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January
15, 2003 Foege WH et al. |
This Week in the
News: ► Summary of ACIP Telephone Conference on Supplemental Recommendations for Smallpox Vaccination The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met via telephone conference call Tuesday, January 14, 2003 to review selected issues related to the Supplemental Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) for Use of Smallpox Vaccine in a Pre-Event Smallpox Vaccination Program. ► Hepatitis A Outbreak In An Elementary School, Lake County A Report on a Hepatitis Outbreak in a Lake County Elementary School. The first recognized school-related case reported an onset date of October 24, 2002 and the most recently reported school-related case experienced an onset date of December 9, 2002. ► Influenza Virus Surveillance Summary Update During week 52, influenza activity, calculated based on the proportion of patients with influenza-like illness (ILI) seeking care by physicians participating in the Florida Sentinel Physicians Surveillance Network was 2.3%, which Is higher than the national baseline Of 1.9% ► Weekly Disease Table Florida Department of Health, Bureau of Epidemiology, Weekly Morbidity Report, Week 52, ending January 4, 2003 Selected Diseases and Conditions (Confirmed Cases Only) |
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This
is an
Carmela Mancini, MPH, FL EIS, Pinellas County Investigative Contributors Fermin
Arguello, MD, Edhelene
Rico, MPH, Carmela
Mancini, MPH, Cindy
Siegenthaler, RN, Epidemiology Nursing Program Specialist, John Pellosie, Jr, DO, MPH, Medical Executive Director, Lake County
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►
Summary
of ACIP Telephone Conference on Supplemental Recommendations for Smallpox
Vaccination January 14, 2003 The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) met via telephone conference call Tuesday, January 14, 2003 to review selected issues related to the Supplemental Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) for Use of Smallpox Vaccine in a Pre-Event Smallpox Vaccination Program. The committee developed these draft recommendations at their regularly scheduled meeting in October, 2002. The discussion focused on several issues related to pre-event smallpox vaccination including: Whether an adult household contact of a child less than one year of age should be deferred from vaccination until the child is at least one year of age? Should the vaccination method for primary vaccinees remain as written, recommending 15 punctures? Is autoimmune disease in the absence of immune-suppressing medication a contraindication for receiving smallpox vaccine? Are inflammatory eye diseases a contraindication for smallpox vaccination? What is appropriate care for vaccination sites? The committee affirmed that smallpox vaccination is contraindicated for infants less than one year of age. The presence of an infant in the household is not a contraindication to vaccination of other members of the household; data suggest that the risk of serious complications from transmission from an adult to a child is extremely small. The ACIP recognizes some programs may defer vaccination of household contacts of infants less than one year of age because of data suggesting a higher risk of adverse events among primary vaccinees in this age group, compared with that among older children. The committee affirmed the recommendation that 15 insertions of the bifurcated needle be used for both primary vaccination and revaccination. Although the FDA package insert recommends 2 to 3 insertions for primary vaccinations, the committee based its recommendation on experience gained during the global eradication program and recent smallpox vaccine clinical trials. The sense of the committee was that some individuals with severe autoimmune diseases such as systemic lupus erythematosus, dermatomyositis, and scleroderma may have immune suppression in the absence of disease therapy, although there are no data documenting an increased rate of complications in such persons following smallpox vaccination. Therefore, it may be prudent in a setting without known smallpox transmission and with an uncertain risk of a smallpox attack to not vaccinate these persons at this time. The committee recommended that persons receiving steroids for eye disease not receive smallpox vaccination until the course of therapy is completed. The committee affirmed semi-permeable dressings should be used in the health care setting to prevent transmission, especially to immunocompromised patients. Other types of dressings may be used outside of health care settings. When using a semi-permeable dressing, it should be applied over a gauze dressing. Back to top ► Hepatitis A Outbreak In An Elementary School, Lake County Introduction Hepatitis A is the most frequently reported vaccine-preventable disease in the United States, despite vaccine licensure in 1995. Hepatitis A is transmitted through the fecal-oral route with an incubation period of 15 to 50 days (average=28 days). Symptoms may include jaundice, dark urine, fever, nausea and anorexia; however, infected individuals may be asymptomatic. Children younger than six years of age are less likely to exhibit symptoms, while older children and adults are typically symptomatic, including the occurrence of jaundice. Peak infectivity occurs during the two weeks prior to the onset of jaundice and begins to decrease following the appearance of jaundice; although, in children virus shedding can continue for several months.
