IZ Express Issue 714 | Immunize.org

IAC Express 2008
Issue number 714: March 3, 2008

Contents of this Issue Select a title to jump to the article.
New: ACIP votes to expand influenza recommendation to include vaccination for children ages 6 months-18 years CDC health advisory alerts clinicians to potential benefits of influenza antiviral use during current influenza season CDC website posts information for clinicians on MMRV vaccine safety CDC reports on measles outbreak in San Diego during January and February CDC reports on human rabies death in Canada in 2007 CDC issues health advisory about revised directions for using HyperRAB/SD human rabies immune globulin in fixed needle 2 mL pre-filled syringe New: CDC's Immunization Safety Office launches website to help public understand the basics of vaccine safety Important: Be sure to give influenza vaccine throughout the influenza season--from now through spring NPHIC develops resource library of communications materials on pandemic influenza California Department of Public Health releases new online presentation, "Marketing Vaccines to Tweens" MMWR notifies readers that CDC has begun distributing a new-generation smallpox vaccine International Conference on Emerging Infectious Diseases scheduled for March 16-19 in Atlanta Vaccines Summit to take place in London on June 16-17

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 714: March 3, 2008

New: ACIP votes to expand influenza recommendation to include vaccination for children ages 6 months-18 years

On February 27, ACIP voted to expand the recommendation for vaccinating children against influenza to include children ages 6 months-18 years. The recommendation currently in effect calls for vaccinating children ages 6-59 months. The expanded ACIP recommendation will become a CDC recommendation once it is accepted by the director of CDC and the Secretary of Health and Human Services and after it is published in MMWR.

Portions of a CDC press release announcing the ACIP vote are reprinted below. Also on February 27, the CDC website posted a podcast for the public explaining the change in the ACIP recommendation, and the Childhood Influenza Immunization Coalition (CIIC) issued a press release related to the ACIP vote. Links to the CDC podcast, to a transcript of the podcast, and to the CIIC press release are given at the end of this IAC Express article.

A panel of immunization experts voted today (February 27, 2008) to expand the recommended ages for annual influenza vaccination of children to include all children from 6 months through 18 years of age. The previous recommendation was for vaccination of children from 6 months to 59 months of age. The expanded recommendation is to take effect as soon as feasible, but no later than the 2009-2010 influenza season.

The Advisory Committee on Immunization Practices (ACIP), which advises the Centers for Disease Control and Prevention (CDC) on vaccine issues, voted on the new recommendation during its February 27-28, 2008, meeting in Atlanta. The new recommendation increases the number of children recommended for vaccination by approximately 30 million.

Studies have shown that healthy children bear a significant burden from influenza disease and are at increased risk of needing influenza-related medical care. In addition, there is evidence showing that reducing influenza transmission among children has the potential to reduce influenza among their household contacts and within the community. . . .

To access the complete CDC press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/2008/r080227.htm

To listen to the CDC podcast, go to:
http://www2a.cdc.gov/podcasts/player.asp?f=8383

To access a transcript of the podcast, go to:
http://www2a.cdc.gov/podcasts/player.asp?f=8383#transcript

To access the CIIC press release, go to: http://www.preventchildhoodinfluenza.org/media/press.php Scroll down and click on the link to the press release dated February 27, 2008.

CDC health advisory alerts clinicians to potential benefits of influenza antiviral use during current influenza season

On February 29, CDC's Health Alert Network (HAN) issued a health advisory titled "Influenza Antiviral Use for Persons at High Risk for Influenza Complications or Who Have Severe Influenza Illness." It is reprinted below in its entirety.

Summary:
Recent surveillance data indicate that many communities are reporting substantially increased influenza activity. This CDC Health Advisory is intended to re-emphasize the importance of considering antiviral medications for use in the treatment or prevention of influenza. The two prescription antiviral medications recommended for treatment or prevention of influenza include oseltamivir (Tamiflu, Roche Laboratories, Nutley, NJ) or zanamivir (Relenza, GlaxoSmithKline, Research Triangle Park, NC). These antiviral medications are also known as neuraminidase inhibitors. Recent studies suggest a considerable protective effect against complications associated with influenza when neuraminidase inhibitors are used for treatment. These benefits include reducing the risk of death among older adults hospitalized with laboratory-confirmed influenza. Because high levels of resistance to adamantane antiviral medications (rimantadine and amantadine) continue to be observed among circulating influenza A viruses, adamantanes are not recommended for treatment or prevention of influenza.

