Issue
Number 411
September 15, 2003
CONTENTS OF THIS ISSUE
- New: CDC releases VIS for intranasal influenza vaccine
and makes minor change to inactivated influenza VIS
- Just in time for flu vaccination season: National
Immunization Program posts 2003-04 "Flu Gallery" materials
- New: National Immunization Program issues Influenza Vaccine
Bulletin #3 for the 2003-04 influenza season
- Minnesota expands and changes day care and school entry
requirements for three childhood vaccines
- CDC reports on global progress toward childhood
hepatitis B vaccination
- IAC's newest web section features PowerPoint presentations
- IAC posts new VIS translations for inactivated influenza,
meningococcal, inactivated polio, and MMR vaccines
- IAC's Hepatitis Prevention Programs website now features
90 programs
----------------------------------------------------------
Back to Top
(1 of 8)
September 15, 2003
NEW: CDC RELEASES VIS FOR INTRANASAL INFLUENZA VACCINE AND MAKES MINOR
CHANGE TO INACTIVATED INFLUENZA VIS
On September 4, the National Immunization Program, Centers for Disease
Control and Prevention (CDC), posted the Vaccine Information Statement (VIS)
for the new intranasal influenza vaccine. Licensed in the United
States earlier this year and sold under the trade name FluMist, the vaccine
is an attenuated (weakened) live vaccine intended to be sprayed into
vaccinees' nostrils.
To access a camera-ready (PDF) copy of the new VIS from the CDC website, go
to:
http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf
In addition, CDC made a minor change to topic four of the VIS for
inactivated influenza vaccine. The change reflects the Advisory Committee on
Immunization Practice's decision to rescind its recommendation for
staged administration and allow everyone to get the vaccine as soon as it's
available. As this change is minor, CDC did not change the VIS issue date;
it is still 5/6/03.
To access a camera-ready (PDF) copy of the revised VIS from the CDC website,
go to:
http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf
The two VISs are also posted on the IAC website. For information about the
use of VISs, as well as VISs for additional vaccines (some in up to 28
languages), visit IAC's VIS web section at
http://www.immunize.org/vis
---------------------------------------------------------------
Back to Top (2 of 8)
September 15, 2003
JUST IN TIME FOR FLU VACCINATION SEASON: NATIONAL IMMUNIZATION
PROGRAM POSTS 2003-04 "FLU GALLERY" MATERIALS
On September 5, the National Immunization Program, Centers for
Disease Control and Prevention posted the majority of its
influenza patient-education materials on its 2003-04 "Flu
Gallery" web section. This season's flu campaign emphasizes
protecting yourself and the ones you love by getting a flu
vaccine. You'll find materials for parents, Spanish speakers,
those at high risk for flu complications, and immunization
providers. Materials are free and can be downloaded easily.
Available for printing in color and/or black and white, the
materials include the following:
One brochure: "Influenza and Your Child: Information for
Parents," prints double sided; one side in English, one side in
Spanish.
Four 8-1/2" x 11" flyers; all available in English and Spanish:
(1) "Flu Vaccine Facts & Myths," (2) "To Protect Yourself and
Those You Love," (3) "When Should You Get Your Flu Vaccination?"
and (4) "Who Is at High Risk for Flu Complications?" (black and
white only).
Three posters; all available in English and Spanish: (1)
"Community Immunity: 'Dominos'," (2) "Protect Your Kids from
Flu," (3) "Top Three Reasons to Get Your Flu Vaccine."
Other materials include the Vaccine Information Statements for
inactivated influenza vaccine and live intranasal influenza
vaccine [for more information, see the preceding "IAC EXPRESS"
article], buttons, pediatric dosage chart, cover letter (English
only), stickers (English only), three-sided stand-up table tent
(English only), and flu logos for print materials or web sites.
These materials will soon be available on a free CD-ROM; the
request form will be coming soon. The limit is one CD per order.
To access "Flu Gallery" materials, go to:
http://www.cdc.gov/nip/flu/gallery.htm
For further information, contact Carolyn O'Mara at
mfo1@cdc.gov
or (404) 639-8237 or Ron Nuse at ran0@cdc.gov or
(404) 639-8738.
