Issue Number
257 July 2, 2001
CONTENTS OF THIS ISSUE
- Correction: Pennsylvania varicella immunization mandate
will take effect in the 2002-2003 school year
- CDC publishes updated guidelines on occupational exposure
to hepatitis B, hepatitis C, and HIV
- CDC publishes data on U.S. vaccination levels among
people 65 and older
- CDC reports on hepatitis B outbreak in a state
correctional facility
- New Spanish translation of IAC's "Screening Questionnaire
for Child and Teen Immunization" now available
- Abstract deadline for the 2002 National Conference on
Immunization Coalitions is August 10
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(1)
July 2, 2001
CORRECTION: PENNSYLVANIA VARICELLA IMMUNIZATION MANDATE
WILL TAKE EFFECT IN THE 2002-2003 SCHOOL YEAR
IAC EXPRESS #256 published the incorrect date for when Pennsylvania's varicella prevention mandate takes effect.
State regulations will require varicella vaccination for students entering kindergarten and seventh grade
beginning with the 2002-2003 school year rather than 2001-2002.
To view IAC's updated table of state mandates for varicella prevention and their implementation dates, go to:
http://www.immunize.org/laws/varicel.htm
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(2)
July 2, 2001
CDC PUBLISHES UPDATED GUIDELINES ON OCCUPATIONAL EXPOSURE TO HEPATITIS B, HEPATITIS C, AND HIV
The Centers for Disease Control and Prevention (CDC) published "Updated U.S. Public Health Service Guidelines for
the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure
Prophylaxis" in the June 29, 2001, issue of "MMWR Recommendations and Reports"
(vol. 50, no. RR-11).
The summary of this report is reprinted below:
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SUMMARY
This report updates and consolidates all previous U.S. Public Health Service
recommendations for the management of health-care personnel (HCP) who have occupational exposure
to blood and other body fluids that might contain hepatitis B virus (HBV), hepatitis C virus (HCV), or human
immunodeficiency virus (HIV).
Recommendations for HBV postexposure management include initiation of the hepatitis B vaccine series to any
susceptible, unvaccinated person who sustains an occupational blood or body fluid exposure. Postexposure
prophylaxis (PEP) with hepatitis B immune globulin (HBIG) and/or hepatitis vaccine series should be considered for
occupational exposures after evaluation of the hepatitis B surface antigen status of the source and the
vaccination and vaccine-response status of the exposed person. Guidance is provided to clinicians and exposed HCP for selecting the
appropriate HBV PEP.
Immune globulin and antiviral agents (e.g., interferon with or without ribavirin)
are not recommended for PEP of hepatitis C. For HCV postexposure management, the HCV status
of the source and the exposed person should be determined, and for HCP exposed to an HCV positive source, follow-up HCV
testing should be performed to determine if infection develops.
Recommendations for HIV PEP include a basic 4-week regimen of two drugs (zidovudine [ZDV] and lamivudine [3TC]; 3TC and
stavudine [d4T]; or didanosine [ddI] and d4T) for most HIV exposures and an expanded regimen
that includes the addition of a third drug for HIV exposures that pose an increased
risk for transmission. When the source person's virus is known or suspected to be resistant to one or more of the
drugs considered for the PEP regimen, the selection of drugs to which the source person's virus is unlikely
to be resistant is recommended.
In addition, this report outlines several special circumstances (e.g., delayed
exposure report, unknown source person, pregnancy in the exposed person, resistance of the
source virus to antiretroviral agents, or toxicity of the PEP regimen) when consultation with local experts and/or the
National Clinicians' Post-Exposure Prophylaxis Hotline ([PEPline] 1-888-448-4911) is advised.
Occupational exposures should be considered urgent medical concerns to ensure timely postexposure management and
administration of HBIG, hepatitis B vaccine, and/or HIV PEP.
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To obtain the complete statement "Updated U.S. Public Health Service Guidelines for the Management of Occupational
Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis," go to the following
links:
Camera-ready (PDF) format:
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf
Text (HTML) format:
http://www.cdc.gov/mmwr/mmwr_rr.html
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, 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 three below.
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(3)
July 2, 2001
CDC PUBLISHES DATA ON U.S. VACCINATION LEVELS AMONG PEOPLE 65 AND OLDER
CDC published a report titled "Influenza and Pneumococcal Vaccination Levels Among Persons Aged 65 Years and Older--United States, 1999" in the
June 29, 2001, issue of MMWR.
According to CDC, the U.S. influenza vaccination coverage rate among adults aged 65 and older in 1999 was 66.9 percent,
compared with 65.5 percent in 1997. Ethnic disparities in vaccination coverage continue, however. Although
69 percent of white Americans aged 65 and older reported getting vaccinated against the flu, only 48.1 percent of black
Americans and 58.6 percent of Hispanics did. The vaccination rate for this age group increased almost 2
percentage points among whites between 1997 and 1999, but it dropped over 2 points among African Americans.