Background:
During this influenza season, a small increase in the number of influenza viruses resistant to oseltamivir has been observed in the United States. Among the 471 influenza A and B viruses tested during the 2007–08 influenza season to date, 27 (5.7%) have been found to be resistant to oseltamivir, compared with 0.7% during the 2006-07 season. All of the oseltamivir-resistant viruses have been influenza A viruses of the H1N1 subtype; 8.7% of the 310 H1N1 viruses tested are resistant to oseltamivir. No resistance to oseltamivir has been observed among the 161 influenza A (H3N2) and influenza B viruses tested to date, and no antiviral resistance to zanamivir has been detected in any subtype.

Recommendations:
Given the low level of overall resistance to oseltamivir among circulating influenza viruses, the finding of resistance only in influenza A (H1N1) viruses, and no resistance to zanamivir, neuraminidase inhibitor medications continue to be recommended for the treatment and chemoprophylaxis of influenza. Antiviral treatment should begin within 48 hours of symptom onset if possible, but treatment should still be considered for persons who present more than 48 hours after illness onset if they have severe influenza illness or are at higher risk for severe complications from influenza. Oseltamivir is approved for treatment and prevention of influenza for persons 1 year and older, while zanamivir is approved for treatment of persons 7 years and older and prevention of influenza in persons 5 years and older. Enhanced surveillance for detection of oseltamivir-resistant influenza viruses is ongoing, and antiviral usage recommendations will be revised to account for changes in antiviral resistance trends as needed. Influenza A viral isolates from affected persons in institutional outbreaks should be subtyped. Healthcare providers should contact their local or state public health department for assistance when an outbreak of influenza in an institutional setting (e.g., a long-term care facility) occurs. State health departments should consult with CDC about the need for antiviral resistance testing when influenza A (H1N1) viral isolates are obtained from outbreaks in institutional settings.

In some communities, circulating influenza virus strains during this influenza season are antigenically different from those contained in current influenza vaccines. Preliminary results from a rapid assessment of vaccine effectiveness suggest that currently available influenza vaccines provide some protection against influenza virus infection requiring medical care. However, the level of protection is likely to be lower than what is observed in seasons in which the vaccine strains are closely matched to circulating influenza virus strains. When influenza vaccine effectiveness is reduced, clinicians should be aware of the potential for appropriately vaccinated persons to develop influenza despite vaccination.

Because approximately 2 weeks is required to develop an optimal immune response to influenza vaccination, use of neuraminidase inhibitors for prevention of influenza during a confirmed influenza institutional outbreak should be considered for persons at higher risk for influenza complications and who were vaccinated within the previous 2 weeks. Persons who were vaccinated more than two weeks before a suspected influenza virus exposure, but who are less likely to develop protective immunity after vaccination (e.g., persons in long-term care facilities or persons with immunosuppression), can be considered for antiviral chemoprophylaxis when local influenza surveillance data indicate that influenza activity is high.

Clinicians should consider whether to recommend influenza antiviral treatment based on the severity of the patient's illness, the time since illness onset, local influenza surveillance data, and influenza test results. Rapid diagnostic tests for influenza have good specificity, but are only moderately sensitive. Positive rapid tests are generally reliable when influenza activity is high in a community and are useful in deciding whether to initiate antiviral treatment. Negative rapid test results are less helpful in making treatment decisions. When local influenza activity is high, persons with severe respiratory symptoms or persons with acute respiratory illness who are at higher risk for influenza complications should still be considered for influenza antiviral treatment despite a negative rapid influenza test unless illness can be attributed to another cause. As reported in a previous HAN, persons with severe influenza illness should also be assessed for invasive bacterial co-infection, and appropriate antimicrobial therapy directed at potential bacterial pathogens, such as methicillin-resistant Staphylococcus aureus, might be necessary.

To reduce the substantial burden of influenza in the U.S., CDC continues to recommend a three-pronged approach: influenza vaccination, use of neuraminidase inhibitor antiviral medications when indicated for treatment or prevention, and use of other measures to decrease the spread of influenza, including promotion of hand hygiene, respiratory hygiene, cough etiquette, and staying home from work and school when ill. Clinicians in communities experiencing increased influenza activity should consider prescribing the neuraminidase inhibitor antiviral medications oseltamivir and zanamivir for the treatment of influenza patients or for prevention of influenza when indicated for institutional influenza outbreaks or for persons at high risk for complications from influenza who have contraindications to influenza vaccination.

