Issue Number
286 December
17, 2001
CONTENTS OF THIS ISSUE
- CDC publishes notice: ACIP approves shorter pregnancy
wait after receipt of rubella-containing vaccine
- Merck recalls some lots of VAQTA in prefilled syringes
- Complete smallpox plan now available on CDC website
- New staff appointments at CDC announced
- Reminder! Fourth National Conference on Immunization
Coalitions registration deadline extended
- Standing Orders Project publishes quarterly "Partner
Newsbrief"
- If your patients ask: New study confirms safety of
influenza vaccine for people with asthma
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December 17, 2001
CDC PUBLISHES NOTICE: ACIP APPROVES SHORTER PREGNANCY WAIT AFTER RECEIPT OF RUBELLA-CONTAINING VACCINE
On December 14, 2001, CDC published "Notice to Readers: Revised ACIP Recommendation for Avoiding Pregnancy After
Receiving a Rubella-Containing Vaccine" in the Morbidity and Mortality Weekly Report (MMWR).
The complete notice, excluding references, reads as follows:
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On October 18, 2001, the Advisory Committee on Immunization Practices (ACIP)
reviewed data from several sources indicating that no cases of congenital rubella
syndrome (CRS) had been identified among infants born to women who were vaccinated inadvertently against rubella
within 3 months or early in pregnancy. On the basis of these data, ACIP shortened its recommended period to avoid
pregnancy after receipt of rubella-containing vaccine from 3 months to 28 days.
Data were available from the U.S. Rubella Vaccine in Pregnancy Registry, the U.K.
National Congenital Rubella Surveillance Programme (National Congenital Registry
Surveillance Programme, unpublished data, 2001; P. Tookey, Ph.D., Center of Paediatric Epidemiology and
Biostatistics, Institute of Child Health, London, personal communication, April 2001), and Sweden and Germany (G.
Enders, M.D., Laboratory of Enders and Partners, and Institute for Virology, Infectology, and
Epidemiology, personnel communication, September 2001) on 680 live births to
susceptible women who were inadvertently vaccinated 3 months before or during
pregnancy with one of three rubella vaccines (HPV-77, Cendehill, or RA 27/3).
None of the infants was born with CRS. However, a small theoretical risk of 0.5 percent
(upper bound of 95 percent confidence limit=0.05 percent) cannot be ruled out.
Limiting the analysis to the 293 infants born to susceptible mothers vaccinated 1-2
weeks before to 4-6 weeks after conception, the maximum theoretical risk is 1.3
percent. This risk is substantially less than the >20 percent risk for CRS associated
with maternal infection during the first 20 weeks of pregnancy.
Measles-mumps-rubella (MMR) vaccine and its component vaccines should not be
administered to women known to be pregnant. Because a risk to the fetus from
administration of these live virus vaccines cannot be excluded for theoretical
reasons, women should be counseled to avoid becoming pregnant for 28 days after
vaccination with measles or mumps vaccines or MMR or other rubella-containing
vaccines.
The goal of the U.S. rubella vaccination program is to prevent congenital rubella
infection. ACIP recommended that MMR vaccine should be offered to all women of
childbearing age (i.e., adolescent girls and premenopausal women) who do not have
acceptable evidence of rubella immunity.
Most rubella cases in the United States occur among young Hispanic adults born
outside the United States, and most infants with CRS are born to foreign-born
mothers.Ensuring immunity in women of childbearing age, especially those at highest risk for exposure, will help to prevent
CRS.
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To obtain the complete text of this Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5049a5.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5049.pdf
HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the "Morbidity and Mortality Weekly
Report" (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 email.
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December 17, 2001
MERCK RECALLS SOME LOTS OF VAQTA IN PREFILLED SYRINGES
On December 10, Merck Vaccine Division issued an urgent recall of selected lots of
VAQTA (hepatitis A vaccine, inactivated) in prefilled syringes. According to the
recall notice, "Recent investigation indicates that some syringes within the [specified]
lots may have antigen levels below the product specification limit. Persons vaccinated with VAQTA in prefilled syringes from the
indicated lots may be insufficiently protected against hepatitis A."
Not affected by the recall are VAQTA in vials and prefilled syringes from lots not
specified.
To see the Merck Product Recall notice with recalled VAQTA lot numbers, go to:
http://www.merckvaccines.com/vaccines/hepa/vaqta_recall_forms.pdf
A list of recalled VAQTA lots is also available on the website of the Food and Drug
Administration at:
http://www.fda.gov/cber/recalls/merhav121001.htm
Questions about returns will be taken by the Merck Order Management Center at
(800) 637-2579.
Questions about free hepatitis A antibody testing of patients who may have been
vaccinated with affected lots of VAQTA will be taken by the Merck Product Assistance
Line at (800) 439-4958.
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December 17, 2001
COMPLETE SMALLPOX PLAN NOW AVAILABLE ON CDC WEBSITE
The Centers for Disease Control and Prevention (CDC) has posted its "Interim
Smallpox Response Plan and Guidelines" and other smallpox-related documents on
its website. The new Smallpox page features agent information for health care
providers--including details about the disease, recommended treatment, and recognizing smallpox in
emergency departments--and lab protocol so that laboratories will have techniques to identify
microorganisms to help clinicians with diagnosis.
