Issue Number 331            August 19, 2002

CONTENTS OF THIS ISSUE

1. Latest issue of VACCINATE ADULTS! is live on the web
2. Updated! Pharmacy Vaccination Mandates page on IAC's website
3. New language! IAC now offers Vaccine Information Statements in Polish
4. Coming up: Immunization Registry Conference will take place October 28-30 in Philadelphia
5. Vaccine Education Center symposium is set for the morning of September 14
6. PEDIATRICS article says fewer foreign-born children in U.S. get all needed doses of three vaccines
7. CDC finds inconsistent Hib serotyping by state health departments in surveillance study

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August 19, 2002
LATEST ISSUE OF VACCINATE ADULTS! IS LIVE ON THE WEB

You're just a click away from the Summer 2002 issue of "VACCINATE ADULTS!", IAC's special bulletin for adult medicine specialists. Hard copies of "VACCINATE ADULTS!" have been mailed.

The 16-page Summer issue contains the most current information and resources on immunization for clinicians who provide this essential preventive service to their patients. "VACCINATE ADULTS!" is not merely a valuable publication; it's also an accessible publication. For the past six years, IAC has offered "VACCINATE ADULTS!" free of charge to public and private immunizers who specialize in the health care of adults. Unfortunately, this year IAC lost some of its traditional funding and has had to cut back publication distribution. Please take a moment to read IAC Executive Director Deborah Wexler's request for financial support on the back page of "VACCINATE ADULTS!"

Every word in "VACCINATE ADULTS!" is reviewed for technical accuracy by national immunization specialists at the Centers for Disease Control and Prevention (CDC). In the "Ask the Experts" column, these specialists cover practical topics about how and when to vaccinate that often get overlooked.

Have you heard conflicting instructions on the use of Vaccine Information Statements (VISs) in your practice? Copy and post IAC's "The Truth about Using VISs" from "VACCINATE ADULTS!" to eliminate confusion and make sure all your vaccine recipients are properly informed vaccine recipients.

There's much more, as you'll see when you access "VACCINATE ADULTS!" articles and charts on the web in one of the following three ways:

1. You can download the entire issue from the web, but be aware that the PDF file of the issue is large (488,821 bytes), and some printers cannot print a file of that size. For helpful tips on downloading and printing PDF files, go to: http://www.immunize.org/nslt.d/tips.htm
    
   If you are ready to download a PDF-format, camera-ready copy of the entire issue of "VACCINATE ADULTS!", go to: http://www.immunize.org/va/va9.pdf
      
2. You can view selected articles (HTML or PDF format) by clicking on links from the table of contents at: http://www.immunize.org/va/index.htm
    
3. Finally, you can simply click on the following links to individual pages of "VACCINATE ADULTS!" Choose between HTML and PDF versions.
    
   a) "Ask the Experts"
   CDC immunization expert William Atkinson, M.D., M.P.H., answers general immunization questions. Hepatitis specialists Stephen C. Hadler, M.D., and Linda A. Moyer, R.N., answer hepatitis questions.
   
   HTML: http://www.immunize.org/va/va9exprt.htm
   PDF: http://www.immunize.org/va/va9exprt.pdf
     
   b) "Vaccine Highlights"
   News from the past half-year is featured here for your review.
   
   HTML: http://www.immunize.org/va/va9vac.htm
   PDF: http://www.immunize.org/va/va9vac.pdf
    
   c) "How to Administer IM and SC Injections"
   Two full-page charts show and tell how to give intramuscular (IM) and subcutaneous (SC) injections. They are a great training tool. Use these to make sure your staff vaccinators are giving shots correctly. Adapted from similar charts by the Minnesota Department of Health.
   
   PDF only: http://www.immunize.org/catg.d/p2020.pdf
    
   d) "Hepatitis B Facts: Testing and Vaccination"
   Now, on one page, you can find answers to these questions: Who needs hepatitis B vaccine? Who needs serologic testing? Plus hepatitis B lab nomenclature and interpreting the hepatitis B results panel.
   
   HTML: http://www.immunize.org/catg.d/p2110.htm
   PDF: http://www.immunize.org/catg.d/p2110.pdf
    
   e) "Unprotected People: Young Doctor Learns He Has Liver Cancer Too Late"
   This story about a young doctor's death from hepatitis B-related liver cancer is a tragic example of the consequence of inadequate medical attention to people with chronic hepatitis B.
    
   HTML: http://www.immunize.org/va/va9story.htm
   PDF: http://www.immunize.org/va/va9story.pdf
     
   f) "Vaccine Refrigerator/Freezer Temperature Log"
   We have adapted this Fahrenheit temperature log from the Michigan Department of Community Health. Once you try using it, you'll make a habit of it--which is, of course, the point! This log makes recording temperatures easy.
   
   PDF only: http://www.immunize.org/catg.d/p3039.pdf
    
   g) "The Truth About Using VISs"
   Too many health professionals remain unsure about how and when to give vaccine recipients a Vaccine Information Statement (VIS). This sheet was created to answer the "to give, or not to give" question both simply and clearly.
   
