Issue
Number 444
February 16, 2004
CONTENTS OF THIS ISSUE
- CDC, ACIP, and professional associations recommend temporary
suspension of the routine use of the fourth dose of PCV7
- Attention adult medical specialists: The latest issue of
"VACCINATE ADULTS!" is on the Web
- Revised: IAC's "Ask the Experts" compilation is updated with
information from the January 2004 issue of "NEEDLE TIPS"
- Updated: IAC adds to its popular collection of video footage
related to vaccine-preventable diseases
- CDC reports on outbreaks of avian influenza in Asia and on
recommendations for evaluating and reporting suspected cases
- CDC reports on recent cases of influenza A (H5N1) in Thailand
- Plan ahead: Dates for National Adult Immunization Awareness
Week are moved up
- Updated VIS translation: The most current meningococcal VIS is
now available in Spanish on IAC's website
- U.S. military personnel who received smallpox vaccine rarely
transferred vaccinia virus to others
- CDC publishes update of smallpox vaccine adverse events among
U.S. civilians during 2003
- April 16 is the early-bird registration deadline for the
Seventh Annual Conference on Vaccine Research
- Mark your calendar: Vaccination Week in the Americas will be
observed April 24-30
- CDC reports on WHO's updated Global Polio Eradication
Initiative Strategic Plan
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ABBREVIATIONS: AAFP, American Academy of Family Physicians; 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 16, 2004
CDC, ACIP, AND PROFESSIONAL ASSOCIATIONS RECOMMEND TEMPORARY SUSPENSION OF
THE ROUTINE USE OF THE FOURTH DOSE OF PCV7
CDC published "Notice to Readers: Limited Supply of Pneumococcal Conjugate
Vaccine: Suspension of Recommendation for Fourth Dose" in the February 13
issue of MMWR. The article concerns CDC's decision, made in conjunction with
ACIP, AAP, and AAFP, to recommend that health care providers temporarily
suspend routine use of the fourth dose of the pneumococcal conjugate vaccine
(PCV7) in response to a shortage arising from production and supply
problems.
In addition, CDC posted on its NIP website a Q&A series and a press release
about the shortage and released a statement about it through one of its
electronic news services, "Immunization Works!"
The MMWR article is reprinted below in its entirety, excluding references.
**********************
In December 2003, CDC reported that Wyeth Vaccines, the only U.S. supplier
of 7-valent pneumococcal conjugate vaccine (PCV7, marketed as Prevnar), was
experiencing production constraints that could cause delays in shipments and
was implementing an allocation plan to ensure the equitable distribution of
available vaccine. In February 2004, Wyeth advised CDC that production
constraints had not been resolved and that supplies will remain limited at
least through July 2004. Until full production capacity is resumed, local
shortages might occur. Effective immediately, CDC recommends that health
care providers temporarily suspend routine use of the fourth dose of PCV7 to
conserve vaccine and minimize the likelihood of shortages.
PCV7 is a highly effective vaccine. In October 2000, a primary series of
three PCV7 injections and one booster was recommended for all children. In
2001, the incidence of invasive pneumococcal disease among children aged <2
years was 69% less than during 1998-1999, before the recommendation.
Preliminary data from CDC's Active Bacterial Core Surveillance program
indicate that effectiveness, at least for the short term, is not compromised
by delaying administration of the fourth dose. A case-control study
comparing the effectiveness of a 3-dose series with a 4-dose series found
that 3 doses were 90% effective (95% confidence interval [CI] = 74%-96%)
against invasive disease caused by serotypes represented in the vaccine,
whereas 4 doses were 96% effective (95% CI = 68%-100%); this difference was
not statistically significant.
Because precise allocation of PCV7 is difficult, spot shortages are
inevitable when supplies are limited. To ensure that every child can be
protected against pneumococcal disease despite the limited supply, and on
the basis of the short-term effectiveness of the 3-dose primary series of
PCV7 at ages 2, 4, and 6 months, CDC, in consultation with the American
Academy of Family Physicians, the American Academy of Pediatrics, and the
Advisory Committee on Immunization Practices, recommends that all health
care providers, regardless of the amount of PCV7 in their inventories, help
conserve the national PCV7 supply by temporarily discontinuing
administration of the fourth dose of PCV7 for healthy children. Health care
providers should continue to administer the fourth dose to children at
increased risk for severe disease*. Children whose booster dose is deferred
should receive PCV7 on their first visit after supplies are restored. If all
health care providers comply with this temporary recommendation, >1 million
doses will be conserved by July 2004, making widespread or prolonged
disruptions in vaccination services less likely.
