IZ Express Issue 658 | Immunize.org

IAC Express 2007
Issue number 658: April 23, 2007

Contents of this Issue Select a title to jump to the article.
It's here! National Infant Immunization Week is April 21-28 New: FDA approves human vaccine to protect against avian influenza virus H5N1 FDA approves accelerated dosing schedule for Twinrix CDC reports on two fatal rabies cases in U.S. in 2006 UNICEF reports on current drive to immunize 3.9 million Iraqi children against measles New: CDC website launches new homepage and other improvements April 18 issue of IAC's Hep Express electronic newsletter now online Interim VIS for meningococcal vaccine and VIS for varicella vaccine now in Turkish Symposium on HIV and hepatitis B vaccines planned for May 10 in Washington, DC For coalitions: IZTA launches the Immunization Coalitions Blog For coalitions: Bring your ideas to the May 1 phone meeting to plan the 2008 National Conference on Immunization Coalitions Reminder: April 27 is deadline for standard registration for the Points Across health promotion conference

Abbreviations

AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.

Issue 658: April 23, 2007

It's here! National Infant Immunization Week is April 21-28

CDC published "Notice to Readers: National Infant Immunization Week—April 21-28, 2007" in the April 20 issue of MMWR. The notice is reprinted below in its entirety, excluding references.

The week of April 21-28, 2007, is National Infant Immunization Week (NIIW) and Vaccination Week in the Americas (VWA). During this week, hundreds of communities throughout the United States are expected to participate in NIIW-VWA by sponsoring activities emphasizing the importance of timely infant and childhood vaccination.

Immunization is one of the most effective ways to protect infants and children from potentially serious diseases. Approximately 11,000 infants are born each day in the United States; according to the recommended immunization schedule, each infant requires approximately 27 doses of vaccine (i.e., administered in 21 or 22 injections of combination vaccines) before age 2 years for protection from 14 vaccine-preventable diseases.

Kick-off events highlighting the need to achieve and maintain high childhood vaccination coverage rates will be hosted in Nevada; Colorado; Hidalgo County, Texas; and communities along the U.S.-Mexico border. Events will include education activities for providers, media events, and immunization clinics in collaboration with CDC, state and local health departments, the United States-Mexico Border Health Commission, and the Pan American Health Organization (PAHO).

NIIW is being held in conjunction with VWA. VWA, sponsored by PAHO, targets children and other vulnerable and underserved populations with low vaccination coverage rates in all countries in the Western hemisphere.

During NIIW-VWA, CDC has English- and Spanish-language public education campaign materials available to communities, including television public service announcements, posters, print advertisements, articles, and educational materials for parents and providers. Additional information about NIIW-VWA and childhood vaccination is available from CDC at http://www.cdc.gov/nip/events/niiw Information on VWA is available at http://www.paho.org/English/DD/PIN/vw_2007.htm

To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5615a6.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5615.pdf

New: FDA approves human vaccine to protect against avian influenza virus H5N1

On April 17, the Food and Drug Administration (FDA) issued a press release announcing that it has approved the first U.S. vaccine for humans that protects against the H5N1 avian influenza virus. Portions of the press release are reprinted below.

Also on April 17, the Department of Health and Human Services (HHS) issued a press release on the subject. A link to the HHS press release appears at the end of this IAC Express article.

FDA APPROVES FIRST U.S. VACCINE FOR HUMANS AGAINST THE AVIAN INFLUENZA VIRUS H5N1

The U.S. Food and Drug Administration (FDA) today announced the first approval in the United States of a vaccine for humans against the H5N1 influenza virus, commonly known as avian or bird flu.

The vaccine could be used in the event the current H5N1 avian virus were to develop the capability to efficiently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an influenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. . . .

The H5N1 virus is one version of the influenza A virus commonly found in birds. Unlike seasonal influenza, where infection ranges from mild-to-serious symptoms in most people, the disease caused by H5N1 is far more severe and happens quickly, with pneumonia and multi-organ failure commonly seen.

While there have been no reported human cases of H5N1 infection in the United States, almost 300 people worldwide have been infected with this virus since 2003 and more than half of them have died. To date, H5N1 influenza has remained primarily an animal disease but should the virus acquire the ability for sustained transmission among humans, people will have little immunity to this virus and the potential for an influenza pandemic would have grave consequences for global public health.

