Issue
Number 431
December 15, 2003
CONTENTS OF THIS ISSUE
- CDC launches new influenza web section
- CDC's update on influenza activity for the
2003-04 season includes new recommendations for influenza prevention
- Standards for Adult Immunization Practices and
Child and Adolescent Immunization Practices both available in
journal-article format
- CDC requests information about acute
encephalopathy associated with influenza virus infection in U.S. children
- Measles immunization campaigns in Iran and
Turkey to reach 53 million children and young people
- IOM meeting on vaccines and autism set for
February 9, 2004
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December 15, 2003
CDC LAUNCHES NEW INFLUENZA WEB SECTION
On December 10, the Centers for Disease Control and Prevention (CDC)
consolidated information about influenza onto a new web section, "Influenza
(Flu) Protect Yourself & Your Loved Ones" (http://www.cdc.gov/flu).
The well-designed main page has links to abundant information for the public
and health care professionals. The subsection for the public is divided
between information about the disease and information about protecting
oneself and others from it. The subsection for professionals directs them to
contacts for vaccine supply, information on prevention and control, and
various government documents such as Vaccine Information Statements,
Influenza Vaccine Bulletins, and pertinent recommendations from the Advisory
Committee on Immunization Practices.
Several web pages keep the public and health professionals up to date on the
status of the current influenza season. The "Flu Activity Update" includes a
map depicting the spread of influenza across the country and a weekly report
summarizing influenza activity. "What's New" has links to documents recently
posted or updated on the flu website; these include Q&As about the disease,
key facts about it, CDC recommendations for preventing it, and much more.
"News and Highlights" includes links to pertinent MMWR articles, press
releases, teleconferences, press conferences, and more.
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December 15, 2003
CDC'S UPDATE ON INFLUENZA ACTIVITY FOR THE 2003-04 SEASON INCLUDES NEW
RECOMMENDATIONS FOR INFLUENZA PREVENTION
The Centers for Disease Control and Prevention (CDC) published "Update:
Influenza Activity--United States, 2003-04 Season" in the December 12 issue
of "Morbidity and Mortality Weekly Report" (MMWR). Portions of the article,
including new recommendations for influenza prevention, are reprinted below.
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Influenza began circulating in the United States unusually early this
season, and influenza activity nationwide is expected to increase. Cases of
severe disease, including deaths, have been reported in children. This
report summarizes influenza activity in the United States during the weeks
ending October 4- December 6, 2003. During the week ending December 6,
influenza activity was reported to CDC as widespread in 24 states. The early
season and the unusually high and persistent demand for vaccine have
resulted in a decreasing supply of trivalent inactivated vaccine. Emphasis
should be placed on vaccinating persons at high risk for complications from
influenza, including healthy children aged 6-23 months. Healthy persons aged
5-49 years who wish to receive vaccine should consider being vaccinated with
the intranasally administered live, attenuated influenza vaccine (LAIV), a
substantial supply of which remains available. . . .
Reports of Severe Illness and Deaths
Pediatric cases. CDC has received reports of severe complications of
influenza occurring in young infants, school-age children, and adolescents.
Complications have included encephalopathy, seizures, dehydration with
severe hypotension, respiratory failure requiring mechanical ventilation,
and secondary bacterial pneumonia, including necrotizing pneumonia with
community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
Three deaths (an infant aged 20 months with underlying reactive airways
disease, a previously healthy infant aged 22 months, and a previously
healthy child aged 16 years) have been associated with secondary pneumonia
caused by CA-MRSA. Other influenza-related deaths not related to CA-MRSA in
children have occurred. Fatal cases reported to CDC are being investigated
by local and state health authorities. Laboratory testing has confirmed
influenza A virus infection in these fatal cases; antigenic characterization
is pending. The vaccination status of the majority of the deceased children
has not been determined.
