Issue Number 255            June 22, 2001

CONTENTS OF THIS ISSUE

1. CDC publishes updated ACIP recommendations on use of smallpox vaccine
2. CDC'S National Immunization Program releases Influenza Vaccine Bulletin #2
3. CDC announces 2001-2002 edition of "Health Information for International Travel" (The Yellow Book)
4. CDC publishes report on measles incidence in Lusaka, Zambia
5. CDC announces the Clinical Immunization Safety Assessment Centers (CISA) network
6. NIP seeks applicants for the position of Chief of the Assessment Branch

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(1)
June 22, 2001
CDC PUBLISHES UPDATED ACIP RECOMMENDATIONS ON USE OF SMALLPOX VACCINE

The Centers for Disease Control and Prevention (CDC) published a statement titled "Vaccinia (Smallpox) Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001" in the June 22, 2001, issue of "MMWR Recommendations and Reports" (vol. 50, no. RR-10).

The MMWR summary of the ACIP statement follows. Use the links provided following the summary to obtain the full statement.

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These revised recommendations regarding vaccinia (smallpox) vaccine update the previous Advisory Committee on Immunization Practices (ACIP) recommendations (MMWR 1991; 40; No. RR-14:1-10) and include current information regarding the nonemergency use of vaccinia vaccine among laboratory and health-care workers occupationally exposed to vaccinia virus, recombinant vaccinia viruses, and other Orthopoxviruses that can infect humans. In addition, this report contains ACIP's recommendations for the use of vaccinia vaccine if smallpox (variola) virus were used as an agent of biological terrorism or if a smallpox outbreak were to occur for another unforeseen reason.

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To obtain the complete statement "Vaccinia (Smallpox) Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001," which includes eight graphic photographs of people infected with smallpox, go to the following links:

Camera-ready (PDF) format:
http://www.cdc.gov/mmwr/PDF/rr/rr5010.pdf

Text (HTML) format:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5010a1.htm

The PDF version of this report includes a free CDC-sponsored continuing education activity that can be completed online or submitted via U.S. mail for CME, CEU, or CNE credit. Simply read the MMWR report, answer the questions at the end of the report, and follow the instructions for submitting your answers.

To find out how to receive a free email subscription to MMWR, see the information following story four below.
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(2)
June 22, 2001
CDC'S NATIONAL IMMUNIZATION PROGRAM RELEASES INFLUENZA VACCINE BULLETIN #2

On June 21, 2001, CDC's National Immunization Program issued the second  in a series of influenza vaccine bulletins designed to update health professionals on the production, distribution, and administration of influenza vaccine for the 2001-2002 influenza season. The bulletin is reprinted below in its entirety.

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The National Immunization Program (NIP) of the Centers for Disease Control and Prevention (CDC) is publishing and distributing a periodic bulletin to update partners about recent developments related to the production, distribution and administration of influenza vaccine for the 2001-2002 influenza season. All recipients of this bulletin are encouraged to distribute each issue widely to colleagues, members and constituents.

INFLUENZA VACCINE SUPPLY/PRODUCTION

Preliminary information from manufacturers suggests that more influenza vaccine will be available this year than last year, but delays in the distribution of influenza vaccine will occur.

Projected distribution of influenza vaccine for 2001, based on aggregate manufacturers' estimates as of June 15, is 83.7 million doses, which would exceed actual distribution in 1999 and 2000. In addition, 53.5 million doses (64 percent) is projected to be available by the end of October 2001, which is twice the amount, 26.6 million doses, available at the same time last year. However, in comparison to 1999, when there was no delay, 75.8 million or 99 percent of the total vaccine for the 1999 season was available by the end of October. In November and December of 2001, another 30.2 million doses (36 percent) of the total 83.7 million is projected to be available. CDC and FDA stress that these are early projections from manufacturers and could change as the season progresses.

INFLUENZA VACCINE DISTRIBUTION

On the basis of these projections, the Advisory Committee on Immunization Practices (ACIP) has agreed on supplemental recommendations to promote the administration of influenza vaccine that is available early to persons at greatest risk of complications from influenza disease.

The ACIP makes the following recommendations to supplement those published earlier:

1. For providers of influenza vaccine

* Providers should actively target vaccine available in September and October to persons at increased risk of influenza complications and to health care workers.

* Providers should continue vaccinating patients, especially those at high risk and in other target groups, through December and later, as long as vaccine is available.

2. For the public

* Persons at high risk for complications from influenza disease should seek vaccination in September and October, or as soon as vaccine is available from their provider. 

* Persons who are not at high risk are encouraged to seek influenza vaccine in November and later when additional supply will become available.

3. For mass immunizers

* Organizers of mass immunization campaigns not in workplaces should plan campaigns in late-October or November when vaccine supply is assured and make special efforts to vaccinate the elderly and those at high risk of influenza complications.

4. For manufacturers, distributors, and vendors

* Distribution of vaccine to worksites should be delayed until November.

* Vaccine that is available early in the season should be apportioned so that some vaccine is distributed to all other providers who have placed orders.

* Manufacturers, distributors, and vendors should inform providers of the amount of vaccine they will receive and date of shipment.

5. For health departments and other organizations providing vaccine

* Groups that provide influenza vaccine services should develop contingency plans responding to a delay in vaccine distribution.