On
November 6, 2002, the LCHD notified the Bureau of Epidemiology, Florida
Department of Health, regarding a hepatitis A outbreak occurring in
a local elementary school; cases
included students and teachers. The
first recognized school-related case reported an onset date of October 24,
2002 and the most recently reported school-related case experienced an
onset date of December 9, 2002. The school allowed a variety of records and documents to be reviewed, including nurse visits, class attendance records and daycare program rosters. The investigation team identified enrollment in school “X’s” pre-kindergarten class “A”, attendance at the before/after school daycare program and/or contact with someone in the pre-kindergarten class “A” as common risk factors among the cases. Methods Results
Discussion References Florida: During Week 52 (December 22-28, 2002) Influenza Activity, Calculated Based On The Proportion Of Patients With Influenza-Like Illness (Ili) Seeking Care By Physicians Participating In The Florida Sentinel Physicians Surveillance Network Was 2.3% Which Is Higher Than The National Baseline Of 1.9%. Higher Flu Activity Than Expected For This Time Of Year (>2%) Was Reported By Physicians In Duval, Leon, Monroe, Okaloosa, Orange, Palm Beach And Polk Counties. Influenza A (H1n1) Was Reported From Leon, Okaloosa And Seminole Counties This Week. Influenza A Of Unknown Subtype Was Reported From Brevard And Duval Counties And The Fourth Influenza B Was Reported From St John’s County. Positive Rapid Tests Were Reported From Miami-Dade And Pinellas Counties. Earlier This Season, Influenza A (H1n1) Viruses Were Detected In Broward, Holmes, Indian River Lake And Leon Counties, Influenza A (H3n2) In Indian River County And Influenza B In Leon County. Positive Rapid Tests Have Been Reported From Bay, Broward, Duval And Miami-Dade Counties. National
Report: Eighteen
Isolates (5 Influenza A And 13 Influenza B Viruses) Were Made From
924 Specimens Tested By The World Health Organization (Who) And National
Respiratory And Enteric Virus Surveillance System (Nrevss) Collaborating
Laboratories This Week. Since September 29, 1.3% (N=273) Of The
21,685 Specimens Tested Nationwide Have Been Positive. Nineteen (25%) Of
The 75 Influenza A Viruses Have Been Subtyped; 14 Were Influenza A H1
Viruses And 5 Were Influenza A (H3n2). Influenza A Activity Has Been
Detected In Florida, Hawaii, Louisiana, Massachusetts, Missouri, Nebraska,
New Jersey, New York, North Carolina, Oregon, South Carolina, North
Dakota, Texas, Virginia, Washington And Wisconsin. Influenza B Isolates
Have Been Identified In Arkansas, Arizona, Indiana, Louisiana, Missouri,
Nebraska, Nevada, New York, North Carolina, Oklahoma, South Carolina And
Texas. Cdc Has Characterized Four Influenza A (H1n1), One Influenza A
(H1n2), Two Influenza A (H3n2) And 17 Influenza B Isolates Antigenically.
All Strains Were Similar Antigenically To Corresponding Vaccine Strains.
The Proportion Of Patient Visits To Sentinel Physicians For Influenza-Like
Illness (Ili) Was 1.3% Nationwide. The State And Territorial
Epidemiologists Reported Widespread Flu Activity In Texas. Outbreaks Were
Reported From Kansas, Oklahoma, Tennessee, Texas And Virginia. Sporadic
Influenza Activity Was Reported From 22 States. The Proportion Of Deaths
Attributed To Pneumonia And Influenza As Reported By The Vital Statistics
Offices Of 122 U.S. Cities Was 7.4% During Week 52. This Percentage Is
Below The Epidemic Threshold Of 7.9% For This Time.
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