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Hep Express Issue 26

Issue Number 26, February 22, 2005
 
Contents of this Issue
1. CDC's draft ACIP hepatitis B recommendations available online for your review and comments
2. Dr. John Ward accepts position as director of CDC's Division of Viral Hepatitis
3. CDC reports on hepatitis A vaccination coverage among U.S. children ages 24-35 months during 2003
4. National Institutes of Health releases Action Plan for Liver Disease Research
5. DHHS adds HBV and HCV to list of known carcinogens
6. CDC reports African Americans have twice the incidence rate for hepatitis B and Streptococcus pneumoniae as whites
7. EPA publishes updated guidance about safe needle/sharps disposal
8. Hepatitis B Foundation establishes new research institute
9. New resources about preventing occupational exposure to bloodborne pathogens available
10. Resources for safer tattooing in prisons available online
11. Journal articles you may have missed

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.
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February 22, 2005
CDC'S DRAFT ACIP HEPATITIS B RECOMMENDATIONS AVAILABLE ONLINE FOR YOUR REVIEW AND COMMENTS

CDC's Division of Viral Hepatitis has posted draft hepatitis B recommendations online at
http://www.cdc.gov/ncidod/diseases/hepatitis/b/HBV_ACIP_Recs.pdf

The hepatitis B working group of the ACIP developed the proposed recommendations. A discussion vote to adopt the recommendations is scheduled for the June 29-30 ACIP meeting. CDC is currently encouraging feedback from health professionals and the public on the proposed statement. Please email comments to aciprecs@cdc.gov before March 4, 2005.
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February 22, 2005
DR. JOHN WARD ACCEPTS POSITION AS DIRECTOR OF CDC'S DIVISION OF VIRAL HEPATITIS

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 01/18/05.]

On January 6, Dr. James M. Hughes, director of the National Center for Infectious Diseases (NCID), announced that Dr. John Ward has accepted the position of director, Division of Viral Hepatitis. The text of Dr. Hughes' announcement is reprinted below in its entirety.

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I am pleased to announce that Dr. John Ward has accepted the position of director, Division of Viral Hepatitis (DVH). Dr. Ward most recently served as editor of the Morbidity and Mortality Weekly Report (MMWR) and as acting director of the Division of Scientific Communications, in the proposed National Center for Health Marketing, National Coordinating Center for Health Information and Service.

Dr. Ward received his MD from the University of Alabama School of Medicine in Birmingham and completed an internship and residency in internal medicine at the University of Alabama Hospitals. In addition to his EIS [Epidemic Intelligence Service] training, he received postgraduate training in tropical medicine at the London School of Tropical Medicine and Hygiene, in pediatric immunology at the Royal Children's Hospital in Melbourne, Australia, and in infectious diseases as a CDC assignee at the University of Washington Medical Center in Seattle. He joined CDC in 1984 as an EIS officer in the Epidemiology Section of what was then known as the AIDS Activity, NCID. He remained in CDC's evolving AIDS program through 1998, working on many high-profile investigations and serving in various leadership positions including section chief and then later branch chief of the Surveillance Branch in the Division of HIV/AIDS, NCID. He became editor of the MMWR in 1998.

The recipient of numerous CDC and PHS [Public Health Service] awards, Dr. Ward is a member of the Emory University School of Medicine clinical faculty and is active on many public health planning and steering committees. He is the author or coauthor of more than 100 scientific publications and serves as a peer reviewer for numerous journals including the American Journal of Public Health, JAMA [Journal of the American Medical Association], and Annals of Internal Medicine.

Please join me both in thanking Dr. Eric Mast for his excellent service as acting director, DVH, for the past six months and in congratulating John and supporting him in his new position.

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February 22, 2005
CDC REPORTS ON HEPATITIS A VACCINATION COVERAGE AMONG U.S. CHILDREN AGES 24-35 MONTHS DURING 2003

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 02/21/05.]

CDC published "Hepatitis A Vaccination Coverage Among Children Aged 24-35 Months--United States, 2003" in the February 18 issue of MMWR. The article is reprinted below in its entirety with the exception of one table, one figure, and references.

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Hepatitis A vaccine was first licensed in the United States in 1995. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended vaccination of children aged >=24 months in populations with the highest incidence of hepatitis A (e.g., American Indian/Alaska Native [AI/AN], Asian/Pacific Islander, and selected Hispanic and religious communities). In 1999, these guidelines were expanded to recommend routine vaccination for children residing in 11 states where average annual hepatitis A incidence during 1987-1997 was at least 20 per 100,000 population (twice the national average) and to consider routine vaccination for children in six states where average annual incidence was 10-20 per 100,000 population. This report is the first national analysis of hepatitis A vaccination coverage among children. The results indicate that, in 2003, vaccination coverage levels with at least 1 dose of hepatitis A vaccine for children aged 24-35 months varied from 6.4% to 72.7% in areas where routine vaccination is recommended. In addition, hepatitis A vaccination coverage rates for children aged 24-35 months are lower than overall rates for other vaccines recommended for children. Sustaining and improving vaccination coverage among young children is needed to ensure continued declines in hepatitis A incidence in the United States.

