Issue
Number 300
March 11, 2002
CONTENTS OF THIS ISSUE
- CDC publishes Notice to Readers on
varicella and MMR vaccine shortages and interim
recommendations
- CDC's National Immunization
Program releases important news on influenza
vaccine for the 2002-2003 season
- New guidelines on mixing schedules
of single-antigen hepatitis vaccines and a
combination vaccine are
available on CDC's website
- IAC creates Pneumococcal Conjugate
Information web page
- Recommended reading: "Living with
Hepatitis B: A Survivor's Guide"
- Second B Informed Conference will
be held June 28-29 in Doylestown, Pennsylvania
- CDC promotes "Increasing Adult
Vaccination Rates: WhatWorks" CD-ROM
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March 11, 2002
CDC PUBLISHES NOTICE TO READERS ON VARICELLA AND MMR
VACCINE SHORTAGES AND INTERIM
RECOMMENDATIONS
On March 8, 2002, the Centers for Disease Control and
Prevention (CDC) published "Notice to
Readers: Shortage of Varicella and Measles, Mumps
and Rubella Vaccines and Interim
Recommendations from the Advisory Committee on
Immunization Practices" in the Morbidity and
Mortality Weekly Report (MMWR). Because
this topic currently affects the ability of health
care providers nationwide to offer
immunization services, IAC is presenting this Notice to
you in full.
The Notice to Readers, excluding references, reads as
follows:
*******************************
A temporary shortage of varicella (VARIVAX) and combined
measles, mumps and rubella (MMR) (M-M-R II) vaccines in
the United States has resulted from two voluntary
interruptions to manufacturing operations
by Merck & Co., Inc., the only U.S. manufacturer
of these products. One interruption was
attributed to modifications Merck made
voluntarily in response to issues raised by the U.S. Food
and Drug Administration (FDA) during a
routine Good Manufacturing Practices inspection.
The other was the result
of scheduled modifications made to the
manufacturer's facility, which took longer than
expected to be completed and had a substantial
impact on production during September-October
2001. Following the interruptions
of production, vaccine supply rapidly declined at the end
of 2001. [VARIVAX and M-M-R II are
registered trademarks.]
VARICELLA VACCINE
Although the duration of the varicella vaccine shortage is
uncertain, Merck predicts that the shortage will
be resolved by late spring or early summer
2002. The annual need for varicella vaccine in the
United States is about 6
to 7 million doses or 500,000-583,000 doses per month.
Because of supply decreases, by March 4,
approximately 1.1 million doses were on back order
for both public and private
sectors. Merck estimates an average of 60 days to
fill these orders. Meanwhile, shortages are expected
nationwide.
Interim ACIP Recommendations for Use of Varicella Vaccine
Varicella is a more severe disease among adolescents and
adults; however, the highest incidence of
disease is among elementary school aged children.
Until adequate supplies of varicella vaccine are
available, ACIP recommends that all vaccine
providers in the United States delay
administration of the routine childhood varicella
vaccine dose from age 12-18 months until age 18-24
months. If the shortage
persists after delaying the dose at age 12-18
months and is of sufficient severity that further
prioritization of vaccine use is needed, recommendations
for use (highest to lowest priority) of Varivax
for susceptible persons are:
- Vaccination of health care workers, family
contacts of immunocompromised persons,
adolescents aged 13 years or
older, and adults and high-risk children (e.g., children
infected with human
immunodeficiency virus and children with asthma
or eczema).
- Vaccination of susceptible children aged
5-12 years, particularly children entering
school and adolescents aged
11-12 years. States may elect to provide guidance on
priority cohorts for vaccination.
- Vaccination of children aged 2-4 years.
Within this age group, states may elect to
provide guidance on priorities
(e.g., children attending child care centers) for
vaccination.
