MINNESOTA DEPAR ARTMENT OF HEALTH DISEASE CONTROL NEWSLETTER Volume 27, Number 1 (pages 1-8) January-April 1999 Recommended Childhood Immunization Schedule - Minnesota, 1999 In this issue you will find the Recommended Childhood Immunization Schedule Minnesota, 1999 which is based on recommendations 1 jointly issued by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), and endorsed by the Immunization Practices Task Force of the Minnesota Department of Health (MDH). Please note the following changes from the 1998 MDH schedule: Polio: recommendations for the use of inactivated poliovirus vaccine (IPV) for the first two doses is further emphasized by the use of IPV in the table, followed by Polio for the final two doses. While either oral poliovirus vaccine (OPV) or IPV is acceptable for the final two doses, OPV is preferred. With the global eradication of polio on the horizon and the general acceptance by parents of IPV, this change will hopefully lead to further reduction of vaccineassociated paralytic polio following oral poliovirus vaccine. Rotavirus (Rv): a recommendation for a three-dose series of Rv vaccine to prevent rotavirus gastroenteritis among infants and children has been incorporated into the routine schedule for childhood immunization. Clarification on several vaccine issues: Due to the discontinuation of low-risk infant hepatitis B vaccine formulation by Merck Vaccine Division, footnote 1 has been simplified and no longer references the different HBV dosing schedules. Both hepatitis B products (Recombivax HB and Engerix- B) are now available as either pediatric (ages 0-19 yrs) or adult (>20 yrs) formulations. A warning that infants should not be given combined DTaP/ Hib for primary vaccination is emphasized within footnote 3. Clinical trials to date have all shown a lower immune response to the combined Hib component as compared to separate injections. The current licensed DTaP/Hib (TriHIBit by Wyeth-Lederle) may only be used as the fourth (booster) dose in infants 15 months of age or older. The catch up chart for children 4 months through 6 years of age, on the reverse side of the schedule, clarifies information regarding when to give Hib vaccine and minimum intervals to observe between doses. 1. Rotavirus disease and vaccine What do we know? The decision to recommend universal immunization of infants against rotavirus (Rv) disease by the ACIP 2 is based on several factors, which include: The extent to which Rv causes severe diarrhea in U.S. children. Virtually all children have one or more Rv infections before the age of 5 years. The disease is responsible for approximately onehalf million physician visits and 50,000 hospitalizations annually. The efficacy of the vaccine in preventing severe disease. While studies done in the U.S., Finland, and Venezuela found efficacy rates of 49% to 68% in preventing any diarrhea caused by Rv, these continued... INSIDE: Update on Head Lice... 5 Web Publications of MDH... 6 Subject Index for the Disease Control Newsletter, 1998... 7 Acute Disease Epidemiology Section Changes at MDH... 8
same studies demonstrated much higher efficacy (69% to 91%) in preventing severe diarrhea and dehydration. The safety of the vaccine. The only adverse reaction seen in the clinical studies was fever. A temperature of 38 C (100.4 F) or higher was observed in 3-5% of vaccinated children. The cost-effectiveness to society through both direct (estimated at $270-450 million) and annual total societal costs (estimated at $1 billion) of Rv disease. Providers should note that the recently published ACIP statement for Rv vaccine contains a more definitive statement concerning vaccination of premature infants. It now reads: The ACIP supports immunization of prematurely born infants if they a) are at least 6 weeks of age, b) are being or have been discharged from the hospital nursery, and c) are clinically stable. 2 This position is also consistent with that of the AAP. 3 While the ACIP/AAP/AAFP harmonized 1999 childhood immunization schedule incorporates routine Rv vaccination, it also acknowledges that health care providers may require time and resources to incorporate this new vaccine into practice. 