Issue
Number 473
August 2, 2004
CONTENTS OF THIS ISSUE
- CDC reports on 2003 vaccination coverage levels among U.S. children
ages 19-35 months
- August is National Immunization Awareness Month--download promotional
materials from the NPI website
- CDC notifies readers of medical errors involving inadvertent
administration of tetanus toxoid-containing vaccines
- Reminder: August 19 is the date for CDC's satellite broadcast
"Immunization Update 2004"
- GLMA develops new hepatitis prevention materials for MSM
- July 28 issue of IAC's "HEP EXPRESS" electronic newsletter now
available online
- Don't miss out: Register today for the National Conference on
Immunization Coalitions
- September 10 is the registration deadline for CHOP's vaccine education
symposium
- Update: "CDC Public Health Law News" electronic newsletter switches to
weekly format
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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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August 2, 2004
CDC REPORTS ON 2003 VACCINATION COVERAGE LEVELS AMONG U.S. CHILDREN AGES
19-35 MONTHS
CDC published "National, State, and Urban Area Vaccination Coverage Among
Children Aged 19-35 Months--United States, 2003" in the July 30 issue of
MMWR. A link to tables describing data collected during the 2003 National
Immunization Survey will be given at the end of this "IAC EXPRESS" article.
Portions of the MMWR article are reprinted below.
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Each annual birth cohort in the United States comprises approximately 4
million infants. Maintaining the gains in vaccination coverage achieved
during the 1990s among these children poses a continuing challenge for
public health practitioners. The National Immunization Survey (NIS) provides
estimates of vaccination coverage among children aged 19-35 months for each
of the 50 states and 28 selected urban areas. This report summarizes NIS
results for 2003, which indicated substantial increases nationwide in
coverage with =>1 dose of varicella vaccine (VAR) and =>3 doses of
pneumococcal conjugate vaccine (PCV) and the highest coverage ever for all
vaccines; however, wide variability in coverage continues among states and
urban areas. Continued vigilance is needed to maintain high levels of
coverage, and sustained efforts will be required to reduce geographic
disparities in coverage. . . .
National vaccination coverage with =>1 dose of VAR increased from 80.6% (95%
confidence interval [CI] = +/-0.9%) in 2002 to 84.8% (95% CI = +/-0.8%) in
2003. Coverage for =>3 doses of PCV increased from 40.9% (95% CI = +/-1.1%)
in 2002 to 68.1% (95% CI = +/-1.0%) in 2003. Coverage for =>4 doses of PCV,
reported for the first time in 2003, was 36.7% (95% CI = +/-1.1%). For all
other vaccines and series, coverage increased in 2003 compared with 2002.
In 2003, substantial differences remained in estimated vaccination coverage
among states. Estimated coverage with the 4:3:1:3:3 series ranged from 94.0%
in Connecticut to 67.5% in Colorado. The range in coverage among the 28
urban areas was less than that among the states. Among the 28 urban areas,
the highest estimated coverage for the 4:3:1:3:3 series was 88.8% in Boston,
Massachusetts, and the lowest was 69.2% in Houston, Texas.
Editorial Note:
The findings in this report indicate that among U.S. children aged 19-35
months, estimated coverage with recommended vaccines was greater in 2003
than in 2002 and represented all-time highs. In addition, coverage for the
two most recently recommended vaccines, VAR and PCV, increased
substantially. The increases in coverage reflect ongoing progress toward
achieving the 2010 national health objectives for childhood vaccinations
(objectives 14-22 to 14-24). Notably, vaccine coverage for the fourth dose
of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine
continues to lag behind other vaccines in the 4:3:1:3:3 series, reducing the
coverage percentage for the overall series.
Continued vigilance is needed to maintain high levels of coverage. Moreover,
increasing coverage in areas where coverage is low remains a priority to
reduce the risk for infection and ongoing transmission if disease is
introduced. . . .
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5329a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5329.pdf
To access NIS 2003 data tables from the CDC website, go to:
http://www.cdc.gov/nip/coverage/NIS/03/toc-03.htm
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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August 2, 2004
AUGUST IS NATIONAL IMMUNIZATION AWARENESS MONTH--DOWNLOAD PROMOTIONAL
MATERIALS FROM THE NPI WEBSITE
This year, National Immunization Awareness Month is focused on the theme
"Are you up-to-date? Vaccinate!" The National Partnership for Immunization (NPI)
has developed a promotional kit with suggested activities, recommendations,
and immunization information designed to involve parents, public health
professionals, employers, and health care providers in efforts to raise
immunization rates throughout the United States.
