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IAC Express 2008 |
| Issue number 729: May 5, 2008 |
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Contents
of this Issue
Select a title to jump to the article. |
- CDC study
finds 28 percent of toddlers not vaccinated in compliance with ACIP
recommendations; CDC develops related talking points
- CDC
reports on syncope after vaccination from January 2005 to July 2007
-
Immunization
Safety Office website posts VAERS reports related to HPV vaccine
- CDC
reports on human rabies fatality in Minnesota in 2007
- New:
Multi-vaccine VIS now available in Hmong, Russian,Somali, and Vietnamese
- For
coalitions: IZTA's June 3 teleconference to feature National Influenza
Vaccine Summit's update on vaccine supply
- April
issue of CDC's Immunization Works electronic newsletter now online
-
Important: Be sure to give influenza vaccine throughout the influenza
season--through the spring months
- CDC
reports on ACIP decision not to recommend routine MCV4 vaccination of all
children ages 2-10 years
-
Reminder: National Conference on Immunization & Health Coalitions will be
held in San Francisco May 21-23
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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 729: May 5, 2008 |
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1. |
CDC study finds 28 percent of
toddlers not vaccinated in compliance with ACIP recommendations; CDC develops
related talking points
The June issue of the American Journal of
Preventive Medicine
(AJPM) includes an article by CDC researchers titled "Compliance
with Vaccination Recommendations for U.S. Children." Using data
from the 2005 National Immunization Survey, the study, which
measures vaccination coverage using all the ACIP recommendations
for valid doses, found that 28 percent of children ages 19-35
months were not vaccinated in compliance with ACIP
recommendations. The article abstract is reprinted below.
CDC has developed talking points to assist states in answering
questions they may get about why this ACIP-compliant measure
differs from the federally reported estimates of vaccine
coverage. Portions of the talking points are reprinted below.
IAC Express editor's note: The article "Compliance with
Vaccination Recommendations for U.S. Children" is not available
online as the AJPM website has not yet posted the June 2008
issue. Also, the CDC website has not posted the talking points
it developed related to the article.
ARTICLE ABSTRACT
Background: Official recommendations for the routine vaccination
of U.S. children, made by the Advisory Committee on Immunization
Practices (ACIP), specify the vaccines for administration, the
number of doses that should be given, the age ranges for
administration, the minimum ages at which doses are considered
valid, the minimum intervals between doses within a series, and
several additional vaccine-specific adjustments and exceptions.
Federally reported estimates of vaccination coverage measure
only compliance with the required number of doses; other
recommendations are not routinely evaluated.
Methods: Analysis of vaccination histories for 17,563 U.S.
children aged 19-35 months from the 2005 National Immunization
Survey.
Main outcome measures: Compliance with, and incremental impact
of, each vaccination recommendation.
Results: Estimated coverage was 72% for the standard vaccination
series accounting for all recommendations, 9 percentage points
lower than coverage based solely on counting doses. Overall, 19%
of children were missing one or more doses, while 8% had
received an invalid dose, and 9% were affected by other
recommendations. The proportion of noncompliance due to missed
doses versus other recommendations varied by state and by
antigen.
Conclusions: Approximately 28% of children were not in
compliance with the official vaccination recommendations. Missed
doses accounted for approximately two-thirds of noncompliance,
with the remainder due to mis-timed doses and other
requirements. Measuring compliance with all ACIP recommendations
provides a valuable tool to assess and improve the quality of
healthcare delivery and ensure that children and communities are
optimally protected from vaccine-preventable diseases.
TALKING POINTS
Portions of the study details not covered in the abstract above:
- The CDC annually reports coverage with the required number of
doses in a vaccine series. However, it has not previously
reported coverage based on all ACIP requirements. The National
Immunization Survey can be used to analyze both.
- Most commonly, children were missing the fourth dose of DTaP
(14%); the single dose of MMR (9%); or the third dose of
poliovirus vaccine (8%).
