IZ Express Issue 713 | Immunize.org

IAC Express 2008
Issue number 713: February 25, 2008

Contents of this Issue Select a title to jump to the article.
FDA advisory panel selects influenza virus strains that will make up the U.S. 2008-09 vaccine; CDC press briefing reveals 12 additional pediatric influenza deaths CDC reports on measles outbreak in Pennsylvania, Michigan, and Texas during August-September 2007 Important: Be sure to give influenza vaccine throughout the influenza season--from now through spring CDC adds to its Seasonal Influenza web section MMWR publishes U.S. influenza update for September 30, 2007-February 9, 2008 For coalitions: March 11 is the date for IZTA's teleconference on building media support for NIIW activities Adolescent immunization symposium scheduled in Atlanta on March 18 to coincide with NIC Adult immunization conference scheduled for March 7 in Chaska, MN

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 713: February 25, 2008

FDA advisory panel selects influenza virus strains that will make up the U.S. 2008-09 vaccine; CDC press briefing reveals 12 additional pediatric influenza deaths

On February 25, the FDA website posted information about the vaccine strains that will compose the U.S. influenza vaccine for the 2008-09 influenza season. The information is reprinted below.

On February 22, CDC held a press briefing on the current influenza situation in the U.S. Significant information included the announcement that 22 laboratory-confirmed pediatric influenza deaths have been reported to CDC for the current influenza season. This is 12 more than CDC reported last week. In addition, widespread influenza activity has been reported in 49 states. A link to a transcript of the February 22 press briefing is given at the end of this IAC Express article.

FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC) met in Gaithersburg, Maryland, on February 21, 2008, to select the influenza virus strains for the composition of the influenza vaccine for use in the 2008-2009 U.S. influenza season. During this meeting, the advisory panel reviewed and evaluated the surveillance data related to epidemiology and antigenic characteristics, serological responses to 2007/2008 vaccines, and the availability of candidate strains and reagents.

The panel recommended that vaccines to be used in the 2008-2009 influenza season in the U.S. contain the following:

An A/Brisbane/59/2007 (H1N1)-like virus
An A/Brisbane/10/2007 (H3N2)-like virus
A B/Florida/4/2006-like virus

A/Brisbane/10/2007 is a current southern hemisphere vaccine virus. B/Florida/4/2006 and B/Brisbane/3/2007 (a B/Florida/4/2006-like virus) are current southern hemisphere vaccine viruses.

The influenza vaccine composition to be used in the 2008-2009 influenza season in the U.S. is identical to that recommended by the World Health Organization on February 14, 2008, for the Northern Hemisphere's 2008-2009 influenza season.

To access the information from the FDA website, go to:
http://www.fda.gov/cber/flu/flu2008.htm

To access the transcript of the February 22 CDC press briefing, go to:
http://www.cdc.gov/od/oc/media/transcripts/2008/t080222.htm

CDC reports on measles outbreak in Pennsylvania, Michigan, and Texas during August-September 2007

CDC published "Multistate Measles Outbreak Associated with an International Youth Sporting Event--Pennsylvania, Michigan, and Texas, August-September 2007" in the February 22 issue of MMWR. Portions of the article are reprinted below. The CDC website offers healthcare professionals and the public a wealth of information about measles disease and vaccine. A link to the measles web section appears at the end of this IAC Express article.

Measles, a highly infectious viral illness, is no longer endemic in the United States because of high coverage rates with an effective vaccine. However, imported cases continue to cause illness and outbreaks among susceptible U.S. residents. In August 2007, a participant in an international youth sporting event who traveled from Japan to the United States became ill with measles. Because he traveled while infectious to an event with thousands of participants and spectators, an outbreak investigation was conducted in multiple states by state and local health departments in coordination with CDC, using standard measles surveillance case definitions and classifications. This report summarizes the results of that investigation, which identified six additional measles cases that were linked epidemiologically to the index case and two generations of secondary transmission. Viral genotyping supported a single chain of transmission; six of the seven cases were linked by genetic sequencing. U.S. organizers of large-scale events attended by international travelers, especially youths, should consider documentation of adequate participant vaccination. This outbreak highlights the need to maintain the highest possible vaccination coverage in the United States, along with disease surveillance and outbreak-containment capabilities.

A sporting event held in central Pennsylvania during August 17-26, 2007, included eight U.S. teams and eight international teams representing Canada, Chinese Taipei, Curacao, Japan, Netherlands, Mexico, Saudi Arabia, and Venezuela. Combined participant and spectator attendance for the event was approximately 265,000. Team members (boys aged 10-13 years) and coaches resided in the same compound during the event, with a common area shared by all teams. Access to the compound was restricted to a small number of officials, corporate sponsors, and event staff members.

