Issue
Number 539
July 25, 2005
CONTENTS OF THIS ISSUE
- New: Provisional ACIP recommendations for combined
tetanus-diphtheria-pertussis vaccine are posted on NIP's website
- New: Interim VISs now available for both injectable and
intranasal influenza vaccines
- July issue of CDC's Immunization Works electronic
newsletter now available on the NIP website
- Updated: IAC revises a professional education piece on
preventing perinatal hepatitis B virus transmission
- Pharmacists and medical assistants: NIP needs you to
pilot test its training programs
- Oregon's Answer to Cancer race--a fund raiser for
hepatitis B virus infection and liver cancer--is scheduled for August 6
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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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July 25, 2005
NEW: PROVISIONAL ACIP RECOMMENDATIONS FOR COMBINED
TETANUS-DIPHTHERIA-PERTUSSIS VACCINE ARE POSTED ON NIP'S WEBSITE
NIP recently posted on its website the provisional ACIP recommendations for
combined tetanus-diphtheria-pertussis (Tdap) vaccine for use in adolescents.
The recommendations will become effective after they are reviewed by the
director of CDC and the Department of Health and Human Services and will
become official when published in the MMWR. Portions of the provisional
recommendations are reprinted below.
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ADVISORY COMMITTEE ON IMMUNIZATION PRACTICE (ACIP) VOTES TO RECOMMEND
ROUTINE USE OF COMBINED TETANUS, DIPHTHERIA, AND PERTUSSIS (Tdap) VACCINES
FOR ADOLESCENTS
Two Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis
Vaccine, Adsorbed (Tdap) products were licensed by the FDA in 2005 as
single-dose booster vaccines to provide protection against tetanus,
diphtheria, and pertussis. Glaxo-Smith-Kline's BOOSTRIX is indicated for
persons aged 10-18 years (www.fda.gov/cber/label/tdapgla050305LB.pdf),
and sanofi pasteur's ADACEL is indicated for persons aged 11-64 years (www.fda.gov/cber/label/tdapave061005LB.pdf).
On June 30, 2005, the Advisory Committee on Immunization Practices (ACIP)
voted to recommend the routine use of Tdap vaccines in adolescents aged
11-18 years in place of tetanus and diphtheria toxoids (Td) vaccines (www.cdc.gov/nip/pr/pr_tdap_jun2005.htm).
Pertussis is a highly contagious respiratory tract infection; immunity from
childhood vaccination wanes over time, leaving adolescents susceptible. In
2003, U.S. adolescents aged 11-18 years made up 36% (4,144) of the total
11,647 reported cases; reported cases underestimate the true burden of
pertussis in adolescents. The clinical presentation of pertussis in
adolescents ranges from mild cough illness to classic pertussis (i.e.,
paroxysms of cough, post-tussive emesis, and inspiratory whoop). The
morbidity of pertussis in adolescents can be substantial with prolonged
cough illness lasting weeks to months. Hospitalization and complications
(e.g., pneumonia and rib fractures) occur in <=2% of reported cases.
Pertussis outbreaks in schools with adolescents are disruptive and lead to
significant public health control efforts.
The primary objective of the adolescent pertussis booster vaccination
program is to protect adolescents against pertussis. Key ACIP
recommendations for Tdap (single dose) and Td use in adolescents aged 11-18
years are summarized below. These ACIP recommendations are under review by
the Director of CDC and the Department of HHS and will become official when
published in CDC's Morbidity and Mortality Weekly Report (MMWR) (www.cdc.gov/mmwr).
Routine Tdap Vaccination in Adolescents 11-18 Years of Age
- Adolescents aged 11-18 years should
receive a single dose of Tdap instead of Td for booster immunization
against tetanus, diphtheria, and pertussis if they have completed the
recommended childhood DTP/DTaP vaccination series and have not received Td
or Tdap. The preferred age for Tdap vaccination is 11-12 years; routinely
administering Tdap to young adolescents will reduce the morbidity
associated with pertussis in adolescents.
