Issue Number 383            May 5, 2003

CONTENTS OF THIS ISSUE

1. "NEEDLE TIPS" spring 2003 issue is in the mail and on the Web
2. Updated: IAC's vaccine administration records now come with how-to-record examples
3. Time during which reconstituted 10-dose vials of Menomune may be used is extended from 10 days to 35 days
4. New: "Vaccination in Long-Term Care" added to IAC's "Topics of Interest" e-library
5. Mark your calendar: June 26 is the date for CDC's satellite broadcast "Adult Immunization Update"
6. New: CDC's Spanish-language infant immunization materials ready for downloading or ordering
7. June 17 is the deadline for submitting abstracts for the 2003 Immunization Registry Conference
8. CDC issues "Summary of Notifiable Diseases--United States, 2001"
9. Free! Copies of "VACCINATE ADULTS!" (Summer 2002 issue) available for the asking
10. CDC reports data from the National Smallpox in Pregnancy Registry
11. New: English-language anthrax VIS and Thai-language PCV7 VIS available on IAC's website
12. CDC publishes guidance on HIPAA privacy rule and public health

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Here are summaries of "NEEDLE TIPS" articles and departments, followed by URLs.

1. "Ask the Experts"
   CDC immunization expert William Atkinson, MD, MPH, and viral hepatitis experts Harold Margolis, MD, and Linda Moyer, RN, answer readers' questions.
    
   HTML: http://www.immunize.org/nslt.d/n27/exprt27.htm
   PDF: http://www.immunize.org/nslt.d/n27/exprt27.pdf
    
2. "Letter to the Editor: Time-Tested Strategies Overcome Parents' Qualms About Immunization"
   Written by Thomas N. Saari, MD, the letter concisely explains some of Dr. Saari's strategies for educating vaccine-hesitant parents and gives ideas for doing so.
    
   HTML: http://www.immunize.org/nslt.d/n27/lett27.htm
   PDF: http://www.immunize.org/nslt.d/n27/lett27.pdf
    
3. "IAC Welcomes Advisory Board Liaisons"
   IAC introduces readers to seven new Advisory Board liaisons representing professional and international organizations, as well as the federal government.
    
   HTML: http://www.immunize.org/genr.d/advbd.htm
   PDF: http://www.immunize.org/nslt.d/n27/lett27.pdf
    
4. "Vaccine Highlights"
   A digest of recent recommendations and news about vaccines, patient education materials, and vaccine administration tools.
    
   HTML: http://www.immunize.org/nslt.d/n27/vaccin27.htm
   PDF: http://www.immunize.org/nslt.d/n27/vaccin27.pdf
    
5. "States Report Hundreds of Medical Errors in Perinatal Hepatitis B Prevention"
   This summary of numerous case reports illustrates common medical errors regarding perinatal HBV prevention and makes the case for giving all newborns hepatitis B vaccine before hospital discharge.
    
   HTML: http://www.immunize.org/catg.d/p2062.htm
   PDF: http://www.immunize.org/catg.d/p2062.pdf
    
6. "Recommended Childhood and Adolescent Immunization Schedule--United States, 2003," "Catch-Up Schedule for Children Age 4 Months Through 6 Years," and "Catch-Up Schedule for Children Age 7 Through 18 Years"
   The revised two-sided table is formatted for copying.
    
   PDF: http://www.immunize.org/nslt.d/n27/scdchild.pdf
    
7. "Recommended Adult Immunization Schedule, United States, 2002-2003," "Footnotes for Recommended Adult Immunization Schedule, United States, 2002-2003," and "Recommended Immunizations for Adults with Medical Conditions, United States, 2002-2003."
   Issued in October 2002, these materials are condensed to three pages for easy reference and easy copying.
    
   PDF: http://www.immunize.org/nslt.d/n27/scdadult.pdf
    
8. "How's Your State Doing?"
   Updated in April, this chart shows influenza and pneumococcal immunization rates by state for adults 65 years of age and older and state mandates for childhood hepatitis B and varicella vaccination.
    
