IAC Express 2009
Issue number 773: January 5, 2009
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Contents of this Issue
Select a title to jump to the article.
  1. New: CDC, AAP, and AAFP release the 2009 Recommended Immunization Schedule for Persons Ages 0 Through 18 Years
  2. Dr. Paul A. Offit's Pediatrics article discusses the problems inherent in Dr. Robert W. Sears' alternative vaccine schedule
  3. National Quality Forum includes the hepatitis B birth dose among its consensus standards for improving health care for mothers and newborns
  4. FDA approves changes in the schedule for administering anthrax vaccine and in the route of administration
  5. Simplified version of IAC's parent-education piece "After the Shots" now available in Spanish and six additional languages
  6. IAC's video of the week celebrates Cervical Health Awareness Month and encourages HPV vaccination
  7. Important: Be sure to give influenza vaccine throughout the influenza season--through spring 2009
 
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 773: January 5, 2009
1.  New: CDC, AAP, and AAFP release the 2009 Recommended Immunization Schedule for Persons Ages 0 Through 18 Years

CDC, AAP, and AAFP have endorsed and released the "Recommended Immunization Schedules for Persons Aged 0 Through 18 Years--United States, 2009." On January 2, CDC published the schedule as an MMWR QuickGuide; it is reprinted below in its entirety, excluding references, two figures, and a table.

In addition, the CDC website posted black and white and color versions of the schedule's figures, table, and references in PDF format. CDC also recapped the MMWR QuickGuide information in a December 31 CDC press release titled "Health Groups Release 2009 Immunization Schedules: Updated schedule includes recommendation that all children six months through age 18 get annual influenza vaccination." Links to the CDC materials are given at the end of this IAC Express article.

Also, AAP published articles about the schedule in the January issues of Pediatrics and the AAP News and issued a related press release. AAFP published an article about the schedule in the January issue of American Family Physician. Links to the AAP and AAFP materials are given at the end of this IAC Express article.


The Advisory Committee on Immunization Practices (ACIP) annually publishes immunization schedules that summarize recommendations for currently licensed vaccines for children aged 18 years and younger. Changes to the previous schedule are as follows:
  • Recommendations for rotavirus vaccines include changes for the maximum age for the first dose (14 weeks 6 days) and the maximum age for any dose (15 months 0 days). [IAC Express editor's note: the maximum age as stated in the MMWR article quoted here is not correct--it is actually 8 months 0 days. MMWR plans to publish a correction in the future. The information included in the actual PDF-format schedule is correct.] The rotavirus footnote also indicates that if RV1 (Rotarix) is administered at ages 2 and 4 months, a dose at 6 months is not indicated.
     
  • Routine annual influenza vaccination is recommended for all children aged 6 months through 18 years. Children aged younger than 9 years who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous season but only received 1 dose should receive 2 doses of influenza vaccine at least 4 weeks apart. Healthy nonpregnant persons aged 2 through 49 years may receive either live attenuated influenza vaccine or inactivated influenza vaccine.
     
  • The minimum interval between tetanus and diphtheria toxoids (Td) and tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) for persons aged 10 through 18 years is addressed. An interval less than 5 years may be used if pertussis immunity is needed.
     
  • Information about the use of Haemophilus influenzae type b (Hib) conjugate vaccine among persons aged 5 years and older at increased risk for invasive Hib disease has been added. Use of Hib vaccine for these persons is not contraindicated.
     
  • Catch-up vaccination with human papillomavirus (HPV) vaccine is clarified. Routine dosing intervals should be used for series catch-up (i.e., the second and third doses should be administered 2 and 6 months after the first dose). The third dose should be given at least 24 weeks after the first dose.
     
  • Abbreviations for rotavirus, pneumococcal polysaccharide, and meningococcal polysaccharide vaccines have been changed.

