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IAC Express 2009 |
| Issue number 776: January 26, 2009 |
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Please click here to subscribe to IAC Express
as well as other FREE IAC periodicals. |
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Contents
of this Issue
Select a title to jump to the article. |
- MMWR
Early Release reports on five cases of Hib disease in Minnesota during
2008, including one death
- New Q&A
newsletter for parents lays out the evidence showing that vaccines do not
cause autism
- Richard
E. Besser, MD, appointed acting CDC director and acting ATSDR
administrator
- IAC's
Video of the Week stresses the importance of pertussis vaccination for new
parents and others with infant contact
- IAC's
popular parent-education chart "Immunizations for Babies" now available in
Spanish and six other languages
-
Spanish-language version of the 2009 Recommended Adult Immunization
Schedule now on CDC's website
- IAC
reviews, updates, and reorganizes its hepatitis B "Ask the Experts" web
section
- January
issue of CDC's Immunization Works electronic newsletter recently released
-
Important: Be sure to give influenza vaccine throughout the influenza
season--through spring 2009
- February
23 is the nomination deadline for the 2009 Natalie J. Smith Award
-
Bangladesh announces plan to vaccinate 4 million children annually with
5-in-1 combination vaccine
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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 776: January 26, 2009 |
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1. |
MMWR Early Release reports on five cases of Hib disease in Minnesota during
2008, including one death
On January 23, CDC published "Invasive
Haemophilus influenzae
type b Disease in Five Young Children--Minnesota, 2008" in an
MMWR Early Release. It is reprinted below in its entirety,
excluding references, two figures, and a table.
Also on January 23, CDC posted updated information on its web
section of resources titled "Hib: For Providers and Parents." A
link to the web section is given at the end of this IAC Express
article. CDC, in conjunction with the Minnesota Department of
Health, held a media briefing on the topic on January 23. As IAC
Express goes to press, the transcript of the media briefing has
not yet been posted on the CDC website.
In 2008, five children aged <5 years were reported to the
Minnesota Department of Health (MDH) with invasive Haemophilus
influenzae type b (Hib) disease; one died. Only one of the
children had completed the primary Hib immunization series;
three had received no doses of Hib-containing vaccine. The five
Hib cases are the largest number among children aged <5 years
reported from Minnesota since 1992. The cases occurred during a
Hib vaccine recall and continuing nationwide shortage that began
in December 2007. The recall of certain lots of the two Hib-containing vaccines manufactured by Merck & Co., Inc. (West
Point, Pennsylvania) and cessation of production of both
vaccines left only one manufacturer of Hib vaccine in the United
States (sanofi pasteur, Swiftwater, Pennsylvania). In response,
CDC recommended that healthcare providers defer the routine 12-15 month booster dose for children not at increased risk for Hib
disease. CDC also emphasized that all children should complete
the primary series with available Hib-containing vaccines.
However, Minnesota vaccination data indicate that primary Hib
series coverage was lower during 2008 than coverage with other
vaccines administered at the same ages and lower than Hib
coverage in previous years. Increases in Hib cases like the one
in Minnesota do not appear to have occurred in other states. The
increase highlights the need to ensure that all children
complete the primary Hib immunization series. Additional
investigation to better elucidate the factors that led to these
cases is being conducted by MDH and CDC.
Minnesota conducts surveillance for invasive H. influenzae
disease as part of the Active Bacterial Core surveillance system
of CDC's Emerging Infections Program. A Hib case is defined as
isolation of H. influenzae from a normally sterile site in a
resident of the state. Merck products are both Hib PRP-OMP
vaccines, for which a primary series consists of 2 doses at 2
and 4 months. Sanofi pasteur products are Hib PRP-TT vaccines,
for which a primary series consists of a 3-dose primary series
at 2, 4, and 6 months. For both Hib vaccine series, a routine
booster is recommended at age 12-15 months.
During 2008 in Minnesota, five children aged 5 months to 3 years
were reported with invasive Hib disease; one died. The patients
resided in five different counties in Minnesota and had no known
relationship to each other. Three patients had received no
vaccinations because of parent or guardian deferral or refusal.
One child was aged 5 months and had received 2 doses of Hib PRP-TT vaccine in accordance with the primary series schedule.
Another child had received 2 doses of Hib PRP-OMP vaccine, but
no booster dose, per CDC recommendations during the shortage.
Subsequent to Hib infection, this child was diagnosed with
hypogammaglobulinemia. None of the five were enrolled in group
child care. The five cases in 2008 were the most reported for 1
year from Minnesota since 1992, when 10 cases were reported.