This recommendation reflects CDC's assessment of the existing national PCV7
supply and may be changed if the supply changes. Updated information about
vaccine supplies is available from CDC at
http://www.cdc.gov/nip/news/shortages
* Includes children with sickle cell disease
and other hemoglobinopathies, anatomic asplenia, chronic diseases (e.g.,
chronic cardiac and pulmonary disease and diabetes), cerebrospinal fluid
leak, human immunodeficiency virus infection and other immunocompromising
conditions, immunosuppressive chemotherapy or long-term systemic
corticosteroid use; children who have undergone solid organ
transplantation; and children who either have received or will receive
cochlear implants. All these children have been identified as being at
either "high risk" or "presumed high risk" for severe invasive
pneumoccocal disease.
**********************
To access a web-text (HTML) version of the complete MMWR article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a6.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5305.pdf
To receive a FREE electronic subscription to MMWR (which includes new ACIP
statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
To access NIP's Q&A series "PCV7 (Prevnar) Shortages and Suspension of the
Recommendation for the Fourth Dose," go to:
http://www.cdc.gov/nip/news/shortages/pcv7-shortage-faqs2-04.htm
To access the CDC press release "Health Groups Recommend Temporary
Suspension of Pediatric Pneumococcal Conjugate Vaccine Dose," go to:
http://www.cdc.gov/od/oc/media/pressrel/r040212.htm
To access the statement in CDC's "Immunization Works!" electronic
newsletter, go to:
http://www.immunize.org/news.d/newssupp204.htm
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February 16, 2004
ATTENTION ADULT MEDICAL SPECIALISTS: THE LATEST ISSUE OF "VACCINATE ADULTS!"
IS ON THE WEB
The hard copy of the February 2004 issue of "VACCINATE ADULTS!" was recently
mailed to nearly 130,000 adult medicine specialists and health departments.
You can access the entire issue or selected articles from the IAC website.
Immunization and hepatitis experts at CDC have reviewed the articles and
education pieces in the issue for accuracy (with the exception of
editorials).
The February issue has a number of hepatitis resources: an editorial,
"Prevent Viral Hepatitis: Vaccinate!"; an updated patient-education piece,
"Every Week Hundreds of Sexually Active People Get Hepatitis B"; and a new
professional-education piece, "Standing Orders for Administering Hepatitis B
Vaccine to Adolescents and Adults." In addition, the issue has two practical
pieces on storing and handling vaccines: "CDC's Guidelines for Maintaining
and Managing the Vaccine Cold Chain" and "Temperature Logs (Fahrenheit and
Celsius) for Vaccines." This is information you won't find anywhere else; we
hope you'll peruse the table of contents (given below) and read articles
that interest you online.
HOW TO ACCESS "VACCINATE ADULTS!" ON THE WEB
You can download the entire issue from the Web or view selected articles
from the table of contents below.
To view the table of contents with links to individual articles, go to:
http://www.immunize.org/va
Please note: The PDF file of the entire February 2004 issue,
linked below, is large at 421,245 bytes. Some printers cannot
print such a large file. For tips on downloading and printing
PDF files, go to: http://www.immunize.org/nslt.d/tips.htm
To download the entire PDF version of the February 2004 issue,
go to: http://www.immunize.org/va/va12.pdf
SUMMARIES OF INDIVIDUAL ARTICLES AND FEATURES
Summaries of "VACCINATE ADULTS!" articles and features are
below, followed by URLs.
"Ask the Experts"
CDC immunization expert William Atkinson, MD, MPH, and viral
hepatitis experts Linda Moyer, RN, and Eric Mast, MD, answer
readers' questions.
HTML: http://www.immunize.org/va/va12exprt.htm
PDF: http://www.immunize.org/va/va12exprt.pdf
"Prevent Viral Hepatitis: Vaccinate!"
Citing the distressing statistic that nearly 80,000 persons in
the United States become infected with hepatitis B virus (HBV)
each year, this editorial urges health professionals to identify
and vaccinate adults with behavioral risk factors for HBV
infection.
PDF: http://www.immunize.org/va/viralhepatitis.pdf
"Vaccine Highlights"
A digest of recent recommendations and news about vaccines and
vaccine resources pertaining to adults.
