Issue Number 96
July 15, 1999
CONTENTS OF THIS ISSUE
- CDC recommends postponing
administration of rotavirus vaccine
- MMWR publishes article on
intussusception among recipients of rotavirus vaccine
- OPV no longer recommended for routine
childhood immunization against polio beginning January 1, 2000
- CDC publishes report on progress
toward measles elimination in Southern Africa
----------------------------------------------------------
Back to Top
(1)
July 15, 1999
CDC RECOMMENDS POSTPONING ADMINISTRATION OF ROTAVIRUS VACCINE
The Centers for Disease Control and Prevention (CDC) announced today that health care
providers and parents should postpone use of the rotavirus vaccine for infants. This
decision was based on early surveillance reports of intussusception among some infants who
received rotavirus vaccine. The official announcement to postpone rotavirus vaccine for
infants as well as a link to CDC's "Rotavirus and Intussusception: Questions and
Answers" follow:
CDC RECOMMENDS POSTPONING ADMINISTRATION OF ROTAVIRUS VACCINE
"CDC recommends that health care providers and parents postpone use of the rotavirus
vaccine for infants, at least until November 1999, based on early surveillance reports of
intussusception (a type of bowel obstruction that occurs when the bowel folds in on
itself) among some infants who received rotavirus vaccine. Although intussusceptions occur
among infants who have not received rotavirus vaccine, CDC will be collecting additional
data in the next several months that may indicate more clearly whether the rotavirus
vaccine increases the risk of intussusception. The recommendation is being made with
the consideration that rotavirus season is still 4-6 months away in most parts of
the United States.
"An estimated 1.5 million doses of rotavirus vaccine have been administered to
infants since it was licensed on August 31, 1998. As of July 7, 1999, the Vaccine Adverse
Event Reporting System (VAERS) has received 15 reports of intussusception. The rate of
intussusception among children receiving the rotavirus vaccine appears to be increased in
the first 2-3 weeks after vaccination. Parents and caretakers of infants should contact
their health care provider if the child develops symptoms of intussusception (persistent
vomiting, bloody stools, black stools, abdominal bloating or severe colic pain). Health
care providers should be aware of the possible increased risk and consider this diagnosis
among children presenting these symptoms. Parents and health care providers should report
intussusception and other adverse events following vaccination to VAERS. VAERS reporting
forms and information can be requested 24 hours a day by calling (800) 822-7967 or
accessing the World Wide Web at:
http://www.fda.gov/cber/vaers/vaers.htm
"In studies done before the Food and Drug Administration (FDA) licensed rotavirus
vaccine for use in the United States, intussusception was noted among 5 of approximately
10,000 vaccine recipients. This number was not significantly higher than among placebo
recipients in the studies. However, the Advisory Committee on Immunization Practices
(ACIP), in its recommendation for routine rotavirus vaccination of infants, indicated that
postlicensure surveillance was needed for intussusception and any other rare adverse
events that might occur following receipt of the vaccine.
"Rotavirus is the most common cause of severe diarrhea in children in the United
States. Virtually all children have one or more rotavirus infections in the first 5 years
of life. Each year in the United States, rotavirus is responsible for approximately
500,000 physician visits and 50,000 hospitalizations. Severe diarrhea and dehydration
occur primarily among children 3 months to 35 months of age. It is a seasonal
disease in the United States with the vast majority of the disease occurring in the
winter and spring months."
For more detailed information, see article number two below regarding the July 16, 1999,
MMWR article on rotavirus and intussusception.
CDC ANSWERS YOUR QUESTIONS ON ROTAVIRUS AND INTUSSUSCEPTION
What is intussusception? How frequently has intussusception occurred following rotavirus
vaccination? What should be done if a child develops intussusception after receiving
rotavirus vaccine? The answers to these questions and more are on the IAC's website:
http://www.cdc.gov/nip/issues/rota/
----------------------------------------------------------
Back to Top
(2)
July 15, 1999
MMWR PUBLISHES ARTICLE ON INTUSSUSCEPTION AMONG RECIPIENTS OF ROTAVIRUS VACCINE
The Centers for Disease Control and Prevention published the article,
"Intussusception Among Recipients of Rotavirus Vaccine -- United States,
1998-1999," in the July 16, 1999, issue of the MMWR.
During September 1, 1999 - July 7, 1999, 15 cases of intussusception (a bowel obstruction
in which one segment of bowel becomes enfolded within another segment) among infants who
had received a tetravalent rhesus-based rotavirus vaccine (RRV-TV) were reported to the
Vaccine Adverse Event Reporting System (VAERS). This article summarizes the clinical and
epidemiologic features of these cases and preliminary data from ongoing studies of
intussusception and rotavirus vaccine.
