Issue
Number 369
March 3, 2003
CONTENTS OF THIS ISSUE
- CDC's Advisory Committee on Immunization Practices votes on
recommendations for the use of Pediarix vaccine
- UNICEF's plan to immunize four million Iraqi children against
polio goes forward despite threat of war
- Three million Rwandan children immunized against measles
- CDC publishes update of smallpox vaccine adverse events
surveillance
- Boost your clinic's immunization rate--IAC's Adult
Immunization Record Cards prompt patients to keep immunizations up to date
- CDC issues supplemental Recommendations for Using Smallpox
Vaccine in a Pre-Event Vaccination Program
- Track pending immunization legislation the easy way on the
website of the National Conference of State Legislatures
- Attention immunization coalitions: The Immunization Coalition
Sustainability Project needs your input
- Newly available: IOM report from the Los Angeles workshop on
immunization finance is in print and online
- Immunize for Life conference scheduled for May 15-16 in Grand
Forks, ND
- MMWR notifies readers about availability of Maxi-Vac smallpox
vaccination software
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March 3, 2003
CDC'S ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES VOTES ON RECOMMENDATIONS
FOR THE USE OF PEDIARIX VACCINE
The Advisory Committee on Immunization Practices (ACIP) is a committee of 15
national experts that provides advice and guidance to the Centers for
Disease Control and Prevention (CDC) regarding the most appropriate use of
vaccines.
At its February 26-27 meeting, ACIP voted on three issues regarding the use
of Pediarix combination vaccine. The results of the votes were: (1) Pediarix
may be given to all infants at 2, 4, and 6 months of age, including infants
of mothers who are HBsAg positive or whose HBsAg status is unknown; (2) the
recommended immunization schedule when Pediarix is used also includes giving
newborns the birth dose of monovalent hepatitis B vaccine before
hospital discharge; (3) Pediarix is recommended for inclusion in CDC's
Vaccines for Children (VFC) program.
Manufactured by GlaxoSmithKline, Pediarix was approved by the Food and Drug
Administration (FDA) in December 2002 to protect infants six weeks of age
and older against diphtheria, tetanus, pertussis, hepatitis B, and polio.
Since its approval, some health professionals have questioned whether it is
still necessary to give the birth dose of monovalent hepatitis B vaccine
before administering Pediarix. ACIP's decisions answer this question and
more.
PEDIARIX APPROVED FOR ALL INFANTS, REGARDLESS OF THE MOTHER'S HBsAg STATUS
According to FDA's prescribing information, Pediarix is indicated only for
infants of HBsAg-negative mothers. However, ACIP voted that Pediarix may be
used for ALL infants six weeks of age and older, including those born to
HBsAg-positive mothers and to mothers whose HBsAg status is unknown.
In expanding the use of Pediarix beyond FDA prescribing information, ACIP
remained consistent with its 1997 vote, which permitted the use of Comvax
(Merck's Hib-hepatitis B combination vaccine) in infants born to HBsAg-positive
mothers and to mothers whose HBsAg status is unknown.
WHEN ADMINISTERING PEDIARIX, THE MONOVALENT HEPATITIS B VACCINE BIRTH DOSE
IS ALSO RECOMMENDED
ACIP voted to recommend that the birth dose of monovalent hepatitis B
vaccine remain a part of the infant immunization schedule when Pediarix is
used. When the birth dose is included, up to four hepatitis B vaccine doses
may be given. According to ACIP, if the mother is HBsAg negative, the birth
dose may be omitted, but this is NOT the preferred hepatitis B vaccination
schedule of ACIP.
For complete information on administering the birth dose and subsequent
doses of vaccine, refer to Footnote 1: Hepatitis B Vaccine (HepB) of the
"Recommended Childhood and Adolescent Immunization Schedule--United States,
2003," which is available in many places, including the website of the
Immunization Action Coalition at
http://www.immunize.org/cdc/child-schedule.pdf
PEDIARIX WILL BE INCLUDED IN THE VFC PROGRAM
ACIP voted to include Pediarix in the VFC program once a contract is
negotiated between CDC and GlaxoSmithKline. When the contract is final, CDC
will issue an announcement.
A "Notice to Readers" article summarizing ACIP's decisions on the use of
Pediarix will be published in a future issue of the "Morbidity and Mortality
Weekly Report."
