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Hep Express Issue 76

Issue Number 76, November 6, 2008
Contents of this Issue

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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November 6, 2008

Sadly, this will be the last issue of Hep Express. Hep Express, which has garnered 10,000 subscribers in the five years it’s been published, has been funded by a cooperative agreement with CDC's Division of Viral Hepatitis. The funding for this project has run out, however, and no other money is available to continue publication.

There are many ways for readers to keep current with viral hepatitis news. Some relevant resources follow.

(1) IAC has published IAC Express, a weekly email news service that covers the latest information about U.S. vaccine recommendations, policies, and resources since 1997. This free electronic newsletter includes news about hepatitis A and B vaccination. To subscribe, go to: http://www.immunize.org/subscribe

(2) CDC will send the weekly issue of MMWR directly to your email once a week at no cost. Go to http://www.cdc.gov/subscribe.html to sign up for MMWR or other
CDC publications.

(3) CDC offers a free email subscription service, which allows users to receive notifications by email when new online information is available. With a subscription profile, you get the updated information on the items of interest to you automatically without having to return to the website to check for changes. Go to http://www.cdc.gov/emailupdates to find out more about the options available.

(4) The Hepatitis B Foundation (HBF) publishes the monthly "B News . . . You Can Use." This electronic newsletter highlights new research and treatment findings, as well as additions to the Hepatitis B Foundation website. Go to http://www.hepb.org/newsletter to sign up for this newsletter, or for the quarterly "Be Informed" publication.

(5) The Caring Ambassadors Hepatitis C Program aggregates and reviews peer-reviewed literature from PubMed and the international hepatitis news monthly. To sign up for the Caring Ambassadors Hepatitis C Program Newsletter visit http://www.HepCChallenge.org and look for the sign-up box in the left column.

(6) Hepatitis C Advocates UNITED! is a national, grassroots network of individuals and organizations fighting for increased funding for hepatitis programs and legislation to mount a comprehensive federal effort to fight the disease. To join this national network, send an email to rclary@projectinform.org with "Subscribe" in the subject field. In the email, put your first name (and last name, if you are comfortable with doing so) and city/state. The group communicates through a moderated listserv and monthly conference calls.

(7) SIGN (Safe Injection Global Network) publishes a weekly electronic newsletter on international injection safety issues, including journal abstracts and excerpts related to viral hepatitis. For more information, go to: http://www.who.int/injection_safety/newsletter/SIGNPost/en

(8) HIVandHepatitis.com provides online news and research information about treatment and experimental vaccine options for hepatitis disease and HIV infection. Find out more at http://www.hivandhepatitis.com

(9) The National Network for Immunization Information publishes Immunization Newsbriefs. Sign up for this free email immunization news service at http://www.infoinc.com/imnews2/regform.html Every Thursday you will receive relevant news abstracted from 1,400 sources.

(10) The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia (CHOP) has an "online community" area on their website where providers can choose to receive email updates on CHOP research, other monthly newsletters, and late-breaking news on children's health topics. To find out more, go to: http://www.chop.edu/consumer/common/email_info.jsp VEC also publishes a monthly vaccine email newsletter for parents. To subscribe, go to: http://www.chop.edu/consumer/jsp/division/generic.jsp?id=79357

(11) Weekly Epidemiological Record (WER), a publication of the World Health Organization (WHO), provides rapid and accurate dissemination of epidemiological information on international cases and outbreaks of diseases. Subscribe to the free electronic version by sending a message to listserv@who.int The subject field should be left blank, and the body of the message should contain only the line "subscribe wer-reh" To access past issues of WER, go to: http://www.who.int/wer/en

CDC's Division of Viral Hepatitis: http://www.cdc.gov/hepatitis

CDC's National Center for Immunization and Respiratory Diseases:http://www.cdc.gov/vaccines

AAP's Childhood Immunization Support Program: http://www.cispimmunize.org

Asian Liver Center: http://livercancer.stanford.edu

All About Hepatitis C: www.all-about-hepatitisc.com

American Liver Foundation (ALF): http://www.liverfoundation.org

Canadian Harm Reduction Network: http://www.canadianharmreduction.com

Canadian Liver Foundation: http://www.liver.ca

Caring Ambassadors Hepatitis C Program: http://www.hepcchallenge.org

Center Watch, Clinical Trials Listing Service: http://www.centerwatch.com/patient/studies/cat79.html

