Issue
Number 353
December 9, 2002
CONTENTS OF THIS ISSUE
- AAP publishes new policy statement on childhood influenza
immunization
- AAP "Refusal to Vaccinate" form helps health professionals
document a parent's refusal to accept vaccination
- CDC's diagnostic poster and worksheet, "Evaluating Patients
for Smallpox," available online
- Updated! IAC's "State Mandates" web pages reflect new
information from two states
- IAC responds to vaccine critics with two new web pages
- Register now for CDC's National Hepatitis Coordinators'
January Conference
- TIDE's online childhood immunization curriculum now fully
certified for CME/CEU/CNE credit
- New website supports the needs of survivors of vaccine
associated paralytic polio
- CDC issues update on U.S. influenza activity for the 2002-03
season
- CMS decision to replace vaccine CPT codes with "Q" codes set
to be implemented January 1, 2003
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December 9, 2002
AAP PUBLISHES NEW POLICY STATEMENT ON CHILDHOOD INFLUENZA IMMUNIZATION
The December 2002 issue of "Pediatrics," the journal of the American Academy
of Pediatrics, contains the Academy's new policy statement on childhood
influenza immunization: "Reduction of the Influenza Burden in
Children," as well as a technical report on the same topic. Following is the
abstract from the new policy statement.
************************
Epidemiologic studies indicate that children with certain chronic
conditions, such as asthma, and otherwise healthy children younger than 24
months are hospitalized for influenza and its complications at high rates
similar to those experienced by the elderly. Currently, annual influenza
immunization is recommended for all children 6 months and older with
high-risk conditions. To protect these children more fully against the
complications of influenza, increased efforts are needed to identify and
recall high-risk children for annual influenza immunization. In addition,
immunization of children 6 through 23 months of age and their household
contacts and out-of-home caregivers is now encouraged to the extent
feasible. The ultimate goal is a universal recommendation for influenza
immunization. Issues that need to be addressed before institution of routine
immunization of healthy young children include education of physicians and
parents about the morbidity caused by influenza, adequate vaccine supply,
and appropriate reimbursement of practitioners for influenza immunization.
************************
To access the text of the complete influenza policy statement from the AAP
website, go to:
http://www.aap.org/policy/030124.html
To access the full text of the companion article, "Technical Report:
Reduction of the Influenza Burden in Children," from "Pediatrics," December
2002, Vol.110(6):ppe80, go to:
http://www.pediatrics.org/cgi/content/full/110/6/e80
For additional information about AAP, visit the AAP websites at
http://www.aap.org and
http://www.cispimmunize.org
To access links to many other AAP vaccine policy
statements, go to the Immunization Action Coalition's web
page "Immunization Policy Statements from the American
Academy of Pediatrics" at http://www.immunize.org/aap
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December 9, 2002
AAP "REFUSAL TO VACCINATE" FORM HELPS HEALTH PROFESSIONALS
DOCUMENT A PARENT'S REFUSAL TO ACCEPT VACCINATION
The American Academy of Pediatrics (AAP) recently posted a
one-page "Refusal to Vaccinate" form on its website. The
AAP website states that the form is intended for health
care providers who "decide it is in their best interest to
formally document a parent's refusal to accept vaccination
for a minor child."
A portion of the explanatory text describes why a health
professional might consider using the form: "All parents
and patients should be informed about the risks and
benefits of preventive and therapeutic procedures,
including vaccination. In the case of vaccination, federal
law mandates this discussion. Despite the health care
provider's best efforts to explain its importance, some
families may refuse one or more vaccinations for their
children. The use of this or a similar form may in some
instances induce a wavering parent to accept your
recommendations because it emphasizes the importance you
place on being appropriately immunized."
To obtain a camera-ready copy (PDF format) of the form,
go to:
http://www.cispimmunize.org/pro/pdf/RefusalToVaccinate.pdf
To obtain copy of the AAP's "Refusal to Vaccinate" form,
as well as the explanatory text, as a Word document, go to:
http://www.cispimmunize.org
Scroll down, looking on the right side of the screen for a
paragraph with this heading: Documenting Parental Refusal
to Accept Vaccination. At the bottom of the paragraph,
click on (See Word doc)
To obtain the form by phone, call AAP at (888) 227-1770.