To view the new Smallpox page on CDC’s website, go to:
http://www.bt.cdc.gov/agent/smallpox/smallpox.asp
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December 17, 2001
NEW STAFF APPOINTMENTS AT CDC ANNOUNCED
The Centers for Disease Control and Prevention (CDC) has temporarily reassigned
Dr. Harold Margolis, Director of the Division of Viral Hepatitis, to the position of CDC
Coordinator of Smallpox Preparedness Activities. This 6-month assignment began
November 26, 2001.
While Dr. Margolis is serving in this new capacity, Dr. Steve Hadler, Chief of the
Global Alliance for Vaccines and Immunization, will be the Acting Director of the
Division of Viral Hepatitis. This assignment began on December 3, 2001.
The CDC has also formed a new Smallpox Preparedness and Response Activity that
will report to the Office of the Director of the National Immunization Program. The
Director of the new Activity is Dr. Joel Kuritsky.
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December 17, 2001
REMINDER! FOURTH NATIONAL CONFERENCE ON IMMUNIZATION COALITIONS REGISTRATION DEADLINE EXTENDED
As previously announced, the Fourth National Conference on Immunization Coalitions, with the theme "Building Healthy
Immunized Communities: Yours, Mine and Ours," will be held January 9-11, 2002, at the San Antonio Marriott
Rivercenter, San Antonio, Texas. (The opening reception will be held in the evening on January
9.) The conference is hosted by Children’s Healthcare of Atlanta and Immunize
Georgia’s Little Guys.
This conference offers information, resources, and skill building sessions to help
local, state, and national organizations create and sustain coalitions and partnerships. Continuing education credits (CMEs, CNEs,
and CECHs) are available for attendees.
The new registration deadline is Monday, December 24. The registration fee is $125
through that date and increases to $250 thereafter. Note: The early hotel registration
deadline was Monday, December 10. Call the San Antonio Rivercenter Marriott for
the regular rates.
For more information on the conference or to obtain a registration form, contact
Dena Stansbury, conference coordinator, by phone at (404) 929-8684, fax at (404)
929-8481, or email at dena.stansbury@choa.org
To view the conference brochure online, go to:
http://www.choa.org/immunization/iglg2.pdf
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December 17, 2001
STANDING ORDERS PROJECT PUBLISHES QUARTERLY "PARTNER NEWSBRIEF"
The Standing Orders Project (SOP), a collaboration of the Centers for Disease
Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services
(CMS), has published the third issue of its quarterly newsletter, "Partner Newsbrief."
The mission of the pilot Standing Orders Project is to increase coverage rates for
pneumococcal and influenza vaccines in long-term care facilities. Nine states are
currently involved in recruiting long-term care facilities.
To subscribe to "Partner Newsbrief," contact Jennifer O’Hagan, SOP Project
Coordinator, by phone at (405) 840-2891 (ext. 205) or by email at okpro.johagan@sdps.org
To see "Partner Newsbrief" online, go to:
http://www.nationalpneumonia.org/sop/soppartnernewsbrief/soppartnernewsbrief.html
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December 17, 2001
IF YOUR PATIENTS ASK: NEW STUDY CONFIRMS SAFETY OF INFLUENZA VACCINE FOR PEOPLE WITH ASTHMA
According to an article in the November 22, 2001, issue of the New England Journal of Medicine (vol. 345, no. 21, pp.
1529-1536), less than 10 percent of patients with asthma become vaccinated against influenza. Some patients with
asthma believe that influenza vaccination will exacerbate their symptoms and
therefore avoid the annual vaccine. Previous studies on the issue have been inconclusive,
according to the article, leaving health care providers with little concrete information to allay their asthma patients’
concerns. Because there are "substantial effects of influenza in patients with asthma" and "influenza is a
common reason for hospitalization in children with asthma," a large clinical
study of flu vaccination of asthma patients was undertaken.
"The Safety of Inactivated Influenza Vaccine in Adults and Children with Asthma" was authored by the Writing
Committee of the American Lung Association Asthma Clinical Research Centers. In the study, led by Mario
Castro, M.D., assistant professor of medicine at Washington University School of Medicine in St. Louis, 2,032 asthma patients
(aged 3-64 years) received both a placebo injection and a flu vaccine injection, but in different
orders, and separated by a mean of 22 days. After each injection, records of
symptoms were kept, including increased frequency of use of bronchodilator medications and decreases in daily peak
expiratory flow rate.
The researchers found that "the frequency of exacerbations of asthma was similar in the two weeks after the influenza
vaccination and after placebo injection . . . only body aches were more frequent after the vaccine injection
than after placebo injection."
The Discussion section states: "The main finding of this controlled study is that
influenza vaccination does not worsen asthma. This finding should be reassuring to
patients and to their physicians, and it provides evidence that the current guidelines for the immunization of
patients with asthma are safe."
To see the abstract of this article, go to:
http://content.nejm.org/cgi/content/abstract/345/21/1529
The entire article is currently available only in print and is not available online.
For original articles, the full text becomes available 6 months after print publication to all registered users of the New England
Journal of Medicine website at www.nejm.org
To order individual reprints, call the New England Journal of Medicine customer service desk at (800) 843-6356. The
cost for an emailed or faxed copy of the article is $12; the cost to have a copy sent via U.S. mail is $10.
Bulk reprint orders (100 or more copies) may be made
online at:
http://www.nejm.org/custserv/reprintorder.asp
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