ClinicalTrials.gov: http://www.clinicaltrials.gov

Hepatitis B Foundation (HBF): http://www.hepb.org

Hepatitis C Advocacy: http://www.hepcadvocacy.org

Hepatitis C Association: http://www.hepcassoc.org

Hepatitis C/HIV Multicultural Outreach: http://www.hepcmo.org

Hepatitis C Support Project HCV Advocate: http://www.hcvadvocate.org

Hep C Connection: http://www.hepc-connection.org

Hepatitis Foundation International (HFI): http://www.hepfi.org

Hepatitis Treatment, Research and Education Center (HepTREC): http://www.heptrec.org

Immunization Action Coalition:
http://www.immunize.org (for healthcare professionals)
http://www.vaccineinformation.org (for the public and healthcare professionals)
http://www.hepprograms.org (for hepatitis prevention program managers and clinicians)
http://www.izcoalitions.org (for those interested in immunization coalitions)

Latino Organization for Liver Awareness (LOLA): http://www.lola-national.org

National Alliance of State & Territorial AIDS Directors: http://www.nastad.org
National Hepatitis C Advocacy Council: http://www.hepcnetwork.org

National Network for Immunization Information: http://www.immunizationinfo.org

National Task Force on Hepatitis B: Focus on Asian Americans and Pacific Islanders: http://www.hepbtaskforce.org

National Vaccine Program Office: http://www.hhs.gov/nvpo

National Viral Hepatitis Roundtable: http://www.nvhr.org

PKIDS (Parents of Kids with Infectious Diseases): http://www.pkids.org

Seattle STD/HIV Prevention Training Center: http://depts.washington.edu/hepstudy

Department of Veterans Affairs National Hepatitis C Program: http://www.hepatitis.va.gov

Vaccine Education Center at the Children's Hospital of Philadelphia: http://vaccine.chop.edu

Viral Hepatitis Prevention Board (VHPB): http://www.vhpb.org

Adult Viral Hepatitis Prevention Coordinators by state:

Perinatal Hepatitis B Coordinators by state:

CDC-INFO Contact Center: (800) 232-4636 or (800) CDC-INFO; TTY hotline, (888)243-6348

We thank our readers for their interest in this publication. We're sorry that we're no longer able to publish Hep Express, but hope to continue our relationship through IAC Express. Be sure to sign up if you are not already a subscriber by going to http://www.immunize.org/subscribe Meet you there!

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November 6, 2008

[The following is cross posted from the Immunization Action Coalition's "IAC Express" electronic newsletter, 9/22/08.]

On September 19, CDC published "Recommendations for Identification and Public Health Management of Persons with Chronic Hepatitis B Virus Infection" in MMWR Recommendations and Reports. On September 18, CDC published a related press release containing the recommendation's highlights. The press release is titled "CDC Expands Testing Recommendations for Chronic Hepatitis B Virus Infection: New guidance also issued on patient management for those infected." It is reprinted below in its entirety. Links to the September 19 recommendations are given at the end of this IAC Express article.


The U.S. Centers for Disease Control and Prevention (CDC) today published new recommendations for healthcare providers that are designed to increase routine testing in the United States for chronic hepatitis B, a major cause of liver disease and liver cancer. CDC recommends testing all individuals born in Asia and Africa, as well as testing additional at-risk populations, including men who have sex with men (MSM) and injection-drug users (IDUs). The recommendations, published today in CDC's Morbidity and Mortality Weekly Report (MMWR) Recommendations & Reports, also for the first time give health professionals guidance for effective management of chronically infected hepatitis B patients.

"Chronic hepatitis B affects the lives of more than one million Americans, many of whom do not even know they are infected. These new recommendations are critical to identifying people who are living with the disease without the benefits of medical attention," said John W. Ward, MD, director of CDC's Division of Viral Hepatitis. "Testing is the first step to identify infected persons so that they can receive lifesaving care and treatment, which can break the cycle of transmission, slow disease progression, and prevent deaths from liver cancer."

