Issue Number 462            June 1, 2004


  1. Errors discovered and corrected in footnotes of "Recommended Childhood and Adolescent Immunization Schedule--United States, July-December 2004" on the NIP website
  2. NIP releases Influenza Vaccine Bulletin #2 for the 2004-05 influenza season
  3. CDC publishes hard copy of ACIP influenza recommendations
  4. NIP publishes new VISs for influenza and typhoid vaccines
  5. May issue of CDC's "Immunization Works!" electronic newsletter available on the NIP website
  6. CDC reports on immunization registry progress
  7. May issue of IAC'S "HEP EXPRESS" electronic newsletter now available online
  8. CDC reports on wild poliovirus importations in West and Central Africa


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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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June 1, 2004

The National Immunization Program (NIP) has discovered several errors in the footnotes of "Recommended Childhood and Adolescent Immunization Schedule--United States, July-December 2004" as published on the NIP website, primarily with the influenza vaccine footnote.

If you have downloaded the new schedule from the NIP website prior to May 28, you should not reproduce or distribute this version of the schedule. The incorrect files have been removed, and corrected versions have been posted on the NIP website.

To access the corrected and reposted "Recommended Childhood and Adolescent Immunization Schedule--United States, July-December 2004," from the NIP website, go to: Scroll down to the section titled "July-December 2004 New!" and select the version you want.

The version of the schedule printed in the April 30 issue of "MMWR Quick Guide," in "Pediatrics," and on IAC's website is correct.

To access the correct "Recommended Childhood and Adolescent Immunization Schedule--United States, July-December 2004" from IAC's website, go to:

To access the original April 30, 2004, MMWR article, go to:

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June 1, 2004

On May 20, NIP issued the second 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.


May 20, 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 Production

  • Vaccine production is on schedule, and no delays are anticipated, according to the Food and Drug Administration (FDA) and vaccine manufacturers. However, it is still early in the manufacturing process, and issues can arise. The Influenza Bulletin provides regular updates on the status of vaccine production. The three manufacturers of influenza vaccine anticipate total influenza vaccine production of between 90 and 100 million doses. Between six and eight million of those doses will include reduced amounts of thimerosal.

Place Orders for Influenza Vaccine!

  • In order to ensure the availability of influenza vaccine for administration in the fall of 2004, healthcare providers should order supplies of influenza vaccine now if orders have not been placed. Last year, cases of influenza began to appear in October with widespread activity in November and December. Because increased demand for vaccine is anticipated, healthcare providers who care for Medicare beneficiaries and others at high risk for complications from influenza must prepare for the upcoming influenza season immediately.
    Additional information on sources of vaccine can be found at, a service provided by the Health Industry Distributors Association.

Influenza Vaccine Contracts

  • For 2004, CDC contracts have a maximum quantity of 6.75 million doses, up from 4.8 million in 2003. These figures represent vaccine purchased with VFC, 317, or state funds for persons of all ages.

VFC Influenza Vaccine Stockpile

  • Demand for influenza vaccine during the 2003-2004 influenza season significantly exceeded supply. Unfortunately, the current manufacturing process does not allow for additional vaccine to be produced in a timely manner after supplies are low. These factors highlight the need for a plan to ensure availability of an adequate supply of influenza vaccine in the U.S.
    In FY 2004 and FY 2005, CDC will purchase influenza vaccine for a national stockpile. This purchase was authorized by the Omnibus Reconciliation Act (OBRA) of 1993 which allows CDC to use Vaccines for Children (VFC) program funds for stockpile purchases. This stockpile, because it is funded through the VFC program, can only be used to provide vaccine to VFC eligible children 18 years of age and younger. Approximately 54 percent of U.S. children would be eligible.
    • In FY 2004, $40 million in VFC program funds has been provided for the influenza stockpile. Based on discussions with vaccine manufacturers, CDC estimates purchasing approximately 4 to 4.5 million doses of influenza vaccine for the stockpile.
    • In FY 2005, $40 million in VFC program funds was included in the President's Budget request. The exact number of doses to be purchased in 2005 will ultimately depend on manufacturers' production and timing capacity and will not be known until they respond to the FY 2005 contract solicitation in May, 2005.
    • In the event that influenza vaccine demand exceeds supply, the VFC-eligible children for whom the vaccine is recommended will have priority access to the stockpile. As determined by CDC, VFC stockpile vaccine may be made available to state and local health departments and manufacturers for distribution. If no influenza vaccine supply shortage occurs, CDC will attempt to distribute the stockpiled vaccine in consultation with the manufacturers.