Although the recall and cessation of production of Merck Hib-containing vaccines in December 2007 resulted in a nationwide
Hib vaccine shortage, supply of the remaining two products
manufactured by sanofi pasteur is adequate for all infants to
complete the 3-dose primary vaccine series. However, in February
2008 the Minnesota Vaccines for Children program began receiving
reports from vaccine providers regarding shortages of vaccine in
their offices. In response, MDH advised providers to ensure
completion of the primary series as recommended whenever
possible and to track and recall infants who had not completed
the primary series so that they could be vaccinated as soon as
doses were available. On January 13, MDH examined 2008
vaccination coverage data in the Minnesota Immunization
Information Connection (MIIC), Minnesota's immunization
registry. Data were reviewed for 25,699 children born between
November 1, 2007 and March 31, 2008. Among children aged 7
months, 3-dose primary Hib series coverage was 46.5%, which is
lower than the age-appropriate coverage for children who had
received pneumococcal conjugate or diphtheria and tetanus
toxoids and acellular pertussis (DTaP) vaccination. In contrast,
data from the 2007 National Immunization Survey, conducted prior
to the shortage, showed that Hib vaccination coverage among
children in Minnesota aged 19 months to 35 months was high and
did not differ from the national average, suggesting that
coverage has declined as a result of the shortage.
Editorial Note:
Before development of Hib conjugate vaccines, Hib was the most
common cause of bacterial meningitis in children aged <5 years.
Since implementation of the Hib conjugate vaccine immunization
program in the United States in the early 1990s, the incidence
of Hib disease has declined from a peak of 41 cases per 100,000
children aged <5 years in 1987 to approximately 0.11 cases per
100,000 in 2007. As with other bacterial diseases in which
acquisition of carriage is necessary for development of invasive
disease, reductions in asymptomatic carriage and transmission
are substantial contributors to the reduction in Hib disease
achieved through vaccination programs. This herd immunity
provided by high vaccination coverage provides additional
protection both for fully vaccinated and undervaccinated
persons.
Three of the five Hib cases in Minnesota occurred in children
who had not been vaccinated. One case occurred in a child who
was too young to complete the primary series, and a fifth case
occurred in a child with an immunodeficiency. Given the
prolonged booster dose deferral and reduced primary series
coverage in the state, the increase in the number of Hib cases
likely reflects increasing carriage and transmission affecting
those with suboptimal primary series vaccination coverage, or a
weakening of herd immunity. None of the children failed to
receive vaccine because of the vaccine shortage. However, MDH is
planning evaluations to describe the extent of Hib carriage in
the affected communities and understand reasons why some
children are not vaccinated. While the shortage continues,
completion of the primary series in all children is essential to
safeguard individual protection as well as to strengthen herd
immunity.
The current Hib vaccine supply in the United States is
sufficient to ensure completion of the primary series for all
children, but not yet to resume the booster dose. However,
vaccine shortages are difficult to manage. Healthcare providers
must maintain sufficient stocks on hand for every child brought
for vaccination each day. During shortages, local supply/demand
mismatches can occur, resulting in missed doses. Hib vaccine
supply problems can be further complicated because the primary
series for the recalled products consists of 2 doses, but the
primary series for the available products consists of 3 doses.
Regardless of brand or product used, full vaccination with the
primary series of Hib vaccine by age 7 months is critical to rotect children from disease. Providers who have questions
regarding Hib vaccine supply needed to complete the primary
vaccine series should contact their state health departments.
Combination products may be used for any or all doses of the Hib
primary series. Further, if combination vaccines are the only
vaccines available to providers, a combination product should be
used to complete the primary Hib series, even when this results
in receipt of additional doses of another antigen. In response
to the findings described in this report, MDH is working with
vaccination providers and other partners to resolve any local
supply problems. As the vaccine supply resolves, MDH will
expedite resumption of the booster dose in communities where Hib
cases have been reported.
Invasive Hib disease in children aged <5 years is a nationally
notifiable condition. Healthcare providers should promptly
report all suspected cases of Hib to their local health
department. CDC routinely analyzes national surveillance data
for invasive Hib disease in children aged <5 years. As of
January 13, 2009, no other increases in Hib cases in children
aged <5 years had been reported from other states or
territories. CDC is working with health departments to identify
areas of suboptimal primary Hib series coverage that might lead
to increased transmission and disease. Prompt recognition and
reporting of Hib cases is important both in understanding the
impact of the Hib vaccine shortage and in guiding
recommendations for resuming routine booster vaccination and
catch-up of undervaccinated children.