   HTML: http://www.immunize.org/catg.d/p2028.htm
   PDF: http://www.immunize.org/catg.d/p2028.pdf
   
   h) "Influenza VIS" (for 2002-2003 season)
   Straight from the National Immunization Program within CDC, this is an official Vaccine Information Statement that you can photocopy and give to all of your patients this flu season.
     
   PDF only: http://www.immunize.org/vis/2flu.pdf
     
   i) "IAC Adult Resources"
   New books, booklets, websites, CD-ROMs, and organization contacts.
    
   PDF only: http://www.immunize.org/va/catalog.pdf
     
   j) "IAC Needs Your Support: Letter from the Director"
   Immunization Action Coalition needs contributions!
    
   HTML: http://www.immunize.org/va/va9back.htm
   PDF: http://www.immunize.org/va/va9back.pdf

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August 19, 2002
UPDATED! PHARMACY VACCINATION MANDATES PAGE ON IAC'S WEBSITE

The most recent state to give pharmacists permission to vaccinate is Pennsylvania. The state just passed its law and will develop specific rules within the next 18 months. Thirty-five states now authorize pharmacists to administer vaccines.

To see IAC's Pharmacy Vaccination Mandates, go to: http://www.immunize.org/laws/pharm.htm

The Immunization Action Coalition (IAC) gratefully obtains its pharmacy immunization information from the American Pharmaceutical Association (APhA), the national professional association of pharmacists. To learn about APhA, go to: http://www.aphanet.org
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August 19, 2002
NEW LANGUAGE! IAC NOW OFFERS VACCINE INFORMATION STATEMENTS IN POLISH

The Immunization Action Coalition (IAC) now offers Vaccine Information Statements (VISs) in Polish in addition to 27 other languages.

The Coalition thanks Danusia Filipowski, M.D., for providing the translations below. Dr. Filipowski completed her medical training in Poznan, Poland, and now lives and works in California. IAC also thanks Dr. Marek Bentkowski and Dr. Chris Kinel, both affiliated with the Northwestern University/St. Joseph Hospital in greater Chicago, Illinois, for final review of these VISs.

To go to the Polish VIS index page, go to:
http://www.immunize.org/vis/index.htm#polish

For specific VISs in Polish, click on links below:

DTaP: http://www.immunize.org/vis/podtap01.pdf
Hib: http://www.immunize.org/vis/po_hib98.pdf
Hepatitis A: http://www.immunize.org/vis/po_hpa98.pdf
Hepatitis B: http://www.immunize.org/vis/po_hpb01.pdf
MMR: http://www.immunize.org/vis/po_mmr98.pdf
Meningococcal: http://www.immunize.org/vis/po_men00.pdf
Td: http://www.immunize.org/vis/po_td94.pdf
Varicella: http://www.immunize.org/vis/po_var98.pdf
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August 19, 2002
COMING UP: IMMUNIZATION REGISTRY CONFERENCE WILL TAKE PLACE OCTOBER 28-30 IN PHILADELPHIA

The Third Annual Immunization Registry Conference will be held Monday, October 28 through Wednesday, October 30 at the Double Tree Hotel in Philadelphia, Pennsylvania. With the theme "Grow, Connect, Protect," this conference provides participants with an opportunity to share knowledge and information about the development and use of immunization registries.

Registration for the full conference is $150 before October 16; the fee is $175 for late and on-site registration. The cost to attend one day of the conference is $50.

For more information on the Immunization Registry Conference, including accommodations information, go to: http://www.cdc.gov/nip/registry/irc2002.htm

To register for the conference online, go to: http://www.cdc.gov/nip/registry/irc2002.htm#reg

If you have questions, contact Gregory Lanman, Conference Planning Team, by phone at (404) 639-8539 or email at ghl2@cdc.gov
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August 19, 2002
VACCINE EDUCATION CENTER SYMPOSIUM IS SET FOR THE MORNING OF SEPTEMBER 14

The Vaccine Education Center at the Children's Hospital of Philadelphia (CHOP) has scheduled its second annual Vaccine Education Symposium for the morning of Saturday, September 14. This half-day program will be full of topnotch speakers on the most important current vaccine topics.

Georges Peter, M.D., will present the keynote address on "Vaccine Shortages: What to Expect and What to Do?"

Stanley Plotkin, M.D., will speak on "Vaccines and Bioterrorism: Smallpox and Anthrax."

Paul Offit, M.D., and director of the Vaccine Education Center at CHOP, will present on two topics: "Do Multiple Vaccines Weaken or Overwhelm the Infant's Immune System?" and "The Rotavirus Vaccine: Lessons from the Past."

Keiji Fukuda, M.D., M.P.H., will address the "Influenza Vaccine: Moving Toward a Universal Recommendation."

James Hodge, J.D., will discuss "Vaccines, Healthcare Professionals, and the Law."

