Issue Number 519            April 4, 2005


  1. Important: CDC issues Dr. Stephen Cochi's message about the publication of a new book on thimerosal and autism
  2. FDA approves new treatment for hepatitis B virus infection
  3. CDC provides information on influenza vaccine prebooking and distribution strategies for the 2005-06 influenza season
  4. April 7 is World Health Day
  5. Recommendations for improving high-risk adults' influenza, PPV, and hepatitis B vaccination coverage now available
  6. CDC reports on estimated influenza vaccination coverage among U.S. adults and children--September 1, 2004-January 31, 2005
  7. April 29 is the application deadline for NPI's 2005 Excellence in Immunization Awards
  8. Big savings: IAC's smallpox immunization record cards available at half price--while supplies last
  9. CDC reports on an inadvertent laboratory exposure to Bacillus anthracis in California in 2004
  10. New: Two rotavirus vaccine resources now available online
  11. Measles cases surge in Nigeria


Back to Top


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.

(1 of 11)
April 4, 2005

On April 1, CDC issued a message from Dr. Stephen Cochi, acting director, NIP, regarding the release of a new book on thimerosal and autism. Titled "Evidence of Harm--Mercury in Vaccines and the Autism Epidemic: A Medical Controversy," the book will be heavily promoted in upcoming months and may cause parents to question the safety of vaccines. Dr. Cochi's message is reprinted below in its entirety.


This message is to inform you of the release of a new book entitled "Evidence of Harm--Mercury in Vaccines and the Autism Epidemic: A Medical Controversy," authored by David Kirby, a journalist and freelance writer. The book is a "look back" at issues related to thimerosal and vaccines--and is primarily written from the perspective of people who believe there is an association between vaccines and autism. Mr. Kirby is on a media tour to promote the book, a schedule of which can be found at

Autism spectrum disorders (ASDs) are an urgent public health issue, and affect the lives of too many families. Parents and families who have children affected by ASD are understandably interested in finding the causes of this lifelong disability. We appreciate the concern of parents of children with autism and their desire for information about its cause and treatment. We are dedicated to understanding better the biological, environmental, and gene-environmental causes of autism and other developmental disabilities. There is much that remains unknown about autism. However, we do know that early identification and intervention can help improve children's outcomes. CDC continues to support research related to autism, including studies designed to examine the possible causal association between autism and other possible environmental causes, including thimerosal-containing vaccines.

We at CDC are in the process of reviewing Mr. Kirby's book in detail, but the general issues raised in the book have already been extensively examined, including by the Institute of Medicine (IOM), in the past few years. As the IOM concluded in a recent report, the vast majority of studies, which have involved hundreds of thousands of children in a number of countries, have failed to find any association between exposure to thimerosal in vaccines and autism; that is, they have failed to find any evidence of harm.

CDC places a high priority on vaccine safety and the integrity and credibility of its vaccine safety research. We welcome attention and interest on vaccine safety. The public should expect safe vaccines, and the public is entitled to safe vaccines. CDC is committed to monitoring and ensuring vaccine safety. We carefully evaluate allegations of harmful vaccine effects and are prepared to adjust our policies if allegations prove scientifically valid.

Given the historical nature of the book, it is important to emphasize that today, with the exception of some influenza (flu) vaccines, none of the vaccines used in the U.S. to protect preschool children against 12 infectious diseases contains thimerosal as a preservative. Though some flu vaccines contain thimerosal as a preservative, preservative free, reduced thimerosal-content influenza vaccines are also available for use in infants, with the supply expected to increase significantly for the coming next season.

CDC and a number of agencies within the Department of Health and Human Services (HHS) have responded to concerns related to the use of thimerosal as a preservative in some of the recommended childhood vaccines. All supported, as a proactive and precautionary measure, efforts to remove, as quickly as possible, the use of thimerosal as a preservative in childhood vaccines. CDC and the National Institutes of Health (NIH) have funded studies to assess the health effects of thimerosal as well as assess whether there is an association between thimerosal and autism, learning or developmental disabilities, and other adverse health outcomes. Research in these areas is ongoing. CDC and the Food and Drug Administration (FDA) have encouraged vaccine manufacturers in their efforts to remove thimerosal as a preservative as fast as possible, and FDA has facilitated the review and licensing of thimerosal preservative-free vaccines.

