IZ Express Issue 678 | Immunize.org

IAC Express 2007
Issue number 678: August 13, 2007

Contents of this Issue Select a title to jump to the article.
MMWR notifies readers of revised recommendations to vaccinate all persons ages 11-18 with MCV4 at earliest opportunity JAMA study concludes that current vaccine financing system results in gaps for underinsured U.S. children IAC website posts updated and new immunization-education print materials CDC issues an update on U.S. and worldwide influenza activity in 2006-07 and on composition of 2007-08 influenza vaccine JAMA study finds community strategies can prevent deaths during influenza pandemic CDC net conferences coming soon--New Influenza Vaccine Recommendations and Travel Health Issues Including Malaria August 9 issue of IAC's Hep Express electronic newsletter now available online Support the National Viral Hepatitis Roundtable Asian Liver Center publishes 2007 edition of its Physician's Guide to Hepatitis B Asian Liver Center operates an information health line National Task Force on Hepatitis B: Focus on Asian and Pacific Islander Americans works to eliminate hepatitis B-related mortality and morbidity National Viral Hepatitis Training Center offers training in San Diego Fifth International Bird Flu Summit scheduled for September 27-28 in Las Vegas

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 678: August 13, 2007

MMWR notifies readers of revised recommendations to vaccinate all persons ages 11-18 with MCV4 at earliest opportunity

CDC published "Notice to Readers: Revised Recommendations of the Advisory Committee on Immunization Practices to Vaccinate All Persons Aged 11-18 Years with Meningococcal Conjugate Vaccine" in the August 10 issue of MMWR. Portions of the notice are reprinted below.

In January 2005, a quadrivalent meningococcal polysaccharide-protein conjugate vaccine (MCV4) (Menactra, sanofi pasteur, Inc., Swiftwater, Pennsylvania) was licensed for use among persons aged 11-55 years. In May 2005, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination with 1 dose of MCV4 for persons aged 11-12 years, persons entering high school (i.e., at approximately age 15 years) if not previously vaccinated with MCV4, and other persons at increased risk for meningococcal disease, including college freshmen living in dormitories. Background information regarding meningococcal disease and the vaccine, including a discussion of duration of protection and use of the vaccine for outbreak control, has been published previously.

In June 2007, ACIP revised its recommendation to include routine vaccination of all persons aged 11-18 years with 1 dose of MCV4 at the earliest opportunity. Persons aged 11-12 years should be routinely vaccinated at the 11-12 years healthcare visit as recommended by ACIP. ACIP continues to recommend routine vaccination for persons aged 19-55 years who are at increased risk for meningococcal disease: college freshmen living in dormitories, microbiologists routinely exposed to isolates of Neisseria meningitidis, military recruits, travelers to or residents of countries in which N. meningitidis meningitis is hyperendemic or epidemic, persons with terminal complement component deficiencies, and persons with anatomic or functional asplenia.

The ACIP goal is routine vaccination of all adolescents with MCV4 beginning at age 11 years. ACIP and partner organizations, including the American Academy of Pediatrics, American Academy of Family Physicians, American Medical Association, and Society for Adolescent Medicine, recommend a healthcare visit for children aged 11-12 years to receive recommended vaccinations and indicated preventive services. This visit is the optimal time for adolescents to receive MCV4. In addition, because the incidence of meningococcal disease increases during adolescence, healthcare providers should vaccinate previously unvaccinated persons aged 11-18 years with MCV4 at the earliest possible healthcare visit. College freshmen living in dormitories are at increased risk for meningococcal disease and should be vaccinated with MCV4 before college entry if they have not been vaccinated previously. Because of difficulties in targeting freshmen in dormitories, colleges may elect to target their vaccination campaigns to all matriculating freshmen. . . .

ACIP encourages healthcare providers to vaccinate with MCV4 throughout the year to minimize seasonal increases in demand during July and August when students prepare to return to school from summer vacation. Vaccine providers should administer MCV4 and Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine to persons aged 11-18 years during the same visit if both vaccines are indicated and available. If simultaneous vaccination is not feasible (e.g., a vaccine is not available), MCV4 and Tdap can be administered using any order of administration. When making decisions about timing of vaccination, providers should consider that eligibility for the Vaccines for Children Program ends at age 19 years.

