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IAC Express 2007
Issue number 648: February 26, 2007
Contents of this Issue
Select a title to jump to the article.
  1. Reminder: Be sure to continue administering influenza vaccine during the early months of 2007
  2. Merck notifies CDC of low yield of varicella-zoster virus in its bulk vaccine
  3. New: "Shots 2007" version of childhood and adult immunization schedules now available for handhelds
  4. CDC reports on measles cases among three U.S. adults visiting China for child adoptions during July-August 2006
  5. New: Standing orders protocol for administering rotavirus vaccine to infants is available on IAC's website
  6. Pediatric Dengue Vaccine Initiative seeks applicants for program officer in its Vaccine Access Program
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 648: February 26, 2007
1.  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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2 Merck notifies CDC of low yield of varicella-zoster virus in its bulk vaccine

CDC published "Notice to Readers: Supply of Vaccines Containing Varicella-Zoster Virus" in the February 23 issue of MMWR. The article is reprinted below in its entirety, excluding references.

CDC received notice from Merck & Co., Inc., that it has lower amounts of varicella-zoster virus (VZV) than expected from recently manufactured bulk vaccine. Bulk vaccine production is an intermediate step in the manufacture of VZV-containing vaccines. Varicella bulk is stored frozen until it is needed in the final preparation phase of each vaccine. Production of VZV bulk has been suspended temporarily while the manufacturer identifies the cause of the low virus yield. Merck is the only U.S. supplier of VZV-containing vaccine, including varicella vaccine (Varivax); combined measles, mumps, rubella, and varicella (MMR-V) vaccine (ProQuad); and zoster vaccine (Zostavax). This lower virus yield does not affect the quality of any of Merck's VZV-containing vaccines currently on the market, any lots of vaccine manufactured and ready for release to the market, or any VZV-containing vaccines presently being manufactured.

To conserve existing bulk vaccine with adequate VZV potency, Merck is prioritizing continued production of varicella and zoster vaccines over production of MMR-V vaccine. Merck is taking this approach because the production of varicella vaccine requires less VZV than the production of MMR-V vaccine. Although zoster vaccine requires a similar amount of VZV for production as MMR-V vaccine, projected supply needs for zoster vaccine are much lower than projected supply needs for MMR-V vaccine. Merck also will increase production of combined measles, mumps, and rubella (MMR) vaccine (M-M-R II).

Current supply assessments in the United States indicate that this interruption in bulk vaccine supply will not affect the supply of either varicella vaccine or zoster vaccine. The U.S. varicella vaccine supply is expected to be adequate to fully implement the recommended immunization schedule for varicella vaccine for all age groups, including the routine 2-dose schedule for children at 12-15 months and at 4-6 years, catch-up vaccination with the second dose for children and adolescents who received only 1 dose, and vaccination with 2 doses for other children, adolescents, and adults without evidence of immunity. For zoster vaccine, the supply is expected to be adequate to vaccinate adults aged >=60 years in accordance with current provisional vaccine policy recommendations. The MMR-V vaccine supply is adequate to continue ordering this combination vaccine; however, the manufacturer expects supplies of MMR-V vaccine to be depleted toward the end of 2007, depending on market demand. When this occurs, supplies of separate MMR and varicella vaccines are expected to be adequate to fulfill the need for these two products in place of MMR-V vaccine. CDC will continue to work with Merck and vaccine-provider stakeholders to monitor the supply of VZV-containing vaccines. Updates on vaccine shortages and delays are available at

To access a web-text (HTML) version of the complete notice, 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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3 New: "Shots 2007" version of childhood and adult immunization schedules now available for handhelds

On February 22, the NIP website posted news that the "Shots 2007" quick-reference guides to the childhood and adult immunization schedules are now available for Palm-OS handhelds and Pocket-PCs handhelds. Both are available on the website of the Group on Immunization Education of the Society of Teachers of Family Medicine.

To access "Shots 2007" for Palm-OS handhelds and Pocket-PCs handhelds, as well as "Shots 2007 Online," go to:

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4 CDC reports on measles cases among three U.S. adults visiting China for child adoptions during July-August 2006

CDC published "Measles Among Adults Associated with Adoption of Children in China—California, Missouri, and Washington, July-August 2006" in the February 23 issue of MMWR. Portions of the article are reprinted below.

On August 15, 2006, the Missouri Department of Health and Senior Services (MoDHSS) was notified of a measles case in a Missouri resident who had recently traveled to China. The patient had traveled with a group of 11 families seeking to adopt children from three orphanages in Guangdong Province. Members of the group, which was sponsored by a Missouri-based adoption agency, traveled separately but stayed at the same hotel in Guangdong Province during July 13-27. This report describes the multistate investigation that followed, which identified two additional measles cases. . . .

Editorial Note:
During 2001-2005, import-associated measles cases (i.e., imported, import-linked, or imported virus cases) accounted for the majority of cases reported in the United States. Imported measles cases among adoptees from China have been reported previously. This report documents imported measles cases during July-August 2006 among adopting parents from the United States who were exposed to measles while visiting China.

China is the leading country of origin for foreign-born children adopted in the United States. During 1998-2005, annual U.S. adoptions of children from China increased by 88%, from 4,206 to 7,906. A national measles outbreak in China increased reported measles cases there from 70,549 in 2004 to 124,219 in 2005. In Guangdong Province, 11,146 measles cases were reported during January-June 2006, a 30% increase compared with the same period in 2005. This situation in China presented an increased risk for measles exposure to travelers and potential importation into the United States. China has set a measles-elimination goal for 2012, and the country is conducting activities to achieve this goal (e.g., conducting an international field review [November 2006] and convening the first National Technical Advisory meeting on measles elimination [December 2006]).

