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March 28, 2007
CDC'S 2005 SURVEILLANCE OF ACUTE VIRAL HEPATITIS CASES INDICATES DRAMATIC DECLINE FROM 1995 TO 2005

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 3/19/07.]

On March 16, CDC issued a report, "Surveillance for Acute Viral Hepatitis—United States, 2005," in the MMWR Surveillance Summaries. The abstract is reprinted below. In addition, on March 15, CDC issued a press release on the topic; portions of it are reprinted below, following the Surveillance Summary abstract.

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ABSTRACT

Problem/Condition: In the United States, acute viral hepatitis most frequently is caused by infection with hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). These unrelated viruses are transmitted through different routes and have different epidemiologic profiles. Safe and effective vaccines have been available for hepatitis B since 1981, and for hepatitis A, since 1995.

Reporting Period: Cases in 2005, the most recent for which data are available, are compared with those from previous years.

Description of the System: Cases of acute viral hepatitis are reported to CDC via the National Notifiable Diseases Surveillance System.

Results: Since 1995, the incidence of reported acute hepatitis A has declined by 88%, to the lowest rate ever recorded (2005: 1.5/100,000 population). Declines were greater among children and in states where routine vaccination of children was recommended beginning in 1999, compared with the remaining states. The proportion of cases among adults has increased. Since 1990, reported acute hepatitis B incidence has declined by 79%, to the lowest rate ever recorded (2005: 1.8/100,000 population). Declines occurred among all age groups but were greatest among children aged <15 years. Since the late 1980s, acute hepatitis C incidence also has declined. In 2005, as in previous years, the majority of these cases occurred among adults, and injection-drug use was the most common risk factor.

Interpretation: The greater declines in hepatitis A rates among the states and age groups included in the 1999 recommendations for routine childhood hepatitis A vaccination suggest that this strategy reduced rates. Universal hepatitis B vaccination of children has resulted in substantially lower rates among younger age groups. Higher rates of hepatitis B continue among adults, particularly males aged 25-44 years, which emphasize the need to vaccinate adults at risk for HBV infection. The decline in hepatitis C incidence is primarily attributed to a decrease in incidence among injection-drug users (IDUs). The reasons for this decrease are multifactorial and are probably related to risk-reduction practices among IDUs.

Public Health Actions: The recent expansion of recommendations for routine hepatitis A vaccination to include all children in the United States aged 12-23 months is expected to further reduce hepatitis A rates. Ongoing hepatitis B vaccination programs will ultimately eliminate domestic HBV transmission, and increased vaccination of adults who have risk factors will accelerate progress toward elimination. Prevention of hepatitis C relies on identifying and counseling uninfected persons at risk for hepatitis C (e.g., IDUs) regarding ways to protect themselves from infection. . . .

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EXCERPTS FROM THE PRESS RELEASE

Acute Viral Hepatitis Cases Down; Hepatitis A and Hepatitis B at Lowest Levels Ever Reported

The three most common forms of acute viral hepatitis in the United States—hepatitis A, B, and C—declined dramatically between 1995 and 2005, with hepatitis A and B at the lowest levels ever recorded since the government began collecting surveillance data more than 40 years ago, according to the Centers for Disease Control and Prevention (CDC). Hepatitis B and C are diseases that can lead to liver cancer and death.

The main factor behind the declines in new cases of hepatitis A and B were the availability of vaccines and strong federally supported immunization programs. Declines in new cases of hepatitis A were greater among children in the 17 states where routine vaccination of children has been recommended since 1999. The declines in hepatitis B were greatest among children and teens age 15 and younger, likely the result of high vaccination coverage in this age group. The CDC recommends three doses of hepatitis B vaccine beginning at birth. Declines in reported new cases of hepatitis C were likely due to reductions in high-risk behaviors among injection drug users, as well as efforts to diagnose individuals infected with hepatitis C and the promotion of health behaviors to reduce person-to-person transmission of the virus.

Since 1995, new cases of reported acute hepatitis A have declined by 88 percent, to an incidence of 1.5 per 100,000 population, the lowest rate ever reported, according to the Morbidity and Mortality Weekly Report (MMWR) Surveillance Summary, "Surveillance for Acute Viral Hepatitis—United States, 2005."

