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Hep Express Issue 51

Issue Number 51, January 10, 2007
 
Contents of this Issue
1. New: CDC issues ACIP's recommendations on elimination of hepatitis B virus infection in U.S. adults
2. New: CDC launches website to promote implementation of revised hepatitis B immunization recommendations for adults
3. Please consider a contribution to support IAC's work!
4. Subscribe to IAC publications! They're free!
5. New: Current Issues in Immunization Net Conference to focus on new adult hepatitis B and Tdap recommendations
6. New: CDC issues ACIP's General Recommendations on Immunization
7. New: CDC, AAP, and AAFP release the 2007 recommended immunization schedules for persons ages 0–18 years
8. IAC revises five pieces related to viral hepatitis
9. A must for every exam room: IAC's laminated U.S. adult immunization schedule—updated for 2006-07
10. Hepatitis B Foundation offers online CME course about hepatitis B in Asian and Pacific Islanders
11. Viral Hepatitis Prevention Board adds new resources to its website
12. Digestive Disease Week to be held in Washington, DC, May 19–24

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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January 10, 2007
NEW: CDC ISSUES ACIP'S RECOMMENDATIONS ON ELIMINATION OF HEPATITIS B VIRUS INFECTION IN U.S. ADULTS

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 12/11/06.]

CDC published "A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Part II: Immunization of Adults" in the December 8 issue of MMWR Recommendations and Reports. The summary and the section on major updates to the recommendations are reprinted below.

Also on December 8, John W. Ward, MD, sent a Dear Colleague letter to health professionals outlining the multifaceted strategy ACIP has recommended to increase hepatitis B vaccination coverage among adults. Dr. Ward is director; Division of Viral Hepatitis; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed); CDC. A link to Dr. Ward's letter appears at the end of this article.

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SUMMARY
Hepatitis B vaccination is the most effective measure to prevent hepatitis B virus (HBV) infection and its consequences, including cirrhosis of the liver, liver cancer, liver failure, and death. In adults, ongoing HBV transmission occurs primarily among unvaccinated persons with behavioral risks for HBV transmission (e.g., heterosexuals with multiple sex partners, injection-drug users [IDUs], and men who have sex with men [MSM]) and among household contacts and sex partners of persons with chronic HBV infection.

This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for HBV infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005; 54 [No. RR-16]:1-33).

In settings in which a high proportion of adults have risks for HBV infection (e.g., sexually transmitted disease/human immunodeficiency virus testing and treatment facilities, drug-abuse treatment and prevention settings, healthcare settings targeting services to IDUs, healthcare settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, healthcare providers should inform all patients about the health benefits of vaccination, including risks for HBV infection and persons for whom vaccination is recommended, and vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, healthcare providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination. . . .

MAJOR UPDATES TO THE RECOMMENDATIONS
This report updates ACIP recommendations published previously for hepatitis B vaccination of adults. The primary changes from previous recommendations are as follows:

  • In settings in which a high proportion of persons are likely to be at risk for HBV infection (e.g., STD/HIV testing and treatment facilities, drug-abuse treatment and prevention settings, healthcare settings targeting services to IDUs, healthcare settings targeting services to MSM, and correctional facilities), ACIP recommends universal hepatitis B vaccination for all adults who have not completed the vaccine series.
     
  • In primary care and specialty medical settings, ACIP recommends implementation of standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine services. To ensure vaccination of adults at risk for HBV infection who have not completed the vaccine series, ACIP recommends the following implementation strategies:
     
    • Provide information to all adults regarding the health benefits of hepatitis B vaccination, including risk factors for HBV infection and persons for whom vaccination is recommended.
       
    • Help all adults assess their need for vaccination by obtaining a history that emphasizes risks for sexual transmission and percutaneous or mucosal exposure to blood.
       
    • Vaccinate all adults who report risks for HBV infection.
       
    • Vaccinate all adults requesting protection from HBV infection, without requiring them to acknowledge a specific risk factor. . . .

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To access a ready-to-print (PDF) version of the recommendations, which includes Appendices A, B, and C, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf

Note: The PDF version includes a free CDC-sponsored education activity that can be completed online or submitted by U.S. mail for CME, CEU, or CNE credit. Simply read the primer, answer the questions at the end, and follow instructions for submitting your answers.

