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IAC Express 2006 |
| Issue number 635: December 11, 2006 |
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Contents
of this Issue
Select a title to jump to the article. |
- New: CDC
issues ACIP's recommendations on elimination of hepatitis B virus
infection in U.S. adults
- New: CDC
launches website to promote implementation of revised hepatitis B
immunization recommendations for adults
-
Important: Errors in table on vaccine storage temperatures in the 2006
General Recommendations have been corrected
- Reminder:
Be sure to continue administering influenza vaccines throughout December
and into 2007
- Revised
VIS: CDC makes a minor change to interim VIS for meningococcal vaccines
- A must
for every exam room: IAC's laminated U.S. adult immunization
schedule—updated for 2006-07
- IAC
revises its online Ask the Experts information on rotavirus, zoster, and
pneumococcal polysaccharide vaccines
- December
issue of CDC's Immunization Works electronic newsletter now available
- December
5 issue of IAC's Hep Express newsletter now online
- MMWR
compiles information about all its current continuing-education exams into
one handy reference list
- WHO
issues position paper on Hib vaccines
- The
Global Alliance for Vaccines and Immunization approves $100 million for
pneumococcal vaccine funding
- PAHO
publishes second edition of its book Recent Advances in Immunization
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| Abbreviations |
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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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Issue 635: December 11, 2006 |
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1. |
New: CDC issues ACIP's recommendations on elimination of hepatitis B virus
infection in U.S. adults
CDC published "A Comprehensive Immunization
Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the
United States: Recommendations of the Advisory Committee on Immunization
Practices (ACIP) Part II: Immunization of Adults" in the December 8 issue of
MMWR Recommendations and Reports. The summary and the section on major
updates to the recommendations are reprinted below.
Also on December 8, John W. Ward, MD, sent a Dear Colleague letter to health
professionals outlining the multifaceted strategy ACIP has recommended to
increase hepatitis B vaccination coverage among adults. Dr. Ward is director;
Division of Viral Hepatitis; National Center for HIV/AIDS, Viral Hepatitis,
STD, and TB Prevention (proposed); CDC. A link to Dr. Ward's letter appears
at the end of this article.
SUMMARY
Hepatitis B vaccination is the most effective measure to prevent hepatitis B
virus (HBV) infection and its consequences, including cirrhosis of the liver,
liver cancer, liver failure, and death. In adults, ongoing HBV transmission
occurs primarily among unvaccinated persons with behavioral risks for HBV
transmission (e.g., heterosexuals with multiple sex partners, injection-drug
users [IDUs], and men who have sex with men [MSM]) and among household
contacts and sex partners of persons with chronic HBV infection.
This report, the second of a two-part statement from the
Advisory Committee on Immunization Practices (ACIP), provides
updated recommendations to increase hepatitis B vaccination of
adults at risk for HBV infection. The first part of the ACIP
statement, which provided recommendations for immunization of
infants, children, and adolescents, was published previously
(CDC. A comprehensive immunization strategy to eliminate
transmission of hepatitis B virus infection in the United
States: recommendations of the Advisory Committee on
Immunization Practices [ACIP]. Part 1: immunization of infants,
children, and adolescents. MMWR 2005; 54 [No. RR-16]:1-33).
In settings in which a high proportion of adults have risks for
HBV infection (e.g., sexually transmitted disease/human
immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, healthcare settings
targeting services to IDUs, healthcare settings targeting
services to MSM, and correctional facilities), ACIP recommends
universal hepatitis B vaccination for all unvaccinated adults.
In other primary care and specialty medical settings in which
adults at risk for HBV infection receive care, healthcare
providers should inform all patients about the health benefits
of vaccination, including risks for HBV infection and persons
for whom vaccination is recommended, and vaccinate adults who
report risks for HBV infection and any adults requesting
protection from HBV infection. To promote vaccination in all
settings, healthcare providers should implement standing orders
to identify adults recommended for hepatitis B vaccination and
administer vaccination as part of routine clinical services, not
require acknowledgment of an HBV infection risk factor for
adults to receive vaccine, and use available reimbursement
mechanisms to remove financial barriers to hepatitis B
vaccination. . . .
