Issue
Number 363
February 3, 2003
CONTENTS OF THIS ISSUE
- CDC publishes "Recommended Childhood and Adolescent
Immunization Schedule--United States, 2003"
- CDC notifies readers that use of standing orders for influenza
and pneumococcal vaccination can increase vaccination rates among persons
age 65 and over
- New! "What If You Don't Immunize Your Child" brochure can help
convince hesitant parents to choose vaccination
- New edition! Canadian Paediatric Society publishes revised
vaccination guide for parents
- Reminder: CDC satellite broadcast series on
vaccine-preventable diseases begins February 13
- Reminder: CDC's National Immunization Conference is set for
March 17-20 in Chicago
- Revised! CDC issues updated version of smallpox Vaccine
Information Statement
- Website of the National Alliance for Hispanic Health offers
bilingual health information
- New! Hepatitis C video "The Hidden Epidemic" now available
from HFI
- IOM report lists immunization as one of twenty priority areas
that can transform U.S. health care system
- March 10 is application deadline for hepatitis C educational
workshop grants
- IOM Immunization Safety Review Committee to meet about the
safety of influenza vaccine on March 13-14
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February 3, 2003
CDC PUBLISHES "RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION
SCHEDULE--UNITED STATES, 2003"
The Centers for Disease Control and Prevention (CDC) published "Recommended
Childhood and Adolescent Immunization Schedule--United States, 2003" in the
January 31 issue of the "MMWR QuickGuide" (MMWR).
MMWR prefaced the 2003 schedule with several introductory paragraphs.
Following is the preface, reprinted in its entirety with the exception
of references.
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Each year, CDC's Advisory Committee on Immunization Practices (ACIP) reviews
the recommended childhood and adolescent immunization schedule to ensure
that it is current with changes in manufacturers' vaccine formulations and
contains revised recommendations for the use of licensed vaccines, including
those newly licensed. The recommended childhood immunization schedule for
2003 has remained the same in content and format since January 2002. The
recommendations and format have been approved by ACIP, the American Academy
of Family Physicians, and the American Academy of Pediatrics.
Catch-Up Childhood and Adolescent Immunization Schedule A new catch-up
immunization schedule for children and adolescents who start late or who are
more than 1 month behind is presented for the first time in 2003. Minimum
ages and minimum intervals between doses are provided for each of the
routinely recommended childhood and adolescent vaccines. The schedule is
divided into two age groups, children aged 4 months–6 years and
children/adolescents aged 7–18 years.
Hepatitis B Vaccine
The schedule indicates a preference for administering the first dose of
hepatitis B vaccine to all newborns soon after birth and before hospital
discharge. Administering the first dose of hepatitis B vaccine soon after
birth should minimize the risk for infection caused by errors or delays in
maternal hepatitis B surface antigen (HBsAg) testing or reporting, or by
exposure to persons with chronic hepatitis B virus (HBV) infection in the
household, and can increase the child's likelihood of completing the vaccine
series. Only monovalent hepatitis B vaccine can be used for the birth dose.
Either monovalent or combination vaccine can be used to complete the series.
Four doses of hepatitis B vaccine can be administered to complete the
series when a birth dose is given. In addition to receiving hepatitis B
immune globulin (HBIG) and the hepatitis B vaccine series, infants born to
HBsAg-positive mothers should be tested for HBsAg and antibody to
HBsAg (anti-HBs) at age 9–15 months to identify those with chronic HBV
infection or those who might require revaccination.
Influenza Vaccine
In addition to the recommendation to administer annual influenza vaccine to
children at high risk, healthy children aged 6–23 months are encouraged to
receive influenza vaccine when feasible. Children in this age group are at
substantially increased risk for influenza-related hospitalizations.
Inactivated Poliovirus Vaccine
The inactivated poliovirus (IPV) vaccine footnote has been removed from the
Recommended Childhood and Adolescent Immunization Schedule, reflecting the
cessation of the use of oral poliovirus (OPV) vaccine in the United States.
An all-IPV schedule for routine childhood poliovirus vaccination has been
recommended in the United States since January 1, 2000. All children should
receive 4 doses of IPV at age 2, 4, and 6–18 months, and at age 4–6 years.
For children who received an all-IPV or all-OPV series, a fourth dose is not
necessary if the third dose was administered at age 4 years or over. If both
OPV and IPV were administered as part of a series, a total of 4 doses should
be administered regardless of the child's current age. These
statements clarify the "Dose Three to Booster Dose" column in Table 2 of the
catch-up schedule. Routine poliovirus vaccination is not generally
recommended for persons age 18 years or over residing in the United States.