Guillain-Barre syndrome (GBS) has been associated with receipt of MCV4. Persons with a history of GBS might be at increased risk for postvaccination GBS; therefore, a history of GBS is a relative contraindication to receiving MCV4. Persons recommended to receive meningococcal vaccination who have a history of GBS (or their parents) should discuss the decision to be vaccinated with their healthcare provider. Meningococcal polysaccharide vaccine (MPSV4) is an acceptable alternative for short-term protection against meningococcal disease (3-5 years). Providers who have questions about ordering MCV4 or MPSV4 may contact sanofi pasteur by telephone at (800) 822-2463 [(800) VACCINE] or online at http://www.vaccineshoppe.com

To access a web-text (HTML) version of the complete notice, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5631.pdf

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

JAMA study concludes that current vaccine financing system results in gaps for underinsured U.S. children

The August 8 issue of the Journal of the American Medical Association (JAMA) includes an article that concludes that because of gaps in the U.S. vaccine financing system, many underinsured children are unable to receive publicly purchased vaccines in either the public or private sectors. Titled "Gaps in Vaccine Financing for Underinsured Children in the United States," the article was written by Grace M. Lee, MD, MPH; Jeanne M. Santoli, MD; Claire Hannan, MPH, et al. The article abstract is reprinted below; the full text is available to JAMA subscribers.

Also in the August 8 issue, JAMA published a related editorial, "Reasons and Remedies for Underinsurance for Child and Adolescent Vaccines," written by Matthew M. Davis, MD, MAPP. A link to an extract (the first 150 words of the editorial) is given at the end of this IAC Express article. The full text is available to JAMA subscribers.

[Article abstract]
Context: The number of new vaccines recommended for children and adolescents has nearly doubled during the past 5 years, and the cost of fully vaccinating a child has increased dramatically in the past decade. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (i.e., have private insurance that does not cover all recommended vaccines). In 2000, approximately 14% of children were underinsured for vaccines in the United States.

Objectives: To describe variation among states in the provision of new vaccines to underinsured children and to identify barriers to state purchase and distribution of new vaccines.

Design, Setting, and Participants: A 2-phase mixed-methods study of state immunization program managers in the United States. The first phase included 1-hour qualitative telephone interviews conducted from November to December 2005 with 9 program managers chosen to represent different state vaccine financing policies. The second phase incorporated findings from phase 1 to develop a national telephone and paper-based survey of state immunization program managers that was conducted from January to June 2006.

Main Outcome Measures: Percentage of states in which underinsured children are unable to receive publicly purchased vaccines in the private or public sectors.

Results: Immunization program managers from 48 states (96%) participated in the study. Underinsured children were not eligible to receive publicly purchased meningococcal conjugate or pneumococcal conjugate vaccines in the private sector in 70% and 50% of states, respectively, or in the public sector in 40% and 17% of states, respectively. Due to limited financing for new vaccines, 10 states changed their policies for provision of publicly purchased vaccines between 2004 and early 2006 to restrict access to selected new vaccines for underinsured children. The most commonly cited barriers to implementation in underinsured children were lack of sufficient federal and state funding to purchase vaccines.

Conclusions: The current vaccine financing system has resulted in gaps for underinsured children in the United States, many of whom are now unable to receive publicly purchased vaccines in either the private or public sectors. Additional strategies are needed to ensure financial coverage for all vaccines, particularly new vaccines, among this vulnerable population.

To access the article abstract from the JAMA website, go to:
http://jama.ama-assn.org/cgi/content/abstract/298/6/638

To access the editorial extract (first 150 words of the editorial) from the JAMA website, go to:
http://jama.ama-assn.org/cgi/content/extract/298/6/680

IAC website posts updated and new immunization-education print materials

IAC recently updated two of its immunization-education materials and created a new one. Details follow:

Intended to help health professionals direct parents and patients to science-based immunization information, the print piece "Reliable Sources of Immunization Information: Where to go to find answers!" was updated with new information.

To access it, go to:
http://www.immunize.org/catg.d/p4012.pdf

The professional-education resource "It's Federal Law! You must give your patients current Vaccine Information Statements (VISs)" was updated to reflect the dates of the most current versions of VISs.