MAJOR UPDATES TO THE RECOMMENDATIONS
This report updates ACIP recommendations published previously
for hepatitis B vaccination of adults. The primary changes from
previous recommendations are as follows:
- In settings in which a high proportion of persons are likely
to be at risk for HBV infection (e.g., STD/HIV testing and
treatment facilities, drug-abuse treatment and prevention
settings, healthcare settings targeting services to IDUs,
healthcare settings targeting services to MSM, and
correctional facilities), ACIP recommends universal hepatitis
B vaccination for all adults who have not completed the
vaccine series.
- In primary care and specialty medical settings, ACIP
recommends implementation of standing orders to identify
adults recommended for hepatitis B vaccination and administer
vaccination as part of routine services. To ensure vaccination
of adults at risk for HBV infection who have not completed the
vaccine series, ACIP recommends the following implementation
strategies:
- Provide information to all adults regarding the health
benefits of hepatitis B vaccination, including risk factors
for HBV infection and persons for whom vaccination is
recommended.
- Help all adults assess their need for vaccination by
obtaining a history that emphasizes risks for sexual
transmission and percutaneous or mucosal exposure to blood.
- Vaccinate all adults who report risks for HBV infection.
- Vaccinate all adults requesting protection from HBV
infection, without requiring them to acknowledge a specific
risk factor. . . .
To access a ready-to-print (PDF) version the recommendations,
which includes Appendices A, B, and C, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf
Note: The PDF version includes a free CDC-sponsored education
activity that can be completed online or submitted by U.S. mail
for CME, CEU, or CNE credit. Simply read the primer, answer the
questions at the end, and follow instructions for submitting
your answers.
To access a web-text (HTML) version of the body of the
recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a1.htm
To access a web-text (HTML) version of Appendix A: Immunization
Management Issues, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a2.htm
To access a web-text (HTML) version of Appendix B: Postexposure
Prophylaxis to Prevent Hepatitis B Virus Infection, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm
To access a web-text (HTML) version of Appendix C:
Identification and Management of Hepatitis B Surface Antigen
(HBsAg)-Positive Persons, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a4.htm
To receive a FREE electronic subscription to MMWR (which
includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
To access Dr. Ward's Dear Colleague letter, go to:
http://www.immunize.org/acip/hepbrecs06.pdf
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2. |
New: CDC launches website to
promote implementation of revised hepatitis B immunization recommendations
for adults
CDC has developed a new website to promote implementation of the
revised adult hepatitis B immunization recommendations. It
includes educational and other materials specifically designed
for each setting where hepatitis B vaccination is recommended
for adults, such as settings serving adults at high risk for
contracting hepatitis B virus infection, primary care and
specialty medical settings, and occupational health providers.
The new website is titled Hepatitis B Recommendations for
Adults. To access it, go to: http://www.heprecenter.com
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3. |
Important: Errors in table on
vaccine storage temperatures in the 2006 General Recommendations have been
corrected
Several errors appeared in Table 9 (titled Vaccine Storage
Temperature Recommendations) of the "General Recommendations on
Immunization: Recommendations of the Advisory Committee on
Immunization Practices (ACIP)," published in the MMWR
Recommendations and Reports on December 1. It is important that
you print the corrected version of Table 9 and insert it into
your copy of the General Recommendations.
The errors concerned the vaccine storage temperatures in
Celsius, as described in "Errata: Vol. 55, No. RR-15" in the
December 8 issue of MMWR. It is reprinted below in its entirety.
In the MMWR Recommendations and Reports, "General
Recommendations on Immunization: Recommendations of the Advisory
Committee on Immunization Practices (ACIP)," in Table 9, on page
21, the vaccine storage temperatures in Celsius were incorrect
for measles, mumps, rubella, and varicella vaccine; live-attenuated influenza vaccine; varicella vaccine; and herpes
zoster vaccine. Following is the corrected table [IAC Express
editor's note: in this issue of IAC Express, the corrected table
can be accessed from the links below].