Vaccine Supply Recommendations
As a result of the vaccine supply shortage, deferral of some doses of
pneumococcal conjugate vaccine (PCV) has been recommended; health-care
providers should record patients for whom vaccination has been deferred and
should contact them once the supply has been restored. Supplies of tetanus
and diphtheria toxoids (Td) vaccine; diphtheria and tetanus toxoids and
acellular pertussis (DTaP) vaccine; measles, mumps, and rubella (MMR)
vaccine; and varicella vaccine in the United States have become
sufficient to permit the resumption of the routine schedule for use as
recommended by ACIP. The range of recommended ages for the Td vaccine has
been extended to 18 years to emphasize that the vaccine can be
administered during any visit if at least 5 years have elapsed since the
last dose of tetanus and diphtheria toxoid–containing vaccine. Information
about vaccine shortages is available from CDC's National Immunization
Program at
http://www.cdc.gov/nip/news/shortages/default.htm
Vaccine Information Statements
The National Childhood Vaccine Injury Act requires that all health-care
providers give parents or patients copies of Vaccine Information Statements
before administering each dose of the vaccines listed in the schedule.
Additional information is available from state health departments and at
http://www.cdc.gov/nip/publications/vis
Detailed recommendations for using vaccines are available from
the manufacturers' package inserts, ACIP statements on specific
vaccines, and the 2000 Red Book. ACIP statements for each
recommended childhood vaccine can be viewed, downloaded, and
printed from CDC's National Immunization Program at
http://www.cdc.gov/nip/publications/acip-list.htm
Instructions on the use of the Vaccine Information Statements
are available at
http://www.cdc.gov/nip/publications/vis/vis-instructions.pdf
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To access the article in camera-ready (PDF) format, go to:
http://www.cdc.gov/mmwr/pdf/wk/mm5204-Immunization.pdf
To obtain a camera-ready (PDF) version of the 2003 schedule on
the IAC website, go to:
http://www.immunize.org/cdc/child-schedule.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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February 3, 2003
CDC NOTIFIES READERS THAT USE OF STANDING ORDERS FOR INFLUENZA
AND PNEUMOCOCCAL VACCINATION CAN INCREASE VACCINATION RATES
AMONG PERSONS AGE 65 AND OVER
The Centers for Disease Control and Prevention (CDC) published a
Notice to Readers, "Facilitating Influenza and Pneumococcal
Vaccination Through Standing Orders Programs," in the January 31
issue of the "Morbidity and Mortality Weekly Report" (MMWR). The
notice, with the exception of references, is reprinted below in
its entirety.
*************************
Influenza and pneumococcal vaccines are underused for persons in
the United States aged 65 years and over (66% receive influenza
vaccine and 55% pneumococcal vaccine), even among patients in
nursing homes (68% for influenza and 38% for pneumococcal
vaccine). Systematic literature reviews by the Task Force on
Community Preventive Services and the Southern California
Evidence-Based Practice Center-RAND have shown that standing
orders programs improve vaccination rates. Standing orders
programs authorize nurses and pharmacists, where allowed by
state law, to administer vaccinations according to an
institution- or physician-approved protocol without the need for
a physician's examination or direct order. Several studies have
shown improved influenza and pneumococcal vaccination rates
through standing orders programs specifically in long-term care
facilities (LTCFs) and hospitals. Based on the strength of
available evidence, the Advisory Committee on Immunization
Practices recommends the use of standing orders programs in
both outpatient and inpatient settings.
As a result of this recommendation, on October 2, 2002, the
Centers for Medicare and Medicaid published an interim final
rule that removes the physician signature requirement for
influenza and pneumococcal vaccinations from the Conditions of
Participation for Medicare and Medicaid participating hospitals,
LTCFs, and home health agencies (HHAs). The Conditions of
Participation for these types of facilities require orders for
drugs and biologicals to be in writing and signed by the
practitioner(s) responsible for the care of the patient, with
the exception of influenza and pneumococcal polysaccharide
vaccines, which can be administered per physician-approved
facility or agency policy after an assessment for
contraindications. State agencies should be informed about this
change so that appropriate policy revisions can be implemented.
This modification will improve access to influenza and
pneumococcal vaccination in hospitals, LTCFs, and HHAs as
allowed by state law, consistent with standing orders programs
already allowed in community and physician's outpatient office
settings. If implemented rapidly, this change will facilitate
achievement of the national health objective for 2010 of
vaccinating at least 90% of the institutionalized and
noninstitutionalized population aged 65 years and over.
