| Issue Number
23, November 18, 2004 |
| |
| Contents of this Issue |
|
|
|
ABBREVIATIONS: ACIP, Advisory Committee on Immunization Practices; CDC, Centers
for Disease Control and Prevention; DVH, Division of Viral Hepatitis; HAV,
hepatitis A virus; HBV, hepatitis B virus; HCV, hepatitis C virus; IAC,
Immunization Action Coalition; IDU, injection drug user; MMWR, Morbidity and
Mortality Weekly Report; MSM, men who have sex with men; STD, sexually
transmitted disease; VIS, Vaccine Information Statement; WHO, World Health
Organization.
----------------------------------------------------------------
(1 of 9)
November 18, 2004
CDC REPORTS 89% DECREASE IN ACUTE HEPATITIS B INFECTION AMONG U.S. CHILDREN AND
ADOLESCENTS DURING 1990-2002
[The following is cross posted from the Immunization Action Coalition's "IAC
EXPRESS" electronic newsletter, 11/8/04.]
CDC published "Acute Hepatitis B Among Children and Adolescents--United States,
1990-2002" in the November 5 issue of MMWR. The article is reprinted below in
its entirety, excluding references, two figures, and a table.
***********************
Since the 1991 adoption of a comprehensive strategy to eliminate hepatitis B
virus (HBV) transmission in the United States, the incidence of acute hepatitis
B cases has declined steadily. Declines have been greatest among children born
after the 1991 recommendations for universal infant hepatitis B vaccination were
implemented. In 1995, the elimination strategy was expanded to include routine
vaccination of all adolescents aged 11-12 years and, in 1999, to include
children aged <18 years who had not been vaccinated previously. To describe the
epidemiology of acute hepatitis B in children and adolescents in the United
States, CDC analyzed notifiable disease surveillance data collected during
1990-2002 and data collected during 2001-2002 through enhanced surveillance of
reported cases of acute hepatitis B in children born after 1990. This report
summarizes the results of that analysis, which indicated that the rate of acute
hepatitis B in children and adolescents decreased 89% during 1990-2002 and that
racial disparities in hepatitis B incidence have narrowed. Many confirmed cases
in persons born after 1990 occurred among international adoptees and other
children born outside the United States. Continued implementation of the
hepatitis B elimination strategy and accurate surveillance data to monitor the
impact of vaccination are necessary to sustain the decline of acute hepatitis B
among children.
Cases of acute hepatitis B were reported weekly to CDC by all 50 states and the
District of Columbia. Acute hepatitis B rates were calculated per 100,000
population by using population denominators from the U.S. Census Bureau. Acute
hepatitis B was defined as an acute illness with (1) discrete onset of symptoms
and jaundice or elevated serum aminotransferase levels and (2) laboratory
evidence of either IgM antibody to hepatitis B core antigen (IgM anti-HBc) or
hepatitis B surface antigen (HBsAg). Since March 2001, CDC has conducted
enhanced hepatitis B surveillance, contacting states to confirm all reported
cases of acute hepatitis B in persons born after 1990. State surveillance staff
members were asked to verify each of the items in the case definition and
provide information regarding vaccination history and country of birth. If
errors were identified during this process, states were asked to correct the
information in an updated submission to CDC.
National Surveillance
During 1990-2002, a total of 13,829 cases of acute hepatitis B were reported in
the United States among persons aged <=19 years. The incidence of reported cases
declined steadily during this period, from 3.03 per 100,000 population in 1990
to 0.34 in 2002, representing a decline of 89%. The incidence among adolescents
aged 15-19 years was consistently higher than the incidence among younger age
groups, ranging from 8.69 per 100,000 population in 1990 to 1.13 in 2002.
Children and adolescents in all age groups experienced steep declines in
incidence during 1990-2002; incidence declined 94% among children aged 0-4
years, 92% among children aged 5-9 years, 93% among those aged 10-14 years, and
87% among adolescents aged 15-19 years.
