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IAC Express 2009 |
| Issue number 802: June 1, 2009 |
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Contents
of this Issue
Select a title to jump to the article. |
- Study
published in Pediatrics indicates children of
parents who refuse pertussis vaccination are at high risk
for the disease
- CDC continually posts new and updated information related
to H1N1 influenza
- Three measles cases confirmed in unvaccinated children in
Bucks County, PA
- IAC's Video of the Week features gripping case summaries
and images of children with vaccine-preventable diseases
- MMWR notifies readers that "Immunization Update 2009"
satellite broadcast and webcast is scheduled for July 30
- AAP's "Sound Advice" audio interviews are available to
answer parents' questions about vaccination
- MMWR publishes report on large-scale human exposures to a
rabid bat in Montana in 2008
- IAC's laminated versions of the 2009 child/teen and adult
immunization schedules offer significant advantages over
paper versions. Place your order today and use them
throughout 2009!
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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 802: June 1, 2009 |
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1. |
Study published in Pediatrics indicates children of
parents who refuse pertussis vaccination are at high risk
for the disease
The June 2009 issue of the journal Pediatrics
includes an
article titled "Parental Refusal of Pertussis Vaccination Is
Associated with an Increased Risk of Pertussis Infection in
Children." It was written by Jason M. Glanz, PhD; David L.
McClure, PhD; David J. Magid, MD, et al. The abstract is
reprinted below.
OBJECTIVE. The objective of this study was to determine if
children who contracted pertussis infection were more likely
to have parents who refused pertussis vaccinations than a
similar group of children who did not develop pertussis
infection.
METHODS. We conducted a case-control study of children
enrolled in the Kaiser Permanente of Colorado health plan
between 1996 and 2007. Each pertussis case was matched to 4
randomly selected controls. Pertussis case status and
vaccination status were ascertained by medical chart review.
RESULTS. We identified 156 laboratory-confirmed pertussis
cases and 595 matched controls. There were 18 (12%)
pertussis vaccine refusers among the cases and 3 (0.5%)
pertussis vaccine refusers among the controls. Children of
parents who refused pertussis immunizations were at an
increased risk for pertussis compared with children of
parents who accepted vaccinations. In a secondary case-control analysis of children continuously enrolled in Kaiser
Permanente of Colorado from 2 to 20 months of age, vaccine
refusal was associated with a similarly increased risk of
pertussis. In the entire Kaiser Permanente of Colorado
pediatric population, 11% of all pertussis cases were
attributed to parental vaccine refusal.
CONCLUSIONS. Children of parents who refuse pertussis
immunizations are at high risk for pertussis infection
relative to vaccinated children. Herd immunity does not seem
to completely protect unvaccinated children from pertussis.
These findings stress the need to further understand why
parents refuse immunizations and to develop strategies for
conveying the risks and benefits of immunizations to parents
more effectively.
To access the abstract, go to:
http://pediatrics.aappublications.org/cgi/content/abstract/123/6/1446
The text of the complete article requires AAP membership, a
subscription to Pediatrics, or the purchase of short-term
access to the article or the June 2009 issue of Pediatrics.
You can also request the article from a medical library.
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2. |
CDC continually posts new and updated information related
to H1N1 influenza
CDC recently posted new or updated information to
four sub-sections of its H1N1 Flu web section. Following are the
titles and URLs of documents that have been posted since the
May 26 IAC Express.
FROM THE NOVEL H1N1 FLU (SWINE FLU) PUBLIC SERVICE
ANNOUNCEMENTS (PSAs) SUB-SECTION
The "H1N1 Consumer Fraud PSA" is a 30-second audio that
cautions consumers to be wary of ads they might receive
through the Internet, email, and other sources that promote
products that claim to prevent, cure, treat, or diagnose
novel H1N1 influenza. The audio is available in English and
Spanish for downloading to M3P players; the script is
available in both languages.
