Issue
Number 313
May 20, 2002
CONTENTS OF THIS ISSUE
- CDC publishes new
guidelines for treatment of sexually transmitted
diseases
- Institute of
Medicine report addresses lower-quality health
care among minorities
- Last call for
abstracts for Hepatitis Coordinators
Conference--deadline May 31
- Hepatitis Foundation
International CD assists listeners with "Sorting
Out the Diagnostics"
- World Health
Organization publishes position paper on rabies
vaccination
- CDC updates
guidelines for using antiretroviral agents in
HIV patients
- Watch for an IAC
DOUBLE EXPRESS later this week for news on
public smallpox forums to be held in June
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May 20, 2002
CDC PUBLISHES NEW GUIDELINES FOR TREATMENT OF SEXUALLY
TRANSMITTED DISEASES
On May 10, 2002, the Centers for Disease Control and
Prevention (CDC) published "Sexually
Transmitted Diseases Treatment Guidelines 2002" in
the Morbidity and Mortality Weekly Report
(MMWR) Recommendations and Reports Series
(vol. 51, no. RR-6). This is the first update to these
guidelines since 1998. Although treatment is emphasized,
diagnosis and prevention also are discussed.
The section titled "Vaccine-Preventable
STDs" covers hepatitis A and hepatitis B
incidence, exposure, transmission, incubation,
diagnosis, prevention, pre- and post-vaccination serologic
testing, and treatment.
The introduction to the section on vaccine-preventable
STDs reads as follows:
*******************************
The most effective means to prevent transmission of
infectious diseases, including STDs, is through
preexposure immunization. Vaccines are available for
prevention of HAV and HBV, both of which can
be transmitted sexually. Vaccines are under
development or are undergoing clinical trials for
other STDs, including
HIV, HPV, and HSV; however, current efforts regarding
vaccination focus largely on integrating
use of currently available vaccines into STD
prevention and treatment activities.
Every person seeking treatment for an STD should be
considered a candidate for hepatitis B
vaccination, and some persons (e.g., MSM and
injection-drug users) should be considered for
hepatitis A vaccination. Evaluation for
vaccination is most effectively done through a screening
and education process that both inquires
about risk factors for infection (e.g., sex
partners and use of illegal drugs),
educates patients about the importance of
vaccination, and excludes persons who are not candidates
for vaccination (e.g., laboratory confirmed diagnosis of
infection and previous vaccination).
Although it is uncommon, patients may present with signs,
symptoms, or laboratory findings of acute or
chronic viral hepatitis. When this occurs,
a precise diagnosis must be made and appropriate
clinical services provided, including
postexposure immunization of contacts and medical
referral.
*******************************
To obtain the complete text of the report online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5106a1.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5106.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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May 20, 2002
INSTITUTE OF MEDICINE REPORT ADDRESSES LOWER-QUALITY
HEALTH CARE AMONG MINORITIES
The Institute of Medicine (IOM), at the urging of Congress,
embarked on a year-long study of the extent
of those racial and ethnic differences in the
quality of health care received by patients in the
United States that cannot be accounted for
by known factors such as inability to make insurance co-payments
and access to care. The final report of this
study was released in March.
"Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care" documents disparities in
testing and treatment for cardiovascular disease, cancer,
diabetes, stroke, and HIV/AIDS, among other
illnesses. The report assesses potential causes of
disparities and potential solutions.
Immunization is mentioned or discussed in chapters on Data
Collection and Monitoring, the Rationing of
Health Care for American Indians/Alaska Natives,
and the Civil Rights Dimension of Racial and
Ethnic Disparities in Health
Status.
"Unequal Treatment: Confronting Racial and Ethnic
Disparities in Health Care" is currently available for
reading or downloading on the website of the National
Academy Press (NAP), which is publishing the
report in book form. For the table of
contents with chapter links, go to:
http://www.nap.edu/books/030908265X/html/
To order a copy of the forthcoming book "Unequal
Treatment: Confronting Racial and Ethnic Disparities
in Health Care" ($35.96 if purchased
online) or a prepublication manuscript version
($40 if purchased online), go to:
http://www.nap.edu/catalog/10260.html
For more information, call the National Academy Press at
(800) 624-6242.
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May 20, 2002
LAST CALL FOR ABSTRACTS FOR HEPATITIS COORDINATORS
CONFERENCE--DEADLINE MAY 31
The Hepatitis Coordinators Conference, to be held January
27-30, 2003, in San Antonio, Texas, will be
organized around topic categories that focus on
viral hepatitis prevention, treatment, counseling,
and testing.
Conference planners are still accepting abstracts for
presentations and workshops that "demonstrate
effective implementation of programs" in one of the five
categories listed in the official Call for Abstracts.
These categories are, briefly, special populations;
program administration issues; working in health-related
settings; surveillance; and outreach.
The deadline for abstract submission for the Conference is
Friday, May 31, 2002.
