Issue
Number 584
February 27, 2006
CONTENTS OF THIS ISSUE
- New: CDC publishes recommendations for preventing
tetanus, diphtheria, and pertussis in adolescents
- New: ACIP recommends new rotavirus vaccine for infants
- New: ACIP expands its influenza vaccine recommendation
for children
- New: CDC reports an investigational drug is available
for postexposure varicella prophylaxis of high-risk patients
- CDC issues two Health Updates about a current case of
inhalation anthrax in Pennsylvania
- CDC reports on an outbreak of mumps in a New York summer
camp during 2005
- CDC reports on the 2004–05 mumps epidemic in the United
Kingdom
- Avian influenza: WHO and CDC report on rapid spread of
the disease in birds
- Influenza vaccination recommendations for healthcare
personnel now in MMWR Recommendations and Reports format
- Updated: IAC revises two patient-education pieces
- Puzzled about the status of vaccine licensures and
recommendations? "Red Book Online" has current information
- CDC reports on U.S. influenza activity during February
5–11
- Attention immunization coalitions: Meet 'n' Greet and
teleconferencing opportunities are available in March
- Reminder: March 6 is registration deadline for meeting
on management of hepatitis B virus
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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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February 27, 2006
NEW: CDC PUBLISHES RECOMMENDATIONS FOR PREVENTING TETANUS, DIPHTHERIA, AND
PERTUSSIS IN ADOLESCENTS
On February 23, CDC published "Preventing Tetanus, Diphtheria, and Pertussis
Among Adolescents: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and
Acellular Pertussis Vaccines: Recommendations of the Advisory Committee on
Immunization Practices (ACIP)" as an MMWR Early Release. Documents published
in the MMWR Early Release format are available only electronically.
Subsequently, they are published in MMWR Recommendations and Reports format
and are available both electronically and in print.
Two sections of the recommendations are reprinted below—the Summary and the
Introduction.
**********************
SUMMARY
During spring 2005, two tetanus toxoid, reduced diphtheria toxoid, and
acellular pertussis vaccine (Tdap) products formulated for use in
adolescents (and, for one product, use in adults) were licensed in the
United States (BOOSTRIX, GlaxoSmithKline Biologicals, Rixensart, Belgium
[licensed May 3, 2005, for use in persons aged 10–18 years], and ADACEL,
sanofi pasteur, Toronto, Ontario, Canada [licensed June 10, 2005, for use in
persons aged 11–64 years]). Prelicensure studies demonstrated safety and
efficacy against tetanus, diphtheria, and pertussis when Tdap was
administered as a single booster dose to adolescents. To reduce pertussis
morbidity in adolescents and maintain the standard of care for tetanus and
diphtheria protection, the Advisory Committee on Immunization Practices (ACIP)
recommends that: (1) adolescents aged 11–18 years should receive a single
dose of Tdap instead of tetanus and diphtheria toxoids vaccine (Td) for
booster immunization against tetanus, diphtheria, and pertussis if they have
completed the recommended childhood diphtheria and tetanus toxoids and whole
cell pertussis vaccine (DTP)/diphtheria and tetanus toxoids and acellular
pertussis vaccine (DTaP) vaccination series (five doses of pediatric DTP/DTaP
before the seventh birthday; if the fourth dose was administered on or after
the fourth birthday, the fifth dose is not needed) and have not received Td
or Tdap. The preferred age for Tdap vaccination is 11–12 years; (2)
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.
An interval of at least 5 years between Td and Tdap is encouraged to reduce
the risk for local and systemic reactions after Tdap vaccination. However,
an interval less than 5 years between Td and Tdap can be used; and (3)
vaccine providers should administer Tdap and tetravalent meningococcal
conjugate vaccine (Menactra, sanofi pasteur, Swiftwater, Pennsylvania) to
adolescents aged 11–18 years during the same visit if both vaccines are
indicated and available. This statement (1) reviews tetanus, diphtheria, and
pertussis vaccination policy in the United States, with emphasis on
adolescents; (2) describes the clinical features and epidemiology of
pertussis among adolescents; (3) summarizes the immunogenicity, efficacy,
and safety data of the two Tdap vaccines licensed for use among adolescents;
and (4) presents recommendations for tetanus, diphtheria, and pertussis
vaccination among adolescents aged 11–18 years.