Cases 1 and 2: Pennsylvania, Imported from Japan
A boy aged 12 years on the Japanese team (the index patient), who had unknown vaccination status, had been exposed to a sibling with measles-like illness in Japan in late July 2007. The boy had a sore throat and malaise on August 11 and traveled to the United States on August 13. The Japanese and Chinese Taipei teams traveled together by aircraft from Tokyo, Japan, to Detroit, Michigan, where they cleared immigration and customs, and then traveled by aircraft to Baltimore, Maryland, where they chartered a bus to Pennsylvania. On August 14, the patient visited the event infirmary to be evaluated for his sore throat. On August 16, he had a measles-compatible rash, cough, Koplik's spots, fever (102.4 degrees F [39.1 degrees C]), and coryza. The infectious period for measles extends from 5 days before to 4 days after rash onset. The Pennsylvania Department of Health (PADOH) was notified, and the patient was isolated. Measles-specific immunoglobulin M (IgM) antibodies were detected in his serum sample; urine culture yielded measles virus, genotype D5.

PADOH reviewed vaccination records for 481 players, coaches, translators, and event staff members at the compound; 292 (61%) either had documentation of 2 doses of measles-containing vaccine or history of measles disease, or were born before 1957 and were, therefore, considered immune. The remaining 189 (39%) were offered measles, mumps, and rubella (MMR) vaccine or serologic testing; 104 chose to be vaccinated, and 85 chose serologic testing. Sixteen (19%) of those tested lacked evidence of immunity and subsequently were vaccinated. Public health staff members and healthcare providers in Pennsylvania were alerted through the state Health Alert Network, and public announcements were issued. State health departments in California, Georgia, and Texas were informed of potential measles exposures among visiting corporate representatives who had already attended the event and departed from Pennsylvania.

A second boy aged 12 years with unknown vaccination status who had direct contact with the index patient only on August 12 in Japan, arrived in the United States on August 15 to watch the competition. On August 20, he had a sore throat and fever, followed by cough and rash on August 23. On August 24, nasopharyngeal, urine, and blood specimens were collected from the boy at a local emergency department. He was placed in isolation in his hotel room. His serum sample was positive for measles-specific IgM antibodies. Nasopharyngeal culture yielded measles virus genotype D5. The boy had minimal public interaction during his infectious period and was deemed not infectious during his airline travel.

The 29 members of his travel group and all 27 hotel staff members were interviewed; 38 (68%) persons without adequate evidence of immunity received MMR vaccine. Guests registered at the hotel during the boy's infectious period were advised to contact their physicians and local health departments in the event of illness. No measles cases were identified among these groups.

Cases 3 and 4: Michigan
In accordance with CDC protocol (CDC, unpublished document, 2008), passenger manifests for the August 13 Tokyo-Detroit and Detroit-Baltimore flights were obtained to contact persons seated within one row of the index patient. A woman aged 53 years seated one row in front of the index patient on the Detroit-Baltimore flight acquired measles (case 3). Although born in 1954, she recalled no history of measles or receiving measles-containing vaccine and was administered immunoglobulin prophylaxis after being identified as a contact. On August 25, she had fever, cough, and coryza, followed by rash on August 28. Serum initially was negative for measles IgM and immunoglobulin G antibodies, but she subsequently seroconverted. Measles viral RNA, detected in urine by reverse transcription-polymerase chain reaction (RT-PCR), had an identical sequence to the genotype D5 sequences obtained from the two patients in Pennsylvania.

Case 4 was identified in a U.S.-born man aged 25 years who was employed as a federal airport officer and had no documented measles vaccination. The officer and the index patient had been present in the same Detroit customs area on August 13. On August 23, the officer had wheezing, abdominal pain, and sweating, followed by rash on August 27. A serum sample obtained August 30 was positive for measles IgM antibodies. Measles virus RNA was detected by RT-PCR from a throat swab; however, attempts to amplify the larger region of the N gene necessary for genotyping were unsuccessful in this case.

A coworker of the officer at the same airport had measles 1 month later. The source of this infection could not be determined; the coworker's measles might have been linked to case 4 through an unrecognized chain of transmission (because the incubation period for measles ranges from 7 to 18 days) or might have resulted from a separate, unrelated exposure.

Cases 5, 6, and 7: Texas
Case 5 was identified in a U.S.-born man aged 40 years who was employed as a corporate sales representative and had no documented measles vaccination. The sales representative had met the index patient on August 14 in Pennsylvania and had cough, conjunctivitis, coryza, and fever on August 26. He had rash on August 28 and was hospitalized the next day with a seizure, fever of 105.7 degrees F (40.9 degrees C), and pneumonia. Measles was confirmed by serum IgM antibodies and viral RNA detected in urine by RT-PCR. He recovered and was discharged from the hospital after 4 days.