"The timing and severity of an influenza pandemic is uncertain, but the danger remains very real," said Jesse L. Goodman, MD, MPH, director of FDA's Center for Biologics Evaluation and Research. "We are working closely with other government agencies, global partners, and the vaccine industry to facilitate the development, licensure, and availability of needed supplies of safe and effective vaccines to protect against the pandemic threat."

The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 influenza virus contained in the vaccine. H5N1 influenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The manufacturer, sanofi pasteur Inc., will not sell the vaccine commercially. Instead, the vaccine has been purchased by the federal government for inclusion within the National Stockpile for distribution by public health officials if needed. . . . .

To access the complete press release, go to:
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01611.html

To access the approval letter, go to:
http://www.fda.gov/cber/approvltr/h5n1san041707L.htm

To access the package insert, go to:
http://www.fda.gov/cber/label/h5n1san041707LB.pdf

To access a Q&A page about the vaccine, go to:
http://www.fda.gov/cber/products/h5n1san041707qa.htm

To access the HHS press release, go to:
http://www.hhs.gov/news/press/2007pres/04/pr20070417a.html

FDA approves accelerated dosing schedule for Twinrix

[The following is cross posted from IAC's Hep Express electronic newsletter, 4/18/07.]

On March 28, FDA approved an accelerated dosing schedule for Twinrix [Hepatitis A (Inactivated) and Hepatitis B (Recombinant) Vaccine, GSK]. The schedule consists of three doses given within three weeks followed by a booster dose at 12 months (0, 7, 21–30 days, 12 months).

The accelerated schedule could benefit individuals traveling to high-risk areas; emergency responders, especially those being deployed to disaster areas overseas; and others who are at risk for hepatitis A and B infection.

To read the FDA product approval information, go to:
http://www.fda.gov/cber/products/hahbgsk032807.htm

To read the package insert, go to:
http://www.fda.gov/cber/label/hahbgsk032807LB.pdf

CDC reports on two fatal rabies cases in U.S. in 2006

CDC published "Human Rabies—Indiana and California, 2006" in the April 20 issue of MMWR. The article is reprinted below in its entirety, excluding references.

Rabies is a viral infection that causes acute, progressive encephalitis and is considered to be universally fatal. However, during 2004, an unvaccinated Wisconsin patient received a new medical treatment and became the first documented survivor of rabies who had not received preexposure vaccination or postexposure prophylaxis (PEP), suggesting the possibility of successful future interventions. This report describes two recent patients with rabies who were treated using therapy similar to that used for the Wisconsin patient; both treatments were unsuccessful. The report also describes the concomitant epidemiologic investigations by the Indiana State Department of Health (ISDH), California Department of Health Services (CDHS), and CDC, and the local public health responses in Marshall County, Indiana, and San Joaquin and Alameda counties in California. The findings in this report underscore the continuing need for enhanced clinical awareness of possible rabies exposure to ensure prompt PEP and timely diagnosis of rabies, especially if treatment is attempted.

Indiana
Case report. On September 30, 2006, a girl aged 10 years had pain in her right arm, and her parents noticed a skin eruption on her trunk and extremities. On October 3, she began vomiting and had increased arm pain and occasional arm numbness. During her initial visit to her family's primary healthcare provider on October 4, radiographs of her arm and clavicle were normal. Three to five days after her initial symptoms began, the patient's speech became difficult to understand, and she had a decreased appetite, sore throat and neck pain, and temperature of 101 [degrees] F. She became irritable and agitated. A rapid Group A streptococcal antigen test and slide heterophil antibody assay were negative on October 6. The patient was hospitalized on October 7 at a community hospital, where she was found to have difficulty swallowing secretions. Her tongue had a whitish coating and was protruding from her mouth. Her complete blood count and electrolytes were normal. She was prescribed methylprednisolone for possible glossitis and fluconazole for mucosal candidiasis.