- The findings suggest that the number of children who needed
additional doses to bring them into compliance with ACIP
recommendations at the time of the interview was nearly 50%
greater than dose-counting alone would imply.
Study interpretation:
- The impact of measuring compliance with all aspects of the
ACIP recommendations in lowering estimated coverage is the
largest when looking at the coverage measure for all needed
doses, and that's because being early for a vaccine or not
following one of the vaccine-specific requirements for just a
single dose of vaccines makes an individual child fall into the
noncompliant category.
- When we look at coverage for MMR vaccine nationally in both
ways, we see that the difference is <1%.
- This rigorous measure of coverage can be used by health
departments to target educational efforts to improve healthcare
delivery.
- There is no reason to conclude from this more rigorous measure
of coverage that coverage is not at or near all-time highs, as
previously reported. This measure of coverage simply reveals
additional information about how compliance with ACIP
recommendations could be improved by improvements in healthcare
delivery.
- These data cannot be used to conclude that parents are
electing to postpone vaccination of their children--it does not
examine late doses. However, previous studies have looked at
late doses of vaccine.
- Mis-timed vaccinations can lead to the reduced immunity of
individuals and increased levels of population susceptibility
and could lead to increases in disease.
- While priority should be given to ensuring that children
receive all of the recommended vaccine doses, compliance with
the remaining recommendations should not be overlooked.
- Vaccination providers should balance the competing goals of
administering valid vaccinations and reducing missed
opportunities.
- Administering a vaccination a few days early is preferred to
missing the opportunity to vaccinate a child who is unlikely to
return at the appropriate time.
- However, in general, providers and parents should adhere to
the specifics of published guidelines whenever possible.
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2. |
CDC reports on syncope after vaccination from January 2005 to July 2007
CDC published "Syncope After Vaccination--United
States, January
2005-July 2007" in the May 2 issue of MMWR. Portions of the
article are reprinted below.
Syncope (vasovagal reaction), or fainting, can be triggered by
various stimuli, including medical procedures. Syncope has been
documented to occur after vaccination, most commonly among
adolescents, and can result in hospitalization for a medical
evaluation or because of injury. During 2005 and 2006, the
Advisory Committee on Immunization Practices (ACIP) recommended
use of three newly licensed vaccines for adolescents: the
quadrivalent human papillomavirus recombinant vaccine (HPV)
(Gardasil, Merck & Co., Inc., Whitehouse Station, New Jersey) in
a 3-dose series, the quadrivalent meningococcal conjugate
vaccine (MCV4) (Menactra, sanofi pasteur, Inc., Swiftwater,
Pennsylvania) in a single dose, and the tetanus toxoid, reduced
diphtheria toxoid, and acellular pertussis vaccine (Tdap)
(Adacel, Sanofi Pasteur; Boostrix, GlaxoSmithKline Biologicals,
Research Triangle Park, North Carolina) in a single dose. To
describe trends in occurrence of postvaccination syncope, CDC
and the Food and Drug Administration (FDA) analyzed data from
the Vaccine Adverse Event Reporting System (VAERS) for January
1, 2005-July 31, 2007, and compared the results with VAERS
reports received during January 1, 2002-December 31, 2004. The
findings indicated that, since 2005, reports to VAERS regarding
postvaccination syncope have increased, primarily among females
aged 11-18 years, and rarely, subsequent serious injuries have
occurred. To prevent syncope-related injuries, vaccine providers
should follow the ACIP recommendation to strongly consider
observing patients for 15 minutes after vaccination. . . .
A total of 463 reports of postvaccination syncope during January
1, 2005-July 31, 2007, were identified among persons aged >=5
years, compared with 203 reports during 2002-2004. The rate of
reports for postvaccination syncope among persons aged >=5 years
were as follows: 0.30 reports per million doses distributed in
2002, 0.35 per million doses distributed in 2003, 0.28 per
million doses distributed in 2004, 0.31 per million doses
distributed in 2005, and 0.54 per million doses distributed in
2006. Compared with reports received during 2002-2004, those
received during 2005-2007 were more likely to involve females
(61.1% versus 77.5%) or persons aged 11-18 years (47.3% versus
62.0%). In 292 (63.1%) of the 463 reports during 2005-2007,
syncope was associated with at least one of the following
recently approved and recommended adolescent vaccines: MCV4,
Tdap, and HPV.