INTRODUCTION
Pertussis, an acute, infectious cough illness, remains endemic in the United
States despite routine childhood pertussis vaccination for more than half a
century and high coverage levels in children for more than a decade. A
primary reason for the continued circulation of Bordetella pertussis is that
immunity to pertussis wanes approximately 5–10 years after completion of
childhood pertussis vaccination, leaving adolescents and adults susceptible
to pertussis. Among the diseases for which universal childhood vaccination
has been recommended, pertussis is the least well-controlled reportable
bacterial vaccine-preventable disease in the United States.
In the United States during 1934–1943, an annual average of 200,752
pertussis cases and 4,034 pertussis-related deaths were reported. After the
introduction of childhood pertussis vaccination during the 1940s, the number
of reported pertussis cases declined dramatically, reaching an historic low
of 1,010 in 1976. Since the 1980s, the number of reported pertussis cases
has been steadily increasing, especially among adolescents and adults.
Possible reasons for the increase in reported pertussis cases include a true
increase in the burden of disease and an increase in the detection and
reporting of cases; the relative contribution of each of these factors to
the increase observed is unclear. . . .
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To access a web-text (HTML) version of the recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e223a1.htm
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/pdf/rr/rr55e223.pdf
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February 27, 2006
NEW: ACIP RECOMMENDS NEW ROTAVIRUS VACCINE FOR INFANTS
On February 21, CDC issued a press release reporting that ACIP had
recommended the newly licensed RotaTeq rotavirus vaccine for use in infants.
The press release is reprinted below in its entirety.
********************
Press Release
For immediate release
February 21, 2006
CDC'S ADVISORY COMMITTEE RECOMMENDS NEW VACCINE TO PREVENT ROTAVIRUS:
Rotavirus is the leading cause of gastroenteritis in infants and young
children in the United States and worldwide.
The Advisory Committee on Immunization Practices (ACIP) to the Centers for
Disease Control and Prevention (CDC) in their meeting in Atlanta today voted
to recommend a newly licensed vaccine to protect against rotavirus, a viral
infection that can cause severe diarrhea, vomiting, fever, and dehydration
(gastroenteritis) in infants and young children.
The ACIP recommendation is for infants to receive three doses of the oral
vaccine at two, four, and six months of age. Children should receive the
first dose of the vaccine by 12 weeks of age and should receive all doses of
the vaccine by 32 weeks of age. There is insufficient data on safety and
efficacy outside of these age ranges. The new vaccine, RotaTeq (marketed by
Merck and Company), is the only vaccine approved in the United States for
prevention of rotavirus gastroenteritis (vomiting and diarrhea).
"Rotavirus is the leading cause of severe gastroenteritis in infants and
young children worldwide" said Dr. Anne Schuchat, director of CDC's National
Immunization Program. "Nearly every child in the United States is infected
with rotavirus by age five and most will develop gastroenteritis, leading to
a large number of physician visits, emergency room visits, and
hospitalizations, with a few deaths. Therefore, this vaccine will help
reduce one of our most common and potentially severe childhood illnesses."
Each year, rotavirus is responsible for more than 400,000 doctor visits,
more than 200,000 emergency room visits, 55,000 to 70,000 hospitalizations,
and between 20 and 60 deaths in U.S. children younger than 5 years of age,
leading to about $300 million in direct medical costs and $900 million in
total societal costs. In developing countries, rotavirus is a major cause of
childhood deaths, causing more than half a million deaths each year in
children younger than five years of age.
Rotavirus vaccine will not prevent gastroenteritis caused by other viruses,
but is very effective against rotavirus disease. Studies indicate the
vaccine will prevent about 74 percent of all rotavirus cases and about 98
percent of the most severe cases, including 96 percent of rotavirus cases
requiring hospitalization. In trials, the vaccine prevented 59 percent of
all causes of gastroenteritis hospitalizations, which highlights the
important role of rotavirus in severe childhood gastroenteritis.
In 1999, RotaShield, a different rotavirus vaccine, was withdrawn from the
market after it was found to be associated with a rare type of bowel
obstruction called intussusception. The risk of intussusception for RotaTeq,
the new vaccine, was evaluated in a large-scale trial of over 70,000
children. In that study, there was no association found between the RotaTeq
and an increased risk of intussusception and it did not cause fever to the
extent caused by RotaShield.
"This is a different vaccine than the vaccine removed from the market
because of problems with bowel obstructions," said Dr. Schuchat. "It is made
differently and was not associated with intussusception in a large clinical
trial. Nevertheless, we will continue to very closely monitor this vaccine
to ensure there are no problems. At the same time it's important to remember
that the known benefits of the vaccine far outweigh any known risks."
