IAC Express 2010 |
Issue number 887: September 7, 2010 |
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as well as other FREE IAC periodicals. |
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Contents
of this Issue
Select a title to jump to the article. |
- Reminder:
August 2010 issues of Needle Tips and Vaccinate Adults available online
- New DVD
for 2010! "Immunization Techniques: Best Practices with Infants, Children,
and Adults"--from the California Department of Public Health, Immunization
Branch
- MMWR
publishes ACIP's updated recommendations for preventing invasive
pneumococcal disease among adults using PPSV23
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Clarification: Tdap/DTaP chart from last week's IAC Express includes
California-specific recommendations
- Mandatory
influenza vaccination for healthcare workers called for by the American
Academy of Pediatrics and the Society for Healthcare Epidemiology of
America
- AAP
releases policy statement on recommendations for influenza immunization of
children
- IAC
updates online "Ask the Experts" Q&A sections related to influenza,
meningococcal, and rabies vaccines and diseases
- IAC's
Video of the Week features Dr. Nancy Snyderman speaking about California's
pertussis outbreak
- Society
for Adolescent Health and Medicine encourages increased efforts in
adolescent immunization
- NACCHO
launches radio campaigns to promote Vaccines for Children program
- CDC
website adds 2010-11 influenza vaccination print materials for a variety
of audiences
- Almost
100 million children in China to receive measles vaccine
- VISs for
influenza and Td/Tdap vaccines now available in additional languages
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Reminder: Vaccine Education Center to hold symposium in Philadelphia on
September 25
-
VICNetwork hosts September 23 webinar on communicating vaccine safety data
to parents
- "CDC
Features" educates about the development of influenza videos for deaf and
hard-of-hearing people
- MMWR
announces a Clinical Vaccinology Course scheduled for November 5-7 in
Bethesda, MD
- PKIDs'
September 23 webinar will discuss social media problems and solutions;
September 30 webinar to focus on traditional media
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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 887: September 7, 2010 |
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1. |
Reminder: August 2010 issues of Needle Tips and Vaccinate Adults available
online
The August 2010 issues of Needle Tips and
Vaccinate Adults
are available online for viewing, downloading, and printing.
Both issues emphasize the importance of vaccinating everyone
age 6 months and older against influenza. Most of the
content of Vaccinate Adults is identical to that of Needle
Tips; only the pediatric information has been removed.
To download the entire issue of Needle Tips right now, go
to: http://www.immunize.org/nslt.d/n46/n46.pdf
To download the entire issue of Vaccinate Adults right now,
go to: http://www.immunize.org/va/va29.pdf
Complete information about the August 2010 issue of Needle
Tips is available at http://www.immunize.org/nt
Complete information about the August 2010 issue of
Vaccinate Adults is available at http://www.immunize.org/va
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2. |
New DVD for 2010! "Immunization Techniques: Best Practices with Infants,
Children, and Adults"--from the California Department of Public Health,
Immunization Branch
The California Department of Public Health (CDPH),
Immunization Branch, recently updated its award-winning
training video, "Immunization Techniques: Best Practices
with Infants, Children, and Adults." The 25-minute program
can be used to train new employees and to refresh the skills
of experienced staff. The video demonstrates the skills and
techniques needed to administer vaccines to patients of all
ages. It includes instruction on the following:
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Selecting, preparing, and administering injectable, oral,
and nasal vaccines
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Documenting immunizations
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Making patients comfortable and educating them
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Facilitating staff and patient communication
Prices start at $17 each for 1-9 copies and are greatly
reduced for large orders, dropping to $4.25 each for 1,000-1,500 copies.
To learn more about the DVD, and find out how to order it,
go to: http://www.immunize.org/shop/toolkit_iztechdvd.asp
For quotes on larger quantities, call (651) 647-9009 or
email admininfo@immunize.org
The Immunization Action Coalition is the only nationwide
vendor of this new DVD.
Note: For healthcare settings located in California, contact
your local health department immunization program for a free
copy.
