Issue Number
272 September
7, 2001
CONTENTS OF THIS ISSUE
- Providers urged to reassess flu vaccine orders, checking
for overestimates, in a letter from Walter A. Orenstein, MD, Director, National Immunization Program
- CDC'S National Immunization Program releases influenza
bulletin #7
- Reminder! CDC's Immunization Update 2001 satellite
broadcast set for September 20
- National Immunization Program issues Q & A for parents
and providers in response to recently published article in New England
Journal of Medicine (August 30, 2001) titled "The Risk of Seizures After Receipt of Whole-Cell
Pertussis or Measles, Mumps, and Rubella Vaccine"
- CDC publishes report on polio eradication efforts in the
South-East Asia Region
- Advance registration deadline approaching for APHA
annual meeting, October 21-25, Atlanta
- Third World Congress on Vaccines and Immunisation set
for June 4-9, 2002, in Opatija, Adriatic Riviera, Croatia
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August 30, 2001
PROVIDERS URGED TO REASSESS FLU VACCINE ORDERS, CHECKING FOR OVERESTIMATES, IN A LETTER FROM WALTER A. ORENSTEIN,
MD, DIRECTOR, NATIONAL IMMUNIZATION PROGRAM
Dr. Orenstein lays out a four-part plan designed to minimize the potential adverse effects of an influenza
vaccine delay this year. His letter is reprinted below in its entirety.
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August 30, 2001
Dear Health Care Provider:
I am writing to ask for your help in maximizing influenza vaccine health benefits and minimizing possible disruptions
due to influenza vaccine distribution delays.
CDC previously encouraged those of you with high risk patients to order vaccine early, to help manufacturers and
distributors gauge demand and improve the opportunity to immunize high risk individuals as early in the
season as possible. We are pleased to learn that many of you followed that advice. Manufacturers have reported that even though
current projections of the total vaccine supply expected for this year exceed that of prior years, all
anticipated influenza vaccine has been obligated much earlier than has previously been the case. (Some vaccine may still be
available from distributors.)
Because orders were placed much earlier this year, we believe that some providers may have over-estimated their
anticipated vaccine needs for the upcoming season and ordered more vaccine than needed. Given the limited
amount of vaccine that will be available prior to November, along with the fact
that vaccination of lower risk individuals should be deferred until November
when supplies should increase, we are now asking that you reassess your needs.
If you find that your influenza vaccine order over-estimates your needs, or if orders were placed with
multiple suppliers, prompt notification of your actual needs to your vaccine providers (i.e., manufacturers or
distributors), will facilitate a broader distribution of vaccine to providers with
high risk patients.
Immunization with influenza vaccine is the best means of preventing serious complications from influenza infection.
During an average influenza season, approximately 20,000 deaths and approximately 114,000 hospitalizations result
from influenza-related complications. Persons at greatest risk from influenza
include those 65 years of age [and older], those in nursing homes, and those
with certain chronic diseases, particularly of the lungs and heart.
Influenza vaccination typically takes place in October through mid November before there is significant influenza
activity. The optimal period for immunization is October through the end of November. Nevertheless, many
persons at high risk of influenza-related complications remain unvaccinated after this time period and vaccination in
December and later can still be beneficial. During the last 19 years, influenza peaked in December during 4
seasons and January or later in 15 seasons.
During the 2001-2002 influenza season, the three influenza vaccine manufacturers are predicting that the overall
number of doses to be produced will be greater than in past years, resulting in about 79 million doses. However,
there will be a substantial delay with 47.8 million doses of vaccine projected to
be distributed by the end of October (60% of projected season totals). Often,
over 99% of vaccine doses are distributed by the end of October. However, current projections indicate the difference this
year will be made up with increased production and distribution of more than 31 million doses in
November and December.
The following plan, based on four primary principles, is designed to minimize
the potential adverse effects of an influenza vaccine delay:
- TARGET USE OF VACCINE AVAILABLE EARLY IN THE SEASON TO
PERSONS AT GREATEST RISK OF COMPLICATIONS FROM INFLUENZA.
