Issue
Number 377
April 7, 2003
CONTENTS OF THIS ISSUE
- Neuropathologists write in "Pediatrics" that a link between
thimerosal and autism is improbable
- Paul Offit's and Charles Hackett's "Pediatrics" article
concludes that studies fail to show that vaccines cause chronic diseases
- CDC notifies readers about ACIP recommendations for additional
exclusion criteria for smallpox vaccination program
- New: Immunization Action Coalition launches "HEP EXPRESS"
electronic newsletter
- FDA approves preservative-free diphtheria and tetanus toxoids
adsorbed (DT) for pediatric use
- Immunization coalitions to see lots of activity in upcoming
weeks
- Dr. Carlo Urbani, communicable disease expert, dies of SARS
- CDC publishes an update of smallpox vaccine adverse events
surveillance
- CDC publishes supplemental Recommendations for Using Smallpox
Vaccine in a Pre-Event Vaccination Program
- CDC report describes hepatitis C virus transmission to organ
and tissue recipients of antibody-negative donor
- Turn to CDC and WHO Internet sites for current SARS
information
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(1 of 11)
April 7, 2003
NEUROPATHOLOGISTS WRITE IN "PEDIATRICS" THAT A LINK BETWEEN THIMEROSAL AND
AUTISM IS IMPROBABLE
"Thimerosal and Autism?" appeared as a commentary article in the March issue
of "Pediatrics." It is written by two neuropathologists, Karin B. Nelson,
MD, of the National Institute of Neurological Disorders and Stroke, and
Margaret L. Bauman, MD, of Harvard Medical School.
After reviewing the scientific literature, the authors conclude a link
between thimerosal exposure and the development of autism is improbable. The
article, which clearly demonstrates that the characteristics of mercury
toxicity and autism are so dissimilar that it would be difficult to confuse
them, will be useful to physicians in allaying parents' concerns about
thimerosal content in vaccines.
Following are the article's two concluding paragraphs:
***************************
Mercury poisoning and autism both affect the central nervous system but the
specific sites of involvement in brain and the brain cell types affected are
different in the two disorders as evidenced clinically and by
neuropathology. Mercury also injures the peripheral nervous system and other
organs that are not affected in autism. Nonspecific symptoms such as
anxiety, depression, and irrational fears may occur both in mercury
poisoning and in children with autism, but overall the clinical picture of
mercurism--from any known form, dose, duration, or age of exposure--does not
mimic that of autism. No case history has been encountered in which the
differential diagnosis of these 2 disorders was a problem. Most important,
no evidence yet brought forward indicates that children exposed to vaccines
containing mercurials, or mercurials via any other route of exposure, have
more autism than children with less or no such exposure.
Continuing vigilance is necessary regarding the safety of vaccines, as is
open-minded evaluation of new evidence. However, such evidence must be of
sufficient scientific rigor to provide a responsible basis for decisions
that influence the safety of children. When information is incomplete, as it
is at present for thimerosal-autism questions, a balancing must be made of
risks posed by vaccine constituents and the benefits of disease prevention
achieved by keeping immunizations widely available. On the basis of current
evidence, we consider it improbable that thimerosal and autism are linked.
***************************
Most articles in "Pediatrics" are available only to subscribers. We commend
the editor of "Pediatrics" for making this important article available to
the broad health care community on the Internet. To access a camera-ready
(PDF) copy of the complete article from the "Pediatrics" website, go to:
http://www.pediatrics.org/cgi/reprint/111/3/674.pdf
Physicians will be interested in referring parents to Jane Brody's synopsis
of the "Pediatrics" article, "Vaccines and Autism, Beyond the Fear Factor."
To access it from the "New York Times" website, go to:
http://www.nytimes.com/pages/health Scroll down the right-hand
column, and click on "More Personal Health Columns."