1 Additionally, a footnote to the harmonized schedule states the AAFP feels that the decision to use rotavirus vaccine should be made by the parent or guardian in consultation with their physician or other health care provider. This statement is intended to reflect concern by some AAFP members over the economic and societal benefits of a universal vaccination program. 4 Rv vaccine, licensed August 31, 1998, will be available through Minnesota Vaccines For Children as soon as a federal supply contract is finalized -- predicted to be yet this spring. The vaccine is given orally and can be stored at room temperature below 25 C (77 F) or in the refrigerator at 2 C to 8 C (36 F to 45 F). An interim Vaccine Information Material (VIM), is available from MDH. Although it is optional at this time, it will be required for use once the vaccine is officially covered by the National Childhood Vaccine Injury Act, the no-fault compensation program for families claiming illness or injury associated with vaccinations. Until Rv vaccine is available through MnVFC, clinics may use their privatelypurchased vaccine for Minnesota Health Care Program patients and request reimbursement through their normal billing process. 2. New Vaccine Information Materials (VIMs) available Camera-ready copies of new VIMs for a number of vaccines covered by the National Childhood Vaccine Injury Act are available from MDH. As a reminder, federal law (42 U.S.C. 300aa-26) requires that these be given to the parent or authorized representative of the pediatric patient, or to the vaccinee if an adult patient, each time a dose of any of these vaccines is administered. You will find English and translated VIMs on the MDH Web site at http:// www.health.state.mn.us/divs/dpc/adps/ translte.htm. Vaccine Information Materials The current versions of VIMS are: DTP/DTaP: 8/15/97 Hepatitis A: 8/25/98 Hepatitis B: 12/16/98 Hib: 12/16/98 Influenza: changes annually MMR: 12/16/98 Pneumococcal: 7/29/97 Polio: 2/1/99 Rv (interim): 3/23/99 Td: 6/10/94 Varicella: 12/16/98 3. Varicella the leading cause of vaccine-preventable deaths in U.S. children 5 The vaccine for the prevention of varicella (i.e., Varivax by Merck) was licensed in March 1995. Recommendations for routine vaccination have been incorporated into the MDH Recommended Childhood Immunization Schedule beginning with the 1996 version. All infants are recommended to receive varicella vaccine as a 1-dose routine vaccination at 12-18 months of age; unvaccinated children without a reliable history of chickenpox as well as susceptible adolescents and adults should also be vaccinated (Note: Give 2 doses >12 years). Unless infant vaccination reaches 100% of infants, it can be assumed that a significant number of adolescents will remain susceptible to the disease as transmission of the wild virus declines. To avoid the serious impact of disease in young adults, it is critical that all providers adhere to a combination of routine vaccination of all infants and assessment and follow-up of adolescents. Varicella vaccination requirements for enrollment in child care facilities and schools will probably be incorporated into the School Immunization Law during the years to come. 4. Hepatitis B requirements in the new millennium Beginning with the 2000-01 school year, all children entering kindergarten in Minnesota will be required to have documentation of hepatitis B vaccination. This requirement will also cover students entering 7 th grade beginning with the 2001-02 school term. For this reason, it is important to take every opportunity to vaccinate your pediatric patients with the threedose hepatitis B vaccine series. Here are some action steps you can take now: Vaccinate all infants routinely. Initiate or complete a three-dose schedule for any child who missed completing a vaccination schedule in infancy. Remember: You never restart a hepatitis B series due to a lapse in the series. Make special efforts to assess