Although pneumococcal vaccination coverage increased from 45.4 percent in 1997 to 54.1 percent in 1999, ethnic
disparities continued in pneumococcal vaccination rates as well. Among whites, the pneumococcal vaccination rate
was 56.8 percent, among blacks 36.4 percent, and among Hispanics 34.6 percent.
To reach the Healthy People 2010 national objective of at least 90 percent influenza and pneumococcal vaccination among people
age 65 and older, new strategies and additional resources may be necessary.
The Editorial Note recommends that "Health care providers should use every opportunity to assess the vaccination
status of patients and offer indicated vaccines. Annual influenza vaccination provides such an opportunity;
influenza and pneumococcal vaccines can be administered concurrently at different sites without increasing side
effects, and pneumococcal vaccine should be administered to patients who are uncertain about their vaccination
history."
To obtain the complete text of this article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5025a2.htm
To obtain the complete issue of the MMWR in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5025.pdf
To obtain information on the National Health Interview Survey (NHIS), which collected the information on influenza
and pneumococcal vaccination coverage, go to: http://www.cdc.gov/nchs/nhis.htm
To find out how to receive a free email subscription to MMWR, see the information following story three below.
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(4)
July 2, 2001
CDC REPORTS ON HEPATITIS B OUTBREAK IN A STATE CORRECTIONAL FACILITY
CDC published an article titled "Hepatitis B Outbreak in a State Correctional
Facility, 2000" in the June 29, 2001, issue of MMWR, which underscores the importance of
implementing hepatitis B vaccination in correctional facilities.
According to the Editorial Note, "The findings in this report are consistent with
previous reports of HBV transmission in prison settings. Since 1982, the Advisory
Committee on Immunization Practices has recommended hepatitis B vaccination of long-term inmates with a history
of risk factors for infection. Although a large proportion of inmates in this prison reported current or
previous risk factors for HBV infection, none of the susceptible inmates had
been vaccinated.
"In the state corrrectional system in this report, approximately one third of
inmates are released each year. Previously incarcerated persons represent a population at
risk for HBV infection. Approximately 30% of persons with acute hepatitis B report a history of incarceration.
Hepatitis B vaccination of prisoners would prevent ongoing HBV transmission among inmates in prison
facilities and after they have been released into the community. Because of the high proportion of inmates with previous risk factors
for HBV infection and the difficulty in ascertaining current risk factors, experts in correctional health
recommend vaccination of all inmates.
"Some states have implemented successfully routine hepatitis B vaccination of
prisoners. However, identifying resources to purchase and administer vaccine
remains the major barrier to national implementation of this strategy. Partnerships
between state health and corrections departments can help to implement hepatitis B vaccination and promote effective
strategies for prevention of other STDs and infections in correctional facilities."
To obtain the complete text of this report online, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5025a1.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)
July 2, 2001
NEW SPANISH TRANSLATION OF IAC'S "SCREENING QUESTIONNAIRE FOR CHILD AND TEEN IMMUNIZATION" NOW AVAILABLE
The current version of IAC's "Screening Questionnaire for Child and Teen Immunization" is now available in Spanish as
well as English. This questionnaire for parents or guardians to fill out is a screening tool for
contraindications and precautions to vaccine administration. It includes a companion
piece in English explaining why each question is asked.
To obtain a copy of this new Spanish translation, go to: http://www.immunize.org/catg.d/p4060-01.htm
To obtain a copy of the screening questionnaire in English, go to: http://www.immunize.org/catg.d/p4060scr.htm
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(6)
July 2, 2001
ABSTRACT DEADLINE FOR THE 2002 NATIONAL CONFERENCE ON IMMUNIZATION COALITIONS IS AUGUST 10
The National Conference on Immunization Coalitions has issued a call for abstracts for its 2002 conference. The
abstract deadline is August 10, and the conference will take place January 9-11, 2002, at the San Antonio Marriott
Rivercenter in San Antonio.
The conference is seeking presenters who can provide participants with practical tools to enhance their
childhood, adolescent, adult, and lifespan immunization coalition services and promotion efforts.
For more information on abstract submission or to be placed on the mailing list for the conference brochure, contact
Dena Stansbury, Children's Healthcare of Atlanta by email at dena.stansbury@choa.org, by telephone
at (404) 929-8684, or by fax at (404) 929-8481.
For a detailed list of additional upcoming immunization and hepatitis conferences and events, visit IAC's "Calendar of
Events" at: http://www.immunize.org/calendar/
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