IZ Express Issue 661 | Immunize.org

IAC Express 2007
Issue number 661: May 7, 2007

Contents of this Issue Select a title to jump to the article.
May is National Hepatitis Awareness Month! Be sure to visit IAC's special web section for an overview of events Journal of Infectious Diseases publishes article about HBV transmission between patients in dental practice: accompanying editorial advocates hepatitis B vaccination for all persons up to age 40 years May 2 issue of IAC's Hep Express electronic newsletter covers events related to Hepatitis Awareness Month New: CDC's booklet "Childcare and School Immunization Requirements: 2005-2006" now available on the IAC website CDC reports on vulvar vaccinia infection after sexual contact with military smallpox vaccinee in Alaska in 2006 Updated: IAC revises its professional-education piece on administering IM and SC injections to adults HHS issues interim guidance on use of facemasks and respirators in public settings during an influenza pandemic For coalitions: May 15 is the date for IZTA's teleconference on the Influenza Summit's update on vaccine supply Seattle STD/HIV prevention training center and University of Washington develop online study site Seminar on new frontiers in cancer immunotherapy scheduled for July 9-11 at Veyrier-du-Lac, France

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 661: May 7, 2007

May is National Hepatitis Awareness Month! Be sure to visit IAC's special web section for an overview of events

May is National Hepatitis Awareness Month. Since 2001, it has been the month designated to raise public awareness of the seriousness, and at time the deadliness, of viral hepatitis.

For this reason, IAC has created a new web section to highlight events, campaigns, conferences, educational opportunities, organizations, print materials, and journal articles that focus on hepatitis awareness. The special section also includes resources on hepatitis prevention through vaccination, public education, testing of high-risk individuals, and treatment.

The section on hepatitis materials offers a compilation of some of IAC's free print materials on hepatitis A, B, and C that includes patient screening questionnaires, information on the vaccines suitable for people with HIV and/or hepatitis C, and a comprehensive overview of the differences between hepatitis A, B, and C.

Visit the new web section at http://www.immunize.org/hepawareness Use the navigation bar on the left to explore the information available.

If you know of conferences and events to add to the new web section, please email the information to maryq@immunize.org

Journal of Infectious Diseases publishes article about HBV transmission between patients in dental practice: accompanying editorial advocates hepatitis B vaccination for all persons up to age 40 years

The May 1 issue of the Journal of Infectious Diseases includes an article about patient-to-patient transmission of hepatitis B virus (HBV) in an oral surgeon's office where investigators found no deficiencies in infection control practices. The issue also features an accompanying editorial written by preventive medicine experts Ban Mishu Allos, MD, and William Schaffner, MD, who advocate universal hepatitis B vaccination of all adults up to age 40 years.

Following is the citation and link for the full article about the case of patient-to-patient HBV transmission.

"Patient-to-Patient Transmission of Hepatitis B Virus Associated with Oral Surgery"
Authors: Redd JT, Baumbach J, et al.
Source: J Infect Dis, May 1, 2007, Vol. 195(9):1311-4
http://www.journals.uchicago.edu/JID/journal/issues/v195n9/36695/36695.html

The editorial is titled "Transmission of hepatitis B in the health care setting: the elephant in the room . . . or the mouse?" Portions of it are reprinted below; the link to the complete editorial appears at the end of this IAC Express article.

[Investigators] describe a 60-year-old, white, non-Hispanic woman who was not sexually active, did not use intravenous drugs, and who had no contacts with persons with hepatitis B virus infection. She went to her dentist in October 2001 for routine tooth extractions. There, despite the oral surgeon's adherence to standard infection control precautions, she was infected with hepatitis B virus. The oral surgeon and all the office staff were tested, and none had serologic evidence of infection with hepatitis B virus. How did this happen? The meticulous investigation that ensued demonstrated that this unfortunate woman's virus was identical to virus isolated from a hepatitis B surface antigen朴ositive 36-year-old woman who had hepatitis B infection dating back to at least 1999. The chronically infected woman had visited the same oral surgeon on the same day and had had 3 teeth extracted just 161 min before the index patient had a similar procedure. . . .