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3. |
MMWR publishes ACIP's updated recommendations for preventing invasive
pneumococcal disease among adults using PPSV23
CDC published "Updated Recommendations for
Prevention of
Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23)" in the
September 3 issue of MMWR. The first paragraph as well as
the text from a box titled " Updated recommendations for
administration of 23-valent pneumococcal polysaccharide
vaccine (PPSV23) among adults aged >=19 years--Advisory
Committee on Immunization Practices (ACIP), United States"
are reprinted below.
Invasive disease from Streptococcus pneumoniae
(pneumococcus) is a major cause of illness and death in the
United States, with an estimated 43,500 cases and 5,000
deaths among persons of all ages in 2009. This report
provides updated recommendations from the Advisory Committee
on Immunization Practices (ACIP) for prevention of invasive
pneumococcal disease (IPD) (i.e., bacteremia, meningitis, or
infection of other normally sterile sites) through use of
the 23-valent pneumococcal polysaccharide vaccine (PPSV23)
among all adults aged >=65 years and those adults aged 19-64
years with underlying medical conditions that put them at
greater risk for serious pneumococcal infection. The new
recommendations include the following changes from 1997 ACIP
recommendations: (1) the indications for which PPSV23
vaccination is recommended now include smoking and asthma,
and (2) routine use of PPSV23 is no longer recommended for
Alaska Natives or American Indians aged <65 years unless
they have medical or other indications for PPSV23. ACIP
recommendations for revaccination with PPSV23 among the
adult patient groups at greatest risk for IPD (i.e., persons
with functional or anatomic asplenia and persons with
immunocompromising conditions) remain unchanged. ACIP
recommendations for prevention of pneumococcal disease among
infants and youths aged <=18 years using the 13-valent
pneumococcal conjugate vaccine (PCV13) and PPSV23 are
published separately.
BOX CONTENT:
Updated recommendations for administration of 23-valent
pneumococcal polysaccharide vaccine (PPSV23) among adults
aged >=19 years--Advisory Committee on Immunization
Practices (ACIP), United States
- PPSV23 should be administered to adults aged 19-64 years
with chronic or immunosuppressing medical conditions,
including those who have asthma.
- Adults aged 19-64 years who smoke cigarettes should
receive PPSV23 and smoking cessation guidance.
- Routine PPSV23 use is no longer recommended for Alaska
Natives or American Indians aged <65 years unless they have
medical indications for PPSV23. However, in certain
situations, public health authorities may recommend PPSV23
for Alaska Natives and American Indians aged 50-64 years who
are living in areas where the risk for invasive pneumococcal
disease is increased.
- All persons should be vaccinated with PPSV23 at age 65
years. Those who received PPSV23 before age 65 years for any
indication should receive another dose of the vaccine at age
65 years or later if at least 5 years have passed since
their previous dose. Those who receive PPSV23 at or after
age 65 years should receive only a single dose.
- ACIP does not recommend routine revaccination for most
persons for whom PPSV23 is indicated. A second dose of
PPSV23 is recommended 5 years after the first dose for
persons aged 19-64 years with functional or anatomic
asplenia and for persons with immunocompromising conditions.
ACIP does not recommend multiple revaccinations because of
uncertainty regarding clinical benefit and safety.
To download a PDF of the updated recommendations, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5934.pdf and see pages
1102-06.
To access the updated recommendations in web-text (HTML)
format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a3.htm
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4. |
Clarification: Tdap/DTaP chart from last week's IAC Express includes
California-specific recommendations
A number of concerned readers contacted IAC about
the
Tdap/DTaP product chart written about in last week's IAC
Express (dated August 30, 2010). The chart was developed by
the California Department of Public Health and reflects
recommendations specific to that state in light of the
current pertussis outbreak. Specifically, the chart shows
Tdap as being used in patients "7 Years of Age or Older,"
which could be misleading to our readers.
No pertussis-containing product is licensed for children age
7-9 years or for adults older than age 64 years. However,
vaccines can be given off-label if the healthcare
professional believes the benefit is greater than any
possible risk. The state of California is currently
recommending Tdap vaccine for children as young as age 7 and
adults older than age 64 in an attempt to stop the pertussis
outbreak that has killed eight infants.