- Adolescents aged 11-18 years who received
Td but not Tdap are encouraged to receive a single dose of Tdap to provide
protection against pertussis if they have completed the recommended
childhood DTP/DTaP vaccination series. A 5-year interval between Td and
Tdap is encouraged to reduce the risk of local or systemic reactions.
However, intervals shorter than 5 years between Td and Tdap can be used.
The benefits of protection from pertussis generally outweigh the risk of
local or systemic reactions in settings with increased risk from pertussis
(e.g., pertussis outbreaks and close contact with an infant aged <6
months).
- Vaccine providers should administer Tdap
(or Td) and tetravalent meningococcal polysaccharide-protein conjugate
vaccine ([MCV4] Menactra) (which contains diphtheria toxoid) during the
same visit if both vaccines are indicated and available (MCV4
recommendations are available at
www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm).
- Tdap (or Td) should be administered with
other vaccines that are indicated during the same visit when feasible.
Each vaccine should be administered using a separate syringe at different
anatomic sites. Some experts recommend administering no more than two
injections per deltoid, separated by one inch during one visit. . . .
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The provisional recommendations also include sections on the following: (1)
special situations for Tdap (single dose) and Td use in adolescents 11-18
years of age;(2) contraindications and precautions for Tdap/Td; (3)
reporting of adverse events after vaccination; and (4) future
considerations.
To access the provisional recommendations in their entirety go to:
http://www.cdc.gov/nip/vaccine/tdap/tdap_acip_recs.pdf
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July 25, 2005
NEW: INTERIM VISs NOW AVAILABLE FOR BOTH INJECTABLE AND INTRANASAL
INFLUENZA VACCINES
On July 18, NIP posted two interim VISs for influenza vaccine to its
website. Because influenza vaccine was recently added to the Vaccine
Injury Compensation Program, the final VISs for influenza vaccine are
being developed under a federally mandated process, which is time
consuming. Providers are encouraged to use the interim VISs until the
final VISs are issued, which may not happen until after the influenza
vaccination season is underway.
The interim VISs reflect changes outlined in "Prevention and Control of
Influenza: Recommendations of the Advisory Committee on Immunization
Practices (ACIP)," which was published July 13 as an electronic MMWR
"Early Release."
INTERIM VIS FOR TRIVALENT INACTIVATED INFLUENZA VACCINE (TIV)
Information in sections 1, 2, 3, 7, and 8 was changed. To access a
ready-to-print (PDF) version of the interim VIS (dated 7/18/05) from the
NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flu.pdf
To access it from the IAC VIS web section, go to:
http://www.immunize.org/vis/2flu.pdf
INTERIM VIS FOR LIVE INTRANASAL INFLUENZA VACCINE (LAIV)
Information in sections 1, 7, and 8 was changed. To access a
ready-to-print (PDF) version of the interim VIS (dated 7/18/05) from the
NIP website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-flulive.pdf
To access it from the IAC VIS web section, go to:
http://www.immunize.org/vis/liveflu.pdf
For information about the use of VISs, and for VISs in a total of 33
languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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July 25, 2005
JULY ISSUE OF CDC'S IMMUNIZATION WORKS ELECTRONIC NEWSLETTER NOW AVAILABLE
ON THE NIP WEBSITE
The July issue of Immunization Works, a monthly email newsletter published
by CDC, is available on NIP's website. The newsletter offers members of
the immunization community non-proprietary information about current
topics. CDC encourages its wide dissemination.
Some of the information in the July issue has already appeared in previous
issues of IAC Express. Following is the text of two articles we have not
covered.
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OTHER IMMUNIZATION NEWS
COULD UK MUMPS OUTBREAK IMPACT US? The United Kingdom is experiencing a
large outbreak of mumps. Since 2003, reported mumps cases in England and
Wales have been on the rise. During the 1990's only a few hundred cases
were reported annually. In 2004, 16,000 cases were reported, and as of
June 17th, the current total for 2005 is 40,367. Most impacted are young
adults 19-23 years of age, who are too old to have received two doses of
MMR vaccine in the UK's national vaccination program.