"The sharp declines in rates of hepatitis A and B are one of the big public health success stories of the last 10 years. The drops in new cases of hepatitis A and hepatitis B are evidence that our prevention strategies have been successful, particularly the widespread use of vaccines for hepatitis A and hepatitis B. In order for these declines to continue, our prevention efforts must be sustained," said Dr. Kevin Fenton, director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. . . .

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To access a web-text (HTML) version of the MMWR Surveillance Summary go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5603a1.htm

To access a ready-to-print (PDF) version of it, go to:
http://www.cdc.gov/mmwr/PDF/ss/ss5603.pdf

To access the complete press release, go to:
http://www.cdc.gov/od/oc/media/pressrel/2007/r070315.htm

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(2 of 12)
March 28, 2007
INPUT REQUESTED REGARDING WORLD HEPATITIS AWARENESS EVENTS

Chris Taylor, viral hepatitis program manager at the National Alliance of State & Territorial AIDS Directors, requested we share the following letter with HEP Express readers.

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Delegates from Africa, Asia, Australia, Europe, and North and South America will be meeting next month to plan for a coordinated global effort to raise awareness and the profile of viral hepatitis epidemics. As the delegate representing North America, I am seeking input to share with organizers. As the steering committee begins to plan for World Hepatitis Awareness events in 2008, now is your opportunity to provide input.

Whether you are a person living with hepatitis, family, friend, medical or social service provider, researcher, public health professional, elected official or concerned citizen, your input is important! Your input will not only help inform organizers of the World Hepatitis Awareness Steering Committee, but may be shared with national as well as state/provincial planners as they begin planning events to observe World Hepatitis Awareness in 2008. If you would like to be a part of planning efforts at the national or state/provincial level, please indicate this on the survey.

If you would like to share your ideas with organizers, please complete the survey and return by Thursday, April 5, 2007. Thank you for your continued dedication and interest in viral hepatitis. Feel free to contact me with any questions.

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To access the survey referred to in the letter, go to:
http://www.immunize.org/WorldHepatitisAwarenessSurvey.doc

To contact Chris Taylor, email: ctaylor@NASTAD.org
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(3 of 12)
March 28, 2007
CALL YOUR U.S. SENATORS AND REPRESENTATIVES ABOUT SIGNING THE IMMUNIZATION APPROPRIATIONS LETTER

No government funds have been used to produce this article.

The 317 Coalition is requesting that people who support the U.S. immunization program contact their U.S. senators and representatives and ask them to sign on to a letter in support of increased funding for the 317 Program for federal Fiscal Year 2008 (FY 2008). The 317 Coalition is a national network of 136 organizations that advocates for increased funding for childhood, adolescent, and adult immunization programs.

You must contact your senators by April 4 and your representative by April 13.

For more information, for talking points to use when calling your legislators, and for instructions on how to contact their offices, please see the March 21 IAC Express at http://www.immunize.org/express/issue653.asp
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(4 of 12)
MARCH 28, 2007
MARCH 2007 ISSUE OF NEEDLE TIPS OFFERS MANY RESOURCES FOR CHILDHOOD, ADOLESCENT, AND ADULT IMMUNIZATION

IAC recently mailed the latest issue of Needle Tips (March 2007) to 160,000 health professionals and others who work in the field of immunization. Packed with immunization and hepatitis resources for health professionals, patients, and parents, the 24-page issue is well worth downloading. All articles and education pieces, except editorials, have been thoroughly reviewed by immunization and hepatitis experts at CDC.

HOW TO ACCESS NEEDLE TIPS 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/nt

The PDF file of the entire issue, linked below, is large. For tips on downloading and printing PDF files, go to:
http://www.immunize.org/nslt.d/tips.htm

To download a ready-to-print (PDF) version of the entire March issue, go to:
http://www.immunize.org/nslt.d/n36/n36.pdf
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(5 of 12)
March 28, 2007
REGISTER NOW FOR THE B INFORMED 2007 PATIENT CONFERENCE

The 7th Annual B Informed Patient Conference will be held in Philadelphia on June 8–9.

In collaboration with the Hepatitis B Information and Support List and the Chinese Health Information Center of Thomas Jefferson University, this year's conference will include a special afternoon Parents Session on Friday, June 8, featuring one of the nation's leading pediatric HBV specialists, Dr. Maureen Jonas, Children's Hospital of Boston. Information sessions will focus on new advances in treatments, healthy living with hepatitis B, discussing hepatitis B with family members and friends, and the basics of hepatitis B in English and Chinese.

