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IAC Express 2007 |
| Issue number 663: May 14, 2007 |
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Contents
of this Issue
Select a title to jump to the article. |
- CDC
updates readers on supply of vaccines containing varicella-zoster virus
- MMWR
highlights Hepatitis Awareness Month
- CDC
reports on epidemiology of chronic HBV infection in San Francisco
- CDC
reports on hepatitis B prevention through universal infant immunization in
China
- CDC
publishes surveillance summary on health behaviors, including influenza
and pneumococcal vaccination
- HAN
issues official Health Advisory about influenza-associated pediatric
mortality and the increase of Staphylococcus aureus co-infection
- CDC
announces addition of hepatitis A module to its "You Call the Shots"
training course
- NASTAD
releases primer on viral hepatitis policymaking and programs
- Former
CDC director writes about changes in public health from 1990-1993
- CDC
publishes record of February ACIP meeting
- FDA
clears first respirators for use in public health medical emergencies
- New
pandemic influenza resources available
- CDC
updates its avian influenza web section
-
California Distance Learning Health Network to offer pandemic influenza
school preparedness training on May 17
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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; 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. |
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Issue 663: May 14, 2007 |
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1. |
CDC updates readers on supply of vaccines containing varicella-zoster virus
CDC published a Notice to Readers titled "Update
on Supply of Vaccines Containing Varicella-Zoster Virus" in the May 11 issue
of MMWR. The article is reprinted below in its entirety, excluding footnotes.
In February 2007, CDC received notice from Merck & Co., Inc.,
that because of lower than expected amounts of varicella-zoster
virus (VZV) in its recently manufactured bulk vaccine, Merck was
prioritizing production of varicella (Varivax) and zoster
vaccines (Zostavax) over production of MMR-V vaccine (ProQuad).
In May 2007, CDC received further notice from Merck that current
projections of orders indicate ProQuad will be unavailable
beginning in July 2007, although timing will depend on market
demand. This might cause extended back orders for the next few
months. After depletion of the existing supply, ProQuad is not
expected to be available for the remainder of 2007. Merck is
requesting that customers begin transitioning from ProQuad to M-M-R II and Varivax at their earliest convenience.
Merck expects to continue to meet demands for Varivax and M-M-R
II to fully implement the recommended immunization schedule.
This will allow for continued use of varicella vaccine for all
age groups, including the routine 2-dose schedule for children
aged 12-15 months and 4-6 years, catch-up vaccination with the
second dose for children or adolescents who received only 1
dose, and vaccination with 2 doses for other children,
adolescents, and adults without evidence of immunity. For zoster
vaccine, the supply of Zostavax is expected to be adequate for
routine vaccination of adults aged >=60 years.
Questions regarding the supply of these Merck products should be
addressed to Merck's National Service Center at (800) 637-2590.
Updates on vaccine shortages and delays are available from CDC
at http://www.cdc.gov/nip/news/shortages/default.htm
To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a6.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf
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2. |
MMWR highlights Hepatitis
Awareness Month
CDC published "Hepatitis Awareness Month--May
2007" in the May
11 issue of MMWR. The article is reprinted below in its
entirety, excluding footnotes.
May 2007 marks the 12th anniversary of Hepatitis Awareness
Month. This issue of MMWR highlights public health measures to
vaccinate and protect children from hepatitis B virus (HBV)
infection in China and to monitor the characteristics of persons
with chronic hepatitis B in San Francisco, California.
Worldwide, 370 million persons have chronic HBV infection, and
500,000-700,000 persons die annually from HBV-related liver
disease; approximately 75% of HBV infections occur in Asia. In
the United States, approximately half of the 1 million persons
with chronic HBV infection are Asians/Pacific Islanders, most of
whom became infected with HBV before arriving in the United
States, including many who remain unaware of their infection.
The HBV-related death rate among Asians/Pacific Islanders is
seven times greater than the rate among whites.
Persons with chronic HBV infection are at risk for premature
death from liver cirrhosis and cancer. Hepatitis B vaccination
of infants worldwide will protect successive generations from
chronic HBV infection and associated liver disease. Persons
already infected with HBV can benefit from HBV screening, care,
and treatment to protect their health and prevent transmission
to others.
To access a web-text (HTML) version of the article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a1.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.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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3. |
CDC reports on epidemiology of chronic HBV infection in San Francisco
CDC published "Characteristics of Persons with
Chronic Hepatitis
B--San Francisco, California, 2006" in the May 11 issue of MMWR.