To access a web-text (HTML) version of the body of the recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a1.htm

To access a web-text (HTML) version of Appendix A: Immunization Management Issues, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a2.htm

To access a web-text (HTML) version of Appendix B: Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a3.htm

To access a web-text (HTML) version of Appendix C:  Identification and Management of Hepatitis B Surface Antigen (HBsAg)-Positive Persons, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a4.htm

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

To access Dr. Ward's Dear Colleague letter, go to:
http://www.immunize.org/acip/hepbrecs06.pdf

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January 10, 2007
NEW: CDC LAUNCHES WEBSITE TO PROMOTE IMPLEMENTATION OF REVISED HEPATITIS B IMMUNIZATION RECOMMENDATIONS FOR ADULTS

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 12/11/06.]

CDC has developed a new website to promote implementation of the revised adult hepatitis B immunization recommendations. It includes educational and other materials specifically designed for each setting where hepatitis B vaccination is recommended for adults, such as settings serving adults at high risk for contracting hepatitis B virus infection, primary care and specialty medical settings, and occupational health providers.

The new website is titled Hepatitis B Recommendations for Adults. To access it, go to:
http://www.cdc.gov/ncidod/diseases/hepatitis/recs
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January 10, 2007
PLEASE CONSIDER A CONTRIBUTION TO SUPPORT IAC'S WORK!

Dear Colleague,

As 2007 dawns, we are publishing our fifty-first issue of Hep Express. We also publish IAC Express, as well as three periodicals, in addition to maintaining four websites. I thought it would be good to remind those of you who might wish to support IAC's work that we are a 501(c)3 charitable organization.

To donate, visit https://www.immunize.org/aboutus/supportiac.asp or send a check to Immunization Action Coalition, 1573 Selby Ave., Saint Paul, MN 55104.

Let me take this opportunity to thank you for your support---financial and otherwise---and to tell you how much all of us at IAC look forward to continuing our collaboration with you during 2007.


Warm regards,

Deborah L. Wexler, MD
Executive Director
deborah@immunize.org
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January 10, 2007
SUBSCRIBE TO IAC'S PUBLICATIONS! THEY'RE FREE!

We want to make sure you know how easy it is to subscribe to IAC's free publications. Simply visit http://www.immunize.org/subscribe and choose the publications you would like to receive (described below):

NEEDLE TIPS: Our semi-annual 24-page flagship print publication includes the popular "Ask the Experts" section, featuring CDC's widely acclaimed experts on immunization.

VACCINATE ADULTS: Our semi-annual 12-page print publication is written specifically for adult medicine specialists.

VACCINATE WOMEN: Our annual 12-page print publication is written specifically for women's health specialists.

IAC EXPRESS: This weekly email news service includes breaking information about all vaccines and immunization issues.

We do not share your contact information with others. Also, you may unsubscribe whenever you wish.

Even though you already receive HEP EXPRESS, please fill out the form at http://www.immunize.org/subscribe, indicating all the publications you wish to receive (including those you already receive). We'll remove duplicates from our mailing lists so that you don't get two copies.

Finally, we would greatly appreciate your forwarding this invitation to your colleagues who work in immunization and/or hepatitis prevention or treatment, whether in medical practices, health departments, hospitals, health plans, corporations, or wherever else people care about immunization or hepatitis information. IAC's goal is to get its information into the hands of all people who work on making sure everyone is vaccinated.

Please let us know at any time if IAC might be able to assist you.

In the meantime, we look forward to sending you the additional IAC publications, so make your selections today by signing up at http://www.immunize.org/subscribe
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January 10, 2007
NEW: CURRENT ISSUES IN IMMUNIZATION NET CONFERENCE TO FOCUS ON NEW ADULT HEPATITIS B AND TDAP RECOMMENDATIONS

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 1/2/07.]

Scheduled for January 18, 2007, from noon to 1PM ET, the net conference Current Issues in Immunization is designed to provide clinicians with up-to-date information on immunization. The program has two primary topics: (1) new adult hepatitis B vaccine recommendations and (2) new adult Tdap recommendations.