To access a ready-to-print (PDF) version of the MMWR Early
Release, go to: http://www.cdc.gov/mmwr/pdf/wk/mm58e0123.pdf
To access a web-text (HTML) version of the MMWR Early Release,
go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0123a1.htm
To receive a FREE electronic subscription to MMWR (which
includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
To access CDC's "Hib: For Providers and Parents" web section, go
to:
http://www.cdc.gov/vaccines/vpd-vac/hib/providers-parents.htm
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2. |
New Q&A newsletter for parents lays out the evidence showing that vaccines do
not cause autism
The Vaccine Education Center (VEC) of the
Children's Hospital of
Philadelphia has developed a four-page newsletter, "Q&A:
Vaccines and Autism: What you should know." It answers parents'
concerns that there is a link between vaccines and autism by
presenting scientific evidence that no connection exists between autism and the following: MMR vaccine, thimerosal, or
vaccinating babies according to the recommended immunization
schedule.
English- and Spanish-language versions are available. Healthcare
professionals can order two packs of 50 newsletters in each
language at no charge. Additional packs are available for $4
each, plus shipping.
To access the English version of the newsletter, click
here.
To access the Spanish version of the newsletter, click
here.
To order online, go to:
https://www.chop.edu/vaccine/vec/profOrder.cfm
Order by phone at (215) 590-9990, by fax at (215) 590-2025, or
by email at vaccines@email.chop.edu
For additional ordering information, go to:
http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75982
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3. |
Richard E. Besser, MD, appointed acting CDC director and acting ATSDR
administrator
On January 22, CDC posted a notice that Richard
E. Besser, MD,
has been appointed the acting director of CDC and the acting
administrator of the Agency for Toxic Substance and Disease
Registry (ATSDR). The notice is reprinted below in its entirety.
Richard Besser, MD, took the helm as acting director of the
Centers for Disease Control and Prevention and acting
administrator of the Agency for Toxic Substance and Disease
Registry on January 22, 2009.
He began his career at CDC in the Epidemic Intelligence Service
working on the epidemiology of food–borne diseases. He has
served as the epidemiology section chief in the Respiratory
Diseases Branch, acting chief of the Meningitis and Special
Pathogens Branch in the National Center for Infectious Disease,
and as the medical director of Get Smart: Know When Antibiotics
Work, CDC's national campaign to promote appropriate antibiotic
use in the community.
Doctor Besser received his bachelor of arts degree in economics
from Williams College in Williamstown, Massachusetts, and his
medical degree from the University of Pennsylvania. He completed
a residency and a chief residency in pediatrics at Johns Hopkins
University Hospital in Baltimore, Maryland. He has authored and
co–authored more than 100 presentations, abstracts, chapters,
editorials, and publications and has received many awards for
his work in public health and his volunteer service.
To access the notice, go to:
http://www.cdc.gov/about/leadership/leaders/besser.htm
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4. |
IAC's Video of the Week stresses the importance of pertussis vaccination for
new parents and others with infant contact
IAC encourages IAC Express readers to watch a
15-second video
that features actress Keri Russell raising awareness about the
importance of pertussis vaccinations for new parents and people
who come in close contact with infants. The video is a
partnership between Ms. Russell and Parents of Kids with
Infectious Diseases (PKIDs).
The video will be available on the home page of IAC's website
through February 1. 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. It may take a few
moments for the video to begin playing; please be patient!
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
To access PKIDs' pertussis web section, go to:
http://www.pkids.org/dis_pert_stsop.php
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5. |
IAC's popular parent-education chart "Immunizations for Babies" now available
in Spanish and six other languages
The most recent version of the IAC chart
"Immunizations for
Babies: A guide for parents--these are the vaccinations your
baby needs!" is now available in Spanish, Arabic, Chinese,
French, Korean, Russian, and Vietnamese. The chart shows parents
when babies should receive the pediatric vaccines routinely
recommended for them during the first 23 months of life. It also
includes basic information on the diseases the pediatric
vaccines prevent.
To access the Spanish version of "Immunizations for Babies," go
to: http://www.immunize.org/catg.d/p4010-01.pdf
To access the Arabic version of "Immunizations for Babies," go
to:
http://www.immunize.org/catg.d/p4010-20.pdf
To access the Chinese version of "Immunizations for Babies," go
to: http://www.immunize.org/catg.d/p4010-08.pdf
To access the French version of "Immunizations for Babies," go
to:
http://www.immunize.org/catg.d/p4010-10.pdf
To access the Korean version of "Immunizations for Babies," go
to:
http://www.immunize.org/catg.d/p4010-09.pdf
To access the Russian version of "Immunizations for Babies," go
to: http://www.immunize.org/catg.d/p4010-07.pdf
To access the Vietnamese version of "Immunizations for Babies,"
go to: http://www.immunize.org/catg.d/p4010-05.pdf
To access the English version of "Immunizations for Babies," go
to: http://www.immunize.org/catg.d/p4010.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. |
Spanish-language version of the 2009 Recommended Adult Immunization Schedule
now on CDC's website
On January 14, the Spanish-language version of
the "Recommended
Adult Immunization Schedule--United States, 2009" was posted to the CDC
website. To access it, click
here.