Pregnant women. In Texas, 88 pregnant women had laboratory-confirmed
influenza A infections. Symptoms included fever, cough, and profound sinus
tachycardia (i.e., 150-170 beats per minute) that resolved subsequently. One
patient required intensive care for bilateral pneumonia and myocarditis. Of
the 88 patients, two (2.3%) had been vaccinated 2 and 10 days before
admission, respectively. No influenza-associated maternal deaths occurred;
one case of fetal loss occurred but was not attributed to maternal influenza
infection. The majority of the 88 cases were associated with influenza A
infection; however, influenza B viruses also were detected. . . .
Editorial Note:
Influenza seasons can vary substantially in terms of timing and pattern of
onset, peaking, decline, and overall severity. In the United States, the
2003-04 influenza season began unusually early, with community activity
first reported in early October, followed by continued spread of influenza
activity during the weeks ending October 4-December 6. National activity
levels have not yet peaked, and neither the duration of activity nor the
season's eventual magnitude is known. As of December 6, influenza A (H3N2)
viruses predominated in the United States, but different influenza viruses
might predominate later in the season. Influenza seasons dominated by A
(H3N2) viruses (e.g., those in 1996-97, 1997-98, and 1998-99) typically are
associated with high levels of severe illness and deaths. No evidence exists
to indicate that the A/Fujian-like viruses in circulation are more virulent
than other influenza A (H3N2) viruses. However, reports of severe pediatric
illnesses and deaths underscore the severe consequences that influenza
infections can cause in children.
Cases of sudden death associated with influenza in previously healthy
children also were reported in the United States during the 2002-03 season
(CDC unpublished data, 2003). Although the pathophysiology of sudden deaths
associated with influenza in children is unknown, atypical symptoms (e.g.,
abdominal pain, absence of fever, and mild respiratory symptoms) have been
reported.
Encephalopathy is another severe and potentially under-recognized
complication of influenza in children. One case so far this season has
resulted in the death of a patient (CDC, unpublished data, 2003). Patients
might report high fevers, seizures, headaches, abnormal mental status,
and/or confusion and do not always exhibit classic influenza symptoms. Cases
have been reported among young children and school-aged children, including
adolescents. Suspected cases should be reported to CDC at telephone, (404)
639-0277 or (404) 639-2893; fax, (404) 639-3866; or e-mail,
tmu0@cdc.gov or
nib9@cdc.gov
Although secondary bacterial pneumonia is a common complication of influenza
infection, S. aureus typically occurs in a minority of such cases. Clinical
and laboratory features of S. aureus pneumonia are similar to other types of
community-acquired pneumonia. Clinicians should be aware that CA-RSA can be
a cause of community-acquired pneumonia. Treatment for pneumonia after
influenza infection should be guided by bacterial culture results when
possible. Aspirin and other salicylate-containing medications should not be
administered to children with fever and respiratory illness.
Pregnant women are at higher risk than nonpregnant women for having
complications secondary to influenza. Pregnant women who will be in their
second or third trimester during influenza season should be vaccinated
against influenza.
CDC Recommendations To Prevent Influenza
Vaccination
- Emphasis should be placed on targeting
trivalent inactivated vaccine to persons at high risk for complications
from influenza: healthy children aged 6–23 months, adults aged 65 years
and older, pregnant women in their second or third trimester during
influenza season, and persons aged 2 years and older with underlying
chronic conditions.
- Persons at high risk should be encouraged
to search locally for vaccine if their usual health-care provider no
longer has vaccine available.
- All children at high risk, including those
aged 6–23 months, who report for vaccination should be vaccinated with a
first or second dose, depending on vaccination status. Doses should not be
held in reserve to ensure that two doses will be available.
- Next priority should be given to
vaccinating those persons at greatest risk for transmission of disease to
persons at high risk, including household contacts and health-care
workers.
- Healthy persons aged 5–49 years should be
encouraged to be vaccinated with intranasally administered live,
attenuated influenza vaccine.
- Decisions about vaccinating healthy
persons, including adults aged 50–64 years, with inactivated influenza
vaccine should be made on a case-by-case basis, depending on local disease
activity, vaccine coverage, feasibility, and supply.
- Health departments should work with their
health-care providers to reallocate influenza vaccine to health-care
providers in need when possible.
