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Issue Number 474            August 9, 2004


  1. Official CDC Health Advisory reports confirmed case of measles on an airline flight from Hong Kong to New York
  2. VIS update: CDC issues revised VIS for hepatitis A vaccine
  3. CDC reports on transmission of hepatitis B virus in Georgia correctional facilities
  4. CDC reports on hepatitis B vaccination of inmates in Texas correctional facilities
  5. If you vaccinate adults, you can't afford to be without the "Adults Only Vaccination" kit
  6. IAC makes minor changes to its English and Spanish patient-education piece "All kids need hepatitis B shots!"
  7. NPI honors recipients of its Excellence in Immunization awards
  8. NIP web section presents detailed information on needle-free injection technology
  9. NIP's free web-based training course on smallpox vaccine storage and handling is approved for CME credit
  10. WHO announces resumption of polio immunization campaigns in Kano, Nigeria
  11. SIGN's annual meeting scheduled for October 20-22 in Cape Town, South 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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August 9, 2004

On August 1, CDC issued an Official CDC Health Advisory about a confirmed case of measles identified on an airline flight to New York. On August 2, CDC issued an Official Health Update correcting some misinformation contained in the health advisory. Following is the corrected version of the August 1 health advisory.


This is an official CDC HEALTH ADVISORY

Distributed via Health Alert Network
Sunday, August 01, 2004, 19:51 EDT (7:51PM EDT)


On July 31, 2004, the New York City Department of Health and Mental Hygiene and CDC were notified of a case of measles in a 2-year-old child. The case was laboratory confirmed at the NYC public health laboratory on 7/31/04. The child was returning to the US from travel to Hong Kong, Thailand, and China. The child did not have a rash but was in the infectious stage of measles illness during the flight. The child had not been vaccinated against measles according to the international certificate of  vaccination that the mother had; two siblings did have documentation of previously receiving MMR. The index case flew non-stop from Hong Kong to New York, arriving on July 30, 2004, at approximately 1:40PM on Cathay Pacific flight 830 at John F. Kennedy International Airport. Passengers from this flight reside in California, Connecticut, Washington DC, Florida, Georgia, Massachusetts, Maryland, Missouri, North Carolina, New Jersey, New Hampshire, New York City, New York State, Ohio, Pennsylvania, Puerto Rico, Texas, and Virginia.

The Quarantine Station at JFK International Airport is overseeing notifying jurisdictions of the names of passengers from the flight. Inquiries regarding passenger names should be directed to the Quarantine Station at (718) 553-1685.

CDC estimates that exposures to measles occur, on average, 10-12 times per year, on commercial aircraft arriving in the United States. The risk of infection following this type of exposure in airline contacts is considered low; CDC has only rarely identified measles cases that apparently resulted from such exposures.

State Public Health Departments and health care providers should be alert to possible cases of measles in persons who traveled on the July 30th Cathay Pacific flight number 830 or their contacts. Health care providers should increase their index of suspicion for measles in clinically compatible cases and notify their local health department of a suspect measles case immediately. It is important to obtain travel histories from the patient and their family, as well as their close contacts. State health departments should report suspect measles cases immediately to CDC. Persons generally can be presumed immune to measles if they have documentation of 2 doses of measles vaccine, laboratory evidence of immunity to measles, documentation of physician-diagnosed measles, or were born before 1957. Persons who are not immune should be given MMR vaccine or immune globulin according to ACIP recommendations.

Measles is an acute disease characterized by fever, cough, coryza, an erythematous maculopapular rash and a pathognomonic enanthem (Koplik's spots). Measles has an incubation period of 7-21 days, and infected people are considered contagious from 4 days before to 4 days after the appearance of rash. Serologic (Measles IgM) testing is required to confirm the diagnosis. In addition to serologic specimens, health departments should collect throat swabs and urine for viral isolation.

Further information on measles can be found at


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August 9, 2004

On August 4, CDC issued a revised VIS for hepatitis A vaccine. The previous VIS for hepatitis A vaccine was issued on 8/25/98. If you have VISs with that date, discard them, and download and print the revised VIS from either the NIP website or the IAC website. Currently, only English-language versions of the revised VIS are available. IAC EXPRESS will alert readers as translations become available.

