Issue
Number 362
January 27, 2003
CONTENTS OF THIS ISSUE
- CDC releases recommendations on prevention and control of
hepatitis virus infections in correctional settings
- IOM report urges caution in implementing national smallpox
immunization program
- CDC publishes guidance for clinicians on smallpox vaccination
and adverse reactions
- New! CDC's "2001-2002 State Immunization Requirements" now on
IAC website
- CDC releases surveillance summary on safety after immunization
- Professional education pieces on the management of patients
chronically infected with HBV are updated on IAC's website
- February 4 is the date for CDC's satellite broadcast and
webcast on clinical management of smallpox adverse events
- CDC publishes report on a recent rabies death in Iowa
- CDC broadcast on smallpox and vaccinia for laboratorians is
set for January 29
- MMWR notifies readers that vaccine research conference is set
for May 5-7; February 7 is abstract deadline
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January 27, 2003
CDC RELEASES REPORT ON PREVENTION AND CONTROL OF HEPATITIS VIRUS INFECTIONS
IN CORRECTIONAL SETTINGS
The Centers for Disease Control and Prevention (CDC) published "Prevention
and Control of Infections with Hepatitis Viruses in Correctional Settings"
in the January 24 issue of "MMWR Recommendations and Reports" (MMWR).
The report was prepared by the Division of Viral Hepatitis of the National
Center for Infectious Diseases. The summary is reprinted below.
************************
This report consolidates previous recommendations and adds new ones for
preventing and controlling infections with hepatitis viruses in correctional
settings. These recommendations provide guidelines for juvenile and adult
correctional systems regarding 1) identification and investigation of acute
viral hepatitis; 2) preexposure and postexposure immunization for hepatitis
A and hepatitis B; 3) prevention of hepatitis C virus infection and its
consequences; 4) health education; and 5) release planning. Implementation
of these recommendations can reduce transmission of infections with
hepatitis viruses among adults at risk in both correctional facilities and
the outside community. These recommendations were developed after
consultation with other federal agencies and specialists in the fields of
corrections, correctional health care, and public health at a meeting in
Atlanta, March 5-7, 2001. This report can serve as a resource for those
involved in planning and implementing health-care programs for incarcerated
persons.
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To obtain the complete text of the report, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5201a1.htm
To obtain the report in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5201.pdf
The PDF version includes a free CDC-sponsored continuing education activity
that can be completed online or submitted via U.S. mail for CME, CDU, CHES,
or CNE credit. Simply read the MMWR report, answer the questions at
the end of the report, and follow instructions for submitting your answers.
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 27, 2003
IOM REPORT URGES CAUTION IN IMPLEMENTING NATIONAL SMALLPOX IMMUNIZATION
PROGRAM
On January 17, the Institute of Medicine (IOM) of the National Academies
issued a news release summarizing the content of IOM's first report advising
the Centers for Disease Control and Prevention (CDC) on the implementation
of the national smallpox vaccination program. CDC sponsored the report. A
private, nonprofit institution, IOM provides health policy advice under a
Congressional charter granted to the National Academy of Sciences.
Titled "Review of the Centers for Disease Control and Prevention's Smallpox
Vaccination Program Implementation--Letter Report #1," the 52-page report
urges CDC to take a cautious, deliberate approach and to implement
midcourse corrections as necessary. Excerpts from the news release are
reprinted below.
*********************
. . . . "While we recognize that CDC has been asked to initiate the
immunization campaign rapidly, it's important to remember that recipients of
the vaccine are voluntarily assuming its risks for the greater public
good. We agree with CDC and President Bush that safety is paramount, and we
support efforts to minimize those risks," said Brian L. Strom, professor and
chair, department of biostatistics and epidemiology, University of
Pennsylvania School of Medicine, Philadelphia, and chair of the study
committee. "Learning from experience, making midcourse corrections on every
aspect of the program, and maintaining constant communication with the
public are integral to developing the safest program possible. We support
efforts by CDC and its state and local partners to share and analyze
information on the program's progress and outcomes, including safety
concerns, at every step before proceeding to the next.". . . .
One of the committee's overarching concerns is that the preparations needed
to educate vaccine recipients and the general public, train vaccine workers
and health care providers, and fully address all other aspects of the
vaccination program appear to require a more generous time frame than
currently proposed for phase one. While the committee cited several issues
that it would like to see addressed more fully before the first phase
begins, at minimum it urged CDC to actively collect and evaluate adverse
reaction data from vaccine recipients and vaccination clinics during this
initial phase to inform any necessary changes prior to the start of phase
two. Also, CDC should develop and communicate the criteria, such as a
threshold number of adverse events, that would trigger midcourse changes to
the agency's current guidance on issues such as screening,
contraindications, and administrative leave policies.