The National Childhood Vaccine Injury Act requires that healthcare providers provide parents or patients with copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedules. Additional information is available from state health departments and from CDC at http://www.cdc.gov/vaccines/pubs/vis

Detailed recommendations for using vaccines are available from ACIP statements (available at http://www.cdc.gov/vaccines/pubs/acip-list.htm), and the 2006 Red Book. Guidance regarding the Vaccine Adverse Event Reporting System form is available at http://www.vaers.hhs.gov or by telephone, (800) 822-7967.


To access a web-text (HTML) version of the QuickGuide, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5751a5.htm

To access a ready-to-print (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5751.pdf

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

CDC MATERIALS:
To access the December 31 press release, go to:
http://www.cdc.gov/media/pressrel/2008/r081231b.htm

To access the child, adolescent, and catch-up immunization schedules in ready-to-print (PDF) format, go to: http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm#printable [IAC Express editor's note: the rotavirus information is correct in these schedules.]

AAP MATERIALS:
In the January 2009 issue of Pediatrics, AAP published "Recommended Childhood and Adolescent Immunization Schedules--United States, 2009" as a policy statement from its Committee on Infectious Diseases.

To access the policy statement, go to:
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;123/1/189.pdf

In the January 2009 issue of AAP News, AAP published "Highlights of 2009 Immunization Schedules"; the highlights are available to subscribers only.

To access the highlights, go to: http://aapnews.aappublications.org/current.shtml and scroll down to "Highlights of 2009 Immunization Schedules."

On December 29, 2008, AAP issued a press release, "AAP Releases 2009 Childhood and Adolescent Immunization Schedule."

To access the press release, go to:
http://www.aap.org/advocacy/releases/jan09immunization.htm

AAFP MATERIALS:
In the January 2009 issue of American Family Physician, AAFP published "ACIP Releases 2009 Child and Adolescent Immunization Schedule" as a Practice Guidelines. It is available to subscribers only.

To access the article, go to: http://www.aafp.org/online/en/home/publications/journals/afp.html and scroll down to the box titled 2009 Immunization Schedules.

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2 Dr. Paul A. Offit's Pediatrics article discusses the problems inherent in Dr. Robert W. Sears' alternative vaccine schedule

"The Problem with Dr. Bob's Alternative Vaccine Schedule," an article written by Paul A. Offit, MD, and Charlotte A. Moser, BS, appears in the January issue of Pediatrics, an AAP journal. The article discusses misinformation published in The Vaccine Book: Making the Right Decision for Your Child, a book written by Robert W. Sears, MD. The Pediatrics article abstract is reprinted below; a link to the full text of the article is given at the end of this IAC Express article.

Dr. Offit is the chief of Infectious Diseases and the director of the Vaccine Education Center at the Children's Hospital of Philadelphia, as well as the Maurice R. Hilleman Professor of Vaccinology and professor of pediatrics at the University of Pennsylvania School of Medicine. Ms. Moser is Dr. Offit's colleague at the Vaccine Education Center.


Article abstract
In October 2007, Dr Robert Sears, in response to growing parental concerns about the safety of vaccines, published The Vaccine Book: Making the Right Decision for Your Child. Sears' book is enormously popular, having sold >40000 copies. At the back of the book, Sears includes "Dr Bob's Alternative Vaccine Schedule," a formula by which parents can delay, withhold, separate, or space out vaccines. Pediatricians now confront many parents who insist that their children receive vaccines according to Sears' schedule, rather than that recommended by the American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians. This article examines the reasons for the popularity of Sears' book, deconstructs the logic and rationale behind its recommendations, and describes how Sears' misrepresentation of vaccine science misinforms parents trying to make the right decisions for their children.

To access the full text of the Pediatrics article, go to:
http://pediatrics.aappublications.org/cgi/reprint/123/1/e164

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3 National Quality Forum includes the hepatitis B birth dose among its consensus standards for improving health care for mothers and newborns

On October 27, 2008, the National Quality Forum (NQF) issued a press release announcing that it has endorsed 17 standards to measure and consequently improve the care received by mothers and babies during the third trimester of pregnancy through hospital discharge. NQF is a not-for-profit membership organization created to develop and implement a national standard for healthcare quality measurement and reporting.