and vaccinate children who are in 4 th grade during the current (i.e.,1998-99) school year. They will be the first cohort affected by the 7 th grade requirement. Assess all adolescents routinely for completion of the three-dose schedule. Note: While they will miss the school requirement, they are entering a high-risk period for disease and should be vaccinated. Provide all patients with a written record of vaccination. Clinics may order quantities of the official Minnesota Immunization Record card (a.k.a. the Gold Card ), free of charge, in packs of 100 by calling the Minnesota Immunization Hotline at 612/676-5100 or 800/ 657-3970. continued... 2
Recommended Childhood Immunization Schedule Minnesota, 1999 Orange bars indicate range of acceptable ages. Green bars indicate catch-up vaccination. Purple column indicates need for assessment. Vaccine z Age Birth 1 mo 2 4 6 12 15 18 2 yrs 4-6 yrs 11-12 yrs 14-18 yrs Hepatitis B 1 Hepatitis B - 1 Hepatitis B - 2 Hepatitis B - 3 Hepatitis B 1 (1-3) Diphtheria, Tetanus, Pertussis 2 Haemophilus influenzae type b 3 Polio 4 Rotavirus 5 DTaP DTaP DTaP DTaP Td DTaP 2 Hib Hib Hib 3 Hib 3 IPV IPV Polio 4 Polio Rv Rv Rv Measles, Mumps, Rubella 6 MMR - 1 MMR-2 6 MMR-2 6 Varicella 7 Hepatitis A 8 Vaccines below line are for selected populations. Varicella Varicella Hepatitis A Influenza 9 Influenza (yearly) Pneumococcal 10 Pneumococcal 1. Hepatitis B (HBV): Regardless of the mother s HBsAg status, give 2nd dose >4 wks after 1st dose and 3rd dose >6 of age. Infants born to HBsAg-positive mothers should receive 0.5 ml hepatitis B immune globulin (HBIG) within 12 hrs of birth, and hepatitis B vaccine at a separate site. The 2nd dose is recommended at 1 mo of age and the 3rd dose at 6 of age. Infants born to mothers whose HBsAg status is unknown should receive hepatitis B vaccine within 12 hours of birth. Maternal blood should be drawn at the time of delivery to determine the mother s HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than 1 wk of age). HBV-2 is recommended at 1 mo of age and HBV-3 at 6 of age. Children and adolescents who have not previously received 3 doses of hepatitis B vaccine should be given HBV-2 >4 wks after HBV-1, and HBV-3 >4 after HBV-1 and >8 wks after HBV-2. 2. Diphtheria, tetanus, and acellular pertussis (DTaP): Children should receive DTaP instead of whole-cell DTP because of its fewer adverse reactions and equal or greater efficacy. Children who have a true contraindication to pertussis vaccine should receive DT (for pediatric use) and not DTaP or DTP. DTaP-4 may be given as early as 12 of age if at least 6 have passed since DTaP-3, and if the child is considered unlikely to return at 15-18 of age. Td (tetanus and diphtheria toxoids, adsorbed, for adult use) is recommended at 11-12 years of age if at least 5 yrs have passed since the last dose of DTP, DTaP, or DT. Subsequent routine Td boosters are recommended every 10 yrs. 3. Haemophilus influenzae type b (Hib): Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB or COMVAX from Merck) is given at 2 and 4 of age, a dose at 6 is not required. DTaP/Hib combination products should not be used for the first 3 doses (primary series). Any Hib conjugate vaccine may be used as a booster. 4. Polio: A schedule of 2 doses of inactivated polio vaccine (IPV) followed by 2 doses of oral poliovirus vaccine (OPV) is recommended. IPV alone is recommended for immunocompromised children and for children with immunocompromised family contacts. OPV is no longer recommended for the first two doses, and an all-opv schedule is acceptable only for special circumstances (e.g., for children on catch-up schedules, whenever parents or providers decline extra injections, and in children likely to travel to polio-endemic countries). 5. Rotavirus (Rv): Administer the 1st dose of Rv vaccine as early as 6 wks but no later than 6 of age. Complete the full series before winter, if possible, using an accelerated schedule of 3 wks between doses, if necessary. Do not give any doses of Rv vaccine >12 of age. Premature infants may receive Rv vaccine at or after discharge from the hospital nursery if they are at least 6 wks of age and are clinically stable. 