Issue Number 386            May 27, 2003

CONTENTS OF THIS ISSUE

1. May "Immunization Works!" bursting with good information
2. CDC reports on global measles control
3. IAC's Hepatitis Prevention Programs website adds five new programs and a support group section
4. IAC posts presentations from CDC's 2003 National Hepatitis Coordinators' Conference
5. CDC publishes an update of smallpox adverse events surveillance

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May 27, 2003
MAY "IMMUNIZATION WORKS!" BURSTING WITH GOOD INFORMATION

The May issue of "Immunization Works!" an email newsletter published by the Centers for Disease Control and Prevention (CDC), has many items of interest to those providing vaccination services. The complete text of eight articles follows:

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The "Catch-Up" Immunization Schedule for Children and Adolescents

What should you do when a child presents in your clinic after having missed one or more doses of vaccine? It can be difficult to determine when and how missed doses of vaccine should be given. The results of a recent study published in the May 2003 edition of Pediatrics demonstrated that childhood vaccine providers are largely unaware of the proper protocol when a child's immunization falls behind schedule. The new, easy-to-reference CDC's Catch-Up Immunization Schedule, approved by the  Advisory Committee on Immunization Practices (ACIP), can guide your clinic staff in safely and appropriately bringing these children up-to-date.

The first cardinal rule of catch-up vaccinations is that you should not restart a vaccine series, regardless of the amount of time that has elapsed between doses. You should continue the series where it left off, giving remaining doses according to the minimum intervals reflected on the catch-up schedule.

All indicated vaccinations should be given when an opportunity presents, even if that means giving more than one vaccine at the same visit (in different syringes and at different sites). Don't further delay vaccination and leave a child at risk by giving only one shot when a child needs to catch up on three or four different vaccines-give them all.

Most vaccine series comprise a fixed number of doses that are required to complete the series. There are three doses, for example, in a routine childhood hepatitis B series, and four in a routine childhood (inactivated) polio series, regardless of the age at which the series is started, and regardless of the length of any prolonged intervals between doses.

Some vaccines, however, require a different number of doses if the series is delayed, or if an interval between doses is prolonged. Children may require less than the complete 4-dose series of Hib and pneumococcal conjugate vaccines if they begin the series late, or if they miss or delay doses. Adolescents or adults who receive varicella vaccine for the first time at or after age 13 years should get two doses to complete the series, while younger children only need one dose.

Complete and correct immunization is one of the most important elements in our fight against infectious disease. Delay in completion of the recommended schedule is one of the most common problems faced by childhood immunization providers, especially now that the recommended schedule has become more complex and confusing. The Catch-Up Schedule is a useful tool that can help you determine the correct timing and spacing of missed doses of routinely-recommended vaccines for children and adolescents aged four months to 18 years.

You can print or download the complete Catch-Up Schedule on the Internet at http://www.cdc.gov/nip/recs/child-schedule.htm#catchup You can also order laminated copies of the regular and Catch-Up Schedules for free from the National Immunization Program using the online publications order format  at http://www.cdc.gov/nip/publications

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Pneumococcal Conjugate Vaccine Shortage Resolved

Vaccine production and deliveries of Prevnar, a 7-valent pneumococcal conjugate vaccine, are now adequate to permit a return to the routine vaccination schedule. According to the original Advisory Committee on Immunization Practices recommendations and more recent guidance from CDC, all children less than 24 months and those 24 to 59 months who are at increased risk for pneumococcal disease should be administered the pneumococcal conjugate vaccine. In addition, providers should consider vaccine for all other children aged 24-59 months, with priority given to children aged 24-35 months, American Indian/Alaska Native and black children, and those who attend group child care. Information regarding the proposed catch-up schedule for children who are incompletely vaccinated can be accessed at www.cdc.gov/nip The highest priority for catch-up vaccination is to ensure that children less than 5 years at high risk for invasive pneumococcal disease because of medical conditions have received a complete series. Second priorities include vaccination of healthy children less than 24 months who have not received any doses of pneumococcal conjugate vaccine and healthy children less than 12 months of age who have not yet received 3 doses.

