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Issue Number 482            October 4, 2004


  1. Updated: NIP posts the September 2004 Immunization Practice Toolkit on its website
  2. Updated: IAC expands and makes extensive revisions to its parent-education piece "After the Shots"
  3. CDC releases Influenza Vaccine Bulletin #3
  4. Act now: Free bulk copies of the latest issue of "VACCINATE WOMEN" (August 2004) will go fast
  5. November 19 is the deadline for abstracts for CDC's 2005 National Immunization Conference
  6. New: "The Vaccine Handbook" is now available for PDAs
  7. CDC reports on emergency measles control activities in Darfur, Sudan, during 2004


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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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October 4, 2004

NIP recently posted the fourth edition of the Immunization Practice Toolkit on its website. A compilation of resources for health care personnel who provide immunization services, the toolkit offers users more than 70 links to a variety of practical immunization resources. The posted information is current as of September 2004.

Resources are organized into nine topics: basic information, clinic operations, vaccine storage and handling, client education, screening, vaccine administration, vaccine safety, travel, and quality improvement. The resources have been gathered from NIP, CDC, California Department of Health Services, IAC, Michigan Department of Community Health, Children's Hospital of Philadelphia, and other organizations. The links go to documents that can be downloaded at no cost, as well as to archived webcasts and online video ordering forms.

To access the toolkit, go to: Click on the topics listed at the left of the screen.

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October 4, 2004

IAC recently revised and expanded its parent-education piece "After the Shots . . . What to do if your child has discomfort." Formerly a one-page document, the piece has been expanded to two pages and now includes a dosing schedule for ibuprofen, as well as acetaminophen.

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:

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October 4, 2004

On September 24, NIP issued Influenza Vaccine Bulletin #3. It is reprinted below in its entirety.


Influenza Season 2004-05
September 24, 2004

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 Update

About 100 million doses of influenza vaccine will be available this year in the United States. Chiron has reported a delay in their vaccine delivery schedule. They expect to distribute about 46-48 million total Fluvirin doses this year plus 2 million doses to CDC stockpile. While vaccine will begin to be shipped in October, Chiron has stated that there will be no prioritization of shipments to distributors once vaccine is released for shipment. Aventis Pasteur has already shipped some vaccine, reports no delays in vaccine delivery, and expects to deliver about 20 million doses in September and the remaining 32 million doses in October. MedImmune expects to deliver all of its approximate 1.5 million doses of preservative-free intranasal influenza vaccine (FluMist) in October. More information is available at

Orders for Influenza Vaccine

By now, health care providers should have placed influenza vaccine orders for administration in the fall of 2004. If orders have not been placed and regular sources of vaccine are booked, health care providers are encouraged to get on a waiting list. Last year, sporadic cases of influenza were reported throughout the summer, with widespread activity in several states in November and in most states during December. Because increased demand for vaccine is anticipated, health care 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, the Centers for Disease Control and Prevention (CDC) has contracted for a maximum quantity of 8 million doses, up from 4.8 million in 2003. This vaccine may be purchased by state and local immunization programs with VFC, 317, or state or local funds for persons of all ages.

On July 30, 2004, CDC signed a contract with MedImmune Vaccines Inc. for a maximum purchase of 500,000 doses of live, intranasal influenza virus vaccine, FluMist. The vaccine is supplied in packs containing 10 pre-filled single-dose, 0.5mL sprayers (0.25mL per nostril). This vaccine is indicated for healthy persons five through 49 years of age. To maintain potency, the vaccine must be stored continuously at or below –15 degrees C (+5 degrees F). Purchasers intending to store the vaccine in frost-free freezers must also receive and use a FluMist FreezeBox supplied by the manufacturer.

VFC Influenza Vaccine Stockpile

CDC has legislative authority through the Vaccines for Children (VFC) program to purchase influenza vaccine for a national stockpile program for children through 18 years of age. Influenza vaccine is being stockpiled by CDC to ensure sufficient supply in case of a shortage like the one experienced this past winter. 4.5 million doses will be purchased for the stockpile this year. Stockpiled vaccine may be made available directly to state immunization programs through the VFC program without additional cost to the programs, or manufacturers may "borrow against" the stockpile for non-VFC populations. Influenza vaccine for non-VFC populations will not be free of cost to vaccine providers.


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

Recommendations have been broadened to protect more people from influenza.

  • CDC has adopted the following new recommendations beginning with the 2004-05 season.
    • 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 health care workers and close contacts of severely immunosuppressed persons. In addition, women who will be pregnant during the influenza season are recommended for vaccination at any stage of pregnancy.

Review ACIP recommendations at

Medicare Payment for Influenza Vaccine Purchase and Administration

Medicare payment rates for influenza vaccine and its administration will be posted by late September by the Centers for Medicare and Medicaid Services (CMS) at

MedImmune Modifies Marketing Strategy for FluMist

MedImmune selected Henry Schein as its exclusive U.S. distributor of FluMist for the upcoming influenza season. MedImmune will oversee all sales and marketing activities with special emphasis on pediatricians and pharmacies. In addition to selling FluMist, Henry Schein will respond to customer product inquiries, process returns, and promote the product through marketing initiatives to primary care physicians. Distribution of FluMist will be handled through MedImmune's distribution center in Louisville, Kentucky, a regulated facility that maintains the FluMist cold chain.

MedImmune has significantly reduced the price of FluMist for the 2004–2005 flu season.

