Issue
Number 437
January 20, 2004
CONTENTS OF THIS ISSUE
- CDC, AAP, and AAFP publish "Recommended
Childhood and Adolescent Immunization Schedule--United States,
January-June 2004"
- New: Freeware puts 2004 childhood immunization
schedule in the palm of your hand
- CDC issues an update of U.S. influenza activity
for January 4-10
- CDC reports on a preliminary assessment of the
effectiveness of the 2003-04 inactivated influenza vaccine
- CDC updates its influenza web section with
interim guidance for schools and other school-related resources
- 1st International Neonatal Vaccination Workshop
scheduled for March 2-4 in McLean, VA
- International Conference on Emerging and
Infectious Diseases to be held in Atlanta February 29-March 3
- New: Japanese Encephalitis Project at PATH adds
links to resources to its website
- IOM meeting on vaccines and autism scheduled for
February 9
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ABBREVIATIONS: AAP, American Academy of
Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers
for Disease Control and Prevention; FDA, Food and Drug Administration; IAC,
Immunization Action Coalition; MMWR Morbidity and Mortality Weekly Report;
NIP, National Immunization Program; VIS, Vaccine Information Statement; WHO,
World Health Organization.
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January 20, 2004
CDC, AAP, and AAFP PUBLISH "RECOMMENDED CHILDHOOD AND ADOLESCENT
IMMUNIZATION SCHEDULE--UNITED STATES, JANUARY-JUNE 2004"
CDC, AAP, and the American Academy of Family Physicians (AAFP) published
"Recommended Childhood and Adolescent Immunization Schedule--United States,
January-June 2004." The schedule appears in the January 16 issue of the "MMWR
QuickGuide," the January issue of "Pediatrics," an AAP journal, and the
January issue of "American Family Physician," an AAFP journal. The schedule
was approved by ACIP, AAP, and AAFP.
As was the case in 2003, the 2004 schedule includes a catch-up schedule for
children who fall behind or start their immunizations late. In addition,
this year, a mid-year schedule will be released describing new additional
recommendations.
MMWR prefaced the 2004 schedule with several introductory paragraphs; AAP
accompanied the schedule with a policy statement, and AAFP with practice
guidelines. Immediately following is the MMWR preface, reprinted in its
entirety with the exception of references. Links to the AAP policy statement
and the AAFP practice guidelines appear at the end of this article.
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Each year, CDC's Advisory Committee on Immunization Practices (ACIP) reviews
the recommended childhood and adolescent immunization schedule to ensure
that it is current with changes in manufacturers' vaccine formulations and
reflects revised recommendations for the use of licensed vaccines, including
those newly licensed. The recommended childhood and adolescent immunization
schedule for January-June 2004, recommendations, and format have been
approved by ACIP, the American Academy of Family Physicians, and the
American Academy of Pediatrics.
Catch-Up Childhood and Adolescent Immunization Schedule
A catch-up
immunization schedule for children and adolescents who start late or who are
>1 month behind was introduced in 2003 and remains the same. Minimum ages
and minimum intervals between doses are provided for each of the routinely
recommended childhood and adolescent vaccines. The schedule is divided into
two age groups: children aged 4 months-6 years and children/adolescents aged
7-18 years.
Hepatitis B Vaccine
The schedule indicates a change in the recommendation for the minimum age
for the last dose in the hepatitis B vaccination schedule. The last dose in
the vaccination series should not be administered before age 24 weeks
(updating the previous recommendation not to administer the last dose before
age 6 months).
Adolescent Tetanus and Diphtheria Toxoids (Td) Vaccine
The range of recommended ages for the adolescent Td vaccine dose has been
updated to emphasize a preference for vaccinating at ages 11-12 years with
ages 13-18 years to serve as a catch-up interval.
Clarification Regarding Certain Final Doses
Clarification was added to the footnotes regarding the timing of the final
vaccine doses in the series for diphtheria and tetanus toxoids and acellular
pertussis (DTaP) vaccine, Haemophilus influenzae type b (Hib) conjugate
vaccine, and pneumococcal conjugate vaccine (PCV). The final dose in the
DTaP series should be given at age >=4 years. The final doses in the Hib and
PCV series should be given at age >=12 months.
Influenza Vaccine
Healthy children aged 6-23 months are encouraged to receive influenza
vaccine when feasible during the 2003-2004 influenza season. Children in
this age group are at substantially increased risk for influenza-related
hospitalizations. ACIP has indicated further that beginning in fall 2004,
children aged 6-23 months will be recommended to receive annual influenza
vaccine. An updated childhood and adolescent immunization schedule for
July-December 2004 will be released to reflect this change.