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March 3, 2003
UNICEF'S PLAN TO IMMUNIZE FOUR MILLION IRAQI CHILDREN AGAINST POLIO GOES
FORWARD DESPITE THREAT OF WAR
In a press release dated February 18, UNICEF announced that it and its
partners planned to immunize four million Iraqi children against polio
during February 23-27. The strategy was to have more than 14,000
health workers go door to door making sure each child was protected.
Carol Bellamy, UNICEF's executive director, said the undertaking would not
be possible without the combined effort of UNICEF, the Iraqi Ministry of
Health, the World Health Organization (WHO), and the Red Crescent.
UNICEF said the polio campaign is crucial to protecting not only Iraqi
children against the disease but also to preventing polio outbreaks
elsewhere in the region. Iraq experienced a major polio outbreak in 1999,
but increased assistance from UNICEF and WHO has reduced the incidence of
polio to zero since January 2000.
To access the press release from the UNICEF website, go to:
http://www.unicef.org/newsline/2003/03pr10iraq.htm
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March 3, 2003
THREE MILLION RWANDAN CHILDREN IMMUNIZED AGAINST MEASLES
In a press release dated February 18, UNICEF announced its support for a
major campaign to immunize more than 3 million children against measles in
Rwanda. The campaign, which ran February 10-23, targeted children from 9
months to 15 years of age, with children less than 5 years of age also
receiving supplemental doses of vitamin A.
Part of a global initiative to reduce child mortality and morbidity from
measles, the campaign received support from the Rwandan government, UNICEF,
the World Health Organization, the Red Cross, and the Centers for Disease
Control and Prevention.
To access the press release from the UNICEF website, go to:
http://www.unicef.org/newsline/2003/03nn06measles.htm
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March 3, 2003
CDC PUBLISHES UPDATE OF SMALLPOX VACCINE ADVERSE EVENTS SURVEILLANCE
The Centers for Disease Control and Prevention (CDC) published "Smallpox
Vaccine Adverse Events Among Civilians--United States, February 18-24, 2003"
in the February 28 issue of "Morbidity and Mortality Weekly Report" (MMWR).
The article updates the information published in the February 21 MMWR.
The February 28 report includes information on 3,141 vaccinees not included
in the February 21 report. Two moderate-to-severe adverse events were
included in the latest report: a 39-year-old woman experienced a suspected
case of generalized vaccinia, and a 60-year-old man experienced angina,
which is not known to be associated causally with smallpox vaccination.
Among 23 vaccinees with reported other nonserious adverse events during
January 24-February 24, the most common signs and symptoms were fever (n =
six), pruritus (n = five), rash (n = four), vasodilation (n = four),
asthenia (n = three), headache/migraine (n = three), malaise (n = three),
paresthesia (n = three), and redness at injection site (n = three). Some
vaccinees reported multiple signs and symptoms.
Surveillance for adverse events during the civilian smallpox vaccination
program is ongoing; regular surveillance reports will be published in MMWR.
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5208a4.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5208.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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March 3, 2003
BOOST YOUR CLINIC'S IMMUNIZATION RATE--IAC'S ADULT IMMUNIZATION RECORD CARDS
PROMPT PATIENTS TO KEEP IMMUNIZATIONS UP TO DATE
Just one look at the Adult Immunization Record Cards will convince you that
they're a great tool for reminding adults that vaccines aren't just for
kids. The card lists seven vaccines that all adults, adults with certain
medical conditions, or adults with an unreliable vaccination history should
receive.
Use the card during patient visits to discuss a patient's vaccination status
with them. Then give it to them and encourage them to refer to it to find
out when they're due for their next Td booster, pneumococcal shot, or other
immunization.
Since introducing Adult Immunization Record Cards in May 2002, the
Immunization Action Coalition (IAC) has shipped approximately three-quarters
of a million cards to health care providers across the United States. Health
professionals nationwide have found the card invaluable for educating
patients that immunization is a lifelong process and for giving patients the
means to keep a lifetime record of their immunization status.
Printed on smudge-proof, rip-proof, waterproof paper, the card comes
pre-folded to fit in a wallet. Its bright, canary-yellow color makes it easy
to spot among credit cards and other items.
The cost for one 250-count box is $25; two boxes (500 cards), $45; three
boxes (750 cards), $60; four boxes (1,000 cards), $70. Additional pricing
for larger quantities can be found on the online order form (see link
below).
