Issue Number 461            May 24, 2004


  1. IOM report says MMR and thimerosal-containing vaccines not associated with autism
  2. CDC announces new goals and organizational design
  3. May 2004 issue of "VACCINATE ADULTS" is in the mail and on the Web
  4. CDC notifies readers about new definitions for travel notices
  5. CVP at PATH launches e-Learning modules
  6. New VIS translation: Rabies vaccine VIS now available in Spanish
  7. Immunization documentary to be aired on BBC World
  8. CDC notifies readers about availability of diphtheria antitoxin through an investigational new drug protocol


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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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May 24, 2004

On May 18, 2004, the Institute of Medicine (IOM) of the National Academies released "Immunization Safety Review: Vaccines and Autism," the third IOM report about vaccines and autism. The report states that based on a thorough review of clinical and epidemiological studies, neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine is associated with autism.

"The overwhelming evidence from several well-designed studies indicates that childhood vaccines are not associated with autism," said committee chair Marie McCormick, Sumner and Esther Feldberg Professor of Maternal and Child Health, Harvard School of Public Health, Boston. "We strongly support ongoing research to discover the cause or causes of this devastating disorder. Resources would be used most effectively if they were directed toward those avenues of inquiry that offer the greatest promise for answers. Without supporting evidence, the vaccine hypothesis does not hold such promise."

A pre-publication version of "Immunization Safety Review: Vaccines and Autism" is available online at You can also obtain a copy from the National Academies Press by calling (202) 334-3313 or (800) 624-6242.

To read the IOM press release, go to:

To read a press release from the American Academy of Pediatrics, "Scientific Panel Rejects Vaccines as Cause of Autism," go to:

To read a press release from the American Medical Association, "AMA welcomes new IOM Report rejecting link between Vaccines and Autism," go to:

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May 24, 2004

On May 13, 2004, CDC Director Dr. Julie Gerberding announced new goals and integrated operations that will allow the federal public health agency to have greater impact on the health of people around the world. The announcement evolved from an ongoing strategic development process called the Futures Initiative which began a year ago at CDC and has included hundreds of employees, other agencies, organizations, and the public.

Dr. Gerberding announced that CDC will align its priorities and investments under two overarching health protection goals: 1) Preparedness: All people in all communities will be protected from infectious, environmental, and terrorist threats. 2) Health Promotion and Prevention of Disease, Injury and Disability: All people will achieve their optimal lifespan with the best possible quality of health in every stage of life. In addition, the agency is developing more targeted goals to assure an improved impact on health at every stage of life including infants and toddlers, children, adolescents, adults, and older adults.

The integrated organization coordinates the agency's existing operational units into four coordinating centers to help the agency leverage its resources to be more nimble in responding to public health threats and emerging issues as well as chronic health conditions.

To read the related press release, go to:

More information can be accessed on CDC's Futures Initiative Update web page:

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May 24, 2004

IAC recently mailed the latest issue of "VACCINATE ADULTS" to 100,000 health professionals and others who work in the field of immunization. Packed with timely immunization resources for health professionals and patients, the 12-page issue is well worth downloading. All articles and education pieces, except editorials, have been reviewed by immunization and hepatitis experts at CDC.

You can view selected articles from the table of contents below or download the entire issue from the Web.

To view the table of contents with links to individual articles, go to:

Please note: The PDF file of the entire issue, linked below, is large at 616,955 bytes. Some printers cannot print such a large file. For tips on downloading and printing PDF files, go to:

To download a ready-to-copy (PDF) version of the May issue, go to:

The articles in the May issue fall into two broad areas: (1) general immunization information and (2) adult immunization resources.

Turn to the following resources for the latest information on immunization.