PLEASE NOTE: When hepatitis A vaccine is added to the Vaccine Injury Compensation Program's injury table, presumably later in 2004, another hepatitis A vaccine VIS will be issued. To avoid large printing expenses, print off only as many of the 8/4/04 VISs as you anticipate needing for the next several months.

To access a ready-to-copy (PDF) version of the 8/4/04 hepatitis A vaccine VIS from the NIP website, go to:

To access it from the IAC website, go to:

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August 9, 2004

CDC published "Transmission of Hepatitis B Virus in Correctional Facilities--Georgia, January 1999-June 2002" in the August 6 issue of MMWR. Reprinted below is a portion of the article, as well as the entire press summary.


[The article's opening paragraph]
Incarcerated persons have a disproportionate burden of infectious diseases, including hepatitis B virus (HBV) infection. Among U.S. adult prison inmates, the overall prevalence of current or previous HBV infection ranges from 13% to 47%. The prevalence of chronic HBV infection among inmates is approximately 1.0%-3.7%, two to six times the prevalence among adults in the general U.S. population. Incarcerated persons can acquire HBV infection in the community or in correctional settings. This report summarizes the results of (1) an analysis of hepatitis B cases among Georgia inmates reported to the Georgia Department of Human Resources, Division of Public Health (DPH) during January 1999-June 2002, including a retrospective investigation of cases reported during January 2001-June 2002; and (2) a prevalence survey conducted in prison intake centers during February-March 2003. These efforts identified cases of acute hepatitis B in multiple Georgia prisons and documented evidence of ongoing transmission of HBV in the state correctional system. The findings underscore the need for hepatitis B vaccination programs in correctional facilities. . . .

[The complete press summary]
All inmates who receive a medical evaluation in a correctional facility should be administered hepatitis B vaccine to prevent ongoing hepatitis B virus transmission in correctional facilities and to reduce transmission in the community after incarceration.

Between January 2001-June 2002, 57 cases of acute hepatitis B virus infection (HBV) were identified among inmates at 31 long-term correctional facilities in Georgia. The majority of cases (72%) were acquired in prison, indicating ongoing HBV transmission occurred in correctional facilities. The extent of HBV transmission among inmates might be underestimated since most persons with acute HBV infection are asymptomatic and investigations of single cases are not routinely conducted. A survey at intake centers also showed most incoming inmates were susceptible to HBV and accepted hepatitis B vaccination (76% and 78% respectively). The ongoing transmission demonstrated in Georgia prisons might be occurring in other states, where similar conditions are likely to exist. Routine hepatitis B vaccination of inmates would interrupt HBV transmission among inmates during incarceration and reduce transmission in the community after incarceration.


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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August 9, 2004

CDC published "Hepatitis B Vaccination of Inmates in Correctional Facilities--Texas, 2000-2002" in the August 6 issue of MMWR. Reprinted below is a portion of the article, as well as the entire press summary.


[The article's opening paragraph]
In December 2002, approximately 2.2 million persons were incarcerated in the United States; an estimated 8 million were released to the community that year. In 2001, approximately 22,000 acute hepatitis B cases and 78,000 new hepatitis B virus (HBV) infections occurred in the United States; an estimated 29% of these cases were in persons who had been incarcerated previously. The majority of HBV infections among incarcerated persons are acquired in the community; however, infection also is transmitted within correctional settings. Hepatitis B vaccination of incarcerated persons is recommended to prevent transmission in correctional facilities and in previously incarcerated persons on their return to the community. In May 2000, the Texas Department of Criminal Justice (TDCJ), which oversees custody of state jail and prison inmates, implemented a hepatitis B vaccination program. To determine hepatitis B vaccination rates of inmates during 2000-2002, TDCJ reviewed charts of inmates released during a 3-day period for documentation of vaccination. This report summarizes the results of that study, which indicated that rates of vaccine acceptance and vaccine series completion among inmates were high. Establishing hepatitis B vaccination programs in prisons and jails can prevent a substantial proportion of HBV infections among adults in the outside community. . . .

[The complete press summary]
Vaccinating offenders in jails and prisons is feasible, and may prevent about 30% of new acute hepatitis B cases in the United States.