   PDF: http://www.immunize.org/nslt.d/n27/state27.pdf
    
9. "Vaccine Administration Record for Children and Teens" and "Vaccine Administration Record forAdults"
   Updated in April, both records present a clear approach to documenting the administration of vaccines, including combination vaccines.
    
   For children and teens:
   HTML: http://www.immunize.org/catg.d/p2022b.htm
   PDF: http://www.immunize.org/catg.d/p2022b.pdf
    
   For adults:
   HTML: http://www.immunize.org/catg.d/p2023b.htm
   PDF: http://www.immunize.org/catg.d/p2023b.pdf
    
10. "Hesitant Parent? Here Are Some Helpful Ideas!" and "Refusal to Vaccinate" form
    Ideas for persuading parents to vaccinate their child and an American Academy of Pediatrics' form to document parents' refusal to do so.
     
    Hesitant Parent:
    HTML: http://www.immunize.org/nslt.d/n27/hesitant.htm
    PDF: http://www.immunize.org/nslt.d/n27/hesitant.pdf
     
    Refusal to vaccinate form:
    PDF: (from the website of the American Academy of Pediatrics)
    http://www.cispimmunize.org/pro/pdf/RefusalToVaccinate.pdf
     
11. "Don't Be Guilty of These Errors in Vaccine Storage and Handling"
    This newly created one-page sheet succinctly explains ten commonly reported errors in vaccine storage and handling and presents suggestions for correcting each.
     
    HTML: http://www.immunize.org/catg.d/p3036.htm
    PDF: http://www.immunize.org/catg.d/p3036.pdf
     
12. "Vaccines and Related Products Distributed in the United States, 2003"
    This one-page information sheet lists all the vaccines and related biologic products licensed for U.S. distribution as of April 2003.
     
    HTML: http://www.immunize.org/catg.d/2019prod.htm
    PDF: http://www.immunize.org/catg.d/2019prod.pdf
     
13. "Coalition Catalog: Publications and Resources"
    Order materials for patients and clinic staff here.
     
    HTML: http://www.immunize.org/nslt.d/n17/catalg1.htm
    PDF: http://www.immunize.org/nslt.d/n27/catalog.pdf
     
14. "Letter from the Executive Director: Don't Risk Another Child's Health--Give the Birth Dose!"
    IAC's Executive Director, Deborah L. Wexler, MD, presents her colleagues with three powerful reasons for giving the birth dose of hepatitis B vaccine.
     
    HTML: http://www.immunize.org/nslt.d/n27/back27.htm
    PDF: http://www.immunize.org/nslt.d/n27/back27.pdf

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May 5, 2003
UPDATED: IAC'S VACCINE ADMINISTRATION RECORDS NOW COME WITH HOW-TO-RECORD EXAMPLES

For the first time, the Immunization Action Coalition (IAC) is including examples to help health professionals record immunizations on IAC's "Vaccine Administration Record for Children and Teens" and "Vaccine Administration Record for Adults."

The PDF version of the record for children and teens includes the following three sample records: (1) how to record Hib-HepB combination vaccine, (2) how to record DTaP-HepB-IPV and DTaP-Hib combination vaccines, and (3) how to record adult HepB vaccine given to 11-15 year olds.

To access a camera-ready (PDF) record for children and teens, go to: http://www.immunize.org/catg.d/p2022b.pdf

The PDF version of the record for adults includes a sample record on how to record combination vaccines given to adults (i.e., HepA-HepB).

To access a camera-ready (PDF) record for adults, go to:
http://www.immunize.org/catg.d/p2023b.pdf
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May 5, 2003
TIME DURING WHICH RECONSTITUTED 10-DOSE VIALS OF MENOMUNE MAY BE USED IS EXTENDED FROM 10 DAYS TO 35 DAYS

On March 28, the Food and Drug Administration notified Aventis Pasteur that it had approved the company's request to extend the use of 10-dose vials of Menomune-A/C/Y/W-135 to 35 days after reconstitution.