To obtain a copy of the Call for Abstracts and the
Abstract Format instructions, go to:
http://www.immunize.org/news.d/abstract.pdf
For more information on the Hepatitis Coordinators
Conference as it becomes available, visit IAC's
Calendar of Events page at:
http://www.immunize.org/calendar
You may also direct questions to Valerie Curry, CDC
Division of Viral Hepatitis, by email at
vcc0@cdc.gov
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May 20, 2002
HEPATITIS FOUNDATION INTERNATIONAL CD ASSISTS LISTENERS
WITH "SORTING OUT THE DIAGNOSTICS"
The Hepatitis Foundation International (HFI) has produced
"Hepatitis B: Sorting Out the Diagnostics," an
audio CD that outlines the diagnostic
process for hepatitis B, covering laboratory
tests, serology, and more. Discussion
of case studies helps consolidate the information
provided. Speakers on the hour-long
CD are Harold Margolis, M.D., Centers for Disease
Control and Prevention (CDC); Anna Lok, M.D.,
University of Michigan Medical School;
Raymond S. Koff, M.D., University of Massachusetts
Memorial Medical Center; Christine J. Bruno, M.D.,
S.E. Permanente Medical Group; and R. Palmer
Beasley, M.D.,
University of Texas School of Public Health.
HFI President Thelma King Thiel says, "Our goal here is to
help the primary care doctors pre-screen
more effectively, avoid running up costs by
choosing the correct lab tests, refer to
specialists more appropriately, and better cope
with their patients on a human level."
The cost of the CD is $6.00. To order "Hepatitis B:
Sorting Out the Diagnostics," call (800) 891-0707 or
fax (973) 857-5044.
For more information about HFI, go to:
http://www.hepfi.org
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May 20, 2002
WORLD HEALTH ORGANIZATION PUBLISHES POSITION PAPER ON
RABIES VACCINATION
The World Health Organization (WHO) has published a new
position paper on rabies vaccines in the
Weekly Epidemiological Record (WER) (vol. 14, no.
77). WHO position papers offer an important
perspective on global disease epidemiology
and vaccine use for all vaccinators.
The WHO Rabies Vaccines Position Paper reads in part as
follows:
******************************
It is estimated that each year at least 50,000 people die
from rabies, and more than 10 million receive
post-exposure vaccination against this disease. Children aged
5-15 years are at particular risk. More
than 99% of all human deaths from rabies occur in
Asia, Africa and South America; India alone
reports 30,000 deaths annually. . . .
In about 100 countries, rabies is enzootic in both wild
and domestic animals and poses a potential threat
to a considerable proportion of the more
than 2.5 billion people living in these areas.
Some island states such as
Iceland, Japan and the United Kingdom, and European states
such as Belgium, Finland, France, Greece,
Norway, Portugal, Spain, Sweden and Switzerland,
are now considered free of rabies.
Until 1995, Australia was considered to be
rabies-free, but in 1996 a rabies-related
lyssavirus (type 7) was discovered in flying
foxes, a bat species. . . .
Among human infections, rabies is believed to be the tenth
most common cause of death. Once clinical
symptoms have occurred, the disease is almost
invariably fatal. However, reporting is often
incomplete and the estimated 50,000
deaths per year may be an underestimate.
******************************
To obtain a copy of the WHO Rabies Vaccines Position Paper
in WER online, go to:
http://www.who.int/wer/pdf/2002/wer7714.pdf
The Immunization Action Coalition (IAC) is compiling a web
page of the WHO vaccine position papers. We
will announce the quick link to this page in the
summer in IAC EXPRESS.
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May 20, 2002
CDC UPDATES GUIDELINES FOR USING ANTIRETROVIRAL AGENTS IN
HIV PATIENTS
On May 17, 2002, the Centers for Disease Control and
Prevention (CDC) published "Guidelines for
Using Antiretroviral Agents Among HIV-Infected
Adults and Adolescents: Recommendations of the
Panel on Clinical
Practices for Treatment of HIV" in the Morbidity and
Mortality Weekly Report (MMWR)
Recommendations and Reports Series (vol. 51, no.
RR-7). This report updates the 1998 guidelines.
To obtain the text of the report online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5107a1.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5107.pdf
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May 20, 2002
WATCH FOR AN IAC DOUBLE EXPRESS LATER THIS WEEK FOR NEWS ON
PUBLIC SMALLPOX FORUMS TO BE HELD IN JUNE
The recent effort to build stores of smallpox vaccine,
spurred by concerns about a possible risk of
deliberate smallpox release by terrorists,
has generated national dialogue on the current
recommendations for the use of smallpox
vaccine. The Advisory Committee on Immunization
Practices (ACIP) and the National Vaccine Advisory
Committee (NVAC) are reviewing the current
recommendations with the aim of developing
additional recommendations for the use of smallpox
vaccine "both pre-event and, should an
event actually occur, post-exposure," according to a
bulletin posted by the Centers for Disease
Control and Prevention (CDC). The recommendations
are expected in late
June.
As part of its recommendations review process, the
ACIP-NVAC smallpox workgroup is inviting
comments and suggestions from health care
professionals, emergency responders, and all
interested or potentially affected
people on the use of smallpox vaccine. This includes the
general public.
Public forums on smallpox vaccine will be held on June 6
in San Francisco and New York and on June 8
in St. Louis and San Antonio. Times and exact
locations will be announced later this week in a
special IAC Double Express issue, as
well as the public comment webpage address on CDC's web site
when it becomes available.
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