Issue
Number 460
May 17, 2004
CONTENTS OF THIS ISSUE
- May 2004 issue of "NEEDLE TIPS" provides up-to-date resources on
childhood, adolescent, and adult immunization
- CDC reports on a varicella outbreak among vaccinated children at a
Michigan elementary school in 2003
- WHO pulls together a partnership to contain outbreak of meningococcal
disease in Burkina Faso
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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; VPD, vaccine-preventable disease; WHO, World Health
Organization.
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May 17, 2004
MAY 2004 ISSUE OF "NEEDLE TIPS" PROVIDES UP-TO-DATE RESOURCES ON CHILDHOOD,
ADOLESCENT, AND ADULT IMMUNIZATION
IAC recently mailed the latest issue of "NEEDLE TIPS" to 100,000 health
professionals and others who work in the field of immunization. Packed with
timely immunization resources for health professionals, patients, and
parents, the 24-page issue is well worth downloading. All articles and
education pieces, except editorials, have been thoroughly reviewed by
immunization and hepatitis experts at CDC.
HOW TO READ "NEEDLE TIPS" ON THE WEB
You can view selected articles from the table of contents below or download
the entire issue from the Web.
To view the table of contents with links to individual articles, go to:
http://www.immunize.org/nt
Please note: The PDF file of the entire issue, linked below, is large at
999,733 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 a ready-to-copy (PDF) version of the May issue, go to:
http://www.immunize.org/nslt.d/n30/n30.pdf
The articles in the May issue fall into three broad areas: (1) general
immunization information,(2) childhood and adolescent immunization
resources, and (3) adult immunization resources.
(1) GENERAL IMMUNIZATION INFORMATION
Turn to the following resources for the latest information on immunization.
- ANSWERS TO PROFESSIONALS' QUESTIONS,
CURRENT VACCINE NEWS, AND CURRENT VACCINE DISTRIBUTION INFORMATION. "Ask
the Experts" answers questions about immunization and viral hepatitis.
"Vaccine Highlights" presents timely information on recommendations,
schedules, specific vaccines, and vaccine safety. Updated in March,
"Vaccines and Related Products Distributed in the United States, 2004" is
an exhaustive listing of vaccines and biologics with information about
brand names, manufacturers' telephone numbers and web addresses, and more.
To access a ready-to-copy (PDF) version of "Ask the Experts," go to:
http://www.immunize.org/nslt.d/n30/expert30.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n30/expert30.htm
To access a ready-to-copy (PDF) version of "Vaccine Highlights," go to:
http://www.immunize.org/nslt.d/n30/vaccin30.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n30/vaccin30.htm
To access a ready-to-copy (PDF) version of "Vaccines and Related Products
Distributed in the United States, 2004," go to:
http://www.immunize.org/catg.d/2019prod.pdf
No web-text (HTML) version is available.
(2) CHILDHOOD AND ADOLESCENT IMMUNIZATION
RESOURCES
The following five articles will be particularly useful to medical
professionals who see pediatric patients.
- VACCINE SAFETY ARTICLES. Increasingly,
as parents turn to the mass media and Internet for health information,
health professionals are called on to counter misinformation, educate
about immunization, and help parents evaluate mass media and Internet
sources. Two articles, "Communicating with Families About Vaccines" and
"Does MMR Vaccine Cause Autism? Examine the Evidence!" give health
professionals powerful tools for speaking with parents who have doubts
about vaccinating their children.
To access a ready-to-copy (PDF) version of "Communicating with Families
About Vaccines," go to:
http://www.immunize.org/nslt.d/n30/vaxandfamilies.pdf
No web-text (HTML) version is available.
To access a ready-to-copy (PDF) version of "Does MMR Vaccine Cause
Autism? Examine the Evidence!" go to:
http://www.immunize.org/catg.d/p4026.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/mmrautism
- IMMUNIZATION ASSESSMENT AND SCHEDULING
RESOURCES. A parent's answers to "Screening Questionnaire for Child and
Teen Immunization" will give health professionals the information they
need to assess whether the child has any contraindications to
vaccination on the day of the visit. Based on resources from CDC, "When
Do Children and Teens Need Vaccinations?" and "Summary of Rules for
Childhood and Adolescent Immunization" present in chart form the
schedule and recommendations for vaccines commonly given to children and
teens.
