Issue
Number 320
June 24, 2002
CONTENTS OF THIS ISSUE
- ACIP approves
post-9/11 recommendations on the use of smallpox
vaccine
- CDC publishes notice
on replenished Td supply
- New interim MMR
Vaccine Information Statement is now available
- Revised! IAC's
"Summary of Rules for Childhood Immunization"
- CDC reports on polio
eradication in Pakistan and Afghanistan
- CDC announces
National HIV Testing Day on June 27
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June 24, 2002
ACIP APPROVES POST-9/11 RECOMMENDATIONS ON THE USE OF
SMALLPOX VACCINE
On June 20, 2002, one year after issuing general smallpox
(vaccinia) vaccine recommendations, the
Advisory Committee on Immunization Practices (ACIP)
responded to the events of September 11, 2001,
by voting to approve new "supplemental"
recommendations on the use of smallpox (vaccinia)
vaccine.
The Centers for Disease Control and Prevention (CDC) has
posted a six-page document explaining the
supplemental recommendations on its website. The
sections of the document are: Introduction,
Smallpox transmission and
control, Critical considerations, Smallpox vaccines and
VIG [vaccinia immune globulin]
availability, Surveillance, and Recommendations.
The first paragraph of the Introduction reads as follows
(Note: specific wording in this document is
subject to minor change on CDC's website over the
next few days):
*******************************
In June 2001, the Advisory Committee on Immunization
Practices (ACIP) made recommendations for
use of smallpox (vaccinia) vaccine to protect
persons working with Orthopoxviruses, to prepare
for a possible bioterrorism
attack and respond to an attack involving smallpox.
Because of the terrorist attacks in the
fall of 2001, the Centers for Disease Control and
Prevention (CDC) asked the ACIP to review
their previous recommendations for smallpox
(vaccinia) vaccination. As a result of this review, these
supplemental recommendations update those for vaccination
of 1) the general population and 2) persons
designated to respond or care for a suspected or
confirmed case of smallpox. In addition, they
clarify and expand the primary strategy for
control and containment of smallpox in the event
of an outbreak.
*******************************
The complete Recommendations section reads as follows:
*******************************
PRE-RELEASE VACCINATION OF THE GENERAL POPULATION
Under current circumstances, with no confirmed
smallpox, and the risk of an attack assessed as low,
vaccination of the general population is not
recommended, as the potential benefits of vaccination
do not outweigh the risks of vaccine
complications.
Recommendations regarding pre-outbreak smallpox
vaccination are being made on the basis of an
assessment that considers the risks of disease and
the benefits and risks of vaccination. The live
smallpox (vaccinia) vaccine virus can be
transmitted from person to person. In addition to
sometimes causing adverse reactions in
vaccinated persons, the vaccine virus can cause adverse
reactions in the contacts of vaccinated
persons. It is assumed that the risk of serious
adverse events with currently
available vaccines would be similar to those
previously observed and could be higher today due to the
increased prevalence of persons with altered immune
systems.
PRE-RELEASE VACCINATION OF SELECTED GROUPS TO
ENHANCE SMALLPOX RESPONSE READINESS
Smallpox Response Teams
Smallpox vaccination is recommended for persons pre-designated by the
appropriate bioterrorism and public
health authorities to conduct investigation and follow-up
of initial smallpox cases that would
necessitate direct patient contact.
To enhance public health preparedness and response for
smallpox control, specific teams at the
federal, state and local level should be
established to investigate and facilitate the
diagnostic work-up of the initial suspect
case(s) of smallpox and initiate control measures. These
Smallpox Response Teams might include
persons designated as medical team leader, public
health advisor, medical epidemiologists, disease
investigators, diagnostic laboratory scientist,
nurse vaccinators, and security/law
enforcement personnel. Such teams may also include
medical personnel who would assist in the
evaluation of suspected smallpox cases.
The ACIP recommends that each state and territory
establish and maintain at least one Smallpox
Response Team. Considerations for additional teams
should take into account population and
geographic considerations and should be
developed in accordance with federal, state, and local
bioterrorism plans.