The National Immunization Survey (NIS) provides annual estimates of vaccination coverage as of the time of household interview among children aged 19-35 months for the 50 states and 28 selected urban areas. In 2003, NIS began to collect data regarding hepatitis A vaccination coverage. Hepatitis A vaccine is a 2-dose regimen (administered at least 6 months apart) licensed for use in children aged >=24 months. Hepatitis A vaccination coverage data were limited to children aged 24-35 months and calculated by considering children who had received at least 1 vaccine dose. To collect vaccination data for all age-eligible children, NIS uses a quarterly, random-digit-dialing sample of telephone numbers for each of the 78 survey areas and determines vaccination status from healthcare provider records. During 2003, information on vaccination history was collected from telephone interviews for 19,979 children; provider verified vaccination records were available for 13,731 (68.7%).

Among children aged 24-35 months residing in the 11 states where routine hepatitis A vaccination is recommended, 50.9% (95% confidence interval [CI] = 47.6%-54.2%; range among states: 6.4%-72.7%) received at least 1 dose of hepatitis A vaccine. Among children aged 24-35 months residing in the six states where routine hepatitis A vaccination should be considered, 25.0% (CI = 21.8%-28.2%; range: 0.6%-32.3%) had received at least 1 dose of hepatitis A vaccine. Among children aged 24-35 months residing in the 33 states without a specific recommendation, 1.4% (CI = 1.0%-1.8%; range: 0.0%-4.3%) had received at least 1 dose of hepatitis A vaccine. Two states (Alaska and Arizona) and four urban areas had coverage estimates >60%. Hispanic and AI/AN children had higher coverage rates than non-Hispanic white or black children in areas where routine vaccination is recommended or should be considered.

Editorial Note:

The national hepatitis A vaccination coverage estimates described in this report indicate that, in 2003, current hepatitis A childhood vaccination recommendations were being implemented in many states. However, coverage varied among areas and populations, likely because of targeted programs within these states. For example, higher coverage in El Paso County, Texas (71%), compared with the overall Texas coverage rate (32%), likely is attributable to vaccination requirements in Texas border counties for all children attending child care programs.

Vaccination coverage also varied by race/ethnicity. Higher coverage among Hispanic and AI/AN children than among children of other racial/ethnic populations might be related to greater disease recognition in these populations and local and national vaccination recommendations that have identified these populations as having higher hepatitis A rates.

The findings in this report are subject to at least three limitations. First, NIS is a telephone survey; although statistical weights adjust for nonresponse and households without telephones, some bias might remain. Second, although NIS relies on provider-verified vaccination histories, incomplete records or reporting could result in underestimates of coverage. Finally, although national estimates are reliable, estimates for states and urban areas and for racial/ethnic populations should be interpreted with caution. The 1999 ACIP hepatitis A prevention recommendations encouraged state and local immunization programs to analyze their surveillance data and implement vaccination strategies that address the epidemiology of hepatitis A in their areas. The variation by state in coverage among children aged 24-35 months likely reflects the varying vaccination strategies adopted by state and local public health officials in response to the ACIP recommendations. Higher coverage among Hispanic and AI/AN children is one indication that vaccination efforts targeting children at higher risk for illness have been successful.

These data do not provide information on why hepatitis A vaccination coverage for children aged 24-35 months remains below that for other childhood vaccinations in most areas where it is recommended. Low coverage rates for young children might be the result of (1) a focus by healthcare providers and immunization programs on vaccinating older children, (2) the few areas with hepatitis A vaccine mandates, or (3) the lack of a licensed hepatitis A vaccine that can be administered to children aged <24 months. Sustaining and improving vaccination coverage among young children is needed to ensure continued declines in hepatitis A incidence in the United States.

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To access a web-text (HTML) version of this article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a1.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5406.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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February 22, 2005
NATIONAL INSTITUTES OF HEALTH RELEASES ACTION PLAN FOR LIVER DISEASE RESEARCH

The National Institutes of Health (NIH) has developed an Action Plan for Liver Disease Research. The goal of the Action Plan is to advance research on liver and biliary diseases with the aim of decreasing the burden of liver and biliary diseases in the United States.