The conference requires pre-registration, as space is limited. Registration will close when the course is full or on January 17, 2006 (midnight ET). To register for the conference, go to: http://www2.cdc.gov/nip/isd/ciinc

The program will combine a telephone audio conference with simultaneous online visual content. It will allow for a question and answer segment both by telephone and Internet. Internet access and a separate phone line are needed to participate.

For instructions and system requirements, go to:
http://www.cdc.gov/nip/ed/ciinc/instructions.htm

For additional information, go to: nipinfo@cdc.gov
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January 10, 2007
NEW: CDC ISSUES ACIP'S GENERAL RECOMMENDATIONS ON IMMUNIZATION

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 12/4/06.]

On December 1, CDC published "General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)" in the MMWR Recommendations and Reports. Last issued in 2002, the recommendations now cover the following topics: (1) timing and spacing of immunobiologics, (2) contraindications and precautions, (3) vaccine administration, (4) altered immunocompetence, (5) special situations, (6) vaccination records, (7) reporting adverse events after vaccination, (8) vaccination programs, and (9) vaccine information sources.

The 2006 revision of the General Recommendations features visual elements, such as diagrams, images, and tables. Following are some of the more notable additions: (1) an updated table of contraindications and precautions to commonly used vaccines, (2) images displaying the correct administration site for intramuscular and subcutaneous injections for infants and adults, (3) a table outlining the treatment of anaphylaxis, (4) a table comparing the advantages and disadvantages of various types of thermometers used to monitor vaccine storage temperatures, and much more.

The Summary, which outlines significant changes made to the General Recommendations, is reprinted below in its entirety.

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

SUMMARY
This report is a revision of General Recommendations on Immunization and updates the 2002 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices and the American Academy of Family Physicians. MMWR 2002;51[No. RR-2]). This report is intended to serve as a general reference on vaccines and immunization. The principal changes include (1) expansion of the discussion of vaccination spacing and timing; (2) an increased emphasis on the importance of injection technique/age/body mass in determining appropriate needle length; (3) expansion of the discussion of storage and handling of vaccines, with a table defining the appropriate storage temperature range for inactivated and live vaccines; (4) expansion of the discussion of altered immunocompetence, including new recommendations about use of live-attenuated vaccines with therapeutic monoclonal antibodies; and (5) minor changes to the recommendations about vaccination during pregnancy and vaccination of internationally adopted children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommendations for each vaccine, and other information about vaccination can be accessed at CDC's National Center for Immunization and Respiratory Diseases (proposed; formerly known as the National Immunization Program) website at http://www.cdc.gov/nip

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To access a web-text (HTML) version of the General Recommendations, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5515a1.htm

To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr5515.pdf

Note: The PDF version includes a free CDC-sponsored education activity that can be completed online or submitted by U.S. mail for CME, CEU, CNE, CHES, or CPE credit. Simply read the primer, answer the questions at the end, and follow instructions for submitting your answers.
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January 10, 2007
NEW: CDC, AAP, AND AAFP RELEASE THE 2007 RECOMMENDED IMMUNIZATION SCHEDULES FOR PERSONS AGES 0-18 YEARS

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 1/8/07.]

CDC, AAP, and AAFP have endorsed and released the "Recommended Immunization Schedules for Persons Aged 0-18 Years—United States, 2007". On January 5, CDC published the schedule as an MMWR QuickGuide; it is reprinted below in its entirety, excluding references, two figures, and a table.

Additional materials. AAP published an article about the 2007 schedule in the January 2007 issue of the journal Pediatrics and also issued a press release. CDC issued a press release about the schedule. Links to the Pediatrics article, AAP press release, and CDC press release are given at the end of this IAC Express article.

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

The Advisory Committee on Immunization Practices (ACIP) periodically reviews the recommended immunization schedule for persons aged 0-18 years to ensure that the schedule is current with changes in vaccine formulations and reflects revised recommendations for the use of licensed vaccines, including those newly licensed.