HTML: http://www.immunize.org/va/va12vac.htm
PDF: http://www.immunize.org/va/va12vac.pdf
"Every Week Hundreds of Sexually Active People Get Hepatitis B"
This recently revised duo-fold patient brochure succinctly
describes the facts associated with hepatitis B: what it is, who
gets it, how they get it, how to prevent it, and more.
HTML: http://www.immunize.org/catg.d/4112std.htm
PDF: http://www.immunize.org/catg.d/4112std.pdf
"Standing Orders for Administering Hepatitis B Vaccine to
Adolescents and Adults"
This one-page sheet outlines the purpose, policy, and procedures
for using standing orders for hepatitis B vaccine administration
and presents information about contraindications, precautions,
and administration techniques.
PDF: http://www.immunize.org/va/orders.pdf
"CDC's Guidelines for Maintaining and Managing the Vaccine
Cold Chain"
Reprinted from the MMWR of October 24, 2003, this article
presents current information on recommended vaccine storage
temperatures, storage requirements, and temperature monitoring.
HTML: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5242a6.htm
PDF: http://www.immunize.org/va/coldchain.pdf
"Temperature Logs (Fahrenheit and Celsius) for Vaccines"
This one-page sheet provides URLs for Fahrenheit and Celsius
temperature logs; each log has space for recording a month's
worth of temperatures.
One-page sheet with URLs for both temperature logs
PDF: http://www.immunize.org/va/templogs.pdf
Fahrenheit temperature log
PDF: http://www.immunize.org/catg.d/p3039.pdf
Celsius temperature log
PDF: http://www.immuize.org/news.d/celsius.pdf
"Adult Resources and Order Form"
Order materials for patients and clinic staff here.
PDF: http://www.immunize.org/va/catalog.pdf
"Letter from the Executive Director: Your Yearly Contribution
Promotes Immunization!"
IAC's Executive Director, Deborah L. Wexler, MD, shows how much
good your money does when you contribute to IAC.
HTML: http://www.immunize.org/va/va12back.htm
PDF: http://www.immunize.org/va/va12back.pdf
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February 16, 2004
REVISED: IAC'S "ASK THE EXPERTS" COMPILATION IS UPDATED WITH
INFORMATION FROM THE JANUARY 2004 ISSUE OF "NEEDLE TIPS"
IAC recently updated its "Ask the Experts" web section with Q&As
from the January 2004 issue of "NEEDLE TIPS." Included are
answers to general vaccine questions, as well as answers to
questions about 14 disease-specific vaccines. The web section is
based on "Ask the Experts" columns written by experts from CDC's
National Immunization Program and Division of Viral Hepatitis.
To access the "Ask the Experts" web section, go to:
http://www.immunize.org/catg.d/p2021.htm
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February 16, 2004
UPDATED: IAC ADDS TO ITS POPULAR COLLECTION OF VIDEO FOOTAGE
RELATED TO VACCINE-PREVENTABLE DISEASES
The video section of IAC's public website now features 63 videos
in RealPlayer format. Some of the new resources include the
following:
- From the Vaccine Education Center, Children's Hospital of
Philadelphia, two videos, "Vaccines: Separating Fact from
Fear" and "Vaccines and Your Baby." Each is available in its
entirety or in separate segments; each can be downloaded or
viewed online.
- From UNICEF, three 30-second public service announcements
about polio eradication.
- From UNICEF, a 3-minute video, "Protect Every Child,"
discusses the role of immunization in global health.
- From the Measles Initiative, an award-winning documentary,
"Disease of the Wind," focuses on measles in Africa. Includes
actress Jane Seymour and eight American school children in
Kenya. We have eleven representative clips, ranging in length
from 1 minute to 3-1/2 minutes. The Measles Initiative is a
project of the American Red Cross, UN Foundation, CDC, WHO,
UNICEF, and the International Federation of Red Cross and Red
Crescent Societies.
- From the Global Alliance for Vaccines and Immunization,
multiple broadcast segments and public service announcements
about vaccinating the world's children.
To access these and other videos directly, go to:
http://www.vaccineinformation.org/video
You can also access the video web page from IAC's two main
websites, www.immunize.org and
www.vaccineinformation.org
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February 16, 2004
CDC REPORTS ON OUTBREAKS OF AVIAN INFLUENZA IN ASIA AND ON
RECOMMENDATIONS FOR EVALUATING AND REPORTING SUSPECTED CASES
CDC published "Outbreaks of Avian Influenza A (H5N1) in Asia and
Interim Recommendations for Evaluation and Reporting of
Suspected Cases--United States, 2004" in the February 13 issue
of MMWR. The article's opening paragraph is reprinted below.