The registration fee of $50 includes breakfast, breaks, parking, and symposium materials. Continuing education credit is available.

For more information, contact Glorene Ford by phone at (215) 590-5263 or by fax at (215) 590-4342.

To download a symposium brochure or register online, go to: http://www.cme.chop.edu
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August 19, 2002
PEDIATRICS ARTICLE SAYS FEWER FOREIGN-BORN CHILDREN IN U.S. GET ALL NEEDED DOSES OF THREE VACCINES

"Vaccination Coverage of Foreign-Born Children 19-35 Months of Age: Findings from the National Immunization Survey, 1999-2000" was published in the August issue of PEDIATRICS (vol. 110, no. 2). Written by six researchers from the National Immunization Program of the Centers for Disease Control and Prevention (CDC), the article reports that foreign-born children in the United States are less likely than U.S.-born children to receive the fourth dose of DTP/DT/DTaP vaccine or adequate doses of Hib and hepatitis B vaccine.

In the study, 7 percent fewer foreign-born children received the fourth dose of DTP/DT/DTaP; 7.8 percent fewer received adequate doses Hib vaccine; and 15.8 percent fewer received 3 or more doses of hepatitis B vaccine. (See Table 2 in the article for confidence intervals and significance values.)

According to the article, foreign-born and U.S.-born children had comparable 3:3:1 series coverage, the standard in most countries. (3:3:1 = 3 or more doses of diphtheria and tetanus toxoids and pertussis vaccine [DTP/DT/DTaP], 3 or more doses of poliovirus vaccine, and 1 or more doses of measles-containing vaccine [MCV].) There was no statistical difference between the two groups for the 3:3:1 combined series; series coverage for both groups was approximately 84 percent.

However, coverage for the 4:3:1:3 U.S. standard was lower among foreign-born children. This standard includes at least 3 doses of Hib and a fourth dose of DTP/DT/DTaP. (4:3:1:3 = 4 or more doses of DTP/DT/DTaP vaccine, 3 or more doses of poliovirus vaccine, 1 or more doses of MCV, and 3 or more doses of Hib vaccine or an adequate number of Hib doses given age at start of series.) Full 4:3:1:3 series coverage was 67.2 percent for foreign-born children and 78.0 percent for U.S.-born children.

The Discussion section reads in part as follows:

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Our study demonstrates that foreign-born children have equivalent 3:3:1 series coverage, the standard in most countries. This comparability is attributable, in part, to the worldwide availability of the 3:3:1 series vaccines. . . promoted globally by the World Health Organization since 1974. . . .

Although vaccination coverage against epidemic-prone diseases such as measles and polio is comparable between foreign- and US-born children, additional progress is needed to increase foreign-born Hib and hepatitis B coverage. Increased coverage is important because, as our analysis shows, foreign-born children are often living in low socioeconomic households. Low socioeconomic status (especially crowding) is a known risk factor for both Hib and hepatitis B disease. Foreign-born children are also at greater risk for hepatitis B disease because a high proportion of these children originate from areas where the disease is more prevalent than in the United States. . . .

The difference in vaccination coverage between foreign- and US-born children, specifically Hib and hepatitis B coverage, suggest[s] a need for increased culturally competent public health immunization interventions. This may have particular impact in large metropolitan areas with high percentages of foreign-born populations such as New York-Northern New Jersey-Long Island (22.8%), Los Angeles-Riverside-Orange County (29.6%), San Francisco-Oakland-San Jose (28.3%), and Miami (42.7%).

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To read the full text of the article online, go to:
http://www.pediatrics.org/cgi/content/full/110/2/e15

To obtain a camera-ready copy (PDF) of the article, go to:
http://www.pediatrics.org/cgi/reprint/110/2/e15.pdf
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August 19, 2002
CDC FINDS INCONSISTENT Hib SEROTYPING BY STATE HEALTH DEPARTMENTS IN SURVEILLANCE STUDY

On August 16, 2002, the Centers for Disease Control and Prevention (CDC) published "Serotyping Discrepancies in Haemophilus influenzae Type b Disease--United States, 1998-1999" in the Morbidity and Mortality Weekly Report (MMWR). Surveillance was conducted in eight states. Of 40 H. influenzae isolates reported to CDC by state laboratories as being serotype b, 28 (70 percent) were incorrectly identified as such by slide agglutination serotyping, according to the article.

"Using standardized procedures and quality control reduced the number of discrepancies," the Editorial Note states. "For example, when three state health department laboratories conducted H. influenzae serotyping after receiving standardized reagents and protocols, over 95 percent of slide agglutination serotyping results agreed with . . . results performed by CDC."

CDC asks state health departments to "send all H. influenzae isolates associated with invasive disease among children aged <5 years, along with surveillance forms, to CDC for slide agglutination serotyping and PCR capsule typing to confirm H. influenzae serotypes."

For more information, contact the CDC Meningitis and Special Pathogens Branch at (404) 639-3158.

To obtain the complete text of this article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5132a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5132.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.