An intranasally administered, live, attenuated influenza vaccine (LAIV) was
approved for use in the United States in June 2003. For healthy persons aged
5-49 years, LAIV is an acceptable alternative to the intramuscular trivalent
inactivated influenza vaccine (TIV).
Vaccine Information Statements
The National Childhood Vaccine Injury Act requires that all health-care
providers give parents or patients copies of Vaccine Information Statements
before administering each dose of the vaccines listed in the schedule.
Additional information is available from state health departments and at
http://www.cdc.gov/nip/publications/vis Detailed recommendations for
using vaccines are available from the manufacturers' package inserts, ACIP
statements on specific vaccines, and the 2003 Red Book. ACIP statements for
each recommended childhood vaccine can be viewed, downloaded, and printed
from CDC's National Immunization Program website at
http://www.cdc.gov/nip/publications/acip-list.htm Instructions on
the use of the Vaccine Information Statements are available at
http://www.cdc.gov/nip/publications/vis/vis-instructions.pdf In
addition, guidance on how to obtain and complete a Vaccine Adverse Event
Reporting System (VAERS) form is available at
http://www.vaers.org or by telephone,
(800) 822-7967.
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To access a web-text (HTML) version of this "MMWR QuickGuide" article, go
to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5301-Immunizationa1.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5301.pdf
Receive a FREE electronic subscription to MMWR (which includes new ACIP
statements) by going to
http://www.cdc.gov/mmwr/mmwrsubscribe.html
To access a ready-to-copy (PDF) version of the 2004 schedule and catch-up
schedule from the CDC website, go to:
http://www.cdc.gov/nip/recs/child-schedule.htm#Printable and select
the format you want.
To access the AAP policy statement, go to:
http://pediatrics.aappublications.org/cgi/content/full/113/1/142
To access the AAFP practice guidelines, which includes a link to the 2004
schedule, go to:
http://www.aafp.org/afp/20040101/practice.html
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January 20, 2004
NEW: FREEWARE PUTS 2004 CHILDHOOD IMMUNIZATION SCHEDULE IN THE PALM OF YOUR
HAND
"Shots 2004" is a quick, portable reference guide to the newly released
"Recommended Childhood and Adolescent Immunization Schedule--United States,
January-June 2004." Produced by the Group on Immunization Education of the
Society of Teachers of Family Medicine (STFM), this freeware for the Palm OS
3.1 provides detailed information on vaccines. All you have to do is click
on them by name.
The program requires Palm OS 3.1 or higher and approximately 379KB of
memory. It runs on color and non-color handhelds.
To download "Shots 2004," go to:
http://www.immunizationed.org/anypage.aspx?pagename=shotspalm
For more information, contact STFM by email at
gieweb@pitt.edu
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January 20, 2004
CDC ISSUES AN UPDATE OF U.S. INFLUENZA ACTIVITY FOR JANUARY 4-10
The CDC published "Update: Influenza Activity--United States, January 4-10,
2004" in the January 16 issue of MMWR. Portions of it are reprinted below.
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The number of states reporting widespread influenza activity continued to
decrease during the reporting week of January 4-10, 2004. Health departments
in 20 states and New York City reported widespread influenza activity. A
total of 24 states reported regional activity, three states reported local
activity, and sporadic activity was reported by two states, the District of
Columbia, Guam, and Puerto Rico. The percentage of outpatient visits for
influenza-like illness (ILI) continued to decrease in all surveillance
regions during the week ending January 10, with an overall national
percentage of 2.8%. This percentage is above the national baseline of 2.5%.
The percentage of specimens testing positive for influenza also decreased;
however, the percentage of deaths attributed to pneumonia and influenza
(P&I) continued to increase. . . .
Antigenic Characterization
Of the 518 influenza viruses collected by U.S. laboratories since October 1,
2003, and characterized antigenically by CDC, 511 were influenza A (H3N2)
viruses, two were influenza A (H1) viruses, and five were influenza B
viruses. The hemagglutinin proteins of the influenza A (H1) viruses were
similar antigenically to the hemagglutinin of the vaccine strain A/New
Caledonia/20/99. Of the 511 influenza A (H3N2) isolates that have been
characterized, 98 (19.2%) were similar antigenically to the vaccine strain
A/Panama/2007/99 (H3N2), and 413 (80.8%) were similar to a drift variant, A/Fujian/411/2002
(H3N2). Four influenza B viruses characterized were similar antigenically to
B/Sichuan/379/99, and one was similar antigenically to B/Hong Kong/330/2001.
