Issue Number 469            July 12, 2004


  1. Important: CDC notifies readers of recommendation to reinstate third dose of pneumococcal conjugate vaccine (PCV7)
  2. NFID's new program, "Kids Need Flu Vaccine, Too!" helps providers increase pediatric influenza vaccination rates
  3. NFID's online CME course gives physicians strategies for implementing pediatric influenza immunization recommendations
  4. Save the date: Live satellite broadcast of CDC's Immunization Update 2004 is scheduled for August 19
  5. CDC reports a fourth death linked to an organ transplant donor infected with rabies virus
  6. CDC publishes hard copy of July 2 electronic article on rabies transmission through solid organ transplantation
  7. Report discusses the role communication plays in strengthening immunization programs in developing countries


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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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July 12, 2004

CDC published "Notice to Readers: Updated Recommendations for Use of Pneumococcal Conjugate Vaccine: Reinstatement of the Third Dose" in the July 9 issue of MMWR. The recommendation is effective immediately.

The article is reprinted below in its entirety, excluding references and one table, an interim catch-up immunization schedule titled "Recommended 7-valent pneumococcal conjugate vaccination (PCV7) regimens during the vaccine shortage, by age, history, and condition." IAC Editor's Note: The information in the table is important. You can access the table from the the two links immediately following this article. You can also access the information directly from the NIP website on the document titled "PCV7 (Prevnar) Shortages and Reinstatement of the 3rd Dose in PCV7 Recommendation, July 8, 2004." You'll find the document at Scroll down to the section titled "Recommended Regimens While the PCV7 Shortage Exists."

On July 9, CDC also issued a press release about the reinstated third dose; a link to the press release is given at the end of this article.


In February 2004, production of the 7-valent pneumococcal conjugate vaccine (PCV7), marketed as Prevnar and manufactured by Wyeth Vaccines (Collegeville, Pennsylvania), failed to meet demand, resulting in shortages. To conserve the limited supply, CDC recommended that the fourth dose of PCV7 be withheld from healthy children. In March, because evidence indicated that production would be curtailed for several months, CDC recommended that the third dose also be withheld. Production problems now appear to have been resolved. As a result, deliveries are projected during the near term to permit the recommendation that every child receive 3 doses. Some providers might have short-term difficulties obtaining vaccine because of distribution delays; however, every effort will be made to provide sufficient vaccine to all providers.

Effective immediately, CDC, in consultation with the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians, and the American Academy of Pediatrics, recommends that providers administer 3 doses of vaccine. The fourth dose should still be deferred for healthy children until further production and supply data demonstrate that a 4-dose schedule can be sustained. The full, 4-dose series should continue to be administered to children at increased risk for pneumococcal disease because of certain immunocompromising or chronic conditions (e.g., sickle cell disease, anatomic asplenia, chronic heart or lung disease, diabetes, cerebrospinal fluid leak, and cochlear implant). Alaska Native children and American Indian children who live in Alaska, Arizona, or New Mexico, and Navajo children who live in Colorado and Utah have a risk for invasive pneumococcal disease more than twice the national average. These children should receive the standard 4-dose PCV7 series despite the shortage.

An interim catch-up schedule is provided for children who are incompletely vaccinated. The highest priority for catch-up vaccination is to ensure that children aged <5 years at high risk for invasive pneumococcal disease are fully vaccinated. Second priorities include vaccination of healthy children aged <24 months who have not received any doses of PCV7 and vaccination of healthy children aged <12 months who have not yet received 3 doses.

Because of the frequency of health care provider visits by children during their first 18 months, catch-up vaccination might occur at regularly scheduled visits for most children who receive vaccines from their primary-care providers. Programs that provide vaccinations but do not see children routinely for other reasons should consider a notification process to contact undervaccinated children.

Wyeth Vaccines is allocating nonpublic-purchased doses of Prevnar directly to all physicians on the basis of previous purchasing patterns or practice birth cohort. Wyeth does not currently ship products to either wholesalers or distributors. Providers with questions about their allocation or about obtaining Prevnar should contact Wyeth's customer service department, telephone (800) 666-7248. For problems not resolved by the customer service department, providers can contact Wyeth directly, telephone (866) 447-8888, extension 37932. For public-purchased vaccine, including Vaccines for Children Program vaccine, providers should contact their state/grantee immunization projects to obtain vaccine. These projects should contact their project officers at the National Immunization Program at CDC for information regarding vaccine supply.

This recommendation reflects CDC's assessment of the existing national PCV7 supply and will be changed if the supply changes. Updated information about the national PCV7 supply is available from CDC 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:

To access the CDC press release, go to:

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

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July 12, 2004

The National Foundation for Infectious Diseases (NFID) recently launched a new in-practice resource program, Kids Need Flu Vaccine, Too! The online program gives health care practitioners an array of useful materials for conducting in-practice pediatric influenza immunization clinics. By conducting clinics, providers can increase influenza vaccination rates and comply with new recommendations issued by CDC, AAP, and other organizations to vaccinate children ages 6-23 months.

The program includes the following:

  • Comprehensive checklist on how to plan and implement in-practice clinics
  • Physician-to-physician video featuring leading pediatric infectious disease experts and practicing physicians
  • Patient video and other patient materials that underscore the importance of influenza vaccination
  • Case studies on effective pediatric immunization programs
  • Sample articles for practice newsletters and tips on communicating the importance of vaccination to parents
  • Tips to ensure proper reimbursement

To access the materials, go to the NFID web section Kids Need Flu Vaccine, Too! at

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July 12, 2004

In February 2004, ACIP adopted a new pediatric influenza immunization recommendation, which calls for giving influenza vaccine to all children ages 6-23 months. In response, the National Foundation for Infectious Diseases (NFID), has developed an online CME course, Increasing Pediatric Influenza Immunization in Infants and Children.