Hepatitis B vaccination in prison has the potential to prevent a substantial portion of hepatitis B cases in the United States, since approximately 30% of reported acute hepatitis B cases are among individuals who have been incarcerated. Although hepatitis B vaccination in correctional facilities has been recommended for over 20 years, only five states have implemented vaccination programs. The Texas Department of Criminal Justice implemented a hepatitis B vaccination program in its prisons and jails, and proved that vaccinating inmates was feasible and was well accepted by inmates and staff. The large majority of both prison and jail inmates accepted the first dose of vaccine when offered. Ninety-six percent of prison inmates incarcerated for 4 months or more received all three vaccine doses.


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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August 9, 2004

THE GOOD NEWS: More and more adults are being vaccinated, not only at doctors' offices but also at non-traditional sites, such as family planning clinics, college health services, STD clinics, pharmacies, and prisons.

THE BEST NEWS: IAC has collected ALL the information you need to vaccinate adults into one user-friendly kit--"Adults Only Vaccination: A Step-by-Step Guide" (the AOV kit).

WHAT IS THE AOV KIT? The kit pares down immunization delivery to its essential components and presents each component in manageable, easy-to-master steps. The steps progress in logical order, starting with setting up a vaccine service at your site and ending with billing for the vaccine services you've delivered.

WHAT'S IN THE KIT? The heart of the kit is the guide, which presents 157 pages of comprehensive, authoritative, CDC-reviewed information on ALL aspects of adult immunization. Organized into seven logically presented steps, the guide is designed to be useful and stay current for years: it has more than 45 patient and provider-education materials that will never go out of date because each is linked to the latest version on IAC's website.

Plus, the guide is tabbed for easy reference, spiral bound to lie flat, and plastic coated for durability. And, it has wide margins for jotting down practical information such as useful web and email addresses, ideas for improving certain aspects of vaccine delivery, etc. This allows you to customize your guide to suit your clinic or practice's unique needs.

In addition to the guide, the kit contains the following:

  • Two "how-to" instructional videos--"Immunization Techniques: Safe, Effective, Caring" and "How to Protect Your Vaccine Supply"
  • Standing orders protocols for administering eight vaccines commonly given to adults; these are indispensable for increasing your clinic or practice's adult immunization rates
  • Vital information for responding to vaccine-related medical emergencies, such as anaphylaxis, or to power outages
  • A pack of 25 adult immunization record cards

WHO SUPPORTS THE KIT? Immunization experts from NIP/CDC reviewed the kit. In addition, the following government agencies signed the guide's introductory letter: US Department of Health and Human Services (Women's Health); several divisions within CDC: the Division of HIV/AIDS Prevention, Division of Sexually Transmitted Diseases Prevention, and Division of Viral Hepatitis. The following professional organizations also signed the letter: the American College Health Association, American College of Obstetricians and Gynecologists, American Medical Association, National Medical Association, and Planned Parenthood Federation of America.

WHO NEEDS THE KIT? Designed to help integrate immunization services into sites new to vaccination, the AOV kit is equally valuable for settings experienced in vaccine delivery. Why? Because it puts ALL the information you need to vaccinate adults right at your fingertips. If you currently find any aspect of adult vaccination confusing, the kit will clarify the issue or give you resources for getting clarification. IF YOU VACCINATE ADULTS, YOU CAN'T AFFORD TO BE WITHOUT THE KIT.

WHAT'S THE PRICE: The kit costs $75. Special discount pricing is available for orders of 10 or more (see the link below).

CAN I GET MORE INFORMATION ABOUT THE KIT? You can get complete information--including a look at the guide's many worksheets, checklists, protocols, and educational materials--by visiting IAC's website at

HOW CAN I ORDER THE KIT? You can order online or by fax or mail, using a credit card, purchase order, or check. To order, go to: Click on the appropriate link.

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August 9, 2004

IAC recently reviewed some of its older patient-education pieces and made minor revisions to the English and Spanish versions of one: "All kids need hepatitis B shots!"