This will facilitate vaccination of persons most in need of protection from influenza in the unlikely event of an early
influenza disease epidemic.
- DISTRIBUTE A PORTION OF VACCINE EARLY TO ALL PROVIDERS.
All providers are likely to serve some high-risk patients and having some early vaccine will enable them to vaccinate
at least some of those individuals.
- DEFER VACCINATION OF LOW RISK PERSONS UNTIL NOVEMBER
WHEN VACCINE SUPPLIES SHOULD INCREASE.
Such a step encompasses deferral of vaccine distribution to work site clinics until November since those clinics
largely vaccinate persons at low-risk for influenza complications. It also includes asking persons at
low-risk of influenza-related complications to delay seeking vaccination until November.
- EXTEND THE RECOMMENDED OPTIMAL TIME FOR VACCINATION
FROM OCTOBER THROUGH THE END OF NOVEMBER AND ENCOURAGE CONTINUED VACCINATION THROUGH DECEMBER
AND LATER, AS LONG AS VACCINE IS AVAILABLE.
This will facilitate effective utilization of vaccine that becomes available later in the season and will help
increase vaccination levels in high-risk and targeted populations.
Achieving influenza vaccination goals will require the combined actions of vaccine providers; the public;
manufacturers, distributors, and vendors; and health departments and other organizations providing
vaccine. The participation of all groups who are involved in the spectrum
of influenza immunization activities is essential to the success of the
plan.
For updated information about influenza availability as the season progresses, we urge you to check our website at
http://www.cdc.gov/nip/flu/. We appreciate your efforts to
ensure individuals at high risk of complications from influenza are appropriately
targeted for immunization and thank you for your consideration in this
important public health matter.
Walter A. Orenstein, MD
Assistant Surgeon General
Director
National Immunization Program
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August 31, 2001
CDC'S NATIONAL IMMUNIZATION PROGRAM RELEASES INFLUENZA VACCINE BULLETIN #7
On August 31, 2001, the National Immunization Program (NIP) issued the seventh 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.
To obtain a camera-ready version (PDF file) of bulletin #7, go to: http://www.immunize.org/news.d/flubull7.pdf
For previous influenza vaccine bulletins, visit: http://www.cdc.gov/nip/flu/News.htm#bulletin
The latest information regarding influenza vaccine issues is available on CDC's website:
http://www.cdc.gov/nip/flu/
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September 7, 2001
REMINDER! CDC'S IMMUNIZATION UPDATE 2001 SATELLITE BROADCAST SET FOR SEPTEMBER 20
The Centers for Disease Control and Prevention (CDC) has scheduled Immunization Update 2001, an interactive
satellite videoconference, for September 20, 2001. The broadcast will air twice, from 9 to 11:30 a.m. and
again from 12 to 2:30 p.m., Eastern Time.
The program will offer the latest immunization recommendations and will also
feature a question-and-answer session via toll-free telephone with medical epidemiologists William Atkinson, MD, MPH, and Raymond
Strikas, MD, and nurse educator Donna Weaver, MN, RN, all from CDC's National
Immunization Program. Anticipated topics include pneumococcal conjugate vaccine, influenza
vaccine, the national shortage of tetanus and diphtheria toxoids, meningococcal vaccine, hepatitis B vaccine for
adolescents, global polio eradication, and recent vaccine safety issues.
The target audience includes health professionals such as physicians, nurses,
physician assistants, nurse practitioners, pharmacists, medical students, and
others who provide vaccination and vaccine information. Continuing education
credit will be offered.
For more information on registration and the technical specifications for the
broadcast, go to CDC's website at: http://www.cdc.gov/phtn/imm2001/
or contact your state or county immunization program. A list of state immunization
program satellite broadcast distance learning coordinators is available on the website of CDC's National Immunization
Program at: http://www.cdc.gov/nip/ed/coordinators.htm
For questions about registration, call (800) 418-7246 (800-41-TRAIN).