The corrected table is available in both web-text (HTML) and
ready-to-print (PDF) formats (see below):
To access the corrected table in HTML format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5548a7.htm and scroll
down to Table 9.
To access the corrected table in PDF format, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5548.pdf and scroll down to
page 1304.
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4. |
Reminder: Be sure to continue administering influenza vaccines throughout
December and into 2007
Remember, influenza vaccination should continue through the
month of December and beyond! Visit the following websites often
to find the information you need to keep vaccinating. Both are
continually updated with the latest resources.
The National Influenza Vaccine Summit website at
http://www.preventinfluenza.org
CDC's Influenza web section at http://www.cdc.gov/flu
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5. |
Revised VIS: CDC makes a minor
change to interim VIS for meningococcal vaccines
On November 16, CDC made a minor change to the interim VIS for
meningococcal vaccines. In light of new reports of Guillain-Barre Syndrome (GBS) following vaccination, a one-word change
was made to Section 5, which is titled "What are the risks from
meningococcal vaccines?" In the second bulleted item under the
subhead titled "Severe Problems," the interim VIS now says that
GBS has been reported in SOME people who received meningococcal
conjugate vaccine (MCV4). Previously, the interim VIS stated
that GBS had been reported in a FEW recipients of MCV4.
Note: CDC advises healthcare professionals that existing stores
of the previous interim VIS for meningococcal vaccines, dated
10/7/05, may be used up. There is no reason to discard them.
To access a ready-to-print (PDF) version of the updated
(ll/16/06) interim VIS from the CDC website, go to:
http://www.cdc.gov/nip/publications/VIS/vis-mening.pdf
To access it from the IAC website, go to:
http://www.immunize.org/vis/menin06.pdf
For information about the use of VISs, and for VISs in more than
30 languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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6. |
A must for every exam room: IAC's
laminated U.S. adult immunization schedule—updated for 2006-07
In 2006, IAC introduced the laminated version of
CDC's adult immunization schedule—and healthcare providers made good use of
it! We are now offering CDC's 2006-07 adult immunization schedule in
laminated format. It provides comprehensive information on two new vaccines:
Tdap (tetanus-diphtheria-acellular pertussis) and HPV (human papillomavirus),
as well as updates that reflect changes to the immunization recommendations
for hepatitis A and hepatitis B vaccines.
Did we mention that we've also reduced the price when you order five
schedules or more?
IAC adapted the 2006-07 schedule from the one posted on the NIP and MMWR
sections of CDC's website. Coated in durable plastic for heavy-duty use and
printed in color for easy comprehension, the laminated schedule is formatted
with essential footnotes. Following are details about the schedule, including
pricing and ordering options.
The laminated schedule is based on the ACIP/AAFP/ACOG/ACP-approved
Recommended Adult Immunization Schedule, Oct. 2006–Sept. 2007. The 4-sided,
11" x 17" schedule is printed back-to-back and folded to 8.5" x 11". To view
it, go to:
http://www.immunize.org/immschedules/immschedule_adult.pdf
It is priced at $5 each for 1–4 copies, $3 each for 5–19 copies, and $2.80
each for 20-99 copies. Discount pricing is available for larger quantities.
Order online with a credit card, or order by mail or fax, using a credit
card, check, or purchase order. Shipping is free within the United States. To
order, go to:
http://www.immunize.org/immschedules
Questions? Email admin@immunize.org
or call (651) 647-9009.
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7. |
IAC revises its online Ask the
Experts information on rotavirus, zoster, and pneumococcal polysaccharide
vaccines
The IAC website recently posted updated Ask the Experts
information on the following diseases and vaccines: rotavirus,
zoster (shingles), and pneumococcal polysaccharide. IAC extends
thanks to William L. Atkinson, MD, MPH, and Andrew T. Kroger,
MD, MPH, for reviewing and revising these Ask the Experts web
pages so that they reflect the most current information. Both
are medical epidemiologists with CDC's National Center for
Immunization and Respiratory Diseases.
