Issue Number
287 December
21, 2001
CONTENTS OF THIS ISSUE
- Holiday greetings from
IAC!
- CDC publishes Notice to Readers on pneumococcal
conjugate vaccine use during shortage
- CDC publishes article on Arkansas rubella outbreak in
1999
- CDC reports on progress with measles transmission in
Region of Americas
- CDC's National Immunization Program releases influenza
bulletin #11
- Letter on Td supply from Aventis Pasteur
- Seventh International Conference on Needle-free and
Auto Injectors will be held February 25-26
- If your patients ask: New study finds no link between
childhood vaccines and risk of juvenile diabetes
- Early announcement: 2002 United States Conference on
AIDS is set for September
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December 21, 2001
HOLIDAY GREETINGS FROM IAC!
All of us at the Immunization Action Coalition hope you are having a happy and healthy holiday season. Whether you
celebrate Hanukkah, Christmas, Ramadan, Kwanzaa, the solstice, or just Influenza Vaccination Time (!), we
wish you all the best!
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December 21, 2001
CDC PUBLISHES NOTICE TO READERS ON PNEUMOCOCCAL CONJUGATE VACCINE USE DURING SHORTAGE
On December 21, 2001, the Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Updated
Recommendations on the Use of Pneumococcal Conjugate Vaccine in a Setting of Vaccine
Shortage--Advisory Committee on Immunization Practices" in the Morbidity and
Mortality Weekly Report (MMWR).
The Notice reads in part as follows:
******************************
In September 2000, CDC published an interim vaccination schedule recommended by the Advisory Committee on
Immunization Practices (ACIP) to be used during a pneumococcal conjugate vaccine shortage that was
anticipated to be brief. Because the duration of the shortage has been longer
and the severity has been greater than anticipated, ACIP has revised these recommendations
to health care providers who had been advised to conserve vaccine by decreasing the number of doses administered to
healthy infants rather than to leave some infants unvaccinated. For infants who receive their
first dose before age 6 months, vaccination with a maximum of 3 doses is recommended; the fourth dose should be deferred. All
health care providers should reduce the number of vaccine doses used and ordered, regardless of
their current supply, so that vaccine is more widely available until supplies are
adequate. Because of greater-than-expected demand, vaccine has been back ordered for the public sector throughout most of
2001. . . . The manufacturer anticipates the distribution of approximately 1.2 million doses per month
[through] March 2002 and approximately 2.0 million doses per month [through]
mid-2002. Until adequate supplies are available, ACIP recommends [in part--please see the full article for the
full recommendation for supply management] the following: 1. Vaccine should be administered to high-risk
children aged <5 years as recommended by ACIP in October 2000, including
children with sickle cell disease and other hemoglobinopathies; anatomic asplenia; chronic
diseases (e.g., chronic cardiac and pulmonary disease, and diabetes); cerebrospinal fluid leak; human
immunodeficiency virus infection and other immunocompromising conditions;
immunosuppressive chemotherapy or long-term systemic corticosteroid use, and
children who have undergone solid organ transplantation. 2. Healthy infants and children aged <24 months
should receive a decreased number of pneumococcal conjugate vaccine doses on the basis of the age at which
vaccination is initiated and the estimated amount of vaccine available to the
health care provider's practice [see Table 1]. . . .
Table 1. Updated recommendations for pneumococcal conjugate vaccine use among healthy children during
moderate and severe shortages--Advisory Committee on Immunization Practices, 2001*
[Presented as one column to accommodate email programs that do not preserve spaces between multiple
columns.]
------------------------------------------
Recommendation by age at first vaccination during moderate shortage**
------------------------------------------
<6 months
2, 4, 6 months (defer 4th dose)
7-11 months
2 doses at 2-month interval; 12-15 month dose
12-23 months
2 doses at 2-month interval
>24 months
No vaccination
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Recommendation by age at first vaccination during severe shortage**
------------------------------------------
<6 months
2 doses at 2-month interval in 1st 6 months of life
(defer 3rd and 4th doses)
7-11 months
2 doses at 2-month interval (defer 3rd dose)
12-23 months
1 dose (defer 2nd dose)
>24 months
No vaccination
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* A column showing the vaccine schedule for "No shortage" is included in the
table in the full Notice, but only as a reference. Providers should not use the
"No shortage" schedule regardless of their vaccine supply until the national
shortage is resolved.
