Issue
Number 465
June 14, 2004
CONTENTS OF THIS ISSUE
- New: State legislatures enact immunization requirements
- Update: CDC makes a minor change to the MMR VIS
- Update: IAC adds information to its professional-education sheet on
using standing orders to administer PPV vaccine
- New: Slides, handouts, and recordings of National Immunization
Conference presentations now available on NIP's website
- New: CDC releases an update on SARS and avian influenza
- World Vaccine Congress to be held October 11-13 in Lyon, France
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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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June 14, 2004
NEW: STATE LEGISLATURES ENACT IMMUNIZATION REQUIREMENTS
In the 2003-04 legislative season, many state legislatures enacted
immunization requirements. All states that have vaccination requirements
have certain legal exemptions. Following is information about new
legislation, organized by vaccine and state. At the end of the article is
information about new legislation regarding pharmacists' scope of practice
in immunization.
HEPATITIS B
Indiana: The governor signed a bill on 3/16/04 that adds hepatitis B
requirements for students entering grades 9 and 12, effective 6/30/05. Note:
Indiana currently has hepatitis B requirements for students in kindergarten
through grade 6.
Kansas: By department of health regulation, all kindergarten enrollees in
the 2004-2005 school year must have evidence of vaccination against
hepatitis B.
Kentucky: The governor signed a bill on 4/2/04 that requires all public and
independent post-secondary educational institutions to provide information
on hepatitis B to all first-time, full-time students. The requirements
become effective 7/15/04.
Ohio: The governor signed a bill on 4/13/04 that requires documentation of
the hepatitis B vaccination status of post-secondary students living in
on-campus housing in public colleges and universities. The law also requires
the state department of health to post information about hepatitis B disease
and vaccine on its website, so it is available to junior and senior high
school students and their parents. Effective date: 7/1/05.
IAC has compiled information about states that have hepatitis B mandates for
prenatal screening, and day care, elementary, and middle school entry. To
access the information, go to:
http://www.immunize.org/laws/hepb.htm
The information about mandates for day care and school entry is also
depicted visually on a map of the United States. To access the map, go to:
http://www.immunize.org/laws/hepbdcmap.pdf
IAC has compiled information about states that have hepatitis B mandates for
college and university entry. To access the information, go to:
http://www.immunize.org/laws/hepbcollege.htm
This information is also depicted visually on a map of the United States. To
access the map, go to:
http://www.immunize.org/laws/hepbcolmap.pdf
INFLUENZA AND PNEUMOCOCCAL POLYSACCHARIDE (PPV)
California: The governor signed a bill on 4/29/04 that requires long-term
care facilities to offer influenza and pneumococcal vaccination to
residents. The new requirements become effective in calendar year 2005.
New Hampshire: Without the signature of the governor, a bill requiring
hospitals, residential-care facilities, adult day care facilities, and
assisted living facilities to offer vaccination against influenza and
pneumococcal disease to residents/patients was enacted on 5/4/04. Effective
1/1/05, all hospitalized patients must be offered vaccination prior to
hospital discharge; residents of the other specified facilities must be
offered vaccination within five working days of becoming a patient.
Documentation is required in the patient's chart. Medical and conscientious
exemptions are permitted. The law requires annual reporting to the federal
Department of Health and Human Services. It also requires the
above-referenced facilities to offer vaccination against influenza by
November 30 of each year for each employee. Employees who begin employment
between October 1 and February 1 of each year must be offered vaccination
before they begin their employment.
Virginia: The governor signed a bill on 4/12/04 that will require nursing
homes to offer residents pneumococcal vaccination, as well as annual
influenza vaccination. The law becomes effective 7/1/04.
IAC has compiled information about states with influenza and/or pneumococcal
(PPV) vaccine mandates for residents in long-term care facilities. To access
the information, go to:
http://www.immunize.org/laws/ltc.htm
The information is also depicted visually on a map of the United States. To
access the map, go to:
http://www.immunize.org/laws/ltcmap.pdf
MENINGOCOCCAL
Colorado: The governor signed a bill on 4/20/04 that requires all public and
nonpublic post-secondary educational institutions to provide information on
meningococcal disease and the vaccine to all students residing in student
housing, effective 7/1/05. Students must also provide information on their
meningococcal vaccination status.
