Issue
Number 417
October 13, 2003
CONTENTS OF THIS ISSUE
- Standards for Adult Immunization Practices and
Child and Adolescent Immunization Practices now in public domain
- CDC publishes the Recommended Adult Immunization
Schedule for 2003-04
- Dear Abby and IAC's executive director will team
up to make the case for influenza immunization on October 14
- This week is Adult Immunization Awareness Week
- CDC reports on racial/ethnic disparities in
influenza and pneumococcal vaccination levels among persons age 65 and
over
- New AAP policy statement: "Increasing
Immunization Coverage" available in current issue of "Pediatrics"
- Causal relationship between
thimerosal-containing vaccines and development of autism not supported by
Danish study
- Revised: CDC updates the online version of its
booklet "Guidelines for Vaccinating Pregnant Women"
- Revised: Case-based influenza prevention
teaching module available at no charge on the ATPM website
- IOM releases its review of influenza vaccines
and neurological complications
----------------------------------------------------------
Back to Top
(1 of 10)
October 13, 2003
STANDARDS FOR ADULT IMMUNIZATION PRACTICES AND CHILD AND ADOLESCENT
IMMUNIZATION PRACTICES NOW IN PUBLIC DOMAIN
The Centers for Disease Control and Prevention (CDC) published "Notice to
Readers: Revised Standards for Adult Immunization Practices and Child and
Adolescent Immunization Practices, 2003" in the October 10 issue of
"Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted
below in its entirety, excluding references.
***********************
During the 1990s, two sets of standards were introduced to guide delivery of
vaccinations for adults and children: Standards for Adult Immunization
Practices, developed by the National Coalition for Adult Immunization in
1990, and Standards for Pediatric Immunization Practices, developed by the
National
Vaccine Advisory Committee (NVAC) in 1992. Under the leadership of NVAC,
both sets of standards have been revised to reflect changes in the
health-care delivery system, new tools and strategies for supporting
vaccination providers, growing recognition of the importance of adolescent
vaccination, and an increasing emphasis on improving communications
regarding vaccine benefits and risks. Key partners and stakeholders
contributed to the revisions, and leading medical and public health organizations have endorsed them.
The revised standards focus on making vaccines readily accessible; properly
assessing patient vaccination status; effectively communicating with
patients; ensuring proper storage, administration, and documentation;
implementing strategies to improve vaccination rates; and developing
community partnerships to reach target patient populations. Concise
explanations of each of the standards describe how to implement them.
The intended audience for both sets of standards includes health-care
providers, public health officials, policymakers, health-plan
administrators, and employers who purchase health-care coverage. By applying
these standards, health-care professionals can begin to develop a
comprehensive plan to improve vaccination delivery in their practices,
protect their patients from vaccine-preventable diseases, and help achieve
the national health objectives for 2010. In addition, health-care providers
and program managers who lack the resources to implement these standards
should find them useful for defining and obtaining the necessary resources.
Both standards have been published; they also are available at
http://www.cdc.gov/nip/recs/rev-immz-stds.htm
***********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a8.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.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
(2 of 10)
October 13, 2003
CDC PUBLISHES THE RECOMMENDED ADULT IMMUNIZATION SCHEDULE FOR 2003-04
The Centers for Disease Control and Prevention (CDC) published "Notice to
Readers: Recommended Adult Immunization Schedule--United States, 2003-2004"
in the October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR).
The notice is reprinted below in its entirety, excluding references.
***********************
In June 2003, the Advisory Committee on Immunization Practices (ACIP)
approved the revised Adult Immunization Schedule for 2003-2004. The format
has been revised to better represent the schedule's two components, by age
group and by medical condition, and [to] better indicate how the footnotes
apply to both figures.
Revisions to the schedule and footnotes include 1) additional information
regarding use of tetanus-diphtheria toxoids as prophylaxis in wound
management; 2) clarification regarding the number of doses of the measles
component of the measles-mumps-rubella vaccine; 3) guidance regarding the
use of intranasally administered, live, attenuated influenza vaccine for
healthy persons aged 5-49 years; 4) recommendations regarding administering
influenza vaccination to pregnant women with or without pre-existing chronic
diseases or conditions; and 5) added information regarding influenza and
consideration of Haemophilus influenzae type b vaccine for asplenic persons.