6. Measles, mumps, rubella (MMR): MMR-2 is recommended at 4-6 yrs, but may be given during any visit, provided >4 wks have elapsed since the 1st dose and both doses are given >12 of age. 7. Varicella: Administer varicella vaccine to all susceptible children at 12-18 of age. Unvaccinated children >18 who lack a reliable history of chickenpox should also be vaccinated. Children <12 yrs should receive 1 dose; those >13 yrs should receive 2 doses 4-8 wks apart. 8. Hepatitis A: Administer hepatitis A vaccine to children and adolescents who are at increased risk of infection, as defined by ACIP*, and consider for all other persons >2 yrs of age wishing to obtain immunity. A booster should be given >6 after the initial dose. 9. Influenza: Administer influenza vaccine annually to children >6 of age who have specific risk factors, as defined by ACIP*, and consider for all others wishing to obtain immunity. Children <12 yrs should receive split virus vaccine in a dosage appropriate for their age (0.25 ml if 6-35 of age or 0.5 ml if >3 yrs). Children <9 yrs of age who are receiving influenza vaccine for the first time should receive 2 doses separated by at least 4 wks. 10. Pneumococcal: Administer pneumococcal vaccine to children >2 yrs of age at increased risk of acquiring systemic pneumococcal infections or increased risk of serious disease if they become infected. Give a 2nd dose to children at highest risk of serious pneumococcal infection, as defined by ACIP*: for those <10 yrs of age, give >3 yrs from 1st dose; for those >10 yrs of age, give >5 yrs from 1st dose. Based on recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), and endorsed by the Immunization Practices Task Force of the Minnesota Department of Health (MDH). * For current ACIP recommendations or other questions, call the Web site: www.health.state.mn.us/divs/dpc/adps/adps.htm Minnesota Immunization Hotline at (612) 676-5100 or toll-free (800) 657-3970. Minnesota Department of Health, March 1999 IC# 141-0188
For Children Who Start Late or Have Fallen Behind For any vaccine given in a series, it is not necessary to start over. Refer to the tables below for recommended schedule and minimum intervals between doses. Determine the number of previous doses of each vaccine received, find that number in the first column, and read across to the appropriate column for the next dose(s) and minimum interval(s). (Note: refer to #5 on reverse side for rotavirus vaccination ages and intervals.) Table 1. Catch-up schedule for children 4 months through 6 years Number of Doses to be given and minimum intervals previous doses of each vaccine First dose Second dose Third dose Fourth dose Fifth dose None One Two Three Four DTaP Polio 1 HBV Hib 2 MMR 3 Varicella 4 DTaP: 4 weeks after 1st dose Polio: 4 weeks after 1st dose HBV: 4 weeks after 1st dose Hib: 4 wks if 1st dose given at <12 of age; 8 wks (as final dose) if 1st dose given 12-14 of age; no more are needed if 1st dose given >15 of age. MMR 3 : 4 weeks after 1st dose DTaP: 4 weeks after 2nd dose Polio: 4 weeks after 2nd dose 5 HBV: 8 weeks after 2nd dose 6 Hib: If current age <12, 4 wks after 2nd dose (exception: see #8 below). If current age 12 to <5 yrs & 2nd dose given either (a) <15, give final dose 8 wks after 2nd dose or (b) >15 of age, no more are needed. DTaP: 6 months after 3rd dose Polio: 4 weeks after 3rd dose 7 Hib 8 : Only necessary for children age 12 months to <5 years who received 3 doses <12 months of age. Table 2. Catch-up schedule for children age 7 through 18 years DTaP 9 : 6 months after 4th dose Number of previous doses of each vaccine Doses to be given and minimum intervals First dose Second dose Third dose Booster dose None Td Polio 1,10 HBV MMR Varicella 4 Td: 4 weeks after 1st dose Polio: 4 weeks after 1st dose HBV: 4 weeks after 1st dose MMR: 4 weeks after 1st dose Varicella 4 : 4 weeks after 1st dose Td: 6 months after 2nd dose Polio: 4 weeks after 2nd dose HBV: 8 weeks after 2nd dose 6 Td: every 10 years (exception, see #2 on reverse side) Polio 7 One Two Three 1. Polio: Those who begin the series >6 months of age may receive an all-opv schedule to reduce the number of injections. 