The materials include a poster, brochures, bookmarks, and stickers. To
access them, go to:
http://www.partnersforimmunization.org/niam_prkit.html
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August 2, 2004
CDC NOTIFIES READERS OF MEDICAL ERRORS INVOLVING INADVERTENT ADMINISTRATION
OF TETANUS TOXOID-CONTAINING VACCINES
CDC published "Inadvertent Intradermal Administration of Tetanus Toxoid-containing
Vaccines Instead of Tuberculosis Skin Tests" in the July 30 issue of MMWR.
The article is reprinted below in its entirety, excluding references.
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CDC and the Food and Drug Administration (FDA) have been notified about the
potential for inadvertent administration of tetanus toxoid-containing
vaccines (TTCVs) instead of tuberculin
purified protein derivative (PPD) (Tubersol, Aventis Pasteur, Swiftwater,
Pennsylvania; Aplisol, Parkedale Pharmaceuticals, Rochester, Michigan) used
for tuberculosis skin tests (TSTs). The Vaccine Adverse Event Reporting
System (VAERS), a passive surveillance system jointly operated by CDC and
FDA, detected clusters of medication errors in at least two states. These
findings, along with another previously reported investigation involving the
same error, suggest the need for health care providers to take additional
steps to minimize the risk for inadvertent intradermal injections of TTCVs.
In April 2004, five reports of medication error involving tetanus toxoid (TT)
from a health care provider were identified. Patients were vaccinated on
three different dates; all experienced local reactions without
complications. Another cluster reported to VAERS in June 2003 involved an
undisclosed number of patients; a health care provider confused tetanus and
diphtheria toxoids (Td) vaccine for adult use (adsorbed) with PPD and
administered Td intradermally. Patients with adverse reactions to these
administrations had skin reactions interpreted as positive TSTs, which
resulted in treatment with isoniazid (INH). Review of the lot numbers on
products thought to be PPD revealed they were Td. Affected patients were
identified and retested with PPD; all TSTs were negative. INH was
discontinued, and no adverse reactions were observed.
As of March 2004, approximately 100 patients had been identified in reports
of TTCV administration instead of PPD. A total of 21 states have reported
both clusters and single cases. Vaccines substituted mistakenly for PPD
include Td (n = 13 reports), TT (n = 12), and diphtheria and tetanus toxoids,
(DT) adsorbed (n = five). For reports of Td, TT, and DT, products involved
included those manufactured by Aventis Pasteur and Wyeth (Collegeville,
Pennsylvania) and vaccines from other unspecified manufacturers. CDC and FDA
have initiated a full review of adverse events caused by inadvertent
administration of vaccines and PPD products reported to VAERS and the FDA
MedWatch Program. A preliminary review indicates that multiple vaccines
other than TTCVs have been involved.
Similarities in packaging of PPD and TTCVs might have contributed to the
medication errors. Both products require refrigeration and often are stored
side by side. Lack of availability of Td in single-dose syringes, resulting
in provider purchase of multiple-dose vials, was cited as a contributing
factor to medication error in one cluster. Conversely, at least eight
reports have been documented of inadvertent substitution for vaccine
products, resulting in intramuscular administration of PPD (FDA, unpublished
data, 2004).