Two measures initiated by the Centers for Medicare and Medicaid Services
(CMS) are expected to increase vaccination among Medicare and Medicaid
beneficiaries. First, in 2002, CMS enacted a new regulation allowing for the
use of standing orders at Medicare- and Medicaid-participating hospitals,
long-term-care facilities, and home-health agencies to deliver influenza and
pneumococcal vaccinations as recommended by ACIP and the Task Force on
Community Preventive Services. Second, CMS increased reimbursement rates for
administering hepatitis, influenza, and pneumococcal vaccines from a
national average of $3.98 in 2002 to $7.72 in 2003. In addition, expansion
of the National Committee for Quality Assurance's Health Plan Employer Data
and Information Set to include quality indicators on influenza vaccinations
for persons aged 50-64 years in 2001 and pneumococcal vaccinations for
persons aged 65 years and older in 2002 might improve vaccination-delivery
services at managed-care organizations.
Health-care providers are reminded they should administer influenza
vaccinations to all persons aged 50 years and older, regardless of
preexisting medical conditions. Family physicians, internists,
obstetrician/gynecologists, and other providers in private practice are
urged to use the Adult Immunization Schedule in conjunction with the
Standards for Adult Immunization Practices. Evidence indicates that chart
reminders, patient reminders/recalls, and standing orders will reduce missed
opportunities to vaccinate.
General information regarding adult immunization and vaccinating
immunosuppressed persons can be obtained from state and local health
departments and from CDC's National Immunization Program at
http://www.cdc.gov/nip The 2003-2004 Adult Immunization Schedule is
available at
http://www.cdc.gov/nip/recs/adult-schedule.htm
Vaccine information statements are available at
http://www.cdc.gov/nip/publications/vis ACIP statements for each
recommended vaccine are available at
http://www.cdc.gov/nip/publications/acip-list.htm In addition,
instructions for reporting adverse events after vaccination to the Vaccine
Adverse Event Reporting System are available at
http://www.vaers.org or by telephone,
(800) 822-7967.
***********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a6.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.pdf
---------------------------------------------------------------
Back to Top
(3 of 10)
October 13, 2003
DEAR ABBY AND IAC'S EXECUTIVE DIRECTOR WILL TEAM UP TO MAKE THE CASE FOR
INFLUENZA IMMUNIZATION ON OCTOBER 14
Be sure to turn the pages of your newspaper to Dear Abby's column on October
14. The column will run an ardent and informative letter urging the public
to be immunized against influenza this fall. Written by the executive
director of the Immunization Action Coalition (IAC), Deborah L. Wexler, MD,
the letter succinctly states the serious nature of influenza's
complications, dispels common misconceptions about the vaccine, and enlarges
the public's understanding of the persons for whom the vaccine is
recommended and encouraged in the U.S.
From IAC's past experience with being published in Dear Abby's column, we
want to alert immunization providers that they may get a number of phone
calls from people seeking appointments for influenza vaccination after the
column is published. The column's reach is broad: the Dear Abby staff
estimates 110 million people read it each day.
If possible, we would appreciate your clipping the October 14 column from
your newspaper and faxing or mailing it to us. We'd like to see the
headlines various papers wrote above the column.
Our fax number is (651) 647-9131; our mailing address is Immunization Action
Coalition, 1573 Selby Ave., Ste. 234, St. Paul, MN 55104. Thank you for your
help with this.
---------------------------------------------------------------
Back to Top
(4 of 10)
October 13, 2003
THIS WEEK IS ADULT IMMUNIZATION AWARENESS WEEK
The Centers for Disease Control and Prevention (CDC) published "Notice to
Readers: National Adult Immunization Week, October 12-18, 2003" in the
October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR). The
notice is reprinted below in its entirety.
***********************
This year's National Adult Immunization Awareness Week (NAIAW) will be
observed October 12-18. NAIAW highlights the influenza vaccination season,
which typically begins in early fall of each year. NAIAW emphasizes the need
for health-care providers and public health officials to intensify their
efforts to vaccinate adults and adolescents according to recommendations of
the Advisory Committee on Immunization Practices. In addition to specifying
the appropriate use of influenza and pneumococcal vaccines for adults and
adolescents, the recommendations cover vaccination of adults and adolescents
against diphtheria, hepatitis A and B, measles, mumps, rubella, tetanus,
meningococcal disease, and varicella.
