Issue Number 455            April 12, 2004


  1. CDC reports on current multistate measles investigation among adoptees from China
  2. CDC issues an update on influenza activity for the 2003-04 influenza season
  3. New: IAC posts 16 adult immunization resources on its website
  4. New: CDC brochures on standards for child, teen, and adult immunization practices are available for online ordering
  5. MMWR notifies readers that National Infant Immunization Week is April 25 through May 1
  6. Update: CDC's website adds Q & A section about recent rabies vaccine recall
  7. CDC notifies readers about manufacturer's recall of human rabies vaccine
  8. Attention: April 23 is the application deadline for the NPI Excellence in Immunization Awards
  9. Clarification: IAC makes a minor change to its "Summary of Rules for Childhood and Adolescent Immunization"
  10. June 1 is the registration deadline for "B Informed 2004"
  11. "World Congress on Vaccines and Immunization" to be held in Tokyo September 30 through October 3


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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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April 12, 2004

On April 9, CDC published "Multistate Investigation of Measles Among Adoptees from China--April 2004" in the electronic publication "MMWR Dispatch." The article is reprinted below in its entirety, excluding references.


On April 6, 2004, Public Health--Seattle and King County, Washington, reported a laboratory-confirmed case of measles in a recently adopted child from China. Public health authorities in Washington state notified CDC, which collaborated with health officials in other states to locate other recently adopted children from China and contact their adoptive families. This report summarizes the preliminary results of an ongoing multistate investigation that has so far identified four confirmed and five suspected cases of measles among adoptees from China, underscoring the need for health care providers to remain vigilant for measles and other vaccine-preventable communicable diseases in children adopted from international regions.

The investigation determined that a group of 11 families traveled to China in March to adopt children. The group, and their 12 adopted children, remained together for approximately 10 days during the adoption process before departing for the United States on March 26. The 12 children were adopted from two orphanages in Hunan Province. They traveled to five U.S. states. Eight traveled to Washington, and one each traveled to Alaska, Florida, Maryland, and New York.

As of April 9, investigators had determined that nine of the 12 adopted children had measles-like rash illness, including four (three in Washington and one in Maryland) who were serologically confirmed to have measles. The nine serologically confirmed or suspected cases were in patients aged 12-18 months; they had rash onset during March 22-April 6. The three children who did not develop measles-like rash illness traveled to Washington (a child aged 7 years), Alaska (a child aged 13 months), and Florida (a child aged 13 months). To date, all 12 children have been or are being evaluated for laboratory evidence of measles or are under observation by public health authorities. Vaccination status or history of measles illness is not known for any of the 12 children. State and local health departments are continuing to investigate, seeking potential cases, identifying and evaluating potential contacts, and providing prophylaxis when indicated, as recommended by the Advisory Committee on Immunization Practices.

Three of the children with suspected measles were likely infectious while traveling from China to the United States on March 26 on the following airline flights: United Airlines flight 862 from Hong Kong to San Francisco, Cathay Pacific flight CX872 from Hong Kong to San Francisco, United Airlines flight 476 from San Francisco to Seattle, and United Airlines flight 794 from San Francisco to Seattle. Because most persons in the United States are immune to measles, U.S. airline passengers usually are at low risk. However, persons traveling on the four flights who have fever or rash on or before April 16 should be evaluated for measles by a health care provider. Investigators have determined that the other six children with rash illness were not likely to have been infectious with measles during the time they traveled from China to their ultimate destinations in the United States.

Editorial Note:

Measles, a highly infectious viral illness that can cause pneumonia, diarrhea, encephalitis, and death, continues to be imported into the United States. Although measles is no longer endemic in the United States, as this investigation highlights, maintaining high levels of vaccination coverage and strong surveillance in the United States is critical.

During 2001, an outbreak among children adopted internationally resulted in 14 U.S. measles cases, 10 among adopted children and four among caregivers and siblings aged 28 months-47 years. Health care providers should have a high index of suspicion for measles in persons with febrile rash illness from families who recently adopted children from abroad and among persons who have had close contact with children who were adopted recently from abroad. Suspected cases should be reported to the local health department.

In the latest outbreak, all confirmed and suspected cases of measles have been in children aged >12 months, for whom vaccination with measles-containing vaccine is recommended in both the United States and China. Vaccination of internationally adopted children is not required before their immigration into the United States, but should occur within 30 days of entry. Although this measure should ensure that internationally adopted children receive recommended vaccines expeditiously, it cannot prevent importation of vaccine-preventable infectious diseases. Efforts to ensure that adoptees are administered safe and age-appropriate vaccines in their country of origin in accordance with recommendations of the World Health Organization or the country of origin could help prevent this type of importation in the future.