To access the rotavirus vaccine Ask the Experts, go to:
http://www.immunize.org/catg.d/p2021r.htm
To access the zoster vaccine Ask the Experts, go to:
http://www.immunize.org/catg.d/p2021s.htm
To access the pneumococcal polysaccharide vaccine Ask the
Experts, go to: http://www.immunize.org/catg.d/p2021o.htm
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8. |
December issue of CDC's
Immunization Works electronic newsletter now available
The December 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 December issue has already
appeared in previous issues of IAC Express. Following is the
text of four articles we have not covered.
OTHER NEWS AND SUMMARIES
PROVIDERS INFLUENCE VACCINATION COVERAGE: A November study in
Pediatrics determined that vaccination coverage among children
19 to 35 months of age is associated with healthcare providers'
influence on parents' decision to vaccinate their children, and
with parents' beliefs about vaccine safety. Parents of 7,695
children 19 to 35 months of age were sampled by the National
Immunization Survey (NIS), a national telephone survey sponsored
by CDC to assess vaccination coverage in children. Parents
provided responses summarizing the degree to which they believed
vaccines were safe, and the influence of providers on their
decisions to vaccinate their children.
Parents who responded that providers were influential were twice
as likely to respond that vaccines were safe for children. In
addition, healthcare providers had a positive influence on
parents to vaccinate their children, even parents who believed
that vaccinations are unsafe. Among children whose parents
believed that vaccines were not safe, those whose parents'
decision to vaccinate was influenced by a healthcare provider
had an estimated vaccination coverage rate that was
significantly higher (74%) than the estimated coverage rate
among children whose parents' decision was not influenced by a
healthcare provider (50%).
Due to the effectiveness of modern vaccination programs, parents
may no longer be motivated to have their children vaccinated by
the fear of vaccine-preventable diseases. Instead, parents may
have concerns about vaccine safety and effectiveness. To address
these concerns, healthcare professionals should increase their
efforts to build honest and respectful relationships with
parents.
The abstract can be found at the American Academy of Pediatrics
website at http://pediatrics.aappublications.org (Pediatrics,
November 2006, Volume 118, Issue 5).
REMINDER—VACCINE INFORMATION STATEMENTS: A federal statute
requires all healthcare providers who administer vaccines
covered by the National Vaccine Injury Compensation Program
(NVICP) to give patients or parents a copy of the relevant
Vaccine Information Statement (VIS). The VIS must be provided
prior to vaccination. While CDC develops VIS statements for all
vaccines, and encourages their use, it is a legal requirement
that healthcare providers give patients or parents a VIS only if
the vaccine is covered by NVICP. Also, the name of the statute,
the National Childhood Vaccine Injury Act (NCVIA), can be
confusing because the statute is not focused just on children. A
vaccine receives coverage when CDC recommends a particular
vaccine for routine administration to children. However, once
the vaccine is in the program, the NVICP covers injuries to
anyone who receives it, child or adult. More information about
VIS statements and current VIS statements can be found on CDC's
website at http://www.cdc.gov/nip/publications/vis/vis-facts.htm
GLOBAL POLIO ERADICATION HINGES ON FOUR COUNTRIES: The world's
success in eradicating polio now depends on four countries—Afghanistan, India, Nigeria, and Pakistan—according to the
Advisory Committee on Polio Eradication (ACPE), the independent
oversight body of the eradication effort. On October 11-12, ACPE
met in Geneva, Switzerland, to review recent global progress in
polio eradication and recommend steps to (1) end poliovirus
transmission rapidly in the remaining four endemic areas; (2)
limit international spread of the virus; and (3) prepare for
eventual eradication of polio and cessation of oral polio
vaccination. To view a press release about the meeting, go to
http://www.polioeradication.org/content/pressreleases/20061012press.asp
MEETINGS, CONFERENCES & RESOURCES
NEW TIDE MODULE: Teaching Immunization Delivery and Evaluation
(TIDE) is a curriculum designed by the Medical University of
South Carolina and the Ambulatory Pediatric Association/Society
for Adolescent Medicine to help health professionals increase
immunization rates for children. TIDE's new Vaccine Storage and
Handling Module is now available online for physicians, nurses,
and other healthcare professionals responsible for immunization
delivery. Free CNE, CME, and CEUs are provided. Information and
registration for the Vaccine Storage and Handling Module and the
rest of the TIDE program can be found at
http://www2.edserv.musc.edu/tide/menu.lasso
To access the complete December issue from the NIP website, go
to: http://www.cdc.gov/nip/news/newsltrs/imwrks/2006/200612.htm
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9. |
December 5 issue of IAC's Hep
Express newsletter now online.
