Issue
Number 569
December 12, 2005
CONTENTS OF THIS ISSUE
- CDC publishes guidelines on antimicrobials recommended
for treatment and postexposure prophylaxis of pertussis
- NIP issues updated version of the provisional
recommendation for vaccinating adolescents with Tdap vaccine
- December Immunization Works newsletter focuses on the
billions routine childhood immunization saves each year
- HHS starts a process to integrate pandemic influenza
planning at federal, state, and local levels
- CDC report on epidemiology of measles in U.S. in 2004
indicates only 37 reported cases, a new one-year low
- New: Current Issues in Immunization Net Conference to
focus on new hepatitis A vaccine recommendations
- MMWR notifies readers that FDA approved lowering the age
limit for Havrix hepatitis A vaccine to 12 months
- Errata: MMWR corrects errors in its December 2 article
on licensure of measles-mumps-rubella-varicella vaccine
- New: Current VISs for injectable and nasal-spray
influenza vaccines now available in Russian and Somali
- New: Interim VIS for meningococcal vaccine now
available in Russian and Somali
- Before the holiday rush, take time to register for
CDC's 2006 National Immunization Conference
- Johns Hopkins/UNICEF report makes the case for
investing in immunization communication
- CDC updates its Influenza web section
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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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December 12, 2005
CDC PUBLISHES GUIDELINES ON ANTIMICROBIALS RECOMMENDED FOR TREATMENT AND
POSTEXPOSURE PROPHYLAXIS OF PERTUSSIS
CDC published "Recommended Antimicrobial Agents for Treatment and
Postexposure Prophylaxis of Pertussis: 2005 CDC Guidelines" in the December
9 issue of MMWR Recommendations and Reports. The article includes
information on disease burden, clinical manifestations, differential
diagnosis, prevention, treatment, general principles of treatment and
postexposure prophylaxis, and specific antimicrobial agents.
The introductory summary to the guidelines is reprinted below.
***********************
The recommendations in this report were developed to broaden the spectrum of
antimicrobial agents that are available for treatment and postexposure
prophylaxis of pertussis. They include updated information on macrolide
agents other than erythromycin (azithromycin and clarithromycin) and their
dosing schedule by age group.
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To access a web-text (HTML) version of the guidelines, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm
To access a ready-to-print (PDF) version of them, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5414.pdf
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December 12, 2005
NIP ISSUES UPDATED VERSION OF THE PROVISIONAL RECOMMENDATION FOR VACCINATING
ADOLESCENTS WITH Tdap VACCINE
On December 9, NIP posted to its Provisional ACIP Recommendations web page
an updated version of the provisional recommendation for vaccinating
adolescents with Tdap vaccine. The updated version includes a new
recommendation for use in pregnancy.
To access a ready-to-print (PDF) version of the updated provisional
recommendation, go to:
http://www.cdc.gov/nip/vaccine/tdap/tdap_acip_recs.pdf
To access the Provisional ACIP Recommendations web page, go to:
http://www.cdc.gov/nip/recs/provisional_recs/default.htm
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December 12, 2005
DECEMBER IMMUNIZATION WORKS NEWSLETTER FOCUSES ON THE BILLIONS ROUTINE
CHILDHOOD IMMUNIZATION SAVES EACH YEAR
The lead article in the December issue of CDC's Immunization Works
newsletter focuses on an NIP study on the economic impact of routine
childhood immunizations. Much of the rest of information in the December
issue has already appeared in previous issues of IAC Express. Following is
the text of the lead article and three articles we have not covered
previously.
************************
ROUTINE CHILDHOOD IMMUNIZATIONS SAVE BILLIONS EACH YEAR
A recent study by CDC's National Immunization Program (NIP) evaluated the
impact of seven vaccines (DTaP, Td, Hib, polio, MMR, hepatitis B, and
varicella) routinely given as part of the childhood immunization schedule
and found that vaccines are tremendously cost effective. This is the first
time the seven vaccines have been examined together and with a common
methodology.
The study found that the use of these seven vaccines will prevent over 14
million cases of disease and over 33,500 deaths over the lifetime of
children born this year. When comparing the cost of the diseases they
prevent and the cost of administering them, these vaccines save nearly $10
billion per year. These vaccines also prevent the need for patients to spend
time seeking care and the need for parents to take time off work to care for
sick children. When including these and other prevented costs to society,
the annual savings exceed $40 billion.
