Division of Disease Control and Health Protection

For July 30, 1999

"When asked by IAC staff to clarify the difference between the United States Public Health Service recommendation and the AAP recommendation, Dr. Harold S. Margolis, Chief of the Hepatitis Branch of the Centers of Disease Control and Prevention, made the following comment:

"IAC EDITORS' NOTE: COMVAX is a thimerosal-free hepatitis B vaccine that also contains a Hib component. It is licensed for use beginning at six weeks of age. It is also anticipated that thimerosal-free, single-antigen hepatitis B vaccines will be available during the month of September.

"The new CDC guidelines, which were released on July 15, 1999, and appear today on the National Immunization Program's website, stress the importance of continuing to vaccinate infants born to HBsAg negative women who belong to populations and groups that have high risk of hepatitis B virus infection as well as infants born to HBsAg positive mothers and to mothers whose status is not known.

"CDC GUIDELINES SAY TO VACCINATE THESE GROUPS OF INFANTS AT BIRTH:

"1. INFANTS BORN TO HBsAg POSITIVE MOTHERS

All infants born to HBsAg positive mothers need hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth.

"2. INFANTS BORN TO MOTHERS WHOSE HBsAg STATUS IS UNKNOWN

All infants born to mothers whose HBsAg status is still unknown 12 hours after birth need hepatitis B vaccine at that time. Draw the mother's blood upon admission and send it to the lab ASAP. If the results cannot be obtained by 12 hours after the infant's birth, the infant should be vaccinated at that time. If the mother is found to be HBsAg positive, administer HBIG to the infant ASAP (no later than 7 days after birth).

"3. INFANTS BORN TO HBsAg NEGATIVE MOTHERS BELONGING TO POPULATIONS OR GROUPS THAT HAVE HIGH RISK OF EARLY CHILDHOOD HBV INFECTION

All infants born to HBsAg negative mothers belonging to populations or groups that have high risk of early childhood HBV infection need hepatitis B vaccine prior to discharge. These high-risk groups include, but are not limited to, Asian Pacific Islanders, immigrant populations from countries in which HBV is of high or intermediate endemicity (see CDC's "Health Information for International Travel, 1999"), and households with persons with chronic HBV.

"NOTE: The AAP has no specific recommendation for infants who are born to women belonging to groups or populations at high risk of early childhood hepatitis B virus infection. Because of this, some hospitals are treating these high-risk infants no differently from infants with low risk of infection and have written policies to delay these infants' hepatitis B vaccination until 6 months of age.

"CDC recommends that if your hospital chooses to follow the recommendation of the AAP, you should vaccinate all children who are born to HBsAg negative women in high-risk communities at two months of age with thimerosal-free vaccine (COMVAX). However, if thimerosal-free vaccine is not available, you should make sure that these high-risk infants receive hepatitis B vaccine no later than two months of age, even if only thimerosal-containing vaccine is available to you (Recombivax HB and Engerix-B).

"Do not wait until these at-risk children are six months old to give dose #1. The need for these infants to receive hepatitis B vaccine by two months of age far outweighs the much smaller theoretical risk of cumulative exposure to thimerosal-containing vaccines.

"The complete guidelines, "Implementation Guidance for Immunization Grantees During the Transition Period to Vaccines Without Thimerosal," can be downloaded from CDC's.

"If you are unable to download these guidelines, call the immunization program manager at your state health department. Your state health department received these guidelines on July 15, 1999.

"CDC also has other important information on thimerosal and vaccines on its website."

A slide series entitled "Epidemiology and Prevention of Viral Hepatitis A to E: An Overview" is offered on the Centers for Disease Control (CDC) website.

The College of Health at the University of North Florida in Jacksonville is developing a new Master of Public Health degree (MPH) program to begin next year. The program will be oriented to working individuals, with off-campus courses and advising available. Information regarding the planned program is provided in the attached document.

"We [sic] the undersigned committee appointed by the chairman to investigate conditions at the County Pest House, have to report that we visited the Pest House this morning and made as thorough an examination as possible, without entering the building, which we could not do as there were five (5) patients in the house with smallpox. We found the sanitary arrangements in a terrible condition, the drainage pipe leading from the toilets and kitchen to the cesspool in such a shape that all the stuff backs up and is deposited under the different parts of the building, causing a bad odor and attracting swarms of flies and other insects. We found discarded clothing of the patients lying all around the yard, also the discarded bedding.

"We questioned Mr. Goss, the man in charge, and got the following information as to how the affairs of the institution are conducted: He is in charge, without any help whatever; he is nurse, cook and everything else at a salary of $15.00 per month and boards himself; he is unable to get any help so that he can get any laundry work done at the hospital and in fact, none is ever done. We believe Mr. Goss to be doing all in his power, with the limited means he is furnished with, to care for the patients, but we wish to censure whoever is in control of the County Pest House for the unsanitary conditions existing there, and for the criminal neglect of the unfortunate people who are obliged to be taken there. And we recommend that the place be put in a sanitary condition at once.