For an array of information on pediatric immunization go
to AAP's Childhood Immunization Support Program website at
http://www.cispimmunize.org
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December 9, 2002
CDC'S DIAGNOSTIC POSTER AND WORKSHEET, "EVALUATING
PATIENTS FOR SMALLPOX," AVAILABLE ONLINE
The 11" x 17", full-color diagnostic poster, "Evaluating
Patients for Smallpox" is available on the website of
Centers for Disease Control and Prevention (CDC). Intended
for use with a worksheet of the same title, the poster
clearly outlines the protocol for distinguishing smallpox
from varicella and other conditions that might be confused
with smallpox and for evaluating risk.
The four-page companion worksheet aids health
professionals in collecting information on cases of acute,
generalized vesicular or pustular rash illness and in
classifying risk of smallpox using the criteria outlined
in the poster.
To obtain the complete 11" x 17" poster, go to:
http://www.bt.cdc.gov/agent/smallpox/diagnosis/pdf/spox-poster-full.pdf
To obtain one half of the poster as an 8-1/2" x 11"
document, go to:
http://www.bt.cdc.gov/agent/smallpox/diagnosis/pdf/spox-poster-1st-half.pdf
To obtain the other half of the poster as an 8-1/2" x 11"
document, go to:
http://www.bt.cdc.gov/agent/smallpox/diagnosis/pdf/spox-poster-2nd-half.pdf
For a copy of the companion worksheet, "Evaluating
Patients for Smallpox," go to:
http://www.bt.cdc.gov/agent/smallpox/diagnosis/pdf/spox-patient-eval-wksheet.pdf
For an array of useful information on all aspects of
smallpox disease and vaccine, go to CDC's website at
http://www.bt.cdc.gov/agent/smallpox
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December 9, 2002
UPDATED! IAC'S "STATE MANDATES" WEB PAGES REFLECT NEW
INFORMATION FROM TWO STATES
The Immunization Action Coalition (IAC) recently updated
its "State Mandates on Immunization and Vaccine-Preventable Disease" web pages to reflect the following
changes made in two states:
Varicella vaccination mandates went into effect for all
children twelve months of age and older in day care in
Delaware in September 2002 and will go into effect for new
enrollees in elementary and middle school in September
2003. Indiana will require varicella vaccination starting
January 2003 for all children age 19 months to six years
in day care.
Pneumococcal conjugate vaccine (PCV7) will be required in
January 2003 for all children age two months through five
years attending day care in Indiana.
To access IAC's updated state mandates web pages, go to:
http://www.immunize.org/laws
Please be sure to let us know of any new immunization
mandates in your state. Although we follow state
activities, we also rely on readers to keep us informed.
Send emails with your updates to admin@immunize.org
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December 9, 2002
IAC RESPONDS TO VACCINE CRITICS WITH TWO NEW WEB PAGES
The Immunization Action Coalition (IAC) recently launched
two web pages of solid, scientific resources that counter
arguments of vaccine critics. The new web page "Answering
Immunization Critics" is intended for health
professionals; the web page titled "Concerned About
Vaccines?" is designed for patients and parents.
"Answering Immunization Critics"
This web page is designed to help health professionals
talk to patients and parents who have concerns about the
safety, efficacy, or ethics of vaccination. The Internet
is fast becoming parents' and patients' source for
vaccination information. Though some Internet information
is based on science, much is based, unfortunately, on
misinformation. This makes it imperative that health
professionals know about the latest arguments and rumors
on the Internet so they can counter misinformation with
facts. This page was developed to be a "one stop" source
for health professionals interested in educating
themselves about such issues.
Since not all patients question immunization for the same
reasons, "Answering Immunization Critics" is divided into
six sections that cover a range of vaccine concerns:
vaccine safety, continuing importance of vaccines,
chiropractors and immunization, immunization and
"alternative medicine," religious and ethical concerns
about vaccination, and issues of civil liberties.
To view the web page for health care providers, go to:
http://www.immunize.org/critics
"Concerned About Vaccines?"
