Issue
Number 443
February 9, 2004
CONTENTS OF THIS ISSUE
- Employment opportunity available at IAC in St. Paul, MN
- CDC Health Advisory includes interim recommendations regarding
influenza A (H5N1) and SARS
- New: 8th edition of "Epidemiology and Prevention of
Vaccine-Preventable Diseases" (the "Pink Book") now available
- Kids with hepatitis can go to camp!
- Minnesota Coalition for Adult Immunization conference set for
March 19
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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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February 9, 2004
EMPLOYMENT OPPORTUNITY AVAILABLE AT IAC IN ST. PAUL, MN
IAC is looking for a full-time administrative assistant to join its crew of
a dozen talented, friendly, dedicated people. If you live in the Twin Cities
and have administrative assistant skills (or know of someone who does),
check out our job description and application instructions on our website at
http://www.immunize.org/admin/jobopp6.htm
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February 9, 2004
CDC HEALTH ADVISORY INCLUDES INTERIM RECOMMENDATIONS REGARDING INFLUENZA A
(H5N1) AND SARS
On February 3, CDC issued an official health advisory, "Update on Influenza
A (H5N1) and SARS: Interim Recommendations for Enhanced U.S. Surveillance,
Testing, and Infection Control." The advisory is reprinted below in its
entirety.
**************************
This is an official CDC Health Advisory
Distributed via Health Alert Network
February 3, 2004 (9:00 AM EST)
UPDATE ON INFLUENZA A (H5N1) AND SARS: INTERIM RECOMMENDATIONS FOR ENHANCED
U.S. SURVEILLANCE, TESTING, AND INFECTION CONTROL
RECENT DEVELOPMENTS
Influenza A (H5N1) Virus Infections
Infections of H5N1 among poultry have been confirmed in Cambodia, China,
Hong Kong SAR [Special Administrative Region of China], Indonesia, Japan,
Korea, Laos, Thailand, and Vietnam (for a continually updated listing of
affected countries, visit the Web site of the World Organization of Animal
Health [OIE] at
http://www.oie.int/eng/en_index.htm).
Human cases of influenza A (H5N1) infection have occurred in Vietnam and
Thailand. On February 1, 2004, the World Health Organization (WHO) reported
that laboratory test results had confirmed two new cases of human H5N1
infection in Vietnam; both patients died. The cases were in two sisters who
are part of a cluster of four cases of severe respiratory illness in a
single family. A detailed investigation of this cluster is under way;
LIMITED HUMAN-TO-HUMAN TRANSMISSION MAY BE ONE POSSIBLE EXPLANATION, BUT
DIRECT POULTRY-TO-HUMAN TRANSMISSION CANNOT BE RULED OUT, ACCORDING TO WHO.
To date, 10 laboratory-confirmed cases of H5N1 infection have been reported
in patients in Vietnam, 8 of whom died. In Thailand, cases of H5N1 infection
have been confirmed in 4 persons, 3 of whom died. Laboratory results on
additional possible cases are pending. (For updated information, visit the
WHO Web site at http://www.who.int/en).
With the exception of the family cluster in Vietnam, it is believed that all
human H5N1 cases resulted from contact with infected birds or surfaces
contaminated with excretions from infected birds. At this time, there is no
evidence of efficient person-to-person transmission in Vietnam or elsewhere.
Genetic sequencing of H5N1 viruses from human cases in Vietnam indicates
that all genes are of avian origin. (The acquisition of human influenza
viral genes increases the likelihood that a virus of avian origin can be
readily transmitted from person-to-person.) Genetic sequencing of human H5N1
isolates from Vietnam additionally showed characteristics commonly known to
confer antiviral resistance to amantadine and rimantadine, two antiviral
drugs used for influenza. The remaining two antivirals (oseltamivir and
zanamivir) should still be effective.
Severe Acute Respiratory Syndrome
On January 31, 2004, WHO announced that a new case of laboratory-confirmed
infection with SARS-associated coronavirus (SARS-CoV) had been reported in
China. This is the fourth SARS case (three confirmed, one probable) reported
in China since December 16, 2003.