To access a ready-to-copy (PDF) version of "Screening Questionnaire for
Child and Teen Immunization" go to:
http://www.immunize.org/catg.d/p4060scr.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4060scr.htm
To access a ready-to-copy (PDF) version of "When Do Children and Teens
Need Vaccinations?" go to:
http://www.immunize.org/catg.d/when1.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n17/when1.htm
To access a ready-to-copy (PDF) version of "Summary of Rules for
Childhood and Adolescent Immunization" go to:
http://www.immunize.org/catg.d/rules1.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n17/rules1.htm
(3) ADULT IMMUNIZATION RESOURCES
If you provide vaccination services to adults, you'll want to
use the following five resources to improve adult immunization
rates in your practice:
- INFLUENZA VACCINATION OF HEALTH CARE WORKERS. In response to
the distressing statistic that only 36% of health care
workers receive annual influenza vaccination, IAC developed
"First Do No Harm. Protect Your Patients by Getting
Vaccinated Against Influenza," a one-page professional-education sheet that outlines the primary steps necessary to
conduct an employee influenza immunization campaign for
health care workers.
To access a ready-to-copy (PDF) version of "First Do No Harm.
Protect Your Patients by Getting Vaccinated Against
Influenza" go to:
http://www.immunize.org/catg.d/p2014.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p2014.htm
- STANDING ORDERS PROTOCOL. "Standing Orders for Administering
Pneumococcal Vaccine to Adults" gives health professionals a
guideline that can be used to allow an appropriately licensed
individual to administer pneumococcal polysaccharide vaccine
without a direct order from a physician.
To access a ready-to-copy (PDF) version of "Standing Orders
for Administering Pneumococcal Vaccine to Adults," go to:
http://www.immunize.org/catg.d/p3075.pdf
No web-text (HTML) version is available.
- ASSESSMENT AND PATIENT EDUCATION RESOURCES. A patient's
answers to "Screening Questionnaire for Adult Immunization"
will give health professionals the information they need to
assess whether the patient has contraindications to
vaccination on the day of the visit. "Immunization . . . Not
Just Kids' Stuff" encourages patients to safeguard their
health by getting vaccinated against VPDs if they haven't had
certain diseases or been vaccinated against them. "Protect
Yourself against Hepatitis A and Hepatitis B . . . A Guide
for Gay and Bisexual Men" educates men who have sex with men
about their increased risk for contracting these two
diseases and makes the case for getting immunized against
them. Please note that this brochure is intended for use in
certain venues--STD clinics and clinics for men who have sex
with men, for example. It's not suitable for the waiting
rooms of most clinics and medical practices.
To access a ready-to-copy (PDF) version of "Screening
Questionnaire for Adult Immunization" go to:
http://www.immunize.org/catg.d/p4065scr.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4065scr.htm
To access a ready-to-copy (PDF) version of "Immunization
. . . Not Just Kids' Stuff," go to:
http://www.immunize.org/catg.d/p4035.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n17/p4035.htm
To access a ready-to-copy (PDF) version of "Protect Yourself
against Hepatitis A and Hepatitis B . . . A Guide for Gay and
Bisexual Men" go to:
http://www.immunize.org/catg.d/p4115.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4115.htm
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May 17, 2004
CDC REPORTS ON A VARICELLA OUTBREAK AMONG VACCINATED CHILDREN
AT A MICHIGAN ELEMENTARY SCHOOL IN 2003
CDC published "Outbreak of Varicella Among Vaccinated Children--Michigan, 2003" in the May 14 issue of MMWR. Portions of the
article are reprinted below.
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On November 18, 2003, the Oakland County Health Division alerted
the Michigan Department of Community Health (MDCH) to a
varicella (chickenpox) outbreak in a kindergarten [through]
third grade elementary school. On December 11, MDCH and Oakland
County public health epidemiologists, with the technical
assistance of CDC, conducted a retrospective cohort study to
describe the outbreak, determine varicella vaccine effectiveness
(VE), and examine risk factors for breakthrough disease (i.e.,
varicella occurring >42 days after vaccination). This report
summarizes the results of that study, which indicated that
(1) transmission of varicella was sustained at the school for
nearly 1 month despite high vaccination coverage, (2) vaccinated
patients had substantially milder disease (<50 lesions), and
(3) a period of =>4 years since vaccination was a risk factor
for breakthrough disease. These findings highlight the
importance of case-based reporting of varicella and the
exclusion of patients from school until all lesions crust or
fade away. Information about recognizing vaccinated patients
with mild cases should be disseminated to health care providers,
school administrators, and parents. . . .
Attack rates were 11.8% (52 of 442) for vaccinated and 76.9%
(10 of 13) for unvaccinated students. VE was 84.7%
(95% confidence interval [CI] = 77.4%-89.7%) in preventing
varicella of any severity and 97.6% (95% CI = 95.0%-98.9%) in
preventing moderate to severe varicella. Vaccinated patients
were more likely to have mild disease than unvaccinated patients
(84.6% versus 20.0%; p<0.01), were less likely to have fever
(44.2% versus 88.9%; p<0.05), and missed fewer days of school
(1.3 versus 3.5 median days; p<0.01). Children vaccinated
=>4 years before the outbreak were nearly five times more likely
to acquire varicella than children vaccinated within the
previous 4 years (relative risk = 4.65; 95% CI = 1.48-14.61).
