Issue
Number 394
June 23, 2003
CONTENTS OF THIS ISSUE
- FDA approves license for FluMist intranasal influenza virus
vaccine
- Seventy-five percent of U.S. tetanus deaths occur in people
age 60 and older, according to CDC's 1998-2000 surveillance
- Three states enact immunization legislation for college
attendance
- "Immunization Techniques" video prepares you and your staff
for the summer and fall immunization rush
- CDC reports 32 new monkeypox cases as the outbreak spreads to
three more states
- Old Vaccine Injury Compensation Program web address is
functional again
- CDC reports on a hepatitis A outbreak among restaurant patrons
in Massachusetts in 2001
- Tuesday, June 24, is the new abstract submission deadline for
CDC's Fourth Immunization Registry Conference
- CDC reports on Nigeria's progress toward polio eradication
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June 23, 2003
FDA APPROVES LICENSE FOR FLUMIST INTRANASAL INFLUENZA VIRUS VACCINE
On June 17, the Food and Drug Administration (FDA) approved a license
application for FluMist, a live trivalent intranasal influenza virus
vaccine. FluMist is indicated for active immunization for the prevention of
disease caused by influenza A and B viruses in healthy children and
adolescents, ages 5-17 years, and healthy adults, ages 18-49 years. FluMist
is a product of MedImmune Vaccines, Inc., Mountain View, CA.
To access the approval letter from the FDA website, go to:
http://www.fda.gov/cber/approvltr/inflmed061703L.htm
To access a camera-ready (PDF) version of the
19-page prescribing information (package insert) from the FDA website, go
to:
http://www.fda.gov/cber/label/inflmed061703lb.pdf
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June 23, 2003
SEVENTY-FIVE PERCENT OF U.S. TETANUS DEATHS OCCUR IN PEOPLE AGE 60 AND
OLDER, ACCORDING TO CDC'S 1998-2000 SURVEILLANCE
The Centers for Disease Control and Prevention (CDC) published "Tetanus
Surveillance--United States, 1998-2000" in the June 20 issue of "MMWR
Surveillance Summaries" (MMWR). The summary abstract is reprinted below in
its entirety.
***********************
Abstract
Problem/Condition: Tetanus is a severe and often fatal infection. The
incidence of reported cases in the United States has declined steadily since
introduction of tetanus toxoid vaccines in the 1940s.
Reporting Period: This report covers surveillance data for 1998-2000.
Description of System: Physician-diagnosed cases of tetanus were reported to
CDC's National Notifiable Disease Surveillance System. Supplemental clinical
and epidemiologic information were provided by states.
Results and Interpretation: During 1998-2000, an average of 43 cases of
tetanus was reported annually; the average annual incidence was 0.16
cases/million population. The highest average annual incidence of reported
tetanus was among persons aged 60 years and older (0.35 cases/million
population), persons of Hispanic ethnicity (0.37 cases/million population),
and older adults known to have diabetes (0.70 cases/million population).
Fifteen percent of the cases were among injection-drug users. The
case-fatality ratio was 18% among 113 patients with known outcome; 75% of
the deaths were among patients aged 60 years and older. No deaths occurred
among those who were up-to-date with tetanus toxoid vaccination.
Seventy-three percent of 129 cases with known injury information
available reported an acute injury; of these, only 37% sought medical care
for the acute injury, and only 63% of those eligible received tetanus toxoid
for wound prophylaxis.
Interpretation: The majority of tetanus cases occurred among persons
inadequately vaccinated or with unknown vaccination history who sustained an
acute injury. Adults aged 60 years and older were at highest risk for
tetanus and tetanus-related death.
Public Health Actions: Tetanus is preventable through routine vaccination
(i.e., primary series and decennial boosters) and appropriate management. A
shortage of tetanus and diphtheria toxoids vaccine that began during 2000
ended in 2002. Efforts by health-care providers are warranted to vaccinate
persons with delayed or incomplete vaccination, with emphasis on older
persons and persons with high-risk conditions.
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To obtain the complete surveillance summary online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5203a1.htm
To obtain a camera-ready (PDF format) copy of the surveillance summary, go
to:
http://www.cdc.gov/mmwr/PDF/ss/ss5203.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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June 23, 2003
THREE STATES ENACT IMMUNIZATION LEGISLATION FOR COLLEGE ATTENDANCE
Three states--Minnesota, Mississippi, and Oklahoma--have enacted legislation
concerning meningococcal immunization for students starting post-secondary
education. In addition, Mississippi has passed similar legislation regarding
hepatitis A and B vaccination, and Oklahoma has passed similar legislation
regarding hepatitis B, measles, mumps, and rubella vaccination.
MENINGOCOCCAL
Minnesota. The Minnesota State Legislature passed legislation requiring all
institutions of higher learning to provide incoming students residing on
campus with information on meningococcal disease and vaccine. The governor
signed the legislation May 28; it went into effect June 1, 2003.
