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IAC Express 2007
Issue number 643: January 29, 2007
Contents of this Issue
Select a title to jump to the article.
  1. Dr. Paul Offit's commentary published in the Wall Street Journal
  2. Reminder: Be sure to continue administering influenza vaccine during the early months of 2007
  3. Updated: IAC revises three of its education materials
  4. Save $25 when you register for NIC before February 17
  5. Global measles deaths drop by 60 percent between 1999 and 2005
  6. APhA annual meeting to feature programming on pharmacy-based immunization
  7. For immunization coalitions: January 30 is the date for IZTA's teleconference on foundation fundraising
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
Issue 643: January 29, 2007
1.  Dr. Paul Offit's commentary published in the Wall Street Journal

On January 20, the Wall Street Journal published a commentary written by Paul A. Offit, MD, director, Vaccine Education Center, and chief, Division of Infectious Diseases, Children's Hospital of Philadelphia (CHOP). The commentary originally appeared in the December 2006 issue of the email newsletter Parents Pack, which is a publication of the Vaccine Education Center.

Dr. Offit's commentary discusses the findings presented in a paper published in the Journal of the American Medical Association (JAMA) on October 11, 2006. The commentary as printed in Parents Pack is reprinted below in its entirety.

Last month [October 2006] the Journal of the American Medical Association (JAMA) published a study that received little attention from the press and, as a consequence, the public. The study examined the incidence of whooping cough (pertussis) in children whose parents had chosen not to vaccinate them; the results were concerning.

Vaccines are recommended by the Centers for Disease Control and Prevention (CDC) and professional societies, such as the American Academy of Pediatrics. But these organizations can't enforce their recommendations; only states can do that蓉sually when children enter day care centers and elementary schools擁n the form of mandates. State vaccine mandates have been on the books since the early 1900s; but aggressive enforcement of them didn't occur until much later, born from tragedy.

In 1963 the first measles vaccine was introduced in the United States. Measles is a highly contagious disease that can infect the lungs causing fatal pneumonia, or the brain causing encephalitis. Before the measles vaccine, measles caused 100,000 American children to be hospitalized and 3,000 to die every year. In the early 1970s, public health officials found that states with vaccine mandates had rates of measles that were 50 percent lower than states without mandates. As a consequence, all states worked toward requiring children to get vaccines. Now every state has some form of vaccine mandates.

But not all children are subject to these mandates. All fifty states have medical exemptions to vaccines, such as a serious allergy to a vaccine component. Forty-eight states also have religious exemptions; Amish groups, for example, traditionally reject vaccines, believing that clean living and a healthy diet are all that are needed to avoid vaccine-preventable diseases. And twenty states have philosophical exemptions; in some states these exemptions are easy to obtain, by simply signing your name at the bottom of a form; and in others they're much harder, requiring notarization, annual renewal, a signature from a local health official, or a personally written letter from a parent.

The JAMA study examined the relationship between vaccine exemptions and rates of disease. The authors found that between 1991 and 2004 the percentage of children whose parents had chosen to exempt them from vaccines increased by 6 percent per year, resulting in a 2.5-fold increase. This increase occurred almost solely in states where philosophical exemptions were easy to obtain. Worse, states with easy-to-obtain philosophical exemptions had twice as many children suffering from pertussis預 disease that causes inflammation of the windpipe and breathing tubes, pneumonia and, in about twenty infants every year, death葉han states with hard-to-obtain philosophical exemptions.

The finding that lower immunization rates caused higher rates of disease shouldn't be surprising. In 1991 a massive epidemic of measles in Philadelphia centered on a group that chose not to immunize its children; as a consequence nine children died from measles. In the late 1990s, severe outbreaks of pertussis occurred in Colorado and Washington among children whose parents feared pertussis vaccine. And in 2005 a 17-year-old unvaccinated girl, unknowingly having brought measles back with her from Romania, attended a church gathering of 500 people in Indiana and caused the largest outbreak of measles in the United States in ten years; an outbreak that was limited to children whose parents had chosen not to vaccinate them. These events showed that for contagious diseases like measles and pertussis it's hard for unvaccinated children to successfully hide among herds of vaccinated children.

Some would argue that philosophical exemptions are a necessary pop-off valve for a society that requires children to be injected with biological agents for the common good. But as anti-vaccine activists continue to push more states to allow for easy philosophical exemptions one thing is clear, more and more children will suffer and occasionally die from vaccine preventable diseases.