We advocate adoption of [this] prevention strategy: universal hepatitis B virus vaccination of all adults up to 40 years of age. Sadly, but not surprisingly, the current risk-based vaccination recommendations endorsed by the Advisory Committee on Immunization Practices have resulted in meager vaccination rates for persons in high-risk groups. Fewer than 10% of young adults with high-risk behaviors (intravenous drug users, persons with multiple sex partners, and men who have sex with men) have received hepatitis B virus vaccine.

In the United States, the majority of new cases of hepatitis B infections occur in adults. Universal hepatitis B vaccination policies produced dramatic declines in the incidence of acute hepatitis B infection in children. In contrast, despite the availability of an effective and safe vaccine for adults, rates of acute hepatitis B virus infection in many adult age groups have plateaued or continue to increase. Universal age-based recommendations might have prevented both the source patient's infection and subsequent transmission to the index patient in the oral surgeon's office.

Bloodborne viruses such as HIV, hepatitis B, and hepatitis C that may be transmitted in healthcare settings continue to present challenges to hospitals, physicians, dentists, and patients. The best efforts of well-meaning providers to eliminate these events will likely not completely succeed. However, strategies that may limit their number include meticulous infection control practices, postexposure prophylaxis administered promptly to those known or suspected of having been exposed to hepatitis B or HIV, and universal hepatitis B vaccination. A thorough search for nontraditional exposure sources for all patients with no recognized risk factors who are diagnosed with HIV, hepatitis B, or hepatitis C also may quantify the magnitude of the risk to patients in medical settings and perhaps shed light on mechanisms of transmission.

To access the editorial in its entirety, go to:
http://www.journals.uchicago.edu/JID/journal/issues/v195n9/37128/37128.html

May 2 issue of IAC's Hep Express electronic newsletter covers events related to Hepatitis Awareness Month

The May 2 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.

The May 2 issue is dedicated to events related to National Hepatitis Awareness Month, which has been observed since May 2001. To access the issue, go to: http://www.hepprograms.org/hepexpress/issue56.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

New: CDC's booklet "Childcare and School Immunization Requirements: 2005-2006" now available on the IAC website

The IAC website recently posted CDC's booklet "Childcare and School Immunization Requirements: 2005-06." IAC posted the booklet in its entirety and also posted information from the following sections of the booklet:

Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine requirements for child care and kindergarten attendance
Tetanus and diphtheria (Td) booster requirements for middle school attendance
Haemophilus influenzae type b (Hib) vaccine requirements for child care attendance
Measles, mumps, and rubella (MMR) vaccine requirements for child care attendance
Measles second-dose vaccine requirements for kindergarten and middle school attendance
Meningococcal conjugate vaccine (MCV) requirements for middle school attendance
Polio vaccine requirements for child care and kindergarten attendance
Vaccination exemptions allowed

To access the entire booklet and the various sections, go to: http://www.immunize.org/laws Scroll down to the second chart and click on the pertinent link(s).

CDC reports on vulvar vaccinia infection after sexual contact with military smallpox vaccinee in Alaska in 2006

CDC published "Vulvar Vaccinia Infection After Sexual Contact with a Military Smallpox Vaccinee輸laska, 2006" in the May 4 issue of MMWR. A summary made available to the press is reprinted below in its entirety.

Healthcare providers and public health professionals should ask about any contact with recent smallpox vaccinees when evaluating patients with vesicular lesions compatible with vaccinia. This pertains to lesions observed on all parts of the body, including the eye and genital regions. Early identification of such an exposure allows for rapid and appropriate diagnostic testing, timely contact tracing, and clinical intervention as needed. In addition, correct, early diagnosis facilitates prompt patient counseling to prevent further transmission of the virus.

Since February 2007, the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Defense have received five reports of vaccinia infection associated with military service members being recently vaccinated for smallpox, including two cases from Indiana and one case each from Alabama, Alaska, and New Mexico. The case in Alaska occurred in October, 2006 and was identified in February 2007. Unintentional transfer of vaccinia virus can occur from a vaccination site to a second site on the vaccinee or to another person, principally via skin-to-skin contact; in addition to skin lesions, genital lesions can also manifest after contact with infectious material from a vaccination site. This report describes a case of vulvar vaccinia caused by sexual interactions with a U.S. service member who had recently received a smallpox vaccination.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5617a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5617.pdf

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

Updated: IAC revises its professional-education piece on administering IM and SC injections to adults

IAC recently made minor revisions to its professional-education piece "How to Administer IM and SC Injections to Adults."