Health care providers should consider ways to prevent vaccine
misadministration. As more vaccines and combination products become
available, the potential for medication errors might increase. Possible
measures to prevent misadministration should include pharmacy dispensing of
vaccines when feasible, physical separation of products, careful visual
inspection and reading of labels, preparation of PPD for patient use only at
time of testing, and improved record keeping of lot numbers of vaccines and
other injectable products. Prevention of such errors through barcode
scanning technology is the goal of a recent FDA rule requiring individual
drug packages to have identifying barcodes. For health care facilities that
possess such technology, package scanning could help prevent errors made
during pharmacy dispensing of products or during vaccine or PPD
administration. In addition, the Product Identification Guide for Routine
Vaccines is a helpful resource for distinguishing commonly used vaccine
products; the guide can be ordered from the California Department of Health
Services, telephone (619) 594-5933. [IAC EXPRESS Editor's Note: the guide
can also be ordered online at
http://cdlhn.com//clickhere.cfm?type=p&id=157&title=Posters] Adverse
events associated with inadvertent vaccine administration can be reported to
VAERS at http://www.vaers.org or
by telephone, (800) 822-7967. Adverse events after PPD administration can be
reported to the FDA MedWatch program at
http://www.fda.gov/medwatch or
by telephone, (800) 332-1088.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5329a5.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5329.pdf
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August 2, 2004
REMINDER: AUGUST 19 IS THE DATE FOR CDC'S SATELLITE BROADCAST "IMMUNIZATION
UPDATE 2004"
The live satellite broadcast and webcast "Immunization Update 2004" will
provide up-to-date information on the rapidly changing field of
immunization. Following is the anticipated course content: new
recommendations for influenza vaccine, including routine vaccination of
children ages 6-23 months and expanded use of live attenuated intranasal
vaccine; pneumococcal conjugate vaccine shortage; varicella vaccine; and
vaccine safety issues.
Sponsored by CDC, the live broadcast is scheduled for August 19 from 9AM to
11:30AM ET. It will be rebroadcast later in the day from noon to 2:30PM ET.
Both broadcasts will feature a live Q&A session in which participants
nationwide can interact with the course instructors via toll-free telephone
lines.
The course instructors are William L. Atkinson, MD, MPH; Donna Weaver, MN,
RN; Sharon Roy, MD, MPH; and Andrew Kroger, MD, MPH. All are with the CDC's
National Immunization Program.
The program's intended audience includes physicians, nurses, nurse
practitioners, physician assistants, Department of Defense
paraprofessionals, pharmacists, and their colleagues who either administer
vaccines or set policy for their offices, clinics, or communicable disease
or infection control programs. Private and public health care providers,
including pediatricians, family physicians, residents, and medical and
nursing students are encouraged to participate.
You DO NOT need to register to participate in the webcast. ONLINE
REGISTRATION IS REQUIRED TO RECEIVE CONTINUING EDUCATION CREDITS. To
register, go to:
http://www.phppo.cdc.gov/phtnonline
Pharmacists can earn continuing education credit through their own online
learning system. To register, pharmacists should go to:
http://www.pharmacist.com
For additional information, go to
http://www.cdc.gov/nip/ed/_satellite_broadcasts.htm#2, email
ce@cdc.gov or call (800) 418-7246.
The program will have a live webcast at
http://www.phppo.cdc.gov/phtn/webcast/immup2004
For technical support and to prepare for the webcast ahead of time, go to:
http://www.phppo.cdc.gov/phtn/webcast/webtest/technical.asp
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August 2, 2004
GLMA DEVELOPS NEW HEPATITIS PREVENTION MATERIALS FOR MSM
[The following is cross posted from the Immunization Action Coalition's "HEP
EXPRESS" electronic newsletter, 7/28/04.]
The Gay & Lesbian Medical Association (GLMA) has developed a new brochure
and matching poster to prevent vaccine-preventable hepatitis (VPH) in men
who have sex with men (MSM). These glossy, full-colored materials are
stylish and eye-catching.
The lead-in message states "Vaccine-preventable hepatitis (VPH) is... joint
pain, nausea, fever, loss of appetite, liver cancer, death, extreme
tiredness, headache, yellow skin, dark urine, yellow eyes, bloated
stomach... vaccine preventable." The brochure clearly explains the risk
factors for hepatitis A and hepatitis B, and the vaccination options.
The MSM educational materials are available from GLMA free of charge by
sending an email to info@glma.org or calling GLMA at (415) 255-4547.
Brochures are packaged in sets of ten; posters individually. Please provide
a complete mailing address and phone number.