In the United States, high MMR vaccination levels in preschool, school,
and college-age students for the last 10-15 years have kept the number of
mumps cases low, less than 300 annually since 2001 (CDC, unpublished
data). However, given today's level of globalization, US physicians should
be prepared to recognize, confirm, and report cases of mumps suspected in
both US- and foreign-born individuals. Physicians should also review the
vaccination histories of their patients and provide all indicated
vaccines. Imported mumps cases may spread in unvaccinated populations,
including infants too young to be vaccinated and persons who are
unvaccinated for medical, religious, or philosophical reasons. To view a
recent article on this topic, please visit
http://bmj.bmjjournals.com/cgi/content/full/331/7508/E363
ACIP MEETING: The Advisory Committee on Immunization Practices (ACIP) held
a meeting on June 29-30, 2005, in Atlanta, Georgia. Minutes from the
meeting are forthcoming and will be posted at the ACIP website:
http://www.cdc.gov/nip/acip/default.htm In addition, Immunization
Works will publish information about the new recommendations in its August
issue.
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To access the complete July issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2005/200507.htm
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July 25, 2005
UPDATED: IAC REVISES A PROFESSIONAL EDUCATION PIECE ON PREVENTING
PERINATAL HEPATITIS B VIRUS TRANSMISSION
IAC recently updated its one-page professional-education piece "Labor &
Delivery and Nursery Unit Guidelines to Prevent Hepatitis B Virus
Transmission." The primary revision was to add emphasis to the information
about the hepatitis B vaccine birth dose. When MMWR publishes the new ACIP
hepatitis B recommendations for children, IAC will update this piece
again.
To access a ready-to-print (PDF) version of the revised piece, go to:
http://www.immunize.org/catg.d/p2130per.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p2130.htm
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July 25, 2005
PHARMACISTS AND MEDICAL ASSISTANTS: NIP NEEDS YOU TO PILOT TEST ITS
TRAINING PROGRAMS
NIP/CDC is currently seeking pharmacists and medical assistants who would
be willing to volunteer to pilot test NIP training programs. These are
mostly self-study courses that can be completed on the Internet. The
typical pilot test involves reviewing a specific course, taking the course
evaluation, and providing feedback. It takes from two to four hours.
CDC is seeking pharmacists and medical assistants as these two groups are
under-represented in its current pool of volunteers. Pilot testers can
obtain continuing education (CE) credits once the training program becomes
approved for such credit. To volunteer, contact Melissa Barnett at
mbarnett2@cdc.gov or at (404)
639-6202. If you know of pharmacists or medical assistants who might be
interested, please forward this message to them.
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July 25, 2005
OREGON'S ANSWER TO CANCER RACE--A FUND RAISER FOR HEPATITIS B VIRUS
INFECTION AND LIVER CANCER--IS SCHEDULED FOR AUGUST 6
IAC recently posted the following to its Calendar of Events web section:
2005 ANSWER TO CANCER RACE.
SCHEDULED FOR August 6 at Evergreen Aviation Museum, McMinnville, OR;
registration begins at 7:30AM.
BACKGROUND INFORMATION: The Answer to Cancer race is the flagship
fund-raising event for the Answer To Cancer Foundation. This year the
funds raised will benefit the Jade Ribbon Campaign, Asian Liver Center,
Stanford University; the MD Anderson Cancer Institute, University of
Texas, Houston; the Hepatitis B Foundation, Doylestown, PA; and the
Willamette Valley Cancer Care Center, McMinnville, OR.
FOR RACE INFORMATION, including course info, online registration, pledge
raising, and sponsors, go to:
http://www.answertocancer.org/raceinfo/index.html
TO DONATE ONLINE, go to:
http://www.answertocancer.org Click on Make a Donation in the left
column.
FOR INFORMATION ON ADDITIONAL EVENTS of interest to those in the
immunization community, visit the IAC Calendar of Events web section at
http://www.immunize.org/calendar |