Packaged as a powder, Menomune must be reconstituted with a separate diluent before it is administered. Until now, health care providers had only 10 days to use 10-dose vials of the vaccine after reconstitution. The vaccine's extended shelf life following reconstitution will allow physicians more time to schedule meningitis vaccinations for their patients.

Revised in January 2003, the Menomune package insert reflects the new timeline for using reconstituted 10-dose vials of Menomune. It's important to note that the 35-day period applies to ALL reconstituted 10-dose Menomune vials, even if the package insert is dated before January 2003 (that is, even if the package insert states that the product must be used within 10 days of reconstitution). The extended timeline for using reconstituted Menomune applies only to 10-dose vials, not to single-dose vials.

To access the January 2003 prescribing information (package insert) from the Aventis Pasteur website, go to: http://www.vaccineshoppe.com/US_PDF/4812_4813_3_03.pdf

Also, as reported in the Spring 2003 issue of "NEEDLE TIPS," because of the current shortage of single-dose vials of Menomune, Aventis Pasteur has instituted a refund program for up to 5 doses of reconstituted vaccine that is not used within 35 days of reconstitution if it is returned to the company.

For further information, contact Aventis Pasteur at www.vaccineshoppe.com or call (800) 822-2463.
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May 5, 2003
NEW: "VACCINATION IN LONG-TERM CARE" ADDED TO IAC'S "TOPICS OF INTEREST" E-LIBRARY

The Immunization Action Coalition (IAC) has added extensive information about vaccination in long-term care (LTC) facilities and other medical settings to its "Topics of Interest" e-library.

Organized under the title "Vaccination in Long-Term Care," the new web page focuses primarily on resources for increasing influenza and pneumococcal vaccination among people age 65 and older, an age group that is not close to reaching its 2010 national health objective of an immunization rate of 90 percent or greater for both diseases.

"Vaccination in Long-Term Care" features links to journal article abstracts; vaccination recommendations for people in LTC (patients and health care workers alike); state laws; and other resources.

To access information from the new web page, go to:
http://www.immunize.org/longtermcare
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May 5, 2003
MARK YOUR CALENDAR: JUNE 26 IS THE DATE FOR CDC'S SATELLITE BROADCAST "ADULT IMMUNIZATION UPDATE"

"Adult Immunization Update" is a live satellite broadcast for health care providers on current adult immunization practice and improving adult immunization coverage levels. Sponsored by the Centers for Disease Control and Prevention (CDC), the broadcast is scheduled for June 26 from noon to 2:30 pm ET. It will feature a Q&A session in which participants nationwide can interact with the course instructors via toll-free telephone lines.

The course instructors are William L. Atkinson, MD, MPH, medical epidemiologist, and Donna L. Weaver, RN, MN, nurse educator. Both are with the CDC's National Immunization Program. For information about program content, email nipinfo@cdc.gov

The program's intended audience includes physicians, nurses, nurse practitioners, Department of Defense paraprofessionals, pharmacists, and others who either administer immunizations or set policy for their offices, clinics, or communicable disease or infection control programs.

Only online registration is available. To register on the Public Health Training Network website, go to: http://www.phppo.cdc.gov/phtnonline

For registration information, call (800) 418-7246 or email ce@cdc.gov

The program will have a live webcast at
http://www.phppo.cdc.gov/phtn/webcast/adult-imm03

For technical support and to prepare for the webcast ahead of time, go to:
http://www.phppo.cdc.gov/phtn/webcast/techsupport.asp
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May 5, 2003
NEW: CDC'S SPANISH-LANGUAGE INFANT IMMUNIZATION MATERIALS READY FOR DOWNLOADING OR ORDERING

During this year's National Infant Immunization Week (NIIW), the National Immunization Program of the Centers for Disease Control and Prevention (CDC) introduced a Spanish-language promotional campaign, "La Promesa" (The Promise). Campaign materials include a Spanish-language poster and an immunization booklet available in Spanish and English.

To view or download the 8-1/2" x 11" "La Promesa" poster from the NIIW web page, go to: http://www.cdc.gov/nip/publications/niiw and scroll down to the block titled "2003 Spanish Immunization Poster."