At present, an estimated 5.5 million Americans have chronic liver disease or cirrhosis, and more than 20 million have gallbladder disease. The impact of liver and biliary diseases is considerable, whether viewed in terms of the number of individuals affected; the severity of the disease and its frequency of fatality; the economic costs to the U.S. health system; as well as those disease outcomes that are less readily quantifiable, but are important on a personal scale, such as disability and quality of life.

The Action Plan for Liver Disease Research can be downloaded from the National Institute of Diabetes & Digestive & Kidney Diseases website at
http://www.niddk.nih.gov/fund/divisions/ddn/ldrb/ldrb_action_plan.htm

Free single copies can be ordered by calling 800-891-5389, or by emailing nddic@info.niddk.nih.gov and providing your name, mailing address, telephone number, and email address.
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February 22, 2005
DHHS ADDS HBV AND HCV TO LIST OF KNOWN CARCINOGENS

The U.S. Department of Health and Human Services (DHHS) has added 17 new substances to the list of cancer-causing agents included in the Eleventh Edition of the Report on Carcinogens. The report now lists 246 carcinogens, 58 of which are "known" to cause cancer in humans and 188 of which are "reasonably anticipated" to cause cancer.

For the first time, the report includes three viruses, the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the human papillomavirus (HPV), all added to the "known" carcinogen category.

To read or download the Eleventh Edition of the Report on Carcinogens go to:
http://ntp.niehs.nih.gov/ntp/roc/toc11.html
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February 22, 2005
CDC REPORTS AFRICAN AMERICANS HAVE TWICE THE INCIDENCE RATE FOR HEPATITIS B AND STREPTOCOCCUS PNEUMONIAE AS WHITES

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 01/18/05.]

CDC published "Racial Disparities in Nationally Notifiable Diseases--United States, 2002" in the January 14 issue of MMWR. The January 14 issue is the third in a MMWR series that focuses on racial/ethnic health disparities. An analysis of surveillance data collected in 2002 indicates that incidence rates are at least two times greater for African Americans than for white Americans for eight of 42 nationally notifiable diseases. Among those are two vaccine-preventable diseases, hepatitis B and Streptococcus pneumoniae. Portions of an article dealing with these issues are reprinted below.

***********************

Infectious diseases are a major cause of morbidity, mortality, and disability in the United States and often affect racial/ethnic populations disproportionately. Eliminating racial disparities is a goal of many of the national health objectives for 2010. To estimate racial disparities in the incidence of nationally notifiable infectious diseases by race/ethnicity, CDC reviewed 2002 data from the Nationally Notifiable Diseases Surveillance System (NNDSS), collected through the National Electronic Telecommunications System for Surveillance (NETSS). This report summarizes the results of that analysis, which indicated that incidence rates were at least two times greater for blacks than whites for eight of 42 nationally notifiable diseases . . . . for hepatitis B, [the rates were] 3.9 for blacks and 1.5 for whites; and for Streptococcus pneumoniae (i.e., invasive, drug resistant), 1.5 for blacks and 0.7 for whites.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a4.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5401.pdf
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February 22, 2005
EPA PUBLISHES UPDATED GUIDANCE ABOUT SAFE NEEDLE/SHARPS DISPOSAL

[The following is excerpted with thanks from the SIGNPost electronic newsletter, 01/12/05.]

In December 2004, the Environmental Protection Agency (EPA) issued new guidance about how the general public should handle syringes and other sharps generated at home or at locations not in healthcare facilities.

The new guidance is in two brochures:

"Protecting Your Community from Sharps: Options for Safe Disposal of Sharps"
http://www.epa.gov/epaoswer/other/medical/med-govt.pdf

"Protect Yourself, Protect Others: Safe Options for Needle Disposal"
http://www.epa.gov/epaoswer/other/medical/med-home.pdf

The guidance suggests that syringe users dispose of used syringes in ways that keep the sharps out of the trash/solid waste. The goal for keeping the sharps out of solid waste is to protect workers along the solid waste "stream" and at land fills.

The previous EPA guidance recommended collecting used sharps/syringes in containers and placing the sharps-filled containers in household trash. . .

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"SIGNpost" is a free weekly electronic forum about safe and appropriate use of injections. To subscribe, go to:
http://www.who.int/injection_safety/newsletter/SIGNPost/en

To visit the SIGN Alliance website, go to:
http://www.who.int/injection_safety/sign/en
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February 22, 2005
HEPATITIS B FOUNDATION ESTABLISHES NEW RESEARCH INSTITUTE

The Hepatitis B Foundation (HBF) recently announced the opening of its new research partner, the Institute for Hepatitis and Virus Research (IHVR), also known as the Pennsylvania Commonwealth Institute.

The IHVR mission is to use discovery science to find new therapies and early detection markers for viral hepatitis and liver cancer. The innovative programs of IHVR include an 80,000-compound library and screening program for anti-hepatitis drug discovery, and a proteomics facility that utilizes sophisticated technology to examine proteins from those infected with hepatitis B and C for use as potential markers for early detection of disease.