Thirty-three (7.1%) of the 463 postvaccination syncope reports
during 2005-2007 were coded as serious; the percentage was not
substantially different from the corresponding 20 (9.9%) serious
reports during the earlier comparison period. . . .
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5717.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. |
Vaccine Safety Office website posts VAERS reports related to HPV vaccine
On April 29, CDC's Immunization Safety Office
(ISO) posted
reports on human papillomavirus (HPV) vaccination that were
submitted to the Vaccine Adverse Events Reporting System (VAERS)
from June 8, 2006, to January 31, 2008.
On June 8, 2006, FDA licensed Gardasil, the first vaccine
developed to prevent cervical cancer caused by certain kinds of
human papillomavirus (HPV). Since then, more than 12 million
doses of Gardasil vaccine have been distributed. The total
number of people vaccinated with HPV vaccine in the U.S. is
unknown. In that period, VAERS received 5,070 reports related to
HPV vaccination; less than 7 percent reported serious side
effects.
To access the reports, go to:
http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm
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4. |
CDC reports on human rabies fatality in Minnesota in 2007
CDC published "Human Rabies--Minnesota, 2007" in
the May 2 issue
of MMWR. Portions of the article are reprinted below.
On October 20, 2007, a Minnesota resident died from rabies,
approximately 1 month after initial symptoms of limb
paresthesia, which progressed to flaccid weakness and ataxia.
This was the only human rabies case reported in the United
States in 2007. A presumptive diagnosis of idiopathic transverse
myelitis was considered initially, because of abnormalities
detected via spinal cord imaging studies and a lack of
laboratory confirmation of a specific infectious etiology. The
presumptive diagnosis subsequently was changed to include
rabies, based on the patient's rapidly deteriorating neurologic
status and elicitation of a history involving bat exposure
during the month before illness onset. This report summarizes
the medical and epidemiologic investigation by the Minnesota
Department of Health and CDC and the ensuing public health
response. The findings underscore the need for early inclusion
of rabies in the differential diagnosis of rapidly progressive
encephalitis, improved public awareness of the risks associated
with animal bites, and appropriate rabies prophylaxis after
exposure. . . .
This report describes the only reported case of human rabies in
the United States in 2007 and the first case in Minnesota since
2000. Investigators determined that the likely source of rabies
in this case was a bat. In Minnesota, bats and skunks are the
only known reservoirs of rabies. In 2006, 42 rabid animals were
reported in the state, including 17 bats and 20 skunks.
During 2000-2007, a total of 25 cases of human rabies were
reported in the United States. Eighteen (28%) cases were
associated with suspected exposure to rabid bats or infection
with bat rabies virus variants. Most of these human cases
occurred in late summer or early autumn, coincident with a
seasonal increase in the prevalence of rabid bats detected in
the United States. Despite repeated documentation of human
rabies attributable to bat exposures and identification of
1,212-1,692 rabid bats in the United States during 2000-2006,
the significance of bat exposures often is ignored.
The animal contact, incubation period, clinical presentation,
and laboratory findings for the patient described in this report
were typical of human rabies cases reported in the United
States. However, a diagnosis of rabies was not considered until
the clinical course appeared atypical of the presumptive
diagnosis of idiopathic transverse myelitis and brain imaging
abnormalities resembled those observed in rabies. One unusual
facet of this case was the inability to detect viral antigens or
nucleic acids in patient samples, although rabies virus
antibodies were identified in the serum and cerebrospinal fluid
(CSF). The only other human rabies case in the United States in
which viral antigens or nucleic acids could not be detected,
since such laboratory methods became more widely available in
the early 1990s, was a 2004 Wisconsin patient, who survived
rabies after a bat bite. However, the Wisconsin patient was an
adolescent girl treated successfully with a drug-induced coma
and antiviral drugs, and the significance of any similarities
between that case and the Minnesota case is unclear.
