Issue
Number 354
December 16, 2002
CONTENTS OF THIS ISSUE
- New! CDC issues smallpox Vaccine Information Statement
- A study published in "The Lancet" indicates infants rapidly
eliminate mercury contained in thimerosal
- Gripping "Photo Notebook of Vaccine-Preventable Diseases" and
"Slide Set of Vaccine-Preventable Diseases" still available
- CDC report on measles outbreak among internationally adopted
children shows importance of immunization for adopting families
- Revised! IAC updates hepatitis B education article "If You
Have Sex, Read This"
- Mark your calendars! CDC's four-part satellite broadcast of
"Epidemiology and Prevention of Vaccine-Preventable Diseases" will be held
in February and March
- First meeting of IOM Committee on Smallpox Vaccination Program
Implementation set for December 18-20
- New poll shows public now slightly more willing to be
vaccinated against smallpox than in May
- Hepatitis C integration training manual now available
- FDA approves supplemental license for hepatitis C treatment
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December 16, 2002
NEW! CDC ISSUES SMALLPOX VACCINE INFORMATION STATEMENT
The Centers for Disease Control and Prevention (CDC) issued a Vaccine
Information Statement (VIS) for smallpox vaccine on December 11. It is
important to note that unlike other VISs, the smallpox VIS must be used with
a separate consent form that requires a signature. The form will be
available soon from CDC.
To obtain a copy of the VIS from the website of the Immunization Action
Coalition (IAC), go to:
http://www.immunize.org/vis/index.htm#smallpox
Click on "English" to access the VIS in camera-ready (PDF) format.
For extensive, up-to-date information about smallpox disease and vaccine,
visit the CDC's bioterrorism website at
http://www.cdc.gov/smallpox
For information about the use of VISs, as well as VISs for additional
vaccines (some in up to 28 languages), visit IAC's website at
http://www.immunize.org/vis
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December 16, 2002
A STUDY PUBLISHED IN "THE LANCET" INDICATES INFANTS
RAPIDLY ELIMINATE MERCURY CONTAINED IN THIMEROSAL
On November 30, "The Lancet" published an article titled
"Mercury Concentrations and Metabolism in Infants
Receiving Vaccines Containing Thimerosal: A Descriptive
Study," which refutes the hypothesis that administration
of vaccines containing thimerosal raises blood
concentrations of mercury above safe levels in infants.
The article is part of an established body of evidence
that rebuts the existence of a link between thimerosal-containing vaccines and the development of autism. The
complete abstract of the article follows.
*********************
Background
Thimerosal is a preservative containing small amounts of
ethylmercury that is used in routine vaccines for infants
and children. The effect of vaccines containing thimerosal
on concentrations of mercury in infants' blood has not
been extensively assessed, and the metabolism of
ethylmercury in infants is unknown. We aimed to measure
concentrations of mercury in blood, urine, and stools of
infants who received such vaccines.
Methods
40 full-term infants aged 6 months and younger were given
vaccines that contained thimerosal (diphtheria-tetanus-acellular pertussis vaccine, hepatitis B vaccine, and in
some children Haemophilus influenzae type b vaccine). 21
control infants received thimerosal-free vaccines. We
obtained samples of blood, urine, and stools 3-28 days
after vaccination. Total mercury (organic and inorganic)
in the samples was measured by cold vapor atomic
absorption.
Findings
Mean mercury doses in infants exposed to thimerosal were
45.6 micrograms (range 37.5-62.5) for 2-month-olds and
111.3 micrograms (range 87.5-175.0) for 6-month-olds.
Blood mercury in thimerosal-exposed 2-month-olds ranged
from less than 3.75 to 20.55 nmol/L (parts per billion);
in 6-month-olds all values were lower than 7.50 nmol/L.
Only one of 15 blood samples from controls contained
quantifiable mercury. Concentrations of mercury were low
in urine after vaccination but were high in stools of
thimerosal-exposed 2-month-olds (mean 82 ng/g dry weight)
and in 6-month-olds (mean 58 ng/g dry weight). Estimated
blood half-life of ethylmercury was 7 days (95% CI 4-10
days).
Interpretation
Administration of vaccines containing thimerosal does not
seem to raise blood concentrations of mercury above safe
values in infants. Ethylmercury seems to be eliminated
from blood rapidly via the stools after parenteral
administration of thimerosal in vaccines.
*********************
To access the article abstract from the PubMed website of
the National Center for Biotechnology Information, click
here and then click on the author's names (hyperlink) in the citation.
