FW: Immunization News for 1/12/00

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Below is today's issue of Immunization Newsbriefs.

Immunization Newsbriefs is published Mondays, Wednesdays

and Fridays (except for holidays) by Information, Inc., of

Bethesda, MD. Today's news, back issues, and a searchable

archive of past Immunization Newsbriefs summaries is available

at http://www.infoinc.com/imnews2. Subscription/Removal

and sponsor information follows the news.

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Immunization News Service

January 12, 2000

The National Network for Immunization Information, a special

project of the Infectious Diseases Society of America (IDSA),

the Pediatric Infectious Diseases Society (PIDS), the American

Academy of Pediatrics (AAP), and the American Nurses Association

(ANA), makes available the following information as a public

service only. Providing this information does not constitute

endorsement by the NNII, the IDSA, PIDS, AAP, or ANA.

Reproduction of this text is encouraged; however, copies may not

be sold, and the Infectious Diseases Society of America should be

cited as the source of the information.

© 2000 Information Inc., Bethesda, MD.

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" Flu Epidemic "

" A Shot of Prevention "

" Flu Epidemic Hits Hard at Industrialized World "

" Influenza Now the Big Millennium Bug for World "

" Varicella Vaccine Effectively Limits Disease Outbreak in

Children "

" Clinton Wants Bigger Budget to Fight Diseases "

" Gore Vows AIDS Initiative "

" Ailing Immigrants: New Era, New Rules "

" Third World Polio Eradication Push Begins "

" Don't Worry About Vaccinations "

" West Nile Viral Encephalitis in an HIV-Positive Woman in New

York "

" Long-Term Trends in Childhood Infectious Disease Mortality

Rates "

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" Flu Epidemic "

USA Today (www.usatoday.com) (01/12/00) P. 15A; Nordwall,

Smita P.

Worldwide, influenza is taking its toll, but the World Health

Organization has said the epidemic's patterns are not out of the

ordinary. In England, some hospitals have canceled surgery to

make space for flu patients, while infected individuals in Israel

are being treated in hallways and cafeterias.

" A Shot of Prevention "

USA Today (www.usatoday.com) (01/12/00) P. 16A

As influenza spreads throughout the United States, the editors of

USA Today call on nursing-home workers to be vaccinated against

the flu. The editors note that people in hospitals and nursing

homes are at high risk for the disease. Furthermore, they point

out that " while most elderly in homes get the flu shot, it offers

them less protection than it does for older, healthier

Americans. " In many cases, employees at nursing homes are the

ones who introduce the virus to the facility; experts estimate

that less than one-third of nursing-home workers in the United

States are vaccinated against the flu. While Texas and Arkansas

have taken a step in the right direction, now requiring by law

that nursing-home workers get flu shots, the editors note that

other states should also adopt such laws but that the vaccination

mandate should include all health workers, not just those in

nursing homes.

" Flu Epidemic Hits Hard at Industrialized World "

Washington Times (www.washtimes.com) (01/11/00) P. A11

The flu epidemic this year has claimed at least 18 lives in the

industrialized world, with millions more infected. As much as 20

percent of the Netherlands is infected, and record numbers of flu

diagnoses are being seen in Sweden. In England, there have been

200,000 emergency admissions to the hospital in the past three

weeks as a result of the flu. Meanwhile in the United States,

the Sydney Type A flu strain started its strike on the West Coast

and has reached the East, swamping emergency rooms. Hospitals

have been put on alert as beds may not be available. Type A

viruses usually cause large outbreaks and mutate often to keep

going.

" Influenza Now the Big Millennium Bug for World "

Reuters (01/11/00); Majendie,

Influenza has become the new millennium bug. Part of the problem

is that immunization campaigns fell short in many nations,

according to the World Health Organization's Dr. Lavanchy.

Despite the high number of cases, experts stress that a serious

epidemic is not taking place in the United States. However, two

new flu drugs, Tamiflu and Relenza, may actually be helping to

spread the disease, because some people may have chosen not to

get vaccinated.

" Varicella Vaccine Effectively Limits Disease Outbreak in

Children "

Reuters Health Information Services (01/12/00)

A report in the January issue of Pediatrics reveals that a

licensed varicella vaccine limited an outbreak of the disease in

children living at a homeless shelter in Philadelphia. After two

cases of varicella appeared, vaccinations were given to 67

people, including 42 children under age 13. None of the children

who were vaccinated developed the disease, according to Dr.

Barbara of the Philadelphia Department of Public Health.

The results support the recommendation of vaccination after

exposure to varicella.

" Clinton Wants Bigger Budget to Fight Diseases "

Reuters (01/10/00)

President Clinton has proposed spending an extra $20 million in

2001 to battle infectious diseases and to form a national

electronic disease surveillance network. The new network, which

would allow for rapid transmission of information from doctors

to state health departments, is being created by the Centers for

Disease Control and Prevention. In a fact sheet detailing the

plan, the White House noted that there has been substantial

improvement in the United States' ability to identify outbreaks

of infectious diseases, although diseases like AIDS and toxic

shock syndrome still pose serious health threats. If approved by

Congress, the additional funding would add to the CDC's existing

budget of $44.3 million for the project.