** "Moderate shortage" is defined in the Notice as an
estimated provider shortfall of <25 percent of the 4-dose infant schedule. "Severe shortage" is
defined in the Notice as an estimated provider shortfall of >50 percent.
3. Health care providers should maintain a list of children for whom conjugate
vaccine has been deferred so that it can be administered when the supply
allows. The highest priority for vaccination among children who have been deferred is infants vaccinated with two doses. . . .
******************************
To obtain the complete text of this Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5050a4.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5050.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 21, 2001
CDC PUBLISHES ARTICLE ON ARKANSAS RUBELLA OUTBREAK IN 1999
On December 21, 2001, the Centers for Disease Control and Prevention (CDC) published "Rubella Outbreak--Arkansas,
1999" in the Morbidity and Mortality Weekly Report (MMWR).
The following is an excerpt from the article:
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On September 7, a pregnant woman aged 23 years presented to a public health clinic in Fort Smith, Sebastian County,
Arkansas, with rash and fever. The woman was from Mexico and had lived in Arkansas for 1 year before
onset of illness. She later delivered a stillborn infant with pathologic findings
compatible with intrauterine rubella infection. The index patient was a household contact of a
Mexican aged 20 years who also was confirmed as infected with rubella by EIA testing. Both patients worked in a
poultry processing plant in Fort Smith. Outbreak investigators interviewed household
and workplace contacts, suspected patients, and potentially exposed pregnant
women and tested them for rubella IgG and IgM antibodies. An additional 10
cases were confirmed by laboratory testing in this and two other counties. . . .
Among the 12 confirmed cases, the median age was 23 years (range: 18-34
years); 10 (83 percent) were Hispanic, nine (75 percent) were foreign-born,
and six (50 percent) were women. All six female patients were pregnant, and
one became infected during the first trimester of pregnancy. Ten (83 percent)
worked in poultry processing plants; the index patient and seven others worked at the same plant in
Fort Smith. Nine of these patients were Hispanic and were foreign-born (Mexico and El Salvador).
Screening of pregnant women for rubella immunity was not part of routine prenatal care in
Arkansas' public health clinics when this outbreak occurred.
Editorial Note: The findings in this report highlight the absence of routine,
recommended prevention and control efforts in the state and the emergence of Hispanic,
foreign-born persons as the main reservoirs of rubella virus in the United States. Prenatal screening followed by
postpartum vaccination against rubella is essential for the control and elimination of congenital rubella
syndrome (CRS). Although recommended by the American College of Obstetricians and Gynecologists and the Advisory Committee
on Immunization Practices, prenatal screening for rubella was discontinued in
Arkansas public health clinics during the early 1980s because of fiscal
constraints. .. . . In the United States, prenatal screening and postpartum vaccination might prevent an estimated 50 percent of all
CRS cases. . . . [The Arkansas Department of Health] has reimplemented routine screening for
rubella immunity in all maternity and family planning clinics.
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To obtain the complete text of this article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5050a3.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5050.pdf
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December 21, 2001
CDC REPORTS ON PROGRESS WITH MEASLES TRANSMISSION IN REGION OF AMERICAS
On December 21, 2001, the Centers for Disease Control and Prevention (CDC) published "Progress Toward Interrupting
Indigenous Measles Transmission--Region of the Americas, January-November 2001" in the
Morbidity and Mortality Weekly Report (MMWR).
The MMWR Press Summary of the article reads as follows:
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A plan developed by the Pan American Health Organization, and implemented
by all member countries in the region, has resulted in record low risk of
measles transmission. Member countries of PAHO reported 423 measles cases to
November 17, 2001 lowing [sic] the previous record of 1,754 in 2000. About 31 percent of these cases were linked to
importation of the disease from other regions in the world. Dominican Republic and Haiti
reported 64 percent of all cases in the region. This success is a result of the
above 90 percent measles vaccination routine coverage achieved among children by 1 year of age since 1999,
combined with successful catch-up and follow up campaigns implemented in the region since 1988. The Western
Hemisphere is close to interruption of endemic transmission of measles. However, worldwide over 800,000
children die each year from measles.