Recent surveys indicate that a significant percentage of the public
misunderstands the risks and safety of the smallpox vaccine, the severity of
the disease, and how the vaccination program will proceed. Clearer,
consistent communication with the public is essential if the campaign is to
succeed, the committee said. . . .
For example, many potential vaccine recipients may falsely assume that the
provisions of the Homeland Security Act of 2002 would reimburse them for
medical expenses or lost income resulting from complications of vaccination.
However, the act covers only injuries that result from vaccine that was
negligently manufactured or administered. . . .
While highly effective, the smallpox vaccine carries considerable side
effects and may be the least-safe vaccine ever used on a large scale, making
data collection on all adverse events paramount to the current campaign's
success. . . . CDC has proposed using the existing Vaccine Adverse Event
Reporting System (VAERS) to monitor for adverse events. However, VAERS is a
passive surveillance system and will not capture all complications, the
report says. The committee strongly urges the agency to use the planned
Pre-event Vaccination System, a secure data exchange system, to actively
collect information on adverse events. Data on adverse reactions collected
from the first phase should be evaluated before the next phase gets under
way.
*********************
To access the full report from the website of the National Academies Press,
go to:
http://www.nap.edu/books/NI000489/html
To access the news release, go to:
http://www4.nationalacademies.org/news.nsf/isbn/01172003?OpenDocument
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January 27, 2003
CDC PUBLISHES GUIDANCE FOR CLINICIANS ON SMALLPOX VACCINATION AND ADVERSE
REACTIONS
The Centers for Disease Control and Prevention (CDC) published "Smallpox
Vaccination and Adverse Reactions: Guidance for Clinicians" in the January
24 issue of "MMWR Dispatch" (MMWR). CDC explained that its policy is to
publish "MMWR Dispatch" only for the "immediate release of important public
health information." It is published "on the Web outside of the routine
weekly publication schedule" and will be available in a print issue of MMWR
in the future.
The 50-page report includes information on interpreting vaccination results,
transmission of vaccinia virus, adverse reactions, prophylaxis, laboratory
diagnosis, treatments, and smallpox vaccine adverse event reporting. A
portion of the report's summary is reprinted below.
**************************
The material in this report originated in the National Center for Infectious
Diseases, James M. Hughes, M.D., Director, and the Bioterrorism Preparedness
and Response Program, Charles Schable, M.S., Acting Director; and the
National Immunization Program, Walter A. Orenstein, M.D., Director, and the
Epidemiology and Surveillance Division, Melinda Wharton, M.D., Director.
The guidance in this report is for evaluation and treatment of patients with
complications from smallpox vaccination in the preoutbreak setting.
Information is also included related to reporting adverse events and
seeking specialized consultation and therapies for these events. The
frequencies of smallpox vaccine-associated adverse events were identified in
studies of the 1960s. Because of the unknown prevalence of risk
factors among today's population, precise predictions of adverse reaction
rates after smallpox vaccination are unavailable. The majority of adverse
events are minor, but the less-frequent serious adverse reactions require
immediate evaluation for diagnosis and treatment. Agents for treatment of
certain vaccine-associated severe adverse reactions are vaccinia immune
globulin (VIG), the first-line therapy, and cidofovir, the second-line
therapy. These agents will be available under Investigational New Drug (IND)
protocols from CDC and the U.S. Department of Defense (DoD).
**************************
To access an HTML version of the complete report, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/di52cha1.htm
To access a camera-ready (PDF) version, go to:
http://www.cdc.gov/mmwr/pdf/wk/MMWRDispatch1-24-03.pdf
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January 27, 2003
NEW! CDC'S "2001-2002 STATE IMMUNIZATION REQUIREMENTS" NOW ON IAC'S WEBSITE
"2001-2002 State Immunization Requirements," a Centers for Disease Control
and Prevention (CDC) publication, is available on the website of the
Immunization Action Coalition. According to its foreword, the
publication "reflects state laws,regulations, or rule making that impose
vaccination requirements for enrollment and/or attendance in day care, Head
Start, kindergarten, grades 1 through 12, colleges, and universities."
The comprehensive, 35-page publication is based on data validated in
February 2002. It represents information supplied by program managers from
50 states, the District of Columbia, the Commonwealth of Puerto Rico, and
staff from CDC's National Immunization Program. The information is organized
by vaccine and presented in table and map formats.