The most recent case occurred in a 40-year-old director of a hospital and
practicing physician in Guangzhou, Guangdong Province, China. He became ill
with SARS-like symptoms on January 7, 2004, and was admitted to a hospital
with pneumonia on January 16 and placed in isolation. Previously reported
confirmed cases include a 20-year-old woman who worked in a restaurant in
Guangdong Province and became ill on December 25, 2003, and a 32-year-old
man in Guangdong Province who had become ill on December 16, 2003. A fourth
person (probable case)–-a 35-year-old business man from the Guangdong
Province who had onset of illness on December 31, 2003--tested positive for
SARS-CoV infection at a national reference laboratory in China and on
preliminary serologic tests performed by WHO SARS International Reference
and Verification Network laboratories in Hong Kong.
All four patients have recovered from their illness and have been discharged
from the hospital. To date, none of the contacts of these cases has
developed a SARS-like illness. The source of infection in these individuals
has not been determined. Samples collected from cages that housed civets at
the restaurant where the waitress with confirmed SARS worked have tested
positive for traces of SARS-CoV, suggesting a possible source of infection.
However, evidence that civets transmit SARS-CoV to humans remains
inconclusive.
INTERIM RECOMMENDATIONS: ENHANCED U.S. SURVEILLANCE AND DIAGNOSTIC
EVALUATION
CDC recommends enhanced surveillance efforts by state and local health
departments, hospitals, and clinicians to identify patients at increased
risk for influenza A (H5N1) and SARS. The clinical presentation and travel
history of persons with influenza A (H5N1) or SARS-CoV infection may
overlap. Interim recommendations for diagnostic evaluation for these agents
in individuals who meet certain epidemiologic and clinical criteria follow
below.
Influenza A (H5N1) Virus Infections
Testing for influenza A (H5N1) is indicated for HOSPITALIZED patients with:
- radiographically confirmed pneumonia,
acute respiratory distress syndrome (ARDS), or other severe respiratory
illness for which an alternate diagnosis has not been established, AND
- history of travel within 10 days of
symptom onset to a country with documented H5N1 avian influenza in poultry
and/or humans (for a listing of H5N1-affected countries, see the OIE
Web site at
http://www.oie.int/eng/en_index.htm and the WHO Web site at
http://www.who.int/en).
Testing for influenza A (H5N1) should be
considered on a case-by-case basis in consultation with state and local
health departments for HOSPITALIZED OR AMBULATORY patients with:
- documented temperature of >38 degrees C
(>100.4 degrees F), AND
- one or more of the following: cough,
sore throat, shortness of breath, AND
- history of contact with domestic poultry
(e.g., visited a poultry farm, household raising poultry, or bird
market) or a known or suspected human case of influenza A (H5N1) in an
H5N1-affected country within 10 days of symptom onset.
Severe Acute Respiratory Syndrome
CDC continues to recommend consideration of testing for SARS-CoV in patients
who require hospitalization for radiographically confirmed pneumonia or ARDS
without identifiable etiology AND who have one of the following risk factors
in the 10 days before the onset of illness:
- Travel to mainland China, Hong Kong,
or Taiwan, or close contact with an ill person with a history of
recent travel to one of these areas, OR
- Employment in an occupation associated
with a risk for SARS-CoV exposure (e.g., health care worker with
direct patient contact; worker in a laboratory that contains live
SARS-CoV), OR
- Part of a cluster of cases of atypical
pneumonia without an alternative diagnosis.
For patients with pneumonia or ARDS who have
recently traveled to Guangdong Province, China, diagnostic testing for
SARS-CoV should be performed immediately. For other patients, diagnostic
testing for SARS should proceed for such patients as described in guidelines
at
www.cdc.gov/ncidod/sars/absenceofsars.htm
INTERIM RECOMMENDATIONS: INFECTION CONTROL PRECAUTIONS FOR INFLUENZA A
(H5N1)
All patients who present to a health-care setting with fever and respiratory
symptoms should be managed according to recommendations for Respiratory
Hygiene and Cough Etiquette and questioned regarding their recent travel
history. Isolation precautions identical to those recommended for SARS
should be implemented for all hospitalized patients diagnosed with or under
evaluation for influenza A (H5N1) as follows:
Standard Precautions
- Pay careful attention to hand
hygiene before and after all patient contact.
