64, total; 34% coverage. Group: Ages >=65; 64% coverage. Group: Pregnant women; 12% coverage. Group: Health care providers; 38% coverage. Group: Household contacts; 18% coverage.

Resource Materials

  • "Influenza Immunization Among Health Care Workers"
    A call for action, published by The National Foundation for Infectious Diseases, suggests a comprehensive approach is essential to improve influenza vaccination rates among health care workers.
    You may download the entire Call to Action at
  • Review recently published "Morbidity and Mortality Weekly Report" (MMWRs) related to influenza by clicking on the following links.


For a ready-to-copy (PDF) version of Influenza Vaccine Bulletin #1, go to:

For more influenza information from CDC's influenza web section, go to:

For influenza information from the IAC website, go to:

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March 29, 2004

CDC published "Guidelines for Preventing Health-Care-Associated Pneumonia, 2003: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee" in the March 26 issue of "MMWR Recommendations and Reports." It includes information on pneumococcal vaccination, standing orders, prevention of pertussis transmission, influenza vaccination (including influenza vaccination of health care workers), and control of influenza outbreaks.

Portions of the summary to the guidelines are reprinted below.


This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia." The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. . . .

In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.


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

To access a ready-to-copy (PDF) version of them, go to:

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March 29, 2004

CDC published "Brief Report: Imported Measles Case Associated with Nonmedical Vaccine Exemption--Iowa, March 2004" in the March 26 issue of MMWR. Originally published in the web-based "MMWR Dispatch," the report has not been available in hard-copy format until now.

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 29, 2004

CDC published "Progress Toward Poliomyelitis Eradication—India, 2003" in the March 26 issue of MMWR. A portion of a summary made available to the press is reprinted below.


Since the World Health Assembly resolved in May 1988 to eradicate poliomyelitis, the estimated global incidence of polio has decreased by more than 99%, and three World Health Organization (WHO) regions (American, Western Pacific, and European) have been certified as polio-free. The countries of the WHO South East Asia Region began accelerating polio eradication activities in 1994, and have made substantial progress toward that goal. By 2001, poliovirus circulation in India had largely been limited to the two northern states of Uttar Pradesh (UP) and Bihar; 268 cases were reported nationwide. However, a major resurgence of polio occurred during 2002, with 1,600 cases detected nationwide, of which 1363 (85%) occurred in these two states.


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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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
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    Arkady Shakhnovich
    Jermaine Royes
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    Laurel H. Wood, MPA
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    Kayla Ohlde

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