Designated Smallpox Healthcare Personnel at Designated
Hospitals
Smallpox vaccination is recommended for selected personnel
in facilities pre-designated to serve as
referral centers to provide care for the initial
cases of smallpox. These facilities would be
pre-designated by the appropriate
bioterrorism and public health authorities, and personnel
within these facilities would be
designated by the hospital.
As outlined in the CDC Interim Smallpox Response Plan and
Guidelines, state bioterrorism response
plans should designate initial smallpox isolation
and care facilities (e.g., type C facilities). In
turn, these facilities
should pre-designate individuals who would care for the
initial smallpox cases. To staff augmented
medical response capabilities, additional
personnel should be identified and trained to care
for smallpox patients.
Implementation of Recommendations
The ACIP recognizes that the implementation of the
supplemental recommendations presented in this
document requires addressing a number of issues,
and that this will take time. The issues include
provider and public education, health care
provider training, availability of vaccine and VIG
[vaccinia immune globulin], developing the
appropriate investigational new drug protocols, screening,
strategies to minimize vaccine wastage,
vaccine adverse event surveillance, and other
logistical and administrative issues.
*******************************
To read the entire CDC document about the new supplemental
smallpox recommendations, go to:
http://www.cdc.gov/nip/smallpox/supp_recs.htm
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June 24, 2002
CDC PUBLISHES NOTICE ON REPLENISHED Td SUPPLY
On June 21, 2002, the Centers for Disease Control (CDC)
published "Notice to Readers: Resumption of
Routine Schedule for Tetanus and Diphtheria
Toxoids" in the Morbidity and Mortality Weekly
Report (MMWR).
The complete text of the Notice reads as follows:
******************************
The supply of adult tetanus and diphtheria toxoids (Td) in
the United States has become sufficient to
permit the resumption of the routine schedule for
Td use as recommended by the Advisory Committee
on Immunization Practices. Adolescents and
adults for whom routine Td booster doses were
deferred should be recalled by their
health-care providers to receive the delayed dose. School
attendance provisions requiring students to
have received a Td booster at age >11 years can be
reinstituted.
The Td shortage began in the last quarter of 2000 and
resulted from 1) decreased production in 2000
by both U.S. manufacturers (Wyeth Lederle
[Pearl River, New York] and Aventis Pasteur [Swiftwater,
Pennsylvania]), 2) the decision by Wyeth
Lederle to cease Td production in 2001, and 3) the
11-month period required for vaccine
production, which led to a lag before increased Td
supplies were available from the remaining
manufacturer distributing vaccine nationally (Aventis
Pasteur). The amount of Td
distributed nationally decreased 40% during
2001-2002, compared with preshortage distribution levels
(Biological Surveillance System, unpublished data, 2002).
To ensure vaccine availability for priority
indications, CDC recommended in May 2001 that all
routine Td boosters in adolescents and adults be
deferred and that health-care providers
record the names of patients whose booster doses
were delayed for call-back once Td supplies are
restored. Health-care providers should review the
vaccination status of their patients and
administer Td and other indicated vaccines as
appropriate.
******************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5124a5.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5124.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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June 24, 2002
NEW INTERIM MMR VACCINE INFORMATION STATEMENT IS NOW
AVAILABLE
The Centers for Disease Control and Prevention (CDC) has
issued a new interim Vaccine Information
Statement (VIS) for Measles-Mumps-Rubella (MMR)
vaccine. Dated 6/13/02, this VIS replaces the
previous one, dated 12/16/98.
The interim MMR VIS reflects the recent reduction in the
recommended waiting period for women to
become pregnant after receiving MMR
vaccine. Previously, women were advised not to
become pregnant for 3 months after
receiving MMR vaccine; now women are advised not to become
pregnant within 4 weeks of receiving MMR
vaccine. (For more information on this
waiting-period recommendation change, see the
December 14, 2001 issue of MMWR at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5049a5.htm)
To obtain a copy of the interim MMR VIS in camera-ready
(PDF) format, use either the following links:
CDC: http://www.cdc.gov/nip/publications/VIS/vis-mmr02int.pdf
IAC: http://www.immunize.org/vis/mmr02int.pdf
To obtain copies of all other VISs, including some in up
to 27 languages, visit IAC's website at:
http://www.immunize.org/vis/
IAC's website also has links to CDC instructions on how to
use VISs and their legal requirements. For
"Vaccine Information Statements: What You
Need to Know," go to:
http://www.immunize.org/vis/instr01.htm
For "Instructions for Use of Vaccine Information Statements,"
go to:
http://www.immunize.org/vis/instr2.pdf
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June 24, 2002
REVISED! IAC'S "SUMMARY OF RULES FOR CHILDHOOD IMMUNIZATION"
The Immunization Action Coalition (IAC) has incorporated
the most current guidelines for vaccinating
children in the widely used two-sided chart,
"Summary of Rules for Childhood Immunization."