To access a ready-to-copy (PDF) version of the updated "All kids need hepatitis B shots!" in English, go to:

To access it in Spanish, go to:

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August 9, 2004

As part of National Immunization Awareness Month, the National Partnership for Immunization (NPI) honored recipients of its Excellence in Immunization awards on July 29 at a ceremony in Washington, DC. Following is information about program recipients:


  1. The Pennsylvania Department of Health, Division of Immunization/Adult Immunization Enhancement Project in 2003 vaccinated historically underimmunized minority populations with more than 32,000 doses of influenza vaccine and more than 1,300 doses of pneumococcal vaccine. For information, contact Joeanne Maljevac, RN, BC, BSN, at (717) 787-5681.
  2. The Turley Family Health Center, Pinellas County, Florida, increased the number of doses of pediatric vaccines in a medically underserved neighborhood from 750 doses in 2001 to 4,115 doses in 2003. For information, contact George Hutter, MD, at (727) 467-2503.

CAMPAIGN AWARDS went of two recipients:

  1. The Alabama Quality Assurance Foundation's "IZ Alabama Covered?" Flu and Pneumonia Prevention Campaign aims to increase influenza and pneumococcal vaccination rates among senior adults. Recent data show a 66% increase in the volume of doses of influenza vaccine administered in Alabama from 2002 to 2003. For information, contact Betsy S. Frazer, RN, BS, at (205) 970-1600 x3511.
  2. Visiting Nurse Service,Inc.'s (VNS) Immunization Programs are helping raise disease awareness and vaccination use in Indianapolis. The number of influenza and pneumococcal vaccines given by VNS increased by 22% from 2002 to 2003. VNS has also raised meningococcal disease awareness and vaccine use among high school seniors. For information, contact Judy Moon at (317) 722-8200.

THE NONTRADITIONAL PARTNER AWARD went to the Southeast Michigan Partners Project, which brings together distinct communities, including insurers, employers, and public health and other stakeholders to develop projects that promote and implement adult immunization services. For information, contact Terrisca Des Jardins, MHSA, at (734) 769-1247.

THE PROVIDER AWARD went to Norman Regional Hospital, which has evaluated nearly 33,000 patients since 2000 and administered more than 5,200 doses of pneumococcal vaccine to eligible patients. For information, contact Yvette Morrison at (405) 307-1955.

For additional information on the award-winning projects, go to:

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August 9, 2004

NIP's web section Needle-free Injection Technology offers a wealth of information on the technology involved in administering vaccines and drugs through the skin without the use of conventional needles. The section provides background information, scientific bibliography, history, and links to news reports, policy sources, device manufacturers, and related sites.

Among the resources available is the "Needle-free Injection Technology News Service," which distributes news and related information by WebBoard forum postings and email broadcasts. To browse as a guest or to subscribe, go to:

To access all the offerings on the Needle-free Injection Technology web section, go to:

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August 9, 2004

NIP and CDC recently announced the release of Smallpox Vaccine Storage and Handling, a free interactive web-based training course approved for CME credit.

Presented in four modules, the course covers vaccine distribution, vaccine storage, vaccine preparation and administration, and procedures and equipment to safeguard the vaccine during an emergency. The intended audience includes state and local health department staff; hospital emergency room technicians, nurses, laboratory workers, and hospital physicians; private physicians; and first responders.

To access additional information and the course itself, go to:

Email with questions and comments.

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August 9, 2004

On August 3, WHO issued a statement on behalf of the Global Polio Eradication Initiative welcoming the resumption of polio immunization campaigns in Kano, Nigeria. The first round of campaigns began in Kano on July 31. Additional campaigns are planned from September to November throughout Nigeria.

The statement reported that Kano's decision to vaccinate children against polio comes at a critical time in the polio eradication program. Sub-Saharan Africa is on the verge of the largest polio epidemic in recent history. Because of the outbreak that originated in Kano and surrounding states, polio cases recorded in the region are five times greater than they were during the same period in 2003 (483 compared with 95).

To access the complete statement, go to:

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August 9, 2004

The Safe Injection Global Network (SIGN) recently announced it will hold its annual meeting on October 20-22 in Cape Town, South Africa. The meeting has four objectives:

  1. Exchange information regarding global progress toward the safe and appropriate use of injections worldwide
  2. Review progress of the various injection safety demonstration projects in Africa
  3. Review progress of the three WHO needle-stick prevention projects
  4. Review progress in infection control activities in Africa

For additional information, go to:

Persons interested in participating in the meeting are encouraged to email the SIGN secretariat 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
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  • Contributing Writer
    Laurel H. Wood, MPA
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    Kayla Ohlde

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