Issue
Number 359
January 13, 2003
CONTENTS OF THIS ISSUE
- JAMA reports U.S. influenza deaths rising steadily
- Freeware puts 2003 childhood immunization schedule in the palm
of your hand
- Updated! NNii revises and adds new sections to its
"Communicating with Patients about Immunization" resource kit
- CDC reports on a recent pertussis outbreak among adults in
Illinois
- Take note: Registration begins January 23 for CDC's
"Epidemiology and Prevention of Vaccine-Preventable Diseases" satellite
broadcast and webcast series
- Reminder: CDC's National Hepatitis Coordinators' Conference
set for January 26-30 in San Antonio
- ASTHO pandemic influenza report urges state officials to
prepare for a likely epidemic
- New! Program report and advocacy booklet available online from
the Children's Vaccine Program at PATH
- GAVI's most recent quarterly newsletter available online
- FDA advises blood-collection industry about accepting blood
from donors recently vaccinated against smallpox
- CDC summarizes Cambodia's success in reducing measles
incidence
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January 13, 2003
JAMA REPORTS U.S. INFLUENZA DEATHS RISING STEADILY
On January 8, the "Journal of the American Medical Association" (JAMA)
published an article, "Mortality Associated with Influenza and Respiratory
Syncytial Virus in the United States." Written by William W. Thompson, PhD;
David K. Shay, MD, MPH; Eric Weintraub, MPH; Lynnette Brammer, MPH; Nancy
Cox, PhD; Larry J. Anderson, MD; and Keiji Fukuda, MD, MPH, the article
indicates that influenza deaths have risen significantly in the past two
decades, in part because of the increase in the nation's aging population.
Three sections from the article abstract--context, results, and
conclusions--are reprinted below.
******************
Context
Influenza and respiratory syncytial virus (RSV) cause substantial morbidity
and mortality. Statistical methods used to estimate deaths in the United
States attributable to influenza have not accounted for RSV circulation.
Results
Annual estimates of influenza-associated deaths increased significantly
between the 1976-1977 and 1998-1999 seasons for all 3 death categories (P
less than .001 for each category). For the 1990-1991 through 1998-1999
seasons, the greatest mean numbers of deaths were associated with influenza
A(H3N2) viruses, followed by RSV, influenza B, and influenza A(H1N1).
Influenza viruses and RSV, respectively, were associated with annual means
(SD) of 8097 (3084) and 2707 (196) underlying pneumonia and influenza
deaths, 36,155 (11 055) and 11,321 (668) underlying respiratory and
circulatory deaths, and 51,203 (15,081) and 17,358 (1086) all-cause deaths.
For underlying respiratory and circulatory deaths, 90% of influenza- and 78%
of RSV-associated deaths occurred among persons aged 65 years or older.
Influenza was associated with more deaths than RSV in all age groups except
for children younger than 1 year. On average, influenza was associated with
3 times as many deaths as RSV.
Conclusions
Mortality associated with both influenza and RSV circulation
disproportionately affects elderly persons. Influenza deaths have increased
substantially in the last 2 decades, in part because of aging of the
population, underscoring the need for better prevention measures, including
more effective vaccines and vaccination programs for elderly persons.
******************
In a related editorial, "Influenza-Related Mortality: Considerations for
Practice and Public Health," David M. Morens, M.D., of the National
Institute of Allergy and Infectious Diseases, concludes by urging his
medical colleagues to strongly recommend influenza vaccination to their
patients and to be vaccinated themselves. Excerpts from the editorial's
conclusion follow:
*******************
. . . Now the medical and public health communities must . . .face the
looming confrontation between an unstoppable force and an immovable object,
the aging of the baby boom generation and the predictability of annual
influenza. Simple demographics practically ensure an impending public health
disaster of great proportion.
Hope lies in the realization that until better influenza and RSV vaccines
become available, there still remains much good to be performed in clinical
practice. This includes ending the many missed opportunities in the
community, the office, and the institution to prevent influenza-associated
death and severe illness. Endorsement by health care professionals appears
to be the strongest determinant of a patient's acceptance of influenza
vaccine.
Physicians and other health care professionals can do even more to protect
patients by receiving annual influenza vaccinations. Clinician vaccination
prevents transmission to patients (a significant risk factor in many patient
care situations), prevents the temporary loss of their services, sets a
powerful example, and might even make a small contribution to community
"herd immunity."
