Issue
Number 474
August 9, 2004
CONTENTS OF THIS ISSUE
- Official CDC Health Advisory reports confirmed case of measles on an
airline flight from Hong Kong to New York
- VIS update: CDC issues revised VIS for hepatitis A vaccine
- CDC reports on transmission of hepatitis B virus in Georgia
correctional facilities
- CDC reports on hepatitis B vaccination of inmates in Texas
correctional facilities
- If you vaccinate adults, you can't afford to be without the "Adults
Only Vaccination" kit
- IAC makes minor changes to its English and Spanish patient-education
piece "All kids need hepatitis B shots!"
- NPI honors recipients of its Excellence in Immunization awards
- NIP web section presents detailed information on needle-free injection
technology
- NIP's free web-based training course on smallpox vaccine storage and
handling is approved for CME credit
- WHO announces resumption of polio immunization campaigns in Kano,
Nigeria
- SIGN's annual meeting scheduled for October 20-22 in Cape Town, South
Africa
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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 9, 2004
OFFICIAL CDC HEALTH ADVISORY REPORTS CONFIRMED CASE OF MEASLES ON AN AIRLINE
FLIGHT FROM HONG KONG TO NEW YORK
On August 1, CDC issued an Official CDC Health Advisory about a confirmed
case of measles identified on an airline flight to New York. On August 2,
CDC issued an Official Health Update correcting some misinformation
contained in the health advisory. Following is the corrected version of the
August 1 health advisory.
********************
This is an official CDC HEALTH ADVISORY
Distributed via Health Alert Network
Sunday, August 01, 2004, 19:51 EDT (7:51PM EDT)
IMPORTED CASE OF MEASLES IDENTIFIED ON AIRLINE FLIGHT INTO NEW YORK
On July 31, 2004, the New York City Department of Health and Mental Hygiene
and CDC were notified of a case of measles in a 2-year-old child. The case
was laboratory confirmed at the NYC public health laboratory on 7/31/04. The
child was returning to the US from travel to Hong Kong, Thailand, and China.
The child did not have a rash but was in the infectious stage of measles
illness during the flight. The child had not been vaccinated against measles
according to the international certificate of vaccination that the
mother had; two siblings did have documentation of previously receiving MMR.
The index case flew non-stop from Hong Kong to New York, arriving on July
30, 2004, at approximately 1:40PM on Cathay Pacific flight 830 at John F.
Kennedy International Airport. Passengers from this flight reside in
California, Connecticut, Washington DC, Florida, Georgia, Massachusetts,
Maryland, Missouri, North Carolina, New Jersey, New Hampshire, New York
City, New York State, Ohio, Pennsylvania, Puerto Rico, Texas, and Virginia.
The Quarantine Station at JFK International Airport is overseeing notifying
jurisdictions of the names of passengers from the flight. Inquiries
regarding passenger names should be directed to the Quarantine Station at
(718) 553-1685.
CDC estimates that exposures to measles occur, on average, 10-12 times per
year, on commercial aircraft arriving in the United States. The risk of
infection following this type of exposure in airline contacts is considered
low; CDC has only rarely identified measles cases that apparently resulted
from such exposures.
State Public Health Departments and health care providers should be alert to
possible cases of measles in persons who traveled on the July 30th Cathay
Pacific flight number 830 or their contacts. Health care providers should
increase their index of suspicion for measles in clinically compatible cases
and notify their local health department of a suspect measles case
immediately. It is important to obtain travel histories from the patient and
their family, as well as their close contacts. State health departments
should report suspect measles cases immediately to CDC. Persons generally
can be presumed immune to measles if they have documentation of 2 doses of
measles vaccine, laboratory evidence of immunity to measles, documentation
of physician-diagnosed measles, or were born before 1957. Persons who are
not immune should be given MMR vaccine or immune globulin according to ACIP
recommendations.
