Issue Number
261 July 18, 2001
CONTENTS OF THIS ISSUE
- CDC announces influenza vaccine delays for 2001-02
season and supplementary ACIP recommendations
- CDC publishes recommendations on the control and
prevention of rubella
- CDC publishes report on hepatitis C prevalence among
clients of HIV counseling and testing sites
- CDC's National Immunization Program releases Influenza
Bulletin #4
- New Chinese translation of "Screening Questionnaire for
Child and Teen Immunization" on IAC's website
- New Turkish translation of "Screening Questionnaire for
Adult Immunization" on IAC's website
- Reminder: CDC's National Immunization Program offers
course on vaccine-preventable diseases August 14-15 in Atlanta
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(1)
July 18, 2001
CDC ANNOUNCES INFLUENZA VACCINE DELAYS FOR 2001-02 SEASON AND SUPPLEMENTARY ACIP RECOMMENDATIONS
The Centers for Disease Control and Prevention (CDC) published in the July 13, 2001, issue of Morbidity and
Mortality Weekly Report (MMWR), a Notice to Readers titled "Delayed Influenza Vaccine Availability for 2001-02 Season
and Supplemental Recommendations of the Advisory Committee on Immunization Practices."
According to the notice, manufacturers expect that nearly 50 million doses of
influenza vaccine will be available for delivery by the end of October. This is
about 26 million fewer doses than were available in October in 1999. Manufacturers expect to supply another 27 million doses in
November and December, however, for a total distribution level higher than last year and
comparable with 1999.
Because of the expected delay, the Advisory Committee on Immunization Practices (ACIP) has developed supplemental
recommendations for influenza vaccination, in hopes that people at highest risk for severe flu and
complications and their health care providers receive the vaccine early. These
recommendations are reprinted below:
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VACCINE PROVIDERS
Providers should target vaccine available in September and October to persons at increased risk for influenza
complications and to health-care workers. The optimal time for vaccinating high-risk persons is October through
November. To avoid missed opportunities, vaccine also should be offered to high-risk persons when they access
medical care in September, if vaccine is available. Vaccinating high-risk persons early can be facilitated
through reminder and recall systems, in which such patients are identified and
encouraged to come into the office for a vaccination-only visit. Additional information that may
help providers implement a reminder/recall system is available at http://www.cdc.gov/nip/flu
Beginning in November, providers should offer vaccine to contacts of high-risk persons, healthy persons aged 50-64
years, and any other persons wanting to reduce their risk for influenza.
Providers should continue vaccinating patients, especially those at high risk
and in other target groups, in December and should continue as long as there
is influenza activity and vaccine is available. To increase vaccination rates,
health-care organizations are encouraged to assess their providers' influenza
vaccine use and provide feedback on coverage among persons aged > or equal to 65 years and
other high-risk patients.
THE PUBLIC
Persons at high risk for complications from influenza, including those aged >
or equal to 65 years and those aged <65 years who have underlying chronic
illnesses, should seek vaccination with their provider when vaccine is available. The optimal vaccination period is October
through November but may include September if vaccine is available. Unvaccinated high-risk
persons should continue to seek vaccine later in the season.
Persons who are not at high risk for complications from influenza, including
household contacts of high-risk persons, are encouraged to seek influenza vaccine in
November and later. Persons who are unsure of their risk status should consult their provider to determine whether
they should receive vaccine earlier and, if so, whether vaccine will be available. When additional vaccine
is available, providers are encouraged to send a reminder to persons deferred
from vaccination.
MANUFACTURERS, DISTRIBUTORS, AND VENDORS
Distribution of vaccine to worksites, where campaigns primarily vaccinate healthy workers, should be delayed
until November. Delaying distribution of vaccine to worksites makes more early-season vaccine available to
providers of high-risk patients. Manufacturers and distributors should identify worksite
orders, or those placing orders should indicate they are doing so for worksites, so arrangements can be made for later vaccine
shipment. Delivery of vaccine to hospitals and chronic-care facilities serving high-risk patients
should not be delayed.
All providers who have placed orders should receive some early season vaccine. This strategy will ensure that
virtually all providers will be able to vaccinate some of their high-risk patients early in the season. As an
exception, complete orders for chronic-care facilities serving high-risk populations should be provided early so
that vaccine can be administered in October or November, the optimal time for vaccination of this highest risk
group.