Prioritization of Influenza Vaccine to High Risk Patients

As the United States influenza vaccine supply is expected to be adequate by October, at present CDC does not envision any need for tiered vaccination recommendations for this upcoming season. Thus, no prioritization of vaccine for those at higher risk of complications from influenza is recommended; however, strong recommendations to immunize those at high risk of complications from influenza continue.

For additional information, visit


Meeting Summary--Advisory Committee on Immunization Practices (ACIP)

ACIP met on June 23-24, 2004. Their agenda included discussions about influenza vaccine supply, influenza surveillance (see the update on influenza activity published in MMWR on July 2, referenced below under Resource Materials), influenza vaccine effectiveness (new data now published in MMWR on August 13; see reference below), a report on the Influenza Vaccine Summit meeting in April 2004, the priming dose of influenza vaccine for children less than 9 years of age, vaccination of health care workers, and pandemic influenza preparedness. The meeting minutes will be available at later this year.

Resource Materials

  • "Improving Influenza Vaccination Rates in Health Care Workers: Strategies to Increase Protection for Workers and Patients"
    This 21-page monograph, released by the National Foundation for Infectious Diseases (NFID), is an all-inclusive report that includes detailed information about influenza immunization rates among health care workers and provides strategies health care institutions can use to improve annual influenza immunization rates among employees.
    You may download the entire Call to Action at

  • "Kids Need Flu Vaccine, Too!"
    Now available online is the National Foundation for Infectious Diseases (NFID) "Kids Need Flu Vaccine, Too!" practice resources program at (Click on the image at the top, right side of the screen.) Features include helpful information and educational materials for conducting pediatric influenza immunization programs.
  • Review and print influenza Vaccine Information Statements.
  • Review recently published Morbidity and Mortality Weekly Reports (MMWRs) related to influenza by clicking on the following links.
    • "Assessment of the Effectiveness of the 2003-04 Influenza Vaccine Among Children and Adults--Colorado, 2003" MMWR August 13, 2004; 53 (31):707-710,
    • "Update: Influenza Activity--United States and Worldwide, 2003-04 Season, and Composition of the 2004-05 Influenza Vaccine" MMWR July 2, 2004; 53(25):547-552,
    • "Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" MMWR May 28, 2004; 53(RR-06)
  • 2004-05 Influenza campaign materials are now available online. Visit the Flu Gallery on the CDC Flu website to download and print influenza-related patient and provider education materials at
  • Refer to previous bulletins at Individual subscriptions to the bulletin should be emailed to Type "subscribe flu-serv" in the body of the email.



To obtain a ready-to-copy (PDF) version of Influenza Vaccine Bulletin #3 from CDC's influenza web section, go to:

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

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October 4, 2004

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

If you have an immunization conference or an educational program coming up for health professionals who work in women's health, this 12-page publication is an excellent item to distribute. "Vaccinate Women" is written for health professionals. IT IS NOT FOR DISTRIBUTION TO THE PUBLIC.

The August issue includes information about the new ACIP recommendation to vaccinate all pregnant women against influenza during the upcoming influenza season, regardless of their stage of pregnancy. It also includes timely information about the importance of vaccinating health care workers against influenza.

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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October 4, 2004

November 19 is the deadline for submitting abstracts for CDC's 2005 National Immunization Conference, which will be held in Washington, DC, on March 21-24, 2005. The deadline for early-bird registration ($150) is January 28. The deadline for regular registration ($175) is March 4.

Abstracts must be submitted online. To access submission guidelines, go to:

For general conference information, including conference goals and objectives and registration, go to:

For additional information, contact the conference planning team at (404) 639-8225 or

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October 4, 2004

"The Vaccine Handbook: A Practical Guide for Clinicians" is now available as a PDA (personal digital assistant) reference for Palm OS; Windows, CE; and Pocket PC handheld devices.

This convenient PDA reference offers clinicians practical, up-to-date guidelines on proper use of vaccines. Users can quickly get detailed information on all vaccines currently recommended for infants and children, travelers, and individuals in special circumstances. Vaccines are presented individually, with information given on the disease and its epidemiology, the vaccine's efficacy and safety, and the practical questions most frequently asked. Clinicians will find answers to specific parental concerns and guidelines on problems such as allergies, breastfeeding, dosing intervals and missed vaccines, and immunocompromised individuals. The handbook is written by Gary S. Marshall, MD, Penelope H. Dennehy, MD, David P. Greenberg, MD, Paul A. Offit, MD, and Tina Q. Tan, MD.

The handbook for PDAs costs $49.95; for additional information and to order online, go to:

The handbook is also available as a soft-cover book for $39.95; for additional information or to order online, go to:

To order by phone, or for additional information, call customer service at (800) 638-3030.

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October 4, 2004

CDC published "Emergency Measles Control Activities--Darfur, Sudan, 2004" in the October 1 issue of MMWR. A summary made available to the press is reprinted below in its entirety.


Measles control is a priority health intervention in areas affected by conflict, and in these situations a collaborative effort by stakeholders can lead to a successful mass vaccination campaign, thereby rapidly reducing measles transmission.

The Darfur region in Sudan is in the midst of a civil conflict with population displacement and disruption of public health infrastructure. Since March 2004, measles outbreaks with high case fatality have been reported in the region. In response, the Federal Ministry of Health in Sudan, in partnership with international agencies, conducted a mass measles vaccination campaign targeting children aged 9 months-15 years in Darfur. The campaign vaccinated over 75 percent of the target population of 2.6 million children and resulted in a decrease in reported measles cases. This demonstrates that adequate planning and collaboration between stakeholders can result in a successful vaccination campaign in a conflict-affected area. Lessons learned in Darfur will be useful in planning measles control activities in other such situations.


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.

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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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