Issue Number 511            February 14, 2005


  1. ACIP recommends newly licensed meningococcal vaccine for adolescents and college freshmen
  2. BRFSS data indicate influenza vaccine was given to priority groups during the first part of the 2004-05 influenza season
  3. Act now: Free bulk copies of the latest issue of "Vaccinate Adults" (October 2004) will go fast
  4. New: CMS has web resources for those who vaccinate Medicare beneficiaries against influenza and pneumococcal disease
  5. CDC reports on a case of Japanese encephalitis in a U.S. traveler returning from Thailand in 2004
  6. New conference listings: Adult immunization and health promotion conferences are scheduled for March and May
  7. MMWR corrects errors in two recent issues


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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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February 14, 2005

On February 10, NIP updated its website with information about ACIP's recommendation regarding meningococcal conjugate vaccine. ACIP made the recommendation during one of its regularly scheduled meetings, which was held in Atlanta on February 10-11. The text of the information posted on the NIP website is reprinted below in its entirety.


February 10, 2005

ACIP Recommends Meningococcal Vaccine for Adolescents and College Freshmen

The Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Prevention (CDC) this week recommended that children 11-12 and teens entering high school, as well as college freshman living in dormitories, receive a newly licensed meningococcal vaccine.

Meningococcal disease is caused by bacteria that infect the bloodstream, lining of the brain, and spinal cord, often causing serious illness. Every year in the U.S., 1,400 to 2,800 people get meningococcal disease. Ten to 14 percent of people with meningococcal disease die, and 11-19 percent of survivors have permanent disabilities (such as mental retardation, hearing loss, and loss of limbs).

The disease often begins with symptoms that can be mistaken for common illnesses, such as the flu. However, meningococcal disease is particularly dangerous because it progresses rapidly and can kill within hours.

"Meningococcus is a serious disease that kills about 300 people each year in the U.S. We are encouraged that today's ACIP recommendation will help to prevent this potentially deadly disease among adolescents," said Dr. Stephen Cochi, acting director of the National Immunization Program at CDC.

The ACIP has an existing recommendation for a routine doctor's visit for 11-12 year-olds, at which they may receive a tetanus-diphtheria booster shot. With the new recommendation, 11-12 year-olds will also receive the meningococcal vaccine at this routine visit. In order to foster the most rapid reduction of meningococcal disease following this recommendation, the committee also recommended that for the next 2-3 years teens entering high school also be vaccinated. College freshman who live in dormitories are at higher risk of meningococcal disease than other college students and should also be vaccinated. Meningococcal vaccine may also be provided to college students who do not live in dormitories and adolescents who want to reduce their risk for meningococcal disease.

The vaccine is highly effective. However, it does not protect people against meningococcal disease caused by "type B" bacteria. This type of bacteria causes one-third of meningococcal cases. More than half of the cases among infants aged <1 year are caused by "type B," for which no vaccine is licensed or available in the United States. The new meningococcal vaccine was licensed by the U.S. Food and Drug Administration (FDA) on January 14, 2005, for use in people 11-55 years of age. It is manufactured by sanofi pasteur and is marketed as Menactra.


To access NIP's web page about this recommendation, go to:

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February 14, 2005

On February 10, CDC issued two documents reporting on data collected by the Behavioral Risk Factor Surveillance System (BRFSS) during the first three weeks of January 2005. One document is a press release, which is reprinted below in its entirety. The other is a five-page addition to the CDC Influenza web section; a link to it is provided at the end of this article.


For immediate release
February 10, 2005

Survey indicates vaccination rates are up for children 6 to 23 months

The Centers for Disease Control and Prevention (CDC) announced today that influenza vaccine was used during the first part of the 2004-2005 flu season to vaccinate those at highest risk of serious complications from influenza, including young children, the elderly, those with chronic health conditions, and healthcare workers.

Data collected during the first three weeks of January by the Behavioral Risk Factor Surveillance System (BRFSS) indicated that 57.3 percent of children aged six to 23 months were vaccinated during September through December 2004, the first year that influenza vaccination was added to the childhood immunization schedule. A 2002 survey indicated only 7.7 percent in the same age group were vaccinated for influenza. Influenza vaccine has a higher first-year vaccination coverage than the pneumococcal vaccine (PCV) at 40.9 percent in 2002 or the varicella vaccine at 16 percent in 1996.