For more information about this new research institute, visit
http://www.ihvr.org
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February 22, 2005
NEW RESOURCES ABOUT PREVENTING OCCUPATIONAL EXPOSURE TO BLOODBORNE PATHOGENS AVAILABLE

The following are two new resources for those interested in preventing occupational exposure to bloodborne pathogens.

"Eye of the Needle: Surveillance of Significant Occupational Exposure to Bloodborne Viruses in Healthcare Workers. Centre for Infections; England, Wales and Northern Ireland Seven-Year Report: January 2005" is a publication of the U.K.'s Health Protection Agency.

To download this document, go to:
http://www.hpa.org.uk/infections/topics_az/bbv/pdf/eye_of_the_needle.pdf

"Preventing Occupational Exposures to Bloodborne Pathogens: Articles from Advances in Exposure Prevention, 1994-2003" is a new book from the International Healthcare Worker Safety Center at the University of Virginia. The book includes 70 collected articles of interest, and practical information on reducing bloodborne exposures in the workplace and complying with OSHA standards.

The book costs $25, including shipping and handling. The table of contents and ordering information can be accessed by clicking here.
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February 22, 2005
RESOURCES FOR SAFER TATTOOING IN PRISONS AVAILABLE ONLINE

Prisoners' HIV/AIDS Support Action Network (PASAN), a Canadian community-based network of prisoners, ex-prisoners, organizations, and activists working together to provide advocacy, education, and support to prisoners on HIV/AIDS, HCV, and related issues, offers online resources on safer tattooing in prison.

Specific print pieces include

"Driving the Point Home: A Strategy for Safer Tattooing in Canadian Prisons"
http://www.pasan.org/Publications/Driving_The_Point_Home.pdf

"Tattooing and You: The Safeguards within Prison"
http://www.pasan.org/Publications/Tattooing_&_You.pdf

"Safe Tattooing"
http://www.pasan.org/Publications/Safe_Tattooing.pdf

PASAN also offers information for injecting drug users and for those infected with HIV/AIDS. Visit their website at http://www.pasan.org and click on "Library."
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February 22, 2005
JOURNAL ARTICLES YOU MAY HAVE MISSED

The following recent journal articles present research related to viral hepatitis prevention or treatment.

"Effects of an Intensive Street-Level Police Intervention on Syringe Exchange Program Use in Philadelphia, Pa."
Authors: Davis CS, Burris S, Kraut-Becher J, Lynch KG, Metzger D
Source: American Journal of Public Health, February 2005, Vol. 95(2):233-6
Click here for abstract.

"Social Context, Sexual Networks, and Racial Disparities in Rates of Sexually Transmitted Infections"
Authors: Adimora AA, Schoenbach VJ
Source: Journal of Infectious Diseases, February 1, 2005, Vol. 191(Suppl 1):S115-122
Click here for abstract.

"Vaccination in the County Jail as a Strategy to Reach High Risk Adults During a Community-Based Hepatitis A Outbreak Among Methamphetamine Drug Users"
Authors: Vong S, Fiore AE, Haight DO
Source: Vaccine, January 11, 2005, Vol. 23(8):1021-8
Click here for abstract.

"Incidence of Hepatitis C Virus and HIV Among New Injecting Drug Users in London: Prospective Cohort Study"
Authors: Judd A, Hickman M, Jones S, McDonald T, Parry JV, Stimson GV, Hall AJ
Source: BMJ, January 1, 2005, Vol. 330(7481):24-5
Click here for abstract.

"Inmate Peer Education Programs: 101"
Author: Simmons TM
Source: Infectious Diseases in Corrections Report, Brown University Medical School, December 2004
http://www.idcronline.org/archives/dec04/peered.html

"Co-occurring Hepatitis C, Substance Use, and Psychiatric Illness: Treatment Issues and Developing Integrated Models of Care"
Authors: Sylvestre DL, Loftis JM, Hauser P, et al.
Source: Journal of Urban Health, December 2004, Vol.81(4):719-734
Click here for abstract.

"Sudden Rise in Uptake of Hepatitis B Vaccination Among Injecting Drug Users Associated with a Universal Vaccine Programme in Prisons"
Authors: Hutchinson SJ, Wadd S, Taylor A
Source: Vaccine, November 25, 2004, Vol. 23(2):210-214
Click here for abstract.

"Frequent Hepatitis C Virus Superinfection in Injection Drug Users"
Authors: Herring BL, Page-Shafer K, Tobler LH, Delwart EL
Source: Journal of Infectious Diseases, October 15, 2004, Vol. 190(8):1396-1403
Click here for abstract.


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