To access a web-text (HTML) version of this issue of "MMWR Dispatch, go to:
To access a ready-to-copy (PDF) version of the issue, go to:

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

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April 12, 2004

CDC published "Update: Influenza Activity--United States, 2003-04 Season" in the April 9 issue of MMWR. Portions of the article and the Editorial Note are reprinted below.


[From the article]
This report summarizes influenza activity in the United States during September 29, 2003-March 27, 2004, and updates the previous summary. This report also summarizes human infections with avian influenza viruses related to poultry outbreaks in North America. Preliminary data collected through CDC influenza surveillance indicate that national influenza activity peaked during late November-December. The most frequently isolated viruses were influenza A (H3N2), and approximately 87% of these were similar to the drift variant A/Fujian/411/2002. . . .

Influenza-Associated Deaths in Children Aged <18 Years

As of March 27, 2004, CDC had received reports of 142 influenza-associated deaths in U.S. residents aged <18 years occurring in the current season. This number represents 21 additional deaths reported since the previous update. All patients had evidence of influenza virus infection detected by rapid-antigen testing or other laboratory tests. These data are preliminary and subject to change as more information becomes available. . . .

[From the Editorial Note]
During the 2003-2004 season, influenza activity in the United States appeared earlier than usual (October 2003), peaked during late November-December, and declined rapidly during January-February 2004. Influenza A (H3N2) viruses predominated, with influenza B viruses isolated sporadically. Preliminary data from national influenza surveillance systems indicate that the current season was more severe than the previous three seasons but was within the range expected for a typical A (H3N2) season.

Influenza-associated pediatric deaths received considerable attention this season, and CDC requested that state and local health departments report influenza-associated deaths in persons aged <18 years. The number of new reported deaths has declined as influenza activity has decreased, with only five new deaths occurring since January 26. Further data collection regarding these reports is ongoing, and efforts are under way to track national pediatric influenza-associated deaths annually.

The avian influenza viruses isolated from the North American poultry outbreaks in 2004 are unrelated to the A (H5N1) epizootic in southeast Asia. Influenza A (H7) viruses cause outbreaks among poultry, but do not typically infect humans. In 2002, Virginia experienced an outbreak of avian influenza A (H7N2) in which 4.7 million turkeys and chickens were destroyed. One culler had upper respiratory symptoms and was tested subsequently and found to have antibodies to avian influenza A (H7N2). In 2003, the Netherlands reported outbreaks of avian influenza A (H7N7) in poultry on several farms. In that report, a total of 89 persons had confirmed H7N7 influenza virus infection associated with this outbreak, accounting for 83 cases of conjunctivitis, seven cases of ILI [influenza-like illness], and one death. Since that time, additional H7N7 infections among humans have not been reported. In response to the avian influenza outbreaks in poultry in the United States, CDC has issued interim recommendations for persons with possible exposure to avian influenza. Those recommendations are available at More information regarding human H7 cases in North America is available at

Influenza surveillance reports for the United States are published weekly during October-May. These reports are available at and through CDC's voice (telephone (888) 232-3228) and fax (telephone (888) 232-3299, document number 361100) information systems.


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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April 12, 2004

Whether you're an old hand at adult vaccination delivery or a beginner, you'll find use for 16 informative, practical resources IAC recently posted on its website. The resources cover four broad areas of adult vaccination delivery: (1) vaccine storage, (2) vaccination clinic set-up, (3) vaccine administration, and (4) standing orders and provider tools. All 16 are available in ready-to-copy (PDF) format.

1. VACCINE STORAGE. "Maintaining the Cold Chain During Transport" gives practical information about transporting eight adult vaccines to an off-site vaccination clinic. "Emergency Response Worksheet" outlines steps to take if a power failure or other event causes the temperature in a vaccine storage refrigerator or freezer to become too hot or cold.
To access "Maintaining the Cold Chain During Transport," go to:

To access "Emergency Response Worksheet," go to:

2. VACCINATION CLINIC SET-UP. The "Suggested Supplies Checklist for Adult Immunization Clinic" lists everything health professionals need to successfully set up a vaccination clinic.
To access "Suggested Supplies Checklist for Adult Immunization Clinic," go to:

3. VACCINE ADMINISTRATION. "How to Administer IM and SC Injections to Adults" tells which adult vaccines are administered intramuscularly (IM) and which subcutaneously (SC) and gives detailed information on both administration methods. The foolproof chart "Administering Vaccines to Adults: Dose, Route, Site, Needle Size, and Preparation" outlines the practical details of adult vaccine administration.
To access "How to Administer IM and SC Injections to Adults," go to:
To access "Administering Vaccines to Adults: Dose, Route, Site, Needle Size, and Preparation," go to:

4. STANDING ORDERS AND PROVIDER TOOLS. If your state permits nurses and pharmacists to administer vaccinations without a physician's examination or direct order, you can use the prototype standing orders protocols for administering the eight vaccines most commonly given to adults: (1) trivalent inactivated influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV), (2) pneumococcal polysaccharide (PPV), (3) hepatitis B, (4) hepatitis A, (5) tetanus-diphtheria (Td), (6) measles-mumps-rubella (MMR), (7) varicella, and (8) meningococcal.

In addition, two resources related to standing orders are available: "Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults" lists contraindications and precautions to the eight common adult vaccines; "Medical Management of Vaccine Reactions in Adult Patients" describes the symptoms and management of localized, psychological, and anaphylactic reactions to adult vaccines.

Lastly, "Do You Vaccinate Adults? Think 'H-A-L-O!'" is an easy-to-use chart for determining which adult patients might benefit from vaccination, based on patients' health status(H), age(A), lifestyle(L), and occupation(O).

To access "Standing Orders for Administering Influenza Vaccine to Adults," go to:

To access "Standing Orders for Administering Pneumococcal Vaccine to Adults," go to:

To access "Standing Orders for Administering Hepatitis B Vaccine to Adults," go to:

To access "Standing Orders for Administering Hepatitis A Vaccine to Adults," go to:

To access "Standing Orders for Administering Tetanus-Diphtheria Toxoid (Td) to Adults," go to:

To access "Standing Orders for Administering Measles, Mumps, & Rubella Vaccine to Adults," go to:

To access "Standing Orders for Administering Varicella (Chickenpox) Vaccine to Adults," go to:

To access "Standing Orders for Administering Meningococcal Vaccine to Adults," go to:

To access "Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults," go to:

To access "Medical Management of Vaccine Reactions in Adult Patients," go to:

To access "Do You Vaccinate Adults? Think 'H-A-L-O!'" go to:

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April 12, 2004

Revised in 2003, the "Standards for Child and Adolescent Immunization Practices" and "Standards for Adult Immunization Practices" in brochure form are now available for online ordering through NIP. Each brochure is based on recommendations made by the National Vaccine Advisory Committee (NVAC) and endorsed by dozens of professional organizations from the public and private sectors.

The purpose of the standards is to guide delivery of vaccinations for adults, teens, and children. The current standards replace ones that were developed in the early 1990s.

To order the brochures online, go to the Immunization Educational and Training Materials order form at The order number for "Standards for Child and Adolescent Immunization Practices" is 00-6221; the number for "Standards for Adult Immunization Practices" is 99-7644. PLEASE NOTE THAT NO MORE THAN 12 COPIES OF EACH BROCHURE ARE AVAILABLE PER ORDER.

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April 12, 2004

CDC published "Notice to Readers: National Infant Immunization Week, April 25-May 1, 2004" in the April 9 issue of MMWR. The notice is reprinted below in its entirety, excluding references.


National Infant Immunization Week (NIIW) is April 25-May 1, 2004. This year's theme is "Vaccination: an Act of Love. Love Them. Protect Them. Immunize Them." This event emphasizes the importance of timely infant and childhood vaccination. Vaccination is one of the most effective ways to protect children, especially infants and young children, from potentially serious diseases.

Because of increased vaccination efforts in the United States, incidences of the majority of vaccine-preventable diseases have decreased approximately 99% from peak prevaccine levels. In 2003, a total of 42 measles cases, one diphtheria case, and no wild poliovirus cases were reported. Approximately 11,000 infants are born each day in the United States; they need approximately 20 doses of vaccine before age 2 years to protect them from 11 vaccine-preventable diseases. Although vaccination coverage levels are high for children of preschool age, approximately 1 million children aged 2 years are missing >=1 recommended vaccine dose.