"It is wonderful news that so many children are being vaccinated against a potentially life-threatening illness like influenza," said Dr. Julie Gerberding, CDC director. "We must continue to urge parents to vaccinate their children and urge those at high risk for serious complications from influenza to step up and get vaccinated because the shot can save lives."

The BRFSS survey results show that influenza vaccination continued during the month of December and was concentrated in the vaccination priority groups outlined for the 2004-2005 season. Vaccination coverage among adults in priority groups was 43.1 percent compared with 8.3 percent vaccination coverage for adults not in priority groups. To date in this influenza season, nearly 59 percent of persons aged 65 years and older reported influenza vaccination through December 2004 compared to 65.5 percent of persons in this age group who reported influenza vaccination in the 2003 National Health Interview Survey.

CDC estimates that approximately 3.5 million doses of influenza vaccine are still available for use through the end of the influenza season. Because February is often the most severe month of the influenza season and because influenza viruses might continue to circulate for several more weeks, it's not too late to benefit from vaccination this season. Persons at highest risk for serious complications from influenza should continue to seek influenza vaccine from their local health departments or healthcare providers.

For more information about influenza, visit the CDC website:


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

CDC has supplemented its Influenza web section with the following document: Influenza vaccination among adults and children during the 2004-05 influenza season: Behavioral Risk Factor System (BRFSS) Summary for data collected January 2-22, 2005.

To access a ready-to-print (PDF) version of the document, go to:

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

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February 14, 2005

IAC is giving away bulk copies (up to 50 per request) of the October 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 October 2004 issue includes a patient-education sheet that explains the vaccinations some or all adults should receive, the Summary of Recommendations for Adult Immunization, a standing orders protocol for administering influenza vaccine to adults, and a patient-education brochure about hepatitis A disease and vaccine.

PLEASE NOTE: The October 2004 issue was printed in September 2004, before the current influenza vaccine shortage began. Some of the influenza vaccination information may therefore be outdated. For the most current national information, visit CDC's Influenza web section at For current local information, visit the website of your state immunization program, which you can access by going to:

Because supplies of the October 2004 issue are limited, it's best to make your request right away. 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, email

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February 14, 2005

The website of the Centers for Medicare & Medicaid Services (CMS) offers two significant resources for those who vaccinate Medicare beneficiaries against influenza and pneumococcal disease. Following is information on both:

1. The web section Medicare Preventive Services: Influenza/Pneumococcal Campaign offers billing information, educational material, standing orders information, claims data, and more. To access it, go to:

2. The web section Immunization Educational Resource Web Guide has links to the following: payment allowances, the immunization standing orders regulation, educational materials, Medicare publications, CMS resources, MedQIC [Medicare Quality Improvement Community], Health and Human Services resources, and CMS immunization partners. To access it, go to:

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February 14, 2005

CDC published "Japanese Encephalitis in a U.S. Traveler Returning from Thailand, 2004" in the February 11 issue of MMWR. Portions of the article are reprinted below.


[From the article text]
Japanese encephalitis (JE) virus is a mosquito-borne flavivirus that is closely related to the West Nile and St. Louis encephalitis viruses endemic to North America. JE virus is a leading cause of viral encephalitis in Asia but is rarely reported among travelers to countries where JE is endemic. This report describes a case of an unvaccinated Washington resident who had JE after traveling to northern Thailand. The Advisory Committee on Immunization Practices (ACIP) recommends JE vaccine for travelers to JE-endemic areas of Asia during the transmission season, especially those spending >=1 month in those areas and whose travel itineraries include rural settings. JE vaccine should also be considered for travelers visiting areas with epidemic transmission or those engaging in extensive outdoor activity in rural settings in areas where JE is endemic, regardless of the duration of their visit. In addition, healthcare providers and organized international travel programs should ensure that travelers obtain appropriate preventive health guidance before travel.