http://www.cdc.gov/h1n1flu/psa/consumerfraud.htm
FROM THE "H1N1 FLU (SWINE FLU): STATE HEALTH DEPARTMENT
WEBSITES" SUB-SECTION:
H1N1 Flu information posted on the websites of 50 state
health departments and the Washington, DC, health department
http://www.cdc.gov/h1n1flu/states.htm
FROM THE "H1N1 FLU (SWINE FLU): GENERAL INFORMATION" SUB-SECTION:
Questions & Answers: H1N1 Flu (Swine Flu) and You
http://www.cdc.gov/h1n1flu/qa.htm
FROM THE "H1N1 FLU CLINICAL AND PUBLIC HEALTH GUIDANCE" SUB-SECTION:
Interim Guidance for Correctional and Detention Facilities
on Novel Influenza A (H1N1) Virus
http://www.cdc.gov/h1n1flu/guidance/correctional_facilities.htm
Interim Recommendations for Facemask and Respirator Use to
Reduce Novel Influenza A (H1N1) Virus Transmission
http://www.cdc.gov/h1n1flu/masks.htm
Update on School (K-12) and Child Care Programs: Interim CDC
Guidance in Response to Human Infections with the Novel
Influenza A (H1N1) Virus
http://www.cdc.gov/h1n1flu/K12_dismissal.htm
The home page of CDC's H1N1 Flu web section can be accessed
from
http://www.cdc.gov/h1n1flu
IAC has gathered important information related to H1N1
influenza in a new web section to make it easier to keep up
to date with developments. To access this resource, go to:
http://www.immunize.org/h1n1
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3. |
Three measles cases confirmed in unvaccinated children in
Bucks County, PA
On May 26, the Bucks County, PA, health
department posted a
press release on its website announcing three confirmed
measles cases. The total number of cases confirmed this year
in Pennsylvania now stands at nine. Six cases were confirmed
in the Pittsburgh area in April.
A portion of the press release about the Bucks County cases
is reprinted below.
The Bucks County Health Department advises the public that
it is closely monitoring three confirmed measles cases in
the county--all of which are under control and limited to
unvaccinated individuals who were in close contact with each
other.
"There is no risk of transmission to others at this point
from these cases, which involve three individuals who were
unvaccinated," noted Bucks County Health Director Dr. David
Damsker. "The first case involves a school-age child. The
other two are directly related to the first case and all
three individuals have been isolated from their schoolmates
and the general population."
Dr. Damsker reiterated the importance of being vaccinated to
provide the best protection against the measles and other
communicable diseases. "There is no substitute for
vaccination, which has been proven to be safe and
effective," he added. . . .
To access the press release, go to:
http://www.buckscounty.org/news/2009/2009-05-26-MeaslesConfirmation.aspx
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4. |
IAC's Video of the Week features gripping case summaries
and images of children with vaccine-preventable diseases
IAC encourages IAC Express readers to watch an
11-minute
video developed by the Colorado Children's Immunization
Coalition (CCIC). Available on YouTube, the video includes
gripping case summaries of and images of Colorado children
with VPDs, as well as information about immunization
registries and the work that CCIC does in improving
immunization coverage in Colorado communities.
The video will be available on the home page of IAC's
website through June 7. 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.
Videos previously featured as IAC's Video of the Week are
archived by month on IAC's website. To view any of them, go
to: http://www.immunize.org/votw/apr09.asp Find the bar at
the top of the page titled Video of the Week Archive 2008-2009, and click on one or more months.
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5. |
MMWR notifies readers that "Immunization Update 2009"
satellite broadcast and webcast is scheduled for July 30
CDC published "Notice to Readers: Webcast:
Immunization
Update 2009" in the May 29 issue of MMWR. The notice is
reprinted below in its entirety.
CDC will present a satellite broadcast and webcast,
Immunization Update 2009, on July 30, 2009. The 2.5-hour
broadcast will occur live during 9:00 a.m.-11:30 a.m. (EDT)
and will be rebroadcast that day during 12:00 noon-2:30 p.m.
Anticipated topics include the novel influenza A (H1N1)
virus, seasonal influenza, rotavirus, vaccine safety, and
vaccine supply. "Alternative" vaccination schedules and
other emerging vaccine issues also will be discussed. Both
broadcasts will feature a live question-and-answer session
in which participants can interact with course instructors
via toll-free telephone lines. Additional information about
the program is available at
http://www2a.cdc.gov/phtn/immupdate2009/default.asp
No registration is necessary to access the webcast.