On October 8, neurologic involvement became more evident, and the attending physician arranged for transfer to a university-affiliated tertiary care pediatric hospital. On arrival at the pediatric hospital, the patient was irritable, with intermittent moments of alertness, altered mental status, and lethargy. She had slurred speech and difficulty swallowing secretions and complained of a drowning sensation. Because of difficulty breathing, low oxygen saturation, and excess secretions, the patient was intubated and placed on a mechanical ventilator. A lumbar puncture was performed, indicating a white blood cell (WBC) count of 26 cells/mm3 (normal: 0-7 cells/mm3), a red blood cell (RBC) count of 1 cell/mm3 (normal: 0 cells/mm3), a protein level of 28 mg/dL (normal: 15-45 mg/dL), and a glucose level of 89 mg/dL (normal: 40-70 mg/dL). Vancomycin, cefotaxime, and acyclovir were administered for the presumptive diagnosis of meningoencephalitis. On the second day of hospitalization, the patient experienced episodes of lethargy, somnolence, generalized skin flushing (associated with vancomycin administration), and hypersalivation.

Initial interviews of family members indicated that the patient frequently was exposed to healthy-appearing household cats and dogs but to no other animals. On the third day of hospitalization, the patient's primary-care physician told staff members at the pediatric hospital that a babysitter suggested the patient might have sustained an animal scratch or bite during June 2006. Family members did not know what type of animal might have scratched her. However, in spite of her endotracheal intubation, the patient was able to indicate that a bat had scratched or bit her. On the same day, serum, saliva, cerebrospinal fluid, and a skin biopsy from the nape of the neck (nuchal sample) were sent to CDC for rabies virologic testing, and a serum rabies-virus—specific antibody test was positive. Reverse transcription—polymerase chain reaction (RT-PCR) performed on saliva and skin samples also were positive for rabies virus amplicons, and direct fluorescent antibody (DFA) staining of the skin biopsy was positive for detection of rabies virus antigens. The patient had not received a rabies vaccine or rabies PEP.

After rabies was confirmed, the Wisconsin rabies treatment protocol was initiated, including antiexcitatory and antiviral therapy with phenobarbital, midazolam, ketamine, and amantadine with aggressive supportive care. On the sixth day of hospitalization, ribavirin was administered intravenously, under a Food and Drug Administration (FDA) emergency use investigational new drug protocol. Coenzyme Q10, l-arginine, tetrahydrobiopterin, and vitamin C also were administered in an attempt to replenish neurotransmitter substrates. During hospitalization, the patient experienced multiple complications, including increased intracranial pressure, bouts of diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), reversible pancreatitis secondary to ribavirin, intracranial venous sinus thrombosis, and cerebral and cerebellar herniation. In spite of a reduction in sedation drugs, the patient never regained consciousness. Because of a deteriorating clinical condition and poor prognosis, life support was withdrawn. The patient died on November 2, 2006, on the twenty-sixth day of hospitalization. Rabies virus antigen was detected in brain tissue collected postmortem.

Public health investigation. The patient's mother reported that in mid-June, the girl had awakened her during the night and said that a bird or bat had flown into her bedroom window and bitten her. The mother saw a small mark on the girl's arm, which the mother washed and treated with an over-the-counter first aid treatment. The mother then went to the girl's bedroom to see whether an animal was present. Finding none, she assumed that the incident was a nightmare, not uncommon for the girl. Approximately 2-3 days later, an older sibling took a dead bat away from the family cat; however, the mother did not associate this event with the previous incident and did not seek rabies PEP for the girl. The mother later reported that at the time of the incident, a bedroom window was probably open without a screen in place.

After genetic sequencing of amplicons obtained from the patient's skin and saliva, on October 14, CDC characterized the infecting agent as a rabies virus variant associated with the silver-haired bat, Lasionycteris noctivagans. ISDH recommended rabies PEP for persons who had been exposed to the patient's saliva, from 7 days before onset of initial symptoms through the time of her death. A total of 66 persons received PEP, including seven members of the patient's immediate family, a healthcare worker at the patient's primary-care site, nine staff members at the first hospital in which she was treated, an ambulance service worker, 17 staff members at the pediatric hospital, and 31 persons from the patient's school and community.