To access a ready-to-print (PDF) version of the revised piece, go to: http://www.immunize.org/catg.d/p2020A.pdf

HHS issues interim guidance on use of facemasks and respirators in public settings during an influenza pandemic

On May 3, the Department of Health and Human Services (HHS) issued a press release, "HHS Issues Interim Guidance for the Use of Facemasks ad Respirators in Public Settings During anInfluenza Pandemic: Facemasks and respirators could provide added value when used in combination with other preventive measures." Portions of it are reprinted below.

Also on May 3, the website www.pandemicflu.gov posted four related documents: (1) a print transcript of a media briefing CDC held on the interim guidance, (2) an audio webcast of the media briefing, (3) online information on masks and respirators, and (4) a summary of the interim guidance. To access the documents, go to: http://www.pandemicflu.gov Scroll down to the section titled "News," and click on the pertinent link(s) in the entries listed for May 03.

[Portions of the May 3 press release]
The Centers for Disease Control and Prevention (CDC) part of the Department of Health and Human Services (HHS) today released interim advice to the public about the use of facemasks and respirators in certain public (non-occupational) settings during an influenza pandemic. There is very little research about the value of masks to protect people in public settings. These interim recommendations are based on the best judgment of public health experts who relied in part on information about the protective value of masks in healthcare facilities.

The guidance stresses that during an influenza pandemic a combination of actions will be needed, including hand washing, minimizing the likelihood of exposure by distancing people who are infected or likely to be infected with influenza away from others and treating them with antiviral medications, having people who are caring for ill family members voluntarily stay home, and encouraging people to avoid crowded places and large gatherings. When used in conjunction with such preventive steps, masks and respirators may help prevent some spread of influenza. . . .

To access the complete press release, go to:
http://www.hhs.gov/news/press/2007pres/05/pr20070503a.html

For coalitions: May 15 is the date for IZTA's teleconference on the Influenza Summit's update on vaccine supply

The Immunization Coalitions Technical Assistance Network (IZTA) May 15 conference call will present an update on the current influenza vaccine supply and other information that was shared at the National Influenza Vaccine Summit's April 2007 meeting. IZTA is a program of the Center for Health Communication, Academy for Educational Development.

The presenter is L.J. Tan, PhD, director of infectious diseases, American Medical Association, and co-chair, National Influenza Vaccine Summit.

This call will be held twice on May 15--once at 1PM ET, and again at 3PM ET. To register, send an email to izta@aed.org Include this message: "Sign me up for the Influenza Summit update on vaccine supply [insert your preferred time--either 1PM ET or 3PM ET]."

For additional information, or to access earlier programs, go to:
http://www.izta.org/confcall.cfm

Seattle STD/HIV prevention training center and University of Washington develop online study site

[The following is cross posted from IAC's Hep Express electronic newsletter, 5/2/07.]

The Seattle STD/HIV Prevention Training Center and the University of Washington announced the release of Hepatitis Web Study, a website designed for healthcare workers who provide clinical care to persons with viral hepatitis. This project was funded by CDC's Division of Viral Hepatitis.

The website features

Fourteen interactive, clinically-relevant case studies that highlight and illustrate key recommendations from national guidelines;
Free continuing education credits, including an easy way to print CME/CNE documentation and an electronic CE tracker;
Numerous high-quality figures that the user can easily download into PowerPoint slides;
Reference linked to Pub Med abstracts, federal guidelines sites, and/or CDC MMWR documents.

The site will be maintained and updated on an ongoing basis and will continue to be expanded. Please visit the site and share the address with your colleagues! To access this valuable resource, go to: http://www.hepwebstudy.org

Bruce Maeder, program manager for this Viral Hepatitis Education and Training Project, welcomes your feedback at (206) 543-1562 or maeder@u.washington.edu

10.

Seminar on new frontiers in cancer immunotherapy scheduled for July 9-11 at Veyrier-du-Lac, France

A seminar on new frontiers in cancer immunotherapy is planned for July 9-11 at Les Pensieres Conference Center, Veyrier-du-Lac, France. The program will be conducted in English.

To access the seminar program and registration form, go to: http://www.fondation-merieux.org/conferences_n_training Scroll down and click on the pertinent link(s) in the section on new frontiers in cancer immunotherapy.

For additional information, write Catherine Dutel at catherine.dutel@fondation-merieux.org

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