P&I Mortality Surveillance
During the week ending January 10, P&I accounted for 10.2% of all deaths
reported through the 122 Cities Mortality Reporting System. This percentage
is again above the epidemic threshold of 8.1% for that reporting week. . . .
Weekly updates on influenza activity will be published in MMWR during the
influenza season. Additional information about influenza activity is
available from CDC at
http://www.cdc.gov/flu
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5301a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5301.pdf
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January 20, 2004
CDC REPORTS ON A PRELIMINARY ASSESSMENT OF THE EFFECTIVENESS OF THE 2003-04
INACTIVATED INFLUENZA VACCINE
The CDC published "Preliminary Assessment of the Effectiveness of the
2003-04 Inactivated Influenza Vaccine--Colorado, December 2003" in the
January 16 issue of MMWR. The MMWR article's editorial note is reprinted
below. In addition, links to a series of questions and answers about the
MMWR article and to a fact sheet about it are given at the end of this
article.
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Editorial Note:
The preliminary findings presented in this report demonstrated no or very
low effectiveness of TIV against ILI. However, these findings do not provide
a basis for assessing the effectiveness of TIV against more severe illness
outcomes or against influenza B or influenza A (H1N1), nor do they assess
the effectiveness of live attenuated influenza vaccine (LAIV). Despite a
suboptimal antigenic match, TIV can still provide protection against
influenza complications. In a study conducted among patients aged >=65
years, TIV was effective in preventing 61% of influenza-related deaths when
the vaccine and circulating strains were well matched and 35% when they were
not well matched.
Estimates of vaccine effectiveness generally are lower against ILI than
against laboratory-confirmed influenza. During the 1998-99 season, when the
vaccine and circulating strains were well matched, TIV effectiveness among
healthy adults was 86% against laboratory-confirmed influenza and 34%
against ILI; during the 1997-98 season, when the vaccine and circulating
strains were not well matched, TIV effectiveness was 50% against
laboratory-confirmed influenza and zero against ILI. Further studies are
under way or planned to estimate the effectiveness of the 2003-04 influenza
vaccine against laboratory-confirmed influenza and influenza-related
complications. The person-time analysis
included all persons in the cohort regardless of when they were vaccinated.
These estimates probably are more precise than those obtained in the
categorical analysis. Some negative effectiveness estimates (i.e., estimates
lower than zero) were obtained in this analysis; because vaccine
effectiveness cannot be lower than zero, such estimates should be considered
zero. These results suggest that the study had unknown or uncorrected
disparities between the vaccinated and unvaccinated groups in terms of risk
for disease or other factors.
The findings in this report are subject to at least five limitations. First,
study participants were not selected at random to receive influenza
vaccination, and persons with greater patient exposure and possibly greater
exposure to influenza viruses were more likely to be vaccinated. Second, a
greater percentage of persons aged >=50 years and persons with one or more
conditions associated with increased risk for influenza-related
complications were vaccinated. Third, other biases, including participation
in the study and reporting illness based on vaccination, might have
occurred. Such biases and other differences between the vaccinated and
unvaccinated groups are very likely to have occurred, given the disparities
noted. For example, persons who were vaccinated and became ill might have
been more likely to complete the questionnaire, biasing the study to
indicate lower effectiveness. Fourth, influenza vaccination and illnesses
were self-reported. Finally, the sample size might not have been large
enough to detect vaccine effectiveness against ILI, particularly because a
large proportion of the respondents were vaccinated. Many of these
limitations can be avoided by using a prospective cohort study design with
laboratory-confirmed disease as an outcome. Conducting annual prospective
studies would provide consistent and comparable vaccine effectiveness data
to assist with public health decision making.
This study does not provide data that permits an assessment of the
effectiveness of TIV against laboratory-confirmed influenza and its
complications. Additional studies to provide such data are under way.
