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IAC Express 2009 |
| Issue number 805: June 15, 2009 |
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Contents
of this Issue
Select a title to jump to the article. |
- CDC
releases new interim H1N1 influenza guidelines,
including one about use of PPSV vaccine
- WHO
raises H1N1 influenza pandemic alert to Phase 6
- IAC's Video of the Week features HHS Secretary Sebelius
discussing the U.S. response to the WHO pandemic
declaration
- Dr.
Thomas Frieden becomes 16th director of CDC
- FDA revises the label for Gardasil to include additional
information on syncope
- CDC releases guidance about protecting infants against
hepatitis B when using Pentacel during the Hib vaccine
shortage
- IAC adds
three letters to its Press Room web section
- VISs can
now be downloaded to mobile devices
- Check out "Factcines," a helpful book for vaccine-hesitant parents
- New
journal articles of interest
- CDC to sponsor net conference on H1N1 and seasonal
influenza on July 16
- Immunize
Georgia conference scheduled for September 11
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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 805: June 15, 2009 |
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1. |
CDC releases new interim H1N1 influenza guidelines,
including one about use of PPSV vaccine
CDC's web page titled H1N1 Flu Clinical and
Public Health Guidance has recently been updated with more interim guidance
documents, including one promoting current recommendations for the use of
PPSV vaccine. Information on the guidance document on the use of PPSV vaccine
follows immediately. Links to other recently posted guidance documents are
given at the end of this IAC Express article.
CDC is urging healthcare professionals to vaccinate all individuals for whom
PPSV vaccine is recommended to protect them from pneumococcal disease during
this H1N1 influenza outbreak. Of special concern are the persons with
high-risk conditions for whom PPSV vaccine is recommended, but to whom the
vaccine is rarely given. For example, in the 2007 National Health Interview
Survey, only 16% of at-risk adults ages 18-49 years had received a dose of
PPSV vaccine.
Following are three paragraphs from the document "Interim
guidance for use of 23-valent pneumococcal polysaccharide
vaccine during novel influenza A (H1N1) outbreak,"
excluding a link to a table.
. . . CDC's Advisory Committee on Immunization Practices
(ACIP) recommends a single dose of PPSV23 for all people 65
years and older and for persons 2 to 64 years of age with
certain high-risk conditions. People in these groups are at
increased risk of pneumococcal disease as well as serious
complications from influenza. A single revaccination at
least five years after initial vaccination is recommended
for people 65 years and older who were first vaccinated
before age 65 years as well as for people at highest risk,
such as those who have no spleen, and those who have HIV
infection, AIDS, or malignancy.
All people who have existing indications for PPSV23 should
continue to be vaccinated according to current ACIP
recommendations during the outbreak of novel influenza A
(H1N1). Emphasis should be placed on vaccinating people aged
less than 65 years who have established high-risk conditions
because PPSV23 coverage among this group is low and because
people in this group appear to be overrepresented among
severe cases of novel influenza A (H1N1) infection, based on
currently available data. PPSV23 coverage estimates are
available at:
http://www.cdc.gov/flu/professionals/vaccination/pdf/NHIS89_07ppvvaxtrendtab.pdf
Use of PPSV23 among people without current indications for
vaccination is not recommended at this time. This
recommendation may be revised as the epidemiology and
clinical presentation of novel influenza A (H1N1) virus
infection as well as the frequency and severity of secondary
pneumococcal infections are better understood . . .