For more information, please see the CDC website:
http://www.cdc.gov/flu/professionals/antivirals

If you have any questions about this Health Advisory, please call the Influenza Division, Epidemiology and Prevention Branch at (404) 639-3747.

After normal business hours, contact CDC's duty officer through the CDC Director's Emergency Operation Center (DEOC) at (770) 488-7100.

To access the health advisory, click here.

CDC website posts information for clinicians on MMRV vaccine safety

On February 27, the CDC website posted a safety update titled "What Clinicians Need to Know About MMRV Vaccine Safety." The safety update was posted in response to information presented to ACIP on the risk of febrile seizures after vaccination with measles-mumps-rubella-varicella vaccine (MMRV vaccine; ProQuad [Merck]). Portions of the safety update are reprinted below.

On February 28, the FDA website posted "Information Pertaining to Labeling Revision for ProQuad." A link to the FDA document is given at the end of this IAC Express article.

PROVIDER SUMMARY
As part of routine safety monitoring for new vaccines, in 2007 CDC implemented a postlicensure vaccine safety study for the combined MMRV vaccine in children aged 12–23 months, the age when the first dose of MMRV or measles, mumps, and rubella (MMR) and varicella vaccines is recommended.

Preliminary results from CDC's MMRV vaccine safety study among children aged 12–23 months found--

The rates of febrile seizures during the 7–10 days after vaccination was about 2 times higher in children who received MMRV vaccine (9 per 10,000 children vaccinated), compared with children who received measles, mumps, and rubella (MMR) and varicella vaccines separately at the same visit (4 per 10,000 children vaccinated).
During the 7–10 days after vaccination, about one additional febrile seizure would be expected to occur for every 2,000 children who receive an MMRV vaccine instead of separate MMR and varicella vaccines.

CDC, FDA, and ACIP continue to evaluate these preliminary findings and other relevant data. They will communicate updates and take any further necessary actions based on this evaluation.

CLINICAL GUIDANCE FOR USING THE MMRV VACCINE
Clinical guidance for using the MMRV vaccine at this time includes--

MMRV vaccine is currently in very limited distribution in the United States, due to manufacturing issues unrelated to vaccine safety or efficacy. MMRV vaccine is not expected to be widely available before 2009; however, some clinics may have MMRV vaccine in stock.
ACIP continues to recommend two doses of vaccines to protect against measles, mumps, rubella, and varicella. The first dose is recommended at age 12–15 months, and the second dose is recommended at ages 4–6 years.
ACIP provisionally recommends that there is no preference for use of combination MMRV vaccine over separate administration of MMR and varicella vaccines. Provisional ACIP recommendations become official when they are published in CDC's Morbidity and Mortality Weekly Report (MMWR).
Providers can choose whether to administer combination MMRV vaccine or MMR and varicella vaccines separately for prevention of measles, mumps, rubella, and varicella.
Healthcare providers can remind parents that most children who receive an MMRV vaccine do not have any problems, and being vaccinated with MMRV or MMR and varicella vaccines is safer than getting measles, mumps, rubella, or chickenpox.
The second dose of MMRV or MMR and varicella vaccines is recommended at age 4–6 years. It is not known whether the risk of febrile seizures is higher in children aged 4–6 years who receive an MMRV vaccine, compared with separate MMR and varicella vaccines at the same visit. However, it is known that the second dose of MMR or MMRV vaccine is less likely to cause fever than the first dose, and rates of febrile seizures are lower in the general population of children aged 4–6 years than in children aged 12–15 months.
ACIP recommends that a personal or family history of seizures is not a contraindication or precaution for administration of MMRV, MMR, or varicella vaccines.
In February 2008, the MMRV package insert was updated based on FDA's review of postmarketing data. The revised package insert includes new and evolving information on the risk of febrile seizures after MMRV vaccination.
Febrile seizures generally have an excellent prognosis. The peak age for febrile seizures is 14–18 months, which overlaps with the ages when first doses of MMR and varicella vaccines are recommended.
Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). A VAERS form is available online or by telephone at (800) 822-7967. . . .

To read the complete CDC safety update, go to:
http://www.cdc.gov/od/science/iso/vsd/mmrv.htm

To access FDA's "Information Pertaining to Labeling Revision for ProQuad," go to: http://www.fda.gov/cber/label/proquadLBinfo.htm

CDC reports on measles outbreak in San Diego during January and February

CDC published "Outbreak of Measles--San Diego, California, January-February 2008" in the February 29 issue of MMWR. Portions of the article are reprinted below.