On IAC's new public website, http://www.vaccineinformation.org, you will find a web
page of excerpts of some of the information from
"Answering Immunization Critics." Titled "Concerned About
Vaccines?" this web page addresses parents' and patients'
questions about vaccination and responds to the arguments
of vaccine critics. Please encourage your web-savvy
patients to consult this page in the course of their
research on immunization.
Visit and refer your patients to "Concerned About
Vaccines?" at
http://www.vaccineinformation.org/concern.asp
IAC's new public website, http://www.vaccineinformation.org is a comprehensive
resource for parents, patients, and members of the media.
It has information about vaccine-preventable diseases and
their vaccines, vaccine safety, and topics of special
interest to non-medical audiences. To increase its
availability and usefulness, IAC requests that you add it
as a link on your website.
We hope you find these collections of resources useful in
your health care setting. We'd appreciate your feedback.
Please email your thoughts about these new web pages and
the new website to us at admin@immunize.org
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December 9, 2002
REGISTER NOW FOR CDC'S NATIONAL HEPATITIS COORDINATORS'
JANUARY CONFERENCE
The Centers for Disease Control and Prevention's National
Hepatitis Coordinators' Conference: Integration of
Services for the Prevention of Viral Hepatitis, is
scheduled for January 26-30 in San Antonio, TX.
The conference program will include plenary sessions,
workshop sessions, poster presentations, and plenty of
opportunities to network with public health professionals
working in viral hepatitis. Conference topics include
viral hepatitis prevention, treatment, counseling, and
testing.
The plenary sessions and workshops will appeal to a broad
audience including public health professionals,
administrators, educators, and others interested in the
prevention and control of viral hepatitis. Attendees will
also include health professionals working with HIV, STD,
immunizations, and hepatitis, as well as those working in
substance abuse and correctional health settings.
Counselors and social workers working with individuals at
increased risk for viral hepatitis should also consider
attending.
The conference is co-sponsored by the Centers for Disease
Control and Prevention, the Immunization Action Coalition,
and the University of Minnesota Office of Continuing
Medical Education.
For a brief overview of the conference and for
registration information, go to:
http://www.cdc.gov/ncidod/diseases/hepatitis/coordinators
For an online copy of the conference brochure, including
complete information on continuing medical education
credits, registration, meeting venue and accommodations,
conference materials, pre- and post-conference sessions,
and the conference program, go to:
http://www.med.umn.edu/cme/brochures2002/hepcoord2003/hepcoordbro2003.html
To access the online registration form, go to:
http://www.med.umn.edu/cme/brochures2002/hepcoord2003/hepcoordreg2003.html
For additional information, call the conference planner,
the University of Minnesota Office of Continuing Medical
Education, at (800) 776-8636.
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December 9, 2002
TIDE'S ONLINE CHILDHOOD IMMUNIZATION CURRICULUM NOW FULLY
CERTIFIED FOR CME/CEU/CNE CREDIT
After pilot testing and evaluation, all four modules of
the curriculum for "TIDE (Teaching Immunization Delivery
and Evaluation): An Online Interactive Education Program"
have been certified for CME/CEU/CNE credit.
A project of the Centers for Disease Control and
Prevention, the Ambulatory Pediatric Association, and the
Society for Adolescent Medicine, TIDE is offered through
the Medical University of South Carolina. It is designed
to "improve knowledge, attitudes, and skills" in clinical
settings, leading to increased rates of childhood
immunization. It is currently available at no charge.
The four self-contained modules are Childhood
Immunization, Assessing Immunization Rates, Improving
Immunization Rates in Your Practice, and Adolescent
Immunization. Learners consider sample pediatric cases,
walk through a chart audit, and use adolescent patient
information to make correct immunization decisions.
To learn more about TIDE, go to:
http://www2.edserv.musc.edu/tide
To register on line to use the TIDE modules, go to:
http://www2.edserv.musc.edu/tide/reg/register.las
If you have questions about TIDE, contact Patti Holsclaw,
TIDE coordinator, by phone at (843) 876-1217 or email at
holsclpw@musc.edu
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December 9, 2002
NEW WEBSITE SUPPORTS THE NEEDS OF SURVIVORS OF
VACCINE ASSOCIATED PARALYTIC POLIO
The Vaccine Associated Polio Society (VAPS) has launched a
website that offers information, education, and resources
to the survivors of vaccine associated paralytic polio
(VAPP) and their families. The society, which has the
motto "Pro-Immunization--Pro-Safe Polio Vaccines," is
dedicated to ensuring continued medical care and sound
public policy for people living with VAPP through
education, advocacy, and research.