Portions of the article are reprinted below.
Chronic hepatitis B is the most common cause of cirrhosis and
liver cancer worldwide. Approximately 45% of the world's
population lives in regions where chronic hepatitis B virus
(HBV) infection is endemic, including most of Asia and the
Pacific Islands, Africa, and the Middle East. Nearly one-fourth
of the population of San Francisco was born in Asia and the
Pacific Islands. In 2006, the San Francisco Department of Public
Health (SFDPH) received reports consistent with probable chronic
HBV infection for 2,238 persons. To characterize persons with
reported confirmed chronic HBV infection in San Francisco in
2006, SFDPH collected additional data on a subset of 567 cases
reported to the SFDPH chronic hepatitis B registry. Eighty-four
percent of the persons were Asians/Pacific Islanders (A/PIs),
80% of whom were foreign born. Fewer than half had been referred
to a gastroenterologist/hepatologist for evaluation at the time
of reporting. Persons with chronic HBV infection can benefit
from medical care by providers with expertise in viral
hepatitis. In addition, close contacts of infected persons
should be screened and offered vaccination if found to be
susceptible to HBV infection. Culturally appropriate counseling
for and follow-up of persons with chronic HBV infection and
their contacts could help reduce the transmission of HBV
infection. . . .
Editorial Note:
The findings in this report suggest that, in 2006, nearly 85% of
persons with confirmed chronic HBV infection in San Francisco
were A/PIs, 80% of whom were born outside the United States.
These persons likely acquired their infections in their
countries of origin, countries where HBV infection is endemic
and infections usually are acquired at birth or during early
childhood. Of persons who acquire chronic HBV infection when
they are aged <5 years, an estimated 15%-40% will eventually
have chronic liver disease, including cirrhosis and liver
cancer. Treatment for chronic hepatitis B is increasingly
effective and can prevent or slow the development of these
sequelae. However, fewer than one-third of persons with chronic
HBV infection in San Francisco in 2006 had been referred to a
specialist for evaluation or undergone treatment at the time of
reporting.
Persons from countries where HBV infection is endemic might be
unaware of their increased risk for hepatitis B-related liver
disease. Hepatitis B screening programs in A/PI communities in
the United States can be an effective means of identifying
persons with chronic HBV infection and encouraging them to seek
medical care.
Health departments and large health systems can use electronic
disease registries to characterize and provide services for
persons with chronic HBV infection and their close contacts.
Persons with chronic HBV infection should receive referrals for
appropriate medical care, which can include treatment for HBV
infection. Their close contacts should undergo screening for HBV
infection and, if found to be susceptible, should receive
hepatitis B vaccination. Registries also can provide local
population-based data on the epidemiology of chronic HBV
infection. . . .
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a3.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf
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4. |
CDC reports on hepatitis B prevention through universal infant immunization
in China
CDC published "Progress in Hepatitis B Prevention
Through
Universal Infant Vaccination--China, 1997-2006" in the May 11
issue of MMWR. The introductory paragraph is reprinted below,
excluding footnotes.
Hepatitis B virus (HBV) infection is a leading cause of illness
and death in China. Approximately 60% of the population has a
history of HBV infection, and 9.8% of persons in China are
chronically infected with HBV and at risk for premature death
from liver disease. Each year, an estimated 263,000 persons in
China die from HBV-related liver cancer or cirrhosis, accounting
for 37%-50% of HBV-related deaths worldwide. Because most HBV
infections occur during infancy or early childhood, when HBV
infection is most likely to become chronic, vaccination of
infants beginning at birth is the key strategy for preventing
chronic HBV infection. This report describes China's progress in
increasing coverage among infants with hepatitis B vaccine
(HepB) and timely administration of the HepB birth dose (i.e.,
within 24 hours of birth). Infant vaccination coverage with both
the timely birth dose and the complete vaccine series was
substantially higher among children born during 2003 than among
those born during 1997; timely birth-dose coverage increased
from 29.1% to 75.8%, and HepB series completion increased from
70.7% to 89.8%. Furthermore, in economically disadvantaged
populations in western and middle provinces targeted by the
China-Global Alliance for Vaccines and Immunization (China-GAVI)
project, reported coverage with timely HepB birth dose increased
from 64% in 2004 to 81% in 2006, and coverage with the complete
HepB series increased from 52% in 2001 to 92% in 2006. China has
established a goal to reduce chronic HBV infection among
children aged <5 years to <1% by 2010. Achieving this goal will
require continued commitment to increasing vaccination coverage
in impoverished regions and ensuring that infants born at home
are vaccinated within 24 hours of birth. . . .
