| Issue Number
4, June 6, 2003 |
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| Contents of this Issue |
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(1 of 8)
June 6, 2003
VACCINES FOR CHILDREN (VFC) PROGRAM SUPPORTS A UNIVERSAL HEPATITIS B BIRTH DOSE
POLICY
The Vaccines for Children (VFC) program recently agreed to support requests from
grantees for four doses of hepatitis B vaccine for routine vaccination of
infants. VFC based its decision on the Advisory Committee on Immunization
Practices' preference for giving all infants the birth dose of hepatitis B
vaccine before hospital discharge and on reports of numerous errors in perinatal
hepatitis B prevention.
In a memorandum dated June 2, Lance E. Rodewald, MD, Director, Immunization
Services Division, National Immunization Program at CDC, outlined the VFC
program's rationale for making the decision and listed eligibility criteria for
purchasing hepatitis B vaccine with VFC funds. The memorandum is reprinted below
in its entirety, excluding one table.
**********************
Date: June 2, 2003
From: Director, Immunization Services Division/NIP
Subject: VFC Support for a Universal Hepatitis B Birth Dose Policy
To: Immunization Program Managers
The Advisory Committee on Immunization Practices (ACIP) and the National
Immunization Program (NIP) support the implementation of a universal hepatitis B
birth dose policy for several reasons:
-
Approximately 20,000 infants born to
hepatitis B surface antigen (HBsAg) positive women are born annually in the
United States. These infants require hepatitis B vaccine and hepatitis B immune
globulin (HBIG) within 12 hours of birth to prevent perinatal hepatitis B
transmission. However, because errors or delays in documenting, testing, and
reporting maternal HBsAg status can and do occur, administering the first dose
of hepatitis B vaccine soon after birth to all infants acts as a safety
net and reduces the risk for perinatal infection in infants whose mothers' HBsAg
status is either unknown or incorrectly documented at the time of delivery.
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Childhood transmission of hepatitis
B virus does occur in infants whose mothers are HBsAg negative but who are
exposed to persons in the household with chronic hepatitis B virus (HBV)
infection. Two out of three cases of childhood transmission occur in this manner
and these children could be protected with a birth dose of hepatitis B vaccine.
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Initiating the hepatitis B vaccine
series at birth has been shown to increase a child's likelihood of completing
the vaccine series according to the recommended childhood schedule.
As indicated in the 2003 Childhood
and Adolescent Immunization Schedule, the ACIP prefers the birth dose of
hepatitis B vaccine over vaccination after discharge from the hospital
recommending that "all infants should receive the first dose of hepatitis B
vaccine soon after birth and before hospital discharge; the first dose may also
be given by age two months if the infant's mother is HBsAg negative."
The VFC Resolution for hepatitis B (Resolution 02/03-1) also explicitly
indicates a preference for administering the first dose of hepatitis B vaccine
at birth, as outlined in the table on the following page. [The table is
available by clicking on the link at the end of this article.]
[TABLE]
Given the ACIP's preference for the birth dose of hepatitis B vaccine and its
preference for combination vaccines, the VFC Program will support requests from
grantees for four doses of hepatitis B vaccine for routine vaccination of
infants. Hospitals using VFC vaccine must enroll as VFC providers and must
screen for eligibility for the VFC program.
If your state is considering providing the hepatitis B vaccine birth dose to all
hospitals, please be aware of the following:
-
If you are supplying the birth dose
of hepatitis B vaccine to hospitals, those hospitals must be registered VFC
providers.
-
You may only supply VFC vaccine to a
hospital to cover children that are VFC-eligible. If you are supplying vaccine
for the hospital to cover all births, you must use vaccine purchased from 317 or
state funds to cover non-VFC-eligible children.
-
Please work with your hospitals to
make provider profiles as accurate as possible. Hospitals screen everyone for
insurance status and can easily tell you how many of their births are covered by
Medicaid, private insurance, or self-pay. This information can be used for
required VFC-eligibility screening in hospitals.
-
We are very concerned that hospitals
may bill for vaccine being supplied by the state. Please work with your
hospitals to assure that they are not billing insurance plans for vaccine
supplied by the state.
If you have any questions about
implementing a universal hepatitis B birth dose policy in your state, please do
not hesitate to contact Tasneem Malik at (404) 639-4213 or your VFC Consultant
at (404) 639-8222.
