Issue Number 480            September 20, 2004


  1. CDC reports that the shortage of pneumococcal conjugate vaccine (PCV7) has been resolved
  2. Dear Abby to publish a letter on September 22 about the importance of childhood influenza immunization
  3. Act now: Free bulk copies of the latest issue of "Vaccinate Adults" (May 2004) will go fast
  4. New: NIP's web-based interactive "Vaccine Quiz" helps adolescents and adults find out which vaccines they need
  5. Paul A. Offit, MD, responds to "Wall Street Journal" article about thimerosal and autism
  6. Coming soon: Teleconference on Eliminating Disparities in Childhood Immunization set for September 23
  7. Updated: IAC makes major revisions to its parent-education piece "Vaccine Concerns"
  8. Updated: IAC revises its patient education brochure "Hepatitis A is a Serious Liver Disease"
  9. The Society for Adolescent Medicine website offers valuable information to professionals, teens, and parents


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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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September 20, 2004

CDC published "Notice to Readers: Pneumococcal Conjugate Vaccine Shortage Resolved" in the September 17 issue of MMWR. The notice is reprinted below in its entirety, with the exception of references and a table. (Titled "Recommended 7-valent pneumococcal conjugate vaccination regimens among children aged <5 years, by history and condition," the table provides detailed scheduling, catch-up, and high-risk information for PCV7. To access the table, go to:


Since February 2004, CDC has recommended that 7-valent pneumococcal conjugate vaccine (PCV7), marketed as Prevnar and manufactured by Wyeth Vaccines (Collegeville, Pennsylvania), be administered to healthy children on an abbreviated schedule to conserve the limited supply. Production capacity has been increased, and supply is now sufficient to meet the national demand for vaccine on the routine, 4-dose schedule. Effective immediately, CDC, in consultation with the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics, recommends that providers resume administration of PCV7 according to the routine schedule.

A vaccination 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 because of certain immunocompromising or chronic conditions (e.g., sickle cell disease, asplenia, chronic heart or lung disease, diabetes, cerebrospinal fluid leak, cochlear implant, or human immunodeficiency virus infection) 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.

Providers with questions about obtaining Prevnar should contact Wyeth's customer service department, telephone (800) 666-7248. For public-purchased vaccine, including vaccines used in the Vaccines for Children Program, 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.


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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September 20, 2004

Be sure to turn the pages of your newspaper to Dear Abby's column on September 22. The column is scheduled to publish a letter that makes the case for giving influenza vaccine to children 6-23 months of age (and their household contacts and out-of-home caregivers) this fall. Representing the views of AAFP, AAP, and the American Medical Association, the letter is signed by leaders from all three professional associations.

From IAC's past experience being published in Dear Abby's column, we want to alert immunization providers that they may get a number of phone calls from people seeking appointments for influenza vaccination after the column is published. The column's reach is broad: the Dear Abby staff estimates 110 million people read it each day.

If possible, we would appreciate your clipping the September 22 column (including the headline) from your newspaper and faxing or mailing it to us. We'd like to see the headlines various papers generate for the column.

Our fax number is (651) 647-9131; our mailing address is Immunization Action Coalition, 1573 Selby Ave., Ste. 234, St. Paul, MN 55104. Thank you for your help with this.

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September 20, 2004

The Immunization Action Coalition (IAC) is giving away bulk copies (up to 50 per request) of the May 2004 issue of "VACCINATE ADULTS."

If you have an immunization conference or an educational program coming up for adult medical specialists, this 12-page publication is an excellent item to distribute. The May issue includes a timely professional-education piece that encourages health professionals to protect their patients by getting immunized against influenza. It also has a patient-education piece advising adults of the need for vaccination throughout the lifespan. PLEASE NOTE: One of the patient-education pieces, "Protect Yourself Against Hepatitis A and Hepatitis B: A Guide for Gay and Bisexual Men," is intended for a gay audience in settings such as STD clinics and clinics for men who have sex with men. It is not intended for routine use in all clinic settings.