Contact Precautions
- Use gloves and gown for all
patient contact.
Eye protection
- Wear when within 3 feet of the patient.
Airborne Precautions
-
Place the patient in an airborne isolation room (i.e., monitored
negative air pressure in relation to the
surrounding areas with 6 to 12 air changes per hour).
-
Use a fit-tested respirator, at least as protective as a NIOSH-approved
N-95 filtering face piece respirator, when entering the room.
For additional information regarding these and other health-care
isolation precautions, see the Guidelines for Isolation
Precautions in Hospitals. These precautions should be continued
for 14 days after onset of symptoms until an alternative
diagnosis is established or until diagnostic test results
indicate that the patient is not infected with influenza A virus
(see Laboratory Testing Procedures below). Patients managed as
outpatients or hospitalized patients discharged before 14 days
should be isolated in the home setting on the basis of
principles outlined for the home isolation of SARS patients (see
http://www.cdc.gov/ncidod/sars/guidance/i/pdf/i.pdf).
LABORATORY TESTING PROCEDURES
Highly pathogenic avian influenza A (H5N1) is classified as a
select agent and must be worked with under Biosafety Level (BSL)
3+ laboratory conditions. This includes controlled access double
door entry with change room and shower, use of respirators,
decontamination of all wastes, and showering out of all
personnel. Laboratories working on these viruses must be
certified by the U.S. Department of Agriculture. The same BSL 3+
laboratory guidelines are recommended for conducting virus
isolation for SARS-CoV. CDC does NOT RECOMMEND that virus
isolation studies on respiratory specimens from patients who
meet the above criteria be conducted unless stringent BSL 3+
conditions can be met. Therefore, respiratory virus cultures
should not be performed in most clinical laboratories and such
cultures should not be ordered for patients suspected of having
H5N1 infection.
Clinical specimens from suspect A (H5N1) cases and SARS-CoV
cases may be tested by PCR assays using standard BSL 2 work
practices in a Class II biological safety cabinet. In addition,
commercial antigen detection testing can be conducted under
BSL 2 levels to test for influenza.
To assist public health public health laboratories with SARS and
respiratory illness diagnostic preparedness efforts, CDC has
developed real-time PCR protocols for a number of respiratory
pathogens, including influenza A and B viruses, adenovirus,
metapneumovirus, Legionella, Chlamydia pneumoniae, and
Mycoplasma pneumoniae. THESE PROTOCOLS ARE CURRENTLY AVAILABLE
ONLY TO PUBLIC HEALTH LABORATORIES AND HAVE BEEN POSTED AT THE
APHL MEMBERS ONLY (PASSWORD REQUIRED) WEB SITE
www.aphl.org/Members_Only/index.cfm, UNDER SARS. THESE PROTOCOLS
ARE NOT AVAILABLE IN ALL PUBLIC HEALTH LABORATORIES, AND
PHYSICIANS SHOULD CONSULT WITH THEIR LOCAL PUBLIC HEALTH
LABORATORY WHEN ORDERING THESE TESTS.
SPECIMENS FROM PERSONS MEETING THE ABOVE CLINICAL AND
EPIDEMIOLOGIC CRITERIA SHOULD BE SENT TO CDC IF
-
The specimen tests positive for influenza A by PCR
[polymerase chain reaction] or by antigen detection
testing, OR
-
PCR assays for influenza or SARS-CoV are not available at the
state public health laboratory.
Because the sensitivity of commercially available rapid
diagnostic tests for influenza may not always be optimal, CDC
also will accept specimens from persons meeting the above
clinical criteria even if they test negative by influenza rapid
diagnostic testing if PCR assays are not available at the state
laboratory.
Requests for testing should come through the state and local
health departments, which should contact the CDC Director's
Emergency Operations Center at (770) 488-7100 before sending
specimens for influenza A (H5N1) or SARS testing.