In conjunction with NAIAW, CDC is introducing Immunize Now, a tool kit
designed to assist doctors and nurses in minimizing staff time and
maximizing patient care during their influenza vaccination efforts. The kit
highlights new developments in influenza vaccination and contains bilingual
patient education materials.
Additional information about influenza, the influenza vaccine, the Immunize
Now provider tool kit, and other influenza education materials is available
at http://www.cdc.gov/nip/flu
Information about NAIAW is available from the National Foundation for
Infectious Diseases, the National Coalition for Adult Immunization, 4733
Bethesda Avenue, Suite 750, Bethesda, MD 20814; telephone, (301) 656-0003;
fax, (301) 907-0878; email, jhan@nfid.org;
and the National Partnership for Immunization, 121 North Washington Street,
Suite 300, Alexandria, VA 22314, telephone, (703) 836-6110, fax, (703)
836-3470, email, npi@hmhb.org
Information about NAIAW also is available at
http://www.nfid.org,
http://www.partnersforimmunization.org and at
http://www.cdc.gov/nip/events/naiaw/default.htm
***********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a7.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.pdf
---------------------------------------------------------------
Back to Top
(5 of 10)
October 13, 2003
CDC REPORTS ON RACIAL/ETHNIC DISPARITIES IN INFLUENZA AND PNEUMOCOCCAL
VACCINATION LEVELS AMONG PERSONS AGE 65 AND OVER
The Centers for Disease Control and Prevention (CDC) published
"Racial/Ethnic Disparities in Influenza and Pneumococcal Vaccination Levels
Among Persons Aged 65 Years and Over--United States, 1989-2001" in the
October 10 issue of "Morbidity and Mortality Weekly Report" (MMWR). Portions
of the article are reprinted below.
***********************
[The article's introductory paragraph]
Influenza and pneumococcal diseases are key causes of mortality among
persons aged 65 years and over, accounting for approximately 36,000 and
3,400 deaths per year, respectively, during 1990-1999. Substantial
racial/ethnic disparities in adult vaccination have been documented in
national surveys. Although the national health objective for 2000 of 60%
receipt of influenza vaccination during the preceding 12 months by persons
aged 65 years and over (objective no. 20.11) was met in 1997, and the
objective of 60% for pneumococcal vaccination was nearly met in 2000,
vaccine coverage levels among non-Hispanic blacks and Hispanics were 31% and
30%, respectively, compared with 57% for non-Hispanic whites. To
characterize these disparities, CDC analyzed data from the 2000 and 2001
National Health Interview Surveys (NHIS) and examined trends in NHIS results
for 1989-2001. This report summarizes the results of these analyses, which
indicate that marked differences in vaccination coverage by race/ethnicity
are observed even among persons most likely to be vaccinated (e.g., persons
with the highest education level and persons with frequent visits to
health-care providers). Racial/ethnic disparities in influenza and
pneumococcal vaccination coverage have persisted over time. Several
approaches to reduce these disparities are needed, including increasing
demand for vaccination among racial/ethnic minority populations and the use
of standing orders and other systems changes that promote vaccination.
[The article's fourth and fifth paragraphs]
During 2000-2001, the average influenza and pneumococcal coverage levels
reported, respectively, were 66% and 57% for non-Hispanic whites, 48% and
33% for non-Hispanic blacks, and 54% and 32% for Hispanics. In general,
influenza vaccination coverage was highest for non-Hispanic whites, followed
by Hispanics and then non-Hispanic blacks; for pneumococcal vaccination,
coverage was similar for non-Hispanic blacks and Hispanics. Vaccine coverage
was less than 60% for all subgroups of non-Hispanic blacks and the majority
of subgroups of Hispanics.
After accounting for variations in sex, age, education, poverty status,
region, insurance status, number of doctor visits, and high-risk conditions,
non-Hispanic blacks remained significantly less likely than non-Hispanic
whites to report influenza vaccination (odds ratio [OR] = 0.7; 95% CI =
0.6-0.8); the difference between Hispanics and non-Hispanic whites was not
statistically significant (OR = 0.9; 95% CI = 0.7-1.1). Both non-Hispanic
blacks and Hispanics were significantly less likely than non-Hispanic whites
to report a pneumococcal vaccination (OR = 0.4; 95% CI = 0.3-0.5 and OR =
0.4; 95% CI = 0.3 and 0.5, respectively).