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To obtain the complete text of this Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5050a2.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5050.pdf
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December 21, 2001
CDC'S NATIONAL IMMUNIZATION PROGRAM RELEASES INFLUENZA BULLETIN #11
On December 18, 2001, the National Immunization Program (NIP) issued the 11th in a series of influenza bulletins
designed to update health professionals on the production, distribution, and administration of influenza vaccine for
the 2001-2002 season.
According to this bulletin, the three primary suppliers of influenza vaccine in
the United States project a total production of 87.7 million doses for the year
2001, and 11.5 MILLION DOSES ARE STILL AVAILABLE FOR PURCHASE AND DISTRIBUTION. Manufacturer phone numbers are provided in
the bulletin: Aventis Pasteur (800/822-2463); Wyeth-Ayerst Laboratories (800/358-7443); Henry Schein or its GIV or
Caligor Divisions (800/772-4346, 800/521-7468, 888/225-4467, respectively). In addition, the bulletin gives brief
regional influenza activity information.
To view Influenza Bulletin #11 on NIP's website, go to:
http://www.cdc.gov/nip/Flu/Bulletins/bulletin_11.htm
For previous influenza vaccine bulletins from NIP, go to:
http://www.cdc.gov/nip/Flu/News.htm#Bulletin
The latest information regarding influenza vaccine, as
well as patient education materials to print and use, is available on CDC's website:
http://www.cdc.gov/nip/flu
The latest patient-education flyer on the above website is titled "Is It a Cold,
the Flu, or Anthrax?"
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December 21, 2001
LETTER ON TD SUPPLY FROM AVENTIS PASTEUR
On Monday, December 17, 2001, IAC received the following letter from Phil Hosbach, Executive Director, Public
Business and Immunization Policy Aventis Pasteur. The letter discusses the current supply and recommended
use of tetanus and diptheria toxoids adsorbed for adult use.
Editor's Note: IAC normally does not publish or publicize product-related information of individual pharmaceutical
or other companies. We make this exception in recognition of the fact that currently a critical shortage exists and
Aventis Pasteur is the sole supplier of Td vaccine.
*******************************
Dear health care professional:
This email is being sent to provide your organization, and ultimately your members concerned about immunization, with
an update about the current supply status of Tetanus and Diphtheria Toxoids Adsorbed For Adult Use (Td).
In the coming months we will continue to keep you updated about our efforts to return to a normal Td vaccine supply
through this monthly email notice.
In January 2001, Aventis Pasteur Inc. unexpectedly became the sole remaining national supplier of non-pediatric
tetanus-containing vaccines. We immediately began to work with the Centers for Disease Control and
Prevention (CDC) to manage the available Td doses to ensure that all critical
immunization needs were being met and that tracking of deferred booster doses was implemented. We
also explored various ways to increase Td production capabilities.
The current supply situation requires that all health care providers continue to
follow the May 2001 CDC recommendations, which include deferment of boosters as
well as keeping a record of those patients whose Td boosters have been delayed. As we enter 2002, deliveries
of Td continue to be restricted to emergency care facilities and public health departments. Aventis
Pasteur Inc. anticipates being able to expand distribution of limited amounts of
vaccine to office-based physicians by mid-year 2002. In addition, a return to the routine
booster immunization schedule is anticipated by late summer or early fall 2002.
The ongoing patience and cooperation of health care providers is greatly appreciated during the Td shortage,
and will continue to be critical as we return to a normal Td supply. In order to assist providers in their efforts,
Aventis Pasteur Inc. has developed a Td Tracking Kit that will help identify
which patients need to be called back when routine booster immunizations resume. Starting
January 7, 2002, a complimentary Td Tracking Kit can be ordered online by logging onto the web site
www.vaccineshoppe.com. Full
Prescribing Information for Td, complete CDC recommendations and additional information are also available at the same web site.