CDC will conduct a large study to rapidly detect any association between
RotaTeq and intussusception as well as other potential adverse events
through its Vaccine Safety Datalink Program that evaluates vaccine safety in
approximately 90,000 infants every year. CDC and FDA will also regularly
monitor reports of intussusception and other serious adverse events reported
to the Vaccine Adverse Event Reporting System (VAERS). Merck has also
committed to conducting a post-licensure study of approximately 44,000
children. In addition, the manufacturer will report cases of intussusception
to FDA within 15 days of receiving them.
Recommendations of the ACIP become recommendations of CDC once they are
accepted by the director of CDC and the Secretary of Health and Human
Services and are published in the Morbidity and Mortality Weekly Report.
For more information on rotavirus and the rotavirus vaccine, visit
www.cdc.gov
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To access the press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060221.htm
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February 27, 2006
NEW: ACIP EXPANDS ITS INFLUENZA VACCINE RECOMMENDATION FOR CHILDREN
On February 23, CDC issued a press release reporting that ACIP had
recommended that children ages 6 months to up to 5 years receive yearly
influenza vaccination. Previously, the recommendation had been to give
yearly vaccination to children ages 6–23 months. Portions of the press
release are reprinted below.
********************
Press Release
For immediate release
February 23, 2006
CDC'S ADVISORY COMMITTEE RECOMMENDS EXPANDED INFLUENZA VACCINATIONS FOR
CHILDREN
The Advisory Committee on Immunization Practices (ACIP) to the Centers for
Disease Control and Prevention (CDC), in its meeting in Atlanta today, voted
to recommend an expansion of routine influenza vaccination for children.
With the expansion, the recommended influenza vaccination age will be from 6
months to up to 5 years old. The previous recommendation was for children 6
months to 23 months old. The new recommendation expands that recommendation
to also cover children from 2 years to up to 5 years old.
The committee also voted to recommend expanding routine vaccination for
household contacts (anyone who spends a significant amount of time in the
home) and out-of-home caregivers of children 24–59 months old. The previous
recommendation had been for household contacts and caregivers for children 6
months to 23 months old. This new recommendation takes into consideration a
broader view of the burden of illness than the earlier recommendation for
vaccination of children, which was based upon the prevention of
hospitalization among children 6 months to 23 months old. . . .
Presenters at the meeting indicated that otherwise healthy children are at
increased risk for requiring influenza-related medical care and that rates
of medial outpatient visits for influenza-related illnesses are high in all
childhood ages. It was also noted that children 24 months to 59 months old
with influenza are nearly as likely to require visits to healthcare
providers and emergency rooms as children 6 months to 23 months old. . . .
Vaccination of all children who have certain chronic medical conditions such
as asthma, diabetes, kidney disease or weakened immune systems continues to
be strongly recommended by ACIP. . . .
The ACIP will continue to review new vaccination strategies for improving
the prevention and control of influenza, including the possibility of
expanding routine influenza vaccination recommendations to the entire U. S.
population. Influenza vaccine manufacturers have indicated that they plan to
produce between 100 million and 120 million doses of influenza vaccine for
the 2006-07 influenza season.
The 2006-07 influenza vaccine will include two new strains, an
A/Wisconsin/67/2005 (H3N2)-like virus and a B/Malaysia/2506/ 2004-like
virus; the A/New Caledonia/20/99(H1N1)-like virus strain from the 2005-2006
season will remain in the upcoming vaccine.
Recommendations of the ACIP become recommendations of CDC once they are
accepted by the director of CDC and the Secretary of Health and Human
Services and are published in the Morbidity and Mortality Weekly Report.
For more information, visit www.cdc.gov
********************
To read the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/r060223.htm
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February 27, 2006
NEW: CDC REPORTS AN INVESTIGATIONAL DRUG IS AVAILABLE FOR POSTEXPOSURE
VARICELLA PROPHYLAXIS OF HIGH-RISK PATIENTS
On February 24, CDC published "A New Product (VariZIG) for Postexposure
Prophylaxis of Varicella Available Under an Investigational New Drug
Application Expanded Access Protocol" as an MMWR Early Release. Documents
published in the MMWR Early Release format are available only
electronically. Subsequently, they are published in MMWR format and are
available both electronically and in print.
Portions of the document are reprinted below.
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On October 27, 2004, the Advisory Committee on Immunization Practices (ACIP)
was informed by the only U.S.-licensed manufacturer of varicella zoster
immune globulin (VZIG), (Massachusetts Public Health Biologic Laboratories,
Boston, Massachusetts), that the company had discontinued production of VZIG.