For questions about the program content of this broadcast, contact Craig Wilkins at (404) 639-8799 or e-mail
ckw4@cdc.gov
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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August 30, 2001
NATIONAL IMMUNIZATION PROGRAM ISSUES Q & A FOR PARENTS AND PROVIDERS IN RESPONSE TO RECENTLY PUBLISHED ARTICLE IN
NEW ENGLAND JOURNAL OF MEDICINE (AUGUST 30,2001) TITLED "THE RISK OF SEIZURES AFTER RECEIPT OF WHOLE-CELL
PERTUSSIS OR MEASLES, MUMPS, AND RUBELLA VACCINE"
William E. Barlow, PhD, and colleagues at the Centers for Disease Control and Prevention Vaccine Safety Datalink
Working Group examined the risk of seizures after the receipt of diphtheria, tetanus, and whole-cell pertussis
(DTP) and measles, mumps, and rubella (MMR) vaccinations. NIP experts provide the following summary of the study:
"Parents concerned about the link between childhood vaccinations and seizures need not worry, according to the
results of this study. The study found that children who suffered rare fever-related seizures after getting DTP
(diphtheria, tetanus, and whole-cell pertussis) and MMR (measles, mumps, and rubella) vaccinations did not have an
increased risk for subsequent seizures or neurodevelopmental (e.g., learning) disabilities. The study
did confirm what was already known--that DTP and MMR vaccinations can temporarily increase the risk for fever-related, or what are called "febrile"
seizures, in some children. Since the period covered by this study, the use of
acellular pertussis (DTaP) vaccine has replaced DTP vaccine in the United States. DTaP has been associated with
fewer side effects than DTP, including febrile seizures."
This summary and the prepared questions-and-answers are available on the NIP website.
To obtain a copy of this summary, go to:
http://www.cdc.gov/nip/issues/mmr-dtp/mmr-dtp.htm
To obtain a copy of NIP's Q & A, go to:
http://www.cdc.gov/nip/issues/mmr-dtp/mmr-dtp-faqs.htm
To read or download a copy of the article abstract (N Engl J Med 2001;345[9]:656-661), go to:
http://content.nejm.org/cgi/content/short/345/9/656
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August 31, 2001
CDC PUBLISHES REPORT ON POLIO ERADICATION EFFORTS IN THE SOUTH-EAST ASIA REGION
The South-East Asia Region of the World Health Organization (WHO) is on the verge of eradicating wild polioviruses,
according to a report published in the August 31, 2001, issue of Morbidity and Mortality Weekly Report
(MMWR). This report summarizes polio eradication activities during January 2000 to June 2001 in the South-East Asia Region,
where wild poliovirus transmission has declined rapidly and is occurring primarily in northern India.
To obtain the full text of this article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5034a3.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5034.pdf
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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September 7, 2001
ADVANCE REGISTRATION DEADLINE APPROACHING FOR APHA ANNUAL MEETING, OCTOBER 21-25, ATLANTA
Pre-registration ends September 14, 2001, for the American Public Health Association
(APHA) annual meeting on October 21-25 in Atlanta.
Featured speakers include Dr. Gro Harlem Brundland, Director-General of the World Health Organization; Rosalyn
Carter, former First Lady; and Dr. Louis Sullivan, former Secretary of Health and Human Services.
For registration materials or further information, call (514) 228-3009, e-mail
APHA@laser-registration.com
or visit the APHA website at http://www.apha.org/meetings/
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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September 7, 2001
THIRD WORLD CONGRESS ON VACCINES AND IMMUNISATION SET FOR JUNE 4-9, 2002, IN
OPATIJA, ADRIATIC RIVIERA, CROATIA
The Third World Congress on Vaccines and Immunisation is being organized by the Infections Control World
Organization under the auspices of the Ministry of Health, Republic of Croatia.
The deadline for closing registration and hotel reservation is February 20, 2002. For registration materials or further
information, e-mail Prof. Dr. Edouard Kurstak at kurstak@sympatico.ca, or visit the Congress at
http://www3.sympatico.ca/kurstak/icwo/
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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