View the complete program at
http://content.ll-0.com/hepbcure/B_Informed_program-2007.doc?i=032207153735

For more information, or to register online, go to: http://www.hepb.org/patients/patient_conference2007.htm There is no charge for conference registration.
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(6 of 12)
March 28, 2007
BAY AREA STUDENTS PROMOTE HEPATITIS B AWARENESS

During March 18–24, the Jade Ribbon Youth Council sponsored Hepatitis B Awareness Week activities in nine California cities in the Bay Area: Fremont, Milpitas, Palo Alto, San Ramon, Newark, Sunnyvale, Cupertino, Saratoga, and Los Altos.

The Jade Ribbon Youth Council is part of the Asian Liver Center at Stanford University and consists of 13 high school students. Because hepatitis B virus infection disproportionately affects Asian Americans, and because approximately 30% of the Bay Area is Asian, the council members thought it crucial to raise awareness of this problem in their community.

Activities included library case displays, tree decorations, mayoral proclamations, television and radio interviews, and informal lunchtime activities.

To read an article about this initiative in the California Chronicle, go to:
http://www.californiachronicle.com/articles/viewArticle.asp?articleID=22096

To visit the Asian Liver Center's (ALC) website, go to:
http://liver.stanford.edu

To read about all ALC high school programs, go to:
http://liver.stanford.edu/JRC/JRC_highschool.php
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(7 of 12)
March 28, 2007
ASIAN LIVER CENTER'S FREE "KNOW HBV" AND "HEPATITIS B AND MOMS-TO-BE" BROCHURES NOW IN KOREAN, LAO, AND TAGALOG

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 3/19/07.]

Two of the Asian Liver Center's brochures, "Know HBV: What every Asian and Pacific Islander should know about hepatitis B and liver cancer" and "Hepatitis B and Moms-to-Be," are now available in Korean, Lao, and Tagalog. Both are also available in English, Chinese, and Vietnamese.

To order them free of charge, go to:
http://liver.stanford.edu/ALC/ALC_order.php

To download them, go to: http://liver.stanford.edu/JRC/JRC_brochures.php and click on the pertinent link(s).
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(8 of 12)
March 28, 2007
APRIL 21—28 IS NATIONAL INFANT IMMUNIZATION WEEK; CDC'S ONLINE RESOURCES MAKE IT EASY TO PROMOTE

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 3/19/07.]

This year National Infant Immunization Week (NIIW) will again be held in conjunction with the Pan American Health Organization's Vaccination Week in the Americas (VWA), April 21-28. The U.S. will join 39 countries in the Western Hemisphere to concurrently promote the need for routine vaccinations for infants and children during the last week in April.

To assist communities in promoting infant immunization during NIIW, CDC posted the following English- and Spanish-language resources:

• Print ads
• Posters
• Web buttons and banners
• English- and Spanish-language television public service announcements (PSAs)
• Spanish-language radio PSA
• Sample key messages
• Sample media advisory
• Sample proclamation stickers
• Much more

To access these materials and planning tools, go to:
http://www.cdc.gov/nip/events/niiw
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(9 of 12)
March 28, 2007
NEW: JOURNAL OF FAMILY PRACTICE'S 2007 IMMUNIZATION SUPPLEMENT, "VACCINES ACROSS THE LIFE SPAN," NOW ONLINE

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 3/5/07.]

Published in February, the Journal of Family Practice's 2007 immunization supplement, "Vaccines Across the Life Span," is now available online. The 76-page supplement contains seven articles (titles below) and an 8-page color centerfold with pictures of vaccine-preventable diseases and immunization schedules.

Following are the titles of the seven articles:

1. HPV vaccine and its recommendations
2. Rotavirus disease and vaccine update
3. Recent changes in influenza vaccination recommendations
4. Routine vaccines across the life span
5. Vaccines for persons at high risk
6. Vaccine schedules and procedures
7. Addressing immunization barriers, benefits, and risks

To access the supplement online, go to: http://www.jfponline.com/pages.asp?id=1061 Scroll down to the subhead titled "Non-CME Supplements 2007," and click on the link titled "Vaccines Across the Life Span."
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(10 of 12)
March 28, 2007
TWO BOOKS FOR PARENTS—"BABY 411" AND "TODDLER 411"—OFFER SOUND VACCINATION INFORMATION

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 3/5/07.]