To access it, go to:
http://www.immunize.org/catg.d/p2027.pdf

IAC recently developed a new two-page chart, titled "Guide to Contraindications and Precautions to Commonly Used Vaccines." It is adapted from information found in the CDC document "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)."

To access the new chart, go to:
http://www.immunize.org/catg.d/p3072a.pdf

CDC issues an update on U.S. and worldwide influenza activity in 2006-07 and on composition of 2007-08 influenza vaccine

CDC published "Update: Influenza Activity--United States and Worldwide, 2006-07 Season, and Composition of the 2007-08 Influenza Vaccine" in the August 10 issue of MMWR. Portions of the article are reprinted below.

During the 2006-07 season, influenza activity peaked in mid-February in the United States and was associated with less mortality and lower rates of pediatric hospitalizations than during the previous three seasons. In the United States, influenza A (H1) viruses predominated overall, but influenza A (H3) viruses were isolated more frequently than influenza A (H1) viruses late in the season. Although influenza A (H1), A (H3), and B viruses co-circulated worldwide, influenza A (H3) viruses were the most commonly reported type in Europe and Asia. Sporadic cases of avian influenza A (H5N1) virus infections associated with severe illness or death were reported among humans in Cambodia, China, Egypt, Indonesia, Laos, Nigeria, and Viet Nam. This report summarizes influenza activity in the United States and worldwide during the 2006-07 influenza season (October 1, 2006-May 19, 2007) and describes the composition of the 2007-08 influenza vaccine.

UNITED STATES
The national percentage of respiratory specimens testing positive for influenza and the proportion of outpatient visits to sentinel providers for influenza-like illness (ILI) peaked in mid-February. Although influenza A (H1) viruses were most commonly isolated overall, influenza A (H3) viruses were more frequently identified than influenza A (H1) viruses from early March through May. A small number of influenza B viruses also were identified. . . .

COMPOSITION OF THE INFLUENZA VACCINE FOR THE 2007-08 SEASON
The Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee recommended that the 2007-08 trivalent influenza vaccine for the United States contain A/Solomon Islands/3/2006-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and B/Malaysia/2506/2004-like viruses. This represents a change only in the influenza A (H1N1) component. A/Solomon Islands/3/2006 is a recent antigenic variant of the 2006-07 vaccine strain A/New Caledonia/20/99. The influenza A (H3N2) and influenza B components remain the same. These recommendations were based on antigenic analyses of recently isolated influenza viruses, epidemiologic data, postvaccination serologic studies in humans, and the availability of candidate vaccine strains and reagents. . . .

PNEUMONIA- AND INFLUENZA-RELATED MORTALITY
During the 2006-07 influenza season, the percentage of deaths attributed to pneumonia and influenza (P&I) did not exceed the epidemic threshold in the 122 Cities Mortality Reporting System. The percentage of P&I deaths peaked three times, once at 7.5% during the week ending January 20, 2007 (week 3), once at 7.7% during the week ending February 24, 2007 (week 8), and again at 7.5% during the week ending March 24, 2007 (week 12). During the previous three influenza seasons, the peak percentage of P&I deaths ranged from 7.8% to 10.4%, and the total number of weeks above the epidemic threshold ranged from one to 16.

INFLUENZA-ASSOCIATED PEDIATRIC MORTALITY
As of August 6, 2007, among persons aged <18 years, a total of 68 deaths associated with influenza infection occurring during October 1, 2006-May 19, 2007, were reported to CDC. These deaths were reported from 26 states (Alabama, Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Minnesota, North Carolina, Nebraska, Nevada, New Mexico, New York, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Virginia, Washington, and Wisconsin). All patients had laboratory-confirmed influenza virus infection. Age-specific information was available for all 68 persons; 10 were aged <6 months, 10 were aged 6-23 months, nine were aged 2-4 years, and 39 were aged 5-17 years. Of the 63 patients for whom influenza virus type was known, 47 had influenza A and 16 had influenza B viruses. Of the 53 patients aged >=6 months for whom vaccination status was known, 50 (94%) had not been vaccinated against influenza. These data are provisional. . . .