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April 7, 2003
PAUL OFFIT'S AND CHARLES HACKETT'S "PEDIATRICS" ARTICLE CONCLUDES THAT
STUDIES FAIL TO SHOW THAT VACCINES CAUSE CHRONIC DISEASES
"Addressing Parents' Concerns: Do Vaccines Cause Allergic or Autoimmune
Diseases?" concludes that epidemiologic studies fail to show that
vaccines cause chronic disease. The article appears in the March issue of
"Pediatrics." It is written by Paul A. Offit, MD, of Children's Hospital of
Philadelphia, the University of Pennsylvania School of Medicine, and the
Wistar Institute of Anatomy and Biology, Philadelphia, and Charles J.
Hackett, PhD, of the National Institutes of Allergy and Infectious Diseases.
The abstract is reprinted below in its entirety.
*************************
ABSTRACT. Anecdotal case reports and uncontrolled observational studies in
the medical literature claim that vaccines cause chronic diseases such as
asthma, multiple sclerosis, chronic arthritis, and diabetes. Several
biological mechanisms have been proposed to explain how vaccines might cause
allergic or autoimmune diseases. For example, allergic diseases might be
caused by prevention of early childhood infections (the "hygiene
hypothesis"), causing a prolongation of immunoglobulin E-promoting T-helper
cell type 2-type responses. However, vaccines do not prevent most common
childhood infections, and large well-controlled epidemiologic studies do not
support the hypothesis that vaccines cause allergies. Autoimmune
diseases might occur after immunization because proteins on microbial
pathogens are similar to human proteins ("molecular mimicry") and could
induce immune responses that damage human cells. However, wild-type viruses
and bacteria are much better adapted to growth in humans than vaccines and
much more likely to stimulate potentially damaging self-reactive
lymphocytes. Consistent with critical differences between natural infection
and immunization, well-controlled epidemiologic studies do not support the
hypothesis that vaccines cause autoimmunity.
Flaws in proposed biological mechanisms that explain how vaccines might
cause chronic diseases are consistent with the findings of many
well-controlled large epidemiologic studies that fail to show a causal
relationship.
*************************
Most articles in "Pediatrics" are available only to subscribers. We commend
the editor of "Pediatrics" for making this important article available to
the broad health care community on the Internet. To access a camera-ready
(PDF) copy of the complete article from the "Pediatrics" website, go to:
http://www.pediatrics.org/cgi/reprint/111/3/653.pdf
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April 7, 2003
CDC NOTIFIES READERS ABOUT ACIP RECOMMENDATIONS FOR ADDITIONAL EXCLUSION
CRITERIA FOR SMALLPOX VACCINATION PROGRAM
The Centers for Disease Control and Prevention (CDC) published a Notice to
Readers, "Supplemental Recommendations on Adverse Events Following Smallpox
Vaccine in the Pre-Event Vaccination Program: Recommendations of the
Advisory Committee on Immunization Practices [ACIP]" in the April 4 issue of
the "Morbidity and Mortality Weekly Report" (MMWR). The opening paragraph
and the three concluding paragraphs are reprinted below.
************************
[opening paragraph]
The Advisory Committee on Immunization Practices (ACIP) has issued
recommendations previously for use of smallpox vaccine and supplemental
recommendations for use of smallpox vaccine in the pre-event civilian
vaccination program. On March 28, 2003, CDC reported cases of cardiac
adverse events among persons vaccinated recently with smallpox vaccine. In
response to these reports, ACIP held an emergency meeting on March 28 to
make recommendations to CDC about medical screening of potential vaccinees
and follow-up of persons with cardiovascular risk factors after vaccination.
These recommendations supplement those previously issued by ACIP.
[concluding paragraphs]
These data are consistent with a causal relation between myocarditis/pericarditis
and smallpox vaccination, but no causal association between the ischemic
cardiac events and smallpox vaccination has been identified. In response to
these reports, CDC issued a health advisory on March 26, recommending as a
precautionary measure that persons with known cardiac disease not be
vaccinated as response team members in the pre-event smallpox vaccination
program at this time. Persons receiving smallpox vaccine should be informed
that myopericarditis is a potential complication of smallpox vaccination and
that they should seek medical attention if they develop chest pain,
shortness of breath, or other symptoms of cardiac disease within 2 weeks
after vaccination.