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf
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5. |
CDC publishes surveillance summary on health behaviors, including influenza
and pneumococcal vaccination
CDC published "Surveillance of Certain Health
Behaviors Among
States and Selected Local Areas--United States, 2005" in the May
11 MMWR Surveillance Summary. The survey collected data on
behavioral risk factors such as smoking, poor diet, physical
inactivity, excessive drinking, and use of preventive health
services.
The two paragraphs related to immunization are reprinted below,
excluding tables.
INFLUENZA VACCINATION
In 2005, state-specific prevalence estimates for self-reported
influenza vaccination among persons aged >=65 years during the
preceding 12 months ranged from 32.0% (CI = 28.3%-35.7%) in
Puerto Rico to 78.1% (CI = 74.8%-81.4%) in Minnesota (median:
65.5%). Among MMSAs [metropolitan and micropolitan statistical
areas], the prevalence of influenza vaccination ranged from
47.6% (CI = 39.1%-56.1%) in Orlando-Kissimmee, Florida, to 83.3%
(CI = 74.7%-91.9%) in Fargo, North Dakota-Minnesota (median:
67.2%); among counties, the prevalence ranged from 40.8% (CI =
32.0%-49.6%) in Miami-Dade County, Florida, to 84.4% (CI =
76.0%-92.8%) in Ramsey County, Minnesota (median: 67.7%).
PNEUMOCOCCAL VACCINATION
The percentage of persons aged >=65 years who reported ever
having a pneumococcal vaccination ranged from 28.3% (CI = 24.6%-32.0%) in Puerto Rico to 71.7% (CI = 68.6%-74.8%) in North
Dakota (median: 65.7%). Among MMSAs, the prevalence of
pneumococcal vaccination ranged from 52.0% (CI = 43.5%-60.5%) in
Fayetteville-Springdale-Rogers, Arkansas-Missouri, to 82.2% (CI
= 75.4%-89.0%) in Winston-Salem, North Carolina (median: 66.0%);
among counties, the prevalence ranged from 34.8% (CI = 26.5%-43.1%) in Miami-Dade County, Florida, to 83.4% (CI = 75.3%-91.5%) in Forsyth County, North Carolina (median: 67.3%).
To access a web-text (HTML) version of the surveillance summary,
go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5604a1.htm
To access a ready-to-print (PDF) version of the surveillance
summary, go to: http://www.cdc.gov/mmwr/PDF/ss/ss5604.pdf
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6. |
HAN issues official Health Advisory about influenza-associated pediatric
mortality and the increase of Staphylococcus aureus co-infection
On May 9, the Health Alert Network (HAN) issued
an official CDC
Health Advisory about influenza-associated pediatric mortality
and the increase of Staphylococcus aureus co-infection. The
Health Advisory is reprinted below in its entirety.
THIS IS AN OFFICIAL CDC HEALTH ADVISORY
Distributed via Health Alert Network
Wednesday, May 9, 2007, 11:15 AM EDT
INFLUENZA-ASSOCIATED PEDIATRIC MORTALITY AND THE INCREASE OF
STAPHYLOCOCCUS AUREUS CO-INFECTION
CDC is requesting that states report all cases of influenza-related pediatric mortality from the 2006-2007 influenza season.
Since 2004, the Influenza-Associated Pediatric Mortality
Surveillance System, part of the Nationally Notifiable Disease
Surveillance System, has collected information on deaths among
children due to laboratory-confirmed influenza, including the
presence of other medical conditions and bacterial infections at
the time of death. From October 1, 2006 through May 7, 2007, 55
deaths from influenza in children have been reported to CDC from
23 state health departments and two city health departments.
Data on bacterial co-infections were reported for 51 cases; 20
(39%) had a bacterial co-infection, and 16/20 were infected with
Staphylococcus aureus. While the number of pediatric influenza
associated deaths is similar to that reported during the two
previous years, there has been an increase in the number of
deaths in which both influenza and pneumonia or bacteremia due
to S. aureus were identified. Only one influenza and S. aureus
co-infection was identified in 2004-2005, and 3 were identified
in 2005-2006. Of the 16 children reported with S. aureus so far
in 2006-2007, 11 children had methicillin-resistant (MRSA)
isolated from a sterile site (9) or sputum (2), and 5 had
methicillin-susceptible S.aureus isolated from a sterile site
(3) or sputum (2). The median age of children with S. aureus co-infection was older than children without S.aureus co-infection
(11 years versus 4 years, p<.01). Children with influenza and S.
aureus co-infections were reported to be in good health before
illness onset but progressed rapidly to severe illness.