In the United States, chronic hepatitis B is the underlying cause of an estimated 2,000-4,000 deaths each year from cirrhosis and liver cancer. The CDC recommendations are key to increasing the early diagnosis of chronic hepatitis B virus (HBV) infection, since many of the estimated 800,000-1.4 million Americans with chronic HBV infection have no symptoms and are unaware of their disease.

Highlights of the recommendations

  • The new testing recommendations build upon and reinforce past recommendations to test all pregnant women, infants born to infected mothers, household contacts and sex partners of infected individuals, and people with HIV.

Along with continued testing of those groups, routine testing is now recommended for additional populations, including:

  • Individuals born in Asia, Africa, and other geographic regions with 2 percent or higher prevalence of chronic HBV infections: Previous CDC recommendations called for testing of people born in areas with 8 percent prevalence or higher. Expanded testing is essential since the rate of liver cancer deaths and chronic HBV in the United States remains high among foreign-born U.S. populations from these areas. For example, nearly one in 12 Asian Americans and Pacific Islanders living in the United States is HBV-infected, and one-third or more are unaware.
  • Men who have sex with men and injection drug users: Routine testing is needed for these persons since both have a higher prevalence of chronic HBV infection than the overall U.S. population. Up to 3 percent of MSM and up to 6 percent of IDUs are estimated to be chronically infected with HBV, compared with three-tenths of one percent of the general population.
  • Persons with abnormal liver function tests (not explained by other conditions) and persons who require immunosuppressive therapy (e.g., chemotherapy for malignant diseases). The new CDC report also gives recommendations for referral of HBV-infected persons to specialists for ongoing monitoring and medical care. Such guidelines are needed now to assist providers, since most of the effective medications for chronic HBV treatment have become available only in the last five years. In addition, the recommendations advise healthcare providers to provide culturally-sensitive ongoing patient education, begin lifelong monitoring for progression of liver disease, and ensure protection of household members and other close contacts of infected persons.

Testing recommendations are a critical component of CDC's strategy to eliminate HBV transmission. CDC continues to work with the medical community to promote comprehensive prevention and treatment efforts for HBV, which include vaccination for all infants and at-risk adults; catch-up vaccination of previously unvaccinated children; routine screening for all pregnant women; treatment of newborns of infected or untested mothers; and testing household contacts and sex partners of HBV-infected persons.

For more information [on] chronic hepatitis B [virus] infection, visit www.cdc.gov/hepatitis/HBV/TestingChronic.htm or www.cdc.gov/hepatitis


To access the press release, go to: http://www.cdc.gov/media/pressrel/2008/r080918.htm

To access a ready-to-print (PDF) version of the recommendations, go to: http://www.cdc.gov/mmwr/PDF/rr/rr5708.pdf

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

To access a web-text (HTML) version of the recommendations, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5708a1.htm

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

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November 6, 2008

The National Viral Hepatitis Roundtable (NVHR) is a coalition of public, private, and voluntary organizations dedicated to reducing the incidence of infection, morbidity, and mortality from viral hepatitis in the United States through strategic planning, leadership, coordination, advocacy, and research.

NVHR's four recommendations for the elimination of viral hepatitis in the United States are

  • Build the capacity to address the challenges of viral hepatitis
  • Vaccinate America to eliminate vaccine-preventable viral hepatitis
  • Counsel, test, and refer persons at risk for viral hepatitis to inform them about how to reduce their risks
  • Care for persons with chronic hepatitis and help them participate in management of their condition

In October, NVHR, in partnership with the National Alliance of State and Territorial AIDS Directors (NASTAD), received funding from CDC under a five-year cooperative agreement for networking, partnering, and information dissemination. The funding will enhance NVHR's capacity to link viral hepatitis coalitions and organizations in the United States. Leveraging the resources and power of a collective voice will increase these organizations' influence on viral hepatitis prevention and control.

For more information about NVHR, visit the home page at http://www.nvhr.org New organizations are welcome to join. To obtain information about membership, click on the link at the lower right corner of the home page.