The California Department of Public Health has kindly
provided IAC with a copy of its earlier Tdap/DTaP product
chart, which is more applicable to the rest of the nation.
To access it, go to:
http://www.immunize.org/tdap_dtap_vial_chart.pdf NOTE: The
VFC telephone number that appears at the bottom left of the
chart applies ONLY TO HEALTHCARE SETTINGS IN CALIFORNIA.
We apologize for the confusion created in last week's IAC
Express and thank our astute readers for their emails.
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5. |
Mandatory influenza vaccination for healthcare workers called for by the
American Academy of Pediatrics and the Society for Healthcare Epidemiology of
America
This past week, both the American Academy of
Pediatrics
(AAP) and the Society for Healthcare Epidemiology of America
(SHEA) joined the Infectious Diseases Society of America
(IDSA) and the National Patient Safety Foundation in calling
for mandatory influenza vaccination for healthcare workers,
with few exceptions allowed. In addition, IDSA endorsed the
updated SHEA policy and similarly amended its organization's
policy on influenza vaccination for healthcare workers.
AAP announced its new policy statement in an article titled
"AAP Policy Calls for Mandatory Flu Shots for Health Care
Workers," which was published in the September 2010 issue of
the AAP News. According to the article, the academy will be
issuing a new policy statement in mid-September that
recommends the implementation of a mandatory influenza
immunization policy for all healthcare personnel. To read
the news story, go to:
http://aapnews.aappublications.org/cgi/content/full/31/9/1-b
According to SHEA's position statement, which was
electronically published on August 31, 2010, "SHEA views
influenza vaccination of HCP [healthcare personnel] as a
core patient and HCP safety practice with which
noncompliance should not be tolerated. . . . Therefore, for
the safety of both patients and HCP, SHEA endorses a policy
in which annual influenza vaccination is a condition of both
initial and continued HCP employment and/or professional
privileges. . . .This recommendation applies to all HCP working
in all healthcare settings, regardless of whether the HCP have
direct patient contact or whether the HCP are directly employed
by the facility. It also applies to all students, volunteers,
and contract workers. SHEA recommends that only exemptions due
to recognized medical contraindications to influenza vaccination
be considered." To access the position statement in its
entirety, go to:
http://www.journals.uchicago.edu/doi/full/10.1086/656558
A press release accompanied the revised position statement
by SHEA; to read it, go to:
http://www.shea-online.org/Assets/files/policy/083110_Vaccination_Release.pdf
On July 28, 2010, IDSA endorsed SHEA's statement and updated
its policy to disallow declination of influenza vaccination
for personal reasons and to specify the steps that should be
taken to protect patients from being infected by unimmunized
healthcare workers. To read IDSA's updated position
statement, go to: http://www.idsociety.org/hcwimmunization.htm
Related press releases, position statements, and the AAP
news article were added to IAC's Honor Roll for Patient
Safety. The honor roll recognizes hospitals, professional
organizations, medical practices, and government entities
that have taken a stand for patient safety by strengthening
mandatory influenza vaccination policies for healthcare
workers.
To be included in the honor roll, an organization's mandate
must require influenza vaccination for employees and must
include serious measures to prevent transmission of
influenza from unvaccinated workers to patients. Such
measures might include a mask requirement, reassignment to
non-patient-care duties, or dismissal of the employee.
To find out specific information on the mandates of the
enrolled organizations or to submit your organization's
application for the honor roll, go to:
http://www.immunize.org/honor-roll
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6. |
AAP releases policy statement on recommendations for influenza immunization
of children
On August 30, the American Academy of Pediatrics
(AAP)
published a policy statement online (ahead of print) made by
AAP's Committee on Infectious Diseases. Titled
"Recommendations for Prevention and Control of Influenza in
Children, 2010-2011," this statement updates the current
recommendations for routine use of trivalent seasonal
influenza vaccine and antiviral medications for the
prevention and treatment of influenza in children.