Mississippi. The Mississippi Legislature passed legislation requiring all
institutions of higher learning to provide all incoming students with
information about meningococcal disease and vaccine. The governor signed the
legislation April 22; it goes into effect July 1, 2003.
Oklahoma. The Oklahoma Legislature passed legislation requiring all
institutions of higher learning to (1) provide all students living in
on-campus housing with information about meningococcal disease and vaccine
and (2) require incoming students to be vaccinated against the disease or
sign a waiver indicating they have received information and declined
vaccination. The governor signed the legislation May 29; it goes into effect
in the 2004-2005 academic year.
HEPATITIS A AND B
Mississippi. The Mississippi Legislature passed legislation requiring all
institutions of higher learning to provide all incoming students with
information about hepatitis A and B diseases and vaccines. The governor
signed the legislation April 22; it goes into effect July 1, 2003.
HEPATITIS B, MEASLES, MUMPS, AND RUBELLA
Oklahoma. The Oklahoma Legislature passed legislation requiring (1) all
institutions of higher learning to provide all incoming students with
information about hepatitis B, measles, mumps, and rubella and (2) all
students enrolling in institutions of higher learning to provide written
documentation of immunization against hepatitis B, measles, mumps, and
rubella or to complete immunization against these diseases within ten months
of enrollment. A signed waiver is required to exempt a student from these
immunizations for medical or religious reasons. The governor signed the
legislation May 29; it goes into effect in the 2004-2005 academic year.
The Immunization Action Coalition (IAC) has compiled information about all
states that have meningococcal prevention mandates for colleges and
universities. To access the information, go to:
http://www.immunize.org/laws/menin.htm
IAC is developing a new web page of information about states that have
hepatitis B prevention mandates for colleges and universities. For this
information (and for comprehensive information on state laws for a variety
of immunizations), please check our state laws web page soon by going to
http://www.immunize.org/laws
We depend on our readers to help us stay informed and to ensure
our website contains the most current and accurate information
available. Please let us know when any changes occur in your
state.
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June 23, 2003
"IMMUNIZATION TECHNIQUES" VIDEO PREPARES YOU AND YOUR STAFF FOR
THE SUMMER AND FALL IMMUNIZATION RUSH
Seasoned health professionals know that a thorough grounding in
administering vaccinations is the best preparation for the busy
summer and fall immunization season. The video "Immunization
Techniques: Safe, Effective, Caring" offers practical
information for immunizing the preschool and school age children
now arriving in your waiting room to catch up on missed
vaccinations before school begins, as well as for immunizing
summer travelers of all ages. As the fall influenza vaccination
season approaches, even more people will need to be immunized.
In fact, the video is such a high-quality, cost-effective
immunization-training tool that health professionals across the
nation have ordered approximately 7,600 copies of it from the
Immunization Action Coalition (IAC) since September 2001, when
IAC first offered it.
Developed by the California Department of Health Services
Immunization Branch and a team of national experts, the
35-minute video is designed for use as a "hands-on"
instructional program. It can be used to train new staff and to
provide a refresher course for experienced staff who administer
vaccines.
It teaches best practices for administering intramuscular (IM)
and subcutaneous (SC) vaccines to infants, children, and adults
and discusses the following:
* Anatomic sites
* Choice of needle size
* Vaccines and routes of administration
* How to "draw up" doses of vaccine from a vial
People of various ages--from infants to adults--are vaccinated
in the video to demonstrate these techniques.
The video comes with presenter's notes that include
instructional objectives, pre- and post-tests, photos showing
vaccination sites appropriate for vaccinating people of
different ages, and a skills checklist to help you document that
your staff is well trained.
IAC distributes the video and presenter's notes at $15 per set
(to U.S. addresses). If you wish to order online (U.S. addresses
only), go to:
https://www.immunize.org/iztech
To order by mail or fax, print an IAC order form, available at
http://www.immunize.org/catg.d/2020a.pdf
Send your order payment (check, credit card information, or
purchase order) to Immunization Action Coalition, 1573 Selby
Ave., Ste. 234, St. Paul, MN 55104, and include your complete
mailing information and phone number. You can fax your order
form with payment information to IAC at (651) 647-9131. If you
are placing an order from outside the United States, please call
IAC at (651) 647-9009 for shipping cost information.
A Spanish-language version of the video is available through the
California Distance Learning Health Network (CDLHN) for $25. To
order, call (619) 594-3348, email
cdlhn@projects.sdsu.edu or
visit CDLHN online at http://www.cdlhn.com
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June 23, 2003
CDC REPORTS 32 NEW MONKEYPOX CASES AS THE OUTBREAK SPREADS TO
THREE MORE STATES
The Centers for Disease Control and Prevention (CDC) published
"Update: Multistate Outbreak of Monkeypox--Illinois, Indiana,
Kansas, Missouri, Ohio, and Wisconsin, 2003" in the June 20
issue of the "Morbidity and Mortality Weekly Report" (MMWR). The
article reports that as of June 18, monkeypox spread to three
additional states--Kansas, Missouri, and Ohio. Of the 87
reported cases, 38 were found in Wisconsin; 24 in Indiana; 19 in
Illinois; 4 in Ohio; and 1 each in Kansas and Missouri.
