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IAC Express 2008 |
| Issue number 745: August 4, 2008 |
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Contents
of this Issue
Select a title to jump to the article. |
- VIS news:
CDC issues two influenza VISs for the 2008-09 influenza season, one for
injectable influenza vaccine, the other for nasal-spray influenza vaccine
- 2006 NIS
data indicate 50 percent of newborns born between January 2003-June 2005
received the hepatitis B birthdose by age 3 days
- CDC
corrects an "Ask the Experts" answer that appeared in recent issues of
Needle Tips, Vaccinate Adults, and Vaccinate Women
- CDC
issues recommendations for postexposure interventions to prevent infection
with hepatitis B virus, hepatitis C virus, or HIV virus and tetanus in
persons wounded during bombings and other mass-casualty events
- CDC
redesigns its viral hepatitis website
- MMWR
notifies readers that the webcast of Immunization Update 2008 is scheduled
for August 28
- July 31
issue of IAC's Hep Express electronic newsletter now available online
- Author
reviews and revises two print materials on childhood hepatitis B virus
infection
- Interim
VIS for HPV vaccine now available in Vietnamese
- FDA
website posts information on storing and using temperature-sensitive
biological products after a power failure or flood
- MMWR
notifies readers that the online application deadline for the Epidemic
Intelligence Service is September 15
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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 745: August 4, 2008 |
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1. |
VIS news: CDC issues two influenza VISs for the 2008-09 influenza season, one
for injectable influenza vaccine, the other for nasal-spray influenza vaccine
On July 24, CDC released a new VIS for the
trivalent inactivated
influenza vaccine (TIV; injectable) and a new VIS for the live
attenuated influenza vaccine (LAIV; nasal spray). The new VISs
reflect changes made in ACIP's 2008 recommendations for
preventing influenza, which were published July 17 in an MMWR
Early Release.
VIS FOR INJECTABLE INFLUENZA VACCINE
To access the VIS for injectable influenza vaccine from the CDC
website, go to:
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf
To access the VIS for injectable influenza vaccine from the IAC
website, go to: http://www.immunize.org/vis/2flu.pdf
VIS FOR NASAL-SPRAY INFLUENZA VACCINE
To access the VIS for nasal-spray influenza vaccine from the CDC
website, go to:
http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flulive.pdf
To access the VIS for nasal-spray influenza vaccine from the IAC
website, go to: http://www.immunize.org/vis/liveflu.pdf
For information about the use of VISs, and for VISs in more than
35 languages, visit IAC's VIS web section at
http://www.immunize.org/vis
To access additional FREE, ready-to-print translations from the
IAC website, go to:
http://www.immunize.org/printmaterials/translations.asp
IAC's Print Materials web section has more than 175 FREE, ready-to-print materials for healthcare professionals and the public.
To access them, go to: http://www.immunize.org/printmaterials
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2. |
2006 NIS data indicate 50 percent of newborns born between January 2003-June
2005 received the hepatitis B birthdose by age 3 days
CDC published "Newborn Hepatitis B Vaccination
Coverage Among
Children Born January 2003-June 2005--United States" in the
August 1 issue of MMWR. It is reprinted below in its entirety,
excluding one table and references.
IAC Express editor's note: We have included links to several
relevant resources at the end of this IAC Express article.
Hepatitis B vaccine was first recommended for administration to
all infants in 1991 by the Advisory Committee on Immunization
Practices (ACIP) as the primary focus of a strategy to eliminate
hepatitis B virus (HBV) transmission in the United States. The
recommended timing of administration of the first dose of
hepatitis B vaccine to infants has evolved since then to
optimize prevention of perinatal and early childhood HBV
infections. In 1991, the first dose was recommended to be
administered at birth before hospital discharge or at age 1-2
months. In 2002, ACIP indicated a preference for the first dose
to be administered to newborns before hospital discharge. In
December 2005, ACIP issued revised recommendations specifying
that all medically stable newborns who weigh >=2,000 g (4.4 lbs)
receive their first dose of hepatitis B vaccine before hospital
discharge. To measure hepatitis B vaccination coverage during
the neonatal period, CDC analyzed data from the 2006 National
Immunization Survey (NIS). This report summarizes the results of
this analysis and provides national, state, and local data on
vaccination coverage for infants who received the hepatitis B
vaccine during the first days of life. The findings reveal that,
during January 2003-June 2005, before implementation of the 2005
ACIP hepatitis B vaccine recommendation, the national newborn
hepatitis B vaccination coverage estimate was 42.8% at age 1 day
and 50.1% at age 3 days, with substantial variation by states
and local areas. To comply with ACIP recommendations and
increase coverage, delivery hospitals should provide hepatitis B
vaccination of newborns as a standard of care.