    "Ask the Experts" answers questions about immunization and viral hepatitis. "Vaccine Highlights" presents timely information on recommendations, schedules, specific vaccines, and vaccine safety.
    To access a ready-to-copy (PDF) version of "Ask the Experts," go to:
    To access a web-text (HTML) version, go to:
    To access a ready-to-copy (PDF) version of "Vaccine Highlights," go to:

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

Following are four resources that can improve adult immunization rates in your practice:

  • INFLUENZA VACCINATION OF HEALTH CARE WORKERS. In response to the distressing statistic that only 36% of health care workers receive annual influenza vaccination, IAC developed "First Do No Harm. Protect Your Patients by Getting Vaccinated Against Influenza," a one-page professional-education sheet that outlines the primary steps necessary to conduct an employee influenza immunization campaign for health care workers.
    To access a ready-to-copy (PDF) version of "First Do No Harm. Protect Your Patients by Getting Vaccinated Against Influenza," go to:
    To access a web-text (HTML) version, go to:
  • STANDING ORDERS PROTOCOL. "Standing Orders for Administering Pneumococcal Vaccine to Adults" gives health professionals a guideline that can be used to allow an appropriately licensed individual to administer pneumococcal polysaccharide vaccine without a direct order from a physician.
    To access a ready-to-copy (PDF) version of "Standing Orders for Administering Pneumococcal Vaccine to Adults," go to:
    No web-text (HTML) version is available.
  • PATIENT EDUCATION RESOURCES. "Immunization . . . Not Just Kids' Stuff" encourages patients to safeguard their health by getting vaccinated against VPDs if they haven't had certain diseases or been vaccinated against them. "Protect Yourself against Hepatitis A and Hepatitis B . . . A Guide for Gay and Bisexual Men" educates men who have sex with men about their increased risk for contracting these two diseases and makes the case for getting immunized against them. (Please note that this brochure is intended for use in certain venues—STD clinics and clinics for men who have sex with men, for example. It's not suitable for the waiting rooms of most clinics and medical practices.)
    To access a ready-to-copy (PDF) version of "Immunization. . . Not Just Kids' Stuff," go to:

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

    To access a ready-to-copy (PDF) version of "Protect Yourself against Hepatitis A and Hepatitis B . . . A Guide for Gay and Bisexual Men" go to:

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


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May 24, 2004

CDC published "Notice to Readers: New Definitions for Travel Notices Regarding Diseases Abroad" in the May 21 issue of MMWR. The article is reprinted below in its entirety.


The Division of Global Migration and Quarantine, Travelers' Health, National Center for Infectious Diseases, is announcing new, scalable definitions for travel notices about disease occurrences abroad. The purpose is to refine the announcements so they are more easily understood by international travelers, U.S. citizens living abroad, health-care providers, and the general public. In addition, defining and describing levels of risk will clarify the need for travelers to take recommended preventive measures.

From a public health perspective, scalable definitions will enhance the usefulness of the travel notices, enabling them to be tailored readily in response to events and circumstances. A complete description of the definitions and criteria for issuing and removing travel notices at each of the four levels is available at

The new notices are as follows:

In the News. This notice provides information about sporadic cases of disease or an occurrence of disease of public health concern affecting a traveler or travel destination. At this level, the risk for an individual traveler does not differ from the usual risk in that area.

Outbreak Notice. Information is provided regarding a disease outbreak in a limited geographic area or setting. The risk for travelers is defined and limited, and the notice reminds travelers about standard or enhanced travel recommendations such as vaccination.

Travel Health Precaution. Specific information is provided to travelers regarding a disease outbreak of greater scope and over a larger geographic area, aimed at reducing the risk for infection. This precaution also provides guidance to travelers about what to do if they become ill while in the area. At this level, CDC does not recommend against travel to a specific area, but might recommend limiting exposure to a defined setting (e.g., poultry farms or health-care facilities).

Travel Health Warning. A recommendation is issued against nonessential travel to an area because a disease of public health concern is expanding beyond the locales or populations that were affected initially. The purpose of a travel warning is to reduce the volume of traffic to affected areas, limiting the risk for spreading the disease to unaffected areas.