Case Report

In late June 2004, a previously healthy woman aged 22 years was admitted to a Seattle hospital within hours of returning from a 32-day visit to Thailand. She had become ill 2 days earlier with fever (101.5 degrees F [38.6 degrees C]), nausea, headache, photophobia, and stiff neck that had worsened over time. A lumbar puncture was performed; her cerebrospinal fluid (CSF) revealed a white blood cell count of 47 cells/microliter (97% polymorphonuclear leukocytes), glucose 60 mg/dL, and protein 37 mg/dL. The patient was presumptively treated for herpes encephalitis with acyclovir and for cerebral malaria with quinidine and corticosteroids.

Two days later, the patient had dysarthria, dysphagia, profound lethargy, and fever (104.0 degrees F [40.0 degrees C]); as a result, she was sedated and endotracheally intubated. A nonenhanced magnetic resonance image revealed edema in the hypothalamus. Polymerase chain reaction studies of CSF for herpes simplex virus and enteroviruses were negative, and peripheral blood smears were negative for plasmodia. The patient improved clinically and was extubated after 2 days but had onset of Bell's palsy on hospital day 11. After 14 days of hospitalization, she was discharged and underwent outpatient rehabilitation for 6 weeks. The patient had no apparent neurologic sequelae. CSF and serum collected 4 days after illness onset and serum collected 21 days after illness onset had JE virus-specific IgM antibodies and neutralizing antibodies confirming a recent JE viral infection.

In May 2004, the patient had traveled with 21 other students to Chiang Mai City, Thailand, on a university-affiliated study-abroad program. Although the program did not require students to consult a healthcare provider before travel, the patient consulted her primary-care physician. She did not receive any vaccinations or malaria prophylaxis. During her month-long stay, the patient slept in a dormitory, where her room did not have screened windows or bed nets. She also spent one night in a poorly screened cabin in the rural Chiang Mai Valley. The patient reported receiving mosquito bites in both the dormitory and cabin. . . .

[From the Editorial Note]
JE virus is a leading cause of viral encephalitis in Asia; JE has a case-fatality rate of approximately 30%. No virus-specific treatment exists, and survivors commonly have neurologic sequelae. Although JE is a substantial public health problem in Asian countries, transmission to short-term travelers to JE-endemic countries rarely has been reported. This report describes the first reported case in a U.S. traveler since 1992.

Less than 1% of JE virus-infected persons have onset of encephalitis; however, because an effective JE vaccine is available, vaccination should be considered for use in travelers to Asia. Although the risk for infection among travelers is low overall, risk varies substantially by season (e.g., risk is highest in the rainy season), geographic location, duration of travel, outbreak presence, and activities of the traveler. Risk estimates based on JE incidence among residents of countries where the disease is endemic are often inaccurate because JE surveillance is not conducted in many Asian countries. In countries with childhood vaccination programs or where the majority of persons aged <15 years have developed immunity after a natural, asymptomatic JE viral infection, the low incidence among residents can be misleading. Despite a history of JE outbreaks in rural Chiang Mai Valley and >=1 month's stay for all 22 travelers described in this report, 40% received no pre-travel medical advice from a healthcare provider, and only one was vaccinated against JE. . . .

JE vaccine is not recommended for all travelers to Asia. For each traveler, careful consideration of the potential risks and benefits of vaccination should be made by a healthcare provider familiar with the person's itinerary, the vaccine, and current CDC recommendations for its use. In general, vaccine should be offered to persons spending >=1 month in JE-endemic areas during the transmission season, especially if travel will include rural areas. Under specific circumstances, vaccine should be considered for persons spending <1 month in JE-endemic areas (e.g., travelers to areas experiencing epidemic transmission and persons whose activities, such as extensive outdoor activities in rural areas, place them at high risk for exposure). In all instances, travelers should be advised to take personal precautions to reduce exposure to mosquito bites (e.g., avoidance of mosquitoes and use of repellents and protective clothing).

To determine a traveler's need for vaccination and prophylaxis, healthcare providers and travelers can review regularly updated CDC travel recommendations for JE, malaria, other vector-borne diseases, and endemic infectious diseases at In addition, healthcare providers can call the CDC Division of Vector-Borne Infectious Diseases, telephone (970) 221-6400, or Division of Global Migration and Quarantine, telephone (404) 498-1600. Finally, organized international travel programs should ensure that their clients obtain appropriate preventive health guidance before travel.