The editorial note includes information on the CDC recommendation to postpone
administration of RRV-TV to children scheduled to receive the vaccine before November
1999, including those who already have begun the RRV-TV series. It also includes
information for health professionals who have administered rotavirus vaccine and a message
to parents or caregivers of children who have recently received rotavirus vaccine to
promptly contact their health care provider if their infant develops symptoms consistent
with intussusception (e.g., persistent vomiting, bloody stools, black stools, abdominal
distention, and/or severe colic pain).
To obtain a text version of this MMWR article, click here: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827a1.htm
For information on how to get a free electronic subscription to the MMWR, see the
instructions that follow article four below.
----------------------------------------------------------
Back to Top
(3)
July 15, 1999
OPV NO LONGER RECOMMENDED FOR ROUTINE CHILDHOOD IMMUNIZATION AGAINST POLIO BEGINNING
JANUARY 1, 2000
The June 17, 1999, Advisory Committee on Immunization Practices (ACIP) recommendation to
begin using an all-IPV schedule for routine childhood polio vaccination in the United
States on January 1, 2000, was published as a "Notice to Readers" in the July
15, 1999, issue of the MMWR. The notice reads as follows:
RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES: REVISED
RECOMMENDATIONS FOR ROUTINE POLIOMYELITIS VACCINATION
"Since 1979, the only indigenous cases of poliomyelitis reported in the United States
(n=144) have been associated with use of the live oral poliovirus vaccine (OPV) (an
additional six imported cases have been reported since 1979, the last of which occurred in
1993). Until recently, the benefits of OPV use (i.e., intestinal immunity, secondary
spread) outweighed the risk for vaccine-associated paralytic polio (VAPP) (one case per
2.4 million doses distributed). In 1997, to decrease the risk for VAPP while maintaining
the benefits of OPV, the Advisory Committee on Immunization Practices (ACIP) recommended a
sequential schedule of inactivated poliovirus vaccine (IPV) followed by OPV. Since 1997,
the global polio eradication initiative has progressed rapidly, and the likelihood of
poliovirus importation into the United States has decreased substantially. In addition,
since 1997, the sequential schedule has been well accepted. No declines in childhood
vaccination coverage were observed, despite the need for additional injections.
"On the basis of these data, on June 17, 1999, to eliminate the risk for VAPP, the
ACIP recommended an all-IPV schedule for routine childhood polio vaccination in the United
States. As of January 1, 2000, all children should receive four doses of IPV at ages 2
months, 4 months, 6-18 months, and 4-6 years.
"OPV should be used only for the following special circumstances:
- Mass vaccination campaigns to control outbreaks of
paralytic polio.
- Unvaccinated children who will be traveling in
<4 weeks to areas where polio is endemic.
- Children of parents who do not accept the
recommended number of vaccine injections. These children may receive OPV only for the
third or fourth dose or both; in this situation, health-care providers should administer
OPV only after discussing the risk for VAPP with parents or caregivers.
"Availability of OPV is expected to be
limited in the future in the United States. ACIP reaffirms its support for the global
polio eradication initiative and use of OPV as the vaccine of choice to eradicate polio
from the remaining countries where polio is endemic."
To obtain a text version of this MMWR "Notice to Readers," click here: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827a4.htm
For information on how to get a free electronic subscription to the MMWR, see the
instructions that follow article four below.
----------------------------------------------------------
Back to Top
(4)
July 15, 1999
CDC PUBLISHES REPORT ON PROGRESS TOWARD MEASLES ELIMINATION IN SOUTHERN AFRICA
The Centers for Disease Control and Prevention published an article entitled
"Progress Toward Measles Elimination -- Southern Africa, 1996-1998," in the July
16, 1999, issue of the MMWR.
Since 1995 the six southern Africa countries of Botswana, Malawi, Namibia, South Africa,
Swaziland, and Zimbabwe have launched measles-elimination initiatives in accordance with
the recommendations of the World Health Organization (WHO) African Regional Office.
This article presents preliminary data about these countries' progress toward measles
elimination, describes the campaigns, and reports that the initiatives have been highly
effective in reducing morbidity and mortality resulting from measles.
The article concludes: "to sustain progress toward measles elimination in southern
Africa, continued national commitment to support and implement WHO strategies is needed to
prevent the re-establishment of measles transmission, and possibly to avoid large
outbreaks, in counties where elimination has been achieved."
To obtain a text version of this MMWR article, click here: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4827a3.htm
HOW TO GET A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR
To get a free electronic subscription to the MMWR (delivered weekly), go to the MMWR
website and sign up. When you sign up, you will also automatically begin to receive all
new ACIP statements which are published as MMWR's "Recommendations and Reports."
To get to the MMWR website, click here: http://www2.cdc.gov/mmwr/ |