MEASLES, MUMPS AND RUBELLA VACCINE
Although the duration of the shortage is uncertain, the
manufacturer predicts that problems with the
MMR vaccine supply should be resolved in
1-3 months. The annual need for MMR vaccine in the
United States is about 13 million
doses. The average number of MMR doses shipped during
January-September 2001 was 943,000 doses; during October-November
2001, an average of 586,000 doses was shipped;
during December 2001-February 2002, an average of 819,000
doses was shipped each month. As of March
4, a total of 1,077,670 doses was on back order
for both the public and private
sectors. As of February 28, 2002, the manufacturer
projects that 5.6 million doses will be supplied
during March-May 2002.
Interim ACIP Recommendation for Use of MMR Vaccine
Two doses of MMR vaccine, separated by at least a month
and administered on or after the first
birthday, are recommended for children,
adolescents, and adults who lack adequate
documentation of vaccination or other acceptable
evidence of immunity. The first dose is recommended at age
12-15 months and the second dose at age 4-6
years. If providers are unable to obtain
sufficient amounts of MMR
vaccine to implement fully ACIP recommendations for MMR
vaccination, ACIP recommends that they
defer the second MMR dose. Because of the severity
of measles in young children, providers
should not delay administration of the
first dose of the MMR series.
Tracking and Recall
Records should be maintained for children who experience a
delay in administration of either varicella
or MMR vaccines so they can be recalled when
vaccine becomes available. The latest information
about vaccine supply issues is available at:
http://www.cdc.gov/nip/news/shortages
*******************************
To obtain the complete text of the Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5109a6.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5109.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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March 11, 2002
CDC'S NATIONAL IMMUNIZATION PROGRAM RELEASES IMPORTANT
NEWS ON INFLUENZA VACCINE FOR THE 2002-2003 SEASON
On February 26, 2002, the National Immunization Program
(NIP) issued the first of this year's annual series of
influenza bulletins. Although it may seem too early to
think about the next flu season when the current one is
not yet over, now really is the time to start planning how
to reach the target populations in your practice--and the
time to order enough vaccine for them.
Influenza Bulletin #1 describes upcoming changes to
current influenza vaccination recommendations, including
"prioritizing" efforts in October and November and
"encouraging" vaccination of healthy children under 2
years of age and the adults who work and/or live with
them. The bulletin also suggests that providers order
influenza vaccine soon and gives company phone numbers and
other ordering information.
Following is the entire section from Influenza Bulletin #1
on "Influenza Vaccine Distribution and Administration":
*******************************
THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)
HAS VOTED ON INFLUENZA RECOMMENDATIONS FOR THE 2002-03
SEASON. THESE RECOMMENDATIONS WILL BE PUBLISHED IN A
FUTURE ISSUE OF CDC'S MMWR. THE MAJOR CHANGES ARE AS
FOLLOWS:
The ACIP voted to prioritize vaccination efforts in
October to target persons at high risk of complications
from influenza and health care workers. In addition,
because children under 9 years of age who are receiving
vaccine for the first time need a booster dose one month
after the initial dose, children between 6 months of age
and 9 years of age receiving influenza vaccine for the
first time should begin vaccinations in October. All other
groups, including household members of high-risk persons,
healthy persons 50-64, and others who wish to decrease
their risk of influenza infection should begin vaccination
in November. This strategy was initiated during the last
two influenza seasons because of significant vaccine
distribution delays and is being continued for the 2002-03
influenza season because of the possibility of similar
situations in future years and to provide continuity in
the recommendations.
In addition, the committee voted to "encourage when
feasible" influenza vaccination for healthy children aged
6 months to 23 months because children in this age group
are at substantially increased risk for influenza-related
hospitalizations. A recommendation to annually vaccinate
healthy children aged 6 months to 23 months is expected
within the next one to three years. For many years, the
committee has recommended vaccination of children 6 months
and older who have high-risk medical conditions, such as
asthma, diabetes mellitus and heart disease. High-risk
children 6 months and older continue to be strongly
recommended for annual vaccination.
Household contacts and out-of-home caregivers of children
0-23 months of age are also now encouraged to receive
influenza vaccine in order to decrease the risk of
contacts transmitting influenza virus to these children.