Measles is an acute disease characterized by fever, cough, coryza, an
erythematous maculopapular rash and a pathognomonic enanthem (Koplik's
spots). Measles has an incubation period of 7-21 days, and infected people
are considered contagious from 4 days before to 4 days after the appearance
of rash. Serologic (Measles IgM) testing is required to confirm the
diagnosis. In addition to serologic specimens, health departments should
collect throat swabs and urine for viral isolation.
Further information on measles can be found at
http://www.cdc.gov/ncidod/diseases/submenus/sub_measles.htm
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August 9, 2004
VIS UPDATE: CDC ISSUES REVISED VIS FOR HEPATITIS A VACCINE
On August 4, CDC issued a revised VIS for hepatitis A vaccine. The previous
VIS for hepatitis A vaccine was issued on 8/25/98. If you have VISs with
that date, discard them, and download and print the revised VIS from either
the NIP website or the IAC website. Currently, only English-language
versions of the revised VIS are available. IAC EXPRESS will alert readers as
translations become available.
PLEASE NOTE: When hepatitis A vaccine is added to the Vaccine Injury
Compensation Program's injury table, presumably later in 2004, another
hepatitis A vaccine VIS will be issued. To avoid large printing expenses,
print off only as many of the 8/4/04 VISs as you anticipate needing for the
next several months.
To access a ready-to-copy (PDF) version of the 8/4/04 hepatitis A vaccine
VIS from the NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-hep-a.pdf
To access it from the IAC website, go to:
http://www.immunize.org/vis/v-hepa.pdf
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August 9, 2004
CDC REPORTS ON TRANSMISSION OF HEPATITIS B VIRUS IN GEORGIA CORRECTIONAL
FACILITIES
CDC published "Transmission of Hepatitis B Virus in Correctional
Facilities--Georgia, January 1999-June 2002" in the August 6 issue of MMWR.
Reprinted below is a portion of the article, as well as the entire press
summary.
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[The article's opening paragraph]
Incarcerated persons have a disproportionate burden of infectious diseases,
including hepatitis B virus (HBV) infection. Among U.S. adult prison
inmates, the overall prevalence of current or previous HBV infection ranges
from 13% to 47%. The prevalence of chronic HBV infection among inmates is
approximately 1.0%-3.7%, two to six times the prevalence among adults in the
general U.S. population. Incarcerated persons can acquire HBV infection in
the community or in correctional settings. This report summarizes the
results of (1) an analysis of hepatitis B cases among Georgia inmates
reported to the Georgia Department of Human Resources, Division of Public
Health (DPH) during January 1999-June 2002, including a retrospective
investigation of cases reported during January 2001-June 2002; and (2) a
prevalence survey conducted in prison intake centers during February-March
2003. These efforts identified cases of acute hepatitis B in multiple
Georgia prisons and documented evidence of ongoing transmission of HBV in
the state correctional system. The findings underscore the need for
hepatitis B vaccination programs in correctional facilities. . . .
[The complete press summary]
All inmates who receive a medical evaluation in a correctional facility
should be administered hepatitis B vaccine to prevent ongoing hepatitis B
virus transmission in correctional facilities and to reduce transmission in
the community after incarceration.
Between January 2001-June 2002, 57 cases of acute hepatitis B virus
infection (HBV) were identified among inmates at 31 long-term correctional
facilities in Georgia. The majority of cases (72%) were acquired in prison,
indicating ongoing HBV transmission occurred in correctional facilities. The
extent of HBV transmission among inmates might be underestimated since most
persons with acute HBV infection are asymptomatic and investigations of
single cases are not routinely conducted. A survey at intake centers also
showed most incoming inmates were susceptible to HBV and accepted hepatitis
B vaccination (76% and 78% respectively). The ongoing transmission
demonstrated in Georgia prisons might be occurring in other states, where
similar conditions are likely to exist. Routine hepatitis B vaccination of
inmates would interrupt HBV transmission among inmates during incarceration
and reduce transmission in the community after incarceration.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5330a2.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5330.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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August 9, 2004
CDC REPORTS ON HEPATITIS B VACCINATION OF INMATES IN TEXAS CORRECTIONAL
FACILITIES
CDC published "Hepatitis B Vaccination of Inmates in Correctional
Facilities--Texas, 2000-2002" in the August 6 issue of MMWR. Reprinted
below is a portion of the article, as well as the entire press summary.