Because supplies are limited, it's best to make your request right away. The free copies go quickly. Sorry, we can mail orders only to addresses within the United States.

To request copies, fill out the online form on IAC's website:

You will be asked to supply the following information:

  • The number of copies you want (maximum 50)
  • A description of how you plan to use the copies
  • Your name and complete contact information, including mailing address, telephone number, and email address

For further information, please email

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September 20, 2004

NIP recently launched a web-based interactive "Vaccine Quiz" to help adolescents and adults understand which vaccines they need and to drive home the point that vaccination is a lifelong, life-saving intervention. Health care providers can reduce the time they spend on patient education by referring patients to the quiz.

It takes a patient only five seconds to answer general questions about their age, lifestyle, and medical conditions. When they finish, the website immediately displays a short list of vaccines that may be appropriate for the patient and encourages her/him to ask about these vaccines during their next medical visit.

Quiz questions and results are based on the latest ACIP recommendations; the quiz is updated whenever the recommendations change. To access the quiz, go to:

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September 20, 2004

On September 14, the "Wall Street Journal" (WSJ) published a letter to the editor from Paul A. Offit, MD, chief, Division of Infectious Diseases, Children's Hospital of Philadelphia (CHOP), and professor of pediatrics, University of Pennsylvania School of Medicine. The letter is a response to an article written by WSJ reporter Tara Parker-Pope, which was published September 7.

Parker-Pope's article, "Controversial Study Reignites Debate on Autism and Childhood Vaccines," suggests that parents "politely ask to see the label" on vials of influenza vaccine to be sure their child receives a thimerosal-free version of the vaccine this year. Parker-Pope's article received media attention. Offit's response, reprinted below from the listserv of CHOP's Vaccine Education Center, may help physicians and other health professionals answer questions raised by the article.


This year, for the first time, the Centers for Disease Control and Prevention (CDC) recommended that all children between six and 23 months of age receive an influenza vaccine. Some of the influenza vaccine used this year will contain a preservative (thimerosal) and some will not. In her article ("Controversial Study Reignites Debate Over Autism and Childhood Vaccines," Wall Street Journal, September 7, 2004), Tara Parker-Pope recommends that, because thimerosal might cause autism, parents should "politely ask to see the label." Because supplies of thimerosal-free influenza vaccine are limited, many parents will be faced with the choice of getting thimerosal-containing influenza vaccine or not getting a vaccine; Parker-Pope leads her readers to believe that no vaccine is the better choice. But a choice not to get an influenza vaccine will unnecessarily put children in harm's way.

Parker-Pope's article is misleading for several reasons. First, thimerosal contained in vaccines doesn't cause autism. Two large epidemiologic studies performed in the United States and Denmark found that children who received thimerosal-containing vaccines were not at greater risk of autism. Because epidemiologic studies are capable of detecting even very rare side effects, the importance of these findings cannot be overlooked. For example, large epidemiologic studies easily found that the swine flu vaccine used in the mid-1970s caused a serious side effect in 1 of every 100,000 people that got it. Parker-Pope can't argue that rates of autism are "as high as 1 in 150" and that epidemiologic studies aren't sensitive enough to find that vaccines are the cause. Second, the article states that after the Institute of Medicine (IOM) "rejected a link between vaccines and autism, a mouse study has reignited the debate." The mouse study to which Parker-Pope refers is not new; it was evaluated by the IOM at the time of their review and found to be critically flawed. The authors of the mouse study found that mice uniquely susceptible to autoimmune diseases developed autism after receiving thimerosal. But mice aren't men, autism is not an autoimmune disease, and the extrapolation from autism in children (a disorder of speech, language, and social behavior) to autism in mice is fanciful. Third, the article states that Congressman Dan Burton's grandson "developed autism five years ago after receiving shots containing thimerosal." This statement would lead the reader to believe that autism was caused by vaccines; something clearly at variance with epidemiologic studies. Fourth, the article states that "[a]nother option is to ask for Flu-Mist, a nasal mist vaccine that doesn't contain thimerosal." The article fails to mention that Flu-Mist is not licensed for children less than five years old and, therefore, cannot be used in 6- to 23-month-olds.