To view a color image of IAC's Adult Immunization Record Card, go to:
http://www.immunize.org/adultizcards/pictures.htm
To order IAC's Adult Immunization Record Cards online (including online with
a purchase order), go to:
https://www.immunize.org/adultizcards/index.htm
To print an order form to send with payment information by fax or mail, go
to:
https://www.immunize.org/adultizcards/izorder.pdf
If you have questions about IAC's Adult Immunization Record Cards, call us
at (651) 647-9009, or email us at
admin@immunize.org
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March 3, 2003
CDC ISSUES SUPPLEMENTAL RECOMMENDATIONS FOR USING SMALLPOX VACCINE IN A
PRE-EVENT VACCINATION PROGRAM
The Centers for Disease Control and Prevention (CDC) published
"Recommendations for Using Smallpox Vaccine in a Pre-Event Vaccination
Program: Supplemental Recommendations of the Advisory Committee on
Immunization Practices (ACIP) and the Healthcare Infection Control Practices
Advisory Committee (HICPAC)" in the February 26 issue of "MMWR Dispatch."
CDC issues the Web-based Dispatch only for the immediate release of
important public health information. The recommendations will be published
in a future issue of "Morbidity and Mortality Weekly Report."
The 18-page recommendations include information on smallpox transmission and
control, vaccines and vaccinia immune globulin availability, pre-outbreak
vaccination of selected groups to enhance smallpox response readiness,
contraindications for the use of smallpox vaccine, and reporting and
managing adverse events. The entire introduction, excluding references, is
reprinted below.
**************************
In June 2001, the Advisory Committee on Immunization Practices (ACIP) made
recommendations for using smallpox (vaccinia) vaccine to protect persons
working with orthopoxviruses and to prepare for and respond to a possible
terrorist attack involving smallpox. Because of the terrorist attacks in
2001, CDC asked ACIP to review its previous recommendations for smallpox
vaccination. These supplemental recommendations update the 2001
recommendations for vaccination of persons designated to respond to or care
for a suspected or confirmed case of smallpox. In addition, they clarify and
expand the primary strategy for control and containment of smallpox in the
event of an outbreak. Recommendations remain unchanged for vaccination of
laboratory workers who directly handle recombinant vaccinia viruses derived
from nonhighly attenuated vaccinia strains or other orthopoxviruses that
infect humans (e.g., monkeypox, cowpox, vaccinia, and variola). The
following recommendations were developed after formation of a joint working
group of ACIP and the National Vaccine Advisory Committee (NVAC) in
April 2002. That working group was joined in September 2002 by the
Healthcare Infection Control Practices Advisory Committee (HICPAC). A series
of public meetings and forums also were held to review available data
related to smallpox, smallpox vaccine, smallpox-control strategies, and
other concerns related to smallpox vaccination.
**************************
To obtain the complete text of the recommendations online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/m2d226.htm
To obtain a camera-ready (PDF format) copy of the recommendations, go to:
http://www.cdc.gov/mmwr/pdf/wk/MMWRDispatch2-26-03.pdf
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March 3, 2003
TRACK PENDING IMMUNIZATION LEGISLATION THE EASY WAY ON THE WEBSITE OF THE
NATIONAL CONFERENCE OF STATE LEGISLATURES
If you want to know the status of pending immunization legislation in your
state or a neighboring state, you'll want to bookmark the website of the
National Conference of State Legislatures (NCSL).
NCSL's "Immunization Legislation 2003" page organizes pending legislation
into categories such as "Exemptions" and "School Requirements." Within each
category, users will find pending legislation arranged alphabetically by
state and numerically by bill number. Each bill is described briefly. By
clicking on the bill number, users are taken to a state legislature's home
page. From there, users can track the status of any pending bill.
To access NCSL's "Immunization Legislation 2003" page, go to:
http://www.ncsl.org/programs/health/immleg2003.htm#s
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March 3, 2003
ATTENTION IMMUNIZATION COALITIONS: THE IMMUNIZATION COALITION SUSTAINABILITY
PROJECT NEEDS YOUR INPUT
Created to identify effective immunization coalitions and communicate their
success to others, the Immunization Coalition Sustainability Project (ICSP)
will conduct a nationwide survey of state and local immunization coalitions
in April.
Data gathered in the survey will be compiled into a catalog featuring the
best practices and best materials developed by coalitions. The catalog will
be distributed to immunization coalitions in ICSP's nationwide
database. ICSP's findings will be presented at the Centers for Disease
Control and Prevention's National Immunization Conference in 2004.