To access more journal articles and other web resources
that rebut the existence of a relationship between
vaccines and autism, use the following links:
"A Population-Based Study of Measles, Mumps, and
Rubella Vaccination and Autism"
Authors: Madsen KM, Hviid A, Vertergaard M, et al
Source: New England Journal of Medicine, November 7,
2002, Vol.347(19):1477-1482
http://content.nejm.org/cgi/content/abstract/347/19/1477
"Neurologic Disorders after Measles-Mumps-Rubella
Vaccination"
Authors: Makela A, Nuorti JP, Peltola H
Source: Pediatrics, November 2002, Vol. 110:957-963
http://www.pediatrics.org/cgi/content/abstract/110/5/957
"Measles, Mumps, and Rubella Vaccination and Bowel
Problems or Developmental Regression in Children with
Autism: Population Study"
Authors: Taylor B, Miller E, Lingam R, Andrews N,
Simmons A, Stowe J
Source: British Medical Journal, February 16, 2002,
Vol. 324(7334):393-6
http://bmj.com/cgi/content/full/324/7334/393/DC1
"No Evidence for a New Variant of Measles-Mumps-Rubella-Induced Autism"
Authors: Fombonne E, Chakrabarti S
Source: Pediatrics, October 2001, Vol. 108(4):E58
http://www.pediatrics.org/cgi/content/full/108/4/e58
"Measles-Mumps-Rubella Vaccine and Autism" (summary
report)
Source: Institute of Medicine
http://www.iom.edu/IOM/IOMHome.nsf/Pages/mmr+report
"Vaccines and Autism"
Author: Offit PA
Source: Vaccine Education Center, Children's Hospital of
Philadelphia
http://www.immunize.org/catg.d/p2065.htm
The Immunization Action Coalition's "Autism Information"
web page (includes related journal articles and
resources for health professionals and parents)
http://www.immunize.org/safety/autism.htm
The Centers for Disease Control and Prevention's
"Vaccines and Autism Theory" web page (includes fact
sheets, FAQs, etc.)
http://www.cdc.gov/nip/vacsafe/concerns/autism
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December 16, 2002
GRIPPING "PHOTO NOTEBOOK OF VACCINE-PREVENTABLE DISEASES"
AND "SLIDE SET OF VACCINE-PREVENTABLE DISEASES" STILL
AVAILABLE
Two powerful visual aids--the "Photo Notebook of Vaccine-Preventable Diseases" and the "Slide Set of Vaccine-Preventable Diseases"--will be of interest to health
departments and medical practices that don't already have
them. Developed by the Immunization Action Coalition
(IAC), the notebook and slide set are intended for staff
and community outreach workers who conduct immunization
presentations. Whether viewed as photos on a tabletop or
as slides on a screen, many have found these images to be
worth more than a thousand words each, and we think you
and your patients will, too.
Photo Notebook
A three-ring binder holds 20 plastic-protected, 8"x10"
color photographs of children and adults with vaccine-preventable diseases. Each picture is accompanied by
simple text that explains the disease portrayed. When you
show your patients pictures of infants with severe
varicella disease and other infections, they will begin to
understand the seriousness of the diseases that vaccines
can prevent.
To see the photos from the Photo Notebook on our website,
go to: http://www.immunize.org/news.d/6025pix.pdf
To view an image of the Photo Notebook, go to:
http://www.immunize.org/images/r2053.jpg
To order your own "Photo Notebook of Vaccine-Preventable
Diseases" online (item R2053, $75 each), go to:
http://www.immunize.org/photobook
The images also can be downloaded for free from IAC's
website at: http://www.immunize.org/catg.d/pict001.htm
Be sure to scroll down to the thumbnail images and click
on the "live labels" next to them to view at different
sizes.
Slide Set
The Slide Set contains eight more images than the Photo
Notebook. To assist you with slide presentations, an
English-language script comes with the Slide Set. A
Spanish-language script is also available upon request.
(The Puerto Rico Immunization Program generously provided
the Spanish-language translation to IAC.)
To order a Slide Set online (item S3010, $25 each), go to:
http://www.immunize.org/slideset
To access the English-language script, go to:
http://www.immunize.org/catg.d/3010slid.pdf
To access the Spanish-language script, go to:
http://www.immunize.org/catg.d/3010-01.pdf
You may also order Photo Notebooks or Slide Sets by
sending a check to IAC, Orders Dept., 1573 Selby Avenue,
Suite 234, St. Paul, MN 55104, or faxing your order along
with your credit card information to (651) 647-9131.