Designed to address Hispanic parents' most commonly asked immunization questions, the pocketbook-size "Libreta de Vacunacion" (immunization booklet) is fully illustrated and comes with a plastic holder and extra pocket to hold appointment cards. It can be ordered online from CDC or by phone or email from HMA, Inc., a marketing company in Washington, DC.

To order the booklet (#99-7171) online from the CDC website, go to: https://www2.cdc.gov/nchstp_od/PIWeb/niporderform.asp

To order the booklet from HMA, Inc., or to get more information, phone (202) 342-0676, ext. 24, or email Irving Rodriguez at irodriguez@hmaassociates.com
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May 5, 2003
JUNE 17 IS THE DEADLINE FOR SUBMITTING ABSTRACTS FOR THE 2003 IMMUNIZATION REGISTRY CONFERENCE

Sponsored by the Centers for Disease Control and Prevention (CDC), the 2003 Immunization Registry Conference will be held October 27-29 in Atlanta. June 17 is the deadline for submitting abstracts for oral and poster presentations. To submit an abstract on the CDC website, go to: http://cdc.confex.com/cdc/irc2003

The conference will bring together more than 400 local, state, federal, and private sector immunization registry partners to promote knowledge and information about the development and use of immunization registries. To access information about the conference program, accommodations, and registration, go to: http://www.cdc.gov/nip/registry/irc/#top

For additional information, call Amanda Bryant at (404) 639-8247 or email siisclear@cdc.gov
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May 5, 2003
CDC ISSUES "SUMMARY OF NOTIFIABLE DISEASES--UNITED STATES, 2001"

The Centers for Disease Control and Prevention (CDC) published "Summary of Notifiable Diseases--United States, 2001" in the May 2 "MMWR Summary of Notifiable Diseases."

The 136-page summary has three primary sections: Part 1: Summaries of Notifiable Diseases in the United States, 2001; Part 2: Graphs and Maps for Selected Notifiable Diseases in the United States; and Part 3: Historical Summaries of Notifiable Diseases in the United States, 1970-2001. The opening paragraph of the preface follows:

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The MMWR "Summary of Notifiable Diseases, United States, 2001" contains, in tabular and graphic form, the official statistics for the reported occurrence of nationally notifiable diseases in the United States for 2001. These statistics are collected and compiled from reports sent by state health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE).

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To obtain the complete text of the summary online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5053a1.htm

Because the summary is a large file (1,201,152 bytes), printing problems may occur because of printer memory size. One solution is to print a few pages at a time. To access more tips on downloading and printing large PDF files, go to:
http://www.immunize.org/nslt.d/tips.htm

To obtain a camera-ready (PDF format) copy of the summary, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5053.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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May 5, 2003
FREE! COPIES OF "VACCINATE ADULTS!" (SUMMER 2002 ISSUE) AVAILABLE FOR THE ASKING

The Immunization Action Coalition (IAC) is giving away bulk copies (up to 50 per request) of the Summer 2002 issue of "VACCINATE ADULTS!" to make room for our new Spring 2003 issue.

If you have an immunization conference or an educational program coming up for health professionals, this is an excellent item to distribute.

Because supplies are limited, it's best to make your request right away. The free copies go quickly. Sorry, we can only mail orders to addresses within the United States.

To request copies, fill out the online form on IAC's website:
http://www.immunize.org/oldva

You will be asked to supply the following information:

1. The number of copies you want (maximum 50)
2. A description of how you plan to use the copies
3. Your name and complete contact information, including mailing address, telephone number, and email address

For further information, please contact Pat Storti, office administrator, by email at pat@immunize.org
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May 5, 2003
CDC REPORTS DATA FROM THE NATIONAL SMALLPOX VACCINE IN PREGNANCY REGISTRY

The Centers for Disease Control and Prevention (CDC) published "Women with Smallpox Vaccine Exposure During Pregnancy Reported to the National Smallpox Vaccine Pregnancy Registry--United States, 2003" in the May 2 issue of the "Morbidity and Mortality Weekly Report" (MMWR). Following are the opening and concluding paragraphs of the article.