California
Case report. On November 15, 2006, a boy aged 11 years had sore throat, fatigue, and fever (101 [degrees] F). He was taken to his pediatrician's office on November 16 for a previously scheduled childhood vaccination related to his recent immigration from the Philippines on October 2, 2006. He received a diagnosis of pharyngitis and was prescribed amoxicillin; the vaccinations were deferred. That evening, the boy was taken to a hospital emergency department (ED) with chest tightness, dysphagia, and insomnia. He had tachycardia (128 beats/min) and hypertension (148/99 mmHg) but no fever; his respiratory rate and oxygen saturation level were normal.

During the next several hours in the ED, the boy experienced irregular lip and mouth movements, hallucinations, and agitation. Rabies-associated signs such as aerophobia, hydrophobia, profuse salivation, and copious oral secretions were noted, and he was transported to a tertiary care pediatric hospital. Because the possibility of rabies was raised by providers at the referring hospital, infection-control measures were initiated at the pediatric hospital, including contact and droplet precautions.

The patient was admitted to the pediatric intensive care unit (PICU). He had profuse salivation and required tracheal intubation, and he experienced intermittent altered mental status. In the ED and subsequently in the PICU, the patient experienced hemodynamic instability associated with sedative administration, and he required cardiac resuscitation. An electrocardiogram showed sinus tachycardia with diffuse ST—T wave changes, and an echocardiogram indicated high systemic vascular resistance and secondary cardiomyopathy. A lumbar puncture indicated a WBC count of 8 cells/mm3, RBC count of 0 cells/mm3, a protein level of 25 mg/dL, and a glucose level of 128 mg/dL. On the basis of the patient's history, clinical signs, and symptoms, he received ketamine and midazolam infusions on the first hospital day for control of dysautonomia, as described in the Wisconsin rabies treatment protocol.

Overnight, after consultation with the California Department of Health Services (CDHS), samples were obtained for rabies diagnosis, including corneal impressions, cerebrospinal fluid, serum, and saliva. On the second hospital day, the samples were sent to CDC and the CDHS Viral and Rickettsial Disease Laboratory. Rabies virus antigens were detected in the corneal impressions by DFA on November 18. After receiving this result, physicians from the hospital consulted with CDHS, CDC, and the physicians who developed the Wisconsin protocol therapy, and intravenous ribavirin and enteral amantadine, tetrahydrobiopterin, and coenzyme Q10 were administered.

The patient's family was asked about possible animal exposures. Although the parents were unaware of any specific incidents, two siblings recalled that the patient had been bitten by a dog approximately 2 years previously, when he was living in the Philippines. He did not receive rabies PEP at that time.

At CDC, rabies virus RNA was detected by RT-PCR in patient saliva samples obtained on the third hospital day. The gene sequences were similar to those of a canine rabies virus variant from the Philippines. Rabies virus antigen was detected by DFA in a nuchal biopsy that was obtained on the fourth hospital day. Serology for detection of rabies virus antibodies was performed daily by an indirect immunofluorescent assay and was negative until the twelfth hospital day, when an immunoglobulin G (IgG) titer of 1:128 was detected. The following day, the serum IgG titer increased to 1:256, and the immunoglobulin M (IgM) titer was 1:10. Rabies virus IgG was first detected in the cerebrospinal fluid on the fourteenth hospital day, with a titer of 1:8. A repeat nuchal biopsy was performed on the twentieth hospital day to assess viral clearing; rabies virus antigen was detected, but the staining intensity was less prominent and had a less organized pattern than the previous biopsy.

The patient experienced multiple complications while hospitalized, including autonomic lability, SIADH, renal insufficiency, superficial thrombophlebitis of the left lower extremity, cerebral artery spasm, subclinical seizures, mild pancreatic enzyme elevation attributed to ribavirin, and progressive heart block requiring transvenous pacing. Cerebral perfusion was monitored daily via transcranial Doppler. Additional anticonvulsant therapy was initiated on the eighteenth hospital day because of seizures. A continuous electroencephalogram (EEG) indicated bursts of electrical brain activity followed by little brain activity (i.e., burst-suppression pattern), and by the twenty-first hospital day indicated that almost no brain activity remained. Transcranial Doppler sonography results remained within normal limits.