When it comes to issues of public health and safety we invariably have laws. Many of these laws are strictly enforced and immutable. For example, we don't allow philosophical exemptions to restraining young children in car seats or smoking in restaurants or stopping at stop signs. And the notion of requiring vaccines for school entry, while it seems to tear at the very heart of a country founded on the basis of individual rights and freedoms, saves lives. Given the increasing number of states allowing philosophical exemptions to vaccines, at some point we are going to be forced to decide whether it is our inalienable right to catch and transmit potentially fatal infections.

To access Dr. Offit's article from Parents Pack, go to:

NOTE: Dr. Offit's Wall Street Journal commentary, titled "Fatal Exemption," is available to the paper's online subscribers at

To access the abstract of the JAMA article ("Nonmedical Exemptions to School Immunization Requirements: Secular trends and association of state policies with pertussis incidence"), go to:

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2 Reminder: Be sure to continue administering influenza vaccine during the early months of 2007.

Remember, influenza vaccination should continue through the early months of 2007. Visit the following websites often to find the information you need to keep vaccinating. Both are continually updated with the latest resources.

The National Influenza Vaccine Summit website at

CDC's Influenza web section at

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3 Updated: IAC revises three of its education materials

IAC recently revised three of its education materials. Following is a list of the updated materials; it explains the changes made and provides links to each.

(1) Changes were made to "Hepatitis A, B, and C: Learn the differences." Specifically, the section outlining who is eligible to receive the vaccines that protect against infection from the hepatitis A and hepatitis B viruses was expanded to reflect changes recently made to the ACIP recommendations for protecting against these diseases.

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

(2) "Hepatitis B Facts: Testing and vaccination" was updated to reflect changes made to ACIP's recommendations that expand the definition of who is eligible to receive hepatitis B vaccine.

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

(3) The patient-education piece "If You Have HIV Infection, Which Vaccinations Do You Need?" now includes information on the recently licensed vaccines for human papillomavirus (HPV), tetanus-diphtheria-acellular pertussis (Tdap), and shingles.

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

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4 Save $25 when you register for NIC before February 17

Scheduled for March 5-8 in Kansas City, MO, the 2007 National Immunization Conference (NIC) is coming up fast. If you haven't already registered, you can save some money by registering before February 17. The fee for standard registration is $225; if you wait until February 17, it goes up to $250 for late and onsite registration. To register online, go to:

For comprehensive program information, go to:

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

To plan some fun in Kansas City, visit the official tourism website at

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5 Global measles deaths drop by 60 percent between 1999 and 2005

On January 19, partners in the Measles Initiative announced that worldwide measles deaths fell by 60 percent since 1999. Following is an excerpt from a press release issued by WHO. Links to related materials are given at the end of this IAC Express article.

Measles deaths fall by 60 percent

Measles deaths have fallen by 60% worldwide since 1999預 major public health success. This exceeds the United Nations goal to halve measles deaths between 1999 and 2005 and is largely due to an unprecedented decline in measles deaths in the African region. The progress was announced today by partners in the Measles Initiative: the American Red Cross, the United States Centers for Disease Control and Prevention (CDC), the United Nations Foundation, UNICEF, and the World Health Organization (WHO).

According to new data from WHO, global measles deaths fell from an estimated 873,000 deaths in 1999 to 345,000 in 2005. In Africa, the progress has been even greater, with measles deaths falling by 75%, from an estimated 506,000 to 126,000. The data will be published in this week's edition of The Lancet. . . .

To access the WHO press release, go to:

To access information about the Measles Initiative from the CDC website, go to:

To access information from the National Immunization Program website, go to:

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6 APhA annual meeting to feature programming on pharmacy-based immunization

This year, the American Pharmacists Association (APhA) will offer pharmacy-based immunization programming at its annual meeting. The meeting is scheduled for March 16-19 in Atlanta.

For comprehensive information on the meeting, including the agenda, go to:

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7 For immunization coalitions: January 30 is the date for IZTA's teleconference on foundation fundraising

The National Immunization Coalition Technical Assistance Network (IZTA) has scheduled a teleconference that will focus on the basics of foundation fundraising. The network is a program of the Center for Health Communication, Academy for Educational Development.

The teleconference will be held at 1:00PM ET, January 30. The presenter is Dr. Bernard Turner, associate vice-president for corporate and foundation relations, Meharry Medical College, Nashville, TN. He will discuss strategies for identifying and approaching foundations and present tips for writing successful grant proposals.

To register, send an email to Include this in the subject line: "Sign me up for the foundation fundraising call."

For additional information, or to access earlier programs, go to:

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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

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