The supply of the licensed VZIG product is now nearly depleted. In February
2006, an investigational (not licensed) VZIG product, VariZIG™ (Cangene
Corporation, Winnipeg, Canada), became available under an investigational
new drug application (IND) submitted to the Food and Drug Administration
(FDA). This product can be requested from the sole authorized U.S.
distributor, FFF Enterprises (Temecula, California), for patients who have
been exposed to varicella and who are at increased risk for severe disease
and complications.
The investigational VariZIG, similar to licensed VZIG, is a purified human
immune globulin preparation made from plasma containing high levels of
anti-varicella antibodies (immunoglobulin class G [IgG]). Unlike the
previous product, the investigational product is lyophilized. When properly
reconstituted, VariZIG is approximately a 5% solution of IgG that can be
administered intramuscularly. As with any product used under IND, patients
must be informed of potential risks and benefits and must give informed
consent before receiving the product.
INDICATIONS FOR USE OF INVESTIGATIONAL VARIZIG
Patients without evidence of immunity to varicella (i.e., without history of
disease or age-appropriate vaccination) who are at high risk for severe
disease and complications, who have been exposed to varicella, and from whom
informed consent has been obtained, are eligible to receive the IND
application product under an expanded access protocol. The patient groups
recommended by ACIP to receive VariZIG include the following:
-
Immunocompromised patients.
-
Neonates whose mothers have signs and symptoms of varicella around the
time of delivery (i.e., 5 days before to 2 days after).
-
Premature infants born at 28 [or more] weeks of gestation who are exposed
during the neonatal period and whose mothers do not have evidence of
immunity.
-
Premature infants born at [less than] 28 weeks of gestation or who weigh
1,000 g [or less] at birth and were exposed during the neonatal period,
regardless of maternal history of varicella disease or vaccination.
-
Pregnant women.
Varicella vaccine was recommended in 1999 for postexposure prophylaxis of
other persons without evidence of varicella immunity and who have no
contraindications to vaccination. The vaccine should be administered
preferably within 96 hours and possibly up to 120 hours postexposure. If
illness occurs, with or without postexposure vaccination, antiviral
treatment (e.g., acyclovir) can be considered for adolescents and adults. .
. .
***********************
To access a web-text (HTML) version of the complete document, go
to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm55e224a1.htm
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm55e224.pdf
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February 27, 2006
CDC ISSUES TWO HEALTH UPDATES ABOUT A CURRENT CASE OF INHALATION ANTHRAX
IN PENNSYLVANIA
On February 22, the Health Alert Network (HAN) issued an official CDC
Health Update about a New York City resident who contracted inhalation
anthrax while working with untreated animal hides imported from Africa. On
February 24, HAN issued another official CDC Health Update reporting
further information about the case investigation. Portions of both Health
Updates are reprinted below.
*************************
This is an official CDC HEALTH UPDATE
Distributed via Health Alert Network
Wednesday, February 22, 2006, 15:58 EST (03:58 PM EST)
INHALATION ANTHRAX CASE IN PENNSYLVANIA
On February 16, a 44-year-old male presented to a hospital in Pennsylvania
with respiratory symptoms including dry cough, shortness of breath and
general malaise. Laboratory Response Network (LRN) and Polymerase Chain
Reaction (PCR) on 2/21 and gamma phage lysis on 2/22 from blood culture
isolate were positive for Bacillus anthracis.
Patient resides in New York City and makes drums from unprocessed domestic
and imported (Africa) animal hides (cow and goat). Patient reports
frequent travel to Africa (most recent travel 12/4/05–12/21/05). Patient
reports last work with animal hides on 2/15. Process includes cleaning and
removal of hair from hides without chemical fixatives. While traveling to
Pennsylvania on 2/16, the patient collapsed with rigors and was
transported and admitted to a small local hospital.
Patient transferred to a tertiary care center on 2/18. Patient is reported
to be stable on antibiotic therapy in the ICU [intensive care unit]
without mechanical ventilation. No signs of cutaneous or pharyngeal
anthrax lesions. Preliminary clinical impression suggests anthrax sepsis
secondary to inhalation route of exposure due to spores from contaminated
animal hides.
Ongoing investigation by PA and NYC departments of health in coordination
with law enforcement includes environmental assessment of patient's
storage/work facility and home, and identification of individuals who may
have had contact with unprocessed hides. . . .