Hygiene
- Good respiratory hygiene should be
encouraged, including cleaning of hands, and staying at home when
symptomatic with fever and respiratory illness.
Medication
- Antiviral medications with specific
activity against influenza A viruses should be considered either for
treatment or chemoprophylaxis for influenza A, especially in persons
at high risk for complications from influenza.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a1.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5249.pdf
Receive a FREE electronic subscription to MMWR (which includes new ACIP
statements) by going to
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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December 15, 2003
STANDARDS FOR ADULT IMMUNIZATION PRACTICES AND CHILD AND ADOLESCENT
IMMUNIZATION PRACTICES BOTH AVAILABLE IN JOURNAL-ARTICLE FORMAT
Published in the August 2003 issue of the "American Journal of
Preventive Medicine," the article "Standards for Adult Immunization
Practices" is available in PDF format on the Centers for Disease
Control and Prevention (CDC) website at
http://www.cdc.gov/nip/recs/rev_stds_adult_AJPM.pdf
Published in the October 2003 issue of "Pediatrics," the article
"Standards for Child and Adolescent Immunization Practices" is
available in PDF format on the "Pediatrics" website. Click
here to view the article.
To access both standards from the CDC
website, as well as explanatory information about them, go to:
http://www.cdc.gov/nip/recs/rev-immz-stds.htm
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December 15, 2003
CDC REQUESTS INFORMATION ABOUT ACUTE ENCEPHALOPATHY ASSOCIATED WITH
INFLUENZA VIRUS INFECTION IN U.S. CHILDREN
The Centers for Disease Control and Prevention (CDC) published "Notice
to Readers: Request for Information About Acute Encephalopathy
Associated with Influenza Virus Infection in U.S. Children" in the
December 12 issue of "Morbidity and Mortality Weekly Report" (MMWR).
The notice is reprinted below in its entirety, excluding references.
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Since the mid-1990s, several hundred cases of acute encephalopathy
have been reported in Japanese children with influenza virus
infection. These cases have been characterized by fever and rapid
onset of encephalopathy, resulting in a high frequency of neurologic
sequelae and mortality. The majority of the children have had
laboratory-confirmed evidence of influenza.
Reports of influenza-associated encephalopathy have been uncommon in
the United States. To determine if a similar pattern is occurring in
the United States, CDC is requesting information on any case meeting
certain criteria. The criteria include a person aged less than 18
years with altered mental status or personality change lasting more
than 24 hours and occurring within 5 days of onset of an acute febrile
respiratory illness, laboratory or rapid diagnostic test evidence of
acute influenza virus infection associated with the respiratory
illness, and diagnosis of the condition in the United States. Cases
meeting these criteria should be reported to CDC [telephone, (404)
639-0277 or (404) 639-2893; fax, (404) 639-3866; or e-mail,
tmu0@cdc.gov or
nib9@cdc.gov].
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5249a5.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5249.pdf
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December 15, 2003
MEASLES IMMUNIZATION CAMPAIGNS IN IRAN AND TURKEY TO REACH 53 MILLION
CHILDREN AND YOUNG PEOPLE
On December 9, UNICEF issued a press release announcing that Iran and
Turkey have launched the largest, most ambitious measles campaigns in
the world. The campaigns are expected to reach a combined total of 53
million children and young people within the next year. In addition,
Iran will also introduce the rubella vaccine as a part of its
immunization schedule for the first time.
To access the press release from the UNICEF website, go to:
http://www.unicef.org/media/media_18172.html
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December 15, 2003
IOM MEETING ON VACCINES AND AUTISM SET FOR FEBRUARY 9, 2004
On February 9, 2004, the Immunization Safety Review Committee of the
Institute of Medicine (IOM) will hold an information-gathering meeting
on the topic Vaccines and Autism. The registration deadline is
February 2, 2004. The committee is seeking input on the topic; the
deadline for submitting input is January 16, 2004.
For information about the meeting and to register online, go to:
http://www.iom.edu/event.asp?id=17047
For additional information or to submit input, contact Amy Grossman at
(202) 334-1361 or (202) 334-1342.
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