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In the absence of circulating smallpox, pregnant women should not be exposed to live vaccinia virus contained in the smallpox vaccine. The smallpox vaccine should not be administered to women who are pregnant or might become pregnant within 4 weeks after vaccination because of the risk for fetal vaccinia, a rare but serious infection of the fetus. In addition, persons who have close contact (e.g., household contact or sexual contact) with pregnant women are advised to forego vaccination. To prevent inadvertent exposure of pregnant women to vaccinia virus, screening for pregnancy is a component of pre-event smallpox vaccination programs. To monitor outcomes of pregnancy in women exposed to smallpox vaccines, CDC, in collaboration with the Department of Defense (DoD) and the Food and Drug Administration (FDA), has established the National Smallpox Vaccine in Pregnancy Registry. This report summarizes data from the registry about these exposures. . . .

Health-care providers, state health departments, and other public health staff are encouraged to report all exposed pregnant women to the National Smallpox Vaccine in Pregnancy Registry. Civilian women should contact their health-care provider or state health department for help enrolling in the registry. Clinicians or public health staff should report civilian cases through their state health department or to CDC, telephone (404) 639-8253 or (877) 554-4625. Military cases should be reported to DoD, telephone (619) 553-9255, DSN 553-9255, fax (619) 553-7601 or e-mail code25@nhrc.navy.mil To better understand potential adverse events of smallpox vaccination during early pregnancy, health-care providers are encouraged to save and forward products of conception from pregnancy losses for vaccinia testing to CDC or DoD. Laboratories should freeze specimens at -94º F (-70º C), preferably in viral transport media. Clinicians can contact the registry for additional information about forwarding laboratory specimens.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5217a3.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5217.pdf
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May 5, 2003
NEW: ENGLISH-LANGUAGE ANTHRAX VIS AND THAI-LANGUAGE PCV7 VIS AVAILABLE ON IAC'S WEBSITE

The Centers for Disease Control and Prevention (CDC) has issued a newly revised Vaccine Information Statement (VIS) for anthrax, dated 4/24/03.

To access a camera-ready (PDF) copy of the anthrax VIS from the website of the Immunization Action Coalition, go to: http://www.immunize.org/vis/anthrx03.pdf

The most recent (9/30/02) pneumococcal conjugate (PCV7) VIS is now available in Thai on the IAC website. IAC gratefully acknowledges Asian Pacific Health Care Venture, Inc., for the translation.

To access a camera-ready (PDF) copy of the PCV7 VIS in Thai, go to: http://www.immunize.org/vis/thpnPCV7.pdf

To access a camera-ready (PDF) copy in English, go to:
http://www.immunize.org/vis/pnPCV7.pdf

For information about the use of VISs, and for VISs in a total of 28 languages, visit IAC's VIS web page at http://www.immunize.org/vis
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May 5, 2003
CDC PUBLISHES GUIDANCE ON HIPAA PRIVACY RULE AND PUBLIC HEALTH

On May 2, the Centers for Disease Control and Prevention (CDC) published "HIPAA Privacy Rule and Public Health: Guidance from CDC and the U.S. Department of Health and Human Services" as a supplement to the "Morbidity and Mortality Weekly Report" (MMWR). Originally published on April 11 as a web-based "MMWR Early Release," the guidance has not been available in hard-copy format until now.

The 24-page document includes an overview of the privacy rule, as well as information on the privacy rule and public health, the privacy rule and public health research, and the privacy rule and other laws. Two appendices are also included: "Appendix A: Selected Privacy Rule Concepts and Definitions" and "Appendix B: Sample Text That Can Be Used To Clarify Public Health Issues Under the Privacy Rule."

To obtain the text of the guidance online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su5201a1.htm

To obtain the text of Appendix A online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su5201a2.htm

To obtain the text of Appendix B online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su5201a3.htm

To obtain a camera-ready (PDF format) copy of the entire document, including Appendix A and Appendix B, go to: http://www.cdc.gov/mmwr/PDF/wk/su5201.pdf