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New Measles Resource Available

A special supplement of the Journal of Infectious Diseases, "Global Measles Mortality Reduction and Regional Elimination: Status Report," (Volume 187, supplement 1) is now available. Published this month, the report compiles the most current scientific findings from measles research and results from measles control programs in one document. This report will serve as an invaluable resource for anyone working in the field of immunization. The report is available at www.journals.uchicago.edu/JID/journal It is also available to those with subscriptions to the electronic version of the Journal of Infectious Diseases. Print copies of the supplement can be ordered from the University of Chicago press by calling 877-705-1878 or by sending an e-mail to: subscriptions@press.uchicago.edu

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Influenza Vaccine Expiration Date

The Food and Drug Administration (FDA) advises that last year's influenza vaccine not be used past its expiration date of June 30, 2003. The Flu Vaccine Information Update can be accessed at www.fda.gov/cber/flu/flu.htm

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2003-2004 Influenza Vaccine Information Statement

The 2003-2004 Influenza Vaccine Information Statement can be accessed from the CDC website at www.cdc.gov/nip If FluMist is licensed later this year a separate VIS will be issued. Health care providers providing immunization to their patients are required by law to provide the patient with the appropriate VIS before administering the vaccine.

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David Fleming Leaves CDC

David Fleming, MD, former Acting Director for CDC and currently serving as Deputy Director for Public Health Science, has announced his departure from CDC. Dr. Fleming has been appointed Director of Global Health Strategies for the Bill and Melinda Gates Foundation. In his new role, Dr. Fleming will be responsible for a broad range of programs addressing cross-cutting public health issues such as global immunizations, maternal and child health, nutrition, surveillance and health technology delivery systems, training and leadership and novel implementation and financing mechanisms for global health. Dr. Fleming became an Epidemic Intelligence Officer in 1984 and officially joined CDC in 2002. He will assume his new position later this summer.

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Adult Immunization Update

Adult Immunization Update: A National Immunization Program and Public Health Training Network Broadcast and Webcast will be held Thursday, June 26, 2003 from 12:00 to 2:30 p.m. eastern time. This live satellite broadcast and webcast will update healthcare providers on current adult immunization practice. The program will highlight the 2002-2003 Recommended Adult Immunization Schedule and strategies to improve adult immunization coverage levels. Continuing education credit will be offered for a variety of professions based on 2.5 hours of instruction. For additional information, including site participant registration information please visit www.phppo.cdc.gov/phtn/Adult-imm03

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2003 Immunization Registry Conference

The 4th Immunization Registry Conference will be held October 27-29, 2003 in Atlanta, Georgia. This conference will provide a forum to build support for immunization registries, enhance collaboration, promote multiple and innovative uses of registry data, explore alternative funding strategies, and demonstrate registry success. The abstract submission deadline is June 17, 2003. For abstract information or for more information about the conference visit www.cdc.gov/nip/registry/irc Questions may also be directed to Amanda Bryant at (404)639-8247.

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To access the complete May issue of "Immunization Works!" from the Immunization Action Coalition website, go to: http://www.immunize.org/news.d/news503.htm
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May 27, 2003
CDC REPORTS ON GLOBAL MEASLES CONTROL

The Centers for Disease Control and Prevention (CDC) published "Update: Global Measles Control and Mortality Reduction—Worldwide, 1991-2001" in the May 23 issue of the "Morbidity and Mortality Weekly Report" (MMWR). A summary made available to the press is reprinted below in its entirety.

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Despite the availability of a safe, effective and inexpensive vaccine for 40 years, measles remains the leading cause of vaccine-preventable deaths in childhood.

Measles was responsible for 770,000 deaths globally in 2000. Of these measles-associated deaths, 98% occurred in the 75 countries with gross domestic products of less than $1,000 per capita, and 58% occurred in the WHO region of Africa. Reducing the high burden of measles will require a comprehensive approach. Affected countries will need to achieve high coverage in each district and nationally with the first dose of measles vaccine administered through routine services to children (who are nine months of age or shortly thereafter). This approach should be followed with a second opportunity for measles immunization for all children, the establishment of effective surveillance for measles, and improved case management.