To access the 2001-2002 CDC requirements in camera-ready (PDF) format from
the IAC website, go to:
http://www.immunize.org/laws/izlaws01-02.pdf
To access information on state mandates on immunization requirements,
organized by vaccine-preventable disease, from the IAC website, go to:
http://www.immunize.org/laws
To access information on school-entry requirements, organized by
state, from the website of the National Network for Immunization
Information, go to:
http://www.immunizationinfo.org/search/index.cfm
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January 27, 2003
CDC RELEASES SURVEILLANCE SUMMARY ON SAFETY AFTER IMMUNIZATION
The Centers for Disease Control and Prevention (CDC) published
"Surveillance for Safety After Immunization: Vaccine Adverse
Event Reporting System (VAERS)--United States, 1991-2001" in the
January 24 issue of "MMWR Surveillance Summaries" (MMWR).
A summary made available to the press is reprinted below.
************************
VAERS was established in 1990 under the joint administration of
CDC and the Food and Drug Administration (FDA) to accept reports
of suspected adverse events after administration of any vaccine
licensed in the United States. VAERS is a passive surveillance
system: reports of events are voluntarily submitted by those who
experience them, their caregivers, or others. During 1991–2001,
VAERS received 128,717 reports, whereas more than 1.9 billion
net doses of human vaccines were distributed. Overall, the most
commonly reported adverse event was fever, which appeared in
25.8 percent of all reports, followed by injection-site
hypersensitivity (15.8 percent), rash (unspecified) (11.0
percent), injection-site edema (10.8 percent), and
vasodilatation (10.8 percent). A total of 14.2 percent of all
reports described serious adverse events, which by regulatory
definition include death, life-threatening illness,
hospitalization or prolongation of hospitalization, or permanent
disability.
************************
To obtain the complete text of the summary, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5201a1.htm
To obtain the summary in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/PDF/ss/ss5201.pdf
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January 27, 2003
PROFESSIONAL EDUCATION PIECES ON THE MANAGEMENT OF PATIENTS
CHRONICALLY INFECTED WITH HBV ARE UPDATED ON IAC'S WEBSITE
The liver-disease experts who work with the Immunization Action
Coalition (IAC) have modified five professional education pieces
on the management of patients chronically infected with
hepatitis B virus. The pieces now reflect information about a
new drug, adefovir dipivoxil (trade name Hepsera), which was
recently approved for use in the United States.
The titles of the five pieces, information about the authors,
and direct links to each piece follow.
- "Does Your Patient Have Chronic Hepatitis B?" by Coleman I.
Smith, MD, was revised January 2003. Dr. Smith is a
gastroenterologist/hepatologist at Minnesota Gastroenterology,
Minneapolis. He is also a member of IAC's Advisory Board.
To access his paper in HTML format, go to:
http://www.immunize.org/nslt.d/n18/p2162.htm
To access it in PDF format, go to:
http://www.immunize.org/catg.d/p2162.pdf
- "Management of Chronic Hepatitis B in Adults," by Brian J.
McMahon, MD, was revised in December 2002. Dr. McMahon,
internal medicine specialist, is director, Viral
Hepatitis Program, Alaska Native Medical Center, Anchorage.
To access his paper in HTML format, go to:
http://www.immunize.org/catg.d/p2161.htm
To access it in PDF format, go to:
http://www.immunize.org/catg.d/p2161.pdf
- "Management of Chronic Hepatitis B in Adults" and "Management
of Chronic Hepatitis B in Children," both written by Hari S.
Conjeevaram, MD, were revised in January 2003.
Dr. Conjeevaram is with the Division of Gastroenterology,
University of Michigan, Ann Arbor.
To access his paper on management in adults in HTML format,
go to: http://www.immunize.org/catg.d/p2141.htm
To access it in PDF format, go to:
http://www.immunize.org/catg.d/p2141har.pdf
To access his paper on management in children in HTML format,
go to: http://www.immunize.org/catg.d/p2140.htm
To access it in PDF format, go to:
http://www.immunize.org/catg.d/p2140har.pdf
- "What the Physician can do to Help the Child who is a
Hepatitis B Carrier," by Sarah Jane Schwarzenberg, MD, was
revised January 2003. Dr. Schwarzenberg is with the Division
of Pediatric Gastroenterology, Hepatology, and Nutrition,
University of Minnesota, Minneapolis.
To access her paper in HTML format, go to:
http://www.immunize.org/catg.d/p2170.htm
To access it in PDF format, go to:
http://www.immunize.org/catg.d/p2170sjs.pdf
To access all five revised pieces on IAC's "Management of
Chronic Hepatitis B in Children and Adults" web page, go to:
http://www.immunize.org/catg.d/p2164.htm
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January 27, 2003
FEBRUARY 4 IS THE DATE FOR CDC'S SATELLITE BROADCAST AND WEBCAST
ON CLINICAL MANAGEMENT OF SMALLPOX ADVERSE EVENTS
The Centers for Disease Control and Prevention (CDC) will offer
a live satellite broadcast, "Clinical Management of Adverse
Events Following Smallpox Vaccination: A National Training
Initiative," on February 4 from 1 to 2:30 pm ET.