The article updates epidemiologic, laboratory, and animal data
for U.S. cases and presents an updated interim case definition
for human cases of monkeypox in table form.
To obtain the complete text of the article online, including the
updated interim case definition, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5224a1.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5224.pdf
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June 23, 2003
OLD VACCINE INJURY COMPENSATION PROGRAM WEB ADDRESS IS
FUNCTIONAL AGAIN
The Health Resources and Services Administration (HRSA) recently
reactivated the old web address for the Vaccine Injury
Compensation Program (VICP). The old address is
http://www.hrsa.gov/bhpr/vicp Last year, the VICP web address
was changed to http://www.hrsa.gov/osp/vicp, and the old address
was made nonfunctional.
In response to the address change, the Centers for Disease
Control and Prevention (CDC) changed the VICP web address on
Vaccine Information Statements (VISs) for the following routine
childhood vaccines: diphtheria, tetanus, and pertussis (DTaP),
pneumococcal conjugate (PCV7), inactivated polio (IPV),
Haemophilus influenzae type b (Hib), hepatitis B, and varicella.
CDC informed health professionals that they could give patients
VISs with the old VICP web address as long as the VISs were
otherwise current (for further information, see "IAC EXPRESS"
issue #389 at http://www.immunize.org/genr.d/issue389.htm#n4).
Now that both the old and new web addresses are functional,
health professionals may use VISs that have either VICP web
address printed on them.
To access copies of the newly revised VISs for routine childhood
vaccines from the VIS web page of the Immunization Action
Coalition, go to: http://www.immunize.org/vis The VIS web page
has information about the use of VISs and also has VISs in up to
28 languages.
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June 23, 2003
CDC REPORTS ON A HEPATITIS A OUTBREAK AMONG RESTAURANT PATRONS
IN MASSACHUSETTS IN 2001
The Centers for Disease Control and Prevention (CDC) published
"Foodborne Transmission of Hepatitis A--Massachusetts, 2001" in
the June 20 issue of the "Morbidity and Mortality Weekly Report"
(MMWR). The opening paragraph states: "This report summarizes
the investigation of an outbreak of foodborne hepatitis A in
Massachusetts in which a food handler with hepatitis A, who was
considered unlikely to transmit HAV, was implicated as the
source. The findings underscore challenges faced by local and
state health departments when determining whether PEP
[postexposure prophylaxis] is appropriate."
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5224a2.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5224.pdf
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June 23, 2003
TUESDAY, JUNE 24, IS THE NEW ABSTRACT SUBMISSION DEADLINE FOR
CDC'S FOURTH IMMUNIZATION REGISTRY CONFERENCE
The Centers for Disease Control and Prevention (CDC) has
extended the deadline for submitting abstracts to its Fourth
Immunization Registry conference until midnight (PST) Tuesday,
June 24. CDC has extended the deadline for oral and poster
presentations in an effort to include as many abstracts as
possible from its partners and colleagues in the field. The
previous deadline was June 17.
To submit an abstract, go to CDC's online system at
http://cdc.confex.com/cdc/irc2003
For comprehensive information about the conference, scheduled
for October 27-29 in Atlanta, go to the conference web site at
http://www.cdc.gov/nip/registry/irc
For additional information, contact Amanda Bryant by email at
siisclear@cdc.gov or by phone at (404) 639-8247.
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June 23, 2003
CDC REPORTS ON NIGERIA'S PROGRESS TOWARD POLIO ERADICATION
The Centers for Disease Control and Prevention (CDC) published
"Progress Toward Poliomyelitis Eradication--Nigeria,
January 2002-March 2003" in the June 20 issue of the "Morbidity
and Mortality Weekly Report" (MMWR). Part of a summary made
available to the press is reprinted below.
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The estimated global occurrence of poliomyelitis has decreased
more than 99 percent since 1998, when the World Health Assembly
resolved to eradicate polio worldwide. Despite progress, Nigeria
remains one of the three global poliovirus reservoirs (along
with northern India and Pakistan) whose low routine OPV
vaccination coverage and high population density favor
poliovirus transmission. This report summarizes the progress
toward polio eradication in Nigeria during January 2002-March 2003, highlighting progress in acute flaccid paralysis
surveillance. The findings of wild poliovirus circulation in
areas of lower vaccination coverage underscore the importance of
achieving high quality supplementary immunization activities.
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To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5224a3.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5224.pdf
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