" Gore Vows AIDS Initiative "

Washington Post (www.washingtonpost.com) (01/11/00) P. A11;

Lynch, Colum

Vice President Al Gore pledged on Monday to seek $150 million

from Congress to combat HIV and other infectious diseases in

Africa and Asia, noting that AIDS is as significant a threat to

global security as war. If approved, the new funds would raise

the total for fighting AIDS overseas to $325 million. The

funding would mostly go towards sub-Saharan Africa, where AIDS is

the leading cause of death. At the meeting of the United Nations

Security Council, Namibian health minister Libertine Amathila and

others warned that AIDS is ruining national health budgets in

Africa. Amathila noted, " Africa has the least access to drugs

but the greatest access to arms. " Vice President Gore also

reported that the White House plans to request $50 million from

Congress to finance research and to buy and distribute drugs that

attack other major killers, including tuberculosis, hepatitis B,

and yellow fever.

" Ailing Immigrants: New Era, New Rules "

New York Times (www.nytimes.com) (01/11/00) P. D7; Chiles, Nick

In the early 1900s, immigrants entering the United States were

inspected at places like Ellis Island for signs of coughing or

other illness. If tuberculosis (TB) was suspected and the

disease had not progressed too much, they were sent back home.

X-rays were used after 1910 to be sure of a diagnosis during a

time when tuberculosis was highly feared. Today, TB is once

again causing fear among public health experts, as TB rates

increase in developing nations and immigration rates from those

countries have never been higher. While the circumstances are

different from the early 1900s, when officials had to make

diagnoses in a matter of seconds and effective antibiotics and

treatments were not available for many diseases, there are other

concerns, including AIDS and drug-resistant TB. Thousands of

immigrants enter the country without medical screening, bringing

TB, skin infections, and colds. Borders have become easier to

cross, and TB rates among foreign-born populations are high. For

individuals born in the United States, the rate of TB is about

five cases per 100,000 people, compared to about 30 per 100,000

among foreign-born individuals in the country.

" Third World Polio Eradication Push Begins "

Pittsburgh Post-Gazette Online (www.post-gazette.com) (01/11/00);

Mazo, Ellen

Rotary International has made polio eradication its mission.

Fifteen Rotary volunteers from the Pittsburgh are heading to

India next week to help immunization efforts. On January 23,

Rotarians from around the world will help to administer the polio

vaccine to millions of kids. The worldwide effort to eliminate

polio recently received a $78 million donation from Bill Gates

and Ted .

" Don't Worry About Vaccinations "

Parade Magazine (01/09/00) P. 10; Rosenfeld, Isadore

Today, children can receive up to 21 shots spread over months or

years, notes Dr. Isadore Rosenfeld. However, some parents who

read anti-vaccination materials may feel the shots have too many

side effects or risks, and thus should not be mandatory. Doctors

agree that all children should be vaccinated against crippling or

fatal diseases, and Rosenfeld points out that vaccination reduces

the overall incidence of disease and prevents outbreaks. The

risks of side effects are rare, and while no vaccine is 100

percent effective, they provide greater protection than no

vaccine. Rosenfeld asserts that for these and other reasons he

supports mandatory universal vaccination. Continued research,

however, is necessary to further increase the safety and efficacy

of vaccines. Inoculation should start at birth with the

hepatitis B vaccine, with most shots completed by age two.

Rosenfeld states that every child should receive vaccination

against measles, mumps, and rubella; polio; diphtheria, tetanus,

and pertussis; Haemophilus influenzae type B; and chicken pox.

He recommends hepatitis B shots for all infants, regardless of

whether their mothers test positive for the virus. Rosenfeld

also recommends flu shots for all his adult patients and

pneumonia shots for individuals at age 60 and again seven or

eight years later.

" West Nile Viral Encephalitis in an HIV-Positive Woman in New

York "

New England Journal of Medicine (www.nejm.org) (01/06/00) Vol.

342, No. 1, P. 59; Szilak, Illya; Minamoto, Grace Y.

In a letter to the editor of the New England Journal of Medicine,

researchers from Montefiore Medical Center in New York present

the case of a 38-year-old woman from the Bronx with HIV infection

and West Nile viral encephalitis. The woman--who had not

traveled outside of the United States--reported a week-long

history of headache and fever and three days of neck stiffness,

photophobia, and vomiting. She was given antibiotics for

possible bacterial meningitis, but they were stopped after 72

hours, when the cultures came back negative. The woman was then

diagnosed as one of 50 patients with suspected West Nile

encephalitis in the New York area. She was the first to also be

coinfected with HIV. According to the researchers, " It remains

to be shown whether HIV ... predisposes patients to overt

clinical encephalitis with arbovirus infection. "

" Long-Term Trends in Childhood Infectious Disease Mortality

Rates "

American Journal of Public Health

(www.apha.org/journal/AJPH2.htm) (12/99) Vol. 89, No. 12, P.

1883; DiLiberti, H.; , R.

Researchers studying long-term trends in U.S. childhood

infectious disease mortality rates (CIDMR) found that although

CIDMR dropped nearly 200-fold between 1861 and 1996, little

change was seen in the last 10 years of the study. Between 1979

and 1995, fatal respiratory and central nervous infections fell

sharply, but deaths from AIDS and other immune conditions rose

after 1984. Most of the adult mortality was attributed to

pneumonia or septicemia. A record low in childhood mortality

rates was reached in 1993. According to the authors, from the

University of Illinois College of Medicine and the Children's

Hospital of Illinois, the varicella vaccine is still too new to

have affected mortality rates and the Haemophilus influenzae B

vaccine was developed long after the number of central nervous

system deaths started to fall. The number of deaths from HIV

after 1984 form a small number of the total rate, although

removal of this factor from the analysis does cause a small

yearly rate of decline in CIDMR. A CIDMR plateau reached

starting in 1986 may be significant, but the mortality trends

need further study to determine this, the researchers said.