To assist you in addressing questions generated by the release of "Evidence of Harm," we want to remind you of these resources and provide you with additional talking points:

Stephen L. Cochi, MD, MPH
Acting Director, National Immunization Program
Centers for Disease Control and Prevention


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

Back to Top

(2 of 11)
April 4, 2005

On March 29, Bristol-Myers Squibb Company of Princeton, NJ, issued a press release announcing that FDA approved the company's drug Baraclude (entecavir) for the treatment of chronic hepatitis B virus (HBV) infection in adults. The drug is an oral antiviral therapy designed to block replication of HBV in the body by interfering with the virus's ability to infect cells. It will be available in the United States as early as April 8.

To access prescribing information from the FDA website, go to:,021798lbl.pdf

Back to Top

(3 of 11)
April 4, 2005

CDC published "Influenza Vaccine Prebooking and Distribution Strategies for the 2005-06 Influenza Season" in the April 1 issue of MMWR. The article is reprinted below in its entirety, excluding references.


For the 2004-05 influenza season, CDC, in coordination with the Advisory Committee on Immunization Practices (ACIP), issued interim influenza vaccine use recommendations after Chiron Corporation announced that none of its inactivated influenza vaccine (Fluvirin) would be available in the United States. To plan for the upcoming 2005-06 influenza season, CDC has met with influenza vaccine manufacturers, including those intending to apply for approval to sell in the United States, to develop supply projections and distribution strategies, including prebooking (i.e., advance ordering of vaccine) and partial shipment of orders to those customers who prebook. As of March 25, 2005, the supply of inactivated influenza vaccine projected for the 2005-06 season appeared adequate to meet the historical demand from persons in the priority groups established by ACIP during the 2004-05 season. If more vaccine becomes available, additional groups can also be targeted for vaccination.

During 2004-2005, Aventis Pasteur (now Sanofi Pasteur, after the merger of Aventis Pasteur and Sanofi) and MedImmune produced approximately 61 million doses of influenza vaccine for distribution in the United States. These two manufacturers anticipate producing approximately the same amount or slightly more doses for the upcoming season. How much, if any, influenza vaccine will be supplied by Chiron to the U.S. market is not known. On March 2, 2005, the British Medicines and Healthcare products Regulatory Agency (MHRA) lifted its October 5, 2004, suspension of Chiron's license to manufacture influenza vaccine (announcement available at The Food and Drug Administration (FDA) must also give its approval before this vaccine can be distributed in the United States. In addition, other manufacturers are discussing with FDA the possible licensure of influenza vaccine for the 2005-06 influenza season and beyond.

The primary method for reducing infections and complications from influenza is immunoprophylaxis with vaccine. The 2010 national health target for influenza vaccine coverage in noninstitutionalized adults aged >=65 years is 90% (objective 14-29a); for noninstitutionalized adults at high risk aged 18-64 years, the coverage target is 60% (objective 14-29c). Neither objective has been achieved. Based on data from the Behavioral Risk Factor Surveillance System (BRFSS) survey for the 2004-05 influenza season, influenza vaccination coverage was estimated at 62.7% for persons aged >=65 years. For persons aged 18-64 with high-risk conditions, coverage was estimated at 25.5%, and for healthcare workers with patient contact, coverage was estimated at 35.7%. For children aged 6-23 months, coverage was estimated at 48.4% and for children aged 2-17 years with high-risk conditions, coverage was estimated at 34.8%. When combined with population estimates for these priority groups, the coverage estimates correspond to a total of approximately 40 million doses of influenza vaccine. To achieve 90% coverage in adults aged >=65 years and 60% coverage for all other priority groups, approximately 70 million doses of vaccine would be needed (CDC, unpublished data, 2005). The supply of influenza vaccine projected from Sanofi Pasteur and MedImmune for the 2005-06 influenza season appears sufficient to meet the historical demand for vaccine by persons in all the priority groups established by ACIP during the 2004-05 influenza season. If additional vaccine becomes available above these levels (e.g., as a result of licensure of one or more additional manufacturers), additional groups can also be targeted for vaccination during the 2005-06 season.