This report underscores the need for increased public awareness
of the risks of direct contact with bats and other wild animals.
After exposure, human rabies is preventable with timely and
appropriate postexposure prophylaxis (PEP), consisting of proper
wound care and prompt administration of rabies biologicals.
Rabies PEP is recommended for all persons with direct
transdermal or mucous membrane exposure to a bat, unless the
animal is found not to have rabies. However, bite lesions from
certain animals, including bats, can be difficult to detect.
Consequently, proper tailoring of health communications to
medical practitioners and the public remains a challenge to
ensure that appropriate PEP is administered when indicated but
not unnecessarily.
Rabies should be considered in the differential diagnosis of
human cases involving acute, rapidly progressive encephalitis,
especially when the clinical course and neuroimaging findings
are compatible, regardless of history of animal exposure. If a
patient is unresponsive, interview of family members and close
contacts might reveal potential exposures. Prompt diagnosis of
rabies can enable rapid case investigation, implementation of
appropriate infection-control measures, and consideration of
experimental therapy.
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a3.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5717.pdf
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5. |
New: Multi-vaccine VIS now available in Hmong, Russian, Somali, and
Vietnamese
Dated 1/30/08, the multi-vaccine VIS is now
available in Hmong,
Russian, Somali, and Vietnamese. IAC gratefully acknowledges the
Minnesota Department of Health for the translations.
To access the Hmong version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/hm_multi.pdf
To access the Russian version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/ru_multi.pdf
To access the Somali version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/so_multi.pdf
To access the Vietnamese version of the multi-vaccine VIS, go
to: http://www.immunize.org/vis/vn_multi.pdf
To access English version of the multi-vaccine VIS, go to:
http://www.immunize.org/vis/vis_multi1.pdf
NOTE: The multi-vaccine VIS comes in additional languages,
including Spanish. To access them, go to: http://www.immunize.org/vis/vis_multi1.asp Click on the link to
the pertinent language.
For information about the use of VISs, and for VISs in more than
30 languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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6. |
For coalitions: IZTA's June 3 teleconference to feature National Influenza
Vaccine Summit's update on vaccine supply
The Immunization Coalitions Technical Assistance
Network (IZTA)
conference call on June 3 will feature an update on the current
supply of influenza vaccine and other information shared during
the National Influenza Vaccine Summit (aka, Flu Summit). IZTA is
a program of the Center for Health Communication, Academy for
Educational Development.
The presenter is L.J. Tan, PhD, director, Infectious Disease,
Immunology, and Molecular Medicine, American Medical
Association.
The June 3 call will be offered twice: first at 1PM ET, and
again at 3PM, ET. To register, send an email to izta@aed.org
Include either of these messages in the subject line: "sign me
up for the Flu Summit update at 1PM" or "sign me up for the Flu
Summit update at 3PM."
For additional information, or to access earlier programs, go
to: http://www.izta.org/confcall.cfm
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7. |
April issue of CDC's Immunization Works electronic newsletter now online
The April issue of Immunization Works, a monthly
email
newsletter published by CDC, is available on the website of the
National Center for Immunization and Respiratory Diseases
(NCIRD). The newsletter offers members of the immunization
community non-proprietary information about current topics. CDC
encourages its wide dissemination.
Some of the information in the April issue has already appeared
in previous issues of IAC Express. Following is the text of six
articles we have not covered.