HUMAN INFECTIONS WITH AVIAN INFLUENZA A (H5N1) VIRUSES
From December 1, 2003, through July 25, 2007, a total of 319 human cases of avian influenza A (H5N1) infection were reported to WHO. Of these, 192 (60%) were fatal. All cases were reported from Asia (Azerbaijan, Cambodia, China, Indonesia, Iraq, Laos, Thailand, Turkey, and Viet Nam) and Africa (Djibouti, Egypt, and Nigeria). To date, no human case of avian influenza A (H5N1) virus infection has been identified in the United States.

EDITORIAL NOTE
During the 2006-07 influenza season, influenza activity in the United States peaked in mid-February, and the percentage of deaths resulting from pneumonia and influenza remained below baseline levels for the entire influenza season. In the United States, influenza A (H1) viruses predominated during most of the season, but influenza A (H3) viruses were more frequently identified than influenza A (H1) viruses since early March. Worldwide, influenza A (H3) viruses predominated in many European and Asian countries.

In the United States, the majority of influenza A (H1) viruses were characterized as A/New Caledonia/20/99, the recommended influenza A (H1N1) component of the 2006-07 influenza vaccine. Fifty percent of the influenza B viruses characterized as belonging to the B/Victoria lineage were further characterized as B/Ohio/01/2005, the antigenic equivalent of B/Malaysia/2506/2004, the recommended influenza B component for the 2006-07 influenza vaccine. In the early months of the season, the majority of influenza A (H3) isolates matched the A/Wisconsin/67/2005 strain, the recommended influenza A (H3N2) component for the 2006-07 vaccine. Beginning in late February 2007, the majority of the influenza A (H3) isolates indicated reduced titers with antisera produced against A/Wisconsin/67/2005. States are requested to submit a subset of their summer influenza isolates and any samples that cannot be subtyped by standard methods or are unusual to CDC for further antigenic characterization.

In May 2007, a Health Alert Network advisory was issued by CDC regarding an increase in the number of influenza-associated pediatric deaths and co-infections with Staphylococcus aureus during the 2006-07 season. Only one pediatric death with influenza and S. aureus co-infection had been reported during 2004-05, and three had been reported during the 2005-06 season. Of the 68 reported deaths among children associated with influenza infections during October 1, 2006-May 19, 2007, a total of 21 had co-infections with influenza and either methicillin-resistant or sensitive S. aureus. State health departments have been asked to ensure that all influenza-associated pediatric deaths from the 2006-07 influenza season are reported to CDC.

At the June 2007 Annual Meeting of the Council of State and Territorial Epidemiologists (CSTE), members voted to ratify a position statement adopted by the CSTE Executive Committee in January 2007 that adds human infections with novel influenza A viruses to the list of nationally notifiable diseases and conditions reportable to the National Notifiable Disease Surveillance System. Novel influenza A viruses are defined as those isolated from a human but subtyped as nonhuman, or those that cannot be subtyped by standard methods. Human infections with novel influenza A viruses that can be transmitted from person-to-person might signal the beginning of an influenza pandemic. Rapid reporting of human infections with novel influenza A viruses will facilitate prompt detection and characterization of influenza A viruses with pandemic potential and accelerate implementation of effective public health responses. In addition, influenza-associated pediatric deaths were maintained as a nationally notifiable disease reportable to the National Notifiable Disease Surveillance System.

In May 2007, health authorities in the United Kingdom identified four persons, two in Wales and two in northwest England, who were infected with a low pathogenic avian influenza A (H7N2) virus. All four persons had been exposed to infected poultry at a farm in Wales; limited evidence of human-to-human transmission has been associated with low pathogenic avian influenza viruses such as influenza A (H7N2) virus. The United Kingdom incident underscores the importance of submission and identification of unusual influenza isolates.

In collaboration with local and state health departments, CDC continues to recommend enhanced surveillance for possible avian influenza A (H5N1) infection among travelers who have severe unexplained respiratory illness and are returning from influenza A (H5N1)-affected countries. Additional information regarding influenza, including avian influenza, is available at http://www.cdc.gov/flu Updates on the worldwide avian influenza situation are available from WHO at http://www.who.int/csr/disease/avian_influenza/en

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5631a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5631.pdf

JAMA study finds community strategies can prevent deaths during influenza pandemic

On August 7, CDC issued a press release titled Community Measures Prevent Deaths During Pandemic, New Study Finds. Portions of it are reprinted below.