Given the uncertainty about the number of doses of inactivated influenza vaccine that might be available for the 2005-06 season, CDC encourages implementation of a two-tiered prebooking strategy by manufacturers, distributors, and customers of inactivated vaccine. This prebooking strategy requires customers of inactivated vaccine to provide two requests for supplies, using (1) the number of doses needed based on anticipated demand among persons in the priority groups, in the event vaccine supply is limited, and (2) the number of doses needed based on priority group use, plus other groups, if supplies prove sufficient to meet demand from other persons seeking vaccination.

Whenever feasible, CDC also encourages a distribution strategy in which partial shipments are first shipped to all prebooked customers, early in the vaccination season, followed by additional shipments later in the season. This strategy will enable all providers to administer vaccine initially to those persons at high risk, even when supplies are limited.

The following priority groups should be used as a guide for prebooking orders for inactivated influenza vaccine:

  • Persons aged >=65 years.
  • Persons aged 2-64 years with underlying chronic medical conditions.
  • All women who will be pregnant during the influenza season.
  • All children aged 6-23 months.
  • Healthcare workers involved in direct patient care.
  • Out-of-home caregivers and household contacts of children aged <6 months.
  • Residents of nursing homes and long-term-care facilities.
  • Children aged 6 months-18 years on chronic aspirin therapy.

These strategies for prebooking and distribution do not apply to live, attenuated influenza vaccine (LAIV), manufactured by MedImmune, which can be ordered in the usual manner for those persons for whom LAIV is indicated. LAIV can be administered to healthy persons aged 5-49 years who are not pregnant, including healthcare workers who are not caring for severely immunocompromised patients in special care units. Further details regarding CDC influenza vaccination recommendations will be published in April 2005 in the annual Prevention and Control of Influenza MMWR Recommendations and Reports. In addition, updated information on inactivated influenza vaccine supply for the 2005-06 influenza season will be provided as it becomes available.


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

To access a ready-to-print (PDF) version of this issue of MMWR, go to:

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:

Back to Top

(4 of 11)
April 4, 2005

On April 1, MMWR published "Notice to Readers: World Health Day--April 7, 2005." The notice is reprinted below in its entirety, excluding references.


The World Health Organization (WHO) has designated April 7, 2005, as World Health Day. The theme for this year's World Health Day is "Make Every Mother and Child Count," with a focus on efforts to decrease mortality from pregnancy-related causes and in early childhood. Maternal and early childhood mortality persists as a major problem around the world, especially in developing regions. Approximately half a million women die each year from pregnancy-related causes. Approximately one in every 12 children throughout the world will not survive to age 5 years; in the least developed countries of the world, this figure is approximately one in six. Implementation of existing low-cost, effective interventions could substantially close the gap and provide opportunity to reduce excessive maternal, perinatal, infant, and child mortality.

"Make Every Mother and Child Count" aims to account for every mother and child through the collection, analysis, and use of public health data. These data are often critical in helping organizations and governments to (1) design, support, and evaluate interventions; (2) identify emerging threats to maternal and child health needs; and (3) monitor the quality of services delivered to women and children. Toward this end, CDC continues to be a partner in domestic and global activities, providing the infrastructure needed to conduct surveillance and special studies to count every woman and child affected by a disease, disorder, or event.