Vaccination of contacts of children less than 6 months old
is particularly encouraged since children less than 6
months of age cannot be vaccinated against influenza and
are the pediatric age group at greatest risk of influenza-related hospitalization.
HEALTH CARE PROVIDERS SHOULD ORDER INFLUENZA VACCINE FOR
THE 2002-03 INFLUENZA SEASON AS SOON AS POSSIBLE.
In 2001, the entire U.S. supply of influenza vaccine was
prebooked before the end of May. Thus, early ordering is
essential for those wishing to ensure timely receipt of
vaccine. Health care providers, distributors and vendors
who are seeking influenza vaccine for 2002-03 should contact
Aventis Pasteur at 1-800-822-2463 [taking orders beginning
March 4-18 online only at http://www.vaccineshoppe.com
and after March 18 by phone, online, or fax (800) 561-1216].
Evans Vaccines through Henry Schein or its GIV or Caligor
Divisions at 1-800-772-4346 or 1-800-521-7468 (currently
taking orders).
Wyeth-Ayerst Labs at 1-800-358-7443 (taking orders
sometime in March). Many other distributors and vendors
may also be taking orders.
*******************************
To read Influenza Bulletin #1 on NIP's website, go to:
http://www.cdc.gov/nip/Flu/Bulletins_2002-03/bulletin_1.htm
To see previous bulletins from the series, go to:
http://www.cdc.gov/nip/Flu/News.htm#Bulletin
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March 11, 2002
NEW GUIDELINES ON MIXING SCHEDULES OF SINGLE-ANTIGEN
HEPATITIS VACCINES AND A COMBINATION VACCINE ARE AVAILABLE
ON CDC'S WEBSITE
The Division of Viral Hepatitis at the Centers for Disease
Control and Prevention (CDC) has posted an article titled
"Twinrix: Combined Hepatitis A and Hepatitis B Vaccine" on
CDC's website. (Twinrix is a registered trademark.) The
web-page article covers general information about this
combination vaccine and specific dosing schedules.
Of special interest for health care providers is new
information on mixing schedules--that is, administering
doses of Twinrix and/or doses of single-antigen hepatitis
A and hepatitis B vaccine to complete a patient's
vaccination series. Readers should note that, according to
the article, "In general, it is best to start and finish a
series with the same vaccine formulation, using the
licensed dosage and schedule." The mixed-schedule
information is intended to help guide decision making
regarding whether patients "who have received mixed
schedules that include Twinrix need further vaccinations
to complete the series."
To read "Twinrix: Combined Hepatitis A and Hepatitis B
Vaccine," go to:
http://www.cdc.gov/ncidod/diseases/hepatitis/twinrix.htm
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March 11, 2002
IAC CREATES PNEUMOCOCCAL CONJUGATE INFORMATION WEB PAGE
The pneumococcal conjugate vaccine (PCV7, or Prevnar) was
licensed in February 2000 to prevent infection from
Streptococcus pneumoniae (pneumococcus), which remains the
most frequent cause of childhood pneumonia, bacteremia,
sinusitis, and acute otitis media. In the United States,
S. pneumoniae causes approximately 17,000 cases per year
of invasive disease in children under age 5 years,
including 700 cases of meningitis and 200 deaths.
Now you can find sources of information that address your
PCV7 questions on IAC's one-stop web page devoted to the
subject. This page currently features 20 links to journal
articles; CDC recommendations; case histories; photos; and
vaccine shortage information.
To visit IAC's new Pneumococcal Conjugate Information web
page, go to:
http://www.immunize.org/pneumoconj/
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March 11, 2002
RECOMMENDED READING: "LIVING WITH HEPATITIS B:
A SURVIVOR'S GUIDE"
"LIVING WITH HEPATITIS B: A SURVIVOR'S GUIDE" is an
excellent new book that can be read not just by people
diagnosed with hepatitis B, but also by noninfected people
in high-risk groups and even interested members of the
general public who like to learn about health issues.