Sincerely,
Phil Hosbach
Executive Director
Public Business & Immunization Policy
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December 21, 2001
SEVENTH INTERNATIONAL CONFERENCE ON NEEDLE-FREE AND AUTO INJECTORS WILL BE HELD FEBRUARY 25-26
The International Conference on Needle-free and Auto Injectors will take place
in London, England, on February 25 and 26, 2002. This conference will enhance
participants' ability to develop and use new and future injector products. Topics include mass vaccination
technologies.
To learn more about the conference and to register, go to:
http://www.management-forum.co.uk/meddevices.htm#N2-8002
To contact the conference organizing company, Management Forum, Ltd., email info@management-forum.co.uk
For more information on needle-free injection technology, go to CDC's web page on the subject at:
http://www.cdc.gov/nip/dev/jetinject.htm
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December 21, 2001
IF YOUR PATIENTS ASK: NEW STUDY FINDS NO LINK BETWEEN CHILDHOOD VACCINES AND RISK OF JUVENILE DIABETES
According to an article in the December 2001 issue of Pediatrics (vol. 108,
no. 6), researchers "did not find an increased risk of type 1 diabetes
associated with any of the routinely recommended childhood vaccines." Most previous studies investigating (but also not finding) a
possible link between vaccines and type 1 (juvenile) diabetes were conducted before 1990 and
therefore did not include all of the currently recommended childhood vaccines. A large, population-based study was recently
conducted to provide data on newer vaccines, including hepatitis B, acellular pertussis, and
varicella vaccines. In addition, the new study evaluated the suggested possibility that timing of hepatitis B vaccination could
be related to the risk of diabetes in children.
"Childhood Vaccinations, Vaccination Timing, and Risk of Type 1 Diabetes Mellitus" was written by Frank DeStefano,
M.D., National Immunization Program, Centers for Disease Control and Prevention; John P. Mullooly,
Ph.D., Center for Health Research, Northwest Kaiser Permanente; Catherine A. Okoro, M.S., National Immunization Program;
Robert T. Chen, National Immunization Program; and eight other authors. In the large,
population-based, case-control study, 252 patients with confirmed diabetes (physician's diagnosis plus treatment with daily insulin
injections) were compared with 768 matched control patients. The vaccination histories of
cases and controls were similar. Statistical analysis consisted of conditional
logistic regression to estimate the odds ratio (OR) of diabetes being associated with vaccination (and,
for hepatitis B, with timing of vaccination).
The researchers concluded, "The results of our study and the preponderance of epidemiologic evidence do not support
an association between any of the recommended childhood vaccines and an increased risk of type 1 diabetes.
Suggestions that diabetes risk in humans may be altered by changes in the timing of vaccinations also are unfounded."
To see the complete text of the article on the Pediatrics website, go to:
http://www.pediatrics.org/cgi/content/full/108/6/e112
For a reprint (PDF format) version of the article, go to:
http://www.pediatrics.org/cgi/reprint/108/6/e112.pdf
On a related note, the American Diabetes Association (ADA) has posted its position statement on the use of influenza
vaccine in patients with diabetes on its website. The statement cites and endorses the recommendations of the
Advisory Committee on Immunization Practices (ACIP).
To obtain the ADA statement, "Immunization and the Prevention of Influenza and Pneumococcal Disease in People
with Diabetes," go to: http://www.diabetes.org/clinicalrecommendations/Supplement101/S99.htm
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December 21, 2001
EARLY ANNOUNCEMENT: 2002 UNITED STATES CONFERENCE ON AIDS IS SET FOR SEPTEMBER
The 2002 United States Conference on AIDS will take place September 19-22 at the Anaheim Hilton in Anaheim, CA. The
conference brings together thousands of decision makers and frontline service providers to share
information and insight that will improve service to people living with HIV/AIDS
and help prevent the further spread of AIDS. For more information on the conference and to register
online, go to: http://www.nmac.org
If you have registration questions, contact Paul Woods, Conference Registrar, by phone at (202) 483-6622 (ext.
343), or by email at pwoods@nmac.org
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