***********************
During December 2003-February 2004, outbreaks of highly
pathogenic avian influenza A (H5N1) among poultry were reported
in Cambodia, China, Indonesia, Japan, Laos, South Korea,
Thailand, and Vietnam. As of February 9, 2004, a total of
23 cases of laboratory-confirmed influenza A (H5N1) virus
infections in humans, resulting in 18 deaths, had been reported
in Thailand and Vietnam. In addition, approximately
100 suspected cases in humans are under investigation by
national health authorities in Thailand and Vietnam. CDC, the
World Health Organization (WHO), and national health authorities
in Asian countries are working to assess and monitor the
situation, provide epidemiologic and laboratory support, and
assist with control efforts. This report summarizes information
about the human infections and avian outbreaks in Asia and
provides recommendations to guide influenza A (H5N1)
surveillance, diagnosis, and testing in the United States.
***********************
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a1.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5305.pdf
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February 16, 2004
CDC REPORTS ON RECENT CASES OF INFLUENZA A (H5N1) IN THAILAND
CDC published "Cases of Influenza A (H5N1)--Thailand, 2004" in
the February 13 issue of MMWR. A summary made available to the
press is reprinted below in its entirety.
***********************
Human disease caused by the current strain of avian influenza is
rapidly progressive, severe, and fatal in most cases.
This article describes the clinical features of the five
confirmed human cases of avian influenza in the ongoing outbreak
in Thailand. It provides the first clear picture of the
unusually severe and rapidly progressive pneumonia, with failure
of other organ systems, and death in all five patients. Set in
the context of an avian outbreak involving at least eight
countries that is not yet under control, the severity of disease
in these young boys provides a reminder that avian influenza,
even without a reassortant event that might result in a strain
capable of efficient human-to-human transmission, is a serious
public health threat.
***********************
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a2.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5305.pdf
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February 16, 2004
PLAN AHEAD: DATES FOR NATIONAL ADULT IMMUNIZATION AWARENESS WEEK
ARE MOVED UP
On January 22, the National Foundation for Infectious Diseases
(NFID) and National Coalition for Adult Immunization (NCAI)
announced they have changed the date for National Adult
Immunization Awareness Week (NAIAW). Previously observed in
October, NAIAW will now be celebrated each year at the end of
September. The dates for 2004 are September 26 to October 2.
NAIAW's new dates allow immunizers and the general public to
better prepare for the start of influenza vaccination season,
which typically begins October 1. Immunizers can plan
immunization events at the start of October, rather than in
mid-October, when NAIAW previously occurred. The end of
September also provides time for the general public,
particularly those considered at high-risk, to schedule earlier
appointments for their influenza, pneumococcal, tetanus-diphtheria, or other needed adult vaccinations.
To learn more about NAIAW, visit the NFID/NCAI website at
www.nfid.org/ncai
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February 16, 2004
UPDATED VIS TRANSLATION: THE MOST CURRENT MENINGOCOCCAL VIS IS
NOW AVAILABLE IN SPANISH ON IAC'S WEBSITE
Dated 7/28/03, the most current meningococcal VIS is now
available in Spanish on IAC's website. IAC gratefully
acknowledges the California Department of Health Services for
the translation.
To obtain a ready-to-copy (PDF) version of the meningococcal VIS
in Spanish, go to: http://www.immunize.org/vis/sp_men03.pdf
To obtain a ready-to-copy (PDF) version of it in English, go to:
http://www.immunize.org/vis/menin03.pdf
For information about the use of VISs, and for VISs in a total
of 30 languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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February 16, 2004
U.S. MILITARY PERSONNEL WHO RECEIVED SMALLPOX VACCINE RARELY
TRANSFERRED VACCINIA VIRUS TO OTHERS
CDC published "Secondary and Tertiary Transfer of Vaccinia Virus
Among U.S. Military Personnel--United States and Worldwide,
2002-2004" in the February 13 issue of MMWR. The article
includes two case studies. Part of a summary made available to
the press is reprinted below.
***********************
Spread of the virus in smallpox vaccine was a rare event in the
Defense Department's Smallpox Vaccination Program. Using
detailed education and good infection-control procedures, only
30 cases of contact transfer occurred after 560,000 smallpox
vaccinations. Most of the 30 were spouses or adult intimate
contacts. No cases arose in the workplace or in hospitals.