ACIP recommends that persons be excluded from the pre-event smallpox
vaccination program who have known underlying heart disease, with or without
symptoms, or who have three or more known major cardiac risk factors (i.e.,
hypertension, diabetes, hypercholesterolemia, heart disease at age 50 years
in a first-degree relative, and smoking). ACIP supported including these
risk factors in prevaccination education materials so that potential
vaccinees can evaluate their risk status, if they have concerns, with their
personal physician before reporting for vaccination; at the vaccination
clinic, verbal screening for known risk factors is recommended. In response
to these recommendations, prevaccination screening forms and other materials
have been revised; these materials have been provided to state health
departments and are available at
http://www.bt.cdc.gov/agent/smallpox.
ACIP did not recommend special medical
follow-up for persons with cardiovascular risk factors who have been
vaccinated. Persons with risk factors or known atherosclerotic coronary
artery disease should be cared for by their physicians in accordance with
standard guidelines for treatment and control of these conditions, such as
those issued by the National Cholesterol Education Program Expert Panel and
other expert groups.
************************
To obtain the complete text of the report online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5213a5.htm
To obtain a camera-ready (PDF format) copy of the report, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5213.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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April 7, 2003
NEW: IMMUNIZATION ACTION COALITION LAUNCHES "HEP EXPRESS" ELECTRONIC
NEWSLETTER
March 31 saw the publication of the first issue of "HEP EXPRESS," the latest
Immunization Action Coalition (IAC) electronic newsletter. Intended for
health and social service professionals involved in the prevention and
treatment of viral hepatitis, "HEP EXPRESS" will be published at least once
a month, as news develops.
"Right now, I foresee "HEP EXPRESS" augmenting the viral hepatitis
information covered in "IAC EXPRESS," said managing editor Teresa A.
Anderson, DDS, MPH. "Some information, particularly on hepatitis C, will be
unique to "HEP EXPRESS."
"HEP EXPRESS" will include the following information on hepatitis A, B, and
C: new resources for health professionals and patients, diagnosis and
treatment updates, relevant recommendations from the Centers for Disease
Control and Prevention and the National Institutes of Health, and links to
other websites.
To sign up to have "HEP EXPRESS" delivered directly to your email box, go
to:
http://www.hepprograms.org/hepexpress/signup.asp
To read the premiere issue, go to:
http://www.hepprograms.org/hepexpress/issue1.asp
To visit the "HEP EXPRESS" home page, go to:
http://www.hepprograms.org/hepexpress
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April 7, 2003
FDA APPROVES PRESERVATIVE-FREE DIPHTHERIA AND TETANUS TOXOIDS
ADSORBED (DT) FOR PEDIATRIC USE
On January 29, the Food and Drug Administration (FDA) approved a
supplement to the biologics license application for Diphtheria
and Tetanus Toxoids Adsorbed (DT), for Pediatric Use,
manufactured by Aventis Pasteur, to include the addition of a
preservative-free, single-dose-vial presentation.
To review the product approval letter, go to:
http://www.fda.gov/cber/approvltr/diphave012903L.htm
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April 7, 2003
IMMUNIZATION COALITIONS TO SEE LOTS OF ACTIVITY IN UPCOMING
WEEKS
This year, spring will give members of immunization coalitions
lots of opportunities for networking and sharing resources and
ideas--all with the aim of increasing immunization rates across
the life span. Here are four activities coalition members are
urged to participate in over the next two months.
NATIONAL INFANT IMMUNIZATION WEEK (NIIW)
If your coalition is involved with childhood immunization, you
will want to participate in National Infant Immunization Week,
scheduled for April 13-19. NIIW emphasizes immunizing infants
against 11 vaccine-preventable diseases by the age of two.
