• Walter A. Orenstein, MD to Retire as Director of the National Immunization Program
• Other immunization news
• Upcoming meetings/conferences
  

The Centers for Disease Control and Prevention’s Immunization Works Monthly Update is provided to national health care provider and consumer groups for distribution to their members and constituencies. The immunization information provided is non-proprietary and is encouraged to be widely disseminated and shared.

Walter A. Orenstein, MD has announced his retirement as Director of the National Immunization Program (NIP) at CDC effective March 1, 2004. Upon retirement, Dr. Orenstein will be joining the Emory University School of Medicine as Director of a new Emory Program for Vaccine Policy and Development and as Associate Director of the Emory Vaccine Center. In his new position he will also serve as Associate Director of the Southeastern Center for Emerging Biologic Threats, a regional partnership led by Emory University.

Dr. Orenstein has been with the immunization program for more than 26 years. He became the Director of the National Immunization Program in 1993 having served in other leadership roles since 1982. Dr. Orenstein has served as an Assistant Surgeon General of the U.S. Public Health Service and as consultant to the World Health Organization and the Pan American Health Association for programs in polio eradication, measles control and smallpox eradication.

In a letter to NIP staff Dr Orenstein noted “I have been privileged to be part of many successful efforts to protect and improve the public’s health; each of which provided an opportunity to work together and in partnership with persons and groups throughout CDC, the United States and the world. During my time at CDC, I witnessed the eradication of smallpox, the elimination of endemic transmission of measles in the United States, and the achievement of record or near record lows for almost all of the childhood vaccine-preventable diseases. And importantly, we have achieved and maintained record or near record high levels of immunization coverage for childhood vaccines.

“As I reflect on my time at NIP, I see many accomplishments that we can point to with much pride and satisfaction. Children with meningitis from Haemophilus influenzae type b (Hib), once a common occurrence on pediatric wards, have become a rarity. There are fewer than 20 cases of acquired rubella reported each year in the United States, down from over 57,000 cases in 1969 when rubella vaccine was first licensed. Marked gains have been made against varicella and invasive pneumococcal disease in children. It’s been an honor and a privilege to have been a part of these successes.”

In preparation for Dr. Orenstein’s retirement, Steve Cochi, MD, has assumed the position of Acting Director of the National Immunization Program with Melinda Wharton, MD serving as the Acting Deputy Director. Dr. Orenstein is serving as a special advisor to Dr. Cochi.

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2004 Childhood Immunization Schedule:
The Advisory Committee on Immunization Practices (ACIP) has made available the recommended 2004 Childhood and Adolescent Immunization Schedule. The current schedule is a 6-month schedule, effective through June, 2004. The reason for the six month schedule is the ACIP has updated the recommendation for influenza vaccine for children 6-23 months old beginning in Fall 2004 for the 2004-2005 flu season.

The ACIP also issued a catch-up immunization schedule for children and adolescents who start late or who are more than 1 month behind in immunization. The catch-up schedule was introduced for the first time in 2003 and remains the same in content.

The following changes have been made in the recommend childhood and adolescent immunization schedule for 2004:

• The schedule indicates a change in the recommendation for the minimum age of the last dose in the hepatitis B immunization schedule. The last dose in the vaccination series should not be administered before age 24 weeks (updating the previous recommendation to not administer the last dose prior to age 6 months);
• The range of recommended ages for the adolescent Td vaccine dose has been updated to emphasize a preference for immunizing at age 11-12 years with ages 13-18 years to serve as a catch-up interval;
• Clarification was added to the footnotes for the timing of the final vaccine doses in the series for diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, Haemophilus influenzae type b (Hib) conjugate vaccine, and pneumococcal conjugate vaccine (PCV). The final dose in the DTaP series should be given at >4 years. The final doses in the Hib and PCV series should be given at age >12 months.
• An intranasally administered live, attenuated influenza vaccine (LAIV) is approved for use in the United States. For healthy persons age 5 to 49 years, LAIV is an acceptable alternative to the intramuscular trivalent inactivated influenza vaccine (TIV).

Healthy children aged 6-23 months are encouraged to receive influenza vaccine when feasible for the 2003-2004 influenza season. Children in this age group are at substantially increased risk for influenza-related hospitalizations. The ACIP has recommended that beginning in the fall 2004, children aged 6-23 months will be recommended to receive annual influenza vaccine. An updated childhood and adolescent immunization schedule for July – December 2004 will be released to reflect this change.

The schedule has been approved by the ACIP, the American Academy of Pediatrics, and the American Academy of Family Physicians. Current immunization schedules for children & adolescents and adults can be found on the NIP web site.

