Issue Number
135
January 31,
2000
CONTENTS OF THIS ISSUE
- Too good to miss! AAP recommends reinstitution of the first dose
of hepatitis B vaccine for all infants at birth to two months of age
- "Hepatitis Control Report" publishes detailed overview of the
controversy concerning thimerosal in vaccines
- CDC publishes report on influenza activity in the United
States
- CDC publishes article on polio eradication efforts in
Chad
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(1)
January 31, 2000
TOO GOOD TO MISS! AAP RECOMMENDS REINSTITUTION OF THE FIRST DOSE OF HEPATITIS B VACCINE FOR ALL INFANTS AT BIRTH
TO 2 MONTHS OF AGE
The American Academy of Pediatrics (AAP) published an article titled "Reinstitute hepatitis B vaccine for all
infants" in the November 1999 issue of "AAP News," the official news magazine of the AAP. The article written by
Margaret B. Rennels, MD, FAAP, states that physicians who may have stopped vaccinating infants at birth against
hepatitis B due to concerns over thimerosal, should now resume hepatitis B vaccination of infants with
thimerosal-free vaccine "optimally at birth and no later than two months of age."
IAC EXPRESS EDITOR'S NOTE: Please resume your previous practice of routinely administering the first dose of
hepatitis B vaccine at birth and no later than two months of age. Hepatitis B vaccine that is thimerosal free is
available and should be used for these newborns according to the "AAP News" article. As has been recommended since
1991, all infants born to women who are hepatitis B surface antigen (HBsAg) positive or to women
whose HBsAg status is unknown at the time of birth MUST receive the first dose
of hepatitis B vaccine no later than 12 hours of age, even if thimerosal-free vaccine is not available.
The full text of Dr. Rennels' article is reprinted here by permission of "AAP
News" (Vol. 15, Issue 11, p.6, copyright 1999). The article reads as follows:
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REINSTITUTE HEPATITIS B VACCINE FOR ALL INFANTS
by Margaret B. Rennels, MD, FAAP
The Food and Drug Administration has approved the first thimerosal-free hepatitis B vaccine, Recombivax
HB Pediatric, manufactured by Merck Vaccine Division. A second preservative-free hepatitis B vaccine made
by Smith-Kline Beecham (Engerix-B Pediatric) currently is under evaluation by
the FDA.
Resumption of hepatitis B vaccination of young infants is important because confusion about recommendations has
resulted in some hospitals failing to immunize children delivered to hepatitis B surface antigen positive women.
Additionally, data demonstrate that children who do not receive hepatitis B vaccine at birth are less likely to
complete this series of immunizations. THEREFORE, HEPATITIS B IMMUNIZATION OF ALL INFANTS SHOULD BE
REINSTITUTED IMMEDIATELY. The initial dose should be given optimally at birth, and no later than 2 months
of age. This schedule may be accomplished by using either thimerosal-free single antigen hepatitis B
vaccine, or for infants 6 weeks of age and older, the combination hepatitis B and
Haemophilus influenzae type B vaccine (Comvax).
Since supplies of the thimerosal-free vaccine are currently limited, it should
be used only for infants less than 6 months of age. Children 6 months of age
and older can be given one of the thimerosal-containing hepatitis B vaccines
until supplies of the preservative-free vaccine are sufficient to immunize all
groups. When a thimerosal-free vaccine is not available for infants less than 6
months of age, the previous recommendations should be followed (AAP policy statement titled
"Thimerosal in Vaccines -- An Interim Report to Clinicians" at www.aap.org/policy/re9935.html).
Dr. Rennels is a member of the AAP Committee on
Infectious Diseases.
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The full text of this article is also available online on IAC's website at: http://www.immunize.org/news.d/aap1-00.htm
For more information about thimerosal in vaccines, visit the website of the National Immunization Program, Centers
for Disease Control and Prevention, at: www.cdc.gov/nip/news/thimerosal.htm
(link discontinued) and the "Thimerosal Information" page on IAC's website at: http://www.immunize.org/genr.d/thimer.htm
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(2)
January 31, 2000
"HEPATITIS CONTROL REPORT" PUBLISHES DETAILED OVERVIEW OF THE CONTROVERSY CONCERNING THIMEROSAL IN VACCINES
An excellent article titled "Uproar over a little-known preservative, thimerosal,
jostles U.S. hepatitis B vaccine policy," appeared in the summer 1999 issue of
the "Hepatitis Control Report" (Vol. 4, No. 2). This article written by Frederic
E. Shaw, MD, JD, editor of the "Hepatitis Control Report," summarizes the history of the controversy over the
use of thimerosal in vaccines, an "uproar" which gained national attention in July 1999.