Questions? Call (651) 647-9009 (no phone orders, please).
Please allow 3-4 weeks for delivery of these items.
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December 16, 2002
CDC REPORT ON MEASLES OUTBREAK AMONG INTERNATIONALLY
ADOPTED CHILDREN SHOWS IMPORTANCE OF IMMUNIZATION FOR
ADOPTING FAMILIES
The Centers for Disease Control and Prevention (CDC)
published "Measles Outbreak Among Internationally Adopted
Children Arriving in the United States, February-March
2001" in the December 13 issue of the "Morbidity and
Mortality Weekly Report" (MMWR).
A separate synopsis available to the press states that "a
10-month-old child adopted from an orphanage in China"
traveled to and within the United States on commercial
airlines while in "an infectious stage of measles,"
potentially exposing "multiple persons during the
communicable period. Subsequent investigations identified
14 U.S. measles cases related to this case." The synopsis
encouraged parents of internationally adopted children to
be sure they and their family members are current in their
immunizations.
The concluding paragraph of the Editorial Note of the MMWR
report is printed below.
************************
Since 1996, all persons seeking a U.S. immigrant visa are
required to show proof of having received at least the
first vaccine of each series of vaccinations recommended
by the Advisory Committee on Immunization Practices
(ACIP), which includes measles. However, internationally
adopted children who are 10 years of age or younger are
exempted from the Immigration and Nationality Act
vaccination requirements with a signed statement from the
adopting parent(s) indicating that the child will receive
vaccination within 30 days of entry into the United
States. Parents of internationally adopted children should
be aware of the importance of confirming that they and
their family members are current in their vaccinations and
that, soon after arrival in the United States, their
adopted children's vaccination status is updated according
to ACIP guidelines. In addition, persons who will be in
contact with internationally adopted children during their
first 3 weeks in the United States, especially household
members and caretakers, should be immune to measles or be
vaccinated before the adoption.
************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5149a3.htm
To obtain a camera-ready (PDF format) copy of this issue
of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5149.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 16, 2002
REVISED! IAC UPDATES HEPATITIS B EDUCATION ARTICLE "IF YOU
HAVE SEX, READ THIS"
The Immunization Action Coalition (IAC) made a minor
modification to its patient education article "If You Have
Sex, Read This . . . And Stop a Killer STD From Sneaking
Up On You!" The article, written by Lynda Liu, first
appeared in "Mademoiselle" magazine in 1999. It relates
the true story of a young woman who contracted hepatitis B
and encourages people to get vaccinated against the
disease.
The single modification was the addition of an editorial
note advising readers that the price for hepatitis B
vaccination may have dropped in the past few years.
To access an HTML version of the revised article, go to:
http://www.immunize.org/catg.d/4113sex.htm
To access a camera-ready (PDF) version, go to:
http://www.immunize.org/catg.d/4113sex.pdf
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December 16, 2002
MARK YOUR CALENDARS! CDC'S FOUR-PART SATELLITE BROADCAST
OF "EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE
DISEASES" WILL BE HELD IN FEBRUARY AND MARCH
The National Immunization Program (NIP) of the Centers for
Disease Control and Prevention (CDC) will be presenting
its live satellite training course "Epidemiology and
Prevention of Vaccine-Preventable Diseases" on four
consecutive Thursdays: February 13, 20, and 27, and
March 6. Each session lasts four hours. Times have not
been announced, and registrations are not being accepted
yet.
The course is intended for health professionals who
provide immunization services. Course content is described
as a comprehensive overview of the principles of
vaccination, general recommendations, immunization
strategies for providers, and specific information about
vaccine-preventable diseases and the vaccines that prevent
them.
To access preliminary course information, go to:
http://www.cdc.gov/nip/ed/newsatellite.htm#1
To access information about the power point slide set or
the text, "Epidemiology and Prevention of Vaccine-Preventable Diseases" (The Pink Book), 7th Edition, go to:
http://www.cdc.gov/nip/ed/epi&Prev-materials.htm
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December 16, 2002
FIRST MEETING OF IOM COMMITTEE ON SMALLPOX VACCINATION
PROGRAM IMPLEMENTATION SET FOR DECEMBER 18-20
The first meeting of a new Institute of Medicine (IOM)
Committee on Smallpox Vaccination Program Implementation
will be held December 18-20 in Washington, DC. The
December 19 session is open to the public; the sessions on
December 18 and 20 are closed. Because of space
limitations, registration for the open session will close
December 17.