Manufacturers, distributors, and vendors should inform providers of the amount of vaccine they will be receiving
and the date of shipment. This will allow providers to notify high-risk patients when vaccine will be available.
HEALTH DEPARTMENTS AND OTHER ORGANIZATIONS
Organizers of mass vaccination campaigns not in workplaces (e.g., at health departments, clinics, senior centers, and
retail stores) should plan campaigns for late October or November or when they are assured of vaccine supply and
make special efforts to vaccinate elderly persons and those at high risk for
influenza complications. Information that may be used in a campaign setting is
available at http://www.cdc.gov/nip/flu
Influenza vaccine service providers should develop contingency plans for possible delays in vaccine
distribution. In a delay or shortage, communications among partner organizations and potential redirection of
vaccine to high-risk persons in the community will be important. State and local health departments can provide guidance
that is appropriate for their population and systems of care.
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To read the complete text of this article online, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5027a3.htm
To read the complete issue of this MMWR in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5027.pdf
To learn how to obtain a free subscription to the MMWR, see the information following story three below.
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(2)
July 18, 2001
CDC PUBLISHES RECOMMENDATIONS ON THE CONTROL AND PREVENTION OF RUBELLA
CDC published "Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella
in Pregnant Women, and Surveillance for Congenital Rubella Syndrome" in the July 13, 2001, issue of
"MMWR Recommendations and Reports" (vol. 50, no. RR-12).
The summary of this report is reprinted below:
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SUMMARY
Outbreaks of rubella continue to occur in the United States despite widespread use of the measles-mumps-rubella (MMR)
vaccine. Throughout the mid- to late-1990s, rubella outbreaks were characterized by increased
numbers of cases among adults born in countries that do not have or have only recently instituted a national rubella vaccination
program. To address this change in disease epidemiology, CDC's National Immunization Program (NIP)
developed the following recommendations in conjunction with public health officials in the field. Public health officials should
implement appropriate responses to reports of suspected rubella to determine if an outbreak exists,
evaluate its scope, and implement appropriate control measures. Health-care providers should be aware of the need for rubella
prevention and control among women of childbearing age and of the appropriate follow-up for
pregnant women exposed to rubella. Comprehensive surveillance for congenital rubella
syndrome should begin during a rubella outbreak.
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To obtain the complete statement, go to the following links:
Camera-ready (PDF) format:
http://www.cdc.gov/mmwr//PDF/rr/rr5012.pdf
Text (HTML) format:
http://www.cdc.gov/mmwr//preview/mmwrhtml/rr5012a1.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, and follow the instructions for submitting your answers.
To learn how to obtain a free subscription to the MMWR, see the information following story three below.
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(3)
July 18, 2001
CDC PUBLISHES REPORT ON HEPATITIS C PREVALENCE AMONG CLIENTS OF HIV COUNSELING AND TESTING SITES
CDC published a report titled "Prevalence of Hepatitis C Virus Infection Among Clients of HIV Counseling and Testing
Sites--Connecticut, 1999" in the July 13, 2001, issue of MMWR.
This report found that HIV counseling and testing sites can be important settings for identifying people with risk
factors for hepatitis C virus (HCV) infection. More people seeking services in the programs studied in
Connecticut had HCV infection than HIV.
According to the report's Editorial Note, "This study documents the potential
for integrating services to prevent major bloodborne and sexually transmitted
virus infections into existing public HIV CTS [counseling and testing sites].
Risk factors for transmission of these viruses are shared by populations seeking public health services in
such sites. Offering HCV counseling and testing as part of existing programs may attract new clients primarily
interested in hepatitis screening but who also are at risk for and might accept
prevention services for HIV. In addition, HIV CTS can provide hepatitis B vaccination to
persons at increased risk for HBV infection. Because of the well-established infrastructure for HIV counseling and
testing in public health programs, expanding these services to include prevention of HCV and HBV
infection should be feasible. Health-care providers in HIV CTS should be trained to screen actively for risk factors for HIV, HBV,
and HCV and to offer prevention education, counseling, and hepatitis B vaccine to clients with risk
factors. In substance abuse treatment settings, data from Connecticut indicate
that counseling and testing for HIV and HCV should be provided to all clients."