To read the entire document, including background about
pneumococcal disease and PPSV and PCV vaccines, go to:
http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm
OTHER NEWLY RELEASED OR UPDATED GUIDANCE DOCUMENTS
Interim Guidance on Case Definitions to be Used For
Investigations of Novel Influenza A (H1N1) Cases
http://www.cdc.gov/h1n1flu/casedef.htm
Interim Guidance-HIV-Infected Adults and Adolescents:
Considerations for Clinicians Regarding Novel Influenza A
(H1N1) Virus
http://www.cdc.gov/h1n1flu/guidance_HIV.htm
Interim Novel Influenza A (H1N1) Guidance for Cruise Ships
http://www.cdc.gov/h1n1flu/guidance/cruiseships.htm
Interim Guidance for Airlines Regarding Flight Crews
Arriving from Domestic and International Areas Affected by
Swine Influenza
http://www.cdc.gov/h1n1flu/guidance/air-crew-dom-intl.htm
CDC has also posted interim guidance on many other topics.
To access the web page, which is constantly evolving, go to:
http://www.cdc.gov/H1N1flu/guidance
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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2. |
WHO raises H1N1 influenza pandemic alert to Phase 6
On June 11, WHO raised the level of influenza
pandemic alert
from Phase 5 to Phase 6. The following explanation comes
from CDC's H1N1 influenza website.
On June 11, 2009, the World Health Organization (WHO) raised
the worldwide pandemic alert level to Phase 6 in response to
the ongoing global spread of the novel influenza A (H1N1)
virus. A Phase 6 designation indicates that a global
pandemic is underway.
More than 70 countries are now reporting cases of human
infection with novel H1N1 flu. This number has been
increasing over the past few weeks, but many of the cases
reportedly had links to travel or were localized outbreaks
without community spread. The WHO designation of a pandemic
alert Phase 6 reflects the fact that there are now ongoing
community level outbreaks in multiple parts of world.
WHO's decision to raise the pandemic alert level to Phase 6
is a reflection of the spread of the virus, not the severity
of illness caused by the virus. It's uncertain at this time
how serious or severe this novel H1N1 pandemic will be in
terms of how many people infected will develop serious
complications or die from novel H1N1 infection. Experience
with this virus so far is limited and influenza is
unpredictable. However, because novel H1N1 is a new virus,
many people may have little or no immunity against it, and
illness may be more severe and widespread as a result. In
addition, currently there is no vaccine to protect against
novel H1N1 virus.
In the United States, most people who have become ill with
the newly declared pandemic virus have recovered without
requiring medical treatment, however, CDC anticipates that
there will be more cases, more hospitalizations and more
deaths associated with this pandemic in the coming days and
weeks. In addition, this virus could cause significant
illness with associated hospitalizations and deaths in the
fall and winter during the U.S. influenza season.
To read more about the current state of this pandemic, go to
the following CDC web page:
http://www.cdc.gov/h1n1flu/update.htm
To read a transcript of the statement by Margaret Chan,
Director-General of WHO, go to:
http://www.who.int/mediacentre/influenzaAH1N1_presstranscript_20090611.pdf
To access a document detailing the definitions for WHO
pandemic phases, go to:
http://www.who.int/csr/disease/influenza/GIPA3AideMemoire.pdf
To read statements by HHS Secretary Kathleen Sebelius and
DHS Secretary Janet Napolitano on the WHO decision to
declare the novel H1N1 virus outbreak a pandemic, go to:
http://www.hhs.gov/news/press/2009pres/06/20090611a.html
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3. |
IAC's Video of the Week features HHS Secretary Sebelius
discussing the U.S. response to the WHO pandemic
declaration
On June 11th, WHO raised the level of influenza
pandemic
alert from Phase 5 to Phase 6. In IAC's Video of the Week,
HHS Secretary Kathleen Sebelius discusses the U.S. response
to the WHO pandemic declaration.
This 2-minute video will be available on the home page of
IAC's website through June 21. 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.
All the videos featured as an IAC Video of the Week have
recently been archived in a new section of IAC's website. To
view any of the videos previously featured, go to:
http://www.immunize.org/votw/may09.asp
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4. |
Dr. Thomas Frieden becomes 16th director of CDC
On June 8, Dr. Thomas Frieden began his role as
CDC
director. A related CDC press release follows in its
entirety.
