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Issue Number 472            July 26, 2004


  1. July issue of CDC's "Immunization Works!" electronic newsletter now available on the NIP website
  2. Two terrific videos teach vaccine administration, and storage and handling
  3. New: WHO and GAVI launch an immunization financing web section
  4. Indiana Fall Awards Conference scheduled for October 4 and 8
  5. New translation: IAC's "Summary of Recommendations for Adult Immunization" now available in Turkish
  6. CDC reports on recent polio eradication efforts in Afghanistan and Pakistan


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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 26, 2004

The July 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.

Some of the information in the July issue has already appeared in previous issues of "IAC EXPRESS." One issue of particular importance to the immunization community is the recommendation to reinstate the third dose of pneumococcal conjugate vaccine (PCV). 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 became effective on July 8.

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

"IAC EXPRESS" published an article about the recommendation on July 12. To access the "IAC EXPRESS" article, go to:

Following is the text of four articles from the July issue of "Immunization Works!" that we have not covered.



NEW STUDIES SHOW PARENTAL VACCINE SAFETY CONCERNS MAY POSE RISK TO IMMUNIZATION RATES: Two studies published this month in "Pediatrics" link parental vaccine safety concerns to lack of immunizations. The first study, by Dr. Philip Smith and colleagues at CDC's National Immunization Program, assessed whether the characteristics of children with no vaccinations differ from those of under-vaccinated children, and identified states with high rates and counties with large numbers of unvaccinated children. The study found that under-vaccinated children tend to be black, have younger, unmarried mothers who do not have college degrees, live in households near the poverty level, and live in a central city. In contrast unvaccinated children tend to be white, to have married mothers who have college degrees, live in households with annual incomes exceeding $75,000/year, and have parents who express concerns over the safety of vaccines and indicate that medical doctors have little influence over vaccination decisions for their child. The results also found that unvaccinated children cluster geographically, increasing the risk of transmitting vaccine preventable diseases to both unvaccinated and under-vaccinated children. The estimated number of unvaccinated children aged 19-35 months increased significantly between 1995 and 2000 from 14,719 in 1995 to 24,073 in 2000.

The second study, conducted by Dr. Deborah Gust and colleagues, examined the attitudes, beliefs, and behaviors of parents whose children were under-immunized for two or more vaccines that have recently received negative attention, and compared them with parents whose child was fully immunized for recommended vaccines. The results indicate that while socioeconomic, family, and health care factors are key contributors for the majority of children who are not up-to-date, about 15% of under-immunization can be attributed to negative parental attitudes, beliefs, and behaviors. In addition, although overall immunization rates remain high and vaccine safety concerns are more common among parents of under-immunized children, many parents of fully immunized children also demonstrated similar attitudes, beliefs, and behaviors, suggesting a potential risk of currently high vaccination rates in the U.S.

FACT SHEETS FOR PARENTS AND HEALTHCARE PROFESSIONALS ON THE IOM REPORT ON VACCINES AND AUTISM: The fact sheets for parents and healthcare professionals summarize important conclusions from a report by the Institute of Medicine (IOM) on Vaccines and Autism. If you are involved in the administration of vaccines, you likely are familiar with allegations asserting that vaccines cause autism. In fact, you may have had patients, or their parents, raise concerns about vaccines and autism. In one study, 27% of family practitioners and pediatricians reported that parents sometimes or often raise concerns about possible neurologic effects of vaccination. The IOM's conclusions on vaccines and autism may be helpful to you in reassuring concerned parents about the safety of vaccines. In their 2004 report, the IOM concluded that neither thimerosal-containing vaccines nor MMR vaccine are associated with autism. The fact sheets can be found at

2004 NIP ANNUAL REPORT & SURVEY: The National Immunization Program (NIP) at CDC released its 2004 Annual Report in May during the National Immunization Conference. If you have not received a copy of the report, you may download the report or order a print copy by visiting This year's report includes highlights about the distinguished career of Walt Orenstein, NIP's former director, and several innovative features, including a NIP event calendar, an index of topics, and a special section covering individual honors and achievements. One unusual new feature is a survey card that lets readers anonymously evaluate the annual report. NIP wants to know if the annual report serves its readers and provides information they need. The survey results let NIP know how the report is used and how it can be improved. To submit the survey, you can print the post-paid survey, complete it, and mail it to NIP. You may also complete the survey online at Please help NIP to serve you better by sending in your survey.

DR. WALTER A. ORENSTEIN RECEIVES SHEPARD AWARD: The Charles C. Shepard Science Award for Lifetime Scientific Achievement was awarded to Walter Orenstein, MD, for his 26 years of service in the CDC's National Immunization Program (NIP). During his tenure at NIP, Dr. Orenstein led successful efforts to combat and markedly reduce the occurrence of once common vaccine-preventable diseases of childhood, including meningitis from Haemophilus influenzae type b, rubella, varicella, and invasive pneumococcal disease. The work accomplished under his leadership has been critical to the development of national vaccine policy and global immunization strategies. Of particular note are the elimination of indigenous measles in the United States, the successful introduction of five new vaccines for routine use and the resultant decrease in the incidence of diseases prevented by these vaccines, the development of a national surveillance system for immunization coverage among preschool children, improvements in the surveillance and investigation of vaccine-associated adverse events, development of evidence-based strategies to improve vaccination coverage, and progress in global polio eradication and measles control. Dr. Orenstein has published more than 140 peer-reviewed publications, authored nearly three dozen chapters in the professional literature, and co-edited the 3rd and 4th editions of "Vaccines," the premier textbook on immunization. Recently retired from CDC, Dr. Orenstein has joined the Emory University School of Medicine as director of a new Program for Vaccine Policy and Development and associate director of the Emory Vaccine Center. He also serves as associate director of the Southeastern Center for Emerging Biologic Threats, a regional partnership led by Emory.