---------------------------------------------------------------
Back to Top (3 of 8)
September 15, 2003
NEW: NATIONAL IMMUNIZATION PROGRAM ISSUES INFLUENZA VACCINE
BULLETIN #3 FOR THE 2003-04 INFLUENZA SEASON
On September 11, the National Immunization Program of the
Centers for Diseases Control and Prevention (CDC) issued
"Influenza Bulletin #3." It is reprinted below in its entirety,
with the exception of one table.
**********************
INFLUENZA VACCINE BULLETIN #3
Influenza Season 2003-04
September 11, 2003
The National Immunization Program (NIP) of the Centers for
Disease Control and Prevention (CDC) publishes and distributes
periodic bulletins to update partners about recent developments
related to the production, distribution, and administration of
influenza vaccine. All recipients of this bulletin are
encouraged to distribute each issue widely to colleagues,
members, and constituents.
INFLUENZA VACCINE DISTRIBUTION AND ADMINISTRATION
Timing of Influenza Vaccination During the 2003-04 Season
- At its June meeting, the ACIP asked CDC, in collaboration
with the FDA and the influenza vaccine manufacturers, to
determine if vaccine supplies for the coming year would be
adequate and timely. The CDC affirmed on August 11, 2003,
that vaccine production for the 2003-04 influenza season is
proceeding satisfactorily, and that projected production and
distribution schedules will allow for sufficient supply of
influenza vaccine during October and November. Therefore,
influenza vaccination can proceed for all high-risk and
healthy persons, individually and through mass campaigns, as
soon as vaccine is available.
Review the Notice to Readers published in the August 22,
2003, Morbidity and Mortality Weekly Report (MMWR) for
complete information and references at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5233a6.htm
CMS Allows Exception to Electronic Reporting Requirement for
Providers Submitting Roster Bills
- On August 15, 2003, the Department of Health and Human
Services (HHS) published the Final Rule for Electronic
Submission of Medicare Claims. The Administrative
Simplification Compliance Act (ASCA) requires nearly all
claims sent to the Medicare Program be submitted
electronically beginning October 16, 2003. However,
providers wishing to submit paper roster bills for
vaccinations are exempt from this requirement. Review the
rule and the few exceptions to these requirements at
http://a257.g.akamaitech.net/7/257/2422/14mar20010800/edocket.access.gpo.gov/2003/pdf/03-20955.pdf
The Centers for Medicare and Medicaid Services (CMS) offers
free training and testing to assure that providers and their
business partners are able to send and receive HIPAA-compliant transactions. Contact your Medicare carrier to
schedule testing.
Additional HIPAA information can be found at
http://www.cms.hhs.gov/hipaa/hipaa2
How to Bill Medicare for Influenza and Pneumococcal Vaccines
Redistribution of Influenza Vaccine
- According to the Food and Drug Administration (FDA),
providers may reallocate inactivated influenza vaccine to
other local providers where vaccine distribution is uneven.
The parameters for redistribution in keeping within the
accepted principles of vaccine storage and handling are
available on CDC's website at
http://www.cdc.gov/nip/Flu/News.htm#redist
Projections of Influenza Vaccine Distribution ["IAC EXPRESS" Editor's Note: The table "Projections
of Monthly Influenza Vaccine Distribution, United States,
2003" is accessible using the link provided at the end of
this article.] INFLUENZA VACCINE COMMUNICATIONS AND RESOURCES
MISCELLANEOUS INFORMATION Pneumococcal Vaccine Payment Increase Effective October 1, 2003
- Effective October 1, 2003, the Medicare Part B payment for
the pneumococcal vaccine will be increased to either the
charge billed to Medicare or the amount of $18.62, whichever
is lower. Annual Part B deductible and coinsurance amounts
do not apply. All physicians, non-physician practitioners,
and suppliers who administer pneumococcal vaccination must
take assignment on the claim for the vaccine.