NIS provides estimates of vaccination coverage among
noninstitutionalized children aged 19-35 months for each of the
50 states and selected local areas. To collect vaccination data,
NIS conducts a random-digit-dialed telephone survey of
households and a mail survey of children's vaccination providers
identified by household respondents. Data are weighted to adjust
for households with multiple telephone lines, household
nonresponse, and exclusion of households without landline
telephones. Infant age at vaccination was calculated by
subtracting birth date from vaccination date. Children included
in the 2006 NIS were born during January 2003-June 2005.
Household response rate for the survey was 64.5%, based on
Council of American Survey and Research Organizations guidelines
(CASRO); 21,044 children with provider-verified vaccination
records were included in this report and represent 70.4% of all
children with completed household interviews. National newborn
hepatitis B vaccination coverage was 42.8% at age 1 day, 48.5%
at 2 days, 50.1% at 3 days, 51.1% at 4 days, 51.8% at 5 days,
and 52.5% at 6 days. State and local area rates showed
substantial variability, with hepatitis B vaccination coverage
at age 1 day ranging from 8.2% in Fresno County, California, to
77.5% in Detroit, Michigan. Among all states and local areas
surveyed, the median coverage estimate was 50.3% at age 1 day
and 58.7% at 3 days.
Editorial Note:
The analysis in this report indicates that, for the January
2003-June 2005 birth cohort, 42.8% of newborns had received
hepatitis B vaccine by age 1 day and 50.1% had received
hepatitis B vaccine by age 3 days. These data provide a baseline
for assessing implementation of the December 2005 ACIP
recommendation to administer hepatitis B vaccine to all newborns
before hospital discharge. The 2009 NIS will be the first to
include all survey-eligible children who were born after the
December 2005 recommendation was made. Therefore, that survey
will be the first to provide full estimates of national newborn
vaccination coverage to evaluate the effect of the 2005 ACIP
recommendation.
Newborn hepatitis B vaccination coverage estimates varied
substantially among and within states. Administration of
hepatitis B vaccine to newborns is dependent on hospital
policies and procedures and on provider and parent preferences.
Although NIS does not distinguish whether hepatitis B vaccine
was given before or after hospital discharge, National Hospital
Discharge Survey data indicate that the average length of
hospital stay for all newborns in 2004 was 3.3 days, with an
average stay of 2.1 days for well newborns and an average stay
of 5.0 days for ill newborns; 85.6% of all newborns were
discharged by age 3 days.
The findings in this report are subject to at least four
limitations. First, NIS is a telephone survey; although results
are statistically adjusted to account for nonresponse and
households without telephones, some bias might remain. Second,
vaccination coverage is confirmed using provider-verified
records. Although clinic providers might not always have records
of a hospital-administered hepatitis B vaccine dose, this does
not appear to result in substantial under-ascertainment of
vaccination. A 2004 study in eight locations matched provider-reported vaccination records for the children sampled in NIS to
their vaccination histories reported by the state Immunization
Information Systems (IIS). NIS data underestimated birth dose
coverage by no more than 5% at any one location when compared
with the combined NIS and IIS coverage among children who had
vaccination histories from both sources (M Khare, CDC, personal
communication, February 2008). Third, estimates from state and
local areas should be interpreted with caution because of
smaller sample size and wider confidence intervals compared with
the national estimate. Finally, infants who were not recommended
to receive hepatitis B vaccine until age 1 month or after
hospital discharge because their birth weights were <2,000 g and
they were born to HBsAg-negative mothers could not be excluded
from the coverage estimates. Inclusion of those infants in the
denominator might result in an underestimate of newborn
coverage, but the effect should be minimal because infants at
this birth weight account for only 3% of births.