Age at vaccination, sex, and preexisting conditions (e.g.,
asthma and eczema) were not associated with vaccine failure.
Vaccine lot numbers were identified for 30 patients; vaccine
from 26 different lot numbers was administered on multiple dates
by multiple providers, indicating that breakdown in vaccine
storage or handling procedures was not a likely risk factor for
vaccine failure.
Editorial Note:
Varicella is a highly infectious disease that, in the prevaccine
era, resulted in approximately 4 million illnesses, 11,000
hospitalizations, and 100 deaths annually in the United States.
In 1995, a live, attenuated varicella vaccine was licensed for
use in the United States, and the majority of studies of vaccine
performance have demonstrated an overall VE of 70%-90%. Since
vaccine licensure, the United States has experienced a steady
decline in the incidence of varicella disease, attributed to
increasing vaccination coverage. The findings in this report are
consistent with those of recently published studies on VE and
the association between longer time since vaccination and
breakthrough disease.
Cases of mild disease, not recognized as varicella before
detection of the outbreak, might have played an important role
in virus transmission in this highly vaccinated population. All
patients with chickenpox should be excluded from schools or day
care centers until all lesions have crusted. However,
breakthrough disease usually is mild and might not include
vesicular lesions that crust. To help prevent disease spread in
schools and day care centers, health care providers, school
administration, and parents must learn to recognize students
with vaccine-modified varicella and exclude them from schools
until lesions fade away or no new lesions appear.
Local varicella surveillance consists of passive reporting of
aggregate case counts to state health departments. Timely
reporting of individual varicella cases and appropriate follow-up might have ensured exclusion of patients from school and
reduced the size of this outbreak. As vaccination coverage
increases, the proportion of breakthrough cases also will
increase. Health departments can begin to evaluate the impact of
varicella vaccination programs through case-based surveillance
that collects information about age, vaccination status, and
severity of disease. These data can help to detect changes in
epidemiology of varicella disease over time, such as a potential
shift to older age groups or changes in disease severity among
breakthrough cases. The Council of State and Territorial
Epidemiologists has recommended that states implement case-based
surveillance of varicella by 2005.
The findings in this report indicate that varicella vaccine was
effective (85%) in preventing varicella of any severity and
highly effective (98%) in preventing moderate to severe disease.
Although longer time since vaccination was identified as a
potential risk factor for vaccine failure, prospective follow-up
studies are needed to examine the importance of individual risk
factors for breakthrough disease, after controlling for the
effects of other factors (e.g., risk for exposure). In addition,
these findings underscore the importance of continuing to
increase vaccination rates nationwide, ensuring that vaccination
remains the cornerstone of efforts to control varicella.
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To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5318a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5318.pdf
To receive a FREE electronic subscription to MMWR (which
includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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(3 of 3)
May 17, 2004
WHO PULLS TOGETHER A PARTNERSHIP TO CONTAIN OUTBREAK OF
MENINGOCOCCAL DISEASE IN BURKINA FASO
Earlier this year, the West African country of Burkina Faso
experienced an outbreak of W135 meningitis that infected 1500
people, of whom 300 died. In comparison, during the last W135
outbreak in 2002, 13,000 people were infected and 1500 died.
According to a press release issued by WHO on April 8, the steep
decline in morbidity and mortality resulted from a cooperative
effort by humanitarian organizations, industry, international
agencies, and lab trainers, as well as contributions from
governments, organizations, and individuals.
Following the 2002 outbreak, WHO began organizing partnerships
to build a mass intervention delivery system in the region. The
following two paragraphs from the WHO press release explain the
partnership and its accomplishments.
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Laboratory workers and field epidemiologists were trained and
supplied with materials so that W135 could be rapidly detected,
tracked, and confirmed. Regional monitoring was established at
WHO's Subregional Multidisease Center in Ouagadougou, Burkina
Faso. At the same time, pharmaceutical partner GlaxoSmithKline
developed a new vaccine, which was tested and approved in record
time. Following negotiations with WHO, the company priced the
vaccine affordably, at one Euro a dose.
To purchase an emergency stockpile of the vaccine, WHO issued an
urgent appeal last September. The reaction was rapid. Funds came
in from the governments of Ireland, Italy, Monaco, and the
United Kingdom, and from Medecins Sans Frontieres [Doctors
Without Borders], the Norwegian Red Cross, UNICEF, and private
individuals. The goal was reached, and the first doses [were]
taken from the stockpile and used in Burkina Faso in [the 2004
outbreak.]
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To access the WHO press release, go to:
http://www.who.int/mediacentre/releases/2004/pr25/en/print.html |