Among children and adolescents aged <=19 years in 1990, incidence per 100,000
population was highest among Asian/Pacific Islanders (A/PIs) (6.74) and blacks
(4.29); whites had the lowest race-specific incidence (1.39). Differences in
incidence between whites and A/PIs and between whites and blacks were 5.34 and
2.90, respectively. From 1990 to 2002, rates declined 92% among A/PIs, 88% among
whites, 88% among blacks, and 84% among American Indians/Alaskan Natives (AI/ANs).
In 2002, the highest incidence per 100,000 population was among A/PIs (0.55),
followed by blacks (0.51), AI/ANs (0.43), and whites (0.16); since 1990,
differences in incidence between whites and A/PIs and whites and blacks declined
by 93% and 88%, respectively.
Case Investigations
Follow-up investigations conducted by CDC and state and local health departments
verified 19 case reports from 2001 and 2002 as cases of acute hepatitis B among
children born after 1990. Of the verified case reports, 12 (60%) involved males,
eight (42%) involved children aged <2 years, and 11 (58%) involved children born
in the United States. Seven (37%) reported race as A/PI, five (26%) as white,
four (21%) as black, and three (16%) as unknown. Eight (42%) cases were reported
in children born outside the United States, including six international adoptees
(32%). Receipt of >=1 dose of hepatitis B vaccine was confirmed in three (16%)
cases. Vaccination status was unknown for 12 cases (63%).
Editorial Note:
The incidence of acute hepatitis B cases in U.S. children and adolescents
decreased during the era of universal childhood vaccination. This decline
coincided with an increase in hepatitis B vaccination coverage among children
aged 19-35 months, from 16% in 1992 to 90% in 2002, and among adolescents aged
13-15, from nearly 0 in 1992 to 67% in 2002.
Declines in incidence were observed for children of all races, including A/PIs,
whose rates historically have been higher than the national average. Because of
the disproportionate burden of hepatitis B in A/PI communities, A/PI children
were among the first groups for whom hepatitis B vaccination was recommended.
The reduction of the disparity between A/PIs and other children is consistent
with recent observations noting a decline in seroprevalence of HBV infection and
successful implementation of routine hepatitis B vaccination among Asians who
have recently immigrated to the United States. However, of the 11 verified cases
during 2001-02 of acute hepatitis B among children born in the United States,
three (27%) involved A/PIs. Although the national origins of these children's
household members are unknown, the substantial proportion of A/PIs suggests that
horizontal transmission of HBV among first-generation Asians might be a
persistent problem.
The higher incidence among older adolescents (aged 15-19 years) likely is
attributable to their having been born before universal infant hepatitis B
vaccination was recommended in 1991. Incidence among older adolescents is
expected to decline further as the vaccinated cohort ages and as 1999
recommendations to vaccinate all previously unvaccinated persons aged 0-18 years
are fully implemented. The expected decline in rates among adolescents also
might be augmented by laws in 32 states requiring proof of hepatitis B
vaccination before entry into middle school.
Follow-up information obtained through surveillance of reported cases suggests
that children born outside the United States, especially international adoptees,
represent a substantial proportion of cases. Cases of acute hepatitis B among
international adoptees might result from undervaccination and increased risk for
exposure while living in areas with high prevalence of chronic HBV infection.
International adoptees are exempt from U.S. regulations that bar entry to
immigrants without documentation of hepatitis B vaccination. Studies have
demonstrated that international adoptees exhibit low rates of protective titers
of antibodies to vaccine-preventable diseases upon arrival in the United States,
including adoptees with written evidence of age-appropriate vaccination provided
by the birth country. Appropriate evaluation and remediation of the immunization
status of international adoptees has been promoted through national guidelines;
however, the extent to which these guidelines have been implemented is unknown.
Despite the decline in acute hepatitis B cases among children in the United
States, the presence of confirmed cases highlights the importance of infant
vaccination and timely completion of the 3-dose vaccination series. The
vaccination series should be started at birth, preferably before the newborn is
discharged from the hospital. Infants born to women who are HBsAg positive or
who have not had prenatal HBsAg testing should receive the first dose of
hepatitis B vaccine within 12 hours of birth. Beginning the vaccination series
at birth decreases the risk for perinatal HBV transmission and predicts
successful completion of the series.