For additional information about Medicare and immunizations,
refer to the Immunizations Quick Reference Guide at
http://www.cms.hhs.gov/medlearn/refimmu.asp
****************************
To access a camera-ready (PDF) version of the bulletin from the
Immunization Action Coalition website, go to:
http://www.immunize.org/news.d/flubul91103.pdf
---------------------------------------------------------------
Back to Top (4 of 8)
September 15, 2003
MINNESOTA EXPANDS AND CHANGES DAY CARE AND SCHOOL ENTRY
REQUIREMENTS FOR THREE CHILDHOOD VACCINES
On September 9, Minnesota's commissioner of health signed an
order adopting new rules that add to and change current day care
and school entry immunization requirements. Beginning with the
2004-05 school year, the following requirements will be in
effect:
Varicella: Children in day care, kindergarten, and seventh grade
will need to show proof they are vaccinated against varicella or
have had the disease.
Pneumococcal disease: Children under age two in day care will
need to show proof they are immunized against pneumococcal
disease.
Measles, mumps, rubella (MMR): Children entering kindergarten
will need to show proof of a second dose of MMR vaccine;
previously, MMR was required by law at seventh grade entry.
The Immunization Action Coalition has compiled information about
all states that have varicella mandates for day care,
elementary, and middle school entry. To access the information,
go to: http://www.immunize.org/laws/varicel.htm
This information is also depicted visually on a map of the
United States. To access the map, go to:
http://www.immunize.org/laws/varimap.pdf
For information about state mandates for other vaccines, go to:
http://www.immunize.org/laws
We depend on our readers to help us stay informed and ensure our
website contains the most current and accurate information
available. Please let us know when any changes occur in your
state by emailing us at admin@immunize.org
---------------------------------------------------------------
Back to Top (5 of 8)
September 15, 2003
CDC REPORTS ON GLOBAL PROGRESS TOWARD CHILDHOOD
HEPATITIS B VACCINATION
The Centers for Disease Control and Prevention (CDC) published
"Global Progress Toward Universal Childhood Hepatitis B
Vaccination, 2003" in the September 12 issue of the "Morbidity
and Mortality Weekly Report" (MMWR). The article is reprinted
below, excluding references and a map.
***********************
In 1992, the World Health Organization (WHO) set a goal for all
countries to integrate hepatitis B vaccination into their
universal childhood vaccination programs by 1997. This report
summarizes the global progress achieved toward vaccination of
children against hepatitis B virus (HBV) infection. Although
many countries have introduced hepatitis B vaccination into
their national vaccination programs, efforts are needed to
increase coverage with the 3-dose hepatitis B vaccination series
and expand vaccination programs into countries where the vaccine
has not yet been introduced.
In 2001, the most recent year for which complete program data
are available, 126 (66%) of 191 WHO member states had universal
infant or childhood hepatitis B vaccination programs. Through
these programs, an estimated 32% of children aged less than
1 year were vaccinated fully with the 3-dose hepatitis B
vaccination series. In the six WHO regions, the proportion of
children aged less than 1 year who were vaccinated fully was
65% in the Western Pacific Region, 58% in the Americas Region,
45% in the European Region, 41% in the Eastern Mediterranean
Region, 9% in the South-East Asian Region, and 6% in the
African Region.
As of May 2003, a total of 151 (79%) of 192 WHO member states
had adopted universal childhood hepatitis B vaccination
policies, including six that have policies for vaccinating
adolescents. Of the 137 member states that have adopted
universal childhood hepatitis B vaccination and for which data
are available, 76 (55%) have a policy for administering the
first dose of vaccine soon after birth (birth dose).
Of the 89 member states with historically high prevalences of
chronic HBV infection (i.e., prevalence of hepatitis B surface
antigen [HBsAg] of 8% or greater) and for which universal infant
hepatitis B vaccination is recommended specifically, 64 (72%)
have adopted universal infant hepatitis B vaccination. Of these
64 member states, 34 (53%) have a policy for administration of a
birth dose of vaccine. Goals for global hepatitis B vaccination
are for the vaccine to be introduced in all countries by 2007
and for coverage with the 3-dose hepatitis B vaccination series
to reach 90% by 2010.