*******************
To access the complete article from the JAMA website, go to:
http://jama.ama-assn.org/issues/v289n2/rfull/joc21709.html
To access a camera-ready (PDF) version of the article, go to:
http://jama.ama-assn.org/issues/v289n2/rpdf/joc21709.pdf
To access the complete editorial, go to:
http://jama.ama-assn.org/issues/current/ffull/jed20081.html
To access an array of information specific to the 2002-03 flu season from
the website of the Centers for Disease Control and Prevention, go to:
http://www.cdc.gov/nip/flu/default.htm
To access general influenza-related materials from the website of the
Immunization Action Coalition, go to:
http://www.immunize.org/influenza
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January 13, 2003
FREEWARE PUTS 2003 CHILDHOOD IMMUNIZATION SCHEDULE IN THE PALM OF YOUR HAND
"Shots 2003" is a quick, portable reference guide to the "Recommended
Childhood and Adolescent Immunization Schedule--United States, 2003."
Produced by the Group on Immunization Education of the Society of
Teachers of Family Medicine (STFM), this freeware for the Palm OS 3.1
provides detailed information on vaccines. All you have to do is click on
them by name.
The program requires Palm OS 3.1 or higher and approximately 279 KB of
memory. It runs on both color and non-color handhelds.
To download "Shots 2003," go to:
http://www.immunizationed.org/AnyPage.asp?Page=Shots2003
For more information, contact STFM by email at
gieweb@pitt.edu
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January 13, 2003
UPDATED! NNii REVISES AND ADDS NEW SECTIONS TO ITS "COMMUNICATING WITH
PATIENTS ABOUT IMMUNIZATION" RESOURCE KIT
In December 2002, the National Network for Immunization Information (NNii)
updated and enlarged its "Communicating with Patients about Immunization"
resource kit (a 114-page volume of vaccine-related resources). Designed to
help health care professionals educate patients about immunization, the kit
has patient-accessible information on a broad spectrum of immunization
topics.
The section on Childhood Vaccine-Specific Information includes new
information on influenza and updated information on hepatitis B, Hib,
measles, mumps, rubella, and meningococcal diseases and vaccines. The Common
Questions has updated information on vaccine safety, adverse events that
follow vaccination, vaccination ingredients, school immunization laws,
immunization doses and schedules, and the immune system and vaccines.
The Background has updated information on how vaccines work and monitoring
vaccine safety. The Bibliography has also been updated.
To access sections of interest to you, go to:
http://www.immunizationinfo.org/healthProfessionals/resourceKit.cfm
To access a camera-ready (PDF) version of the entire kit, go to:
http://www.immunizationinfo.org/PDFs/KIT_FULL.pdf
Hard copies of the kit are no longer available; you can print out the
complete kit from the link above, however.
NNii also publishes "Newsbriefs" newsletter, a Monday-Wednesday-Friday email
summary of immunization news from around the world. To subscribe, go to:
http://www.immunizationinfo.org/newsbriefs/subscribe.cfm
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January 13, 2003
CDC REPORTS ON A RECENT PERTUSSIS OUTBREAK AMONG ADULTS IN ILLINOIS
The Centers for Disease Control and Prevention (CDC) published "Pertussis
Outbreak Among Adults at an Oil Refinery--Illinois, August-October 2002" in
the January 10 issue of the "Morbidity and Mortality Weekly Report" (MMWR).
Part of the summary made available to the press is printed below:
"On September 16, 2002, a local county health department reported to the
Illinois Department of Public Health (IDPH) four cases of cough illness
among workers at an oil refinery. Following an investigation by IDPH, 17
individuals from the oil refinery were diagnosed with pertussis from August
1-October 9, 2002. Additionally, 7 patients with pertussis were identified
in the local community from August 30-October 11, 2002. All 24 patients
received treatment with antibiotics and there were no deaths. Among
recommended childhood immunizations, pertussis is the only vaccine
preventable disease with increased number of cases in the United States
during the last 20 years. The number of pertussis cases in adults has risen
substantially since the 1980s. Pertussis should be considered in adults with
a cough illness lasting more than 2 weeks with paroxysms of coughing,
inspiratory "whoop," or post-tussive vomiting."