OTHER NEWS & SUMMARIES
42ND NIC DRAWS NEARLY 1,500 ATTENDEES: Nearly 1,500 attendees
participated in the 42nd National Immunization Conference (NIC),
which was held March 17-20, 2008, in Atlanta, GA. Dr. Anne
Schuchat, director of CDC's National Center for Immunization and
Respiratory Diseases (NCIRD), and Dr. Renee Jenkins, president
of the American Academy of Pediatrics (AAP; http://www.aap.org),
spoke at the opening session. The Phil Horne award was presented
to Jane Seward, a deputy director with CDC's viral diseases
division. The Hilleman Lecture was delivered by Dr. Mathu
Santosham, of the Johns Hopkins' Bloomberg School of Public
Health, and a primary investigator in an effort to promote the
integration of Hib vaccine into immunization programs around the
world. Closing remarks were delivered by Joe Lastinger, a
founding board member of Families Fighting Flu
(http://www.familiesfightingflu.org) and father to Emily, who
died at 3-1/2-years-old from influenza. Handouts and audio/video
recordings from the conference are available online at the NIC
website (http://www.cdc.gov/vaccines/events/nic/#agenda).
Remember to mark your calendars for the 43rd NIC, to be held
March 30-April 2, 2009, in Dallas, TX.
MEETINGS, CONFERENCES & RESOURCES
DATA INTERACTIVE QUERY TOOL: CDC has launched a new tool for
research concerning Immunization Information Systems (IIS)
called the IIS Data Interactive Query Tool
(http://www2a.cdc.gov/nip/registry/IISAR/IISAR_QUERY.asp). The
searchable database contains detailed calendar-year 2004-2006
data--previously unavailable to the public--from the
Immunization Information Systems Annual Report (IISAR). IISAR is
an annual assessment of IIS activity among the 64 immunization
program grantees that receive funding under section 317b of the
Public Health Service Act. For more information, please contact
Bobby Rasulnia at bba9@cdc.gov
IIS SEARCHABLE PUBLICATIONS DATABASE: CDC has launched a new
tool for searching Immunization Information Systems (IIS)
publications called the IIS Publications Searchable Database
(http://www2a.cdc.gov/nip/IIS/IISPubs/IISPubsMain.asp). The
database contains references for IIS-related articles published
in peer-reviewed journals, IIS guidance documents, and CDC
Morbidity and Mortality Weekly Reports (MMWRs) from 2000 to the
present. This database will be updated as new articles and
guidance documents are published. For more information, please
contact Bobby Rasulnia at bba9@cdc.gov
BEST PRACTICES FOR HEALTHCARE WORKER INFLUENZA VACCINATION: NFID
has recently released a new "Best Practices" report called
Immunizing Healthcare Personnel Against Influenza
(http://www.nfid.org/HCWtoolkit/report.html). The basis for the
report, which was developed with input from The National
Influenza Vaccine Summit
(http://www.preventinfluenza.org/nivs.asp), was to locate
successful programs for immunizing healthcare workers against
influenza, and present them as models that could be replicated
by other organizations.
IMMUNIZATION LEGISLATION TRACKING WEBSITE: The Association of
State and Territorial Health Officials (ASTHO) has created an
Immunization Legislation Tracking website
(http://www.astho.org/templates/display_pub.php?pub_id=2919&admin=1)
that follows state and federal legislation and provides
links to external immunization legislation resources. For more
information, please contact Olivia Chang, analyst, Immunization
Policy, at ochang@astho.org
SPANISH LANGUAGE MATERIALS: A Spanish-language version of the
Recommended Immunizations for Babies is now available
(http://www.cdc.gov/vaccines/spec-grps/infants/downloads/rec-iz-babies-sp.pdf).
In addition, a Spanish-language version of CDC's
Multi-Vaccine Vaccine Information Statement
(http://www.immunize.org/vis/sp_multi.pdf) is now available.
NATIONAL INFLUENZA VACCINE SUMMIT: The 2008 National Influenza
Vaccine Summit (NIVS;
http://www.preventinfluenza.org/2008_summit_info.pdf) will be
held on May 12-13 in Atlanta, GA. NIVS, co-sponsored by the
American Medical Association (http://www.ama-assn.org) and CDC,
meets annually to provide a forum for discussing influenza
vaccine issues with diverse stakeholders.
