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Issue Number 525            May 16, 2005


  1. CDC report recommends health professionals limit use of IgM anti-HAV testing to specific indications
  2. MMWR notifies readers that May is Hepatitis Awareness Month
  3. New VIS: NIP posts VIS for Japanese encephalitis vaccine to its website
  4. CDC issues "Summary of Notifiable Diseases--United States, 2003"
  5. UNICEF reports new cases of polio in Indonesia and Yemen; major vaccination campaigns to begin soon


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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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May 16, 2005

CDC published "Positive Test Results for Acute Hepatitis A Virus Infection Among Persons With No Recent History of Acute Hepatitis--United States, 2002-2004" in the May 13 issue of MMWR. Portions of the article are reprinted below.


[From the article text]
Hepatitis A is a nationally reportable condition, and the surveillance case definition includes both clinical criteria and serologic confirmation. State health departments and CDC have investigated persons with positive serologic tests for acute hepatitis A virus (HAV) infection (i.e., IgM anti-HAV) whose illness was not consistent with the clinical criteria of the hepatitis A case definition. Test results indicating acute HAV infection among persons who do not have clinical or epidemiologic features consistent with hepatitis A are a concern for state and local health departments because of the need to assess whether contacts need postexposure immunoprophylaxis. This report summarizes results of three such investigations, which suggested that most of the positive tests did not represent recent acute HAV infections. To improve the predictive value of a positive IgM anti-HAV test, clinicians should limit laboratory testing for acute HAV infection to persons with clinical findings typical of hepatitis A or to persons who have been exposed to settings where HAV transmission is suspected. . . .

[From the Editorial Note]
Health departments have previously noted positive IgM anti-HAV tests among persons who do not have illness meeting the case definition for hepatitis A (CDC, unpublished data, 2001-2005); however, this report is the first to describe the clinical and epidemiologic characteristics of these persons. Findings in this report indicate that persons who are unlikely to have acute viral hepatitis should not be tested for IgM anti-HAV and that the use of IgM anti-HAV as a screening tool or as part of testing panels used in the workup of nonacute liver function abnormalities should be discouraged. Health departments should continue to apply clinical criteria in the case definition when conducting hepatitis A surveillance and determining whether postexposure immunoprophylaxis is needed for contacts. Postexposure immunoprophylaxis for contacts is unlikely to be indicated for persons whose illness does not meet the case definition, unless recent exposure to a person with acute HAV infection has occurred.

A positive IgM anti-HAV test result in a person without typical symptoms of hepatitis A might indicate asymptomatic acute HAV infection, previous HAV infection with prolonged presence of IgM anti-HAV, or a false-positive test result. HAV infection can manifest a broad clinical spectrum, ranging from asymptomatic infection to typical hepatitis with fever and jaundice. Although an estimated 70% of children aged <6 years with HAV infection are asymptomatic, older children and adults usually have symptoms, and 70% are jaundiced. Studies conducted during hepatitis A outbreaks or among family members exposed to HAV indicate that HAV infection can cause asymptomatic infection with or without abnormal liver tests, primarily among young children. . . .

Testing of persons with no clinical symptoms of acute viral hepatitis, and among populations with a low prevalence of acute HAV infection, lowers the predictive value of the IgM anti-HAV test. Diagnostic tests for viral hepatitis, including licensed IgM anti-HAV tests, are highly sensitive and specific when used on specimens from persons with acute hepatitis. However, their use among persons without symptoms of hepatitis A can lead to IgM anti-HAV test results that are false positive for acute HAV infection or of no clinical importance. This might be occurring with use of laboratory test panels that include routine testing for IgM anti-HAV without requiring a specific order for the test (i.e., "reflex testing") among persons who are not being evaluated for possible acute hepatitis (e.g., persons with liver function test abnormalities or persons being screened for hepatitis C). . . .