Continued efforts are needed so smallpox vaccinees keep their
vaccination site covered, wash their hands, and use good
hygiene, especially at home. The rate of contact transfer was
similar to the rate seen in the 1960s, even though far fewer
people today are immune to this virus. The virus in smallpox
vaccine is called vaccinia virus and cannot cause smallpox
itself.
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To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5305.pdf
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February 16, 2004
CDC PUBLISHES UPDATE OF SMALLPOX VACCINE ADVERSE EVENTS AMONG
U.S. CIVILIANS DURING 2003
CDC published "Update: Adverse Events Following Civilian
Smallpox Vaccination--United States, 2003" in the February 13
issue of MMWR. A summary made available to the press is
reprinted below in its entirety.
***********************
CDC, the Food and Drug Administration, and state health
departments are continuing to monitor for vaccine-associated
adverse events among civilian vaccinees.
This report provides updated information on smallpox
vaccine-associated adverse events (possible side effects)
among civilians vaccinated since the beginning of the program
and among contacts of vaccinees, received by CDC as of
December 31, 2003.
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To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5305.pdf
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February 16, 2004
APRIL 16 IS THE EARLY-BIRD REGISTRATION DEADLINE FOR THE SEVENTH
ANNUAL CONFERENCE ON VACCINE RESEARCH
The Seventh Annual Conference on Vaccine Research is scheduled
for May 24-26 in Arlington, VA. The National Foundation for
Infectious Diseases (NFID) is the conference sponsor, along with
several national and international organizations. NFID members
who register by April 16 can save $68; non-members can save $75.
The conference will feature international experts leading
seminars and panel discussions on topical areas of basic
immunology, product development, clinical testing, regulation,
and other aspects of vaccine research. The intended audience
includes researchers, scientists, epidemiologists,
microbiologists, immunologists, molecular biologists, public
health officials, physicians, veterinarians, and vaccine
manufacturers.
For a comprehensive overview of the conference, including
information on registration, abstract submission, and a
preliminary program, go to:
http://www.nfid.org/conferences/vaccine04
For additional information, contact Sharon Cooper-Kerr or Sheena
Majette by phone at (301) 656-0003, ext. 19; by fax at
(301) 907-0878; or by email at vaccine@nfid.org
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February 16, 2004
MARK YOUR CALENDAR: VACCINATION WEEK IN THE AMERICAS WILL BE
OBSERVED APRIL 24-30
On February 9, the Pan American Health Organization (PAHO)
issued a press release announcing that Vaccination Week in the
Americas is set for April 24-30. Countries from Canada to the
tip of South America and throughout the Caribbean plan to take
part. The majority of countries plan to vaccinate children less
than five years of age, along with women of childbearing age and
senior citizens. The event is supported by UNICEF, the Red
Cross, CDC, USAID (United States Agency for International
Development), and other organizations.
To access the press release, go to:
http://www.paho.org/English/DD/PIN/pr040209.htm
For more information, contact Daniel Epstein at PAHO by phone at
(202) 974-3459 or by email at epsteind@paho.org or Curtis Allen
at CDC by phone at (404) 639-8487.
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February 16, 2004
CDC REPORTS ON WHO'S UPDATED GLOBAL POLIO ERADICATION INITIATIVE
STRATEGIC PLAN
CDC published "Brief Report: Global Polio Eradication Initiative
Strategic Plan, 2004" in the February 13 issue of MMWR. A
summary made available to the press is reprinted below in its
entirety.
***********************
The remaining few countries still endemic for polio will require
the highest levels of commitment from national governments and
international partners to ensure that the final poliovirus
reservoirs are eliminated. Although remarkable progress has been
made since 1988 toward achieving the goal of global polio
eradication, challenges remain. This updated Strategic Plan
details the actions necessary to realize the goal of global
polio eradication.
An updated Global Polio Eradication Strategic Plan (2004-2008)
was released on 15 January 2004 by the World Health
Organization. The plan outlines the activities required to
interrupt poliovirus transmission globally (2004-05), to achieve
global certification of polio eradication (2006-08), and to
prepare for cessation of childhood immunization with oral
poliovirus vaccine (OPV) (2009 and beyond). Eliminating all
remaining poliovirus reservoirs is now crucial, because the
discontinuation of mass immunization campaigns in most polio-free countries has left these areas vulnerable to importations
of wild poliovirus from the remaining endemic countries.
***********************
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5305a5.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5305.pdf |