To access a ready-to-print (PDF) version of this statement,
go to:
http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2216v1
To access the abstract of the statement, go to:
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2010-2216v1
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7. |
IAC updates online "Ask the Experts" Q&A sections related to influenza,
meningococcal, and rabies vaccines and diseases
IAC recently updated the online "Ask the Experts"
Q&A
sections related to these three vaccines/diseases:
influenza, meningococcal, and rabies. IAC's online "Ask the
Experts" Q&As are reviewed and updated annually with input
from vaccination experts at CDC. The process is ongoing; IAC
Express will inform readers as sections are reviewed and
revised.
To access the revised influenza Q&As, go to:
http://www.immunize.org/askexperts/experts_inf.asp
To access the revised meningococcal Q&As, go to:
http://www.immunize.org/askexperts/experts_men.asp
To access the revised rabies Q&As, go to:
http://www.immunize.org/askexperts/experts_rab.asp
To access the index page of "Ask the Experts" Q&As for all
other vaccines, go to: http://www.immunize.org/askexperts
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8. |
IAC's Video of the Week features Dr. Nancy Snyderman speaking about California's
pertussis outbreak
IAC encourages IAC Express readers to watch a
4-minute video
featuring Dr. Nancy Snyderman, MSNBC's chief medical editor.
Dr. Snyderman appeared on the Today Show to discuss the
recent pertussis outbreak in California and the serious
consequences of vaccine exemptions.
The video will be available on the home page of IAC's
website through September 12. To access it, go to:
http://www.immunize.org and click on the image under the
words Video of the Week. After that date, the video will be
available on MSNBC at
http://today.msnbc.msn.com/id/38447752/ns/health-infectious_diseases
Remember to bookmark IAC's home page to view a new video
every Monday. To view an IAC Video of the Week from the
past, go to the video archive at http://www.immunize.org/votw
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9. |
Society for Adolescent Health and Medicine encourages increased efforts in
adolescent immunization
On August 19, in response to a National
Immunization Survey
report on U.S. adolescent vaccination coverage that was
published in MMWR on August 20, the Society for Adolescent
Health and Medicine issued a press release titled "The
Society for Adolescent Health and Medicine (SAHM) Advocates
for Ways to Improve Immunization Rates and Halt Disease
Outbreaks." Portions of the press release are reprinted
below.
In light of today's report of the National Immunization
Survey results, the Society for Adolescent Health and
Medicine (SAHM) encourages increased efforts in fully
immunizing all adolescents.
The report issued by the National Immunization Survey (NIS)
shows progress in increasing immunization rates among teens
13-17 years of age. However, rates remain unacceptably low
for those vaccines that are targeted specifically to prevent
disease in adolescents: meningococcal meningitis (53.6 %),
human papillomavirus (44.3% received one dose, while only
26.7% received all three recommended doses),
tetanus/diphtheria/pertussis (Tdap) (55.6 %). Low rates
among adolescents may be responsible for the epidemic of
pertussis (whooping cough) that is presently occurring in
California. . . .
A variety of challenges face providers and public health
authorities in vaccinating adolescents. SAHM recommends the
following steps to help providers overcome these barriers:
(1) Vaccinate adolescents at every opportunity possible,
regardless of the reason for a medical visit; (2) Make sure
vaccinations are a priority for comprehensive health visits,
including sports physicals; (3) Utilize standing orders
which instruct office staff to vaccinate adolescents when
indicated, even if a provider forgets; (4) Utilize a vaccine
reminder and recall system to get patients to return for
additional vaccines when they need them; (5) Lobby for and
utilize centralized statewide vaccine registries where all
adolescents can have their vaccine status documented; (6)
support the use of school-located programs and other
alternative sites to provide immunization services for those
with less access to comprehensive services, and (7) educate
patients at every opportunity about the benefits of
vaccines. SAHM urges patients and parents to talk to their
providers about vaccines including the efficacy and safety
of this most important primary prevention tool. . . .
To access the complete press release, go to:
https://www.adolescenthealth.org/Press_Releases.htm Click
on the link to the press release dated August 19, 2010.