On the twenty-fourth hospital day, the patient had diabetes insipidus, and the EEG indicated almost no electrical brain activity. A cranial computed tomography scan on the same day indicated loss of differentiation of the gray-white boundary of the brain and diffuse cerebral edema. Transcranial Doppler sonography indicated a high resistive index with no diastolic flow. Midazolam infusion was discontinued. After discussions between the family and the care team, life support was withdrawn on December 13, the twenty-seventh hospital day, and the patient died. Rabies virus antigen was detected in brain tissue collected postmortem.

Public health investigation. To identify exposures to the patient and the need for rabies PEP among identified contacts, CDHS distributed rabies assessment tools (which vary according to exposure scenario) to the public health department in San Joaquin County, where the patient first became ill, and in Alameda County, the location of the pediatric hospital. All 13 members of the patient's family were identified as potentially exposed because they had shared food and drink with the patient and reported contact with the patient's saliva; all received PEP. None of the three staff members at the primary-care physician's office or two emergency-transport personnel were determined to require PEP. Healthcare workers at the hospital in San Joaquin County were interviewed, and eight of 22 elected to begin PEP because of potential contact with saliva. No additional interventions were deemed necessary in San Joaquin County. Twenty-four healthcare workers were interviewed at the pediatric hospital in Alameda County. Three received PEP for potential exposure to saliva through mucous membranes or uncovered breaks in the skin.

Editorial Note
During 2000-2006, a total of 19 of the 24 human rabies cases reported in the United States were acquired indigenously. The history of exposure to a bat given by the patient in Indiana described in this report and the identification of a specific bat rabies virus variant support the explanation of indigenous rabies acquisition via bat bite. In contrast, the history of a dog bite in the patient from California described in this report, even though the bite occurred years before his immigration to the United States, suggests acquisition of rabies in the Philippines; this is supported by isolation and identification of a specific canine-associated rabies virus variant found in the Philippines. Typical rabies incubation periods vary from 1 to 3 months after exposure, but longer intervals have been documented.

Human rabies is preventable with proper wound care and timely, appropriate administration of human rabies immune globulin and rabies vaccine before onset of clinical symptoms. PEP is recommended for all persons who have been bitten or scratched by an animal suspected to have rabies virus and for all persons whose mucous membranes have been exposed to the virus.

Twenty-seven healthcare workers received PEP as part of the investigations in Indiana and California. Previous reports have described administration of PEP to contacts of humans with rabies. The indications for PEP among healthcare workers who care for patients with rabies include exposure of mucous membranes or open wounds to infectious body fluids or tissue (e.g., saliva, tears, cerebrospinal fluid, or neurologic tissue) from the patient. Adherence to standard infection-control precautions minimizes the risk for healthcare workers' exposure to rabies.

During 2004, the first documented survival of a patient who had not received preexposure vaccination or rabies PEP occurred in a patient from Wisconsin. Treatment for this patient included an intensive protocol that included drug-induced coma and administration of antiviral drugs. However, the benefits of any particular experimental regimen have not been determined, and no single specific course of therapy for rabies in humans has been demonstrated effective after clinical signs manifest.

Rabies is usually a fatal illness in humans. To consider use of the Wisconsin rabies treatment protocol, the disease must be diagnosed as early in the course as possible, which requires enhanced clinical awareness of the disease among healthcare providers. Rabies should be included in the differential diagnosis of any unexplained acute, rapidly progressive viral encephalitis. Although initial signs and symptoms of rabies are nonspecific, a history of an animal bite or travel to a rabies-indigenous country, combined with clinical signs such as paresthesia, hypersalivation, dysphagia, hydrophobia or aerophobia, behavioral changes, or sudden autonomic instability, should lead to a strong suspicion of rabies. Rapid diagnosis of rabies virus infection can be beneficial to the treatment of the patient and can facilitate appropriate prophylaxis for exposed persons. In addition to current measures, other national and international interventions are needed to raise awareness, improve health education, expand diagnostic testing, and improve rabies prevention, control, and treatment.

To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5615a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5615.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

UNICEF reports on current drive to immunize 3.9 million Iraqi children against measles

On April 20, UNICEF issued a press release titled "Lifesaving Immunization Drive for 3.9 Million Children in Iraq." Portions of it are reprinted below.