More than 500 communities across the nation are expected to take
part in this important week by planning community awareness and
media events to promote infant immunizations to parents, care
givers, health care providers, and the general community.
To help in planning community activities, the National
Immunization Program's NIIW web pages offer ideas for creating
an NIIW kickoff event. Sample public relations materials,
posters, flyers, web-link icons, tri-fold brochures, and other
resources are also available.
To access these materials, go to the NIIW web pages at
http://www.cdc.gov/nip/publications/niiw
IMMUNIZATION COALITION CONFERENCE
The Fifth National Immunization Coalition Conference will take
place at the Westin Kierland Resort and Spa in Phoenix-Scottsdale, AZ, on May 28-30, 2003. The conference theme, "An
Oasis of Ideas in Arizona," describes the goal of the meeting,
which is to be a wellspring of information, resources, and
skills-building sessions designed to refresh and "grow"
immunization coalitions at every stage of development. It will
offer sessions tailored to local, state, and national
coalitions, and address childhood, adolescent, and adult
immunization issues as they relate to coalition efforts.
For a copy of the conference brochure, go to:
http://www.hsc.usf.edu/publichealth/conted/iz03.html
For questions about program or content, contact Debbie McCune
Davis, Program Director, by phone at (602) 253-0090, ext. 234 or
by email at tapi@aachc.org
IMMUNIZATION COALITION SUSTAINABILITY PROJECT
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.
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
"IZ COALITIONS" WEBSITE
Since launching its "IZ Coalitions" website in January 2002, the
Immunization Action Coalition (IAC) has posted information from
122 immunization coalitions. The site includes data from
coalitions at all levels (local, state, regional, national, and
international) and of all types, vaccine-specific as well as
age-specific (childhood, adult, senior).
This online database allows health professionals, parents,
immunization advocates, and others to contact specific
coalitions to find resources, share ideas, and form strategic
partnerships. Searches can be done by name or geographic area.
Be sure your coalition is part of this powerful web-based
networking tool by logging on and signing up today. If you're
already signed up, and information about your coalition has
changed recently, be sure to update your listing to help us keep
the site current and accurate.
To search the "IZ Coalitions" site or add your coalition to it,
go to:
http://www.izcoalitions.org
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April 7, 2003
DR. CARLO URBANI, COMMUNICABLE DISEASE EXPERT, DIES OF SARS
The World Health Organization issued a press release on March 29
about the death of Dr. Carlo Urbani. It is reprinted below in
its entirety.
*************************
29 March 2003
Geneva
Dr. Carlo Urbani, an expert on communicable diseases, died today
of Severe Acute Respiratory Syndrome (SARS). Dr. Urbani worked
in public health programs in Cambodia, Laos, and Viet Nam. He
was based in Hanoi, Viet Nam. Dr. Urbani was 46.
Dr. Urbani was the first World Health Organization (WHO) officer
to identify the outbreak of this new disease, in an American
businessman who had been admitted to a hospital in Hanoi.
Because of his early detection of SARS, global surveillance was
heightened and many new cases have been identified and isolated
before they infected hospital staff. In Hanoi, the SARS outbreak
appears to be coming under control.
"Carlo was a wonderful human being and we are all devastated,"
said Pascale Brudon, the WHO Representative in Viet Nam. "He was
very much a doctor, his first goal was to help people. Carlo was
the one who very quickly saw that this was something very
strange. When people became very concerned in the hospital, he
was there every day, collecting samples, talking to the staff,
and strengthening infection control procedures."
Dr. Urbani was married and the father of three children.
Dr. Urbani received his medical degree from the University of
Ancona, Italy, and did post-graduate work in malaria and medical
parasitology. He was an expert in the parasitic diseases of
schoolchildren. He was also a president of Médecins Sans
Frontieres-Italy.
"Carlo Urbani's death saddens us all deeply at WHO," said Dr.
Gro Harlem Brundtland, WHO's Director-General. "His life reminds
us again of our true work in public health. Today, we should all
pause for a moment and remember the life of this outstanding
physician."