Although enhanced surveillance data from verified case reports suggest that
international adoptees and other children born outside the United States might
particularly benefit from future prevention efforts, many case reports lacked
risk factor information. As the incidence of acute hepatitis B among children
and adolescents declines, accurate surveillance data become increasingly
important to monitor the effect of immunization recommendations. Continued
efforts of local, state, and national surveillance staff to improve data quality
are critical to eliminating HBV transmission in the United States.
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5343a4.htm
To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5343.pdfTo receive a FREE electronic
subscription to MMWR, go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
----------------------------------------------------------------
Return to top
(2 of 9)
November 18, 2004
VIS TRANSLATIONS: NEW HEPATITIS A VACCINE VIS NOW AVAILABLE IN EIGHT ADDITIONAL
LANGUAGES
[The following is cross posted from the Immunization Action Coalition's "IAC
EXPRESS" electronic newsletter, 11/1/04.]
Dated 8/4/04, the current version of the VIS for hepatitis A vaccine is now
available on the IAC website in eight additional languages: Arabic, Armenian,
Cambodian, Farsi, Haitian Creole, Hmong, Korean, and Vietnamese. IAC gratefully
acknowledges the Massachusetts Department of Public Health for the Haitian
Creole translation and the California Department of Health Services for the
remaining translations.
PLEASE NOTE: When hepatitis A vaccine is added to the Vaccine Injury
Compensation Program's injury table, presumably later in 2004, another hepatitis
A vaccine VIS will be issued. To avoid large printing expenses, print off only
as many of the 8/4/04 VISs as you anticipate needing for the next several
months.
To obtain a ready-to-copy (PDF) version of the VIS for hepatitis A vaccine in
ARABIC, go to:
http://www.immunize.org/vis/ab_hpa04.pdf
To obtain it in ARMENIAN, go to:
http://www.immunize.org/vis/ar_hpa04.pdf
To obtain it in CAMBODIAN, go to:
http://www.immunize.org/vis/ca_hpa04.pdf
To obtain it in FARSI, go to:
http://www.immunize.org/vis/fa_hpa04.pdf
To obtain it in HAITIAN CREOLE, go to:
http://www.immunize.org/vis/ha_hpa04.pdf
To obtain it in HMONG, go to:
http://www.immunize.org/vis/hm_hpa04.pdf
To obtain it in KOREAN, go to:
http://www.immunize.org/vis/ko_hpa04.pdf
To obtain it in VIETNAMESE, go to:
http://www.immunize.org/vis/vn_hpa04.pdf
To obtain it in ENGLISH, go to:
http://www.immunize.org/vis/v-hepa.pdf
For information about the use of VISs, and for VISs in a total of 32 languages,
visit IAC's VIS web section at
http://www.immunize.org/vis
----------------------------------------------------------------
Return to top
(3 of 9)
November 18, 2004
CDC CREATES VIRAL HEPATITIS SLIDE SHOW FOR HIGH SCHOOL STUDENTS
CDC's Division of Viral Hepatitis has developed a three-part
slide set for high school students, designed to give adolescents
basic information and raise awareness about HAV, HBV, and HCV.
The set can be used as a resource for science or health
projects, as an outline for a teaching tool, or as reference
material to inform others (e.g., family, friends).
Click
here to view or download this resource.
----------------------------------------------------------------
Return to top
(4 of 9)
November 18, 2004
NEW YORK INITIATIVE PROVIDES FREE HEPATITIS B VACCINE TO
HOSPITALS ADOPTING A UNIVERSAL BIRTH DOSE POLICY
The Hepatitis B Birth Dose Program is an initiative of the New
York State Department of Health (NYSDOH) that provides free
hepatitis B vaccine to any birthing hospital in New York State
that agrees to adopt a universal hepatitis B birth dose policy.
Since October 2003, the program has enrolled 50 (out of 113)
upstate and 25 (out of 45) New York City birthing hospitals.