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August 2, 2004
JULY 28 ISSUE OF IAC'S "HEP EXPRESS" ELECTRONIC NEWSLETTER NOW AVAILABLE
ONLINE
The July 28 issue of "HEP EXPRESS," an electronic newsletter published by
IAC, is now available online. "HEP EXPRESS" is intended for health and
social service professionals involved in the prevention and treatment of
viral hepatitis. The July 28 issue includes articles on the following:
- Two online physician resources: a guide to
chronic hepatitis B treatment and a CME course on current issues in
hepatitis B
- New hepatitis prevention materials for men
who have sex with men (see article #5 above)
- The 2004 "Answer to Cancer" fund-raising
race in support of the Asian Liver Center, Hepatitis B Foundation,
American Liver Foundation, and MD Anderson Cancer Center
- The Summer 2004 issue of the Hepatitis B
Foundation's newsletter, "B Informed"
- New online resources posted on the Viral
Hepatitis Prevention Board's website
To access the July 28 issue, go to:
http://www.hepprograms.org/hepexpress/issue19.asp
To sign up for a free subscription to "HEP EXPRESS," go to:
http://www.hepprograms.org/hepexpress/signup.asp
To access previous issues of "HEP EXPRESS," go to:
http://www.hepprograms.org/hepexpress/index.asp
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August 2, 2004
DON'T MISS OUT: REGISTER TODAY FOR THE NATIONAL CONFERENCE ON IMMUNIZATION
COALITIONS
The National Conference on Immunization Coalitions will be held September
20-22 in Norfolk, VA. Leaders of immunization coalitions well meet to
discuss resources for funding, models of coalition activities to increase
community awareness and immunization rates, information on how to advocate
for legislative change, and more.
This year's conference theme is "Chart Your Coalition's Course for Norfolk."
It sums up the conference's primary goal, which is to provide training in
creating, leading, and sustaining effective local and state coalitions that
address childhood, adolescent, and adult immunization. This year's program
will also focus on coalitions as agents of social change, elements of
successful coalitions, and social and ethnic diversity in coalitions.
Physicians, nurses, community-based health care providers, health educators,
social workers, managed care organizations, grass roots community-based
organizations, and individuals are encouraged to participate, even if
immunization is not the focus of their health coalition work.
For comprehensive information on the conference, including the conference
brochure, go to:
http://www.cme.hsc.usf.edu/coph/immcoal
To register online, go to:
https://www.cme.hsc.usf.edu/coph/iz/register.html
For additional information, email
conted@hsu.usf.edu or call (888) 873-2674, press "2," and reference
the Immunization Conference.
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August 2, 2004
SEPTEMBER 10 IS THE REGISTRATION DEADLINE FOR CHOP'S VACCINE EDUCATION
SYMPOSIUM
The Vaccine Education Center at the Children's Hospital of Philadelphia
(CHOP) will host its fourth annual Vaccine Education Symposium on September
18 in Philadelphia. The registration deadline is September 10.
The one-day course will focus on the health of the U.S. vaccine
infrastructure in light of recent vaccine shortages, new vaccines, practical
considerations for administering influenza vaccine in an office-based
setting, and the value and limitations of meningococcal vaccination of all
adolescents.
The faculty includes Paul A. Offit, MD, Vaccine Education Center at CHOP;
Walter A. Orenstein, MD, Emory Vaccine Center, Atlanta; Emilio Emini, PhD,
International AIDS Vaccine Initiative, New York; Bruce Gellin, MD, National
Vaccine Program Office, Washington, DC; and Michael Torrence, MD, Children's
Medical Associates, Ridley Park, PA.
To access a camera-ready (PDF) copy of the symposium brochure, go to:
http://www.chop.edu/cme/2004/Vaccine/images/vaccine_2004.pdf
Registration is required. To register online, go to:
https://www.chop.edu/cme/2004/Vaccine/regis.cfm
For additional information or to have the symposium brochure
mailed to you, contact Glorene Ford by email at
fordg@email.chop.edu or by phone at (215) 590-5263.
To visit the Vaccine Education Center website, go to:
http://www.chop.edu/consumer/jsp/microsite/microsite.jsp?id=75918
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August 2, 2004
UPDATE: "CDC PUBLIC HEALTH LAW NEWS" ELECTRONIC NEWSLETTER
SWITCHES TO WEEKLY FORMAT
Begun as a daily in July 2003, the "CDC Public Health Law News"
electronic newsletter is now being distributed on a weekly
basis. Published by the CDC Public Health Law Program, the
newsletter is intended for persons who wish to keep up with
developments in public health law, regulation, legislation, and
related topics.
The newsletter contains abstracts of current news stories on
public health law and related subjects; announcements from
publications related to public health law, conferences,
Congressional hearings, and other events; a news quotation of
the day; and other timely material.
For a free subscription, go to:
http://www.cdc.gov/subscribe.html
To access the most recent issue or search back issues, visit the
CDC Public Health Law Program web site at
http://www.phppo.cdc.gov/od/phlp |