The full text version (HTML format) of Dr. Shaw's article is available online on
the website of the "Hepatitis Control Report" at: http://www.hepatitiscontrolreport.com/v4n2.html
The "Hepatitis Control Report" is a free, quarterly newsletter devoted to news
on the public health control of viral hepatitis. To view past issues of this
publication, go to the Report's website at: http://www.hepatitiscontrolreport.com/
To subscribe to the "Hepatitis Control Report," send an e-mail to vjpappas@hepatitiscontrolreport.com, or call
(610) 664-2793.
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(3)
January 28, 2000
CDC PUBLISHES REPORT ON INFLUENZA ACTIVITY IN THE UNITED STATES
The Centers for Disease Control and Prevention (CDC) published an article titled "Update: Influenza Activity
-- United States, 1999-2000 Season" in the January 28, 2000, issue of the MMWR.
The article begins: "Influenza activity in the United States began to increase
substantially during mid-December 1999, and as of January 15, 2000, laboratory-confirmed influenza
infections have been reported from all nine surveillance regions. The predominant viruses isolated this season have
been influenza type A(H3N2) viruses that have been circulating in the United States
for the last two influenza seasons and are well-matched to this season's vaccine."
The article's "Editorial Note" states in part: "For the
1999-2000 season, influenza activity began to increase in mid-December, approximately 4 weeks
earlier than in the 1997-98 season, and 7-8 weeks earlier than in the 1998-99
season... As of January 15, 2000, the percentage of patient visits for influenza-like illness (ILI) to
sentinel physicians, the percentage of respiratory specimens testing positive for influenza, and the number
of state and territorial epidemiologists reporting either widespread or regional influenza activity have
been similar to the last two seasons. Recent declines in visits to sentinel physicians for ILI and in the percentage of
respiratory specimens testing positive for influenza viruses suggest that influenza activity may have peaked
nationally."
The "Editorial Note" concludes: "Despite the use of rapid diagnostic tests and
availability of neuraminidase inhibitor drugs, influenza vaccination remains the
most important measure to protect persons against influenza. At this time of
year, influenza vaccine supplies are limited, but unvaccinated persons at high
risk for complications from influenza (e.g., persons aged greater than or equal
to 65 years; adults and children who have chronic disorders of the pulmonary (including asthma) or cardiovascular
system and chronic metabolic diseases (including diabetes); and women in their second or third trimester of
pregnancy) should consider vaccination if influenza vaccine is available in their area.
"Influenza surveillance data collected by CDC are updated weekly from October through May. Summary reports are
available through CDC's voice information system, telephone (888) 232-3228, fax (888) 232-3299 (request
document number 361100), or through CDC's National Center for Infectious Diseases, Division of Viral and Rickettsial
Diseases, Influenza Branch World-Wide Web site, http://www.cdc.gov/ncidod/diseases/flu/weekly.htm"
To obtain the full text version (HTML format) of this MMWR article, go to: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4903a2.htm
For information on how to obtain a free electronic subscription to the MMWR,
see the instructions that follow article four below.
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(4)
January 28, 2000
CDC PUBLISHES ARTICLE ON POLIO ERADICATION EFFORTS IN CHAD
The Centers for Disease Control and Prevention (CDC) published an article titled "Progress Toward Poliomyelitis
Eradication -- Chad, 1996-1999" in the January 28, 2000, issue of the MMWR. Since 1990, reported routine infant
vaccination coverage in Chad (e.g., three doses of oral poliovirus vaccine [OPV]) has been 10%-25%.
The article's "Editorial Note" states in part: "Chad connects western and central Africa where polio is endemic.
Three decades of civil war have left Chad with a damaged health infrastructure, severe financial problems, and
limited human resources. These factors and a large mobile population (e.g., nomads, migrant workers, and refugees)
have led to low routine coverage with three doses of OPV and continued widespread transmission of wild poliovirus.
"Chad's Ministry of Health is increasingly successful in implementing the World Health Organization's
recommendations for supplemental OPV vaccination and intensified surveillance... Improved surveillance will
depend on better coordination among all levels of government and local nongovernmental organizations,
and cooperation across international borders."
To obtain the full text version (HTML format) of this MMWR article, go to: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4903a3.htm
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 listed below. 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 automatically arrive in your e-mail box. To go to the MMWR website, visit:
http://www2.cdc.gov/mmwr
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