The course is intended for family physicians, general practitioners, pediatricians, pediatric infectious disease physicians, and others interested in lessening the burden of influenza in children. It is divided into four topics: (1) influenza epidemiology and disease burden in children; (2) safety, immunogenicity, and efficacy of influenza vaccine in children; (3) ten tips to increase influenza vaccination rates in your office; and (4) increasing pediatric immunization rates with influenza vaccine clinics in a private practice.

The course is intended to be completed in two hours. For more information and to begin the course, go to:

A CD-ROM of the course is also available; to request one, call NFID at (866) 686-6343 or send an email to

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July 12, 2004

The live satellite broadcast and webcast Immunization Update 2004 will provide up-to-date information on the rapidly changing field of immunization. As of today, the course instructors, final course content, and webcast information have not been announced. "IAC EXPRESS" will notify readers when more information is available.

Sponsored by CDC, the live broadcast is scheduled for August 19 from 9AM to 11:30AM ET. It will be rebroadcast later in the day from noon to 2:30PM ET. Both broadcasts will feature a live Q&A session in which participants nationwide can interact with the course instructors via toll-free telephone lines.

Following is the anticipated course content: new recommendations for influenza vaccine, including routine vaccination of children ages 6-23 months and expanded use of live attenuated intranasal vaccine; pneumococcal conjugate vaccine shortage; varicella vaccine; and vaccine safety issues.

The program's intended audience includes physicians, nurses, nurse practitioners, physician assistants, Department of Defense paraprofessionals, pharmacists, and their colleagues who either administer vaccines or set policy for their offices, clinics, or communicable disease or infection control programs. Private and public health care providers, including pediatricians, family physicians, residents, and medical and nursing students are encouraged to participate.

Registration will begin July 22. To register and receive continuing education credits, you must register online on the Public Health Training Network website at

Pharmacists can earn continuing education credit through their own online learning system. To register, pharmacists should go to:

For additional information, go to, email or call (800) 418-7246.

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July 12, 2004

CDC published "Update: Investigation of Rabies Infections in Organ Donor and Transplant Recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004" in the July 9 issue of "MMWR Dispatch." CDC publishes the web-based "MMWR Dispatch" only for the immediate release of important public health information. The article will be published in a print issue of MMWR in the future.

The July 9 "MMWR Dispatch" is reprinted below in its entirety, excluding one reference.


On July 1, 2004, CDC reported laboratory confirmation of rabies as the cause of encephalitis in an organ donor and three organ recipients at Baylor University Medical Center (BUMC) in Dallas, Texas. Hospital and public health officials in Alabama, Arkansas, Oklahoma, and Texas initiated public health investigations to identify donor and recipient contacts, assess exposure risks, and provide rabies postexposure prophylaxis (PEP). As of July 9, PEP had been initiated in approximately 174 (19%) of 916 persons who had been assessed for exposures to the organ recipients or the donor. As a result of its public health investigation, the Arkansas Department of Health determined that the donor had reported being bitten by a bat (Frank Wilson, MD, Arkansas Department of Health, personal communication, 2004).

On July 7, CDC was notified of an additional organ transplant patient at BUMC who had died of encephalopathy of unknown origin in early June. This case was detected as part of an ongoing review of transplant-patient autopsies. The patient, who had end-stage liver disease, had received a liver transplant at BUMC in early May 2004. The patient remained hospitalized with transplant-related complications and began having neurologic abnormalities in early June, progressing to seizure, coma, and death. On July 7, pathologists at BUMC identified intracytoplasmic inclusions, suggestive of rabies, in neurons in multiple areas of the brain.

Specimens from the recipient were sent to CDC on July 7, and direct fluorescent antibody and immunohistochemical staining procedures confirmed the presence of rabies viral antigens in multiple areas of the brain, including the hippocampus, midbrain, pons, medulla, and cerebellum. Similar to the findings with the three previously known rabies-infected transplant recipients, preliminary antigenic characterization of the agent was consistent with a rabies virus variant associated with insectivorous bats. On July 8, CDC laboratory testing of tissues and serum from the donor who provided the liver yielded no evidence of infection with rabies virus.

Review of surgical procedures at BUMC determined that a segment of iliac artery recovered from the donor subsequently determined to have rabies had been stored at the facility for future use in liver transplants. This artery segment subsequently was used in the transplantation of the liver in the most recently identified rabies-infected recipient. Investigation of rabies transmission sources is ongoing, although current evidence suggests that the artery segment originating from the rabies-infected donor likely is the source of the latest rabies infection. Identification of contacts of this liver recipient is under way, and initiation of PEP when indicated or as appropriate is in progress.


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

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

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July 12, 2004

CDC published "Investigation of Rabies Infections in Organ Donor and Transplant Recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004" in the July 9 issue of MMWR. Originally published July 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 complete article, go to:

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

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July 12, 2004

"Strengthening Immunization Programs: The Communication Component" was published in May 2004 by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development (USAID). The 36-page report is available in English and French.

According to its abstract, the report "provides an overview of immunization communication and describes how to maximize its contribution to immunization programs in developing countries. The discussion and examples focus on communication's place within immunization planning, activities, and partnerships, based on lessons learned from behavior-centered analyses and programming. A detailed case study of Madagascar's immunization communication activities is provided as an example of country implementation."

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

To access it in French, go to:

For other useful documents and tools in immunization and other child survival interventions, visit the BASICS II website 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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