Infants infected with HBV typically are asymptomatic and have a
90% likelihood of remaining chronically infected. Up to 25% of
chronically infected children die prematurely of cirrhosis or
liver cancer. Two primary modes of HBV transmission occur during
infancy and early childhood: (1) from an infected mother to her
infant during delivery, and (2) from infected household contacts
to infant or child. Both modes of transmission can be prevented
by immunization of newborn infants. For infants born to mothers
identified as hepatitis B surface antigen (HBsAg)-positive
(i.e., HBV-infected), administration of hepatitis B vaccine and
hepatitis B immune globulin within 12 hours of birth is 85%-95%
effective as postexposure prophylaxis in preventing HBV
infection in the infant. In addition, hepatitis B vaccine alone
is 70%-95% effective in preventing perinatal HBV transmission
when the first dose is given within 24 hours of birth. Thus,
administration of hepatitis B vaccine soon after birth provides
timely postexposure prophylaxis to infants born to HBsAg-positive mothers who were not screened prenatally, or were not
identified as HBsAg-positive because of testing errors or lapses
in reporting or documentation of test results. Hepatitis B
vaccination of all newborns also provides early preexposure
protection to infants born to uninfected women during a period
when the risk for developing chronic HBV infection is greatest.
The 2005 ACIP recommendation to administer the first dose of
hepatitis B vaccine to all newborns before hospital discharge
will increase hepatitis B vaccination coverage during the first
days of life. Delivery hospitals play a key role in the national
strategy to eliminate HBV transmission. The 2005 ACIP statement
recommends that delivery hospitals have policies and procedures
in place, including appropriate standing orders, to ensure (1)
administration of hepatitis B vaccine to all newborns with birth
weights >=2,000 g before hospital discharge and (2)
identification of all infants born to HBsAg-positive mothers and
infants born to mothers with unknown HBsAg status to allow
initiation of postexposure prophylaxis within 12 hours of birth.
State and local information on prevention of HBV infection in
infants and children, including information on hospital-based
policies and procedures to prevent HBV infection, is available
through CDC-funded perinatal hepatitis B prevention coordinators
based in state health departments. Contact information for those
coordinators is available at
http://www.cdc.gov/vaccines/vpd-vac/hepb/perinatal-contacts.htm
To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a3.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5730.pdf
To receive a FREE electronic subscription to MMWR (which
includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
Relevant resources:
"A Comprehensive Immunization Strategy to Eliminate Transmission
of Hepatitis B Virus Infection in the United States.
Recommendations of the Advisory Committee on Immunization
Practices (ACIP). Part 1: Immunization of Infants, Children and
Adolescents": http://www.cdc.gov/mmwr/PDF/rr/rr5416.pdf
"AAP Endorsed Policy Statement: A Comprehensive Immunization
Strategy to Eliminate Transmission of Hepatitis B Virus
Infection in the United States":
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/1/404
"Guidelines for Standing Orders in Labor & Delivery & Nursery
Units to Prevent Hepatitis B (HBV) Transmission to Newborns":
http://www.immunize.org/catg.d/p2130.pdf
"Hepatitis B Shots Are Recommended for All New Babies":
http://www.immunize.org/catg.d/p4110.pdf
"States Report Hundreds of Medical Errors in Perinatal Hepatitis
B Prevention": http://www.immunize.org/catg.d/p2062.pdf
"Unprotected Babies: Two More Infants Chronically Infected with
Hepatitis B Virus . . . the Medical Errors Continue":
http://www.immunize.org/catg.d/p2127.pdf
"Medical Errors Put Infants at Risk for Chronic Hepatitis B
Virus Infection--Six Case Reports":
http://www.immunize.org/catg.d/p2128.pdf
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3. |
CDC corrects an "Ask the Experts" answer that appeared in recent issues of
Needle Tips, Vaccinate Adults, and Vaccinate Women
IAC was informed by a careful reader that an
incorrect answer
was published in "Ask the Experts" in Needle Tips (March 2008,
page 22), Vaccinate Adults (March 2008, page 10), and Vaccinate
Women (June 2008, page 10). The question concerned pre-exposure
prophylaxis for travelers to protect them from hepatitis A virus
infection. The question and its corrected answer follow.
QUESTION:
What are the new recommendations for vaccination of travelers to
protect them from hepatitis A virus (HAV) infection?
ANSWER:
The new recommendations
(www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm)
state that (1) hepatitis A vaccine is recommended for healthy
susceptible persons ages 1 through 40 years who travel to or
work in regions where hepatitis A is endemic and (2) hepatitis A
vaccine should be given as soon as travel is considered, but it
can be given any time prior to departure. For optimal
protection, persons older than age 40 years, immunocompromised
persons, and persons with diagnosed chronic liver disease or
other chronic medical conditions, if departure will take place
within two weeks, should also receive IG simultaneously with the
first dose of hepatitis A vaccine but at a different anatomic
injection site. For travelers younger than age 1 year, IG alone
is recommended because hepatitis A vaccine is not licensed for
use in this age group. Hepatitis A is endemic in all regions
except the United States, Western Europe, New Zealand,
Australia, Canada, and Japan.