The changes to the previous childhood and adolescent immunization schedule, published January 2006, are as follows:

  • The new rotavirus vaccine (Rota) is recommended in a 3-dose schedule at ages 2, 4, and 6 months. The first dose should be administered at ages 6 weeks through 12 weeks with subsequent doses administered at 4-10 week intervals. Rotavirus vaccination should not be initiated for infants aged >12 weeks and should not be administered after age 32 weeks.
     
  • The influenza vaccine is now recommended for all children aged 6-59 months.
     
  • Varicella vaccine recommendations are updated. The first dose should be administered at age 12-15 months, and a newly recommended second dose should be administered at age 4-6 years.
     
  • The new human papillomavirus vaccine (HPV) is recommended in a 3-dose schedule with the second and third doses administered 2 and 6 months after the first dose. Routine vaccination with HPV is recommended for females aged 11-12 years; the vaccination series can be started in females as young as age 9 years; and a catch-up vaccination is recommended for females aged 13-26 years who have not been vaccinated previously or who have not completed the full vaccine series.
     
  • The main change to the format of the schedule is the division of the recommendation into two schedules: one schedule for persons aged 0-6 years and another for persons aged 7-18 years. Special populations are represented with purple bars; the 11-12 years assessment is emphasized with the bold, capitalized fonts in the title of that column. Rota, HPV, and varicella vaccines are incorporated in the catch-up immunization schedule.

Vaccine Information Statements
The National Childhood Vaccine Injury Act requires that healthcare providers provide parents or patients with copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedule. Additional information is available from state health departments and from CDC at http://www.cdc.gov/nip/publications/vis

Detailed recommendations for using vaccines are available from package inserts, ACIP statements on specific vaccines, and the 2003 Red Book. ACIP statements for each recommended childhood vaccine are available from CDC at http://www.cdc.gov/nip/publications/acip-list.htm In addition, guidance for obtaining and completing a Vaccine Adverse Event Reporting System form is available at http://www.vaers.hhs.gov or by telephone, (800) 822-7967.

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To access a ready-to-print (PDF) version of the MMWR QuickGuide, go to:
http://www.cdc.gov/mmwr/pdf/wk/mm5551-Immunization.pdf

To access a web-text (HTML) version of it, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5551a7.htm

Additional material
AAP. In the January 2007 issue of Pediatrics, AAP published "Recommended Immunization Schedules for Children and Adolescents—United States, 2007" as a policy statement from its Committee on Infectious Diseases.

To access a ready-to-print (PDF) version of the article, go to:
http://pediatrics.aappublications.org/cgi/content/full/119/1/207

On January 2, AAP issued a press release, "AAP Issues Recommended 2007 Immunization Schedule."

To access it, go to:
http://www.aap.org/advocacy/releases/jan07immsch.htm

CDC. On January 4, CDC issued a press release, "Health Groups Release New Immunization Schedules."

To access it, go to:
http://www.cdc.gov/od/oc/media/pressrel/2007/r070104.htm
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January 10, 2007
IAC REVISES FIVE PIECES RELATED TO VIRAL HEPATITIS

IAC recently revised five of its hepatitis-related education materials for health professionals, patients, and parents. Following is a list of the updated materials; it explains the changes made to each and gives the link to each:

For health professionals:
(1) "Does Your Patient Have Chronic Hepatitis B?" now has updated information about medical management of patients with chronic infection.

To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p2162.pdf

For patients:
(2) "Should You Be Vaccinated Against Hepatitis A? A screening questionnaire for adults" now tells patients that they can be vaccinated if they want to be protected against infection from the hepatitis A virus, even if they are not in one of the risk groups for the disease. If they are in a risk group, they do not need to indicate which one.

To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/2190hepa.pdf

(3) "Should You Be Vaccinated Against Hepatitis B? A screening questionnaire for adults" now tells patients that they can be vaccinated if they want to be protected against infection from the hepatitis B virus, even if they are not in one of the risk groups for the disease. If they are in a risk group, they do not need to indicate which one.

To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/2191hepb.pdf

(4) "Should You Be Tested for Hepatitis C? A screening questionnaire for adults" now informs patients that they can be tested for hepatitis C virus (HCV) without indicating if they are in a specific risk group for contracting HCV. In addition, minor revisions were also made.