School closures and other community strategies designed to reduce the possibility of spreading disease between people during an epidemic can save lives, particularly when the measures are used in combination and implemented soon after an outbreak begins in a community, according to a new study based on public records from the 1918-1919 influenza pandemic.

The findings, which are published in the August 8 issue of the Journal of the American Medical Association [JAMA], provide vital clues to help public officials planning for the next influenza pandemic and highlight the importance of community strategies. These strategies are particularly important because the intervention most likely to provide the best protection against pandemic influenza--a vaccine--is unlikely to be available at the outset of a pandemic. Community strategies that delay or reduce the impact of a pandemic (also called non-pharmaceutical interventions) may help reduce the spread of disease until a vaccine that is well-matched to the virus is available. . . .

"Communities that were most successful during the 1918 pandemic quickly enacted a variety of measures," said Dr. Martin Cetron, director of CDC's Division of Global Migration and Quarantine and senior author of the study. "Those planning for the next pandemic need to carefully consider how to best use these strategies to protect people and decrease the potential impact of the next pandemic in their communities. . . ."

To access the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/2007/r070807.htm

CDC net conferences coming soon--New Influenza Vaccine Recommendations and Travel Health Issues Including Malaria

CDC has scheduled two Current Issues in Immunization Net Conferences for the near future. New Influenza Vaccine Recommendations is scheduled for September 13; speakers will be Dr. Anthony Fiore and Alan Janssen. Travel Health Issues Including Malaria is scheduled for October 11; the speaker will be announced in the future. Dr. Andrew Kroger will moderate both net conferences, and both are scheduled for noon-1PM, ET. Both events require online pre-registration.

Registration for the September 13 event will close at midnight September 11 or when the course is full. To pre-register, go to: http://www2.cdc.gov/nip/isd/ciinc

Registration for the October 11 event will close at midnight October 10 or when the course is full. To pre-register, go to: http://www2.cdc.gov/nip/isd/ciinc2

These are live net conferences designed to provide clinicians with the most up-to-date immunization information. They combine a telephone audio conference with simultaneous online visual content and feature a Q&A segment both by telephone and Internet. Internet access and a separate phone line are needed to participate. On-demand replays and presentations will be available shortly after each event.

For additional information, go to:
http://www.cdc.gov/vaccines/ed/ciinc

August 9 issue of IAC's Hep Express electronic newsletter now available online

The August 9 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 August 9 Hep Express; titles of articles we have not yet covered follow.

2007 Perinatal Hepatitis B and HIV Grantees' Meeting presentations available online
MedPage Today offers teaching brief about treating HBV [hepatitis B virus] and HIV co-infections
Hepatitis B Foundation's webcast on HIV and hepatitis B available online
Hepatitis B Foundation International hosting Atlantic Regional Hepatitis Coordinators' Meeting on September 17-18
HEP DART meeting scheduled for December 9-13 in Maui

To access the August 9 issue, go to:
http://www.hepprograms.org/hepexpress/issue59.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

Support the National Viral Hepatitis Roundtable

[The following is cross posted from IAC's Hep Express electronic newsletter, 8/9/07.]

The National Viral Hepatitis Roundtable (NVHR) is a coalition of public, private, and voluntary organizations dedicated to reducing the incidence of infection, morbidity, and mortality from viral hepatitis in the United States through strategic planning, leadership, coordination, advocacy, and research.

You can support NVHR in its mission by listing your organization as supporting its hepatitis elimination strategy as detailed in the publication "Eliminating Hepatitis: A Call To Action."

To read this document, go to:
http://www.nvhr.org/pdf/NVHR_CalltoAction.pdf

For sign up as an organizational supporter of this plan, go to:
http://www.nvhr.org/calltoaction.htm

In addition, NVHR is creating a web-based toolkit to aid in its collective lobbying and advocacy efforts. This new resource will communicate the National Hepatitis Elimination Strategy in a consistent and powerful way to policymakers. If your organization has any fact sheets, testimonials, success stories, talking points, model legislation, or other information that you think would be helpful, please share these resources with NVHR by August 15.