Every year in the United States, influenza causes about 115,000 people to be hospitalized--about 40 percent are young children. Children with influenza are hospitalized because they suffer high fever, croup, wheezing, or severe pneumonia. Last year about 150 children in the United States died from influenza; most were previously healthy and many were less than two years old. A choice not to get an influenza vaccine containing thimerosal will not lessen the risk of autism; it will only increase the risk of getting a potentially fatal infectious disease.


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September 20, 2004

Each month, the National Association of City and County Health Officials (NACCHO) and CityMatCH present a teleconference in a series on Emerging Issues in Maternal and Child Health. Scheduled for September 23 from 3PM to 4:30PM (ET), the next teleconference will focus on the topic Eliminating Disparities in Childhood Immunization.

Presenters will highlight current initiatives addressing the provision of childhood immunization and the improvement of immunization rates among racial and ethnic minorities and individuals of lower socioeconomic status.

Among the presenters are Susan Y. Chu, PhD, MSPH, associate director for science, NIP/CDC; and Anne Bailowitz, MD, MPH, chief, Bureau of Child Health and Immunization, Baltimore City Health Department.

For more information on the teleconference, go to:

To register for the teleconference, click here.

For information about this and upcoming teleconferences in the series, contact Angela Ablorh-Odjidja, MPH, at

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September 20, 2004

IAC recently revised its 10-page parent-education piece, "Vaccine Concerns." The revised piece is entirely reprinted from "Common Concerns about Vaccines," a chapter in the most recent (third) edition of the book "Vaccines: What You Should Know." Paul A. Offit, MD, and Louis M. Bell, MD, wrote the book; the third edition was published in 2003.

"Vaccine Concerns" presents comprehensive information about vaccine efficacy, safety, and side effects; autism; thimerosal; and other current concerns related to childhood immunization. It replaces an earlier IAC parent-education piece, "Vaccine Myths," which was reprinted from an earlier edition of Offit and Bell's book.

To access a ready-to-copy (PDF) version of the revised piece, go to:

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

To purchase a copy of the third edition of the book, visit your local bookstore or go to the publisher's website at

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September 20, 2004

IAC recently made significant revisions to its two-page patient-education brochure "Hepatitis A Is a Serious Liver Disease." Written in Q&A format, the brochure was expanded to include more questions. In addition, new graphics give the brochure a fresh, contemporary look.

To access a ready-to-copy (PDF) version the updated brochure, go to:

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

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September 20, 2004

Intended primarily for professionals involved in improving the physical and psychological health of adolescents, the website of the Society for Adolescent Medicine (SAM) also provides resources for teens and parents.

Resources for professionals
The "Journal of Adolescent Health" is SAM's main resource for professionals. In addition, SAM holds an annual meeting for its members, publishes a member newsletter, and offers a variety of opportunities for continuing education, professional education, and training in various subjects related to adolescent health.

For complete information on SAM's resources for professionals, go to:

To access the "Journal of Adolescent Health," go to:

Resources for teens
In 2003, SAM published a pamphlet, "Health Guide for America's Teens," full of information about issues pertinent to maintaining good physical and psychological health during adolescence. The pamphlet covers topics such as friends and relationships, health habits (including immunization), food and fitness, smoking, sex and safety, and drinking and drugs. Its purpose is to give teens the information they need to make sound health decisions.

To download a copy of the pamphlet, go to:

Resources for parents
Published in 2003, "The Healthy Student: A Parent's Guide to Preparing Teens for the College Years" is intended to remind parents to review important physical and mental health topics with their college-bound child before the start of college. Available in English and Spanish, the 12-page pamphlet discusses communication, independence and confidentiality, immunizations, health insurance, medical records and prescriptions, and more.

To download an English-language copy of the pamphlet, go to:

To download a Spanish-language copy, go to:

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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
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    Laurel H. Wood, MPA
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