*************************
To access a copy of the press release from the WHO website, go
to:
http://www.who.int/mediacentre/notes/2003/np6/en
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April 7, 2003
CDC PUBLISHES AN UPDATE OF SMALLPOX VACCINE ADVERSE EVENTS
SURVEILLANCE
The Centers for Disease Control and Prevention (CDC) published
"Update: Adverse Events Following Smallpox Vaccination—United
States, 2003" in the April 4 issue of the "Morbidity and
Mortality Weekly Report" (MMWR). The opening paragraph is
reprinted below.
"During January 24-March 28, 2003, smallpox vaccine was
administered to 29,584 civilian health-care and public health
workers in 54 jurisdictions as part of an effort to prepare the
United States for a terrorist attack using smallpox virus. This
report summarizes data on ten cases of cardiac adverse events
reported among civilian vaccinees since the beginning of the
smallpox vaccination program, including three new cardiac
adverse events reported to CDC from the Vaccine Adverse Event
Reporting System (VAERS) during March 24-30. Fourteen cases of
myocarditis and one fatal myocardial infarction have been
reported among military personnel. This report summarizes data
on the three new cases of cardiac adverse events, updates data
on seven previously reported cases among civilian vaccinees,
summarizes selected cases of cardiac adverse events among
military vaccinees, and updates information on all adverse
events reported in the civilian vaccination program as of March
30."
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5213a4.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5213.pdf
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April 7, 2003
CDC PUBLISHES 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 April 4 issue of the "MMWR Recommendations and
Reports" (MMWR). Originally published in the web-based "MMWR
Dispatch," the report has not been available in hard-copy format
until now.
The 16-page report includes information on preoutbreak
vaccination of selected groups, vaccination method,
contraindications, simultaneous administration of smallpox
vaccine with other vaccines, and reporting and managing adverse
events.
To obtain the complete text of the report online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5207a1.htm
To obtain a camera-ready (PDF format) copy of the report, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5207.pdf
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April 7, 2003
CDC REPORT DESCRIBES HEPATITIS C VIRUS TRANSMISSION TO ORGAN AND
TISSUE RECIPIENTS OF ANTIBODY-NEGATIVE DONOR
The Centers for Disease Control and Prevention (CDC) published
"Hepatitis C Transmission from an Antibody-Negative Organ and
Tissue Donor--United States, 2000-2002" in the April 4 issue of
the "Morbidity and Mortality Weekly Report" (MMWR). Part of a
summary made available to the press is reprinted below.
*****************************
This report describes HCV transmission to recipients of organs
or tissues from a donor who had tested negative for HCV
infection using a screening antibody test. A patient developed
acute hepatitis C after receiving a tissue transplant from a
donor. We performed an additional test on the donor's stored
serum and detected the RNA of the virus. He was likely in an
early phase of infection before the development of detectable
antibodies. The donor was the source of HCV infection for 8
recipients of organs or tissues. Although HCV transmission from
antibody-negative donors is likely uncommon, determining the
frequency of such transmission will be important in evaluating
whether additional prevention measures are warranted.
*****************************
To obtain the complete text of the report online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5213a2.htm
To obtain a camera-ready (PDF format) copy of the report, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5213.pdf
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April 7, 2003
TURN TO CDC AND WHO INTERNET SITES FOR CURRENT SARS INFORMATION
As of April 5, there have been 2,416 reported cases of Severe
Acute Respiratory Syndrome (SARS) worldwide and 89 reported
deaths. In recent weeks, the Centers for Disease Control and
Prevention (CDC) and the World Health Organization (WHO) have
issued health alerts and announcements about SARS.
In addition, each organization has posted extensive information
about the disease. Health professionals are urged to keep
themselves informed by visiting the CDC and WHO web pages.
To access the CDC SARS web pages, go to:
http://www.cdc.gov/ncidod/sars
To access the WHO SARS web pages, go to:
http://www.who.int/csr/sars/en
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