2004 Influenza Vaccination Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Recommendations have been broadened to protect more people from influenza.

  • The Centers for Disease Control and Prevention (CDC) has adopted the following recommendations.
  • Children 6 months to 23 months of age should be vaccinated annually against influenza.
  • Household contacts and out-of-home caregivers of children 0 to 23 months of age should be vaccinated annually to prevent these contacts from infecting young children with influenza.

Other changes from last year's recommendations include the composition of the influenza vaccine for the 2004-2005 season and clarification about the use of live, attenuated influenza vaccine in healthcare workers and close contacts of severely immunosuppressed persons.

Review the ACIP Recommendations at

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 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 Vaccine for Children (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 healthcare 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

  • The basis for Medicare payment of influenza vaccine will continue to be 95% of the average wholesale price, as stated by the Centers for Medicare and Medicaid Services (CMS) at

MedImmune Reacquires Rights to FluMist from Wyeth

  • On April 26, 2004, MedImmune, Inc. and Wyeth announced the dissolution of their collaboration for the nasal influenza vaccine, FluMist (Influenza Virus Vaccine Live, Intranasal) and an investigational second-generation liquid formulation, Cold Adapted Influenza Vaccine-Trivalent (CAIV-T). As a result of the dissolution, subject to obtaining necessary government approval, MedImmune will have worldwide rights to these products and will assume full responsibility for the manufacturing, marketing, and selling of FluMist.

As part of the dissolution process, MedImmune will acquire Wyeth's distribution facility in Louisville, Kentucky. Wyeth is providing bulk manufacturing materials and will transfer clinical trial data, as well as provide manufacturing services, during a transition that the companies expect to complete in large part by fourth quarter 2004.


38th National Immunization Conference

The objective of the conference, held on May 11-14, 2004, in Nashville, Tennessee, was to bring together a wide variety of local, state, federal, and private-sector immunization partners to explore science, policy, education, and planning issues related to immunization in general and vaccine-preventable disease. The conference featured plenary sessions on influenza and adult immunization, as well as a total of 14 workshops dedicated to the two topics. Over 1300 persons were pre-registered for the conference. For additional information, please visit

2004 National Influenza Vaccine Summit

The National Influenza Summit is acknowledged as an informal partnership of stakeholders who advise on and respond to issues of influenza vaccination all year round. This year, the Summit moved away from the workgroup-oriented approach of the previous summits and towards a topical/ thematic approach. This topical approach allowed relevant and current background material to be presented at the plenary session for each theme. The plenary sessions were then followed by moderated breakout sessions on a variety of topics pertinent to that theme allowing all Summit participants an opportunity to contribute to all themes. To view individual presentations and additional information from the Summit, visit

Resource Materials

  • "Influenza Immunization Among Health Care Workers"
    A call for action, published by The National Foundation for Infectious Diseases, suggests that a comprehensive approach is essential to improve influenza vaccination rates among health care workers. Since influenza vaccine coverage for health care professionals is estimated nationally at 38 percent, additional efforts are needed to reach a greater percentage of this important subpopulation.
    You may download the entire Call to Action at
  • An article in Volume 26, Number 4 of the 2004 American Journal of Preventive Medicine, "Operational Conditions Affecting the Vaccination of Older Adults", by John Fontanesi and colleagues, suggests that adequate description has not been provided on the content and context of the process for vaccinating older adults against influenza in outpatient settings. While patient and provider beliefs and characteristics may affect the likelihood that a provider recommends influenza immunization, other factors may present as much or even greater influence.
  • Review recently published Morbidity and Mortality Weekly Reports (MMWRs) related to influenza by clicking on the following links.
    "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" MMWR April 30, 2004; 53 (Early Release),
    "Update: Influenza Activity—United States, 2003-04 Season"
    MMWR April 9, 2004; 53(13):284-287 ,

    "Preliminary Assessment of the Effectiveness of the 2003-04 Inactivated Influenza Vaccine -Colorado, December 2003" MMWR January 16, 2004; 53(1):8-11,
    "Recommended Childhood and Adolescent Immunization Schedule—United States, January-June 2004" MMWR January 16, 2004; 53(1):Q1-4
    "Update: Influenza-Associated Deaths Reported Among Children Aged <18 Years—United States, 2003-04 Season" MMWR January 9, 2004; 52(53):1286-1288
  • Reference previous bulletins at


For a ready-to-copy (PDF) version of Influenza Vaccine Bulletin #2, go to:

For a text version of Influenza Vaccine Bulletin #2, 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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June 1, 2004

On April 30, CDC issued "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" as an electronic "MMWR Early Release." On May 28, CDC published a hard copy of the same document in "MMWR Recommendations and Reports" (RR-6). The content is the same in both versions.