Editorial Note:
Each year, approximately 600,000 HBV-related deaths occur
worldwide (CDC and WHO, unpublished data, 2003). An estimated
93% of these deaths result from the chronic sequelae of HBV
infection: cirrhosis and hepatocellular carcinoma (HCC) (CDC,
unpublished data, 2003). Approximately 21% of HBV-related deaths
result from infection acquired in the perinatal period and
48% from infection acquired in early childhood (age 5 years or
less) (CDC, unpublished data, 2003). Therefore, vaccination of
infants and children is the highest priority for hepatitis B
vaccination programs. Three doses of hepatitis B vaccine are
90%-95% efficacious in preventing HBV infection and its chronic
sequelae. To prevent perinatal HBV transmission, the first dose
of vaccine should be administered within the first 24 hours
after birth.
Hepatitis B vaccination has been shown to reduce the prevalence
of chronic HBV infection and the incidence of HCC dramatically.
In The Gambia, the prevalence of chronic infection among
children declined from 10.0% to 0.6% after implementation of
universal infant hepatitis B vaccination. Similar declines in
prevalence of chronic infection associated with infant and
childhood hepatitis B vaccination have been demonstrated in
China, Indonesia, Senegal, and Thailand, and among Alaska
Natives. After implementation of universal infant hepatitis B
vaccination in Taiwan, the incidence of HCC among children
declined from 0.7 to 0.36 per 100,000.
Several important challenges remain to achieve the goal of
global childhood hepatitis B vaccination introduction. Countries
that have not yet introduced hepatitis B vaccine should do so.
For many of these countries, this will require strengthening
their existing vaccination program infrastructure to accommodate
the addition of a new vaccine. In countries where the vaccine
has been introduced already, coverage with the 3-dose
hepatitis B vaccination series should be increased to that of
the 3-dose diphtheria-tetanus-pertussis (DTP) series, and then
to 90% or greater. Countries that do not have a policy for
administration of a birth dose of vaccine should consider the
feasibility of implementing such a policy. In countries with
high hepatitis B vaccination coverage among children,
consideration should be given to catch-up vaccination of older
children, adolescents, and adult populations at increased risk
for HBV infection.
A major barrier to the introduction of hepatitis B vaccination
has been the high cost of hepatitis B vaccines. Although the
price of monovalent hepatitis B vaccine for developing countries
has decreased from approximately U.S.$3.00 per dose in 1990 to
U.S.$0.30 per dose in 2001, the cost remains higher than that of
the older vaccines (e.g., DTP, oral polio, and measles), which
cost U.S.$0.06-$0.10 per dose. Since 1999, support from the
Global Alliance for Vaccines and Immunization (GAVI) and the
Vaccine Fund (VF) has accelerated introduction of hepatitis B
vaccine in the world's poorest countries. As of May 2003, of
75 countries eligible for GAVI/VF support, 48 (64%) had received
funding for hepatitis B vaccination introduction.
Administration of a birth dose of vaccine presents a challenge.
Worldwide, approximately 50% of infants are born at home and do
not have immediate access to health care. However, because
hepatitis B vaccine has been shown to be heat stable, it could
be administered by trained birth attendants to infants born at
home. The feasibility of such a strategy has been demonstrated
in Indonesia, where trained birth attendants were taught to
administer the birth dose of vaccine to infants born at home by
using a single-use, pre-filled injection device.
WHO, in collaboration with CDC and other GAVI partners,
conducted process evaluations of hepatitis B vaccination
introduction in five African countries where the vaccine had
been introduced recently. These evaluations demonstrated that
hepatitis B vaccine introduction did not negatively impact the
existing vaccination programs, including coverage with the other
childhood vaccines. However, several problems were identified
related to the management of this relatively costly vaccine:
vaccine freezing during storage and shipment, and vaccine
wastage. Outcome evaluations are needed to document the impact
of vaccination on the prevalence of chronic HBV infection and
HBV-related morbidity and mortality.
***********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5236a5.htm
To obtain a camera-ready (PDF format) copy of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5236.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.