To access the English-language version of the schedule in
various formats, go to:
http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm#print
Scroll down to find the format you want.
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7. |
IAC reviews, updates, and reorganizes its hepatitis B "Ask the Experts" web
section
IAC recently reviewed, updated, and reorganized
information on
its online "Ask the Experts" web section on hepatitis B. The web
section includes information on the following: hepatitis B
disease; general hepatitis B vaccine issues; hepatitis B tests
and interpretation; pregnancy, perinatal, and infant hepatitis
B; child and teen hepatitis B vaccination; adult hepatitis B
vaccination; healthcare workers and hepatitis B; and chronic
hepatitis B virus infection.
To access the updated hepatitis B "Ask the Experts" web section,
go to: http://www.immunize.org/askexperts/experts_hepb.asp
All of IAC's "Ask the Experts" web sections are reviewed and
updated annually. The process is ongoing; IAC Express will
inform readers as sections are reviewed and revised.
To access all of IAC's "Ask the Experts" web sections, go to:
http://www.immunize.org/askexperts
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8. |
January issue of CDC's Immunization Works electronic newsletter recently
released
CDC recently released the January issue of its
monthly
newsletter Immunization Works; it will soon be posted on the
website of the National Center for Immunization and Respiratory
Diseases (NCIRD). The newsletter offers the immunization
community information about current topics. The information is
in the public domain and can be reproduced and circulated
widely.
Following are titles of articles that appear in the January
issue:
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Increase in Hib cases in Minnesota, parents urged to make sure
infants and children under five are vaccinated
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Updated immunization schedules for all ages
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PCV7 vaccine is a success: fewer hospitalizations for all-cause pneumonia among young children
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Status of Merck hepatitis B vaccine
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Status of monovalent measles, mumps, and rubella vaccines
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Interim recommendations for influenza antiviral medications
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Antiviral resistance net conference
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Seasonal flu podcasts: CDC's Flu Gallery
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Annual conference on vaccine research
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Mark your calendars for NIC
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Twins battle pertussis, become immunization
champions
Issues of Immunization Works are posted on CDC's Vaccines &
Immunizations website a few days after publication. To access
the January issue, go to:
http://www.cdc.gov/vaccines/news/newsltrs/imwrks Click on the
link titled "JAN" under the banner titled "2009 Newsletters
Available Online."
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9. |
Important: Be sure to give influenza vaccine throughout the influenza
season--through spring 2009
Influenza activity is increasing, and yearly
vaccination is the
first and most important step in protecting against influenza
and its complications. It is important to continue vaccinating
into the spring months. The supply of influenza vaccine is
robust; if you run out of vaccine in your work setting, please
place another order.
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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10. |
February 23 is the nomination deadline for the 2009 Natalie J. Smith Award
The Association of Immunization Managers (AIM) is
soliciting
nominations for the 2009 Natalie J. Smith Award for excellence
in program management. Nominations are due on February 23. The
award is given annually at the National Immunization Conference
to an outstanding program manager of one of the 64 federal
immunization grantee immunization programs.
The nomination form is available on the AIM website at
http://www.immunizationmanagers.org
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11. |
Bangladesh announces plan to vaccinate 4 million children annually with
5-in-1 combination vaccine
The GAVI Alliance recently issued a press release
announcing
that Bangladesh plans to vaccinate 4 million children annually
with a combination vaccine that protects against five diseases:
Haemophilus influenzae type b (Hib), tetanus, diphtheria,
pertussis, and hepatitis B. The GAVI Alliance is an organization
that aligns public and private resources in a global effort to
increase immunization.
The press release explains the significance of the use of the 5-in-1 vaccine as follows: "Instead of three different injections
(for DPT, hepatitis B, and Hib), children will only need one
injection at three different times during their first year of
life: at the age of 6 weeks, 10 weeks, and 14 weeks. This will
make it easier for health workers who will need less time and
less logistics to immunize all children. It will also increase
the uptake of vaccine as each child will get all five vaccines
at once."
To access the complete press release, go to:
http://www.gavialliance.org/media_centre/press_releases/Bangladesh_HIB.php
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