Measles, once a common childhood disease in the United States, can result in severe complications, including encephalitis, pneumonia, and death. Because of successful implementation of measles vaccination programs, endemic measles transmission has been eliminated in the United States and the rest of the Americas. However, measles continues to occur in other regions of the world, including Europe. In January 2008, measles was identified in an unvaccinated boy from San Diego, California, who had recently traveled to Europe with his family. After his case was confirmed, an outbreak investigation and response were initiated by local and state health departments in coordination with CDC, using standard measles surveillance case definitions and classifications. This report summarizes the preliminary results of that investigation, which has identified 11 additional cases of measles in unvaccinated children in San Diego that are linked epidemiologically to the index case and include two generations of secondary transmission. Recommendations for preventing further measles transmission from importations in this and other U.S. settings include reminding healthcare providers to (1) consider a diagnosis of measles in ill persons who have traveled overseas, (2) use appropriate infection-control practices to prevent transmission in health-care settings, and (3) maintain high coverage with measles, mumps, and rubella (MMR) vaccine among children.

The index patient was an unvaccinated boy aged 7 years who had visited Switzerland with his family, returning to the United States on January 13, 2008. He had fever and sore throat on January 21, followed by cough, coryza, and conjunctivitis. On January 24, he attended school. On January 25, the date of his rash onset, he visited the offices of his family physician and his pediatrician. A diagnosis of scarlet fever was ruled out on the basis of a negative rapid test for streptococcus. When the boy's condition became worse on January 26, he visited a children's hospital inpatient laboratory, where blood specimens were collected for measles antibody testing; later that day, he was taken to the same hospital's emergency department because of high fever 104 degrees F (40 degrees C) and generalized rash. No isolation precautions were instituted at the doctors' offices or hospital facilities.

The boy's measles immunoglobulin M (IgM) positive laboratory test result was reported to the county health department on February 1, 2008. During January 31-February 19, a total of 11 additional measles cases in unvaccinated infants and children aged 10 months-9 years were identified. These 11 cases included both of the index patient's siblings (rash onset: February 3), five children in his school (rash onset: January 31-February 17), and four additional children (rash onset: February 6-10) who had been in the pediatrician's office on January 25 at the same time as the index patient. Among these latter four patients, three were infants aged <12 months. One of the three infants was hospitalized for 2 days for dehydration; another infant traveled by airplane to Hawaii on February 9 while infectious. . . .

California allows personal beliefs exemptions (PBEs) to vaccinations required of schoolchildren; parents can request exemptions if all or some vaccinations are contrary to their beliefs. The index patient and one of his siblings attended a school with 376 children, who ranged in age from 5 to 14 years. Thirty-six (9.6%) of the children had PBEs on file at the school. Among the nine patients aged >=12 months, including the index patient, eight were unvaccinated because of PBEs. Among the 36 schoolchildren with PBEs, four had documentation of previous measles vaccination, 11 were vaccinated during the outbreak, and the remaining 21, who did not have evidence of immunity to measles, were placed under voluntary quarantine for 21 days after their last exposure. Overall, approximately 70 children exposed to children with measles in the school, a day care center, the pediatrician's office, and other community settings were placed under voluntary home quarantine because their parents either declined measles vaccination or they were too young to be vaccinated.

As part of the public health response in San Diego, surveillance has been enhanced to identify additional rash illnesses, and outbreak response measures in the community are ongoing. In Hawaii, ongoing response measures include following up airplane and other contacts of the infant who traveled to Hawaii to inform them of their potential exposure and refer them to their physicians regarding their susceptibility to measles. Five exposed infants, four airplane contacts, and one personal acquaintance were administered immune globulin within 72 hours of exposure. No secondary cases have been identified in Hawaii to date. . . .

The community transmission that has occurred during the San Diego outbreak is consistent with previous observations that the frequency of vaccination exemptors in a community is associated with the incidence of measles in that community; in addition, imported measles cases have demonstrated the potential for sizeable outbreaks in U.S. communities with suboptimal vaccine coverage. The public health response to this outbreak has included identification of cases, isolation of patients and vaccination, administration of immune globulin, and voluntary quarantine of contacts who have no evidence of measles immunity. Costs associated with control of these outbreaks can be substantial. In Iowa, the public health response to one imported measles case cost approximately $150,000.