---------------------------------------------------------------
Back to Top (6 of 8)
September 15, 2003
IAC'S NEWEST WEB SECTION FEATURES POWERPOINT PRESENTATIONS
[The following is cross posted from the Immunization Action
Coalition's "HEP EXPRESS" electronic newsletter, 9/10/03.]
The Immunization Action Coalition (IAC) recently launched a new
web section featuring public domain Microsoft PowerPoint
presentations. These presentations were collected to provide
health professionals easy access to educational tools for both
staff training and patient education.
The site features links to presentations from the Centers for
Disease Control and Prevention's (CDC) National Immunization
Program, CDC's Division of Viral Hepatitis, the World Health
Organization, UNICEF, OSHA, the Rotary Foundation, the
Children's Vaccine Program at PATH, and more.
Subjects covered in these presentations include the basics of
childhood vaccines, vaccine safety, needle safety, global
issues, and viral hepatitis. The web page indicates whether a
presentation is intended for health professionals or the public.
Visit this new resource at
http://www.immunize.org/presentations
If you know of any other available PowerPoint presentations,
please let us know by writing to: teresa@immunize.org
---------------------------------------------------------------
Back to Top (7 of 8)
September 15, 2003
IAC POSTS NEW VIS TRANSLATIONS FOR INACTIVATED INFLUENZA,
MENINGOCOCCAL, INACTIVATED POLIO, AND MMR VACCINES
The Immunization Action Coalition (IAC) recently posted Vaccine
Information Statements (VISs) for inactivated influenza and
meningococcal vaccines (Thai), inactivated polio vaccine
(Polish), and measles-mumps-rubella (MMR) vaccine (Marshallese).
IAC gratefully acknowledges Asian Pacific Health Care Venture,
Inc., for the Thai translations, Danusia Filipowski, MD, for the
Polish translation, and the Hawai'i State Department of Health
for the Marshallese translation.
To access the VIS for inactivated influenza vaccine in Thai, go
to: http://www.immunize.org/vis/th_flu03.pdf
To access the VIS for meningococcal vaccine in Thai, go to:
http://www.immunize.org/vis/th_men03.pdf
To access the VIS for inactivated polio vaccine in Polish, go
to: http://www.immunize.org/vis/po_pol00.pdf
To access the VIS for MMR vaccine in Marshallese, go to:
http://www.immunize.org/vis/ma_mmr03.pdf
For information about the use of VISs, as well as VISs for
additional vaccines (some in up to 28 languages), visit IAC's
VIS web section at http://www.immunize.org/vis
---------------------------------------------------------------
Back to Top (8 of 8)
September 15, 2003
IAC'S HEPATITIS PREVENTION PROGRAMS WEBSITE NOW FEATURES
90 PROGRAMS
[The following is cross posted from the Immunization Action
Coalition's "HEP EXPRESS" electronic newsletter, 9/10/03.]
The Immunization Action Coalition (IAC) recently added four new
programs to its Hepatitis Prevention Programs website, bringing
the total number of featured programs to 90. The site,
www.hepprograms.org, highlights programs successfully preventing
hepatitis A, B, and/or C in adults and adolescents at risk of
infection.
The new projects are:
Hawaii State Department of Health
STD/AIDS Prevention Branch
http://www.hepprograms.org/msm/msm18.asp
HCV Prison Support Project
http://www.hepprograms.org/adult/adult11.asp
New York City Department of Health and Mental Hygiene
Bureau of STD Control, Hepatitis Program
http://www.hepprograms.org/std/std13.asp
Pennsylvania Department of Health
Division of Immunizations
http://www.hepprograms.org/std/std12.asp
In addition, the following program information was updated:
Rhode Island Department of Corrections
(formerly listed as the Harold and Esther Chester Immunology
Center, Miriam Hospital)
http://www.hepprograms.org/adult/adult6.asp
In addition to the 90 model programs, the site includes links to
hundreds of other related resources, including journal articles,
organizations, and provider and client education materials.
If you have a hepatitis prevention program for adults or
adolescents at risk that is not listed, we would love to add
your project to the site: just complete the form titled "Tell us
about your program" at
http://www.hepprograms.org/tellus.htm |