Thomas R. Frieden, MD, MPH, today became the 16th director
of the Centers for Disease Control and Prevention (CDC) and
administrator for the Agency for Toxic Substances and
Disease Registry (ATSDR). He was named director of CDC by
the White House and the Department of Health and Human
Services on May 15.
Dr. Frieden, 48, has been the director of the New York City
(NYC) Health Department since 2002. He is an infectious
disease expert and has led initiatives that support wellness
and prevention. He replaces Dr. Richard Besser who has been
the acting CDC director and acting ATSDR administrator since
mid January. Dr. Besser returns to his role as director of
CDC's Coordinating Office for Terrorism Preparedness and
Emergency Response.
In a May 15 White House press release, President Obama
praised Dr. Frieden for his efforts in NYC and stated: "Dr.
Frieden is an expert in preparedness and response to health
emergencies, and has been at the forefront of the fight
against heart disease, cancer, obesity, and infectious
diseases such as tuberculosis and AIDS, and in the
establishment of electronic health records. Dr. Frieden has
been a leader for health care reform, and his experiences
confronting public health challenges in our country and
abroad will be essential in his new role."
"Dr. Frieden is widely regarded as one of the premier public
health experts in the world and has a wealth of experience
in public health and science," Health and Human Services
Secretary Kathleen Sebelius said. "Dr. Frieden has a strong
track record as a public health innovator and leader, which
will serve CDC well as it continues to meet the nation's
public health needs."
"I'm excited about the opportunity to lead CDC--the depth
and breadth of knowledge at CDC is enormous," Dr. Frieden
said. "President Obama and Secretary Sebelius recognize the
importance of prevention--something CDC does well. Both are
committed to prevention as a key component of health reform,
as evidenced by the Recovery Act, and have highlighted the
need for our society to do more to prevent, manage, and
treat chronic diseases."
Dr. Frieden was a CDC Epidemic Intelligence Service Officer
(EIS) from 1990 until 1992. He worked in NYC and
investigated and fostered public awareness around
tuberculosis, including strains of the bacteria with drug
resistance. Along with then NYC Health Commissioner and
current US Food and Drug Administration Commissioner Dr.
Margaret Hamburg, Dr. Frieden led the effort that stopped
the spread of drug-resistant tuberculosis in NYC in the mid
1990s. Following that, Dr. Frieden helped the Indian
government establish a tuberculosis control program which
has now saved more than one million lives. As NYC Health
Commissioner, Dr. Frieden led efforts that reduced the
number of smokers by 350,000 and cut teen smoking in half.
NYC has also increased cancer screening, reduced AIDS deaths
by 40%, improved collection and availability of information
on community health, and implemented the nation's largest
community electronic health records project. Dr. Frieden and
this team have responded effectively to several urgent
health problems, including cases of anthrax, plague, and,
most recently novel H1N1 influenza.
Dr. Frieden earned his B.A. degree at Oberlin College in
Ohio and his M.D. degree at Columbia University College of
Physicians and Surgeons in New York. He earned his Masters
of Public Health (MPH) at Columbia University's School of
Public Health. He completed his internship and residency in
internal medicine at Columbia-Presbyterian Medical Center
and sub-specialty training in infectious diseases at Yale
University. He is married with two children.
The CDC is the nation's disease prevention and wellness
promotion agency, protecting people's health and safety,
providing credible information to enhance health decisions,
and improving health through strong partnerships. The agency
includes 18 institutes, centers and offices, with
approximately 14,000, full time, part time, and contract
employees. CDC is headquartered in Atlanta and has experts
located throughout the United States and in 54 countries.
Its fiscal year 2009 budget is $6.7 billion with an
additional $3.4 billion for the Vaccines for Children
program.