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


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July 26, 2004

Before you know it, your office or clinic will be flooded with children and adolescents seeking back-to-school vaccinations. Once they're gone, people of all ages will start showing up for influenza immunization. The fastest, surest, and most cost effective way to ready yourself and your immunization staff for the busy season ahead is to order and view the two videos described below.


"IMMUNIZATION TECHNIQUES: SAFE, EFFECTIVE, CARING" Developed by the California Department of Health Services Immunization Branch and a team of national experts, this 35-minute video is designed for use as a "hands-on" instructional program. It can be used to train new staff and to provide a refresher course for experienced staff who administer vaccines.

It teaches best practices for administering intramuscular (IM) and subcutaneous (SC) vaccines to infants, children, and adults and discusses the following:

  • Anatomic sites
  • Choice of needle size
  • Vaccines and routes of administration
  • How to "draw up" doses of vaccine from a vial

People of various ages--from infants to adults--are vaccinated in the video to demonstrate these techniques.

The video comes with presenter's notes that include instructional objectives, pre- and post-tests, photos showing vaccination sites appropriate for vaccinating people of different ages, and a skills checklist to help you document that your staff is well trained.

IAC distributes the video and presenter's notes at $25 per set (to U.S. addresses). For additional information about the video and to order online, or by mail, fax, or purchase order, go to:

For additional information, contact IAC by email at or by phone at (651) 647-9009.

Produced by CDC in 2004, this 25-minute video presents practical, up-to-date information on all aspects of vaccine storage and handling. It covers temperature monitoring equipment, required documentation and record-keeping, storage and handling procedures, and action steps to take when a problem occurs.

ORDERING FROM NIP. You can order one free copy from NIP. To order online, go to the online order form at The video is product number 00-6526. A BETA master tape is also available if you want to reproduce the video in bulk.

To order by phone, call the CDC Immunization Information Hotline at (800) 232-2522.

To play the video online, using Windows Media Player, go to:

ORDERING FROM IAC. You can order single or multiple copies from IAC for $15 per copy (discount pricing is available for orders of 20 or more). For additional information about the video and to order online, or by mail, fax, or purchase order, go to:

For additional information, contact IAC by email at or by phone at (651) 647-9009.

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July 26, 2004

WHO and the Global Alliance for Vaccines & Immunization (GAVI) recently announced the availability of a new web section on WHO's website. Titled Immunization Financing, the web section was developed by WHO's Immunization, Vaccines, and Biologics department under GAVI auspices. It is intended as an online resource for GAVI partners, international donors, policy makers, health planners, immunization program managers, and researchers who seek and share information about immunization financing.

To access the new web section, go to:

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July 26, 2004

The Indiana State Department of Health Immunization program will hold the Indiana Fall Awards Conference 2004 on two dates and at two Indianapolis locations. The October 4 conference will be held at Indianapolis Marriott North; the October 8 conference is scheduled for Primo South Banquet & Conference Center.

The program at both conference venues is the same. Both offer workshops on basic immunization information, influenza, pneumococcal vaccine and disease, and the Indiana Immunization Registry.

The conference is free; registration is required by September 10. For registration information and the conference agenda, go to:

For additional information, contact Shannon Goheen by email at or by phone at (317) 847-7368, or contact Jennifer McCarthy by email at or by phone at (317) 435-1319.

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July 26, 2004

Updated in July, IAC's "Summary of Recommendations for Adult Immunization" is now available in Turkish. IAC gratefully acknowledges Doctors Mustafa Kozanoglu and Murat Serbest of Adana, Turkey, for the translation.

A two-sided reference table on appropriate use, scheduling, and contraindications of adult vaccines, the revised adult summary now reflects ACIP's latest recommendations for adult influenza immunization.

To obtain the summary in ready to copy (PDF) format in Turkish, go to:

To obtain it in ready-to-copy (PDF) format in English, go to:

To obtain it in web-text (HTML) format in English, go to:

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July 26, 2004

CDC published "Progress Toward Poliomyelitis Eradication--Afghanistan and Pakistan, January 2003-May 2004" in the July 23 issue of MMWR. A summary made available to the press is reprinted below in its entirety.


While substantial progress toward polio eradication has been made in Pakistan and Afghanistan, significant challenges remain. The two countries must work together closely to interrupt poliovirus transmission, which can only occur if both countries maintain sensitive surveillance systems and further improve the quality of their supplemental immunization activities (SIAs), especially in areas where cultural practices limit access and in areas that are not secure.

Since the 1988 World Health Assembly resolution to eradicate poliomyelitis, the number of countries where polio is endemic decreased from approximately 125 to six by the end of 2003. Global polio cases decreased from 1,918 in 2002 to 784 in 2003, and approximately 340 through June 2004. In 2003, poliovirus importations were reported in 10 countries. Pakistan and Afghanistan are two countries where polio remains endemic. Pakistan experienced an overall increase in the number of polio cases in 2003 compared with 2002; however, the increased number, intensity, and quality of SIAs in 2003 and 2004 have resulted in a decrease in polio incidence that began in mid-2003. Afghanistan reported eight cases of polio in 2003 and three to date in 2004. Intense cross-border migration continues in both directions, favoring continuous virus movement between both countries.


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:

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.

IZ Express Disclaimer
ISSN 2771-8085

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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