(After all, who would not benefit from the chapter
"Learning about Your Liver: Your Body's Chemical
Factory"?) Of course, the book is intended primarily for
the nearly 1.25 million Americans who have chronic
hepatitis B and their families and friends. This book will
help them live--and live well--with their illness.
"LIVING WITH HEPATITIS B" was written by Gregory T.
Everson, M.D., F.A.C.P., Director of Hepatology,
University of Colorado Health Sciences Center, and Hedy
Weinberg, award-winning writer and hepatitis B patient.
The authors cover hepatitis B in history, early warning
symptoms, diagnosis, emotional effects of the disease,
nutrition, liver transplants, the hepatitis B vaccine, and
more. Hatherleigh Press, an affiliate of W.W. Norton,
accurately promotes the 303-page book as "a comprehensive
handbook written in understandable language."
For more information about "LIVING WITH HEPATITIS B,"
go to:
http://www.hepatitisonline.com
For information from the book's publisher, go to:
http://www.hatherleighpress.com
"LIVING WITH HEPATITIS B: A SURVIVOR'S GUIDE" is available
through most bookstores and retails for $15.95. Group
purchases can be made by calling (800) 528-2550.
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March 11, 2002
SECOND B INFORMED CONFERENCE WILL BE HELD JUNE 28-29 IN
DOYLESTOWN, PENNSYLVANIA
The B Informed 2002 Conference, sponsored by the Hepatitis
B Foundation and the Hepatitis B Information and Support
List, will take place June 28-29 at Delaware Valley
College, Doylestown, Pennsylvania. It is the "second
gathering of HBV friends."
The registration fee for B Informed is $60 for the first
participant and just $30 for family members and friends of
that participant. This fee includes everything--lodging in
the College dormitories, meals, a mug, and all
programming.
Doc Misra will present on the topic "Integrating the HBV
Knowledge of West and East." Other presentation topics
will include vaccine therapy, health insurance rights, and
treatment of patients with hepatitis B virus mutations.
For more information on B Informed 2002, email Steve Bingham
at srb@rmci.net or Sheree Martin at
martins@zoomnet.net
or call Steve Bingham at (208) 342-3945.
To learn about other conferences and seminars related to
immunization and hepatitis B, visit IAC's online Calendar
of Events at: http://www.immunize.org/calendar/
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March 11, 2002
CDC PROMOTES "INCREASING ADULT VACCINATION RATES:
WHATWORKS" CD-ROM
On March 8, 2002, the Centers for Disease Control and
Prevention (CDC) published "Notice to Readers:
Availability of Continuing Education CD-ROM Program on
Strategies to Increase Adult Vaccination Rates" in the
Morbidity and Mortality Weekly Report (MMWR).
Following is the entire Notice to Readers:
*******************************
The Association of Teachers of Preventive Medicine (ATPM)
and the National Immunization Program (NIP)/CDC have
released "Increasing Adult Vaccination Rates: WhatWorks,"
an interactive instructional program on CD-ROM that offers
primary-care providers strategies to increase vaccination
rates among their adult patients.
The program gives users the opportunity to test their
knowledge of vaccine usage and explore facts about
vaccine-preventable diseases; access reference materials
and answers to frequently asked questions; review
information about effective strategies (e.g., standing
orders, chart reminders, and mailed/telephoned reminders)
and test their knowledge of how to best implement these
strategies; and develop a customized adult vaccination
action plan for their practice.
The CD-ROM features web links to appropriate resources,
predominantly those on the NIP/CDC Web site. The program
is approved for 2 hours of Continuing Medical Education
credit, 2.3 hours Continuing Nursing Education credit, and
0.2 hours Continuing Education units through CDC.
WhatWorks can be ordered free of charge through ATPM at
http://www.atpm.org Additional information is available
through ATPM, telephone (800) 789-6737, or by email at
whatworks@atpm.org
*******************************
To obtain the complete text of the Notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5109a7.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5109.pdf
IAC announced this CD-ROM in IAC EXPRESS #280, which can
be found at:
http://www.immunize.org/genr.d/issue280.htm
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