Iowa: The governor signed a bill on 4/2/04 that will require colleges and
universities that have on-campus housing to provide information about
meningococcal disease and the vaccination to each student. Students must
indicate their meningococcal vaccination status on their student health
forms. Effective 7/1/04.
Kentucky: The governor signed a bill on 4/22/04 that requires each public
and private post-secondary educational institution to provide information
about meningitis to full-time students living in residence housing. Students
must indicate their meningococcal vaccination status. Effective: 2004-05
school year.
Maine: The governor signed a bill on 3/30/04 that will require colleges and
universities that have on-campus housing to provide information about
meningococcal disease and the vaccination to new freshmen who will be living
in dormitories. Students must indicate their meningococcal vaccination
status on their student health forms. Implementation will begin in summer
2004.
New Jersey: An amendment to the state's existing meningococcal law was
approved on 1/14/04 to expand the existing information requirements to
include a vaccination requirement for students residing in campus
dormitories, effective in September 2004.
Ohio: The governor signed a bill on 4/13/04 that requires documentation of
the meningococcal vaccination status of post-secondary students living in
on-campus housing in public colleges and universities. The law also requires
the state department of health to post information about meningococcal
disease and vaccine on its website, so it is available to junior and senior
high school students and their parents. Effective date: 7/1/05.
IAC has compiled information about states with meningococcal prevention
mandates for colleges and universities. To access the information, go to:
http://www.immunize.org/laws/menin.htm
The information is also depicted visually on a map of the United States. To
access the map, go to:
http://www.immunize.org/laws/meninmap.pdf
VARICELLA
Kansas: By department of health regulation, all kindergarten enrollees in
the 2004-05 school year must have evidence of vaccination against varicella.
North Dakota: The governor signed a bill on 3/17/03 that would require
varicella vaccination for children in child care facilities and
kindergarten. The department of health promulgated rules in October 2003
that specified the effective dates: child care requirements became effective
in January 2004 and kindergarten requirements will become effective in the
2004-05 school year.
New Jersey: By department of health rulemaking, effective September 2004,
all children born on or after 1/1/98 must have evidence of varicella
vaccination (or disease history) to enroll in or attend kindergarten or
first grade. All children 19 months of age and older must have such evidence
to attend a child care center.
IAC has compiled information about all states that have varicella mandates
for day care, elementary, and middle school entry. To access the
information, go to:
http://www.immunize.org/laws/varicel.htm
This information is also depicted visually on a map of the United States. To
access the map, go to:
http://www.immunize.org/laws/varimap.pdf
OTHER VACCINES
For information about state mandates for other vaccines, go to:
http://www.immunize.org/laws
PHARMACISTS' SCOPE OF PRACTICE
Maryland: The governor signed a bill on 5/11/04 that allows
pharmacists to administer influenza vaccination. The new law
becomes effective 10/01/04.
IAC has compiled information about states that authorize
pharmacists to vaccinate. To access the information, go to:
http://www.immunize.org/laws/pharm.htm
The information is also depicted visually on a map of the United
States. To access the map, go to:
http://www.immunize.org/laws/pharmmap.pdf
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June 14, 2004
UPDATE: CDC MAKES A MINOR CHANGE TO THE MMR VIS
CDC recently made a one-word change to the current (1/15/03)
Vaccine Information Statement for measles, mumps, and rubella
(MMR) vaccine. In Section 3, the end of the sentence in the
first bullet was changed from ". . . or a previous dose of MMR
vaccine" to ". . . or to a previous dose of MMR vaccine" (i.e.,
the word "to" was added).
CDC has posted the updated VIS to its website, as has IAC (only
the English-language version). The date on the VIS remains the
same. CDC states that providers do NOT have to discard their
existing supply of MMR VISs. However, the next time providers
have a need to print more MMR VISs, they should get the updated
version from the CDC or IAC websites.