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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May 24, 2004

The Children's Vaccine Program (CVP) at PATH has announced the pre-launch of the first set of Advanced Immunization Management (AIM) e-Learning modules. The AIM modules are being developed by CVP and SUMMIT at Stanford University School of Medicine, in collaboration with partners of the Global Alliance for Vaccines and Immunization (GAVI).

AIM e-Learning modules are a tool for global health managers trying to improve immunization programs. The modules provide up-to-date information through an interactive experience available on the Internet and CD-ROM.

To see a short demonstration movie describing AIM e-Learning, go to and click on one of the three bandwidth options. To view the interactive site on the Internet, go to:

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May 24, 2004

Dated 11/4/03, the current version of the rabies vaccine VIS is now available on the IAC website in Spanish. IAC gratefully acknowledges the California Department of Health Services for the translation.

To obtain a ready-to-copy (PDF) version of the rabies VIS in Spanish, go to:

To obtain it in English, go to:

For information about the use of VISs, and for VISs in a total of 31 languages, visit IAC's VIS web section at

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May 24, 2004

"Fragile Lives—Immunization at Risk," a new film by award-winning documentary producer Jenny Barraclough, will be seen by more than 28 million people in 200 countries when it airs on BBC World later this month.

"Fragile Lives" is an informative, emotionally engaging film on the values of vaccines and the need to increase investment in immunization programs. The film will air four times May 29, 30, and 31, depending on time zone. Unfortunately, the film is not yet scheduled for airing where BBC World is not available, such as in the United States or England.

For more information on "Fragile Lives," visit

To view the BBC World schedule for your country, go to:

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May 24, 2004

CDC published "Notice to Readers: Availability of Diphtheria Antitoxin Through an Investigational New Drug Protocol" in the May 21 issue of MMWR. The notice is reprinted below in its entirety, excluding two references.


Cases of respiratory diphtheria continue to occur sporadically among persons in the United States. Respiratory diphtheria is caused by toxigenic Corynebacterium diphtheriae (also, rarely, by toxigenic C. ulcerans) and frequently manifests insidiously as a membranous nasopharyngitis or obstructive laryngotracheitis accompanied by a low-grade fever. Respiratory diphtheria most often affects unvaccinated or inadequately vaccinated persons, particularly those who travel to areas where diphtheria is endemic and those who come into close contact with travelers from such areas. Effective treatment of respiratory diphtheria includes early administration of an equine diphtheria antitoxin (DAT). Delay in DAT administration can lead to life-threatening respiratory obstruction, myocarditis, and other complications. To ensure quick access to DAT, CDC maintains a stock of DAT for release to U.S. physicians.

No manufacturer has sought U.S. licensure of a DAT product since 1996. In 1997, an equine DAT product manufactured by Pasteur Merieux (Lyons, France) was made available in the United States through a Food and Drug Administration (FDA)–approved Investigational New Drug (IND) protocol.  Production of this product ceased in 2002, and remaining supplies at CDC will expire on May 30, 2004.

To ensure the continued availability of DAT in the United States, CDC has procured an equine DAT product from the Instituto Butantan in Brazil. CDC will provide this product to U.S. physicians under an FDA-approved IND protocol. U.S. physicians caring for patients with suspected respiratory diphtheria can obtain DAT by contacting the diphtheria duty officer at CDC's Bacterial Vaccine Preventable Disease Branch in the Epidemiology and Surveillance Division of the National Immunization Program (telephone, 404-639-8257) from 8 a.m. to 4:30 p.m. Eastern time or from the Emergency Operations Center (telephone, 770-488-7100) at all other times. The duty officer will discuss the case and protocol with the physician and, if indicated, DAT will be rushed from one of eight U.S. Public Health Service quarantine stations. Respiratory diphtheria is a reportable disease; physicians should report any suspected case of respiratory diphtheria promptly to their local and state health departments.


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:

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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