Hospitals may participate in the program by submitting a brief
application, along with their birth dose policy, to NYSDOH for
review. The policy must clearly show that all newborns will be
routinely vaccinated against hepatitis B at birth regardless of
maternal hepatitis B surface antigen status, infant's insurance
status, or individual physician preference.
The provision of hepatitis B vaccine to all infants at birth
provides a safety net to high-risk infants who do not receive
appropriate prophylactic treatment against HBV transmission at
birth, and to infants who are exposed to HBV postnatally from
another family member or caregiver.
In a 2002 survey of New York State birthing hospitals, cost of
vaccine was identified as a barrier to vaccinating infants at
birth by many hospitals. Through this new program, NYSDOH hopes
to eliminate additional hospital costs for vaccine purchase
while improving hospital compliance with recommended standards
of care.
Questions regarding the program can be directed to Perinatal
Hepatitis B Program Manager Elizabeth Herlihy, RN, MS, at
(518) 473-4437 or EJH04@health.state.ny.us
----------------------------------------------------------------
Return to top
(5 of 9)
November 18, 2004
REPORT ON ILLINOIS HOSPITAL PRACTICES RELATED TO HEPATITIS B
BIRTH DOSE AVAILABLE ONLINE
The Illinois Chapter of the American Academy of Pediatrics (AAP)
and the Illinois Department of Public Health collaborated on a
study titled: "Report of Illinois Birthing Hospital Practices
with Respect to the Administration of the Hepatitis B Birth Dose
Vaccine and Hospital Participation in the Vaccines for Children-Plus Program."
The first four study objectives were
-
Assess Illinois birthing hospital practices and policies
with respect to administration of the hepatitis B vaccine
to newborns prior to hospital discharge.
-
Identify strategies to increase the hepatitis B birth
dose vaccination rate in Illinois.
-
Determine how many Illinois birthing hospitals are
currently enrolled in the Vaccines for Children-Plus
(VFC-Plus) program. [VFC-Plus provides hospitals with
vaccines, such as that for hepatitis B, for children who
do not have insurance or for whom private insurance will
not pay.]
-
Identify factors impacting enrollment/non-enrollment into
the VFC-Plus program.
The study found that the establishment of hospital policies, and
more importantly, written standing orders for administration of
the hepatitis B birth dose correlated with significantly higher
hepatitis B birth dose administration rates. Hospitals enrolled
in the Illinois VFC-Plus program demonstrated significantly
higher hepatitis B birth dose vaccination rates when compared
with non-enrolled hospitals.
The study is an excellent example of collaboration between a
state public health department and the state AAP chapter and can
be used to stimulate discussion and planning in other states.
To read the report online, go to:
http://www.illinoisaap.org/HepBFinalReport.pdf
----------------------------------------------------------------
Return to top
(6 of 9)
November 18, 2004
CDC ISSUES NOTICE ABOUT FALSE-POSITIVE HBsAg TESTS
[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 11/1/04.]
CDC recently posted the following notice on the Viral Hepatitis
section of the National Center for Infectious Diseases' (NCID)
website.
*********************
FALSE-POSITIVE HBsAg TESTS NOTED
BD and Abbott Diagnostics have initiated an investigation
concerning the increased rate of initial and/or repeat reactive
results for the AUSZYME Monoclonal test when using BD Vacutainer
SST Plus tubes. As described in the AUSZYME package insert,
reactive specimens should be repeated in duplicate. If either of
the repeats is positive, the sample should then be tested with a
licensed neutralizing confirmatory test, such as the HBsAg
Confirmatory Assay. Only those specimens in which the HBsAg can
be neutralized by the confirmatory test procedure may be
designated as positive for HBsAg. All highly sensitive
immunoassay systems have a potential for nonspecific reactions.
The specificity of a repeatedly reactive specimen can be
confirmed by neutralization tests.
*********************
To access the notice, go to:
http://www.cdc.gov/ncidod/diseases/hepatitis/new.htm#top Click
on the link titled "False positive HBsAg tests noted."