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November 6, 2008

[The following is cross posted from the Immunization Action Coalition's "IAC Express" electronic newsletter, 10/13/08.]

CDC published "Vaccination Coverage Among Adolescents Aged 13–17 Years--United States, 2007" in the October 10 issue of MMWR. A portion of the summary made available to the press is reprinted below.


CDC conducts the National Immunization Survey–Teen (NIS–Teen) to determine vaccination coverage estimates in a national sample of adolescents aged 13–17 years. Three new vaccines have been recommended for adolescents since 2005: meningococcal conjugate vaccine (MCV4), tetanus, diphtheria, acellular pertussis vaccine (Tdap), and human papillomavirus vaccine (HPV4). Adolescents should also receive childhood vaccinations that were missed. Between 2006 and 2007, there were substantial increases in receipt of new adolescent vaccinations including Tdap (from 10.8 percent to 30.4 percent) and MCV4 (from 11.7 percent to 32.4 percent), and increases in coverage of childhood vaccinations including measles, mumps, and rubella (MMR), hepatitis B, and varicella vaccines (among those without prior disease history). For HPV4 coverage, which is reported for the first time, 25.1 percent of adolescent females had initiated the vaccine series (>1 dose). To improve vaccination coverage among adolescents, providers should take advantage of every healthcare visit as an opportunity to evaluate vaccination status and administer vaccines when needed.


To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5740a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5740.pdf

To access a transcript from the related October 9 press briefing, go to: http://www.cdc.gov/media/transcripts/2008/t081009.htm

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November 6, 2008

(1) IAC recently reviewed and revised an educational piece for the public titled "Hepatitis A is a serious liver disease. Vaccination can protect you!" Updated information includes the age for routine childhood immunization and changes regarding pre-travel and post-exposure prophylaxis.

To access the revised piece, go to: http://www.immunize.org/catg.d/p4080.pdf

(2) Sarah Jane Schwarzenberg, MD, and Karen Y. Wainwright, RN, BS, CCRA, reviewed their piece titled "You are not alone! Information for young adults who are chronically infected with HBV" and updated some statistics.

To access the revised piece, go to: http://www.immunize.org/catg.d/p4118.pdf

(3) In response to the recent media attention given to vaccines, autism, and other controversies concerning vaccines, IAC received permission to reprint and distribute information for parents previously published by Dr. Ari Brown in her book "Baby 411: Clear Answers & Smart Advice for Your Baby's First Year."

The new 6-page article is titled "Clear Answers & Smart Advice About Your Baby's Shots." In it, Dr. Brown discusses the etiology of autism, vaccines and autism, mercury preservatives in vaccines, the Poling case, MMR vaccine and autism, additives in vaccines, the number of recommended vaccines in the childhood schedule, and more in a respectful and readable style.

To download this exciting new ready-to-copy article for parents on vaccine concerns, go to: http://www.immunize.org/catg.d/p2068.pdf

(4) IAC recently posted a new and important resource for healthcare professionals. Titled "Sample Vaccine Policy Statement--Ready for you to adapt for your practice," this piece gives professionals a template for creating a clear way to communicate a medical practice's strong support for childhood vaccination to the parents of their patients.

The Sample Vaccine Policy Statement is based on a statement developed by the clinicians at All Star Pediatrics, Lionville, PA. IAC has reformatted it and posted it on the IAC website as an MS Word document that can be downloaded and edited for your practice's use in developing its own policy.

To access the statement in MS Word format, go to: http://www.immunize.org/catg.d/p2067.doc

The statement is also available in PDF format at http://www.immunize.org/catg.d/p2067.pdf

(5) IAC recently revised its parent-education resource "Immunizations for Babies: A guide for parents--these are the vaccinations your baby needs!" by updating information on rotavirus vaccine, influenza vaccine, and hepatitis A vaccines.

To access the updated piece, go to: http://www.immunize.org/catg.d/p4010.pdf

(6) IAC recently developed a simplified version of its popular parent-education piece "After the Shots. . . What to do if your child has discomfort."

This alternative version uses more basic English terms and doesn't include the second page detailing possible medicines and dosages for reducing pain and fever. Instead, a box at the bottom of the page provides space for the healthcare provider to write in information about contacting the office and recommended fever- or pain-reducing medication.