IAC regrets the confusion the initial Q&A may have caused
readers of Needle Tips, Vaccinate Adults, and Vaccinate Women.
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4. |
CDC issues recommendations for postexposure interventions to prevent
infection with hepatitis B virus, hepatitis C virus, or HIV virus and tetanus
in persons wounded during bombings and other mass-casualty events
On August 1, CDC published "Recommendations for
Postexposure
Interventions to Prevent Infection with Hepatitis B Virus,
Hepatitis C Virus, or Human Imunodeficiency Virus, and Tetanus
in Persons Wounded During Bombings and Other Mass-Casualty
Events--United States, 2008: Recommendations of the Centers for
Disease Control and Prevention (CDC)" in MMWR Recommendations
and Reports. The recommendations' Summary is reprinted below.
Summary
This report outlines recommendations for postexposure
interventions to prevent infection with hepatitis B virus,
hepatitis C virus, or human immunodeficiency virus, and tetanus
in persons wounded during bombings or other events resulting in
mass casualties. Persons wounded during such events or in
conjunction with the resulting emergency response might be
exposed to blood, body fluids, or tissue from other injured
persons and thus be at risk for bloodborne infections. This
report adapts existing general recommendations on the use of
immunization and postexposure prophylaxis for tetanus and for
occupational and nonoccupational exposures to bloodborne
pathogens to the specific situation of a mass-casualty event.
Decisions regarding the implementation of prophylaxis are
complex, and drawing parallels from existing guidelines is
difficult. For any prophylactic intervention to be implemented
effectively, guidance must be simple, straightforward, and
logistically undemanding. Critical review during development of
this guidance was provided by representatives of the National
Association of County and City Health Officials, the Council of
State and Territorial Epidemiologists, and representatives of
the acute injury care, trauma and emergency response medical
communities participating in CDC's Terrorism Injuries:
Information, Dissemination and Exchange (TIIDE) project. The
recommendations contained in this report represent the consensus
of U.S. federal public health officials and reflect the
experience and input of public health officials at all levels of
government and the acute injury response community. . . .
To access a ready-to-print (PDF) version of the recommendations,
go to: http://www.cdc.gov/mmwr/PDF/rr/rr5706.pdf
To access a web-text (HTML) version of the recommendations, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5706a1.htm
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5. |
CDC redesigns its viral hepatitis website
[The following is cross posted from IAC's Hep
Express electronic
newsletter, 7/31/08.]
CDC's Division of Viral Hepatitis recently redesigned its
website, accessed at http://www.cdc.gov/hepatitis
The changes are designed to make it easier for people to find
hepatitis information and resources quickly. The pages for
hepatitis A, B, and C information have separate entry portals
for members of the public and health professionals.
Take a look and be sure to bookmark this great resource.
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6. |
MMWR notifies readers that the webcast of Immunization Update 2008 is
scheduled for August 28
CDC published "Notice to Readers: Webcast:
Immunization Update
2008" in the August 1 issue of MMWR. The notice is reprinted
below in its entirety.
CDC and the Public Health Training Network will present a
webcast, Immunization Update 2008, on August 28, 2008. The 2-hour broadcast will occur during 12:00 noon-2:00 p.m. EDT.
Anticipated topics include influenza and zoster vaccines,
recently approved vaccines, and updates on vaccine supplies and
vaccine safety. Continuing education (CE) credits will be
provided. Additional information about the program is available
at http://www2a.cdc.gov/phtn/immupdate2008/default.asp
No registration is necessary to access the webcast via an
Internet connection. The link to the webcast is available at
http://www2a.cdc.gov/phtn/webcast/immupdate2008/default.asp
The webcast will remain accessible through an Internet
connection until September 29, 2008. The program will become
available as a self-study DVD and Internet-based program in
October 2008.
To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a5.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5730.pdf
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7. |
July 31 issue of IAC's Hep Express electronic newsletter now available online
The July 31 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 preventing, screening, and treating viral hepatitis.
IAC Express has already covered some of the information
presented in the July 31 Hep Express; titles of articles we have
not yet covered follow.