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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5204a4.htm
To obtain a camera-ready copy (PDF format) of this issue of
MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5204.pdf
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February 3, 2003
NEW! "WHAT IF YOU DON'T IMMUNIZE YOUR CHILD?" BROCHURE CAN HELP
CONVINCE HESITANT PARENTS TO CHOOSE VACCINATION
The Immunization Action Coalition (IAC) is pleased to announce
the availability of a new parent-education brochure that can
help providers convince hesitant parents to vaccinate their
children.
Titled "What If You Don't Immunize Your Child?" the piece
succinctly relates the risks unvaccinated children face and the
risk they pose to others. It also offers parents several
reliable sources of vaccination information.
IAC is grateful to the Immunization Branch of the California
Department of Health for permission to adapt the brochure.
Designed for double-sided printing, the camera-ready (PDF)
version can be made into an attractive duo-fold brochure. To
access it from the IAC website, go to:
http://www.immunize.org/catg.d/p4017.pdf
To access the HTML version, go to:
http://www.immunize.org/catg.d/p4017.htm
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February 3, 2003
NEW EDITION! CANADIAN PAEDIATRIC SOCIETY PUBLISHES REVISED
VACCINATION GUIDE FOR PARENTS
Updated and expanded, the second edition of "Your Child's Best
Shot: A Parent's Guide to Vaccination" is a comprehensive,
clearly written, and well-organized book. It was written by
Ronald Gold, MD, MPH, professor emeritus of pediatrics,
University of Toronto, and reviewed by the 2001-02 Infectious
Diseases and Immunization Committee of the Canadian Paediatric
Society (CPS).
Developed to give parents reliable information about childhood
vaccination, the book contains general information on how
vaccines work and on their safety and effectiveness. The next
section contains exhaustive information on each of the 13
vaccine-preventable childhood diseases, the vaccines that
prevent them, possible side effects, and contraindications. The
book concludes with chapters on vaccines for travel, answers to
common questions, and vaccine tables.
Available in English and French versions, the book costs $19.95
(Canadian dollars) for the general public or $16.95 for CPS
members.
To order by phone, call (613) 526-9397; to order online from the
CPS website, go to:
http://www.cps.ca/english/publications/bookstore/YourChildsBestShotnew.htm
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February 3, 2003
REMINDER: CDC SATELLITE BROADCAST SERIES ON VACCINE-PREVENTABLE
DISEASES BEGINS FEBRUARY 13
Intended for professionals who either give vaccinations or set
policy in their workplaces, the satellite broadcast series
"Epidemiology and Prevention of Vaccine-Preventable
Diseases," is scheduled from noon to 3:30 pm ET on four
consecutive Thursdays: February 13, 20, and 27, and March 6.
The course is cosponsored by the National Immunization Program
(NIP) of the Centers for Disease Control and Prevention (CDC)
and the Public Health Training Network. Its 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 course information online, go to:
http://www.phppo.cdc.gov/phtn/epv03/factsheet.asp
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February 3, 2003
REMINDER: CDC'S NATIONAL IMMUNIZATION CONFERENCE IS SET FOR
MARCH 17-20 IN CHICAGO
The Centers for Disease Control and Prevention's National
Immunization Conference, "Immunization: A Strong Foundation for
Today's Challenges," will bring together local, state, federal,
and private-sector immunization partners to explore science,
policy, education, and planning issues related to immunization
and vaccine-preventable diseases. It will be held in Chicago
March 17-20.
Meeting topics will include immunization for all age groups,
barriers to vaccination, global immunization, surveillance,
health education policy, new vaccines and vaccine development,
immunization registries, and vaccine safety.
To register online, go to:
http://conferences.taskforce.org/NIC2/Registration-Form.asp
For registration information, call (800) 765-7173 or (404)
639-8225 or email nipnic@cdc.gov
For information on the conference program and objectives,
meeting agenda, and accommodations, go to:
http://www.cdc.gov/nip/nic
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February 3, 2003
REVISED! CDC ISSUES UPDATED VERSION OF SMALLPOX VACCINE
INFORMATION STATEMENT
On January 16, the Centers for Disease Control and Prevention
(CDC) issued the revised smallpox Vaccine Information Statement
(VIS). The revised VIS is part of CDC's Smallpox Information
Packet, which includes five supplements (A through E). The VIS
should be used with the supplements.