Officially revised on June 2, 2002, the chart now includes
language on the new recommendation to
encourage influenza vaccination for young children
(aged 6-23 months) when feasible; a reminder to
consult "The Red Book" regarding hepatitis B
vaccination of preterm infants; and the meningococcal
vaccination recommendation for young
children with risk factors as well as the
recommendation to discuss meningococcal disease,
risk, and vaccine with college students. (This
piece was last updated in
March 2002 to reflect the shorter recommended waiting period
to become pregnant following MMR
vaccination.) The layout of the new "Summary of
Rules for Childhood Immunization" has also been
modified to accommodate the additional information.
To obtain a copy of the new "Summary of Rules for Childhood
Immunization," go to:
HTML: http://www.immunize.org/nslt.d/n17/rules1.htm
PDF: http://www.immunize.org/catg.d/rules1.pdf
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June 24, 2002
CDC REPORTS ON POLIO ERADICATION IN PAKISTAN AND
AFGHANISTAN
On June 21, 2002, the Centers for Disease Control and
Prevention (CDC) published "Progress Toward
Poliomyelitis Eradication--Pakistan and
Afghanistan, January 2000-April 2002" in the
Morbidity and Mortality Weekly Report (MMWR).
According to the article, "Both countries aim to stop
transmission of poliovirus by the end of
2002; however, the unstable security situation in
the region might threaten this success."
The Editorial Note reads in part as follows:
*****************************
Pakistan and Afghanistan constitute a single epidemiologic
block representing one of the three
remaining major global reservoirs for poliovirus
transmission (the other two being northern India
and Nigeria). . . .
Although armed conflict in Afghanistan has posed many
challenges to surveillance and vaccination
activities, data from January-April 2002 indicate
that progress toward eradication has resumed. The
improved quality of SIAs [supplemental
immunization activities] and the addition of
targeted SNID [subnational immunization day]
rounds in Afghanistan before September 2001 appear
to have prevented a widespread resurgence of
poliovirus in the country during the recent
conflict. Despite continuing military
and political instability, public health staff in
Afghanistan and Pakistan succeeded in
implementing NIDs in late September and November
and continued essential surveillance activities. .
. .
In Afghanistan, the new interim administration is
committed to polio eradication, and in Pakistan,
political commitment from the newly formed
district governments to the federal government is
high. Close collaboration
between local governments and their global partners has
been critical in sustaining eradication
activities in both countries and will continue to
be essential to achieve polio eradication.
*****************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5124a1.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5124.pdf
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June 24, 2002
CDC ANNOUNCES NATIONAL HIV TESTING DAY ON JUNE 27
The Centers for Disease Control and Prevention (CDC)
announced in a Notice to Readers in the June
21, 2002, issue of Morbidity and Mortality
Weekly Report (MMWR) that Thursday, June 27 is
National HIV Testing Day.
The complete text reads as follows:
*******************************
The National Association of People with AIDS will sponsor
the eighth annual National HIV Testing Day
on June 27. Testing Day is a nationwide campaign
promoting human immunodeficiency virus (HIV)
education and voluntary HIV counseling,
testing, and referral to encourage persons at risk
for HIV infection to know their status and to
reduce their risks for HIV transmission.
Public health departments and other partners are
encouraged to support community HIV education and
testing efforts during June 23--29.
Activities can include sponsoring mobile HIV
counseling, testing, and referral
units; participating in health fairs at which HIV
education, counseling, testing, and referral
services are offered; and partnering with
local media to promote HIV prevention and testing
messages.
Additional information about HIV counseling, testing, and
referral services is available at
http://www.hivtest.org.
*******************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5124a1.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5124.pdf
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