***********************
[The article's opening paragraph]
In December 2002, approximately 2.2 million persons were incarcerated in the
United States; an estimated 8 million were released to the community that
year. In 2001, approximately 22,000 acute hepatitis B cases and 78,000 new
hepatitis B virus (HBV) infections occurred in the United States; an
estimated 29% of these cases were in persons who had been incarcerated
previously. The majority of HBV infections among incarcerated persons are
acquired in the community; however, infection also is transmitted within
correctional settings. Hepatitis B vaccination of incarcerated persons is
recommended to prevent transmission in correctional facilities and in
previously incarcerated persons on their return to the community. In May
2000, the Texas Department of Criminal Justice (TDCJ), which oversees
custody of state jail and prison inmates, implemented a hepatitis B
vaccination program. To determine hepatitis B vaccination rates of inmates
during 2000-2002, TDCJ reviewed charts of inmates released during a 3-day
period for documentation of vaccination. This report summarizes the results
of that study, which indicated that rates of vaccine acceptance and vaccine
series completion among inmates were high. Establishing hepatitis B
vaccination programs in prisons and jails can prevent a substantial
proportion of HBV infections among adults in the outside community. . . .
[The complete press summary]
Vaccinating offenders in jails and prisons is feasible, and may prevent
about 30% of new acute hepatitis B cases in the United States.
Hepatitis B vaccination in prison has the potential to prevent a substantial
portion of hepatitis B cases in the United States, since approximately 30%
of reported acute hepatitis B cases are among individuals who have been
incarcerated. Although hepatitis B vaccination in correctional facilities
has been recommended for over 20 years, only five states have implemented
vaccination programs. The Texas Department of Criminal Justice implemented a
hepatitis B vaccination program in its prisons and jails, and proved that
vaccinating inmates was feasible and was well accepted by inmates and staff.
The large majority of both prison and jail inmates accepted the first dose
of vaccine when offered. Ninety-six percent of prison inmates incarcerated
for 4 months or more received all three vaccine doses.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5330a3.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5330.pdf
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August 9, 2004
IF YOU VACCINATE ADULTS, YOU CAN'T AFFORD TO BE WITHOUT THE "ADULTS ONLY
VACCINATION" KIT
THE GOOD NEWS: More and more adults are being vaccinated, not only at
doctors' offices but also at non-traditional sites, such as family planning
clinics, college health services, STD clinics, pharmacies, and prisons.
THE BEST NEWS: IAC has collected ALL the information you need to vaccinate
adults into one user-friendly kit--"Adults Only Vaccination: A Step-by-Step
Guide" (the AOV kit).
WHAT IS THE AOV KIT? The kit pares down immunization delivery to its
essential components and presents each component in manageable,
easy-to-master steps. The steps progress in logical order, starting with
setting up a vaccine service at your site and ending with billing for the
vaccine services you've delivered.
WHAT'S IN THE KIT? The heart of the kit is the guide, which presents 157
pages of comprehensive, authoritative, CDC-reviewed information on ALL
aspects of adult immunization. Organized into seven logically presented
steps, the guide is designed to be useful and stay current for years: it has
more than 45 patient and provider-education materials that will never go out
of date because each is linked to the latest version on IAC's website.
Plus, the guide is tabbed for easy reference, spiral bound to lie flat, and
plastic coated for durability. And, it has wide margins for jotting down
practical information such as useful web and email addresses, ideas for
improving certain aspects of vaccine delivery, etc. This allows you to
customize your guide to suit your clinic or practice's unique needs.