Program information
Intended to prepare clinicians to recognize, report, and
clinically manage adverse reactions to smallpox vaccination, the
program is directed to the following health professionals:
- Clinical specialists such as infectious disease specialists,
dermatologists, critical care specialists, neurologists,
ophthalmologists, allergists, and immunologists
- Primary care clinicians including emergency room clinicians,
internists, pediatricians, and family medicine physicians
- State and local health department staff involved in adverse
event assessment and reporting
Technical information
Webcast information and viewing options are available at
http://www.phppo.cdc.gov/phtn/webcast/smallpox0204/default.asp
Technical support for the webcast is available at
http://www.phppo.cdc.gov/phtn/webcast/techsupport.asp
Procedural information
Additional information, including participant registration
(encouraged but not required), options for submitting questions
during the broadcast, and options for ordering a post-broadcast
videotape or CD-ROM of the program, is available at
http://www.phppo.cdc.gov/phtn/smallpox0204.asp
Registration questions will be answered by phone at (800) 418-7246 or (404) 639-1292; or by email at
ce@cdc.gov (when
emailing, type "Clinical Management of Adverse Events Following
Smallpox Vaccination" in the subject line).
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January 27, 2003
CDC PUBLISHES REPORT ON A RECENT RABIES DEATH IN IOWA
The Centers for Disease Control and Prevention (CDC) published
"Human Rabies--Iowa, 2002" in the January 24 issue of the
"Morbidity and Mortality Weekly Report" (MMWR). Part of a
summary made available to the press is reprinted below.
*************************
In September 2002, a 20-year-old man, residing in Iowa, died
from rabies. This is the first human case of rabies in that
state since 1951. The source of the patient's infection remains
unclear. Because the patient was a musician who had traveled to
recording studios in several cities in Iowa and Illinois during
the infectious stage of his illness, family members permitted
the public release of his name to the media. A total of 53
family members or associates of the patient were given rabies
post-exposure prophylaxis (PEP). Additionally, 71 hospital
staff members were also given PEP. This case represents the
third report of human rabies during 2002.
*************************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5203a3.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5203.pdf
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January 27, 2003
CDC SATELLITE BROADCAST AND WEBCAST ON SMALLPOX AND VACCINIA FOR
LABORATORIANS IS SET FOR JANUARY 29
The Centers for Disease Control and Prevention (CDC) will offer
a live satellite broadcast, "Smallpox and Vaccinia Laboratory
Testing: A National Training Initiative," on January 29 from
1 to 3 pm ET.
Program information
The program is intended to prepare the nation's laboratorians to
respond effectively to vaccine adverse events and the
intentional release of smallpox. It is directed to the following
health professionals: All laboratorians and those who use
laboratory services; laboratorians in state and local public
health, clinical, reference and physician office laboratories;
pathologists, physicians, phlebotomists, and specimen handlers
and transporters; and state chief medical officers and
epidemiologists.
Procedural information
Additional information, including participant registration
(encouraged but not required), options for submitting questions
during the broadcast, and options for ordering a post-broadcast
videotape or CD-ROM of the program, is available at
http://www.phppo.cdc.gov/phtn/smallpox0129.asp
Registration questions will be answered by phone at (800) 418-7246 or (404) 639-1292; or by email at
ce@cdc.gov (when
emailing, type "Smallpox and Vaccinia Laboratory Testing: A
National Training Initiative" in the subject line).
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January 27, 2003
MMWR NOTIFIES READERS THAT VACCINE RESEARCH CONFERENCE IS SET
FOR MAY 5-7; FEBRUARY 7 IS ABSTRACT DEADLINE
The Centers for Disease Control and Prevention (CDC) published a
Notice to Readers: "Conference on Vaccine Research" in the
January 24 issue of the "Morbidity and Mortality Weekly Report"
(MMWR). The notice is reprinted below in its entirety.
*************************
The sixth annual conference on Vaccine Research: Basic Science,
Product Development, Clinical and Field Studies will be held May
5-7, 2003, in Arlington, Virginia. The meeting is co-sponsored
by CDC, the National Foundation for Infectious Diseases (NFID),
and nine other national and international agencies, institutes,
and organizations involved in research, development, and use of
vaccines and associated technologies for the prevention of human
and veterinary diseases through vaccination.
The deadline for online submission of abstracts for oral and
poster presentations is February 7. Program announcements and
forms for abstract submission, registration, and hotel
reservation are available at
http://www.nfid.org/conferences/vaccine03 and from NFID,
Suite 750, 4733 Bethesda Avenue, Bethesda, MD, 20814-5278;
telephone (301) 656-0003, ext. 19; fax (301) 907-0878; or email
vaccine@nfid.org
*************************
To obtain the notice online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5203a4.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5203.pdf
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