[Portions of the article's Editorial Note]
The findings in this report indicate that although influenza and
pneumococcal vaccination rates have increased for non-Hispanic blacks and
Hispanics, as they have for non-Hispanic whites, substantial gaps persist by
race/ethnicity. Differences in coverage are observed among persons with
similar education levels, similar numbers of health-care encounters, and
similar insurance status. These differences remain after controlling for
factors with multivariable analysis, with the exception of receipt of
influenza vaccination among Hispanics. Increases in vaccination rates for
non-Hispanic blacks and Hispanics have not occurred at a rate sufficient to
reach the national health objective for 2010 of eliminating disparities in
health. Among non-Hispanic whites, influenza vaccination coverage was stable
during 1997-2001 at less than 70%, and for all three groups, coverage was
below the 90% health objective for 2010.
Reasons for differences in coverage are poorly understood. In this analysis,
substantial racial/ethnic disparities in vaccination coverage were observed
among persons with zero to one, two to nine, and 10 or more health-care
provider contacts during the preceding 12 months, suggesting that access to
care might not be a key factor. In the 1996 Medicare Current Beneficiary
Survey, race/ethnicity was not related to reasons given for not being
vaccinated. For influenza vaccination, the two leading reasons for not being
vaccinated were not knowing it was recommended and concerns about the
vaccine (e.g., fear of getting influenza and fear of side effects); for
pneumococcal vaccination, the leading reason for not being vaccinated was
not knowing it was recommended. Determining the reasons for the
racial/ethnic disparity requires further examination. Possible reasons might
include non-Hispanic blacks and Hispanics receiving care disproportionately
in settings in which vaccination coverage is lower or differences in the
provider-patient interaction for non-Hispanic blacks and Hispanics compared
with non-Hispanic whites. . . .
System changes that promote adherence to evidence-based guidelines play a
key role in reducing disparities. The absence of racial/ethnic disparities
in Veteran's Administration clinics, in which standing orders and other
interventions to increase vaccination have been implemented, suggests that
this approach might be effective in eliminating disparities. In addition,
programs are needed to increase demand for vaccination among older
non-Hispanic blacks and Hispanics through state and local outreach programs
and coalitions to engage new partners.
***********************
To obtain the complete text of the article online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5240a3.htm
To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5240.pdf
---------------------------------------------------------------
Back to Top
(6 of 10)
October 13, 2003
NEW AAP POLICY STATEMENT: "INCREASING IMMUNIZATION COVERAGE" AVAILABLE IN
CURRENT ISSUE OF "PEDIATRICS"
On October 6, the American Academy of Pediatrics (AAP) issued a press
release announcing the publication of its new policy statement, "Increasing
Immunization Coverage," in the October issue of "Pediatrics." The first
paragraph of the press release is reprinted below.
***************************
NEW STRATEGIES RECOMMENDED TO IMPROVE IMMUNIZATION RATES
October 6, 2003
A new AAP policy entitled, "Increasing Immunization Coverage" recommends
that pediatricians and child health professionals take additional steps to
improve child immunization rates. Despite advances in vaccine delivery, only
77.2 percent of toddlers, ages 19 to 35 months, had received all recommended
vaccinations in 2001. Children who are poor, or a member of a racial or
ethnic minority group, are especially at risk. The new policy recommends
that pediatricians mail parents reminders for upcoming visits and vaccine
recall notices, use prompts during office visits to remind parents and staff
about immunization, and ensure that nurses and other support staff routinely
screen patients for needed vaccines. The policy also calls for a reduction
in socioeconomic and racial disparities in immunization rates, and
reiterates the importance of every child having a medical home, where all
medical records, including immunization information, are maintained.
***************************
To access a copy of the policy statement from the AAP website, go to:
http://www.aap.org/policy/s060014.html
---------------------------------------------------------------
Back to Top
(7 of 10)
October 13, 2003
CAUSAL RELATIONSHIP BETWEEN THIMEROSAL-CONTAINING VACCINES AND DEVELOPMENT
OF AUTISM NOT SUPPORTED BY DANISH STUDY
On October 1, the "Journal of the American Medical Association" published
"Association Between Thimerosal-Containing Vaccine and Autism." Portions of
the abstract are reprinted below.
****************************
Objective: To determine whether vaccination with a thimerosal-containing
vaccine is associated with development of autism.