Written by Denise Fields and pediatrician Ari Brown, MD, "Baby 411" and "Toddler 411" offer parents "clear answers and sound advice," according to the book jackets. Each has a chapter on vaccinations that covers topics such as the following: vaccines and the diseases they stop, the biggest vaccine misconceptions, truths about vaccines, vaccine controversies, and vaccine shortages.

For additional information, and to order online, go to:
http://www.windsorpeak.com/baby411
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(11 of 12)
March 28, 2007
PRE-TRAVEL HEALTH ADVICE IS THE TOPIC FOR CDC'S APRIL 12 CURRENT ISSUES IN IMMUNIZATION NET CONFERENCE

[The following is cross posted from the Immunization Action Coalition's "IAC EXPRESS" electronic newsletter, 3/12/07.]

Scheduled for April 12, from noon to 1PM ET, the net conference Current Issues in Immunization is designed to provide clinicians with up-to-date information on immunization.

In the April conference, the CDC Traveler's Health Team will present an overview of issues related to international travel health and safety. The discussion will highlight current information about international travel including its status, epidemiology, risks, safety, vaccines, health counseling, and available resources. The team will present content followed by a question and answer session for providers.

Two additional sessions focusing on specific travel topics (e.g., travel vaccines, malaria) are being planned for late summer. Because content of the next two net conferences will build on material presented in April, it is recommended that you participate in the April conference.

The conference requires pre-registration, as space is limited. Registration will close when the course is full or on April 11 (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, email: nipinfo@cdc.gov
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(12 of 12)
March 28, 2007
JOURNAL ARTICLES YOU MAY HAVE MISSED

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

"A Review of the Evidence for Suboptimal Compliance of Healthcare Practitioners to Standard/Universal Infection Control Precautions"
Authors: Gammon J, Morgan-Samuel H, Gould D
Source: J Clin Nurs, February 28, 2007
Click here for abstract.

"Potential Work-Related Exposures to Bloodborne Pathogens by Industry and Occupation in the United States Part II: A Telephone Interview Study"
Authors: Chen GX, Jenkins EL
Source: Am J Ind Med, March 5, 2007
Click here for abstract.

(The abstract for Part I of this study can be accessed by clicking here for abstract.)

"High Immunogenicity of Delayed Third Dose of Hepatitis B Vaccine in Travellers"
Authors: Jackson Y, Chappuis F, et al.
Source: Vaccine, January 11, 2007
Click here for abstract.

"Convenience is the Key to Hepatitis A and B Vaccination Uptake among Young Adult Injection Drug Users"
Authors: Campbell JV, Garfein RS, et al.
Source: Drug Alcohol Depend, February 1, 2007
Click here for abstract.

"New and Emerging Treatment of Chronic Hepatitis B"
Authors: Keeffe EB, Marcellin P
Source: Clin Gastroenterol Hepatol, March 2007, Vol. 5(3):285-294
Click here for abstract.

"Immunogenicity of an Inactivated Hepatitis A Vaccine in Infants and Young Children"
Authors: Bell BP, Negus S, et al.
Source: Pediatr Infect Dis J, February 2007, Vol. 26(2):116-22
Click here for abstract.

"Vaccination in Juvenile Correctional Facilities: State Practices, Hepatitis B, and the Impact on Anticipated Sexually Transmitted Infection Vaccines"
Authors: Tedeschi SK, Bonney LE, et al.
Source: Public Health Rep, January-February 2007, Vol. 122(1):44-48
Click here for abstract.

"Impact of Hepatitis A Vaccination on Healthcare Utilization in the United States, 1996-2004"
Authors: Zhou F, Shefer A, et al.
Source: Vaccine, January 25, 2007
Click here for abstract.

"Prevalence and Risk Factors for Bloodborne Exposure and Infection in Correctional Healthcare Workers"
Authors: Gershon RR, Sherman M, et al.
Source: Infect Control Hosp Epidemiol, January 2007, Vol. 28(1):24-30
Click here for abstract.

"Do HIV Care Providers Appropriately Manage Hepatitis B in Coinfected Patients Treated with Antiretroviral Therapy?"
Authors: Jain MK, Opio CK, et al.
Source: Clin Infect Dis, April 1, 2007, Vol. 44(7):996-1000
Click here for abstract.