In one of the biggest humanitarian operations in Iraq in the last two years, a wave of 8,000 vaccinators will set out across the country starting this Sunday to prevent a possible outbreak of measles amongst Iraq's children—many of whom have not received their routine immunization as a result of insecurity.

The ambitious immunization drive will last for two weeks and aim to bring the measles-mumps-rubella (MMR) combined vaccine to as many of the 3.9 million Iraqi children aged between one and five years old as possible.

Measles can be deadly to children, killing more worldwide each year than any other vaccine-preventable disease, but is easily prevented by immunization. Iraq's Ministry of Health is organizing the MMR campaign as part of Iraq's long-term Measles Elimination Plan, with support from UNICEF and the World Health Organization (WHO) and invaluable financing from the European Commission.

"Insecurity in Iraq has increased the risk of a widespread measles epidemic that could claim the lives of up to 10 percent of infected children," said Dr. Naeema Al-Ghasser, WHO Representative for Iraq. "All children between 12-59 months everywhere in Iraq need to be immunized, even if they have had the vaccine before. The vaccine is safe and effective, and gives lifelong immunity against measles."

"The timing of this MMR campaign is critical." said Roger Wright, UNICEF Special Representative for Iraq. "One million Iraqi children now have no protection against measles, as a result of insecurity and falling immunization rates. This vaccine will certainly save many young lives and we are calling on everyone in Iraq to ensure vaccinators reach children safely over the next two weeks."

Iraq's Measles Elimination Plan has been remarkably successful to date, reducing measles cases nearly 20-fold—from 9,181 in 2004 to fewer than 500 reported last year. However, UNICEF and WHO said that in Iraq's current conditions many cases may go unreported. For this campaign, WHO has helped to train the vaccinators and provided critical technical advice for campaign planning, implementation, and monitoring. UNICEF has contracted over 2,000 vehicles to transport the vaccinators as well as providing safety boxes to dispose of syringes, and is helping to engage the support of Iraq's community leaders.

Iraq's growing humanitarian crisis has also added to the campaign's challenges, the UN Agencies said, increasing the risks for vaccinators and making it harder to calculate numbers of children to immunize. UNICEF and WHO are particularly concerned to secure access to children stranded in the most violent parts of Baghdad, Diyala, and Anbar, as well as children who have been displaced because of insecurity. Special plans are being made to deliver the vaccine to these populations, where the risk from measles is highest.

Al-Ghasser praised the dedication and courage of all involved in the campaign, saying: "The unflagging determination of Iraq's health workers and many local volunteers to deliver this important vaccine is both admirable and heartening."

"We have a short window of opportunity to give children lifelong protection against a dangerous disease," said Wright. "This MMR campaign must proceed unhindered and unite everyone for children's sake. . . ."

To access the complete press release, go to:
http://www.unicef.org/media/media_39422.html

New: CDC website launches new homepage and other improvements

On April 19, CDC issued a press release announcing the launch of a new homepage. Portions of the press release are reprinted below.

CDC LAUNCHES NEW HOME PAGE AND OTHER WEB SITE IMPROVEMENTS:
Usable layout, new search engine, and new features help people more easily find information and resources

The Centers for Disease Control and Prevention (CDC) today unveiled a new look for the homepage and major topic pages of its website. The changes are designed to make it easier for people to find health information and resources quickly. The CDC website address is http://www.cdc.gov

The redesigned site has an improved layout, a more powerful search engine, and other features to help people locate needed health and science information more efficiently. The CDC website averages nine million visits a month, with an average of 37 million pages viewed monthly. . . .

For more information and a tutorial about the changes to the CDC website, visitors can take a virtual tour at http://www.cdc.gov/vrtour.html Additional information and images can also be found at http://www.cdc.gov/Other/about_cdcgov.html

To access the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/2007/r070419.htm

April 18 issue of IAC's Hep Express electronic newsletter now online

The April 18 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 April 18 Hep Express; titles of articles we have not yet covered follow.