MORE INFORMATION
For further details about the reported cases of influenza
A (H5N1) in Asia, see the WHO Web site
http://www.who.int/en
Additional information about influenza is available on the CDC
Web site at www.cdc.gov/flu
For more information about current U.S. SARS control guidelines,
see the CDC document, "In the Absence of SARS-CoV Transmission
Worldwide: Guidance for Surveillance, Clinical and Laboratory
Evaluation, and Reporting" at
www.cdc.gov/ncidod/sars/absenceofsars.htm The document is part
of CDC's draft Public Health Guidance for Community-Level
Preparedness and Response to Severe Acute Respiratory Syndrome
(SARS)
www.cdc.gov/ncidod/sars/sarsprepplan.htm
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To access this health advisory, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00185
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February 9, 2004
NEW: 8TH EDITION OF "EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES" (THE "PINK BOOK") NOW AVAILABLE
The 8th edition of "Epidemiology and Prevention of Vaccine-Preventable Diseases," widely known as the "Pink Book," is now
available in print for purchase and online for free downloading.
A comprehensive source of current epidemiologic data and vaccine
recommendations, the 8th edition includes a new chapter on
meningococcal disease.
The cost of the "Pink Book" is $29 plus shipping and handling.
To order a copy, choose one of the following methods: call
(877) 252-1200 or (800) 418-7246 between 9:00 am and 5:00 pm ET;
send a fax order with credit card or purchase order information
to (301) 843-0159; or visit the Public Health Foundation (PHF)
bookstore at: http://bookstore.phf.org/prod171.htm
To print a ready-to-copy (PDF) format of the entire "Pink Book"
or selected chapters, go to:
http://www.cdc.gov/nip/publications/pink/default.htm
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February 9, 2004
KIDS WITH HEPATITIS CAN GO TO CAMP!
Children with hepatitis B or C will have a chance to attend camp
this summer at two of the top U.S. medical camps, thanks to the
national nonprofit organization PKIDs (Parents of Kids with
Infectious Diseases) and Paul Newman's Association of Hole In
The Wall Gang Camps.
PKIDs, which supports families touched by viral hepatitis and
HIV/AIDS, has acquired a number of slots for children with
chronic hepatitis B or C at camps in upstate New York (Double
"H" Hole in the Woods Ranch in Lake Luzerne) and Florida (Boggy
Creek Gang Camp in Eustis). The camps specialize in providing a
fun, traditional summer camp experience for children and teens
with medical needs.
Children must be between the ages of 6 and 16 and must be
receiving medical treatment of any kind. PKIDs and the camps
will pay travel and camp costs for qualified children--the
families pay nothing. Any parent, caretaker, physician, or
health care worker interested in sending a child to either camp
should contact PKIDs for an application at
pkids@pkids.org
(email) or (877) 557-5437. Completed applications are due at the
PKIDs' office by March 31. PKIDs is also seeking donations to
help pay the costs of sending children to the two camps. If you
are interested in sponsoring a child at camp, please email or
call PKIDs at the email address or phone number above.
For more information, call PKIDs at (360) 695-0293 or go to
http://www.pkids.org
To visit the website of the Double "H" Hole in the Woods Ranch,
go to: http://www.doublehranch.org
To visit the website of the Boggy Creek Gang Camp, go to:
http://www.boggycreek.org
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February 9, 2004
MINNESOTA COALITION FOR ADULT IMMUNIZATION CONFERENCE SET FOR
MARCH 19
The Minnesota Coalition for Adult Immunization will hold its
13th annual conference on March 19 in Bloomington, MN. Titled
"Issues and Strategies in Adult Vaccine Preventable Diseases,"
the conference is intended for health care providers committed
to preventing influenza, pneumococcal disease, and other
vaccine-preventable diseases.
For comprehensive conference information, including the
conference agenda and registration information, go to:
http://www.vaccinateadult.org
For additional information, call Chere Wood at
cwood@mnqio.sdps.org or (952) 853-8558. |