To access a ready-to-copy (PDF) version of the updated MMR VIS
from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-mmr.pdf
To access a ready-to-copy (PDF) version of it from the IAC
website, go to: http://www.immunize.org/vis/mmr03.pdf
For information about the use of VISs, and for VISs in a total
of 31 languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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June 14, 2004
UPDATE: IAC ADDS INFORMATION TO ITS PROFESSIONAL-EDUCATION SHEET
ON USING STANDING ORDERS TO ADMINISTER PPV VACCINE
IAC recently added information to its professional-education
sheet "Standing Orders for Administering Pneumococcal Vaccine to
Adults." The sheet now includes criteria for determining which
patients require a second dose of pneumococcal polysaccharide
vaccine (PPV). Following is the added material:
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2. Identify adults in need of a second and final dose of PPV if
five or more years have elapsed since the previous vaccination
and the patient is:
-
Age 65 years or older and received prior PPV vaccination when
less than age 65 years
-
At highest risk for serious pneumococcal infection and/or
likely to have a rapid decline in pneumococcal antibody
levels . . .
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To access a camera-ready (PDF) version of the standing orders,
go to:
http://www.immunize.org/catg.d/p3075.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p3075.htm
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June 14, 2004
NEW: SLIDES, HANDOUTS, AND RECORDINGS OF NATIONAL IMMUNIZATION
CONFERENCE PRESENTATIONS NOW AVAILABLE ON NIP'S WEBSITE
CDC recently announced that slides, handouts, and recordings
(audio and/or video) of many presentations made at the 38th
National Immunization Conference are available on the NIP
website. Additional files are continually being updated and
uploaded; check the web page below often to access a more
complete collection of presentation files.
To access the presentation files, visit the interactive
conference agenda at http://www.cdc.gov/nip/nic/#agenda Follow
the instructions provided.
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June 14, 2004
NEW: CDC RELEASES AN UPDATE ON SARS AND AVIAN INFLUENZA
On June 10, CDC issued a Health Update on SARS and avian
influenza. It is reprinted below in its entirety.
******************
This is an official CDC Health Update
Distributed via Health Alert Network
Thursday, June 10, 2004, 17:47 EDT (5:47 PM EDT)
UPDATE ON SARS AND AVIAN INFLUENZA A (H5N1)
This update reviews the current situation and the surveillance
and diagnostic recommendations for both severe acute respiratory
syndrome (SARS) and avian influenza A (H5N1). The updates have
been combined because the clinical presentation and travel
history of persons with avian influenza A (H5N1) or SARS
coronavirus (SARS-CoV) infection may overlap. The
recommendations for SARS have been revised downward because the
most recent SARS activity in China has been contained. The
recommendations for avian influenza A (H5N1) remain at the
enhanced level established in February 2004. As detailed in the
recommendations below, vigilance in the clinical setting for
SARS and avian influenza (H5N1) requires that health care
providers consistently obtain international travel and other
exposure risk information for persons who have specified
respiratory symptoms.
SEVERE ACUTE RESPIRATORY SYNDROME
Current situation
During April 22-29, 2004, the Chinese Ministry of Health (MOH)
reported a total of nine cases (one fatal) of SARS in China;
seven of the patients were from Beijing, and two were from Anhui
Province, located in east-central China. Two of the nine
patients were graduate students who worked at National Institute
of Virology Laboratory (NIVL) in Beijing, which is known to
conduct research on SARS-CoV. The NIVL was closed on April 23
and remains closed to date. Possible sources of infection for
the two laboratory workers, neither of whom is known to have
worked directly with SARS-CoV, are being investigated. Of the
seven other SARS cases, two were directly linked to close
contact with one of the graduate students who worked at NIVL;
these two cases were in the graduate student's mother (who died)
and in a nurse who provided care to the graduate student. The
remaining five cases were linked to close contact with the
nurse.
No further cases of SARS in China or anywhere else in the world
have been reported since April 29, 2004. On May 18, the World
Health Organization (WHO) reported on its website that the
outbreak in China appears to have been contained, but that
laboratory biosafety concerns remain and further investigation
is under way. CDC is in close communication with WHO and is
working with its other public health partners to reinforce the
need for strict adherence to applicable biosafety precautions to
reduce the risk of laboratory-related exposures to SARS-CoV.
Recommended U.S. SARS control measures
Given that the recent SARS outbreak in China appears tohave
been contained with relatively limited secondary transmission,
CDC is revising previously issued guidance for enhanced
surveillance of SARS in travelers to China
(http://www.cdc.gov/ncidod/sars/han/han_China042304.htm). In the
current setting, surveillance efforts should aim to identify
patients who (1) require hospitalization for radiographically
confirmed pneumonia or acute respiratory distress syndrome
without identifiable etiology AND (2) 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.