Additional information on World Health Day and associated activities is available from WHO at and from the Pan American Health Organization at


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

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

Back to Top

(5 of 11)
April 4, 2005

On April 1, CDC issued "Improving Influenza, Pneumococcal Polysaccharide, and Hepatitis B Vaccination Coverage Among Adults Aged <65 Years at High Risk: A Report on Recommendations of the Task Force on Community Preventive Services," as a Recommendation and Reports issue of MMWR. The summary is reprinted below.


The Task Force on Community Preventive Services conducted systematic reviews to evaluate the effectiveness of interventions to improve targeted vaccination coverage (i.e., coverage with vaccines recommended for some but not all persons in an age range on the basis of risk for exposure or disease) among adults aged <65 years at high risk when implemented alone (single-component interventions) and in combination with other interventions (multicomponent interventions). A 1999 report by the Task Force examined the effectiveness of interventions to increase coverage with universally recommended vaccinations (i.e., vaccines recommended for all persons in particular age groups). Three targeted vaccinations recommended for populations at risk are addressed in this review: influenza, pneumococcal polysaccharide, and hepatitis B. The Task Force identified evidence that certain combinations of interventions have improved vaccination coverage. To increase targeted vaccination coverage, the Task Force recommends a combination of interventions that include selected interventions from two or three categories of interventions (i.e., increasing community demand for vaccinations, enhancing access to vaccination services, and provider- or system-based interventions). The Task Force also recommends provider reminders, when implemented alone, to improve targeted vaccination coverage. This report provides additional information about population-based interventions to improve the coverage of influenza, pneumococcal polysaccharide, and hepatitis B vaccines among populations at risk, briefly describes how the reviews were conducted, and provides information that can help in applying the interventions locally.


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

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

Back to Top

(6 of 11)
April 4, 2005

CDC published "Estimated Influenza Vaccination Coverage Among Adults and Children--United States, September 1, 2004-January 31, 2005" in the April 1 issue of MMWR. Portions of the article are reprinted below. In addition, CDC issued a press release on the same topic on March 31; a link to it appears at the end of this article.


In response to the unexpected shortfall in the 2004-05 influenza vaccine supply, CDC recommended in October 2004 that vaccine be reserved for persons in certain priority groups, including persons aged >=65 years and 6-23 months, persons aged 2-64 years with conditions that increased their risk for influenza complications, residents of chronic-care facilities, close contacts of infants aged <6 months, and healthcare workers with direct patient contact. In late December 2004, based on declining demand among these groups, two additional groups (i.e., healthy persons aged 50-64 years and household contacts of all persons at high risk) were added to the list of vaccination priority groups. To monitor influenza vaccination coverage during the 2004-05 season, the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, telephone survey of civilian, noninstitutionalized persons, added new questions to collect information on priority status and the month and year of vaccination for adults and children. This report is based on analysis of data collected during February 1-27, 2005, regarding respondent-reported receipt of influenza vaccination during September 1, 2004-January 31, 2005. The results of this analysis indicated that influenza vaccination coverage levels through January 2005 among adults in priority groups nearly reached those in recent years, whereas coverage levels among adults not in priority groups were approximately half of levels in 2003, in part because 9.3% of those unvaccinated persons in nonpriority groups declined vaccination this season. The results further suggested that designation of the priority groups successfully directed the nation's influenza vaccine supply to those at highest risk. In addition, vaccination coverage among children aged 6-23 months was notable (48.4%), given that 2004-05 was the first year this group was recommended for influenza vaccination. . . .

Among adults, influenza vaccination coverage through January of the 2004-05 season was highest among persons aged >=65 years (62.7%), followed by healthcare workers with patient contact (35.7%) and those aged 18-64 years with high-risk conditions (25.5%). In comparison, the 2003 NHIS indicated coverage of 65.6% for persons aged >=65 years, 40.1% for healthcare workers, and 34.2% for adults aged 18-64 years with high-risk conditions. In contrast, influenza vaccination coverage among healthy persons aged 18-64 years who were not healthcare workers or contacts of children aged <6 months was lower than in the previous season (8.8% compared with 17.8%) (CDC, unpublished data, 2005). Among the reasons cited by respondents for not receiving vaccination, was "saving vaccine for people who need it more," cited by 9.3% of those who were not in priority groups and were not vaccinated. This represents approximately 17.5 million doses of vaccine potentially made available to persons in priority groups.