Influenza strains isolated from these children have not been
different from common strains circulating in the community and
the MRSA strains have been typical of those associated with MRSA
skin infection outbreaks in the United States.
Healthcare providers should be alerted to the possibility of
bacterial co-infection among children with influenza, and
request bacterial cultures when bacterial co-infection is
suspected. Clinicians, clinical agencies, and medical examiners
are asked to contact their local or state health department as
soon as possible when deaths among children due to laboratory-confirmed influenza are identified. CDC requests that all cases
of pediatric influenza-associated deaths be reported promptly by
state health departments to CDC through http://sdn.cdc.gov and
that information about bacterial pathogens isolated from sterile
sites and/or from sputum or endotracheal aspirates be completed
on the Influenza-Associated Pediatric Mortality Surveillance
System case report form. If the influenza death was complicated
by S. aureus infection, please contact the clinical agency to
determine if the S. aureus isolate is available. CDC is
interested in receiving S. aureus isolates to better
characterize those from fatal cases of influenza in children.
If you have any questions about this Health Advisory, please
call the Influenza Division, Epidemiology and Prevention Branch
at (404) 639-3727.
To access the Health Advisory online, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00259
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7. |
CDC announces addition of hepatitis A module to its "You Call the Shots"
training course
CDC recently announced the addition of a
hepatitis A module to
the web-based training course "Immunization: You Call the
Shots." This module discusses hepatitis A virus infection, the
hepatitis A vaccines, recommendations for vaccine use, and
indications for administration of immune globulin. Extra
learning opportunities, self-test practice questions, reference
and resource materials, and a glossary are all provided.
For additional information on "You Call the Shots," go to:
http://www.cdc.gov/nip/ed/youcalltheshots.htm
To access the hepatitis A module, go to:
http://www2.cdc.gov/nip/isd/ycts/mod1/courses/hepa/start.asp
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8. |
NASTAD releases primer on viral hepatitis policymaking and programs
On May 5, the National Alliance of State &
Territorial AIDS
Directors (NASTAD) released a primer titled "Raising the
Profile, Raising Your Voice: A Primer on Viral Hepatitis
Policymaking and Programs at the Federal Level."
This new document serves to educate persons who are dedicated to
viral hepatitis prevention and care about the federal policy
process and the programs that address viral hepatitis.
Understanding the process through which federal viral hepatitis
funding and program decisions are made is critical to impacting
policies affecting state hepatitis programs and persons living
with hepatitis.
To access a ready-to-print (PDF) version of this resource, go
to:
http://www.nastad.org/Docs/highlight/200754_NASTAD_VH_Primer_May07.pdf
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9. |
Former CDC director writes about changes in public health from 1990-1993
CDC published "CDC's 60th Anniversary: Director's
Perspective--William L. Roper, MD, MPH, 1990-1993" in the May 11 issue of
MMWR. The years 1990-1993 saw tremendous change in public
health, with CDC strengthening the public health infrastructure,
improving the health of children, and making prevention a
practical reality in the nation's health system.
The article cites many examples of activities that helped
fulfill these objectives. Two specifically related to
immunization are vaccine financing and polio eradication; the
associated sections are reprinted below, excluding footnotes.
VACCINE FINANCING
Today, the life-saving and health-preserving impact of
immunizations exceeds almost all other public health
interventions, both in terms of effectiveness and cost-effectiveness. However, in the early 1990s, costs were a
significant barrier to obtaining recommended vaccines for
persons who were uninsured or underinsured. The necessity for
achieving high vaccination coverage rates was made especially
clear through a resurgence of measles in 1989, which involved
more than 55,000 cases and 123 deaths, with preschoolers
disproportionately affected. In 1993, the challenge of
addressing vaccine financing led to the Childhood Immunization
Initiative, which set a goal of 90% vaccination coverage for
preschool children and addressed vaccine financing to make this
possible.