When individuals meeting these criteria are identified,
appropriate infection control should be instituted, as described
in the guidelines at
www.cdc.gov/ncidod/sars/absenceofsars.htm
Diagnostic testing should be performed judiciously, and
preferably only in consultation with the local or state health
department. SARS-CoV testing should be considered if no
alternative diagnosis is identified 72 hours after initiation of
the clinical evaluation and the patient is thought to be at high
risk for SARS-CoV disease (e.g., part of a cluster of
unexplained pneumonia cases). Infection control practioners and
other health-care personnel also should be alert for clusters of
pneumonia among two or more health care workers who work in the
same facility.
Additional SARS information
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
http://www.cdc.gov/ncidod/sars/absenceofsars.htm Additional
information about SARS preparedness is available in CDC's
document "Public Health Guidance for Community-Level
Preparedness and Response to Severe Acute Respiratory Syndrome
(SARS)" at
http://www.cdc.gov/ncidod/sars/sarsprepplan.htm;
general information about SARS is available at
http://www.cdc.gov/ncidod/sars
AVIAN INFLUENZA A (H5N1)
Current situation
Since January 2004, a total of 34 confirmed human cases of avian
influenza A (H5N1) virus infections have been reported in
Vietnam (22 cases, 15 deaths) and Thailand (12 cases, 8 deaths).
The last case officially reported by Vietnam occurred in
February 2004. One additional case was described in several
media reports in mid-March in southern Vietnam
http://www.who.int/csr/don/2004_03_22a/en All persons with
confirmed H5N1 influenza had severe illness and were
hospitalized with pneumonia; most cases occurred in children and
young adults who had direct close contact with live, sick, or
dead poultry. There currently is no evidence of efficient human-to-human transmission of avian influenza A (H5N1) viruses.
These cases were associated with widespread H5N1 poultry
outbreaks that occurred at commercial and small backyard poultry
farms. Since December 2003, eight countries have reported H5N1
outbreaks among poultry. Outbreaks in South Korea and Japan were
limited to commercial farms and have been adequately contained;
however, outbreaks in Vietnam, Thailand, Indonesia, Cambodia,
Laos, and China have been more extensive and the degree to which
they have been controlled remains uncertain. On the basis of
current information, human infection with avian influenza A
(H5N1) viruses remains a public health risk in these countries.
Enhanced U.S. Surveillance, Diagnostic Evaluation, and Infection
Control Precautions for Avian Influenza A (H5N1): CDC recommends
maintaining the enhanced surveillance efforts by state and local
health departments, hospitals, and clinicians to identify
patients at increased risk for avian influenza A (H5N1) that
were issued by CDC on February 3, 2004
http://www.cdc.gov/flu/han020302.htm Guidelines for enhanced
surveillance are:
Testing for avian 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 avian 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°C (>100.4°F), AND
-
One or more of the following: cough, sore throat, shortness
of breath, AND
-
History of contact with poultry (e.g., visited a poultry
farm, a household raising poultry, or a bird market) or a
known or suspected human case of influenza A (H5N1) in an
H5N1-affected country within 10 days of symptom onset.
Infection control precautions for H5N1 remain unchanged from the
CDC interim recommendations published on February 3, 2004,
http://www.cdc.gov/flu/han020302.htm. These recommendations are
further described in the CDC guidance document "Interim
Recommendations for Infection Control in Health-Care Facilities
Caring for Patients with Known or Suspected Avian Influenza"
http://www.cdc.gov/flu/avian/professional/infect-control.htm
Additional avian influenza A (H5N1) information
For general information about influenza, see the CDC website at
www.cdc.gov/flu
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June 14, 2004
WORLD VACCINE CONGRESS TO BE HELD OCTOBER 11-13 IN LYON, FRANCE
Intended for vaccine industry executives, officials from
national and international organizations, and high-level
scientists, the World Vaccine Congress will be held in Lyon,
France, October 11-13.
To access the conference program, go to:
http://www.lifescienceworld.com/2004/wvcl_FR/confprog.asp
To register online, go to:
http://transaction.terrapinn.com/form_page1.asp?SEID=480&DF=1
For additional information, contact Sarah Butt, sponsorship
manager, by phone at +44 (0)207 827 5962 or by email at
sarah.butt@terrapinn.com |