Providing immune globulin is not recommended for contacts of IgM anti-HAV positive persons when the date that these persons might have been infectious is unknown (because no defined symptom onset is known), even for those patients who repeatedly test IgM anti-HAV positive. Clinicians and public health officials who receive reports of persons who are IgM anti-HAV positive in the absence of symptoms of viral hepatitis or history of recent contact with a hepatitis A patient should consider seeking additional information when making decisions about the need for postexposure immunoprophylaxis among contacts. Acute HAV infection is unlikely in persons who have received 1 or more doses of hepatitis A vaccine >=1 month before symptom onset. Testing the patient for total anti-HAV and retesting for IgM anti-HAV might be helpful. Persons with acute HAV infection will test total anti-HAV positive; if the total anti-HAV test is negative, acute HAV infection is unlikely. Retesting the same or another serum specimen, preferably by using a different test format, might indicate that the person is IgM anti-HAV negative.

Published guidelines for the workup of abnormal liver enzyme tests among asymptomatic patients do not include IgM anti-HAV testing. Healthcare providers should limit use of IgM anti-HAV testing to persons with evidence of clinical hepatitis or to those who have had recent exposure to an HAV-infected person. Persons who are IgM anti-HAV positive but who do not have illness consistent with the case definition for hepatitis A should not be reported to CDC.


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:

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May 16, 2005

CDC published "Notice to Readers: Hepatitis Awareness Month--May 2005" in the May 13 issue of MMWR. The notice is reprinted below in its entirety, excluding references.


May is Hepatitis Awareness Month. In 2003, in the United States, an estimated 61,000 new infections occurred with hepatitis A virus, 73,000 with hepatitis B virus, and 30,000 with hepatitis C virus. Effective interventions, such as hepatitis A and hepatitis B immunization and counseling and testing for hepatitis C, can help prevent and control viral hepatitis and protect personal and community health. Additional information regarding Hepatitis Awareness Month, activities associated with this month, prevention and control of viral hepatitis, and free educational materials is available at


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:

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May 16, 2005

On May 11, NIP posted a new VIS to its website. It is intended for use with patients who receive Japanese encephalitis vaccine. This is the first time a VIS has been available for this vaccine.

To access the VIS from the NIP website, go to:

To access it from the IAC website, go to:

For information about the use of VISs, and for VISs in a total of 32 languages, visit IAC's VIS web section at

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May 16, 2005

CDC published "Summary of Notifiable Diseases--United States, 2003" in the April 22 issue of MMWR Summary of Notifiable Diseases.

The 88-page summary has three primary sections. They are Part 1: Summaries of Notifiable Diseases in the United States, 2003; Part 2: Graphs and Maps for Selected Notifiable Diseases in the United States, 2003; and Part 3: Historical Summaries of Notifiable Diseases in the United States, 1972-2003. The opening paragraph of the preface follows.


The "Summary of Notifiable Diseases--United States, 2003" contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable diseases in the United States for 2003. Unless otherwise noted, the data are final totals for 2003 reported as of June 30, 2004. These statistics are collected and compiled from reports sent by state health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The Summary is available at This site also includes publications from past years.


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

Because the summary is a large file (1.5 MB), printing problems may occur because of printer memory size. One solution is to print a few pages at a time. To access more tips on downloading and printing large PDF files, go to:

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

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May 16, 2005

UNICEF recently issued two press releases that report on new cases of polio in Indonesia and Yemen and outline vaccination campaigns intended to protect unvaccinated children from the disease. The following information is based on the press releases.

A press release dated May 5 reports that two unimmunized girls, ages 18 months and 20 months, were recently paralyzed by poliovirus type one (P1). Both girls reside in West Java. In response, an estimated 1500 children in the affected area were vaccinated on May 5-6. Starting May 31, 5.2 million children will be vaccinated throughout West Java, which includes Jakarta, Indonesia's capital.

Before these two polio cases, it had been a decade since Indonesia's last reported case. The virus reported in Indonesia is related to the West African virus currently causing an epidemic across Africa. The ongoing outbreak has so far re-infected 15 formerly polio-free countries and re-established transmission in six of them.

To access the May 5 press release, go to:

A press release dated May 10 reports 41 cases of polio in Yemen, up from 22 reported in late April. Epidemiologists expect the total number of cases to exceed 100 before the outbreak is stopped. The country had been polio free since disease surveillance began in 1996.

In response to the outbreak, Yemen will receive 6 million doses of oral polio vaccine. Starting the end of May, the vaccine will be used to vaccinate all of the country's children under the age of five years.

To access the May 10 press release, go to:

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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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