According to the Advisory Committee on Immunization Practices (ACIP), persons born during 1957 or later without (1) adequate documentation of immunity by previous vaccination with 2 doses of MCV, (2) laboratory evidence of immunity, or (3) physician-diagnosed measles should be vaccinated with the measles, mumps, and rubella (MMR) vaccine before travel abroad. The U.S. Department of State requires that internationally adopted children aged >10 years receive the following vaccines before entry into the United States: measles, mumps, and rubella; polio; tetanus and diphtheria toxoids; pertussis; Haemophilus influenzae type B; hepatitis B; varicella; and pneumococcal. For those aged <=10 years, the adopting parents must sign an affidavit promising to provide these vaccinations within 30 days of entry to the United States. The education that most adoptive parents receive regarding their own medical preparations before travel can vary substantially. In this instance, the adoption agency provided the ACIP recommendations to the clients and repeatedly advised their clients about the importance of being properly vaccinated; however, no standard mechanisms were in place to ensure that these recommendations were followed before travel abroad. In the United States and internationally, several organizations (e.g., the American Academy of Pediatrics Section on Adoption and Foster Care and the Joint Council for International Children's Services) are working to improve immunization and education standards regarding international adoptions. Healthcare providers should continue to promote appropriate pre-travel vaccination for their patients.

Investigation of all three cases was substantially delayed because of delays in diagnosis and delays in notifying jurisdictions where exposed travelers resided. Because measles is rare in the United States (as a result of high immunization levels), it is often unrecognized by clinicians who might not consider measles in a differential diagnosis. Healthcare providers should routinely gather information regarding the patient's travel history and maintain a high level of suspicion for measles in patients with rash, fever, and recent travel to areas of known measles endemicity. Although a single dose of measles vaccine administered in the second year of life induces immunity in 95% of vaccinees, cases can occur even among vaccinated persons. More common than vaccine failure is incomplete documentation or inaccurate recall of vaccination status. In the cases described in this report, the patient from Missouri had 2 MCV doses documented, the patient from Washington had 1 MCV dose documented, and the patient from California had no MCV doses documented.

DGMQ [the CDC's Division of Global Migration and Quarantine] is authorized to conduct investigations involving international flights arriving in the United States and can assist state health departments with investigations involving interstate flights. In the case of interstate flights, DGMQ may request passenger manifests and passenger-locator information to assist the state in which the plane lands. Once notified of an exposure, DGMQ contacts the airline to obtain the passenger manifest and passenger-locating information of contacts. A software application developed by DGMQ, eManifest, is used to securely import, sort, and assign passenger-locator information to jurisdictions. These data are transmitted securely to state and territorial health agencies via the Epidemic Information Exchange (Epi-X) forum. Staff from the 18 CDC quarantine stations follow up with public health agencies to ensure the information has been received. DGMQ continues to work with airlines to develop mechanisms for the timely provision of passenger-locator information to CDC and with federal and state partners to improve the process of distributing this information.

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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5 New: Standing orders protocol for administering rotavirus vaccine to infants is available on IAC's website

Newly developed, IAC's professional-education piece "Standing Orders for Administering Rotavirus Vaccine to Infants" is now available in ready-to-print (PDF) format on IAC's website at

To access a table with links to all IAC's standing orders protocols for vaccine administration, go to:

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6 Pediatric Dengue Vaccine Initiative seeks applicants for program officer in its Vaccine Access Program

The Pediatric Dengue Vaccine Initiative (PDVI), a program of the International Vaccine Institute (IVI), Seoul, Korea, is seeking to fill program officer position of the Vaccine Access Program.

The PDVI mission is to accelerate evaluation and introduction of dengue vaccines for children in developing countries. Successful applicants will participate in PDVI programs to plan for the introduction and use of dengue vaccines in developing countries.

Applicants should be experts in private and public partnership to develop and promote plans for national and international vaccine procurement and distribution and develop effective communications. Specific knowledge of dengue would be a distinct advantage. Applicants should have experience in program development and management, working in public-private partnerships, and international health.

Qualifications include a master's degree, Ph.D., or equivalent degree and training in business, marketing, biotechnology, and product introduction. Past research experience in economic studies of disease burden and the prevention effectiveness of vaccination strategies in developing countries is highly desirable.

The Program Officer, Vaccine Access position requires at least 5 years of public health or equivalent experience, a record of peer-reviewed publications, and successful management of research programs.

Salary will be internationally competitive. The Institute provides appropriate fringe benefits including a housing allowance, home leave, and income tax reimbursement.

The International Vaccine Institute (IVI) is a non-profit organization dedicated to accelerating research, evaluation, and introduction of new and improved vaccines primarily in developing countries. The IVI was established under the Vienna Convention of 1969. These positions are located at the IVI and PDVI headquarters in Seoul, Korea.

Further information can be obtained from Dr. Richard Mahoney, Director, Vaccine Access, Pediatric Dengue Vaccine Initiative ( Letters of application, along with current curriculum vitae and three references, should be addressed to

Mr. Hong-ki Jong
Senior Administrative Officer
International Vaccine Institute
Kwanak PO Box 14
Seoul, Korea
Tel: 82-2-872-2801 Fax: 82-2-872-2803

Absolute confidentiality will be respected.

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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.

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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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