A bio of Dr. Frieden is available at
http://www.cdc.gov/about/leadership/leaders/Frieden.htm, and
a high-resolution photo is available for download at
http://www.cdc.gov/media/subtopic/images.htm
To read this press release online, go to:
http://www.cdc.gov/media/pressrel/2009/r090608.htm
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5. |
FDA revises the label for Gardasil to include additional
information on syncope
On June 9, FDA's Center for Biologics Evaluation
and
Research revised the label for Gardasil HPV vaccine to
include new information in the Warning and Precautions
section noting that individuals who faint sometimes have
tonic-clonic (jerking) movements and seizure-like activity.
Information on syncope has been in Gardasil's labeling for
both providers and patients since 2007. However, FDA and CDC
continue to receive reports of traumatic injuries in
individuals who have fainted and fallen after receiving
Gardasil. The addition of this information is intended to
remind providers that Gardasil recipients should be observed
closely for 15 minutes after vaccination.
Syncope has been reported after administration of other
adolescent and adult vaccines, and is not unique to Gardasil
or even to vaccination.
More complete information about this change can be found on
FDA's website at
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm165145.htm
CDC published information about syncope after vaccination in
the May 2, 2008, MMWR. To read this article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a2.htm
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6. |
CDC releases guidance about protecting infants against
hepatitis B when using Pentacel during the Hib vaccine
shortage
CDC has posted a new document on its Current
Vaccine
Shortages and Delays web section to provide guidance about
completing the hepatitis B vaccine series in settings where
Pentacel (DTaP-IPV/Hib) is being used for the primary Hib
series during the Hib vaccine shortage.
Providers using Pentacel vaccine to protect infants against
Hib disease need to make every effort to have an adequate
supply of monovalent hepatitis B vaccine available to ensure
all infants receive timely hepatitis B vaccination and avoid
excess doses of other antigens such as DTaP. This new
document summarizes the best strategies for vaccination when
using Pentacel, taking into account the infant's mother's
hepatitis B surface antigen status and vaccine availability.
To access "Protecting Infants against Hepatitis B Virus
Infection When Using Pentacel Vaccine during the Hib Vaccine
Shortage," go to:
http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/eo-hib-hepb-cov.pdf
The home page of CDC's Current Vaccine Shortages and Delays
web section can be accessed at
http://www.cdc.gov/vaccines/vac-gen/shortages
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7. |
IAC adds three letters to its Press Room web section
IAC recently added three letters related to
current
immunization issues to its Press Room web section.
Descriptions of and links to the letters added to the Press
Room page follow.
May 28, 2009
Letter to the Editor of the Star Tribune: IAC applauds the
editorial that recognized the parallels between the parents
of Danny Hauser and parents who fail to immunize their
children against life-threatening diseases.
http://www.immunize.org/press/pr_startribune.asp
May 26, 2009
Letter to the Honorable Secretary Kathleen Sebelius: IAC
encourages the Secretary to expand Medicare Part B benefits
to cover all vaccines recommended for adults 65 years and
older by the CDC's Advisory Committee on Immunization
Practices
http://www.immunize.org/press/pr_sebelius.asp
May 22, 2009
Letter to the United States Senate Finance Committee: IAC
calls for a reduction of cost-sharing for all vaccines
recommended for older Americans by ACIP and the
consolidation of all such vaccines under Medicare Part B
http://www.immunize.org/press/pr_senate1.asp
Other letters and information for the media can be accessed
from IAC's Press Room at http://www.immunize.org/press
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8. |
VISs
can now be downloaded to mobile devices
CDC has announced that patients and parents can
now choose
to download VISs onto a mobile device (e.g., iPhone, Palm
Pre, BlackBerry) instead of taking a paper copy.
A new web page
(http://www.cdc.gov/vaccines/pubs/vis/vis-downloads.htm) has
been created to give patients easy access to the
English-language VISs.