Because TIV was effective against laboratory-confirmed influenza and
influenza-related complications in previous years in which it was not
effective against ILI, and because influenza B and influenza A (H1N1)
viruses might cause serious illness later this season, influenza vaccine
continues to be recommended for persons at increased risk for
influenza-related complications, their household contacts, and health-care
personnel.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5301a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5301.pdf
To access "Questions and Answers about the Colorado Healthcare Workers Study
of the Effectiveness of the Inactivated Influenza Vaccine Against
Influenza-like Illness" from the CDC website, go to:
http://www.cdc.gov/flu/about/qa/fluseason.htm#effectiveness
To access a fact sheet on the Influenza Vaccine Effectiveness Studies from
the CDC website, go to:
http://www.cdc.gov/od/oc/media/pressrel/fs040115.htm
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January 20, 2004
CDC UPDATES ITS INFLUENZA WEB SECTION WITH INTERIM GUIDANCE FOR SCHOOLS AND
OTHER SCHOOL-RELATED RESOURCES
On January 12, CDC added "Stop the Spread of Germs: Actions for Schools" to
its influenza web section. School resources include the following:
To access additional materials for
schools--including the "Be a Germ Stopper" poster and "It's a SNAP"
absenteeism-reduction toolkit--go to:
http://www.cdc.gov/flu/school
To access an array of influenza information for the public and health
professionals, go to:
http://www.cdc.gov/flu
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January 20, 2004
1ST INTERNATIONAL NEONATAL VACCINATION WORKSHOP SCHEDULED FOR MARCH 2-4 IN
MCLEAN, VA
The U.S. Department of Health and Human Services (DHHS) is sponsoring the
1st International Neonatal Vaccination Workshop. It will be held on March
2-4 at the Hilton McLean Tysons Corner Hotel in McLean, VA. The
pre-registration deadline is February 13.
The workshop will explore the feasibility and safety of strategies to
protect neonates from a variety of bacterial, viral, and parasitic agents.
Sessions will focus on the science of neonatal vaccination and will cover
the following: immune responses of the neonate to vaccine antigens,
clinical experience with vaccines administered to neonates, the industry
and regulatory perspectives on the expanded use of vaccines in the
neonate, and alternative strategies to protect neonates, such as maternal
immunization.
The workshop is coordinated by the National Vaccine Advisory Committee's
Future Vaccines Subcommittee, CDC, FDA, the National Institutes of Health,
and the Task Force for Child Survival and Development (TFCSD). It is
supported by a grant from the DHHS National Vaccine Program Office.
For comprehensive information about the workshop, including registration
information, go to:
http://www.cdc.gov/nip/events/neonatal_wkshop
For additional information, email
neonatal@cdc.gov or call Beverly Fowler at TFCSD at (404)
592-1425.
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January 20, 2004
INTERNATIONAL CONFERENCE ON EMERGING AND INFECTIOUS DISEASES TO BE HELD IN
ATLANTA FEBRUARY 29-MARCH 3
Scheduled for February 29-March 3 in Atlanta, the International Conference
on Emerging Infectious Diseases will bring together health professionals
in an exchange of scientific and public health information on global
emerging infections. Major topics include current work on surveillance,
epidemiology, research, communication and training, bioterrorism, and
prevention and control of emerging infectious diseases, in the United
States and abroad.
For a comprehensive overview of the conference, including registration and
program information, go to:
http://www.iceid.org
For additional information, contact the American Society for Microbiology
by phone at (202) 942-9330 or by email at
iceid@asmusa.org
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January 20, 2004
NEW: JAPANESE ENCEPHALITIS PROJECT AT PATH ADDS LINKS TO RESOURCES TO ITS
WEBSITE
The Japanese Encephalitis Project at PATH (Program for Appropriate
Technology in Health) recently announced that its website now offers links
to Japanese Encephalitis resources developed by several organizations,
including CDC and WHO.
To access the section on resources, go to:
http://childrensvaccine.org/html/v_enceph_links.htm
To access an array of information on Japanese Encephalitis, go to:
http://childrensvaccine.org/html/v_enceph_qf.htm The right column
offers links to topics.
A press release issued on December 9, 2003, offers more information about
PATH's Japanese Encephalitis Project. To access it, go to:
http://childrensvaccine.org/html/rel-031209.htm
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January 20, 2004
IOM MEETING ON VACCINES AND AUTISM SCHEDULED FOR FEBRUARY 9
The Immunization Safety Review Committee of the Institute of Medicine
(IOM) will hold a meeting on vaccines and autism on February 9 in
Washington, D.C. The meeting, part of the committee's
information-gathering process, is open to the public. Registration is open
until February 2.
To register online, go to:
http://www4.nationalacademies.org/iom/Registrations.nsf/Register?OpenForm&039
For additional information, call Amy Grossman at (202) 334-1342 or go to:
http://www.iom.edu/event.asp?id=17047 |