Many solutions were considered and supported by various
perspectives, but the compromise approach involved passage in
1993 of the Vaccines for Children (VFC) Act, which ensures that
children who are uninsured or on Medicaid, who are American
Indians/Alaska Natives, or who are underinsured and seen in
Federally Qualified Health Centers, all have a right to receive
free of charge any vaccines recommended by the Advisory
Committee on Immunization Practices. The innovation of this
entitlement was provision of vaccines directly to clinical-care
providers, who then administer them to children as needed,
permitting children to remain in their primary medical homes
without requiring referrals and without loss of continuity of
care. This collaboration between public health and the private
sector created a large network of VFC providers and within 3
years led to >75% vaccination coverage. Today, more than 40% of
vaccinations for children are provided through VFC, and
vaccination rates are at record or near-record highs. Measles
vaccinations for preschoolers exceed 90%, and racial and ethnic
disparities in vaccination have been reduced dramatically.
POLIO ERADICATION
In 1988, CDC had joined forces with the World Health
Organization (WHO), UNICEF, and Rotary International to
spearhead the Global Polio Eradication Initiative. Despite
elimination from the Americas in 1991, polio remained at high
rates in many countries in Asia and Africa. CDC's commitment to
global eradication intensified in the early 1990s, when CDC
began assigning epidemiologists to the Pan American Health
Organization and WHO to help in the polio battle. These
dedicated CDC workers traveled around the world helping other
countries develop and implement plans of action to eradicate
polio. At the same time, CDC began hosting global polio
eradication meetings. With the technical aid of CDC's
immunization, laboratory, and epidemiology experts, as well as
substantial financial contributions, the number of children with
paralytic polio has been reduced worldwide from 350,000 in 1988
to approximately 2,000 in 2006. . . .
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5618a4.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5618.pdf
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10. |
CDC publishes record of February ACIP meeting
CDC has published a record of the proceedings of
the February
21-22, 2007, meeting of the Advisory Committee on Immunization
Practices (ACIP).
To access a Word version of the meeting proceedings, go to:
http://www.cdc.gov/nip/ACIP/minutes/acip_min_feb07.doc
To access a ready-to-print (PDF) version of the meeting
proceedings (96 pages), go to:
http://www.cdc.gov/nip/ACIP/minutes/acip_min_feb07.pdf
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11. |
FDA clears first respirators for use in public health medical emergencies
On May 8, the Food and Drug Administration (FDA)
cleared for
marketing the first respirators that can help reduce the user's
exposure to airborne pathogens during a public health medical
emergency, such as an influenza pandemic.
The two facepiece respirators, manufactured by the 3M Company,
will be available to the general public without a prescription.
To read the FDA press release about these products, go to:
http://www.fda.gov/bbs/topics/NEWS/2007/NEW01630.html
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12. |
New pandemic influenza resources available
Two organizations released new resources related
to pandemic
influenza on May 9.
The Department of Defense announced the release of its "National
Pandemic Influenza Strategy Implementation Plan." The plan,
dated August 2006, provides strategic guidance to all Department
of Defense components for preparation and response to an
outbreak of pandemic influenza.
To access a ready-to-print (PDF) version of the plan, click
here.
The World Health Organization published "Questions and Answers
on Pandemic Influenza Vaccine."
To access a web-text (HTML) version of these Q&As, go to:
http://www.who.int/immunization/newsroom/PI_QAs/en/print.html
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13. |
CDC updates its avian influenza web section
On May 7, CDC posted an updated version of
"Questions and
Answers About Avian Influenza (Bird Flu) and Avian Influenza A
(H5N1) Virus" on its Influenza web section.
To access this resource and more, go to:
http://www.cdc.gov/flu/whatsnew.htm#updated and click on the
pertinent link.
To access a broad range of continually updated information on
seasonal influenza, avian influenza, pandemic influenza, and
swine influenza, go to: http://www.cdc.gov/flu
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14. |
California Distance Learning Health Network to offer pandemic influenza
school preparedness training on May 17
The California Distance Learning Health Network
has collaborated
with the California Department of Health Services and the
Department of Education to develop a satellite broadcast and
exercise to help schools across the nation plan and increase
their preparedness for a possible influenza pandemic.
The broadcast will cover topics such as school closure,
continuity of education, average daily attendance, issues
specific to certain populations, and ways schools can
incorporate pandemic influenza planning into their existing safe
school plans.
The live broadcast will be accessible from various locations
around the nation on May 17, from 9:00-10:30AM PT. A tabletop
exercise will follow, during which participants will develop a
portion of a plan or analyze their existing plan, exercise their
plan, and debrief the results.
For more information, click
here.
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