Influenza Vaccine Effectiveness Studies:
The CDC routinely conducts studies to estimate the effectiveness of vaccines for the diseases they are designed to protect against. The early onset of the 2003-2004 flu season and the presence of a new, or “drifted” influenza A strain caused CDC to pursue a series of studies to answer questions about how effective this year’s influenza vaccine is against the circulating viruses. The first study in the series was designed to obtain a rapid estimate of the effectiveness of the vaccine against influenza like illness while the flu season was still underway. Assessing influenza vaccine effectiveness presents unique challenges because circulating influenza viruses and influenza vaccine vary from year to year.

This is the first time CDC has conducted such a study in the midst of a flu season. CDC decided to undertake this rapid study to see if it would reveal any information that would help the public, physicians and public health officials make decisions about the use of influenza vaccine, antiviral medications, or other preventive measures. Sometimes, as in this case, the studies do not yield concrete results, but do help us understand how to better approach an issue in the future.

This initial study showed that the 2003-2004 influenza vaccine was not effective or had very low effectiveness against “influenza-like illness” in a group of healthcare workers in Colorado. However, the study does not provide sufficient information to conclude that the vaccine is not effective at all against the dominant circulating influenza strain.

“Influenza-like illness” is a broad definition that includes people with influenza, but it may also include people with colds and people who are suffering from respiratory illness not caused by influenza.

This study provides us some limited information about the effectiveness of this year’s influenza vaccine. The tradeoff for immediate information is the inability to obtain complete information. Results from additional studies, now underway, will be necessary to further gauge the effectiveness of this season’s vaccine. Those studies may have different outcomes from this very early study. In previous years with “drifted” influenza virus strains, such studies have demonstrated the effectiveness of the vaccine against laboratory confirmed influenza and influenza-related complications, even when no effectiveness is demonstrated against influenza-like illness. Results from other studies are expected in late spring or early summer 2004.

CDC continues to recommend that people, particularly those who are at highest risk of complications from influenza, and their contacts, get vaccinated if they have not yet done so. For the latest information on influenza visit www.cdc.gov/flu.

Measles Initiative Continues:
The American Red Cross, along with CDC, United Nations Foundation, World Health Organization, and United Nations Children’s Fund continue to support the Measles Initiative, a 5 year program to control measles death in Africa by vaccinating 200 million children in 36 sub-Saharan countries by 2005. While most Americans barely remember the disease, measles kills nearly 800,000 children, a half million of those in Africa alone. This fact makes measles the single leading vaccine-preventable cause of death among children in Africa yet it can be easily prevented with a simple vaccination. At the initiative’s mid-way point, more than 106 million children have been vaccinated in 24 countries, saving 194,000 young lives. For more information about the Measles Initiative visit www.measlesinitiative.org.

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The 38th National Immunization Conference:
The 38th National Immunization Conference is scheduled by May 11-14, 2004 in Nashville, Tennessee. The conference will bring together a wide variety of local, state, federal, and private-sector immunization partners to explore science, policy, education, and planning issues related to immunization in general and vaccine-preventable disease. To take advantage of early bird registration, visit www.cdc.gov/nip/nic.

International Neonatal Vaccination Workshop:
The CDC, along with the FDA, NIH and the National Vaccine Advisory Committee’s Future Vaccines Subcommittee, as well as others, will sponsor the International Neonatal Vaccination Workshop, March 2-4 in Washington DC. The Workshop will explore the feasibility and safety of strategies to expand protection of young infants against vaccine-preventable diseases including a variety of viral agents, diphtheria/tetanus/pertussis, Haemophilus influenzae type b and pneumococcus. Presentations by national and international experts will focus on the immune responses of the neonate to vaccine antigens, review clinical experience, consider expanded use of vaccines in the neonate from industry and regulatory perspectives, and explore other strategies to protect neonates such as maternal immunization. Pre-registration deadlines is February 13, 2004. For more information visit www.cdc.gov/nip/events/neonatal_wkshop.

Advisory Committee on Immunization Practices: The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting February 24-25, 2004 at the Marriott Century Center in Atlanta, Georgia. The meeting is open to the general public. For more information on the ACIP visit www.cdc.gov/nip/acip/default.htm.

New CDC Publications:
CDC has several new publications available on immunization related issues. All items are free of charge and can be ordered by using the NIP online order form at https://www2.cdc.gov/nchstp_od/PIWeb/niporderform.asp. The new items include:

• Vaccine Information Statements (Provider Set with all current VIS’s)
• 2004 Adult Immunization Schedule (8.5 x 11 and pocket-size laminated cards)
• Guide to Contraindications
• Standards for Adult Immunization Practices
• Standards for Child and Adolescent Immunization Practices

Job Openings within the National Immunization Program:
NIP is committed to recruiting and hiring qualified candidates for a wide range of positions. Researchers, Medical Officers and Epidemiologists as well as other specialties are often needed to fill positions within NIP. We encourage all interested parties to apply for these jobs. For a current listing of positions available at NIP, please visit www.usajobs.opm.gov. Once at the site, conduct a search for “National Immunization Program”.

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