To access the August 20 MMWR report titled "National, State,
and Local Area Vaccination Coverage among Adolescents Aged
13-17 Years--United States, 2009," go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5932a3.htm
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10. |
NACCHO launches radio campaigns to promote Vaccines for Children program
On September 1, the National Association of
County and City
Health Officials (NACCHO) held radio interviews in national
and selected English- and Spanish-speaking regional radio
markets across the country. The radio tour was intended to
educate the public about the Vaccines for Children (VFC)
program, which makes vaccines available at no- or low-cost
to those qualifying for coverage. This is an attempt to
reduce financial barriers to seeking necessary health care
because of the current poor economy.
The radio tour is the beginning of a broader campaign that
will be phased in over the next several weeks. Public
service announcements will soon be available for download
from NACCHO's website. In the coming weeks, information will
also be available on how local health departments and
private providers can order free posters and tear-pads
promoting the VFC program to reach VFC-eligible families who
may not know about the program.
To learn more about the campaign and when campaign materials
will be available, visit www.naccho.org/VFC
If you have questions about the campaign, contact Paul
Etkind at petkind@naccho.org
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11. |
CDC website adds 2010-11 influenza vaccination print materials for a variety
of audiences
Right on time for the beginning of the 2010-11
influenza
vaccination season, CDC has posted an array of print
materials that encourage influenza vaccination for various
population groups including
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General public
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Families and children
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Speakers of Spanish and other non-English languages
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People with high-risk conditions
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Pregnant women
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Adults ages 19-24 years
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Adults age 65 years and older
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Businesses and employers
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Healthcare workers
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Minority populations
All materials can be downloaded at no charge and can be
printed on standard office printers or at commercial
printers. Materials are or will be available in Spanish,
Arabic, Chinese, French, German, Korean, Russian, and
Vietnamese.
To access the materials, go to:
http://www.cdc.gov/flu/freeresources/print.htm Click on
each image to see the different sizes and languages
available. Search by audience or topic. Materials will be
added throughout the month of September, so be sure to check
back often.
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12. |
Almost 100 million children in China to receive measles vaccine
On September 1, UNICEF and WHO issued a press
release titled
"UNICEF, WHO: Nearly 100 Million Children to Be Vaccinated
against Measles in China." A portion of it is reprinted
below.
Nearly 100 million children across China will be vaccinated
against measles from 11-20 September in one of the world's
biggest such public health undertakings to date. The
nationwide campaign will protect millions of children
against the disease and bring China closer to reaching the
measles elimination goal by 2012 in line with the target set
by the World Health Organization's Western Pacific region.
"China is a priority country in the global fight against
measles and we commend the government for its leadership in
this life-saving work," said Dr Michael O'Leary, the World
Health Organization (WHO) Representative in China.
In 2009, more than 52,000 people in China were reported to
have contracted measles, accounting for about 86 per cent of
the measles cases in WHO's Western Pacific region. . . .
To access the complete press release, go to:
http://www.unicef.org/media/media_55859.html
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13. |
VISs for influenza and Td/Tdap vaccines now available in additional languages
The interim 2010-11 VISs for trivalent
inactivated influenza
vaccine (TIV; injectable) and live attenuated intranasal
influenza vaccine (LAIV; nasal spray) are now available in
Arabic, Armenian, Cambodian, Farsi, and Tagalog. The interim
VIS for Td/Tdap vaccines is now available in Chinese,
Tagalog, and Vietnamese. IAC gratefully acknowledges the
California Department of Public Health, Immunization Branch,
for the translations.
INFLUENZA VISs
To access the new translations of the interim VIS for
injectable influenza vaccine, as well as the injectable
influenza vaccine VIS in English and other translations, go
to: http://www.immunize.org/vis/vis_flu_inactive.asp
To access the new translation of the interim VIS for nasal-spray influenza vaccine, as well as the nasal-spray
influenza vaccine VIS in English and other translations, go
to: http://www.immunize.org/vis/vis_flu_live.asp
Td/Tdap VIS
To access the new translations of the interim VIS for Td/Tdap vaccines, as well as the interim VIS for Td and Tdap
vaccines in English and other translations, go to:
http://www.immunize.org/vis/vis_td-tdap.asp
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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14. |
Reminder: Vaccine Education Center to hold symposium in Philadelphia on
September 25
The Vaccine Education Center at The Children's
Hospital of
Philadelphia will hold a Vaccine Education Symposium on
September 25 in Philadelphia. The symposium is intended for
physicians, allied health and public health professionals,
nurses, and other healthcare professionals who work in the
field of immunizations.