Continuing education credit for this activity is pending.
The program will become available as a self-study DVD and
Internet-based program in October 2009.
To access a web-text (HTML) version of the notice, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5820a4.htm
To access a ready-to-print (PDF) version of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5820.pdf
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6. |
AAP's "Sound Advice" audio interviews are available to
answer parents' questions about vaccination
[The following is cross posted from the AAP
Immunization
Initiatives Newsletter, May 2009.]
Sound Advice Audio Interviews
To answer the questions that many parents have about their
children's vaccines, the American Academy of Pediatrics
offers a collection of interviews with pediatricians,
researchers, and other parents. Access the interviews at
http://www.cispimmunize.org/fam/soundadvice.html
To access the May issue of the AAP Immunization Initiatives
Newsletter, go to:
http://www.cispimmunize.org/resour/pdf/May2009_enews.pdf
To be added to the newsletter listserv, email
cispimmunize@aap.org with "Newsletter" in the subject line
and your name and email address in the body of the email.
To access archived issues, go to:
http://www.cispimmunize.org/resour/rsc_main.html
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7. |
MMWR publishes report on large-scale human exposures to a
rabid bat in Montana in 2008
CDC published "Human Exposures to a Rabid
Bat--Montana,
2008" in the May 29 issue of MMWR. Portions of the article
are reprinted below.
On September 29, 2008, the Ravalli County Public Health
Department (RCPHD) notified the Montana Department of Public
Health and Human Services (MDPHHS) of a large-scale human
exposure to a dead bat at an elementary school. On October
1, the bat was confirmed to be rabid, and on October 4,
MDPHHS requested assistance from CDC in evaluating persons
for rabies exposure. Of 107 persons assessed, only one
person (1%) was recommended for rabies postexposure
prophylaxis (PEP) in accordance with guidance from the
Advisory Committee on Immunization Practices (ACIP);
however, 74 persons (68%) ultimately pursued rabies PEP.
This report describes the incident and public health
response, and highlights the importance of unified risk
communication. After a potential large-scale exposure to
rabies virus, guidance from clinicians should be consistent
with ACIP recommendations to ensure appropriate use of
rabies PEP.
Incident Description
On September 28, a parent of two students at a Ravalli
County elementary school found a dead bat carried into the
house by the family cat. The bat carcass was placed in a jar
and stored overnight. On September 29, one parent
accompanied the children to school with the bat, and before
leaving school premises, removed the carcass from the jar
and presented it to eight different classrooms (one
kindergarten, four 5th-grade, and three 4th-grade
classrooms). Students and teachers in at least five
classrooms touched the bat, along with a few other staff
members of the school.
Later that morning, the school nurse notified RCPHD after
learning of the presentation. RCPHD subsequently advised the
parent to submit the bat for rabies diagnosis. That
afternoon, the parent took the bat carcass to an off-campus
soccer practice attended by students from the school. Some
of these children touched the bat. On September 30, the bat
was shipped to the Montana Veterinary Diagnostic Laboratory
(MVDL). On October 1, MVDL detected the presence of rabies
viral antigen in the animal's brain via direct fluorescent
antibody testing. On October 16, CDC identified the
implicated virus variant as one associated with the silver-haired bat (Lasionycteris noctivagans).
On September 30, while awaiting the results of the
laboratory testing, school officials sent letters home with
students enrolled in the five classrooms (kindergarten and
5th grade) where the teacher observed students touching the
bat. The letter described concern for potential exposure to
the rabies virus. School officials did not send letters home
to students enrolled in the three 4th-grade classrooms
because teachers did not observe any of these students
touching the bat. On the evening of October 1, school
officials telephoned households of students in the
kindergarten and 5th-grade classes with news of the positive
laboratory findings; voice-mail messages were left if no one
answered. The cat that had discovered the bat received a
rabies booster shot after a veterinarian confirmed its
current rabies vaccination status. The cat was observed in
the owner's home for 45 days and was reported to be healthy
at the time of this report. . . .