To access the ready-to-copy (PDF) version of this recommendation, go to:

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June 1, 2004

On May 24, the National Immunization Program (NIP) posted Vaccine Information Statements (VISs) for the inactivated influenza vaccine and the live, intranasal influenza vaccine for the 2004-05 influenza season.

To access a ready-to-copy (PDF) version of the inactivated influenza vaccine VIS from the CDC website, go to:

To access a ready-to-copy (PDF) version of the live, intranasal influenza vaccine VIS from the CDC website, go to:

On May 19, NIP posted a new typhoid vaccine VIS on their website.

To access a ready-to-copy (PDF) version of the typhoid vaccine VIS, go to:

You can access all current VISs in English from NIP at

The three VISs are also posted on the IAC website. For information about the use of VISs, as well as VISs in up to 30 translations and alternative formats, visit IAC's VIS web section at

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June 1, 2004

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

The May issue summarizes the April 30, 2004 document, "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)," and reports on several conferences and resources.

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

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June 1, 2004

CDC published "Immunization Registry Progress—United States, January-December 2002" in the May 28 issue of MMWR. The first paragraph of this article is reprinted below, excluding references.


Immunization registries are confidential, computerized information systems that collect vaccination data within a geographic area. By consolidating vaccination records from multiple health-care providers, generating reminder and recall notifications, and assessing clinic and vaccination coverage, registries serve as key tools to increase and sustain high vaccination coverage. One of the national health objectives for 2010 is to increase to 95% the proportion of children aged less than 6 years who participate (i.e., have two or more vaccinations recorded) in fully operational, population-based immunization registries (objective 14.26). This report summarizes data from CDC's 2002 Immunization Registry Annual Report (2002 IRAR), a survey of registry activity among immunization programs in the 50 states and the District of Columbia (DC) that receive grant funding under section 317b of the Public Health Service Act. These data indicate that approximately 43% of children aged less than 6 years are enrolled in a registry; achieving the national health objective will require increased implementation of functional standards to improve data quality.


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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June 1, 2004

The May 20 issue of "HEP EXPRESS," an electronic newsletter published by IAC, is available online. "HEP EXPRESS" is intended for health and social service professionals involved in the prevention and treatment of viral hepatitis. The May 20 issue includes articles on the following:

  • CDC's new web section on preventing STDs among MSM
  • CDC's "Top 11" FAQ page about viral hepatitis
  • Free CME courses for physicians on viral hepatitis available through Medscape
  • Hepatitis B Foundation's online expert speaker forum
  • Links to recent journal article abstracts about viral hepatitis

To access the May 20 issue, go to:

To sign up for a free subscription to "HEP EXPRESS," go to:

To access previous issues of "HEP EXPRESS," go to:

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June 1, 2004

CDC published "Wild Poliovirus Importations—West and Central Africa, January 2003-March 2004" in the May 28 issue of MMWR. A summary made available to the press is reprinted below in its entirety.


To restore gains made in polio eradication in West and Central Africa, wild poliovirus transmission must be interrupted in Nigeria and Niger. Until then, immunization activities must be of high enough quality to provide an immunity barrier to keep poliovirus from re-establishing and causing disease in these neighboring polio-free countries.

During 2003 and the first quarter of 2004, 8 previously polio-free West and Central African countries reported wild poliovirus importations resulting in 63 polio cases. All importations can be traced to ancestral strains that circulate in northern Nigeria and southern Niger. Many of these 8 countries had continued transmission after importation because of low vaccination coverage and decreased frequency or quality of immunization activities. Until the major Nigeria/Niger PV reservoir has been eliminated, neighboring countries must create a population immunity barrier by implementing quality immunization activities (routine and especially supplementary activities). The quality of recent campaigns in these countries has improved by increasing the level of political commitment and a strengthening in the monitoring and supervision of activities.


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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