In addition to the guide, the kit contains the following:
- Two "how-to" instructional
videos--"Immunization Techniques: Safe, Effective, Caring" and "How to
Protect Your Vaccine Supply"
- Standing orders protocols for
administering eight vaccines commonly given to adults; these are
indispensable for increasing your clinic or practice's adult immunization
rates
- Vital information for responding to
vaccine-related medical emergencies, such as anaphylaxis, or to power
outages
- A pack of 25 adult immunization record
cards
WHO SUPPORTS THE KIT? Immunization experts
from NIP/CDC reviewed the kit. In addition, the following government
agencies signed the guide's introductory letter: US Department of Health and
Human Services (Women's Health); several divisions within CDC: the Division
of HIV/AIDS Prevention, Division of Sexually Transmitted Diseases
Prevention, and Division of Viral Hepatitis. The following professional
organizations also signed the letter: the American College Health
Association, American College of Obstetricians and Gynecologists, American
Medical Association, National Medical Association, and Planned Parenthood
Federation of America.
WHO NEEDS THE KIT? Designed to help integrate immunization services into
sites new to vaccination, the AOV kit is equally valuable for settings
experienced in vaccine delivery. Why? Because it puts ALL the information
you need to vaccinate adults right at your fingertips. If you currently find
any aspect of adult vaccination confusing, the kit will clarify the issue or
give you resources for getting clarification. IF YOU VACCINATE ADULTS, YOU
CAN'T AFFORD TO BE WITHOUT THE KIT.
WHAT'S THE PRICE: The kit costs $75. Special discount pricing is available
for orders of 10 or more (see the link below).
CAN I GET MORE INFORMATION ABOUT THE KIT? You can get complete
information--including a look at the guide's many worksheets, checklists,
protocols, and educational materials--by visiting IAC's website at
http://www.immunize.org/guide
HOW CAN I ORDER THE KIT? You can order online or by fax or mail,
using a credit card, purchase order, or check. To order, go to:
http://www.immunize.org/guide Click on the
appropriate link.
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August 9, 2004
IAC MAKES MINOR CHANGES TO ITS ENGLISH AND SPANISH PATIENT-EDUCATION PIECE "ALL KIDS NEED HEPATITIS B SHOTS!"
IAC recently reviewed some of its older patient-education pieces
and made minor revisions to the English and Spanish versions of
one: "All kids need hepatitis B shots!"
To access a ready-to-copy (PDF) version of the updated "All kids
need hepatitis B shots!" in English, go to:
http://www.immunize.org/catg.d/4055kidb.pdf
To access it in Spanish, go to:
http://www.immunize.org/catg.d/4055sp.pdf
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August 9, 2004
NPI HONORS RECIPIENTS OF ITS EXCELLENCE IN IMMUNIZATION AWARDS
As part of National Immunization Awareness Month, the National
Partnership for Immunization (NPI) honored recipients of its
Excellence in Immunization awards on July 29 at a ceremony in
Washington, DC. Following is information about program
recipients:
ADDRESSING DISPARITIES AWARDS went to two recipients:
- The Pennsylvania Department of Health, Division of
Immunization/Adult Immunization Enhancement Project in
2003 vaccinated historically underimmunized minority
populations with more than 32,000 doses of influenza vaccine
and more than 1,300 doses of pneumococcal vaccine. For
information, contact Joeanne Maljevac, RN, BC, BSN, at
(717) 787-5681.
- The Turley Family Health Center, Pinellas County, Florida,
increased the number of doses of pediatric vaccines in a
medically underserved neighborhood from 750 doses in 2001 to
4,115 doses in 2003. For information, contact George Hutter,
MD, at (727) 467-2503.
CAMPAIGN AWARDS went of two recipients:
- The Alabama Quality Assurance Foundation's "IZ Alabama
Covered?" Flu and Pneumonia Prevention Campaign aims
to increase influenza and pneumococcal vaccination rates
among senior adults. Recent data show a 66% increase in the
volume of doses of influenza vaccine administered in Alabama
from 2002 to 2003. For information, contact Betsy S. Frazer,
RN, BS, at (205) 970-1600 x3511.
- Visiting Nurse Service,Inc.'s (VNS) Immunization Programs are
helping raise disease awareness and vaccination use in
Indianapolis. The number of influenza and pneumococcal
vaccines given by VNS increased by 22% from 2002 to 2003. VNS
has also raised meningococcal disease awareness and vaccine
use among high school seniors. For information, contact Judy
Moon at (317) 722-8200.