Among the 17 endorsed standards are two that relate to hepatitis B vaccination at birth and one that relates to delivery of other vaccines to newborns hospitalized for more than 60 days after birth. The two hepatitis B standards are (1) administration of hepatitis B vaccine to all newborns prior to hospital discharge and (2) administration of hepatitis B vaccine and hepatitis immune globulin within 12 hours of birth to newborns of mothers with chronic hepatitis B virus infection. The immunization standard for hospitalized newborns calls for vaccination with DTaP, hepatitis B, IPV, Hib, and PCV vaccines according to current AAP guidelines.

To access the NQF press release, go to:
http://www.qualityforum.org/news/releases/102708-endorsed-measures-pc.asp

To access additional information on the 17 consensus standards, go to:
http://www.qualityforum.org/pdf/projects/perinatal/tbAppA-Specs-%2010-20-08.pdf

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4 FDA approves changes in the schedule for administering anthrax vaccine and in the route of administration

On December 11, FDA approved a supplement to the biologics application for anthrax vaccine adsorbed (BioThrax, manufactured by Emergent BioSolutions). The vaccine administration schedule is now 0 and 4 weeks and 6, 12, and 18 months. Previously, the schedule was 0, 2, and 4 weeks and 6, 12, and 18 months. The newly approved administration route is intramuscular; previously, it was subcutaneous.

To access the approval letter, go to:
http://www.fda.gov/Cber/approvltr/biothrax121108L.htm

To access the package insert, go to:
http://www.fda.gov/Cber/label/biothraxLB.pdf

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5 Simplified version of IAC's parent-education piece "After the Shots" now available in Spanish and six additional languages

The one-page, simplified version of IAC's popular parent-education piece "After the Shots. . . What to do if your child has discomfort" is now available in Spanish, Arabic, Chinese, French, Korean, Russian, and Vietnamese. The simplified version employs basic vocabulary and omits dosing information for pain- and fever-reducing medication.

To access the Spanish version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-01.pdf

To access the Arabic version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-20.pdf

To access the Chinese version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-08.pdf

To access the French version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-10.pdf

To access the Korean version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-09.pdf

To access the Russian version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-07.pdf

To access the Vietnamese version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014-05.pdf

To access the English version of the simplified piece, go to:
http://www.immunize.org/catg.d/p4014.pdf

IAC's Print Materials web section offers healthcare professionals and the public approximately 250 FREE English-language materials (many also available in translation), which we encourage website users to print out, copy, and distribute widely. To access all of IAC's free print materials, go to:
http://www.immunize.org/printmaterials

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6 IAC's video of the week celebrates Cervical Health Awareness Month and encourages HPV vaccination

IAC encourages IAC Express readers to watch a two-minute video of Heather Burcham urging young women to get the human papillomavirus vaccine (HPV). A 31-year-old woman from Austin, TX, Ms. Burcham suffered from cervical cancer and became a national spokesperson and advocate for HPV vaccination. The video was recorded two months before her death.

The video will be available on the home page of IAC's website through January 11. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week, which you'll find toward the top of the page.

Remember to bookmark IAC's home page to view a new video every Monday. While you're at our home page, we encourage you to browse around--you're sure to find resources and information that will enhance your practice's immunization delivery.

To view IAC's video collection, go to:
http://www.vaccineinformation.org/video

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7 Important: Be sure to give influenza vaccine throughout the influenza season--through spring 2009

Influenza vaccine for the 2008-09 influenza season is widely available, and the supply is robust. If you run out of vaccine in your work setting, please place another order. Influenza vaccination efforts should continue into the spring months of 2009.

For abundant information about influenza vaccination, visit the following two websites often. They 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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About IZ Express

IZ Express is supported in part by Grant No. NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of Immunize.org and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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