To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/2192hepc.pdf

For parents:
(5) "Hepatitis B Shots Are Recommended for All New Babies" has been updated with the most current information about the birth dose.

To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p4110bab.pdf
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January 10, 2007
A MUST FOR EVERY EXAM ROOM: IAC'S LAMINATED U.S. ADULT IMMUNIZATION SCHEDULE—UPDATED FOR 2006-07

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 12/11/06.]

In 2006, IAC introduced the laminated version of CDC's adult immunization schedule—and healthcare providers made good use of it! We are now offering CDC's 2006-07 adult immunization schedule in laminated format. It provides comprehensive information on two new vaccines: Tdap (tetanus-diphtheria-acellular pertussis) and HPV (human papillomavirus), as well as updates that reflect changes to the immunization recommendations for hepatitis A and hepatitis B vaccines.

Did we mention that we've also reduced the price when you order five schedules or more?

IAC adapted the 2006-07 schedule from the one posted on the NIP and MMWR sections of CDC's website. Coated in durable plastic for heavy-duty use and printed in color for easy comprehension, the laminated schedule is formatted with essential footnotes. Following are details about the schedule, including pricing and ordering options.

The laminated schedule is based on the ACIP/AAFP/ACOG/ACP-approved Recommended Adult Immunization Schedule, Oct. 2006–Sept. 2007. The 4-sided, 11" x 17" schedule is printed back-to-back and folded to 8.5" x 11". To view it, go to:
http://www.immunize.org/immschedules/immschedule_adult.pdf

It is priced at $5 each for 1–4 copies, $3 each for 5–19 copies, and $2.80 each for 20-99 copies. Discount pricing is available for larger quantities.

Order online with a credit card, or order by mail or fax, using a credit card, check, or purchase order. Shipping is free within the United States. To order, go to:
http://www.immunize.org/immschedules

Questions? Email admin@immunize.org or call (651) 647-9009.
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January 10, 2007
HEPATITIS B FOUNDATION OFFERS ONLINE CME COURSE ABOUT HEPATITIS B IN ASIAN AND PACIFIC ISLANDERS

The Hepatitis B Foundation has developed an interactive web course that provides comprehensive information about the global burden of hepatitis B, with particular emphasis on the Asian and Pacific Islander population. "Hepatitis B in Asian and Pacific Islanders; Steps Towards Cultural Competency" is intended for physicians specializing in internal medicine, gastroenterology, or hepatology, as well as other healthcare or social service professionals conducting research or providing care for individuals with diseases of the liver.

The course is offered in collaboration with the University of New Mexico School of Continuing Medical Education.

To access the four modules of this online course, go to: http://www.hepb.org/hepb_course/API_course.php
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January 10, 2007
VIRAL HEPATITIS PREVENTION BOARD ADDS NEW RESOURCES TO ITS WEBSITE

The Viral Hepatitis Prevention Board (VHPB) website has been updated to include new resources.

The program, pre-meeting document, and most of the presentations from the November 2006 meeting, "Prevention and control of viral hepatitis in Spain: Lessons learnt and the way forward" are available online by going to the homepage at http://www.vhpb.org

Presentations from the March 2006 meeting, "Prevention and control of perinatal hepatitis B virus (HBV) transmission in the WHO European Region" are available online by going to the homepage at http://www.vhpb.org

The latest issue of Viral Hepatitis, Volume 14(2), can be accessed as a PDF document by clicking here.
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January 10, 2007
DIGESTIVE DISEASE WEEK TO BE HELD IN WASHINGTON, DC, MAY 19–24

Digestive Disease Week (DDW) is an educational opportunity for physicians and researchers in the fields of gastroenterology, hepatology, endoscopy, and gastrointestinal surgery. This year's DDW will be held in Washington, DC, on May 19–24.

Registration for member of AASLD, AGA, ASGE, and SSAT opens January 9. Individuals who are not members of any of these professional groups can register starting January 18.

For registration materials and the preliminary DDW program, go to: http://www.ddw.org


Nastad
www.nastad.org
nastad@nastad.org
          Hepatitis Prevention Programs
www.hepprograms.org
nastad@nastad.org

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