A child is protected from vaccine-preventable diseases after receiving a
series of vaccines over time, not just one shot. Therefore, this economic
evaluation is groundbreaking in that previous studies demonstrating the cost
savings of childhood vaccination in the United States have only focused on
single vaccines. Expanding beyond the single-vaccine cost benefit
perspective provides policymakers better information about the economic
impact of the immunization program by examining a routine seven-vaccine U.S.
childhood immunization schedule.
This analysis will be helpful in understanding the economic effects of the
immunization program under current circumstances. Administrators and
policymakers may use the results to justify sustained support for programs,
make needed modifications, and guide future programs.
The publication--entitled "Economic Evaluation of the 7-Vaccine Routine
Childhood Immunization Schedule in the United States, 2001"--appears in the
December 2005 edition of the Archives of Pediatrics and Adolescent Medicine.
A summary can be found on the Archive website at
http://archpedi.ama-assn.org/cgi/content/short/159/12/1136
OTHER IMMUNIZATION NEWS
CDC SEEKS PUBLIC COMMENT: CDC is seeking public comment on the new CDC
Health Protection Research Guide, 2006-2015. The comment period, which began
on Friday, November 18, 2005, will last for 60 days, concluding on January
15, 2006.
The Research Guide will provide a comprehensive, long-range vision of
national and global public health needs that CDC and its partners can
address through research. The Research Guide will help identify critical
knowledge needed to achieve CDC's new Health Protection Goals, which are
designed to maximize the health impact of programs, services, and emergency
responses.
The Research Guide can be accessed, and comments can be submitted from a
public website:
http://www.rsvpBOOK.com/custom_pages/50942/index.php
Comments from CDC partners, stakeholders, and the public will be considered
in producing the final version the Research Guide, expected to be completed
in early 2006. For more information, please call Jamila Rashid, PhD, MPH, of
CDC's Office of Public Health Research, at (404) 639-4621 or send an email
to ResearchGuide@cdc.gov More
information about the Office of Public Health Research and the new Research
Guide can be found at
http://www.cdc.gov/od/ophr
INFLUENZA [VACCINE] SUPPLY UPDATE: As of the end of November, more than 78
million doses of influenza vaccine had been produced and distributed within
the United States. However, while some communities and providers appear to
have ample supplies of influenza vaccine, others may not have received much
influenza vaccine and may have used most, if not all, of their supply. Some
communities and providers may not have received any vaccine.
The total amount of vaccine expected to be available in the United States
this season is enough to meet past consumer demand, which has usually been
around 70-75 million doses. However, in some communities current demand for
vaccine might be exceeding what has been seen in previous years (perhaps due
to increased media attention on avian influenza, or "bird flu", concerns
resulting from last year's vaccine shortage, or increased use among
children).
In addition, Chiron Corporation recently announced that it will not be able
to produce as much vaccine as it originally anticipated. Consequently,
providers and distributors who ordered from Chiron received substantially
less vaccine than they had ordered.
The very last doses of influenza vaccine are currently being produced (3.5
million doses from sanofi pasteur and 680,000 doses from Chiron) and will be
available late in December or January as part of the CDC influenza vaccine
stockpile. Since influenza peaks most often in January and February,
vaccination is encouraged through the winter months.
CDC is currently assessing how distribution of influenza vaccine has gone
this season with physicians, public health agencies, community vaccinators,
pharmacists, occupational health providers, federally qualified health
centers, nursing homes, and the public. While influenza vaccine distribution
and administration are mostly private sector enterprises, CDC will continue
to work with manufacturers and our partners to address challenges of
matching influenza vaccine supplies with demand at national, state,
community, and provider levels.
To view questions and answers concerning the 2005-06 influenza vaccine
supply, please visit
http://www.cdc.gov/flu/about/qa/0506supply.htm
MEETINGS, CONFERENCES, AND RESOURCES
NIP NEEDS PILOT TESTERS: The National Immunization Program (NIP) has an
ongoing need for volunteers to pilot test immunization training courses.