The symposium will examine vaccines in light of these and
other topics:
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Vaccine safety concerns
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Current challenges in vaccine financing
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Parents refusal to vaccinate
For more information, download the symposium brochure at
http://www.chop.edu/system/galleries/download/pdfs/articles/cme/vaccine-2010.pdf
To register online, go to:
https://www.chop.edu/professionals/educational-resources/continuing-medical-education/registration.cfm/vaccine-2010
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15. |
VICNetwork hosts September 23 webinar on communicating vaccine safety data to
parents
The Virtual Immunization Communication Network (VICNetwork)
is hosting a free webinar on September 23 at 11AM Pacific
time/2PM Eastern time. "Making the CASE for Vaccines:
Communicating about Vaccine Safety" features Alison Tepper
Singer, the co-founder and president of the Autism Science
Foundation, a nonprofit organization dedicated to supporting
autism research. Ms. Singer will describe strategies for
communicating vaccine safety information to parents and
discuss new developments in the search for the causes of
autism.
There is no fee to participate in the webinar, but pre-registration is required. To pre-register, send an email to
VICNetwork at info@vicnetwork.org
For more information, go to http://vicnetwork.org
VICNetwork is a project of the National Public Health
Information Coalition (NPHIC) in collaboration with the
California Immunization Coalition (CIC).
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16. |
"CDC Features" educates about the development of influenza videos for deaf
and hard-of-hearing people
The "CDC Features" web section now includes
information
about the development of two videos that use American Sign
Language (ASL) to communicate influenza information to
people in the deaf and hard-of-hearing community. One video
contains influenza prevention information; the other informs
deaf parents about how to care for their children during
influenza season.
To access the CDC Feature titled "Seasonal Flu Videos in
American Sign Language," go to:
http://www.cdc.gov/Features/FluVideos
To access the influenza videos in ASL directly, go to
http://www.cdc.gov/flu/freeresources/media.htm Click on the
pertinent links under the title Videos.
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17. |
MMWR announces a Clinical Vaccinology Course scheduled for November 5-7 in
Bethesda, MD
CDC published "Announcements: Clinical
Vaccinology Course--November 5-7, 2010" in the September 3 issue of MMWR.
Portions of the announcement are reprinted below.
CDC and six other national organizations are collaborating
with the National Foundation for Infectious Diseases (NFID),
Emory University School of Medicine, and the Emory Vaccine
Center to sponsor a Clinical Vaccinology Course November 5-7, 2010, at the Hyatt Regency Bethesda in Bethesda,
Maryland. . . .
Continuing education credits will be offered. Information
regarding the preliminary program, registration, and
hotel accommodations is available online
(http://www.nfid.org). . . .
To access the announcement in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5934a4.htm
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18. |
PKIDs' September 23 webinar will discuss social media problems and solutions;
September 30 webinar to focus on traditional media
PKIDs (Parents of Kids with Infectious Diseases)
has
scheduled a 90-minute webinar for September 23. It will be a
roundtable discussion of participants' social media problems
and solutions. A 90-minute webinar scheduled for September
30 will focus on traditional media outreach. The webinars
are part of Communications Made Easy, a PKIDs' program
intended to help immunization educators learn the ropes of
social marketing and traditional and social media.
The roundtable discussion social media problems/solutions is
scheduled for September 23 at 9AM Pacific time/noon Eastern
time. Space is limited and pre-registration is recommended.
For additional information and to register, go to:
https://cc.readytalk.com/cc/schedule/display.do?udc=67sr1csslru9
The webinar on traditional media is scheduled for September
30 at 9AM Pacific time/noon Eastern time. Space is limited
and pre-registration is recommended. For additional
information and to register, go to:
https://cc.readytalk.com/cc/schedule/display.do?udc=ohvot83uhwsq
For more information on the Communications Made Easy
program, go to: http://www.pkids.org/cme
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