For case definitions, treatment guidelines, laboratory testing procedures,
etc., see Anthrax Information for Healthcare Providers [at]
http://www.bt.cdc.gov/agent/anthrax/anthrax-hcp-factsheet.asp
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To read the complete 2/22/06 Health Update, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00241
*************************
Distributed via Health Alert Network
Friday, February 24, 2006, 16:08 EST (04:08 PM EST)
INHALATION ANTHRAX CASE INVESTIGATION, PENNSYLVANIA, NEW YORK CITY—UPDATE,
2/24/2006
Laboratory testing from the patient's storage/work facility, his van and
his residence have identified Bacillus anthracis. These findings are
consistent with the hypothesis that the patient's exposure occurred while
working on contaminated hides while making traditional drums.
The patient remains hospitalized in Pennsylvania.
Investigation of other potentially exposed persons continues; seven
persons are currently on post-exposure prophylaxis for inhalation anthrax.
None of these individuals have symptoms of anthrax. In addition,
surveillance has not identified any other illness consistent with anthrax
disease in NY and PA.
Animal hides pose a low risk of cutaneous anthrax, and an extremely low
risk of inhalation anthrax. Exotic animal hides may pose a higher risk for
exposure than domestic (U.S.-origin) hides. The risk of contracting
Bacillus anthracis from handling individual hides is believed to be very
low. The industrial handling of large numbers of hides, or hair from
multiple animals, has historically been associated with increased risk of
anthrax. Among the 236 cases of anthrax reported to CDC from 1955 to 1999,
153 (65%) were associated with industrial handling of animal hide or hair.
Only 9 of the 153 cases (6%) associated with industrial handling of hair
or hide were inhalation anthrax. . . .
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To read the complete 2/24/06 Health Update, go to:
http://www.phppo.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00242
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February 27, 2006
CDC REPORTS ON AN OUTBREAK OF MUMPS IN A NEW YORK SUMMER CAMP DURING 2005
CDC published "Mumps Outbreak at a Summer Camp—New York, 2005" in the
February 24 issue of MMWR. Portions of the article are reprinted below.
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On July 26, 2005, the Sullivan County Health Department (SCHD) and the New
York State Department of Health (NYSDOH) were notified of a cluster of cases
of parotitis among campers and staff members at a summer camp. An
investigation conducted by NYSDOH identified 31 cases of mumps, likely
introduced by a camp counselor who had traveled from the United Kingdom (UK)
and had not been vaccinated for mumps. This report summarizes the results of
the subsequent investigation by NYSDOH, which determined that, even in a
population with 96% vaccination coverage, as was the case with participants
in the summer camp, a mumps outbreak can result from exposure to virus
imported from a country with an ongoing mumps epidemic.
Camp was in session during June 28–August 18. A case of mumps was defined as
unilateral or bilateral parotitis of [more than] 2 days' duration with no
other apparent cause in a camper or staff member who was examined during
June 30–September 1, 2005. Among 541 campers and staff members, 31 cases of
mumps were identified (attack rate: 5.7%), with illness onsets during June
30–August 9. The index patient was a man aged 20 years who resided in the UK
and who had not been vaccinated for mumps. The man came to the United States
on June 19 to work as a counselor at the camp; on June 30, he had left-sided
parotitis, sore throat, and a low-grade fever. However, mumps was not
considered as a diagnosis by healthcare staff members at the infirmary.
The patient was not isolated and continued to work among the camp
population. During July 15–23, a total of 25 additional cases of parotitis
were identified, consistent with exposure beginning June 28. However, the
diagnosis of mumps was not made by members of the healthcare staff at the
infirmary or by community healthcare providers for any patient with
parotitis until July 24. SCHD and NYSDOH were alerted to a possible outbreak
on July 26, and diagnosis of mumps for the first 23 (74%) cases was made via
retrospective chart review by NYSDOH on July 27. At that time, five (16%)
patients were either symptomatic or in isolation. Subsequently, an
additional three (10%) cases were identified, beginning on August 2. . . .
Twelve (39%) of the 31 mumps cases were among campers. All were U.S.
residents aged 10–15 years who had been vaccinated with 2 doses of measles,
mumps, and rubella (MMR) vaccine after the first birthday. Nineteen (61%) of
the mumps cases were among staff members; of these, nine (47%) were UK
residents, five (26%) were U.S. residents, three (16%) were residents of
Australia, and two (11%) were residents of Germany. Staff members with mumps
ranged in age from 19 to 41 years (median: 21 years). Of the 17 staff
members with mumps for whom vaccination history could be obtained by
vaccination or medical record, nine (53%) had not been vaccinated for mumps,
four (24%) had been vaccinated with 1 dose, and four (24%) had been
vaccinated with 2 doses of a mumps-containing vaccine. Symptoms, illness
duration, and complications (e.g., orchitis) did not differ substantially
between vaccinated and unvaccinated patients. . . .