Volunteers are particularly needed in the following occupations: physicians,
pharmacists, health educators, medical assistants, and nurses. To learn more
about becoming a pilot tester, please send an email to
nippilot@cdc.gov
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To access the complete December issue from the NIP website, go to:
http://www.cdc.gov/nip/news/newsltrs/imwrks/2005/200512.htm
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December 12, 2005
HHS STARTS A PROCESS TO INTEGRATE PANDEMIC INFLUENZA PLANNING AT FEDERAL,
STATE, AND LOCAL LEVELS
On December 5, Health and Human Services (HHS) issued a press release
announcing the start of pandemic influenza planning among federal, state,
and local government agencies. Portions of the press release are reprinted
below.
********************
For immediate release
December 5, 2005
FEDERAL GOVERNMENT BEGINS PANDEMIC PLANNING WITH STATES
"Pandemic planning needs to go beyond public health"
Noting that communities will be on the front lines of any effort to stop or
contain a pandemic, HHS Secretary Mike Leavitt today convened senior state
and local officials to establish an integrated federal-state
influenza-pandemic planning process. Department of Homeland Security
Secretary Michael Chertoff helped open the meeting. Officials from every
U.S. state, territory, Puerto Rico, and tribal governments participated. The
officials were advised to plan broadly. . . .
"By their nature, pandemics happen across the globe--but their effects are
excruciatingly local," Secretary Leavitt said. "Pandemic planning needs to
go beyond public health. Discussion at the state and local level needs to
address how schools, businesses, public agencies, and others participate in
pandemic preparedness. . . ."
Secretary Leavitt asked participants to begin preparing for a series of
in-state pandemic-planning summits to be held in every state over the next
several months. These in-state summits will help the public health and
emergency response community in each state inform and involve their
political, economic, and community leadership in this process. . . .
A web cast of today's proceedings, the state and local health department
checklist, the National Strategy, HHS Pandemic Influenza Plan, and more
information can be found online at
www.pandemicflu.gov
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To access the complete press release, go to:
http://www.hhs.gov/news/press/2005pres/20051205.html
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December 12, 2005
CDC REPORT ON EPIDEMIOLOGY OF MEASLES IN U.S. IN 2004 INDICATES ONLY 37
REPORTED CASES, A NEW ONE-YEAR LOW
CDC published "Measles--United States, 2004" in the December 9 issue of MMWR.
Portions of the article are reprinted below.
***********************
Measles is a highly infectious, acute viral illness that can cause severe
pneumonia, diarrhea, encephalitis, and death. During 2004, a total of 37
cases (incidence: [less than] 1 case per million population) was reported to
CDC by local and state health departments, the lowest number of measles
cases ever reported in 1 year in the United States and a decrease of 16%
from the previous low of 44 cases in 2002. This report describes the
epidemiology of measles in the United States in 2004, documenting the
absence of endemic measles and the continued risk for internationally
imported measles cases that can result in indigenous transmission. . . .
Editorial Note
The 37 confirmed cases in 2004 represent a record low number of reported
measles cases since measles became a nationally reportable disease in 1912.
The epidemiology of measles in 2004 confirms the previous finding that
endemic transmission of measles virus has been eliminated in the United
States. Thirty-three (89%) cases were import-associated (i.e., imported or
import-linked), and 14 imported cases occurred among U.S. residents who
contracted measles while traveling abroad. Sixty-four percent of the
imported cases among U.S. residents could have been prevented if
long-standing ACIP recommendations concerning measles vaccination of foreign
travelers had been followed.
Of the 27 persons with imported cases in 2004, 13 (48%) traveled on aircraft
while infectious. Measles virus is a highly infectious pathogen, and
intercontinental flights create the potential for prolonged exposure.
However, on the basis of available data, the risk for in-flight measles
transmission among passengers appears to be low. . . .
As long as measles is endemic in most countries worldwide, sustaining
measles elimination in the United States will require maintenance of high
levels of vaccination coverage (i.e., [greater than] 90%), vigilance in
detecting and containing imported cases, and enhanced surveillance to detect
and characterize cases and identify sources and viral genotypes.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a1.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5448.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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December 12, 2005
NEW: CURRENT ISSUES IN IMMUNIZATION NET CONFERENCE TO FOCUS ON NEW HEPATITIS
A VACCINE RECOMMENDATIONS
Scheduled for January 19, 2006, from noon to 1PM ET, the net conference
Current Issues in Immunization is designed to provide clinicians with
up-to-date information on immunization. The program has two primary topics:
(1) new hepatitis A vaccine recommendations and (2) overview of vaccine
information statements (VISs).