To read the complete text of this report online, including two tables showing
HCV prevalence by injection drug user status and selected characteristics, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5027a2.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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(4)
July 18, 2001
CDC'S NATIONAL IMMUNIZATION PROGRAM RELEASES INFLUENZA VACCINE BULLETIN #4
On July 12, 2001, the National Immunization Program issued the fourth 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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INFLUENZA VACCINE BULLETIN #4
July 12, 2001
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 AND PRODUCTION
Vaccine manufacturers have provided CDC with updated projections and now expect that 77.1 million doses of
influenza will be distributed this season. Some delays in distribution are still anticipated.
- Projected distribution of influenza vaccine for 2001,
based on aggregate manufacturers' estimates as of July 10, is 77.1 million doses, which is greater
than in 2000 and comparable with 1999. By the end of October, 49.8 million
doses will be available for delivery and 27.3 million doses are projected to be
available in November and December. Delays this year are not expected to be
as great as those experienced last season. Nevertheless, officials at FDA and
CDC stress that these are early projections from manufacturers and could
change as the season progresses.
INFLUENZA VACCINE DISTRIBUTION AND ADMINISTRATION
Supplemental influenza recommendations of the Advisory Committee on Immunization Practices will be published in
CDC's Morbidity and Mortality Weekly Report (MMWR) dated July 13, 2001.
- On the basis of current projections, the Advisory
Committee on Immunization Practices (ACIP), is making supplemental recommendations to
promote the administration of influenza vaccine that is available early to
persons at greatest risk of complications from influenza disease (see Influenza Bulletin #2 for summary). When published, these
recommendations can be found at CDC's influenza vaccine website at http://www.cdc.gov/nip/flu
INFLUENZA VACCINE COMMUNICATIONS
The latest information regarding influenza vaccine issues is available on CDC's newly designed website:
http://www.cdc.gov/nip/flu
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(5)
July 18, 2001
NEW CHINESE TRANSLATION OF "SCREENING QUESTIONNAIRE FOR CHILD AND TEEN IMMUNIZATION" ON IAC'S WEBSITE
The current version of IAC's "Screening Questionnaire for Child and Teen Immunization" is now available in Chinese.
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 Chinese translation, go to: http://www.immunize.org/catg.d/p4060-08.pdf
To obtain a copy of the screening questionnaire in English, go to: http://www.immunize.org/catg.d/p4060scr.htm
IAC appreciates the contributions of the State of New York, which generously
provided this new translation.
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(6)
July 18, 2001
NEW TURKISH TRANSLATION OF "SCREENING QUESTIONNAIRE FOR ADULT IMMUNIZATION" ON IAC'S WEBSITE
The "Screening Questionnaire for Adult Immunization" is now available in Turkish translation. This one-page
questionnaire for patients provides 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 screening questionnaire in Turkish, go to: http://www.immunize.org/catg.d/p4065tu.pdf
To obtain it in English, go to: http://www.immunize.org/catg.d/p4065scr.htm
IAC appreciates the contributions of Dr. Mustafa Kozanoglu, pediatrician, and
Dr. Murat Serbest, pediatric hematologist, both in a private pediatric practice
in Adana, Turkey, who generously provided this new translation.
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(7)
July 18, 2001
REMINDER: CDC'S NATIONAL IMMUNIZATION PROGRAM OFFERS COURSE ON VACCINE-PREVENTABLE DISEASES AUGUST 14-15 IN
ATLANTA
Don't miss the August 3 deadline! Register now for "Epidemiology and Prevention of Vaccine-Preventable
Diseases," a two-day course presented by CDC's National Immunization Program (NIP) and scheduled for August 14-15
at the Marriott North Central in Atlanta.
Attendees are expected to bring their own textbook,
"Epidemiology and Prevention of Vaccine-Preventable Diseases" (sixth edition). Also known as
The Pink Book, the text can be ordered for $25 from Public Health Foundation
by calling (877) 252-1200 or visiting its online bookstore at http://bookstore.phf.org/prod154.htm
It can also be downloaded free from CDC's website at: http://www.cdc.gov/nip/publications/pink/
The cost for the course is $38. Hotel information and course registration forms are available online at:
http://www.cdc.gov/nip/ed/epivacaug2001.htm
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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