Click
here for additional technical or product-related information or to read
the BD technical bulletin.
If you have identified a cluster of infants born to false-positive HBsAg mothers, who because of the false-positive
results, have been monitored as if they were born to HBsAg-positive mothers, please call Susan A. Wang, MD, MPH, at NCID
at (404) 371-5953.
----------------------------------------------------------------
Return to top
(7 of 9)
November 18, 2004
UPDATED: IAC REVISES TWO HEPATITIS-RELATED EDUCATION PIECES
IAC recently revised two of its long-standing hepatitis B
education pieces.
"Hepatitis B Shots Are Recommended for All New Babies" is a
brochure targeted at expectant or new parents who might question
the need for, or timing of, infant vaccination against HBV.
To access a ready-to-copy (PDF) version of "Hepatitis B Shots
Are Recommended for All New Babies," go to:
http://www.immunize.org/catg.d/p4110bab.pdf
To access a web-text (HTML) version of it, go to:
http://www.immunize.org/catg.d/p4110bab.htm
"Hepatitis B Information for Asian and Pacific Islander
Americans" was created to answer the questions of Asian and
Pacific Islander Americans (APIA), including immigrants and
refugees, as well as persons of APIA descent born in the United
States. The revised version includes an updated list of related
organizations that readers might wish to contact.
To access a ready-to-copy (PDF) version of "Hepatitis B
Information for Asian and Pacific Islander Americans," go to:
http://www.immunize.org/catg.d/4190apia.pdf
To access a web-text (HTML) version of it, go to:
http://www.immunize.org/catg.d/4190apia.htm
----------------------------------------------------------------
Return to top
(8 of 9)
November 18, 2004
OCTOBER ISSUE OF "VACCINATE ADULTS" IS ON THE WEB
IAC recently mailed the latest issue of "VACCINATE ADULTS"
(October 2004) to 100,000 health professionals and others who
work in the field of immunization. Packed with immunization
resources for health professionals and patients, the 12-page
issue is well worth downloading. All articles and education
pieces, except editorials, have been thoroughly reviewed by
immunization and hepatitis experts at CDC.
PLEASE NOTE: Current as of September 2004, the resources in the
October "VACCINATE ADULTS" do not contain the most recent
information on influenza vaccine and vaccine supply. On October
5, ACIP developed interim influenza vaccine recommendations in
response to Chiron Corporation's announcement that its trivalent
inactivated influenza vaccine will not be available in the
United States for the 2004-05 influenza season. The information
in the interim recommendations is not reflected in any of the
influenza information published in the October "VACCINATE
ADULTS."
HOW TO READ "VACCINATE ADULTS" ON THE WEB
You can view selected articles from the table of contents below
or download the entire issue from the Web.
To view the table of contents with links to individual articles,
go to:
http://www.immunize.org/va
The PDF file of the entire issue, linked below, is large at
608,197 bytes. Some printers cannot print such a large file. For
tips on downloading and printing PDF files, go to:
http://www.immunize.org/nslt.d/tips.htm
To download a ready-to-copy (PDF) version of the October issue,
go to:
http://www.immunize.org/va/va14.pdf
----------------------------------------------------------------
Return to top
(9 of 9)
November 18, 2004
NEW ISSUE OF "VIRAL HEPATITIS" AVAILABLE ON VHPB WEBSITE
The Viral Hepatitis Prevention Board (VHPB) website has been
updated to include a new issue of the publication "Viral
Hepatitis."
"Viral Hepatitis," Volume 13, Number 1, is prepared from
material presented at the VHPB meeting on March 11-12, 2004, in
Sevilla, Spain. The topic of this meeting was "Hepatitis B
vaccine: long-term efficacy, booster policy, and impact of HBV
mutants on hepatitis B vaccination programmes."
To access the ready-to-copy (PDF) versions of this issue,
go to:
http://www.vhpb.org/Default.asp?navItem=newsletters
To access the home page of the VHPB website, go to:
http://www.vhpb.org
|
Home