To access the complete April issue from CDC's Vaccines &
Immunizations website, go to:
http://www.cdc.gov/vaccines/news/newsltrs/imwrks/2008/200804.htm
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8. |
Important: Be sure to give influenza vaccine throughout the influenza
season--through the spring months
Influenza is currently circulating, and
vaccination should
continue through the spring months. 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
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9. |
CDC
reports on ACIP decision not to recommend routine MCV4 vaccination of all
children ages 2-10 years
CDC published "Report from the Advisory Committee
on
Immunization Practices (ACIP): Decision Not to Recommend Routine
Vaccination of All Children Aged 2-10 Years with Quadrivalent
Meningococcal Conjugate Vaccine (MCV4)" in the May 2 issue of
MMWR. Portions of the article are reprinted below.
At its February 2008 meeting, the Advisory Committee on
Immunization Practices (ACIP) decided not to recommend routine
vaccination of children aged 2-10 years against meningococcal
disease unless the child is at increased risk for the disease.
This report summarizes the deliberations of ACIP and the
rationale for its decision and restates existing recommendations
for meningococcal vaccination among children aged 2-10 years at
increased risk for meningococcal disease. . . .
Based on reviews of safety and immunogenicity data, the
epidemiology of meningococcal disease, a cost-effectiveness
analysis, and programmatic considerations, ACIP decided not to
recommend routine vaccination against meningococcal disease for
all children aged 2-10 years at its February 2008 meeting. ACIP
continues to recommend vaccination for children aged 2-10 years
at increased risk for meningococcal disease. These children
include travelers to or residents of countries in which
meningococcal disease is hyperendemic or epidemic, children who
have terminal complement deficiencies, and children who have
anatomic or functional asplenia. Healthcare providers also may
elect to vaccinate children aged 2-10 years who are infected
with human immunodeficiency virus (HIV). MCV4 is preferred to
MPSV4 for children aged 2-10 years in these groups at increased
risk and for control of meningococcal disease outbreaks. In
addition, if healthcare providers or parents elect to provide
meningococcal vaccination to other children in this age group,
MCV4 is preferred to MPSV4. Recommendations for use of MCV4 in
persons aged 11-55 years, including a recommendation for routine
vaccination with MCV4 of persons aged 11-18 years, have been
published previously and remain unchanged.
For children aged 2-10 years who have received MPSV4 and remain
at increased risk for meningococcal disease, ACIP recommends
vaccination with MCV4 at 3 years after receipt of MPSV4.
Children who last received MPSV4 more than 3 years before and
remain at increased risk for meningococcal disease should be
vaccinated with MCV4 as soon as possible. For children at
lifelong increased risk for meningococcal disease, subsequent
doses of MCV4 likely will be needed. ACIP will monitor available
data on duration of protection to determine whether
recommendations for revaccination with MCV4 are indicated.
Persons with a history of Guillain-Barre syndrome (GBS) might be
at increased risk for GBS after MCV4 vaccination; therefore, a
history of GBS is a precaution to administration of MCV4.
Effective meningococcal conjugate vaccines for infants might be
available in the near future. Phase III clinical trials for
meningococcal conjugate vaccine in infants are ongoing, and
published data suggest these vaccines are safe and immunogenic.
Vaccines that provide protection against meningococcal disease
early in life have the potential to greatly reduce the burden of
meningococcal disease, especially if they provide protection
against serogroup B meningococcal disease.
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a4.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5717.pdf
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10. |
Reminder: National Conference on Immunization & Health Coalitions will be
held in San Francisco May 21-23
The eighth National Conference on Immunization &
Health
Coalitions will be held in San Francisco on May 21-23. The
deadline for standard registration is May 15.
To access comprehensive conference information, including an
updated conference agenda, go to:
http://www.sfimmunize.org/page2.html
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