EDITORIAL NOTE
Previous investigations of mumps outbreaks reported similar clinical
symptoms among vaccinated and unvaccinated patients. With the decrease in
mumps incidence in the United States, healthcare providers have become less
likely to suspect mumps in patients with parotitis. In the camp outbreak,
although patients were evaluated by multiple healthcare providers, including
camp and hospital physicians, parotitis was not recognized as mumps until
well into the outbreak. Providers, parents, and child care and school staff
members need to be aware of mumps signs and symptoms, potential
complications, and communicability and the need to suspect mumps regardless
of patient vaccination status. In addition, given the low prevalence of
mumps in the U.S. population, laboratory confirmation should be encouraged
to diagnose mumps accurately.
In the camp outbreak, mumps likely was introduced by an unvaccinated
counselor who traveled from the UK, where an epidemic of mumps was ongoing,
with 56,390 notified cases reported during 2005 in England and Wales. The
likelihood of disease in U.S. residents as a result of imported virus from
areas with mumps epidemics remains high. Vaccination of counselors who will
be working in summer camps is recommended, particularly because mumps
vaccine effectiveness can be [less than] 85% in outbreak settings. As a
result of this outbreak, agencies involved in assigning foreign staff to
U.S. camps and organizations of camp administrators have begun revising
their admission requirements to include immunity to vaccine-preventable
diseases such as mumps.
The outbreak described in this report likely resulted from a combination of
delay in diagnosis of mumps and failure to report the cluster of illnesses
in a timely manner, in addition to close contact and social mixing among
camp participants. Controlling the outbreak resulted in a substantial burden
on the camp and its staff, including cancellation of activities and likely
loss of revenue. Previous mumps outbreaks also have carried substantial
burden, particularly with respect to costs associated with school
absenteeism. To prevent large outbreaks of mumps in their communities, U.S.
healthcare providers should suspect mumps independent of vaccination
history, diagnose mumps by using laboratory testing, and report mumps
immediately to local health authorities.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5507.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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February 27, 2006
CDC REPORTS ON THE 2004–05 MUMPS EPIDEMIC IN THE UNITED KINGDOM
CDC published "Mumps Epidemic—United Kingdom, 2004–2005" in the February
24 issue of MMWR. Portions of the article are reprinted below.
***********************
During 2004-2005, the United Kingdom (UK) experienced a nationwide
epidemic of mumps, which peaked during 2005 when 56,390 notified cases
were reported in England and Wales. The majority of confirmed cases during
2004–2005 were in persons aged 15–24 years, most of whom had not been
eligible for routine mumps vaccination. Mumps usually is a self-limited
viral disease that appears as parotitis. However, mumps also can lead to
serious complications such as encephalitis or pancreatitis. This report
summarizes the epidemiology of the 2004–2005 mumps epidemic in England and
Wales.
Reporting was based on notified cases (i.e., clinically diagnosed cases of
mumps reported by general practitioners). Since late 1994, laboratory
confirmation of all notified cases of mumps has been recommended using a
test to detect mumps-specific IgM antibodies in either serum or an oral
fluid. The proportion of such cases began to increase in 1999 and
increased further in each subsequent year, indicating an increase in the
incidence of true infection. . . .
During 2004, approximately 79.1% of confirmed cases were in persons aged
15–24 years. Among all mumps patients during 2004, approximately 3.3% were
reported as having received 2 doses of measles, mumps, and rubella (MMR)
vaccine, and another 30.1% had received 1 dose of MMR. The number of
notified cases of mumps continued to increase through the first 6 months
of 2005, with 20,653 cases occurring during the first quarter and 21,981
cases during the second quarter. During the third quarter of 2005, the
number of notified cases decreased by 64.0% to 7,907; during the fourth
quarter, a further decrease to 5,882 notified cases was observed. During
the first month of 2006, notified cases of mumps averaged approximately
500 per week.
During 2005, the majority of notified mumps cases were in persons aged
19–23 years and attending colleges or universities; the third-quarter
decrease in the number of notified cases coincided with summer vacations.
Local health services have been encouraged by the UK Health Protection
Agency to ensure that all students have received 2 doses of MMR before
leaving school. In addition, many universities have advised enrolling
first-year students to receive MMR vaccination before arriving at college.
EDITORIAL NOTE
In October 1988, mumps vaccination was added to the UK vaccination
schedule as part of the new combined MMR vaccine. . . .