For more information, see the note on CDC's VIS News page at
http://www.cdc.gov/vaccines/pubs/vis/vis-news.htm
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
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9. |
Check out "Factcines," a helpful book for vaccine-hesitant parents
"Factcines" is a book written for parents by
Susan Shoshana
Weisberg, MD, FCP, FAAP, a board certified pediatrician with
over 25 years of clinical experience. The book presents
facts and data on vaccines, vaccine-preventable diseases,
and possible vaccine side effects in a neutral manner.
The opening paragraph of the introduction reads, "There is
no such thing as a risk free vaccine. There is no such thing
as a complication free disease. And there is no such thing
as a germ free life. So if you are reading this to find out
if vaccines are safe, you are asking the wrong question. The
issue is not simply whether a vaccine is safe or not, but
rather if a vaccine is justified or not. And justifying
immunizations is an equation that takes into account vaccine
side effects, disease dangerousness, and exposure
probability. The issue is not a one dimensional safety
scale, but a more complex model of relative risk."
The book covers both general immunization issues such as the
politics and economics of immunizations and vaccine
schedules, and individual vaccines and the diseases they
prevent.
To order a copy, go http://www.amazon.com and type in the
name of the book. Dr. Weisberg donates all profits from the
sale of this book to nonprofit charities that honor the
memory and inspiration of Dr. Janusz Korczak, the pen name
of Henryk Goldszmit, a beloved Polish pediatrician who died
in a Nazi death camp in 1942.
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10. |
New journal articles of interest
Several articles have recently been published in
peer-reviewed journals that may be of interest to IAC Express
readers.
Litigation related to vaccine safety
Litigation, Regulation, and Education--Protecting the
Public's Health through Childhood Immunization
Author: Silverman RD
Source: N Engl J Med, June 11, 2009, Vol. 360(24):2500-01
http://content.nejm.org/cgi/content/extract/360/24/2500
When Vaccine Injury Claims Go to Court
Author: Stewart AM
Source: N Engl J Med, June 11, 2009, Vol. 360(24):2498-2500
http://content.nejm.org/cgi/content/extract/360/24/2498
Tdap
Response to an Education Program for Parents about Adult
Pertussis Vaccination
Authors: Tam PY, Visintainer P, Fisher D
Source: Infect Control Hosp Epidemiol, June 2009, Vol.
30(6):589-92
http://www.ncbi.nlm.nih.gov/pubmed/19419326?dopt=AbstractPlus
Influenza
Worksite Policies Related to Influenza Vaccination: A Cross-Sectional Survey of U.S. Registered Nurses
Authors: Clark SJ, Cowan AE, Wortley PM
Source: Hum Vaccin, August 21, 2009, Vol. 5(8)
http://www.ncbi.nlm.nih.gov/pubmed/19458489?dopt=AbstractPlus
Adolescent Immunization
Increasing Adolescent Vaccination: Barriers and Strategies
in the Context of Policy, Legal, and Financial Issues
Authors: Ford CA, English A, Davenport AF, Stinnett AJ
Source: J Adolesc Health, June 2009, Vol. 44(6):568-74
http://www.ncbi.nlm.nih.gov/pubmed/19465321?dopt=AbstractPlus
IAC offers links to thousands of immunization-related
articles and abstracts at
http://www.immunize.org/journalarticles
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11. |
CDC to sponsor net conference on H1N1 and seasonal
influenza on July 16
CDC will be sponsoring a net conference titled
"Novel
Influenza A (H1N1) Update and Seasonal Influenza
Recommendations for the 2009-2010 Season" on July 16 from
noon-1:00 ET. The speaker will be Dr. Joseph Bresee.
Registration is free, but limited. For registration
information, go to: http://www2.cdc.gov/vaccines/ed/ciinc
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12. |
Immunize Georgia conference scheduled for September 11
The 16th annual Immunize Georgia conference will
take place
on September 11 at Stone Mountain. The purpose of the
conference is to provide the latest immunization information
to healthcare providers who care for families, children,
adolescents, and young adults.
For more information, download the conference brochure
here.
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