To obtain a ready-to-print (PDF) version of this new resource, go to: http://www.immunize.org/catg.d/p4014.pdf

To obtain a ready-to-print (PDF) version of the original two-page piece in English, go to: http://www.immunize.org/catg.d/p4015.pdf

(7) IAC recently updated its parent-education print resource "When Do Children and Teens Need Vaccinations?" Sections pertaining to the vaccines that protect against rotavirus, human papillomavirus (HPV), and influenza were revised.

To access the revised piece, go to: http://www.immunize.org/catg.d/p4050.pdf

(8) IAC added resources to its parent-education piece "Reliable Sources of Immunization Information: Where to go to find answers!"

To access the revised piece, go to: http://www.immunize.org/catg.d/p4012.pdf

IAC's Print Materials web section offers healthcare professionals and the public approximately 250 FREE, English-language materials (many also available in translation), which we encourage website users to print out, copy, and distribute widely. To access all of IAC's free print materials, go to: http://www.immunize.org/printmaterials

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November 6, 2008

[The following is cross posted from the Immunization Action Coalition's "IAC Express" electronic newsletter, 9/29/08.]

On September 18, CDC posted an updated interim edition of the pediatric multi-vaccine VIS. This edition has been made consistent with the recently updated rotavirus VIS by noting the availability of two rotavirus vaccines in the "Routine Childhood Vaccines" section and adding "irritability" to the mild problems listed for rotavirus in the "Vaccine Risks" section.

Otherwise, the VIS is identical to the 1/30/08 edition. Providers using the multi-vaccine VIS when administering Rotarix should begin using the new edition now. When Rotateq is administered, the older edition may be used until your older multi-vaccine VIS supply is used up.

To access the 9/18/08 interim pediatric multi-vaccine VIS from the IAC website, go to: http://www.immunize.org/vis/vis_multi1.pdf

For information about the use of VISs, and for VISs in more than 35 languages, visit IAC's VIS web section at http://www.immunize.org/vis

For general information about VISs from CDC's website go to: http://www.cdc.gov/vaccines/pubs/vis

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November 6, 2008

The Hepatitis B Foundation (HBF) recently announced an opportunity for healthcare professionals to learn about hepatitis B in Asian/Pacific Islander (A/PI) communities.

HBF is offering a free CME course that focuses on screening, diagnosing, and treating chronic hepatitis B virus infection in A/PI communities. It is an interactive online Hepatitis B Clinical Consults Cases course intended for primary care physicians, particularly those who treat A/PI populations. It  expires on September 15, 2009.

For detailed information and to register, go to: http://www.hepb.org/cc/clinical_consults

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November 6, 2008

[The following is cross posted from the Immunization Action Coalition's "IAC Express" electronic newsletter, 10/20/08.]

November 14 is the deadline for submitting abstracts for CDC's 2009 National Immunization Conference, which will be held in Dallas, TX, on March 30-April 2, 2009. Abstracts must be submitted online. To access submission guidelines, go to: http://cdc.confex.com/cdc/nic2009/cfp.cgi

The deadline for early-bird registration ($225) is January 30. The deadline for regular registration ($250) is March 13. Late and on-site registration will be $275.

For general information on the 43rd National Immunization Conference, including conference goals, objectives, and registration, go to: http://www.cdc.gov/vaccines/events/nic

Those without Internet access can contact the conference planning team at (404) 639-8225 or nipnic@cdc.gov

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November 6, 2008

[The following is cross posted from the Immunization Action Coalition's "IAC Express" electronic newsletter, 9/29/08.]

The Southwest Viral Hepatitis Summit will be held November 13-14, 2008, in Las Vegas, NV. The conference is sponsored by Hepatitis Foundation International (HFI) and is intended for physicians, physician assistants, nurses, psychologists, counselors, outreach workers, patient advocates, and others working with people who are affected by or infected with viral hepatitis.

For information about the agenda or registration, go to: http://www.hepfi.org/pdfs/SouthWest_Summit_Registration_&_Agenda.001.pdf

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