Vaccination uptake was higher in October and November and tapered off during December and January. Among the adults in the priority groups established in October, 2% of the vaccinations through January occurred in September, 40% in October, 32% in November, 17% in December, and 9% in January.

Influenza vaccination coverage (>=1 doses) among children aged 6-23 months (48.4%) and among children aged 2-17 years with high-risk conditions (34.8%) was substantially higher than among children not in priority groups (12.3%). Of the vaccinations received through January, 17% occurred in September, 23% in October, 28% in November, 20% in December, and 12% in January. In comparison, the 2003 NIS data indicated that coverage among children aged 6-23 months for the 2002-03 influenza season, before they were recommended for vaccination by the Advisory Committee on Immunization Practices (ACIP), was 7.4%.

During September 1, 2004-January 31, 2005, estimates of influenza vaccination coverage indicate that despite an unexpected and substantial vaccine shortfall, coverage levels among adults in the original influenza vaccine priority groups were similar to historical demand based on the 2003 NHIS, thereby suggesting the effectiveness of prioritization. This resulted, in part, from the estimated 17.5 million persons not in priority groups whose primary reported reason for not being vaccinated was to save vaccine for people who needed it more. According to the February 2005 BRFSS, approximately two thirds of the administered vaccine doses through January went to persons in the initial priority groups identified in October whereas, during 2003, only approximately one half of all doses of influenza vaccine were administered to persons in these groups.

The provision of >=1 doses of influenza vaccination to 48.4% of children aged 6-23 months during this first influenza season following implementation of the ACIP recommendations suggests how quickly physicians and parents can adopt a new disease-prevention guideline. Because the Chiron vaccine was not licensed for use in children aged <4 years, the supply of influenza vaccine for children aged 6-23 months was not affected by the shortfall. . . .

Vaccination patterns during the 2004-05 influenza season have been affected by several factors. Although an unexpected and substantial reduction of vaccine supply occurred at the beginning of the season, prioritization was quickly recommended and followed. The 2004-05 influenza season was less severe than the 2003-04 season and did not peak until mid-February. In addition, this was the first full season following the ACIP recommendation to vaccinate all children aged 6-23 months.

Despite the shortfall of inactivated influenza vaccine, the level of coverage achieved among those groups prioritized in 2004-05 appears to be similar to historical coverage. Additional guidelines for prioritization of influenza vaccination in the event of a future influenza vaccine shortfall are in development and should assist with efforts to maximize use of available vaccine.


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

To access a ready-to-print (PDF) version of this issue of MMWR, go to:

To access the CDC press release "Targeting and Collaborations a Big Success; Priority Groups Received Majority of 2004-05 Influenza Vaccine Thanks to 17 Million Healthy Americans Stepping Aside," go to:

Back to Top

(7 of 11)
April 4, 2005

The National Partnership for Immunization (NPI) is requesting applications for the 2005 Excellence in Immunization Awards, to be announced in conjunction with National Immunization Awareness Month (August). The application deadline is April 29. The awards are intended to provide national recognition of activities and programs that serve neighborhoods, communities, counties, states, or regions.

Awards are given for the following: addressing disparities, conducting an educational campaign (at the local, state, or regional level), developing and implementing an education program or campaign (by a non-traditional immunization partner), and demonstrating initiatives that increase immunization coverage (by an individual or practice).

For additional information and application instructions, go to:

If you have questions, email or call (703) 836-6110.

Back to Top

(8 of 11)
April 4, 2005

If you work on smallpox-related issues, you may want to take this opportunity to stock up on IAC's smallpox adult immunization record cards--and pay only half the regular price! The price for a box (250 cards) has been reduced from $40 to $20.