Before his hospitalization, the man had made sales visits to three Houston-area colleges. Cases 6 and 7 were identified among male college roommates, aged 18 and 19 years, who had attended one of the sales events on August 28. Both students were born in the United States and had received 2 documented doses of MMR vaccine. They had fever, chills, and myalgia on September 9 and 10, respectively; one had conjunctivitis. Both had rash on September 11, detectable measles IgM antibodies in serum, and measles virus RNA by RT-PCR in throat swab specimens. No additional cases were identified. The genotype D5 sequences obtained from the three Texas patients were identical to those of the two patients from Pennsylvania and to one of the two patients (case 3) from Michigan. On August 30, the outbreak was reported to the World Health Organization under the revised International Health Regulations as a public health emergency of international concern. . . .

Because international events provide opportunities for measles transmission, organizers of large gatherings attended by international travelers, especially youths, should consider documentation of adequate participant vaccination. To prevent spread of measles, international travelers are encouraged to be fully vaccinated. MMR vaccine, administered to susceptible persons within 72 hours of measles exposure, is a recommended intervention for measles outbreak containment. . . .

The attack rate of measles among susceptible persons has been documented as >90%. Previous imported measles cases have demonstrated the potential for larger outbreaks in U.S. communities with poor vaccination coverage. The small number of identified cases in this outbreak, despite the large number of exposed persons, demonstrates the value of maintaining high measles vaccination coverage in the U.S. population through adherence to routine vaccination recommendations. This outbreak also highlights the continuing importance of promoting measles control and elimination in other countries and sustaining strong surveillance and response measures in the United States. . . .

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5707a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5707.pdf

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

A CDC web section provides the public with information about measles disease and vaccine, beliefs and concerns, vaccine safety, and persons who should not be vaccinated. It provides healthcare professionals with clinical information, recommendations, references and resources, provider information and materials for patients. To access the CDC measles web section, go to: http://www.cdc.gov/vaccines/vpd-vac/measles

Important: Be sure to give influenza vaccine throughout the influenza season--from now through spring

Influenza is currently circulating and vaccination should continue from now until April and May. Visit the following websites often to find the information you need to keep vaccinating. Both are continually updated with the latest resources.

The National Influenza Vaccine Summit website at
http://www.preventinfluenza.org

CDC's Seasonal Flu web section at http://www.cdc.gov/flu

CDC adds to its Seasonal Influenza web section

CDC recently added five resources to its Seasonal Flu web section:

"Updated: CDC influenza pandemic operation plan (OPLAN) from January 11, 2008"
"The 2007-2008 flu season"
"Seasonal flu vaccine"
"Influenza antiviral drug resistance"
"Misconceptions about influenza and influenza vaccine"

To access these resources, go to: http://www.cdc.gov/flu/whatsnew.htm 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

MMWR publishes U.S. influenza update for September 30, 2007-February 9, 2008

On February 15, CDC published "Update: Influenza Activity--United States, September 30, 2007-February 9, 2008" as an MMWR Early Release. On February 22, CDC published the update in the MMWR.

To access the update in the February 22 MMWR, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5707a4.htm

To access the February 22 MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5707.pdf

For coalitions: March 11 is the date for IZTA's teleconference on building media support for NIIW activities

The Immunization Coalitions Technical Assistance Network (IZTA) March 11 conference call will provide tips and ideas on how coalitions can build media support for National Infant Immunization Week (NIIW) activities. Coalitions will also learn about CDC's NIIW media materials and tools. IZTA is a program of the Center for Health Communication, Academy for Educational Development.

The March 11 call will be held at 1PM, ET. To register, send an email to izta@aed.org Include this message: "Sign me up for the building media support call."

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

Adolescent immunization symposium scheduled in Atlanta on March 18 to coincide with NIC

Adolescent Immunization: A New Focus on the Next Generation is scheduled for the Georgia Aquarium in Atlanta the evening of March 18, which coincides with the National Immunization Conference, scheduled in Atlanta March 17-20. Sponsored by Albert Einstein College of Medicine and Montefiore Medical Center, the adolescent symposium offers attendees Continuing Medical Education and Continuing Education credits. Pre-registration is advised by 4PM, ET, March 17.

To access the symposium brochure and online registration information, go to: http://w4.isisgold.com/adolimmunatlmar08

To reach the registration hotline, call (800) 636-1668.

Adult immunization conference scheduled for March 7 in Chaska, MN.

Presented by the Minnesota Coalition for Adult Immunization, "Issues and Strategies in Adult Vaccine-Preventable Diseases" is scheduled for March 7 at the Minnesota Landscape Arboretum, Chaska, MN. The registration deadline is February 29.

To access the conference brochure and register online, click here.

For additional information, contact Mari Drake at maridrake@comcast.net or (651) 428-6591.

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