Results: During 2,986,654 person-years, we identified 440 autism cases and
787 cases of other autistic-spectrum disorders. The risk of autism and other
autistic-spectrum disorders did not differ significantly between children
vaccinated with thimerosal-containing vaccine and children vaccinated with
thimerosal-free vaccine. . . .
Conclusion: The results do not support a causal relationship between
childhood vaccination with thimerosal-containing vaccines and development of
autistic-spectrum disorders.
****************************
To access the entire abstract, go to:
http://jama.ama-assn.org/cgi/content/abstract/290/13/1763
To access journal articles and other resources on autism from the
Immunization Action Coalition (IAC) website, go to:
http://www.immunize.org/safety/autism.htm
To access journal articles and other resources on thimerosal from the IAC
website, go to:
http://www.immunize.org/safety/thimerosal.htm
---------------------------------------------------------------
Back to Top
(8 of 10)
October 13, 2003
REVISED: CDC UPDATES THE ONLINE VERSION OF ITS BOOKLET "GUIDELINES FOR
VACCINATING PREGNANT WOMEN"
CDC has recently updated one of its online resources, the "Guidelines for
Vaccinating Pregnant Women." The revised booklet now includes information
that pregnant women are among the populations that should not be vaccinated
with live attenuated influenza vaccine (LAIV; trade name FluMist).
To access the document online, go to:
http://www.cdc.gov/nip/publications/preg_guide.htm
To access a camera-ready (PDF) copy, go to:
http://www.cdc.gov/nip/publications/preg_guide.pdf
---------------------------------------------------------------
Back to Top
(9 of 10)
October 13, 2003
REVISED: CASE-BASED INFLUENZA PREVENTION TEACHING MODULE AVAILABLE AT NO
CHARGE ON THE ATPM WEBSITE
On October 2, the Association of Teachers of Preventive Medicine (ATPM)
announced the availability of an updated case-based teaching module on
influenza prevention. The updated module is the latest one released by the
Teaching Immunization for Medical Education (TIME) project, a collaboration
of ATPM, the Centers for Disease Control and Prevention, and a national
advisory committee of medical experts. TIME's goal is to improve the
teaching of immunization and vaccine-preventable diseases to health
professionals.
The updated module has two components, a facilitator's guide and a
small-group booklet. Both are available at no charge from the ATPM website.
To access the facilitator's guide, go to:
http://www.atpm.org/Immunization/TIME/FLU_Facilitators_Guide.pdf
To access the small-group booklet, go to:
http://www.atpm.org/Immunization/TIME/FLU_SmallGroup.pdf
TIME has many existing no-cost immunization teaching modules and anticipates
releasing several more in the next year. To access other modules and for
more information about TIME, go to:
http://www.atpm.org/Immunization/TIME/body_time.html
For additional information, call ATPM at (540) 380-5883 or (202) 463-0550.
---------------------------------------------------------------
Back to Top
(10 of 10)
October 13, 2003
IOM RELEASES ITS REVIEW OF INFLUENZA VACCINES AND
NEUROLOGICAL COMPLICATIONS
On October 6, the Institute of Medicine (IOM) of the National Academies
released a report, "Immunization Safety Review: Influenza Vaccines and
Neurological Complications." The report is the result of IOM's Committee on
Immunization Safety's review of the data on influenza vaccine and
neurological conditions. Portions of a press release announcing the report
follow.
************************
Scientific evidence shows that influenza vaccines do not trigger relapses of
multiple sclerosis (MS) in adults with the disease, says the latest report
on vaccine safety from the Institute of Medicine of the National Academies.
In addition, the report confirmed the well-studied link between the specific
influenza vaccine used to ward off an anticipated epidemic of the "swine
flu" in 1976 and several hundred cases of the rare paralytic disorder
Guillain-Barré syndrome (GBS) that occurred in vaccinated adults. . . .
************************
To access the complete press release, go to:
http://www4.nationalacademies.org/news.nsf/isbn/0309090865?OpenDocument
To access a synopsis of the report, go to:
http://www.iom.edu/report.asp?id=15625
To access a prepublication copy of the report, go to:
http://www.nap.edu/books/0309090865/html
To place a prepublication order, go to:
http://books.nap.edu/allpricing.phtml?record_id=10822
To contact the customer service department of the National Academies Press,
call (800) 624-6242. |