This committee was established to advise the Centers for
Disease Control and Prevention (CDC) on selected aspects
of pre-event smallpox vaccination program implementation.
At the December 19 session, representatives from CDC, the
Department of Health and Human Services, and the
Department of Defense will present the Committee with
comprehensive and current information about smallpox
planning.
To register for the December 19 session and view the
meeting agenda and the Committee roster, go to:
http://www.iom.edu/smallpox
For further information, contact Nicole Amado at
namado@nas.edu (email), (202) 334-2481 (phone), or
(202) 334-2939 (fax).
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December 16, 2002
NEW POLL SHOWS PUBLIC NOW SLIGHTLY MORE WILLING TO BE
VACCINATED AGAINST SMALLPOX THAN IN MAY
The results of a public poll commissioned by the Robert
Wood Johnson Foundation showed that six percent more
people (65 percent) were willing to be vaccinated against
smallpox than were in May (59 percent), when a similar
poll was taken. Conducted in late October and released
December 11, the poll drew on the responses of 1,002
adults as a way of gauging public attitudes toward
bioterrorism preparedness and the state of the U.S. public
health system one year after the anthrax attacks.
The following two paragraphs are reprinted from the press
release.
*************************
As the Bush Administration and public health experts gear
up to implement a broad-scale smallpox vaccination plan, a
new poll shows that an increasing number of Americans are
willing to be immunized against the disease. Despite the
risks associated with smallpox immunization, 65 percent of
the poll's respondents say they are willing to be
vaccinated, up from 59 percent last May. The findings
reflect a growing concern about the potential use of
smallpox in a terrorist attack and could signal the
public's uncertainty about the ability of the nation's
health officials to contain a smallpox outbreak. . . .
The survey found that, one year after the anthrax attacks,
Americans are feeling "uneasy." Although the public
accepts that many important steps have been taken to
improve national readiness for bioterrorism, it still
feels more needs to be done to prepare the public health
system to respond to an attack.
*************************
To access a camera-ready (PDF) version of the 11-page full
report of the poll from the website of the Robert Wood
Johnson Foundation, go to:
http://www.rwjf.org/publications/publicationsPdfs/02report-d7.pdf
For a 2-page summation of the report's key findings, go
to:
http://www.rwjf.org/news/special/bioterrorismKeyFindings1.jhtml
For further information, call Jennifer Hudman, Chuck
Alexander, or Janet Firshein at (301) 652-1558.
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December 16, 2002
HEPATITIS C INTEGRATION TRAINING MANUAL NOW AVAILABLE
A publication of the American Liver Foundation (ALF),
funded by the Centers for Disease Control and Prevention
(CDC), "HIT'M--The Hepatitis Integration Training Manual,"
is available for order on ALF's website.
The manual is a comprehensive guide that integrates
hepatitis C education in the areas of HIV/AIDS, sexually
transmitted disease, harm reduction and/or substance abuse
treatment. It shows readers how to incorporate hepatitis C
information into existing health messages using trainer
notes, session outlines and presentation tips, slide
shows, and other hepatitis resources.
It also equips health care professionals and harm
reduction counselors with current hepatitis information
and resources they can use to impart life-saving messages
to people who need hepatitis C education the most.
To learn more about the manual or to order it, go to ALF's
website at http://www.liverfoundation.org or call Jackie
Spencer at (800) 465-4837.
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December 16, 2002
FDA APPROVES SUPPLEMENTAL LICENSE FOR HEPATITIS C
TREATMENT
On December 3, the Food and Drug Administration (FDA)
approved a supplemental license application for Peginterferon
alfa-2a (Pegasys) to include combination therapy with
Ribavirin, USP (Copegus), for the treatment of chronic
hepatitis C virus infection. Peginterferon alfa-2a, alone
or in combination with Copegus, is indicated for the
treatment of adults who have compensated liver disease and
have not been previously treated with interferon alpha.
Peginterferon alfa-2a is marketed by Hoffmann-LaRoche
under the trade name Pegasys.
To view the approval letter for the supplemental license,
go to:
http://www.fda.gov/cber/approvltr/pegihof120302L.htm
To view the approval letter for the initial license, go
to:
http://www.fda.gov/cber/approvltr/pegihof101602L.htm
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