Bakalian Consulting Group, Santa Cruz, CA, administers ICSP. Pat Bakalian,
the group's principal, was formerly a regional outreach consultant
with the Centers for Disease Control and Prevention (CDC) National
Immunization Program for seven years and has been involved in community
coalition building for 15 years.
"When working for CDC, it was always a challenge to identify what
immunization coalitions were doing and systematically share best practices,"
Bakalian said. "I'm excited to be undertaking a project that can help
fill that gap. By increasing peer-to-peer collaborative learning, and
decreasing duplicating efforts, we hope to minimize the constant
re-invention of the wheel."
To ensure your coalition is entered in the ICSP database and represented in
the survey, sign up at
http://www.bakalianconsulting.com
For additional information, call Pat Bakalian at (831) 420-1935, or email
her at
pat@bakalianconsulting.com
Also, be sure your coalition is registered in the Immunization Action
Coalition's online database of coalitions; sign up on our Directory of
Immunization Coalitions website at
http://www.izcoalitions.org
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March 3, 2003
NEWLY AVAILABLE: IOM REPORT FROM THE LOS ANGELES WORKSHOP ON
IMMUNIZATION FINANCE IS IN PRINT AND ONLINE
A new report titled "Setting the Course: A Strategic Vision for
Immunization. Part 3: Summary of the Los Angeles Workshop" was
recently published by the National Academies Institute of
Medicine (IOM).
The report summarizes the discussions of the IOM workshop held
in Los Angeles in January 2002 and is part of the immunization
finance dissemination effort associated with the release of an
earlier IOM report, "Calling the Shots: Immunization Finance
Policies and Practices."
The Los Angeles workshop report summarizes the findings of
"Calling the Shots" and reviews the challenges that remain in
establishing a reliable financial base for the U.S. immunization
system, with specific reference to challenges and strategies in
California, and Los Angeles and San Diego counties in
particular.
To access the report and order it online for $14.40 (which is 20
percent off the $18 list price), go to:
http://www.nap.edu/catalog/10607.html
For further information, call customer service at (888) 624-8373.
To access links to several IOM immunization publications from
the website of the Immunization Action Coalition, go to:
http://www.immunize.org/iom
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March 3, 2003
IMMUNIZE FOR LIFE CONFERENCE SCHEDULED FOR MAY 15-16 IN GRAND
FORKS, ND
Sponsored by the Greater Grand Forks Immunization Coalition, the
Immunize for Life conference will be held at the Alerus Center
in Grand Forks, ND, May 15-16. William L. Atkinson, MD, MPH,
medical epidemiologist at the Centers for Disease Control and
Prevention National Immunization Program, is one of the featured
speakers.
Intended for public and private health care providers, the
conference will address immunization practices for people of all
ages, from infants to the elderly. Workshop topics include
vaccine safety, pediatric travel medicine, West Nile virus,
Native American health issues, the anti-vaccine movement, the
history of smallpox, varicella vaccine, and future practices.
For more information, call Kathy Dunn of Grand Forks Public
Health at (701) 787-8100 or email her at
kdunn@grandforksgov.com
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March 3, 2003
MMWR NOTIFIES READERS ABOUT AVAILABILITY OF MAXI-VAC SMALLPOX
VACCINATION SOFTWARE
The Centers for Disease Control and Prevention (CDC) published a
Notice to Readers, "Availability of Maxi-Vac Smallpox
Vaccination Software," in the February 28 issue of "Morbidity
and Mortality Weekly Report" (MMWR).
MMWR noted the following: "Use of trade names and commercial
sources is for identification only and does not imply
endorsement by the U.S. Department of Health and Human
Services." The notice is reprinted below in its entirety.
**********************
Free copies of the Maxi-Vac software program are now available. Maxi-Vac allows officials to refine smallpox vaccination clinic
human resource allocations (e.g., physicians, nurses, and other
staff) to maximize patient flow-through.
Maxi-Vac software and the accompanying manual can be downloaded
at http://www.bt.cdc.gov/agent/smallpox/vaccination/maxi-vac
Operation of Maxi-Vac requires the use of Visual Basic Runtime
v. 6.0, which also can be downloaded at the Maxi-Vac web page.
The Maxi-Vac manual can be downloaded in either a Microsoft Word
format or an Adobe Acrobat format. The Maxi-Vac software and
manual are in the public domain and may be used and copied
without permission; however, citation as to source is
appreciated.
**********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5208a5.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5208.pdf
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