This outbreak also illustrates the risk for measles transmission in healthcare settings. Airborne transmission of measles has been reported in emergency departments, physician offices, and pediatric ambulatory-care settings. Persons exposed to measles should be instructed to inform all healthcare providers of their exposure before entering a healthcare facility. Healthcare personnel providing care to suspected measles patients (i.e., patients with febrile illness and generalized maculopapular rash or known contacts with prodromal symptoms) should apply appropriate isolation practices, including airborne precautions, in addition to taking standard precautions for such patients. . . .

Measles morbidity and mortality can be reduced through vaccination with MMR vaccine. Vaccination of U.S. travelers can reduce measles importations. Sustained high population immunity through vaccination, effective surveillance, and robust public health preparedness and response capacity are needed to keep the United States free from indigenous measles transmission and control any outbreaks associated with importations.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5708.pdf

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

CDC reports on human rabies death in Canada in 2007

CDC published "Human Rabies--Alberta, Canada, 2007" in the February 29 issue of MMWR. A press summary of the article is reprinted below in its entirety.

Rabies is a fatal but easily preventable disease. There is no established effective therapy after the onset of illness. Underestimation of the importance of the exposure can lead to a fatal outcome. Persons bitten by a bat should immediately (1) wash the wound thoroughly with soap and water; (2) capture the animal, if this can be done safely (i.e., by avoiding direct contact with the animal) or call local animal control services for assistance and submit the animal for diagnostic testing; (3) report the incident to relevant public health officials; and (4) see a physician for evaluation regarding the need for [postexposure prophylaxis].

On April 26, 2007, a 73-year-old man from Alberta, Canada, died from encephalitis after 9 weeks in an intensive care unit (ICU). The infection was caused by a rabies virus variant associated with silver-haired bats. He was bitten by a bat on his left shoulder while sleeping at home. He perceived the bite and killed the bat, but was unaware of the risk of rabies acquisition. Thus, he did not seek medical attention and did not send the bat for diagnostic testing. Rabies is an acute progressive fatal viral disease with no established effective therapy after the onset of illness. The disease is easily prevented if a person receives prompt and properly instituted postexposure prophylaxis. An experimental approach to treat human rabies requires early diagnosis; therefore, rabies should be included in the differential diagnosis of any unexplained acute progressive viral encephalitis.

To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a1.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5708.pdf

CDC issues health advisory about revised directions for using HyperRAB/SD human rabies immune globulin in fixed needle 2 mL pre-filled syringe

On February 26, CDC's Health Alert Network issued a health advisory titled "Important Safety Information--Revised Directions for Using Rabies Immune Globulin (Human), HyperRAB S/D in Fixed Needle 2 mL Pre-filled Syringe." Portions of the advisory are reprinted below.

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have been notified by Talecris Biotherapeutics, Inc. that its Rabies Immune Globulin (Human), HyperRAB S/D in fixed needle 2 mL pre-filled syringe does not address all dosing situations. Specifically, the fixed needle (22 gauge, 1.25 inch) and the absence of graduations on the 2-mL pre-filled syringe do not permit administration of the recommended dose of Rabies Immune Globulin (Human), HyperRAB S/D in one or more of the following situations:

A dose <2 mL is required (e.g. for pediatric use);
A dose <2 mL must be injected over multiple sites; or
An alternate needle (different length or gauge) is required based on the patient (adult or child), wound, or site of injection.

Three lots of HyperRAB S/D have been manufactured with the 2 mL pre-filled syringe configuration. . . .

Healthcare providers may continue to administer HyperRAB S/D supplied in the 2 mL pre-filled syringe by following the "Revised Directions for Use" that are packaged with these lots. The full "Revised Directions for Use" of these lots is available on-line at http://www.fda.gov/cber/safety/hyperrab022208inst.pdf Talecris has discontinued manufacturing the HyperRAB S/D fixed needle 2 mL pre-filled syringe.

For additional information regarding this product, please contact Talecris online at www.talecris.com, or call (919) 412-1030, or (800) 520-2807. . . .

To access the complete Health Advisory, go to:
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00270

New: CDC's Immunization Safety Office launches website to help public understand the basics of vaccine safety

CDC's Immunization Safety Office (ISO) recently launched a new website intended to reach the public with scientifically accurate messages that address widespread myths about the dangers of vaccines. Designed and organized for easy navigation, the new site helps the public understand the basics of vaccine safety, describes ISO's public health activities, and directs visitors to a variety of CDC resources about vaccines.

Some of the updated information includes concerns about vaccine safety relating to sudden infant death syndrome, fainting after vaccination, and vaccine recalls. Future plans include posting the number of reports to the Vaccine Adverse Event Reporting System (VAERS) quarterly, adding links to scientific articles as they are published, and addressing vaccine safety concerns as they come up in the press.