During NIIW, states and approximately 500 communities in the United States will sponsor activities highlighting the need to achieve and maintain high childhood vaccination coverage rates. Special events, including provider education activities, media events, and immunization clinics also are planned along the United States-Mexico border in collaboration with the United States-Mexico Border Health Commission. In addition, CDC and its partners will debut a new public service campaign consisting of a 30-second public service announcement (PSA) in English and Spanish, a Spanish video news release, Spanish and English text for live radio PSAs, and posters and print ads in Spanish and English. NIIW is being held in conjunction with Vaccination Week in the Americas, scheduled for April 24-30. That event, sponsored by the Pan American Health Organization (PAHO), will promote childhood immunization and access to health services concurrently in all countries in the Western Hemisphere. Additional information about NIIW and childhood vaccinations is available from CDC's National Immunization Program at or the National Immunization Information Hotline, telephone (800) 232-2522 (English) or (800) 232-0233 (Spanish). Information on Vaccination Week in the Americas is available from PAHO 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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April 12, 2004

On April 7, a CDC Health Update was issued regarding information about Aventis Pasteur's voluntary recall of certain lots of IMOVAX rabies vaccine. The update is reprinted below in its entirety.


This is an official CDC Health Update
April 7, 2004, 9:20 AM EDT

Frequently Asked Questions about Rabies Vaccine Recall

CDC and the Food and Drug Administration (FDA) were previously notified of a voluntary recall of certain lots of IMOVAX Rabies Vaccine (Aventis Pasteur, Swiftwater, Pennsylvania). Information regarding the recall was distributed in a Health Alert Network (HAN) message and an MMWR Dispatch on April 2, 2004. In addition, a list of frequently asked questions regarding the recall was posted on the CDC Rabies website on April 2, 2004 (

The website has been updated as of April 6, 2004, with additional questions and answers that may be helpful to state health departments and health care providers. The website will continue to be updated as more information becomes available, and individuals are encouraged to check the site frequently.


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April 12, 2004

CDC published "Notice to Readers: Manufacturer's Recall of Human Rabies Vaccine--April 2, 2004" in the April 9 issue of MMWR. Originally published April 2 in the web-based "MMWR Dispatch," the article has not been available in hard-copy format until now.

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

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

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April 12, 2004

The National Partnership for Immunization (NPI) will be accepting applications for the 2004 Excellence in Immunization Awards through April 23. The awards honor innovation in immunization services and recognize programs that are making a difference in their neighborhoods, communities, counties, and states.

For complete information on the awards and an application form, go to:

For additional information, contact Mischka Garel by email at or by phone at (703) 836-6110, ext. 235.

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April 12, 2004

In an article titled "Update: IAC revises two resources on childhood and teen vaccination," which appeared in the April 5 issue of "IAC EXPRESS," we informed readers about revisions made to the "Summary of Rules for Childhood and Adolescent Immunization."

The updated version contained a redundancy in the section on influenza vaccine, which we have corrected. In the column "Ages usually given and other guidelines," the second bullet point in the influenza section stated, "Vaccinate children >=6m of age with risk factors as defined by ACIP." The bullet point has been changed to state, "Vaccinate children >=24m of age with risk factors as defined by ACIP."

If you printed the "Summary of Rules for Childhood and Adolescent Immunization" from the URL given in the April 5 issue of "IAC EXPRESS," please discard your printed copies and use the new version instead.

To access the new ready-to-copy (PDF) version, go to:

To access the new web-text (HTML) version, go to:

IAC thanks pediatrician Mustafa Kozanoglu, MD, of Adana, Turkey, for bringing this to our attention.

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April 12, 2004

The Hepatitis B Foundation (HBF), in partnership with the Asian Liver Center, is sponsoring "B Informed 2004: A Gathering of Friends." The conference will be held June 26-27 at the Asian Liver Center in Stanford, CA. There is no registration fee, the cost of lodging at the Stanford Guesthouse is modest, and meals will be provided. The registration deadline is June 1; register early as space is limited.

The conference will focus on the care and treatment of persons living with chronic hepatitis B; it is intended for patients, families, and others concerned about the disease.

Participants need to make their own lodging reservations by visiting the Stanford Guesthouse website at or calling (650) 926-2800.

To download a registration form, go to: Send the completed form to the Hepatitis B Foundation by fax at (215) 489-4920 or by mail at 700 East Butler Ave., Doylestown, PA 18901.

For additional information, email HBF at or call (215) 489-4900.

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April 12, 2004

Organized by Infections Control World Organization (ICWO), "World Congress on Vaccines and Immunization" will be held in Tokyo September 30 through October 3. The congress presents a forum for discussing the development of new vaccines and immunization strategies to prevent and control infections. Its plenary sessions, symposia, workshops, and poster sessions will be of interest to participants from academia, industry, government services, hospitals, research institutes, and international health organizations.

For information on all aspects of the congress, including the scientific program, registration, and exhibits, go to:

For additional information, email Edouard Kurstak, ICWO president, at

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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