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Hep Express Issue 4

(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:

  1. 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.
     
  2. 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.
     
  3. 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:

  1. If you are supplying the birth dose of hepatitis B vaccine to hospitals, those hospitals must be registered VFC providers.

  2. 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.

  3. 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.

  4. 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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