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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February 14, 2005

IAC recently posted the following conferences to its Calendar of Events web section:


SCHEDULED FOR March 11 at the Hilton Minneapolis/St. Paul Airport, Bloomington, MN.

INTENDED FOR healthcare providers committed to preventing influenza, pneumococcal disease, and other VPDs.

SPEAKERS INCLUDE Dr. Kristin Nichol, Veterans Affairs Medical Center; Dr. Raymond Strikas, CDC; Dr. Fred Ruben, sanofi pasteur; Kristen Ehresmann and Claudia Miller, Minnesota Department of Health.

REGISTRATION DEADLINE is March 2; registration fee is $90.

PRESENTED BY the Minnesota Coalition for Adult Immunization.


FOR ADDITIONAL INFORMATION, contact Chere Wood by email at or by phone at (952) 853-8558.


SCHEDULED FOR May 4 at the Sheraton Columbia Hotel, Columbia, MD.

INTENDED FOR health professionals interested in developing effective health promotion campaigns.

FACULTY INCLUDES experts in social marketing, health literacy, program evaluation, and events planning.

EARLY-BIRD REGISTRATION DEADLINE is March 15; early-bird registration fee is $50 for Maryland Partnership for Prevention (MPP) members and $70 for non-members. Early registration is suggested.

STANDARD REGISTRATION DEADLINE is April 15; standard registration fee is $70 for MPP members and $90 for non-members.

PRESENTED BY MPP and the Center for Immunization, Maryland Department of Health and Mental Hygiene.

FOR A CONFERENCE BROCHURE, go to: Scroll down and click on the link for Points Across II Conference Brochure.

FOR ADDITIONAL INFORMATION, email or call (410) 902-4677.

FOR INFORMATION ON ADDITIONAL CONFERENCES of interest to those in the immunization community, visit the IAC Calendar of Events web section at

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February 14, 2005

The February 11 MMWR included two notices about errors that appeared in recent MMWR issues. One notice, "Errata: Volume 54, No. 3," pertains to the article "Outbreaks of Pertussis Associated with Hospitals--Kentucky, Pennsylvania, and Oregon, 2003," which appeared in the January 28 issue. The other, "Errata: Vol. 54, No. 4," pertains to table III, "Deaths in 122 U.S. Cities, Week Ending January 29, 2005 (4th Week)," which appeared in the February 4 issue. The notices are reprinted below in their entirety, with the exception of one table.


Errata: Volume 54, No. 3

In the report, "Outbreaks of Pertussis Associated with Hospitals--Kentucky, Pennsylvania, and Oregon, 2003," an error occurred in the last sentence on page 70 (continuing to page 71). The text should read as follows: "A recent study that compared azithromycin administered as 10 mg/kg (maximum: 500 mg) on day 1 followed by 5 mg/kg (maximum: 250 mg) on days 2-5 with a 10-day treatment of erythromycin (40 mg/kg/day in 3 divided doses; maximum 1 g/day) demonstrated equivalence between the two treatments (9)."

In addition, on page 69, the first sentence of the third full paragraph should read as follows: "In late September 2003, physician C treated an infant aged 2 months with PCR-confirmed pertussis in the pediatric ICU."

Also on page 69, the first sentence of the Editorial Note should read as follows:

"Despite high childhood coverage for pertussis vaccination (4), reported pertussis incidence in the United States has increased from a low of 1,248 cases (0.54 per 100,000 population) in 1981 to an annual average of 9,431 cases during 1996-2004 (average annual rate: 3.3 per 100,000 population) (5)."


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


Errata: Vol. 54, No. 4

In Table III, "Deaths in 122 U.S. Cities, Week Ending January 29, 2005 (4th Week)," on page 111, total deaths attributable to pneumonia and influenza (P&I) for San Francisco, California; the Pacific Region; and across all reporting cities were incorrectly reported. The correct mortality data are as follows: [a portion of Table III, which IAC Express cannot reproduce, appears at this point in the published document].

Corrected data are available at, select "Search Mortality Tables" and MMWR year 2005 and MMWR week 4.


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

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