INFLUENZA VACCINE COMMUNICATIONS 

CDC has launched its 2001-02 influenza season website at http://www.cdc.gov/nip/flu

Materials related to this year's influenza season such as current ACIP influenza recommendations, CDC's "Best Practices" guidelines for mass clinics, and Questions and Answers can be found at the website. In addition, the website contains materials that may help providers implement a reminder/recall system. As preparation for the 2001-02 influenza season proceeds, regular communications among CDC, FDA, the vaccine manufacturers and a wide range of partners will continue. 

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(3)
June 22, 2001
CDC ANNOUNCES 2001-2002 EDITION OF "HEALTH INFORMATION FOR INTERNATIONAL TRAVEL" (THE YELLOW BOOK)

In the June 22, 2001, issue of MMWR, CDC published the following Notice to Readers:

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AVAILABILITY OF HEALTH INFORMATION FOR INTERNATIONAL TRAVEL

CDC's Division of Global Migration and Quarantine (DQ), National Center for Infectious Diseases has released the 2001-2002 edition of Health Information for International Travel (The Yellow Book). The new edition contains updated vaccination information; updated information on malaria risk and prophylaxis (by country); updated and revised disease-specific text and tables; new sections on altitude sickness and international adoption; updated country listings; and improved maps and indexing. The Yellow Book can be purchased from the Public Health Foundation, telephone (877) 252-1200 or at http://bookstore.phf.org DQ will no longer distribute the book.

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To obtain the full text of this notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5024a4.htm

To find out how to receive a free email subscription to MMWR, see the information following story four below.
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(4)
June 22, 2001
CDC PUBLISHES REPORT ON MEASLES INCIDENCE IN LUSAKA, ZAMBIA

CDC published a report titled "Measles Incidence Before and After Supplementary Vaccination Activities--Lusaka, Zambia, 1996-2000," in the June 22, 2001, issue of MMWR.

The Editorial Note states that even though supplemental vaccination activities (SVAs) in Lusaka did not significantly lower measles morbidity and mortality, the expected seasonal peak of measles during September through December 1999 was blunted and the cases among children aged 1-4 years was reduced. The article states that SVAs had limited impact for two reasons: (1) the reported vaccination coverage was less than 85 percent, and the coverage rate may have been overestimated, and (2) routine coverage declined during the study period, increasing the number of susceptible infants.

To obtain the complete text of this article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5024a2.htm

HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR: To obtain a free electronic subscription to MMWR, visit CDC's MMWR website at: http://www.cdc.gov/mmwr Select "Free MMWR Subscription" from the menu at the left of the screen. Once you have submitted the required information, weekly issues of the MMWR and all new ACIP statements (published as MMWR's "Recommendations and Reports") will arrive automatically by e-mail.
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(5)
June 22, 2001
CDC ANNOUNCES THE CLINICAL IMMUNIZATION SAFETY ASSESSMENT (CISA) CENTERS NETWORK

CDC has announced that applications are being considered for a series of cooperative agreements to begin the process of setting up a Clinical Immunization Safety Assessment (CISA) Centers network.

The CISA project seeks to improve the scientific understanding of immunization safety issues at the individual patient level. Because clinically significant adverse events occur rarely, they are infrequently seen in clinical trials and individual clinicians see them too infrequently to be able to manage them in a standardized fashion.

CISA Centers will:

• develop and disseminate standardized clinical evaluation protocols to clinicians who may be required to apply them to a patient; 
     
• provide referral and consultation services to health care providers on how to evaluate patients who may have had an adverse reaction to vaccination, which will include how to manage the adverse reaction, as well as advise on continued immunization; and
    
• undertake outreach and educational interventions in the area of immunization safety.

One goal of the project is to enhance understanding of known serious or unusual vaccine reactions, including the pathophysiology and risk factors (such as genetics) for such reactions. A further goal is to evaluate and gain an understanding for newly hypothesized syndromes or events identified from the routine and enhanced assessment of Vaccine Adverse Event Reporting System (VAERS) case reports, in order to clarify any potential relationship with immunization.

Program announcement 01112, Clinical Immunization Safety Assessment Centers (CISA), has been published in the Federal Register dated June 12, 2001, Vol. 66, No. 113, pages 31649-31652.

To obtain a copy of the announcement, visit CDC's website at: http://www.cdc.gov/od/pgo/funding/01112.htm
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(6)
June 22, 2001
NIP SEEKS APPLICANTS FOR THE POSITION OF CHIEF OF THE ASSESSMENT BRANCH

CDC's National Immunization Program (NIP) is seeking a person to fill the position of Chief, Assessment Branch, within the Data Management Division. The Assessment Branch consists of approximately 15 employees, including statisticians, epidemiologists, and computer programmers. The position has been posted under several classification, including epidemiologist, medical officer, and behavior scientist to find the best qualified applicant. Applications will be accepted until July 9, 2001.

Desirable qualifications include:

• the ability to provide management leadership and direction
• the ability to present analysis of survey data
• experience in survey research demonstrated by publication of scientific articles in peer-review journals
• ability to work with a variety of federal, state, and local agencies.

Assessment Branch activities include:

• collecting, analyzing, and disseminating information on vaccination coverage
• managing the National Immunization Survey, one of the nation's largest telephone surveys
• evaluating the school vaccine coverage data collected at the state and local level

For more information about the position, contact Heidi Steele, Acting Director of the Data Management Division at NIP at (404) 639-8030 or Dr. Lawrence Barker, Associate Director for Science at (404) 639-8560. To suggest potential candidates, call Beverly Ashton-Howard, Associate Director for Management and Operations, at (404) 639-8585.