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Presentations from Hepatitis B Foundation's (HBF) patient
conference now available online
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HBF posts Spring 2008 issue of "B Informed" newsletter on its
website
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HBF adds more Expert Speaker presentations to its website
To access the July 31 issue, go to:
http://www.hepprograms.org/hepexpress/issue73.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
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8. |
Author reviews and revises two print materials on childhood hepatitis B virus
infection
Sarah Jane Schwarzenberg, MD, recently reviewed
two of her print
materials on childhood hepatitis B virus infection and revised
one of them. Both print materials are posted on IAC's website.
Dr. Schwarzenberg is a pediatric gastroenterologist and an
associate professor in the Department of Pediatrics, Division of
Gastroenterology and Nutrition, University of Minnesota. She is
also a member of the Immunization Action Coalition Advisory
Board.
"Brief Introduction to Hepatitis B for Parents of Adopted
Children" was reviewed and found to be still accurate. To access
it, go to: http://www.immunize.org/catg.d/p4150.pdf
Minor changes were made to "What the Physician Can Do to Help
the Child with Chronic Hepatitis B Virus Infection." To access
it, go to: http://www.immunize.org/catg.d/p2170.pdf
IAC's Print Materials web section has more than 175 FREE, ready-to-print English-language materials for healthcare professionals
and the public--as well as many in translation. To access all of IAC's print materials, go to:
http://www.immunize.org/printmaterials
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9. |
Interim VIS for HPV vaccine now available in Vietnamese
The interim VIS for human papillomavirus (HPV)
vaccine (dated
2/2/07) is now available in Vietnamese. IAC gratefully
acknowledges the Minnesota Department of Health for the
translation.
To access the Vietnamese version of the interim VIS for HPV
vaccine, go to: http://www.immunize.org/vis/vn_hpv.pdf
To access the English version of the interim VIS for HPV
vaccine, go to:
http://www.immunize.org/vis/vis-hpv-gardasil.pdf
NOTE: The interim VIS for HPV vaccine comes in additional
languages, including Spanish. To access them, go to:
http://www.immunize.org/vis/vis_hpv_gardasil.asp Click on the link to
the pertinent language.
For information about the use of VISs, and for VISs in more than
35 languages, visit IAC's VIS web section at
http://www.immunize.org/vis
IAC's Print Materials web section has more than 175 FREE, ready-to-print English-language materials for healthcare professionals
and the public--as well as many in translation. To access all of IAC's print materials, go to:
http://www.immunize.org/printmaterials
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10. |
FDA website posts information on storing and using temperature-sensitive
biological products after a power failure or flood
On July 31, the FDA website posted the three-page
document
"Impact of Severe Weather Conditions on Biological Products." It
provides interested persons with information concerning the
storage and use of temperature-sensitive biological products
that have been involved in a temporary electrical power failure
or flood conditions. The document includes information on
vaccines that require refrigeration or frozen storage.
To access the document, go to:
http://www.fda.gov/cber/weatherimpact.htm
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11. |
MMWR notifies readers that the online application deadline for the Epidemic
Intelligence Service is September 15
CDC published "Notice to Readers: Epidemic
Intelligence Service
Online-Only Application Deadline--September 15, 2008" in the
August 1 issue of MMWR. The notice is reprinted below in its
entirety.
Applications for CDC's July 2009-June 2011 Epidemic Intelligence
Service (EIS) program are now being accepted. This year,
applications are only being accepted via the new EIS online
application system.
EIS is a 2-year, postgraduate program of service and on-the-job
training for health professionals interested in the practice of
epidemiology. Each year, EIS provides approximately 90 persons,
selected from applicants around the world, opportunities to gain
hands-on experience in epidemiology at CDC or at state or local
health departments. EIS officers, often called CDC's "disease
detectives," have gone on to occupy leadership positions at CDC
and other public health agencies nationally and internationally.
However, the experience also is useful for health professionals
who want to gain a population health perspective.
Persons with a strong interest in applied epidemiology who meet
at least one of the following qualifications may apply to EIS:
- physicians with >=1 year of clinical training;
- persons with a PhD, DrPH, or other doctoral degree in
epidemiology, biostatistics, social or behavioral sciences,natural sciences, or nutrition sciences;
- dentists, physician assistants, and nurses with an MPH or
equivalent degree;
- or veterinarians with an MPH or equivalent degree or relevant
public health experience.
Additional information regarding the EIS program and the new
online application system is available at
http://www.cdc.gov/eis/applyeis/toapply.htm; by telephone
([404]) 498-6110); or by email (eisepo@cdc.gov).
To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5730a4.htm
To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5730.pdf
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