To visit the site, go to: www.cdc.gov/vaccinesafety

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

NPHIC develops resource library of communications materials on pandemic influenza

The National Public Health Information Coalition (NPHIC) recently announced the development of a new web section, "Pandemic Flu Prepared," a resource library of free communications materials about pandemic influenza. The library includes brochures, fact sheets, press releases, public service announcements, talking points, and more.

To access the library, go to www.nphic.org Scroll down the left column and click on the box titled Pandemic Flu.

10.

California Department of Public Health releases new online presentation, "Marketing Vaccines to Tweens"

The California Department of Public Health has released a new online presentation "Marketing Vaccines to Tweens". The 25-minute webcast discusses social marketing and disease prevention. It offers insights and suggestions on health-related social marketing directed at Tweens, (young people age 9-12 years) and how to empower them to get the immunizations they need. Find out what motivates and inspires Tweens to action and learn how to break down communication barriers and develop effective Tween immunization campaigns.

To view the presentation, go to:
www.cdlhn.com/socialmarketingPHC.info

11.

MMWR notifies readers that CDC has begun distributing a new-generation smallpox vaccine

CDC published "Notice to Readers: Newly Licensed Smallpox Vaccine to Replace Old Smallpox Vaccine" in the February 29 issue of MMWR. The notice is reprinted below in its entirety, excluding references.

CDC has begun distribution of a new-generation smallpox vaccine, ACAM2000 (Acambis, Inc., Cambridge, Massachusetts), to civilian laboratory personnel, the military, and state public health preparedness programs. ACAM2000 is a live, vaccinia virus smallpox vaccine that was licensed for use in the United States by the Food and Drug Administration in August 2007. ACAM2000 will be replacing Dryvax smallpox vaccine (Wyeth Pharmaceuticals, Inc., Marietta, Pennsylvania) because of withdrawal of the Dryvax license. ACAM2000 is a live vaccinia virus derived from plaque purification cloning from Dryvax. The safety data available from the ACAM2000 clinical trials indicate a similar safety profile to Dryvax.

Wyeth intends to withdraw the Dryvax license and asks that all remaining quantities of vaccine held by civilian and military users be quarantined by February 29, 2008, for the purpose of destruction. This withdrawal is not necessitated by any safety, purity, or quality concerns with the product but rather is consistent with a contract agreement between CDC and Wyeth. All lots of Dryvax vaccine will expire on February 29, 2008, and should not be used after that date.

All Dryvax vaccine should be destroyed on site. Vaccine vials can be (1) dropped into the hospital sharps container and autoclaved or (2) disposed of following the procedure for all other biohazard materials. In sites where medical waste is buried, soaking the medical waste in a 1:10 dilution of bleach for at least 10 minutes before disposal is advised. All programs that hold supplies of Dryvax vaccine must provide documentation of Dryvax vaccine destruction to the CDC Drug Service by March 31, 2008. These programs are advised to use the Dryvax vaccine destruction form.

CDC will continue to provide ACAM2000 smallpox vaccine to protect responders as part of state public health preparedness programs and civilian laboratory personnel who risk exposure to orthopoxviruses. Unlike Dryvax, ACAM2000 expires 18 months after release from the CDC Strategic National Stockpile. Requests for smallpox vaccine should be directed to the CDC Drug Service by email (drugservice@cdc.gov) or telephone ([404] 639-3670).

To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a6.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5708.pdf

12.

International Conference on Emerging Infectious Diseases scheduled for March 16-19 in Atlanta

The International Conference on Emerging Infectious Diseases (ICEID) is a forum for public health professionals to explore issues in surveillance, research, epidemiology, and prevention and control of emerging infectious diseases. It is scheduled to take place in Atlanta on March 16-19, dates coincidental with the dates of the National Immunization Conference, which will be held in Atlanta on March 17-20.

For comprehensive information on ICEID, go to: http://www.iceid.org

Registration is complimentary for credentialed media representatives, and pre-registration is encouraged. To pre-register, go to: http://www.iceid.org/newsroom.asp

13.

Vaccines Summit to take place in London on June 16-17

The Vaccines Summit is scheduled for London on June 16-17; a half-day post-conference workshop on progress in the field of cancer vaccines is scheduled for June 18. A discounted registration price is available for those who register by March 31.

For complete information on the summit, go to:
http://www.smi-online.co.uk/events/overview.asp?is=4&ref=2863

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