The December 5 issue of Hep Express, an electronic newsletter
published by IAC, is now available online. It is intended for
health professionals, program planners, and advocates involved
in prevention, screening, and treatment of viral hepatitis.
IAC Express has already covered some of the information
presented in the December 5 Hep Express. Following are the
titles and a small amount of information about articles we have
not yet covered.
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"Updated U.S. Treatment Guidelines for Management of Chronic
Hepatitis B Published" (The treatment algorithm for managing
chronic hepatitis B in the United States, first published in
2004, has been updated.)
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"APAMSA Develops New Hepatitis B Outreach Guide" (APAMSA is
the Asian Pacific American Medical Student Association.)
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"American Liver Foundation Launches Website for the Public
about Liver Health" (The website is designed to teach the
public about liver wellness and liver disease.)
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"CDC's Division of Viral Hepatitis Offers Brochure in
Multiple Languages" (The brochure, titled "Protect Your Baby
for Life from Hepatitis B," is now available in Spanish,
Chinese, Marshallese, Tagalog, and Vietnamese.)
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"Hepatitis B Foundation Adds Turkish-Language Chapter to Its
Website" (The Turkish chapter is a new addition; the website
also offers users chapters in Chinese, Korean, Spanish, and
Vietnamese.)
To access the December 5 issue, go to:
http://www.hepprograms.org/hepexpress/issue50.asp
To sign up for a free subscription to Hep Express, go to:
http://www.immunize.org/subscribe
To access previous issues of Hep Express, go to:
http://www.hepprograms.org/hepexpress
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10. |
MMWR compiles information about
all its current continuing-education exams into one handy reference list
CDC published "MMWR Continuing Education Exams Available for
Credit" in the December 8 issue of MMWR. Several of the exams
listed concern recent immunization recommendations and
guidelines. If you are interested in receiving continuing-education credit for reading a recommendation or guideline and
taking a brief exam, go to:
http://www2a.cdc.gov/ce/availableactivities.asp
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11. |
WHO issues position paper on Hib
vaccines
The November 24 issue of the WHO periodical "Weekly
Epidemiological Record" covered the latest WHO position paper on
Haemophilus influenzae type b conjugate vaccine. To access it,
go to: http://www.who.int/wer/2006/wer8147.pdf
A collection of WHO position papers on vaccines is available in
alphabetical order at
http://www.who.int/immunization/documents/positionpapers
They are available in chronological order on the IAC website at
http://www.immunize.org/who
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12. |
The Global Alliance for Vaccines
and Immunization approves $100 million for pneumococcal vaccine funding
On November 29, the board of the Global Alliance for Vaccines
and Immunization (GAVI) announced that it had approved $100
million for purchasing pneumococcal vaccine and for supporting
the strategic and technical activities needed to support its
use.
For additional information, go to the website of PneumoADIP at
http://www.preventpneumo.org and click on the link titled "Read
PneumoADIP Statement" under the heading "News from the Field" in
the left column.
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13. |
PAHO publishes second edition of
its book Recent Advances in Immunization
The Pan American Health Organization (PAHO) recently announced
the publication of the book Recent Advances in Immunization. It
is primarily intended for national immunization program managers
in the Americas and their staffs, but it has application for
other health professionals. Currently, available only in
English, PAHO's book on immunization advances will be available
in Spanish, French, and Portuguese.
For a description of the book and ordering information, go to:
http://publications.paho.org/english/moreinfo.cfm?Product_ID=868
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