THE NONTRADITIONAL PARTNER AWARD went to the Southeast Michigan
Partners Project, which brings together distinct communities,
including insurers, employers, and public health and other
stakeholders to develop projects that promote and implement
adult immunization services. For information, contact Terrisca
Des Jardins, MHSA, at (734) 769-1247.
THE PROVIDER AWARD went to Norman Regional Hospital, which has
evaluated nearly 33,000 patients since 2000 and administered
more than 5,200 doses of pneumococcal vaccine to eligible
patients. For information, contact Yvette Morrison at
(405) 307-1955.
For additional information on the award-winning projects, go to:
http://www.partnersforimmunization.org/2004recipients.html
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August 9, 2004
NIP WEB SECTION PRESENTS DETAILED INFORMATION ON NEEDLE-FREE
INJECTION TECHNOLOGY
NIP's web section Needle-free Injection Technology offers a
wealth of information on the technology involved in
administering vaccines and drugs through the skin without the
use of conventional needles. The section provides background
information, scientific bibliography, history, and links to news
reports, policy sources, device manufacturers, and related
sites.
Among the resources available is the "Needle-free Injection
Technology News Service," which distributes news and related
information by WebBoard forum postings and email broadcasts. To
browse as a guest or to subscribe, go to:
http://vaxdev.forum.cdc.gov
To access all the offerings on the Needle-free Injection
Technology web section, go to:
http://www.cdc.gov/nip/dev/jetinject.htm
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August 9, 2004
NIP's FREE WEB-BASED TRAINING COURSE ON SMALLPOX VACCINE STORAGE
AND HANDLING IS APPROVED FOR CME CREDIT
NIP and CDC recently announced the release of Smallpox Vaccine
Storage and Handling, a free interactive web-based training
course approved for CME credit.
Presented in four modules, the course covers vaccine
distribution, vaccine storage, vaccine preparation and
administration, and procedures and equipment to safeguard the
vaccine during an emergency. The intended audience includes
state and local health department staff; hospital emergency room
technicians, nurses, laboratory workers, and hospital
physicians; private physicians; and first responders.
To access additional information and the course itself, go to:
http://www2.cdc.gov/nip/isd/spoxvsh/launch1.html
Email nipinfo@cdc.gov with questions and comments.
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August 9, 2004
WHO ANNOUNCES RESUMPTION OF POLIO IMMUNIZATION CAMPAIGNS IN
KANO, NIGERIA
On August 3, WHO issued a statement on behalf of the Global
Polio Eradication Initiative welcoming the resumption of polio
immunization campaigns in Kano, Nigeria. The first round of
campaigns began in Kano on July 31. Additional campaigns are
planned from September to November throughout Nigeria.
The statement reported that Kano's decision to vaccinate
children against polio comes at a critical time in the polio
eradication program. Sub-Saharan Africa is on the verge of the
largest polio epidemic in recent history. Because of the
outbreak that originated in Kano and surrounding states, polio
cases recorded in the region are five times greater than they
were during the same period in 2003 (483 compared with 95).
To access the complete statement, go to:
http://www.who.int/mediacentre/statements/2004/statement4/en/print.html
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August 9, 2004
SIGN'S ANNUAL MEETING SCHEDULED FOR OCTOBER 20-22 IN CAPE TOWN,
SOUTH AFRICA
The Safe Injection Global Network (SIGN) recently announced it
will hold its annual meeting on October 20-22 in Cape Town,
South Africa. The meeting has four objectives:
- Exchange information regarding global progress toward the
safe and appropriate use of injections worldwide
- Review progress of the various injection safety demonstration
projects in Africa
- Review progress of the three WHO needle-stick prevention
projects
- Review progress in infection control
activities in Africa
For additional information, go to:
http://www.who.int/injection_safety/en
Persons interested in participating in the meeting are
encouraged to email the SIGN secretariat at
sign@who.int |