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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5220a4.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5220.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 27, 2003
IAC'S HEPATITIS PREVENTION PROGRAMS WEBSITE ADDS FIVE NEW PROGRAMS AND A SUPPORT GROUP SECTION

[The following is cross posted from the Immunization Action Coalition's "HEP EXPRESS" electronic newsletter, 5/21/03.]

The Hepatitis Prevention Programs website of the Immunization Action Coalition (IAC) has added five programs, bringing the total to 84! Another five programs have substantially updated their information, and a new section has been added to the site: "Support Groups for Persons Living with Viral Hepatitis."

The website, http://www.hepprograms.org, features programs successfully preventing hepatitis A, B, and/or C in adults and adolescents at risk for infection. The five new programs are

Denver Health/Denver Public Schools Adolescent Immunization Program
http://www.hepprograms.org/school/school7.asp

Hepatitis B Initiative (Boston and Washington, D.C.)
http://www.hepprograms.org/apia/apia8.asp

Houston Middle School Study
http://www.hepprograms.org/school/school8.asp

Lifeguard Harm Reduction Services (Central Illinois)
http://www.hepprograms.org/drug/drug11.asp

Nevada State Health Division and Nevada Department of Corrections HCV and HBV Seroprevalence Study
http://www.hepprograms.org/adult/adult10.asp

The five updated programs are

Bronx Lesbian & Gay Health Resource Consortium
http://www.hepprograms.org/msm/msm2.asp

Florida Department of Health, Hepatitis and Liver Failure Prevention and Control Program
http://www.hepprograms.org/drug/drug4.asp

Illinois Health Education Consortium
http://www.hepprograms.org/apia/apia1.asp

New York State Health Department
http://www.hepprograms.org/std/std1.asp

Texas Department of Health Hepatitis A Vaccine Initiative
http://www.hepprograms.org/other/other3.asp

The new support group section features national organizations that provide online forums and links to local support groups. Another page lists support groups by state. The support group section can be accessed at: http://www.hepprograms.org/support/index.asp

Please encourage your clients infected with hepatitis B or C virus to use this resource to find an online or local source of information and support.

We are always looking for new programs, support groups, and provider and patient resources to add to the site! If you have program information you would like to share with your colleagues, go to the "Tell us about your program" page at http://www.hepprograms.org/tellus.htm You can also email us with other information at evaluation@immunize.org
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May 27, 2003
IAC POSTS PRESENTATIONS FROM CDC'S 2003 NATIONAL HEPATITIS COORDINATORS' CONFERENCE

The Immunization Action Coalition (IAC) has collected plenary and workshop presentations from CDC's 2003 National Hepatitis Coordinators' Conference and made them available online. If you weren't able to attend the conference in January (or even if you were), you can access much of the information presented in San Antonio from the comfort of your office or home.

Visit "National Hepatitis Coordinators' Conference 2003 Presentations" at http://www.hepprograms.org/hepcoord/2003

Just a reminder to presenters at the 2003 National Hepatitis Coordinators' Conference… if your presentation isn't available on this page, it's not too late to add it! Just email your PowerPoint presentation or Microsoft Word document to becky@immunize.org
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May 27, 2003
CDC PUBLISHES AN UPDATE OF SMALLPOX ADVERSE EVENTS SURVEILLANCE

The Centers for Disease Control and Prevention (CDC) published "Update: Adverse Events Following Civilian Smallpox Vaccination--United States, 2003" in the May 23 issue of the "Morbidity and Mortality Weekly Report" (MMWR).

During January 24-May 9, 2003, smallpox vaccine was administered to 36,217 civilian health-care and public health workers in 55 jurisdictions. This report updates information on all vaccine-associated adverse events among civilians vaccinated since the beginning of the program, and provides information on one suspected case of myo/pericarditis and one suspected case of postvaccinial encephalomyelitis reported during the week of May 3-9, 2003.

To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5220a5.htm

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5220.pdf