Original Signed By
Lance E. Rodewald, M.D.
Director
Immunization Services Division
National Immunization Program
**********************
To access the CDC memorandum (including the table showing the routine
recommended schedule for hepatitis B vaccination for infants born to hepatitis B
surface antigen negative mothers), from the website of the Immunization Action
Coalition, go to:
http://www.immunize.org/cdc/hepbmemo.pdf
For a wealth of information about the importance of the birth dose, go to the
Immunization Action Coalition birth dose web page at
http://www.immunize.org/birthdose
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(2 of 8)
June 6, 2003
AMERICAN ACADEMY OF PEDIATRICS PAPER REBUTS ARTICLE PURPORTING A
CONNECTION BETWEEN THIMEROSAL AND AUTISM
[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 6/02/03.]
In response to an article by Geier and Geier that has received
media attention, the American Academy of Pediatrics (AAP)
recently issued a paper, "Study Fails to Demonstrate a
Connection Between Thimerosal and Autism."
The paper informs clinicians about numerous flaws in the
article, which claims to show a correlation between thimerosal
and autism. The AAP advises clinicians that the Geiers' article
uses data from the Vaccine Adverse Event Reporting System
inappropriately and contains abundant conceptual and
scientific flaws, omissions of fact, inaccuracies, and
misstatements.
Titled "Thimerosal in Childhood Vaccines, Neurodevelopment
Disorders, and Heart Disease in the United States," the Geiers'
article was published in the "Journal of American Physicians and
Surgeons," Vol. 8, No. 1, Spring 2003.
To access a camera-ready (PDF) copy of the AAP paper, go to:
http://www.cispimmunize.org/pro/pdf/Geiersummary.pdf
To access a camera-ready (PDF) copy of the Geiers' article, go
to:
http://www.jpands.org/vol8no1/geier.pdf
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(3 of 8)
June 6, 2003
THREE NEW ARTICLES ABOUT PREVENTING HEPATITIS B IN WOMEN AND
CHILDREN
Three articles about preventing hepatitis B in women, infants,
and children were published in the past month.
"Summary--AAP Preference for Birth Dose of Hepatitis B"
summarizes the history of the American Academy of Pediatrics'
long-standing preference for the birth dose of hepatitis B
vaccine.
"Successful Promotion of Hepatitis B Vaccinations Among
Vietnamese-American Children Ages 3 to 18: Results of a
Controlled Trial" compares a media-led education campaign in
Houston, TX, and a community mobilization strategy in Dallas,
using Washington, D.C., as a control site.
"Impact of the Thimerosal Controversy on Hepatitis B Vaccine
Coverage of Infants Born to Women of Unknown Hepatitis B Surface
Antigen Status in Michigan" reports on hepatitis B vaccine birth
dose coverage during three periods; before July 1999,
immediately after recommendations changes, and March-April 2000.
Citations and links to abstracts follow:
"Summary--AAP Preference for Birth Dose of Hepatitis B"
Author: Saari TN
Source: Section on Infectious Diseases Newsletter, Spring 2003,
Vol. 6(1)
http://www.cispimmunize.org/pro/pdf/Hep%20B%20guidance.pdf
"Successful Promotion of Hepatitis B Vaccinations Among
Vietnamese-American Children Ages 3 to 18: Results of a
Controlled Trial"
Authors: McPhee SJ, Nguyen T, Euler GL, et al
Source: Pediatrics, June 2003, Vol. 111(6):1278-1288
http://pediatrics.aappublications.org/cgi/content/abstract/111/6/1278
"Impact of the Thimerosal Controversy on Hepatitis B Vaccine
Coverage of Infants Born to Women of Unknown Hepatitis B Surface
Antigen Status in Michigan"
Authors: Biroscak BJ, Fiore AE, Fasano N, Fineis P, Collins MP,
Stoltman G
Source: Pediatrics, June 2003, Vol. 111(6):e645-9
http://pediatrics.aappublications.org/cgi/content/abstract/111/6/e645
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(4 of 8)
June 6, 2003
IAC POSTS PRESENTATIONS FROM CDC'S 2003 NATIONAL HEPATITIS
COORDINATORS' CONFERENCE
[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 5/27/03.]
The Immunization Action Coalition (IAC) has collected plenary
and workshop presentations from CDC's 2003 National Hepatitis
Coordinators' Conference and made them available online. If you
weren't able to attend the conference in January (or even if you
were), you can access much of the information presented in San
Antonio from the comfort of your office or home.