During November 1994, approximately 8 million school children aged 5–16
years (i.e., born during September 1978–August 1989) were offered combined
measles-rubella vaccine to prevent a predicted epidemic of measles. At
that time, a global shortage prevented offering MMR to this group.
Therefore, a proportion of the 8 million children remained susceptible to
mumps. Modeling based on serologic surveillance data for 1993 estimated
that 19% of children aged 11–15 years in 1997 (i.e., aged 19–23 years in
2005) would be susceptible to mumps.
The 2004-2005 mumps epidemic in the UK did not result from the decrease in
MMR vaccination coverage in recent years, but rather from gaps in
eligibility of certain cohorts, which has been evident during the epidemic
by the age breakdown among patients with confirmed cases; mumps occurred
predominantly in older teens and young adults, with the highest attack
rate occurring in those born during 1983–1986. Persons born before
September 1987 generally were not eligible for any routine mumps
vaccination, although some might have received 1 dose of MMR upon school
entry as part of a catch-up campaign after October 1988 that targeted
children who missed their measles vaccination. Persons born before 1982
are more likely to have been exposed to mumps infection when it was still
a common childhood disease. Only 2.4% of confirmed cases in 2004 occurred
in persons who would have been eligible for 2 doses of MMR routinely.
The UK epidemic illustrates the susceptibility of certain cohorts who have
not been vaccinated and have not developed immunity through exposure to
mumps because of a decrease in mumps circulation after implementation of a
childhood immunization program. The epidemic also underscores the
importance of ensuring high levels of mumps immunity among adolescents and
young adults when vaccination with mumps-containing vaccine is introduced
into the routine immunization schedule for children.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a1.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5507.pdf
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February 27, 2006
AVIAN INFLUENZA: WHO AND CDC REPORT ON RAPID SPREAD OF THE DISEASE IN BIRDS
It was recently posted on the websites of WHO and CDC that numerous
countries have reported their first cases of avian influenza in birds. In
addition, Iraq reported two fatal cases of the disease in humans. Following
is information from both websites.
WHO
On February 21, the WHO website posted an article, "Avian influenza—spread
of the virus to new countries." Portions of the article are reprinted below.
********************
The occurrence of the disease in India, reported on 18 February, is part of
a recent pattern of rapid geographical spread of the virus in wild and
domestic birds. India is one of 13 countries that have reported their first
cases of H5N1 infection in birds since the beginning of February. (The 13
countries, listed in order of reporting, are Iraq, Nigeria, Azerbaijan,
Bulgaria, Greece, Italy, Slovenia, Iran, Austria, Germany, Egypt, India, and
France.)
On 20 February, Malaysia reported a fresh outbreak in poultry after having
been considered free of the disease for more than a year. . . .
Apart from Iraq, none of the countries newly affected during February has
reported human cases. Iraq has reported two human cases, both of which were
fatal; samples from several other patients are currently undergoing tests. .
. .
********************
To read the complete article, go to:
http://www.who.int/csr/don/2006_02_21b/en
For comprehensive, continually updated information on avian influenza
worldwide, visit WHO's Avian Influenza web section at
http://www.who.int/csr/disease/avian_influenza/en
CDC
CDC recently updated its Influenza web section with information that the
following were added to a list of countries reporting animal cases of avian
influenza:
India, Bosnia, and Herzegovina (posted 2/21/06); Austria, Egypt, and France
(posted 2/20/06); Azerbaijan (posted 2/17/06); and Iran (posted 2/16/06).
In addition, the following document was updated with an introduction, "Past
Avian Influenza Outbreaks" (posted 2/17/06)
To access these resources, go to:
http://www.cdc.gov/flu/whatsnew.htm#updated and click on the pertinent
link(s).
To access a broad range of continually updated information on seasonal
influenza, avian influenza, and pandemic influenza, go to:
http://www.cdc.gov/flu
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February 27, 2006
INFLUENZA VACCINATION RECOMMENDATIONS FOR HEALTHCARE PERSONNEL NOW IN MMWR
RECOMMENDATIONS AND REPORTS FORMAT
On February 24, "Influenza Vaccination of Health-Care Personnel:
Recommendations of the Healthcare Infection Control Practices Advisory
Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP)"
was published in print and electronically in MMWR Recommendations and
Reports. Previously, the document was available only electronically as an
MMWR Early Release.