AAPCHO [Association of Asian Pacific Community Health Organizations] responds to CDC report about declining incidence of acute viral hepatitis infections
PKIDS [Parents of Kids with Infectious Diseases] offers access to health professionals' expertise
Hepatitis B Foundation expands its Expert Speakers Forum
APAMSA [Asian Pacific American Medical Student Association] launches new website
HepB.tv offers hepatitis B programming for Asian Americans
VHPB [Viral Hepatitis Prevention Board] updates its website with new meeting report

To access the April 18 issue, go to:
http://www.hepprograms.org/hepexpress/issue55.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

Interim VIS for meningococcal vaccine and VIS for varicella vaccine now in Turkish

The interim VIS for meningococcal vaccine and the VIS for varicella vaccine are now available on the IAC website in Turkish. IAC gratefully acknowledges Mustafa Kozanoglu, MD, and Murat Serbest, MD, for the translations.

INTERIM VIS FOR MENINGOCOCCAL VACCINE (dated 11/16/06)
To obtain a ready-to-print (PDF) version interim VIS in Turkish, go to: http://www.immunize.org/vis/tu_men.pdf

To obtain it in English, go to:
http://www.immunize.org/vis/menin06.pdf

VIS FOR VARICELLA VACCINE (dated 1/10/07)
To obtain a ready-to-print (PDF) version of the VIS in Turkish, go to: http://www.immunize.org/vis/tu_var.pdf

To obtain it in English, go to:
http://www.immunize.org/vis/varic07.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

Symposium on HIV and hepatitis B vaccines planned for May 10 in Washington, DC

Combating HIV and Hepatitis B, a symposium on the development of HIV and hepatitis B vaccines, is scheduled for May 10 to coincide with World AIDS Vaccine Day on May 18 and Hepatitis Awareness Week, May 7-11.

The program will begin at 9AM in Room 119 of the Thomas Jefferson Building, 10 First St. S.E., Washington, DC. The event is free and open to the public; tickets are not required.

The symposium will be cybercast live at www.loc.gov After May 10, the webcast will be available at http://www.loc.gov/today/cyberlc

The Library of Congress's Kluge Center is holding the symposium in partnership with the International AIDS Vaccine Initiative (IAVI) and the Hepatitis B Foundation (HBF), with support from the Dana Foundation.

10.

For coalitions: IZTA launches the Immunization Coalitions Blog

The Immunization Coalitions Technical Assistance Network (IZTA) has launched the Immunization Coalitions Blog. The first guest blogger is Andrew Resignato, director, San Francisco Immunization Coalition. He writes weekly postings about the coalition's successes, challenges, and upcoming activities, and also shares his thoughts on current immunization issues and how they affect his coalition's work in the Bay Area. Different coalition bloggers will be featured every few months. Check it out at http://izta.blogspot.com

11.

For coalitions: Bring your ideas to the May 1 phone meeting to plan the 2008 National Conference on Immunization Coalitions

The next National Conference on Immunization Coalitions (NCIC) is scheduled for 2008 in San Francisco. The planning committee is being formed, and volunteers are needed.

There is a place for everyone to become involved. Volunteers of all stripes are needed: event planners, fund raisers, organizers, speakers, evaluators, promoters, coordinators, phoners, recruiters, schmoozers, worker bees, and more.

Interested? Join in on the next NCIC planning committee phone meeting, scheduled for May 1 at 2PM ET. Call (866) 331-0889; the participant code is 185760.

For more information, or to be added to the NCIC planning committee email list, contact Andrew Resignato at andrew@sfimmunize.org

12.

Reminder: April 27 is deadline for standard registration for the Points Across health promotion conference

Sponsored by the Maryland Partnership for Prevention (MPP), "Points Across IV: Proven Strategies for Lasting Success" is scheduled for May 17 in Columbia, MD. The deadline for standard registration has been extended from April 17 to April 27.

An additional event, an Evidence-Based Institute pre-conference, is planned for May 16. Both meetings will highlight best practices and provide instruction on collecting, interpreting, applying, and reporting health promotion program data.

To access the conference brochure, which includes comprehensive program and registration information, go to: http://www.edcp.org/pdf/Points_Across_Brochure.pdf Registrations must be postmarked or faxed by April 27.

For additional information, call (410) 902-4677.

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