Editorial Note
Large-scale human contact with rabid animals requires
mobilization of substantial resources and involvement of
public health officials, as demonstrated by this incident, a
similar occurrence in New Hampshire during 1994, and a
multistate incident in 2007. These incidents typically
generate high public anxiety, which can lead to unnecessary
rabies PEP. This report differs from accounts of previous
large-scale human rabies exposures because it describes the
compliance with ACIP recommendations by persons who were
evaluated and counseled by public health officials.
During 2007-2009, the human rabies vaccine supply was
limited because of temporary suspension of production by one
manufacturer. To acquire rabies vaccine during that time,
clinicians were required to first consult with state or
local public health officials. MDPHHS requested CDC
assistance because of the anticipated challenges posed by
assessing and counseling so many persons in this incident,
especially during a time of limited vaccine supply.
Approximately one third of rabies large-scale exposures
occur in school settings, which also are ideal sites for
educational outreach to promote safe animal practices. Such
outreach should include messages that warn against contact
with wildlife (both dead and alive) and instructions on what
to do if an animal is found on school or home premises.
School policies that prohibit bats and other common rabies
reservoirs in classrooms are recommended to lessen exposure
risks. All animals suspected of being infected with the
rabies virus should be handled carefully and brought
promptly to public health officials for testing.
Risk communication is an integral component of a public
health response after potential large-scale exposures,
including those involving potential exposure to the rabies
virus. Many of the persons who pursued PEP in this incident
appear to have acted upon advice from community physicians
in preference to information provided by public health
officials. Clinicians can play an important role in ensuring
that only persons with exposure that meet ACIP criteria
receive PEP. Coordination among the medical and public
health officials involved in a response to a potential
large-scale rabies exposure is critical to ensuring the
delivery of a unified message to the public regarding the
appropriateness of PEP. Timely dissemination of ACIP
exposure criteria to local clinicians via the Health Alert
Network (HAN) or other communication tools might help ensure
that exposed persons receive advice consistent with
recommended public health practice.
To access a web-text (HTML) version of the complete article,
go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5820a1.htm
To access a ready-to-print (PDF) version of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5820.pdf
To receive a FREE electronic subscription to MMWR (which
includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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8. |
IAC's laminated versions of the 2009 child/teen and adult
immunization schedules offer significant advantages over
paper versions. Place your order today and use them
throughout 2009!
IAC's 2009 laminated immunization schedules are a
must for
every immunization setting: from conventional health clinics
and private practices to walk-in shot clinics in workplaces,
pharmacies, schools, and other sites. IAC offers the
laminated schedules for two age groups. The child/teen
immunization schedule is for people ages 0 through 18 years;
the adult schedule is for those older than 18. Though both
are adapted from the immunization schedules that were posted
on the CDC website in January, the laminated schedules offer
these advantages over downloadable paper versions:
(1) Coated in thick plastic, the laminated schedules are
washable and will hold up to a year's worth of use as
teaching tools that providers in any immunization setting
can use to give patients and parents authoritative
information about the vaccines recommended for various age
groups. You can also use them as a handy reference to
consult at a moment's notice.
(2) For the second year in a row, IAC has added a
significant feature to the two laminated schedules. Each
includes a guide to contraindications and precautions for
the pertinent age group (i.e., the child/teen schedule has a
guide to contraindications and precautions for child/teen
vaccines, and the adult schedule has a guide for adult
vaccines). Healthcare professionals will find these guides
extremely valuable in making an on-the-spot determination
about vaccinating any patient they see in any immunization
setting.
The durable laminated schedules come complete with essential
footnotes and are printed in color for easy reading. Each
schedule has six pages (i.e., three double-sided pages), and
when folded, measures 8.5" x 11".
For specific information about the child/teen schedule, to
view images of it, or to order online or download an order
form, visit http://www.immunize.org/shop/schedule_child.asp
For specific information about the adult schedule, to view
images of it, or to order online or download an order form,
visit http://www.immunize.org/shop/schedule_adult.asp
Prices start at $10 each for 1-4 copies and drop to $6.50
each for 5-19 copies. Discount pricing is available for 20
or more copies. For quotes on customizing or placing orders
in excess of 999 schedules, call (651) 647-9009 or email
admininfo@immunize.org
To learn about other essential immunization resources
available for purchase from IAC, go to:
http://www.immunize.org/shop
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