The conference requires pre-registration, as space is limited. Registration
will close when the course is full or on January 17, 2006 (midnight ET). To
register for the conference, go to:
http://www2.cdc.gov/nip/isd/ciinc
The program will combine a telephone audio conference and simultaneous
online visual content. Participants can join the Q&A session by telephone or
Internet. For instructions and system requirements, go to:
http://www.cdc.gov/nip/ed/ciinc/instructions.htm
For additional information, go to:
nipinfo@cdc.gov
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December 12, 2005
MMWR NOTIFIES READERS THAT FDA APPROVED LOWERING THE AGE LIMIT FOR HAVRIX
HEPATITIS A VACCINE TO 12 MONTHS
CDC published "Notice to Readers: FDA Approval of Havrix (Hepatitis A
Vaccine, Inactivated) for Persons Aged 1-18 Years" in the December 9 issue
of MMWR. The notice is reprinted below in its entirety, with the exception
of footnotes.
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On October 17, 2005, the Food and Drug Administration approved an
application to allow use of the pediatric/adolescent formulation of Havrix
(hepatitis A vaccine, inactivated) (GlaxoSmithKline Biologicals, Rixensart,
Belgium) for persons aged 1-18 years. Previously, pediatric use of Havrix
was approved for use in persons aged 2-18 years.
Vaccine Description
The formulation, dosage, and schedule for Havrix were not changed. Each
0.5-mL dose of pediatric/adolescent Havrix contains 720 enzyme-linked
immunosorbent assay units of formalin-inactivated hepatitis A viral antigen
adsorbed onto aluminum hydroxide. The formulation contains 0.5%
2-phenoxyethanol as a preservative.
The pediatric/adolescent formulation of Havrix is indicated for vaccination
of persons aged 1-18 years against disease caused by hepatitis A virus.
Recommendations for hepatitis A vaccination have been published previously
and are periodically updated. The primary vaccination schedule is unchanged
and consists of 2 doses, administered on a 0, 6-12-month schedule.
In a study presented as part of the labeling change application, 99% of 218
children aged 11-13 months and 100% of 200 children aged 15-18 months who
received 2 doses of Havrix developed a vaccine response. The approval
included concomitant use of Havrix with Haemophilus influenzae type b
conjugate vaccine (PRP-T Hib). Data regarding concomitant use with other
routinely recommended childhood vaccines are limited. According to general
recommendations of the Advisory Committee on Immunization Practices,
inactivated vaccines usually do not interfere with the immune response to
other inactivated or live vaccines.
Among the 723 healthy children who received 1 or more dose of Havrix, the
most common adverse events were similar among children aged 11-18 months and
children aged 23-25 months. Havrix is contraindicated in persons with known
hypersensitivity to any component of the vaccine. Additional information is
available from the manufacturer's package insert and GlaxoSmithKline
Biologicals at telephone (888) 825-5249.
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a4.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5448.pdf
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December 12, 2005
ERRATA: MMWR CORRECTS ERRORS IN ITS DECEMBER 2 ARTICLE ON LICENSURE OF
MEASLES-MUMPS-RUBELLA-VARICELLA VACCINE
CDC published "Errata: Vol. 54, No. 47" in the December 9 issue of MMWR. The
article is reprinted below in its entirety.
***********************
In the Notice to Readers, "Licensure of a Combined Live Attenuated Measles,
Mumps, Rubella, and Varicella Vaccine," multiple errors occurred.
On page 1212, in the last sentence of the first paragraph, the sentence
should read: The titer of Oka/Merck varicella-zoster virus is higher in MMRV
vaccine than in single antigen varicella vaccine, VARIVAX (Merck), a minimum
of 3.99 log 10 plaque-forming units (pfu) versus 1,350 pfu (approximately
3.13 log 10), respectively.
On page 1213, under "Indications and Usage," No. 1, the last sentence should
read: MMRV vaccine can reduce the number of injections when administered to
children aged 12 months-12 years for whom (1) the first doses of MMR and
varicella vaccines are indicated and (2) the second dose of MMR and either
the first or second dose (e.g., during a varicella outbreak) of varicella
vaccine are indicated. MMRV vaccine is administered subcutaneously as a
single 0.5-mL dose.