Visit "National Hepatitis Coordinators' Conference 2003
Presentations" at
http://www.hepprograms.org/hepcoord/2003
Just a reminder to presenters at the 2003 National Hepatitis
Coordinators' Conference: if your presentation isn't available
on this page, it's not too late to add it! Just email your
PowerPoint presentation or Microsoft Word document to
becky@immunize.org
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(5 of 8)
June 6, 2003
KNOW SOMEONE WITH CHRONIC HEPATITIS B INFECTION? IF SO, BE SURE
TO TELL THEM ABOUT THE "B-INFORMED 2003" CONFERENCE!
[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 6/02/03.]
Sponsored by the Hepatitis B Foundation (HBF), "B-Informed 2003:
A Gathering of Friends" will be held July 20-22 at Delaware
Valley College, Doylestown, PA. Intended for patients, parents,
and families of persons affected by chronic hepatitis B, the
conference will give participants the opportunity to meet others
who understand what it's like to live with the disease and share
their personal experiences.
Samuel So, MD, Director, Asian Liver Center, Stanford, CA, will
give the keynote address, "Eliminating the Voodoo from
Hepatitis B." The conference program includes the latest updates
on research, drug treatments, and management of hepatitis B
given by scientific, medical, and pharmaceutical experts.
For information from the HBF website, go to:
http://www.hepb.org/2-00-02-416.hepb
To access the registration form, go to:
http://hepb.org/pdf/BInformed_registration.pdf
For additional information, email Sarah, the conference
coordinator, at sarah@hepb.org or call her at (215) 489-4900.
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(6 of 8)
June 6, 2003
NASTAD's "HIV PREVENTION BULLETIN" GOING EXCLUSIVELY ELECTRONIC
The National Alliance of State and Territorial AIDS Directors
(NASTAD) is changing the organization's method of distributing
its "HIV Prevention Bulletin" to an exclusively electronic
format. A print version of this publication will no longer be
available.
The "HIV Prevention Bulletin" is free and often includes
information about viral hepatitis in groups at high risk. To
continue or start receiving this resource, please send an email
to: bulletin@nastad.org
Please provide your name, position, agency, address, email
address, and phone number.
Back issues of the "HIV Prevention Bulletin" are available on
the NASTAD website at http://www.nastad.org Click on
"Publications" in the left column to access the Bulletin and
many other resources, including some specifically about viral
hepatitis.
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(7 of 8)
June 6, 2003
GAYHEALTH.COM LAUNCHES HEPATITIS AWARENESS CAMPAIGN
Stephen E. Goldstone, M.D., Director, GayHealth.com, announced a
new Hepatitis Awareness Campaign targeted toward men who have
sex with men. Dr. Goldstone writes, "The goal of the Campaign is
to educate gay men about hepatitis---not preaching or passing
judgments, but providing useful information."
The Campaign includes a new hepatitis page on the GayHealth.com
website. To access this page, go to:
http://www.gayhealth.com/templates/0/sex/hepatitis/index.html
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(8 of 8)
June 6, 2003
NEW: ENGLISH- AND SPANISH-LANGUAGE HEPATITIS B VACCINE
INFORMATION STATEMENTS AVAILABLE IN AUDIO FORMAT
[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 6/02/03.]
The hepatitis B Vaccine Information Statements (VISs) in English
and Spanish are available in audio format for the first time as
links on the Immunization Action Coalition (IAC) website. IAC
gratefully acknowledges Healthy Roads Media, National Library of
Medicine Multilingual Health Education Resource Project for
providing the audio versions.
To access the VISs in audio format from the IAC website, go to:
http://www.immunize.org/vis/index.htm#hepatitisb and click on
either English Audio VIS or Spanish Audio VIS.
To obtain a camera-ready (PDF) copy of the hepatitis B VIS in
English, go to: http://www.immunize.org/vis/hepb01.pdf
To obtain a camera-ready (PDF) copy of the hepatitis B VIS in
Spanish, go to: http://www.immunize.org/vis/sphepb01.pdf
For information on the use of VISs, and for VISs in a total of
28 languages, visit IAC's VIS web page at
http://www.immunize.org/vis
For information about Healthy Roads Media, go to:
http://www.healthyroadsmedia.org
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