The MMWR article discusses diagnosis and treatment of the disease and
includes a box summarizing its epidemiology, diagnosis, treatment, and
prevention.
In light of the increase of pertussis in the adult U.S. population, the
article's Editorial Note gives the following information:
"Adults with pertussis can have mild symptoms and might not seek medical
care, and clinicians might not consider pertussis as a cause of illness. . .
.
"Outbreaks of pertussis in adults are controlled through prompt treatment of
patients and antimicrobial prophylaxis for close contacts. Acellular
pertussis vaccines are licensed in the United States for infants and
children aged 6 weeks-6 years (i.e., before the seventh birthday). These
vaccines might have a future role in the prevention of disease and control
of outbreaks in older age groups."
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5201a1.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5201.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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January 13, 2003
TAKE NOTE: REGISTRATION BEGINS JANUARY 23 FOR CDC'S "EPIDEMIOLOGY AND
PREVENTION OF VACCINE-PREVENTABLE DISEASES" SATELLITE BROADCAST AND WEBCAST
SERIES
Individual registration begins January 23 for "Epidemiology and Prevention
of Vaccine-Preventable Diseases," a live satellite training course presented
by the National Immunization Program (NIP) of the Centers for Disease
Control and Prevention (CDC). It is scheduled from noon to 3:30 pm ET on
four consecutive Thursdays: February 13, 20, and 27, and March 6. Site
registration began January 8.
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.
Presenters are William Atkinson, MD, MPH; Judy Schmidt, RN, EdD; and Donna
Weaver, MN, RN. All are with CDC's immunization program.
Participants are strongly encouraged to buy a copy of the primary course
text, "Epidemiology and Prevention of Vaccine-Preventable Diseases" (The
Pink Book), 7th Edition. It is available for $25 from the Public Health
Foundation by phone at (877) 252-1200 or online at
http://bookstore.phf.org/prod171.htm
Registration is online only, at
http://www.phppo.cdc.gov/phtnonline/
For additional registration information and questions, email
ce@cdc.gov or call (800) 418-7246.
Webcast information and viewing options are available at
http://www.phppo.cdc.gov/phtn/webcast/epv03/default.asp
Technical support for the webcast is available at
http://www.phppo.cdc.gov/phtn/webcast/techsupport.asp
For general information online, go to:
http://www.phppo.cdc.gov/phtn/epv03/factsheet.asp
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January 13, 2003
REMINDER: CDC'S NATIONAL HEPATITIS COORDINATORS' CONFERENCE SET FOR JANUARY
26-30 IN SAN ANTONIO
Less than two weeks remain before the start of the Centers for Disease
Control and Prevention's National Hepatitis Coordinators' Conference.
It will be held in San Antonio on January 26-30.
Designed to provide training and networking opportunities, the conference is
intended for public health professionals, administrators, educators,
counselors, social workers, and others working with clients at risk for
viral hepatitis.
For 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
For registration information, call the conference planner, the University of
Minnesota Office of Continuing Medical Education, (800) 776-8636.
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January 13, 2003
ASTHO PANDEMIC INFLUENZA REPORT URGES STATE OFFICIALS TO PREPARE FOR A
LIKELY EPIDEMIC
The Association of State and Territorial Health Officials (ASTHO) recently
announced that a new publication, "Preparedness Planning for State
Health Officials: Nature's Terrorist Attack--Pandemic Influenza," is now
available on the ASTHO website.
Published in November 2002, the report identifies major issues that each
state will face during an influenza pandemic and offers suggestions for
linking pandemic planning to bioterrorism and other public health emergency
preparedness efforts. Included is a checklist that gives officials a
preliminary way to assess their states' readiness to respond to an influenza
pandemic.
At the conclusion, the authors underscore the importance of seizing the
moment by combining knowledge learned in past pandemics with knowledge
learned from the September 11 terrorist attacks to create a comprehensive
influenza pandemic plan. Part of the report's concluding two paragraphs are
reprinted here.
***********************
The World Trade Center and anthrax attacks served as harsh reminders of the
importance of disaster planning for both terrorist and naturally occurring
emergencies. While advance warning for a terrorist attack is unlikely, the
warning already exists for pandemic influenza. It will happen again, but it
is not possible to pinpoint the date. . . .