For more information about the NVHR lobbying and advocacy toolkit, including information on submitting resources, go to: http://www.nvhr.org/e_toolkit.htm

For more information about NVHR, go to http://www.nvhr.org

If your organization is interested in becoming a member of NVHR, please contact Dick Conlon at rconlon@nvhr.org

Asian Liver Center publishes 2007 edition of its Physician's Guide to Hepatitis B

[The following is cross posted from IAC's Hep Express electronic newsletter, 8/9/07.]

The Asian Liver Center at Stanford University recently published its 2007 Physician's Guide to Hepatitis B. This 20-page document provides an excellent summary of HBV infection and liver cancer with a special emphasis on the Asian Pacific Islander communities.

Of all the people with chronic HBV infection in the world, approximately two-thirds live in Asia. In the United States, the incidence of hepatitis B and liver cancer constitutes the greatest health disparity that exists between Asians and Pacific Islanders (APIs) and the general U.S. population. As many as one in 10 APIs is chronically infected with HBV compared with one in 1,000 in the general population.

The guide provides straightforward information on preventing, diagnosing, and managing chronic HBV infection; monitoring for liver damage; and screening for liver cancer.

To download this valuable resource, go to:
http://liver.stanford.edu/files/2007Handbook.pdf

10.

Asian Liver Center operates an information health line

[The following is cross posted from IAC's Hep Express electronic newsletter, 8/9/07.]

The Asian Liver Center (ALC) at Stanford University offers many services for Asian and Pacific Islander communities and individuals. One such service is an information help line in English, Mandarin, and Cantonese. To call toll free, dial (888) 311-3331.

To visit the ALC website, which features hepatitis B educational materials in multiple languages, go to: http://liver.stanford.edu

11.

National Task Force on Hepatitis B: Focus on Asian and Pacific Islander Americans works to eliminate hepatitis B-related mortality and morbidity

[The following is cross posted from IAC's Hep Express electronic newsletter, 8/9/07.]

The National Task Force on Hepatitis B: Focus on Asian and Pacific Islander Americans brings together scientists, health professionals, not-for-profit organizations, and concerned citizens in a concerted effort to eliminate hepatitis B-related mortality and morbidity over the next generation.

The group's mission is to support national, state, and local efforts to prevent new hepatitis B virus infections through vaccination, to identify chronically infected individuals, and to offer appropriate treatment and cancer screening.

Please visit the group's website at http://www.hepbtaskforce.org to learn more about the task force or to be added to their listserv or monthly conference call. The task force has collected useful resources for those working with Asian Pacific Islander Americans and made them available on their website at http://www.hepbtaskforce.org/resources.htm

12.

National Viral Hepatitis Training Center offers training in San Diego

The National Viral Hepatitis Training Center at the New York State Department of Health (NYSDOH) is offering "It's Time: Integrate viral hepatitis into your work" in San Diego, California, in September. NYSDOH will be delivering both its "It's Time! Training" and its "It's Time! Training of Trainers" courses.

"It's Time! Training" prepares staff working in settings that serve people at high risk for viral hepatitis, including substance use programs, HIV/AIDS programs, correctional settings, and public health/STD clinics to address viral hepatitis in their work with clients. These sessions will take place on September 25-26.

"It's Time! Training of Trainers" prepares individuals to deliver the "It's Time! Training" to health and human services providers. These sessions will take place on September 27-28.

For more information on registering for a training or becoming an authorized training agency, please contact mag20@health.state.ny.us or visit the NYSDOH website at http://www.health.state.ny.us/diseases/aids/training/viralhepatitis.htm

13.

Fifth International Bird Flu Summit scheduled for September 27-28 in Las Vegas

The Fifth International Bird Flu Summit will be held in Las Vegas on September 27-28. For comprehensive information, including the event brochure, go to:
http://www.new-fields.com/birdflu5

For additional information, contact New Fields Exhibitions at (202) 536-5000 or http://www.new-fields.com/page.php?p=Contact%20Us

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