In addition to the VIS and supplements A-E, the Smallpox
Information Packet includes information about pre-event
screening, treatment for certain severe vaccine adverse events,
and post-vaccination follow up, among other topics.
To access the complete Smallpox Information Packet from the CDC
website, go to:
http://www.bt.cdc.gov/agent/smallpox/vaccination/infopacket.asp
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 other VISs, as well as VISs for
additional vaccines (some in up to 28 languages), visit the
website of the Immunization Action Coalition at
http://www.immunize.org/vis
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February 3, 2003
WEBSITE OF THE NATIONAL ALLIANCE FOR HISPANIC HEALTH OFFERS
BILINGUAL HEALTH INFORMATION
The website of the National Alliance for Hispanic Health (NAHH)
posts an array of health information in Spanish and English.
Topics include environmental hazards, prevalent diseases such as
various cancers and diabetes, and childhood and adult
vaccination. Information is presented in question-and- answer
mode and is available in HTML and PDF formats.
In addition, the website posts telephone numbers for bilingual
helplines and publications and has links to hundreds of health-related websites.
To access immunization information in Spanish from the NAHH
website, go to:
http://www.hispanichealth.org/immunization_span.htm
To access immunization information in English, go to:
http://www.hispanichealth.org/immunization.htm
To access the entire website, go to:
http://www.hispanichealth.org
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February 3, 2003
NEW! HEPATITIS C VIDEO "THE HIDDEN EPIDEMIC" NOW AVAILABLE FROM
HFI
Recently released by the Hepatitis Foundation International
(HFI), "The Hidden Epidemic--Unraveling the Mysteries of
Hepatitis C" gives patients and their families a comprehensive
overview of the disease.
It uses 3-D animation to illustrate how hepatitis C affects the
liver and narration to explain the disease's cause,
transmission, treatment, and other topics. Interviews with
patients and health professionals add interest and provide
encouragement to viewers. It runs 28 minutes and costs $45.
To order it online from the HFI website, go to:
http://www.hepfi.org/pdfs/orderform.pdf
To order by phone, call HFI at (800) 891-0707.
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February 3, 2003
IOM REPORT LISTS IMMUNIZATION AS ONE OF TWENTY PRIORITY AREAS
THAT CAN TRANSFORM U.S. HEALTH CARE SYSTEM
In January, the Institute of Medicine (IOM) of the National
Academies released a report advising the Department of Health
and Human Services and others in the health care community that
attention to 20 priority areas could bring major improvements in
health care quality and delivery for all Americans.
In including immunization as a priority area, the report
mentioned the need to increase rates of influenza and
pneumococcal immunization among nursing-home residents and rates
of immunization in general among black and Hispanic adults and
low-income, inner-city children.
Titled "Priority Areas for National Action: Transforming Health
Care Quality," the report will be available later this year from
the National Academies Press at (800) 624-6242 or (888) 624-8373
or on the Internet at http://www.nap.edu
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February 3, 2003
MARCH 10 IS APPLICATION DEADLINE FOR HEPATITIS C EDUCATIONAL
WORKSHOP GRANTS
Through a cooperative agreement with the Division of Viral
Hepatitis of the Centers for Disease Control and Prevention
(CDC), the National Association of County & City Health
Officials (NACCHO) will be awarding eight grants of $10,000 each
to convene community-wide and/or state-wide hepatitis C
educational training sessions. March 10 is the date applications
must be received (not postmarked) by NACCHO.
To access the request for proposal from NACCHO's website, go to:
http://archive.naccho.org/Documents/HepatitisC-RFP.pdf
To access the application, go to:
http://archive.naccho.org/Documents/HepatitisC-ApplicationForm.pdf
For additional information, phone NACCHO at (202) 783-5550.
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February 3, 2003
IOM IMMUNIZATION SAFETY REVIEW COMMITTEE TO MEET ABOUT THE
SAFETY OF INFLUENZA VACCINE ON MARCH 13-14
A meeting of the Immunization Safety Review committee (ISR) of
the Institute of Medicine (IOM) will explore the influenza
vaccine and possible neurological complications. It is scheduled
for March 13-14 in Washington, DC.
A part of ISR's information-gathering process, the March 13
session is open to the public and will be webcast live. The
webcast address and draft meeting agenda will be posted closer
to the meeting date on the IOM website at http://www.iom.edu
Registration for the public session is online; to register go to
the IOM website at
http://www4.nationalacademies.org/iom/Registrations.nsf/Register?OpenForm&013
For additional information, email ISR at
imsafety@nas.edu or
call (202) 334-1361.
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