By combining lessons learned from the 2001 terrorist incidents with those
gleaned from pandemic history and the annual influenza season, the public
health community can develop an effective response. State health officials
have an unprecedented opportunity, using their states' bioterrorism
preparedness assessments and plans as scaffolding, to help create strategies
that address unique influenza preparedness issues and to improve the
nation's response as a whole to future pandemics.
***********************
To access a camera-ready (PDF) copy of the report (20 pages) and State
Health Official Checklist (4 pages) from the ASTHO website, go to:
http://www.astho.org/pubs/Pandemic%20Influenza.pdf
For a print copy, email
publications@astho.org or call (202) 715-1630.
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January 13, 2003
NEW! PROGRAM REPORT AND ADVOCACY BOOKLET AVAILABLE ONLINE FROM THE
CHILDREN'S VACCINE PROGRAM AT PATH
In December 2002, the Children's Vaccine Program (CVP) at the Program for
Appropriate Technology in Health (PATH) released its 28-page biennial
report, "Building the Future of Immunization." To access a camera-ready
(PDF) version of the report, go to:
http://www.childrensvaccine.org/files/Building_the_Future_Screen.pdf
A 16-page advocacy booklet, "The Case for Childhood Immunization," is also
available. For a copy in camera-ready (PDF) format, go to:
http://www.childrensvaccine.org/files/CVP_Occ_Paper5.pdf
For information about CVP and for an array of immunization resources in
English, Spanish, and French, visit CVP's website at
http://www.childrensvaccine.org
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January 13, 2003
GAVI'S MOST RECENT QUARTERLY NEWSLETTER AVAILABLE ONLINE
The December 2002 issue of "Immunization Focus," the quarterly
electronic newsletter published by the Global Alliance for
Vaccines and Immunization (GAVI), is now available on the GAVI
website.
An invaluable source of information on global vaccine topics,
the newsletter provides updates and topical debate about key
immunization issues. The current issue's lead article is "An
Investment for Life," a summary of several GAVI-supported
countries' use of funds raised by the Vaccine Fund. The other
articles are "Polio: Can Immunization Ever Stop?" and "Yellow
Fever: New Momentum for Epidemic Control."
To access a camera-ready (PDF) version of the December issue, go
to:
http://www.vaccinealliance.org/site_repository/resources/Dec02.pdf
To access the GAVI website, go to:
http://www.vaccinealliance.org
For additional information, email gavi@unicef.org
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January 13, 2003
FDA ADVISES BLOOD-COLLECTION INDUSTRY ABOUT ACCEPTING BLOOD FROM
DONORS RECENTLY VACCINATED AGAINST SMALLPOX
In December 2002, the Food and Drug Administration (FDA) issued
a guidance document for the blood- and plasma-collection
industry. FDA is concerned that people who receive blood
transfusions may be harmed by blood donated by recent smallpox
vaccine recipients. Though the risk of harm is slight, FDA
recommends that the blood- and plasma-collection industry defer
accepting blood donations from people who have been inoculated
with the smallpox vaccine until at least 21 days after
vaccination.
To access the final guidance document on the FDA website, go to:
http://www.fda.gov/cber/gdlns/smpoxdefquar.htm
To access a camera-ready (PDF) version of the document, go to:
http://www.fda.gov/cber/gdlns/smpoxdefquar.pdf
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January 13, 2003
CDC SUMMARIZES CAMBODIA'S SUCCESS IN REDUCING MEASLES INCIDENCE
The Centers for Disease Control and Prevention (CDC) published
"Accelerated Measles Control--Cambodia, 1999-2002" in the
January 10 issue of the "Morbidity and Mortality Weekly Report"
(MMWR). Part of the summary made available to the press is
reprinted below:
"Cambodia is currently rebuilding its public health
infrastructure following a long civil war and has limited
trained personnel and logistic capacity. However, the country
has made significant strides in the control of measles since
1999. 'Rolling' vaccination campaigns have improved measles
vaccination coverage in the country. These campaigns have led to
a marked decline in reported cases from 11,940 cases in 2000 to
1,234 in 2002 (through 18 October 2002). To continue to improve
measles control, Cambodia will need to further increase
vaccination coverage through both routine services and periodic
supplementary campaigns and strengthen surveillance. The lessons
learned in Cambodia may be useful in planning measles control in
other post-conflict settings."
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5201a2.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5201.pdf
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