Designed to meet CDC's needs, the smallpox adult immunization record card differs from IAC's very popular standard adult immunization record card in two ways:

  1. The smallpox card has space for health professionals to document smallpox vaccine administration, in addition to space to document administration of seven vaccines recommended for some or all adults. The standard card has space for documenting only the seven vaccines.
  2. The smallpox card is light green; the standard card is canary yellow.

Like the standard card, the smallpox card is printed on smudge-proof, rip-proof, waterproof paper, and is pre-folded to fit in a wallet. Its light-green color makes it easy to spot among credit cards and other items.

To view both sides of the smallpox card online, go to:

Packed in boxes of 250 cards, the smallpox card is now available--while supplies last--at $20 per box (reduced from $40 per box). In addition, there is NO SHIPPING CHARGE for orders within the United States, no matter the size of the order.

You can place an order for the half-price smallpox card in three ways:

Online. To order online on our secure website (including online with a purchase order), go to:

By fax. Print the page at the URL above; fill in the ordering information (including credit card information) in the spaces provided, and fax your order to us at (651) 647-9131.

By email. Send an email to Include your complete shipping information (your name, shipping address, and daytime phone number).

We accept payment by check, purchase order, or credit card; we will ship in 2-3 weeks. If you have questions about IAC's smallpox card, call us at (651) 647-9009, or email us at

Orders will be shipped IN THE ORDER WE RECEIVE THEM until supplies are depleted. Don't delay!

Back to Top

(9 of 11)
April 4, 2005

CDC published "Inadvertent Laboratory Exposure to Bacillus anthracis--California, 2004" in the April 1 issue of MMWR. A portion of a summary made available to the press is reprinted below.


In 2004, workers at a research laboratory in California were inadvertently exposed to viable Bacillus anthracis organisms. The laboratory was working with a material that they believed to contain killed B. anthracis. Inhalation anthrax results from breathing in aerosolized B. anthracis spores. The California Department of Health Services and CDC investigated procedures at the facility. Health officials felt that potentially exposed workers were at low risk for inhalation of B. anthracis, but recommended they receive antibiotics. None of the workers developed symptoms of anthrax. B. anthracis can be resistant to heat and chemical disinfection. As a result, it is important that those working with killed B. anthracis organisms use appropriate bio-safety measures and adequately test materials to make sure that the organism has been inactivated.


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

To access a ready-to-print (PDF) version of this issue of MMWR, go to:

Back to Top

(10 of 11)
April 4, 2005

Recently, the Albert B. Sabin Vaccine Institute and the Rotavirus Vaccine Program each made rotavirus vaccine resources available online.

The Sabin Institute has published the proceedings of the Sixth International Rotavirus Symposium, which was held in Mexico City July 7-9, 2004. Titled "Rotavirus and Rotavirus Vaccines: Proceedings of the Sixth International Rotavirus Symposium, Mexico City, July 7-9, 2004," the 55-page document is available in English and Spanish-language versions.

To download a ready-to-print (PDF) version in ENGLISH, go to:

To download a ready-to-print (PDF) version in SPANISH, go to:

The Rotavirus Vaccine Program has published the most recent issue of its online newsletter, Rotavirus Update. Dated First Quarter 2005, the newsletter is available at


Back to Top

(11 of 11)
April 4, 2005

On March 21, WHO reported that more than 500 children have died from measles since January, according to information posted on the website of the Integrated Regional Information Networks (IRIN), part of the UN Office for the Coordination of Humanitarian Affairs.

More than 90 percent of the 23,575 measles cases reported in the country so far this year occurred in the northern states, as have the overwhelming majority of deaths. People in the northern region are reported to be wary of vaccinations for religious reasons. In 2003-04, four northern states banned polio vaccination campaigns on the grounds that the campaigns were a Western plot to sterilize Muslims and infect them with HIV/AIDS.

To access additional information from the IRIN website, click here.

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

This page was updated on .