To access a web-text (HTML) version of the MMWR Recommendations and Reports,
go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5502.pdf
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February 27, 2006
UPDATED: IAC REVISES TWO PATIENT-EDUCATION PIECES
IAC recently updated two of its patient-education pieces: "Are you 11–19
years old? Then you need to be vaccinated against these serious diseases!"
and "Vaccinations for adults: You're NEVER too old to get immunized!"
On each piece, the section on tetanus, diphtheria, and pertussis vaccine was
revised to include information on the newly licensed Tdap vaccine. Other
minor revisions were also made.
To access a ready-to-print (PDF) version of "Are you 11–19 years old?" go
to:
http://www.immunize.org/catg.d/11teens8.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4020.htm
To access a ready-to-print (PDF) version of "Vaccinations for adults," go
to:
http://www.immunize.org/catg.d/p4030a.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n18/p4030new.htm
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February 27, 2006
PUZZLED ABOUT THE STATUS OF VACCINE LICENSURES AND RECOMMENDATIONS? "RED
BOOK ONLINE" HAS CURRENT INFORMATION
On February 8, AAP updated the table "Status of Licensure and
Recommendations for New Vaccines," which is part of the publication "Red
Book Online." The table's content is based on information from vaccine
manufacturers, ACIP meetings, and AAP. It is updated as changes occur.
To access a ready-to-print (PDF) version of the table, go to:
http://aapredbook.aappublications.org/news/vaccstatus.pdf
To access a web-text (HTML) version, go to:
http://aapredbook.aappublications.org/news/vaccstatus.shtml
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February 27, 2006
CDC REPORTS ON U.S. INFLUENZA ACTIVITY DURING FEBRUARY 5–11
CDC published " Update: Influenza Activity—United States, February 5–11,
2006" in the February 24 issue of MMWR. The opening paragraph of the
article is reprinted below.
***********************
During February 5–11, 2006, the number of states reporting widespread
influenza activity increased to 13. Twenty-one states reported regional
activity, 11 reported local activity, and five reported sporadic activity.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5507a5.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5507.pdf
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February 27, 2006
ATTENTION IMMUNIZATION COALITIONS: MEET 'N' GREET AND TELECONFERENCING
OPPORTUNITIES ARE AVAILABLE IN MARCH
The National Immunization Coalition TA [technical assistance] Network has
arranged a Meet 'n' Greet opportunity for its members at the National
Immunization Conference (NIC) on March 8. In addition, the network has
scheduled a teleconference for March 14.
MEET 'N' GREET AT NIC
A Meet 'n' Greet gathering is planned from noon to 2PM on March 8 in the
Cypress Room of the Omni Hotel. Staff from the network hope to meet network
members at the event. Feel free to bring questions and materials.
NOTE: The network has cancelled workshops it had planned for March 5, the
day before NIC begins. Instead, workshops will be held during the National
Conference for Immunization Coalitions, which is scheduled for August 9–11
in Denver.
TELECONFERENCE
The teleconference will focus on how to set up a Vote and Vax clinic (an
influenza vaccination clinic at polling places) on Election Day in fall
2006. It will be held at 1:00PM, ET, March 14.
NOTE: CDC will give updates on the current influenza vaccine supply at the
beginning of this teleconference and at the beginning of future
teleconferences throughout the influenza season.
The Vote and Vax presenter is Douglas Shenson, MD, MPH, president, Sickness
Prevention Achieved through Regional Collaboration (SPARC).
Teleconference participants will learn (1) how to choose the right polling
place; (2) what to expect on Election Day; (3) how to do outreach and
publicity; (4) what to do if influenza vaccine is in short supply.
To register for the teleconference, send an email to
IZTA@aed.org Include this message: "Sign
me up for Vote and Vax."
For additional information, or to access earlier programs, go to:
http://www.izcoalitionsta.org/confcall.cfm
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February 27, 2006
REMINDER: MARCH 6 IS REGISTRATION DEADLINE FOR MEETING ON MANAGEMENT OF
HEPATITIS B VIRUS
The registration deadline for the Management of Hepatitis B Virus meeting
is March 6. The meeting is scheduled for April 6–8 in Bethesda, MD. It is
sponsored by the National Institute of Diabetes and Digestive and Kidney
Diseases of the National Institutes of Health, the American Association
for the Study of Liver Diseases, the Hepatitis B Foundation, and Hepatitis
Foundation International.
The goals of the meeting are to assess current understanding of hepatitis
B virus, the disease that it causes, and its optimal management; and to
make recommendations for directions for future research, both basic and
clinical.
For comprehensive meeting information, go to:
http://www.niddk.nih.gov/fund/other/hbv2006 |