On page 1214, in Reference 8, the Internet address should read:
http://www.cdc.gov/nip/vaccine/varicella/varicella_acip_recs.pdf
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To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5448a8.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5448.pdf
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December 12, 2005
NEW: CURRENT VISs FOR INJECTABLE AND NASAL-SPRAY INFLUENZA VACCINES NOW
AVAILABLE IN RUSSIAN AND SOMALI
The current versions of the VISs for trivalent inactivated influenza
vaccine(TIV; injectable) and live attenuated influenza vaccine (LAIV; nasal
spray) are now available on the IAC website in Russian and Somali. IAC
gratefully acknowledges the Minnesota Department of Health for the
translations.
VIS for TIV vaccine (dated 10/20/05)
To obtain a ready-to-print (PDF) version of the VIS for TIV vaccine in
Russian, go to:
http://www.immunize.org/vis/ru_flu05.pdf
To obtain it in Somali, go to:
http://www.immunize.org/vis/so_flu05.pdf
To obtain it in English, go to:
http://www.immunize.org/vis/2flu.pdf
VIS for LAIV vaccine (dated 10/20/05)
To obtain a ready-to-print (PDF) version of the VIS for LAIV vaccine in
Russian, go to:
http://www.immunize.org/vis/ru_LAIV05.pdf
To obtain it in Somali, go to:
http://www.immunize.org/vis/so_LAIV05.pdf
To obtain it in English, 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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December 12, 2005
NEW: INTERIM VIS FOR MENINGOCOCCAL VACCINE NOW AVAILABLE IN RUSSIAN AND
SOMALI
The interim VIS for meningococcal vaccine (dated 10/7/05) is now available
on the IAC website in Russian and Somali. IAC gratefully acknowledges the
Minnesota Department of Health for the translations.
To obtain a ready-to-print (PDF) version of interim VIS for meningococcal
vaccine in Russian, go to:
http://www.immunize.org/vis/ru_men05.pdf
To obtain it in Somali, go to:
http://www.immunize.org/vis/so_men05.pdf
To obtain it in English, go to:
http://www.immunize.org/vis/menin05.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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December 12, 2005
BEFORE THE HOLIDAY RUSH, TAKE TIME TO REGISTER FOR CDC'S 2006 NATIONAL
IMMUNIZATION CONFERENCE
Take time NOW--before you start juggling work with a long string of winter
holiday celebrations--to register for CDC's 2006 National Immunization
Conference. Scheduled for March 6-9, 2006, in Atlanta, the conference will
give you a chance to get recharged and revitalized by getting together with
old friends and colleagues, meeting people you know only through phone
conversations and email messages, touring the conference exhibit space, and
getting fresh ideas from poster sessions, workshops, and plenary meetings.
You don't want to miss it!
The deadline for early-bird registration ($175) is January 13, but why wait?
Register today, and you'll have something to look forward to throughout
winter. To register online, go to:
http://conferences.taskforce.org/2006NIC/2006NIC.htm
To plan some fun in Atlanta, visit the official tourism website at
http://www.atlanta.net
For general conference information, including conference goals and
objectives, go to:
http://www.cdc.gov/nip/nic
Here's some information not yet available on the conference website: The six
topic tracks for this year's conference are (1) adult and adolescent
immunization, (2) epidemiology and vaccine safety, (3) health and risk
communication, (4) immunization information systems, (5) programmatic
issues, and (6) policy and legislation.
For additional information, contact the conference planning team at (404)
639-8225 or nipnic@cdc.gov
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December 12, 2005
JOHNS HOPKINS/UNICEF REPORT MAKES THE CASE FOR INVESTING IN IMMUNIZATION
COMMUNICATION
In June, the Health Communication Partnership (based at Johns Hopkins
Bloomberg School of Public Health) and UNICEF published a report titled "Why
Invest in Communication for Immunization? Evidence and Lesson Learned." In
28 pages, the report outlines key immunization challenges that can be
addressed by communication, presents recommendations for addressing
immunization challenges, and lists lessons learned from successful
communication interventions.
To access a ready-to-print (PDF) version of the report, go to:
http://www.hcpartnership.org/Publications/CommunicationforImmunization.pdf
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December 12, 2005
CDC UPDATES ITS INFLUENZA WEB SECTION
CDC recently updated a page of its Influenza web section:
"Recent avian influenza outbreaks in Asia and Europe"(12/6/05).
To access this resource, go to:
http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent
link.
To access a broad range of continually updated influenza information, go to:
http://www.cdc.gov/flu |