A predecessor organization, Informed Parents Against VAPP,
helped lead a successful campaign to change federal
vaccine policy from oral polio vaccine, which can cause
VAPP, to inactivated polio vaccine, which cannot.
For additional information about VAPS, visit the website
at http://www.vaps.us or call (888) 363-VAPP (8277).
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December 9, 2002
CDC ISSUES UPDATE ON U.S. INFLUENZA ACTIVITY FOR THE
2002-03 SEASON
The Centers for Disease Control and Prevention (CDC)
published "Update: Influenza Activity--United States,
2002-03 Season" in the December 6 issue of "Morbidity and
Mortality Weekly Report" (MMWR). The Editorial Note,
excluding four footnoted references, reads as follows.
**********************
All four national influenza surveillance system components
indicated that levels of influenza activity were low in
the United States during the weeks ending October 5-November 23. Both influenza A and B viruses have been
identified this season, but it is too early to determine
which strain(s) will predominate. Influenza activity is
expected to increase during the coming weeks and months.
The best prevention against influenza is annual
vaccination. Although the optimal time to receive
influenza vaccination is during October-November, CDC
encourages continuing vaccination efforts in December and
throughout the influenza season. The American Medical
Association, with support from CDC, has declared December
2-13 as "National Influenza Vaccination Catch-up
Fortnight" because millions of persons at high risk for
complications from influenza remain unvaccinated each
year. It is particularly important to vaccinate those at
high risk for serious complications from influenza
(including persons 65 years of age and over and those with
certain underlying medical conditions), and health-care
providers. Such persons might benefit from vaccination
even after influenza has been detected in their community.
Vaccine supplies continue to be plentiful. The
manufacturers estimate that approximately 93 million doses
of influenza vaccine were produced this year, compared
with approximately 87 million doses produced during the
2001-02 season.
On November 19, Wyeth Vaccines announced that it will no
longer produce inactivated influenza vaccine after the
2002-03 influenza season. This development will not
jeopardize this year's vaccination programs or vaccine
availability. The two remaining influenza vaccine
manufacturers in the U.S. market, Aventis Pasteur, Inc.
and Evans Vaccines, Ltd., have indicated that they plan to
increase influenza vaccine production for the 2003-04
season to make up for the loss of the Wyeth Vaccines
product.
Influenza surveillance reports for the United States are
published weekly during October-May and are available at
http://www.cdc.gov/ncidod/diseases/flu/weekly.htm or
through CDC's voice [(888) 232-3228] and fax
[(888) 232-3299, document number 361100] information
systems.
**********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5148a4.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5148.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
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 9, 2002
CMS DECISION TO REPLACE VACCINE CPT CODES WITH "Q" CODES
SET TO BE IMPLEMENTED JANUARY 1, 2003
Earlier this fall, the Center for Medicare and Medicaid
Services (CMS) issued instructions to its contractors to
replace hepatitis B vaccine CPT codes with "Q" codes,
effective January 1, 2003.
The decision has raised concern among some in the health
community, particularly physician and non-physician health
care professionals involved in hepatitis B immunization,
from both a clinical and payment policy perspective.
Currently, health professionals have five CPT codes
available to them for billing for hepatitis B
immunization. When "Q" codes become effective, only three
codes will be available. Health professionals are
concerned that the reduction from five codes to three will
result in the loss of detailed information useful to
clinicians and public health professionals.
The possibility exists to defer implementation of new "Q"
codes until the concerns of various groups in the health
community have been discussed further.
For a more detailed discussion of the topic, and of steps
being taken to possibly defer implementation, go to the
websites of the American Immunization Registry Association
at http://www.immregistries.org/hep-b-alert_1-1-03.html or
of the American College of Physicians- American Society of
Internal Medicine at http://www.acponline.org/hpp/cpt_q.htm
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