2. Hib: Vaccine is not generally recommended for children >5 years. 3. MMR: Do not administer MMR vaccine before 12 months of age. Administer 2nd dose of MMR routinely at 4-6 years or earlier, if desired. 4. Varicella: Do not administer varicella vaccine before 12 months of age. Give 2 dose series to all susceptible adolescents >13 years of age. 5. Polio: For those receiving IPV alone, an interval of 6 months between IPV-2 and IPV-3 will provide optimal response and is preferred. 6. HBV: The minimum interval between HBV-2 and HBV-3 is 8 weeks; however, an interval of 4-12 months will result in higher final titers of anti-hbs. 7. Polio: Children on an IPV/OPV sequential schedule should receive all 4 doses, regardless of age when first initiated. In such cases, the minimum interval between the last 2 doses is 4 weeks. The 4th dose in an all-ipv or all-opv schedule is not necessary if the 3rd dose was given after the 4th birthday. 8. Hib: If PRP-OMP was given for the first 2 doses, no more than 3 doses are needed, with the final dose given at 12-15 months and at least 8 weeks after the previous dose. If a 3rd dose of HbOC or PRP-T is given >12 months of age, a 4th dose is not needed. 9. DTaP: The 5th dose is not necessary if the 4th dose was given after the 4th birthday. 10. Polio: Vaccine is not generally recommended for persons >18 years. Children who present with a mild acute illness, with or without fever, should not be deferred for vaccination. Only true contraindications to vaccination should be followed (See MDH Guide to Contraindications). There are no contraindications to simultaneous administration of vaccines recommended for routine use in children. For children 12-18 months of age, multiple vaccines may be administered over 1 or 2 visits, but are strongly encouraged in 1 visit for children who have fallen behind. Adults need immunizations, too. Use every encounter to assess adult vaccination status (See MDH Recommended Schedule for Adult Immunization). Special Notes on Immunization 4 Reporting adverse reactions: Report adverse reactions to vaccines through the federal Vaccine Adverse Event Reporting System. For information on reporting reactions following vaccines administered by private clinics, call the 24-hour national toll-free information line (800) 822-7967. Report reactions to vaccine administered in public clinics to the Minnesota Department of Health, (612) 676-5414 or toll-free (877) 676-5414. Disease reporting: Report suspect cases of vaccine-preventable diseases to the local health department or to the Minnesota Department of Health, 717 Delaware Street S.E., Minneapolis, Minnesota 55440, (612) 676-5414 or tollfree (877) 676-5414.
5. Other reference materials available from MDH The Recommended Childhood Immunization Schedule published by the MDH is updated annually due to the ever-changing nature of pediatric vaccines and recommendations. It is generally distributed in the spring (March or April) following the publication of the ACIP/AAP/AAFP harmonized schedule in January. We highly recommend two other MDH publications that relate to immunization of adults and international travelers. Fortunately, the recommendations within each of these schedules have not changed since their last publication. They include: Recommended Adult Immunization Schedule (April 1997) Got Your Shots? Tips on Advising Patients About Shots for International Travel (1998) References: 1. CDC. Recommended Childhood Immunization Schedule United States, 1999. MMWR 1999;48:8-16. 2. CDC. Rotavirus Vaccine for the Prevention of Rotavirus Gastroenteritis Among Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-2);1-23. 3. American Academy of Pediatrics, Committee on Infectious Diseases. Prevention of Rotavirus Disease: Guidelines for Use of Rotavirus Vaccine. Pediatrics. 1998;102:1483-1491. 4. Universal Rotavirus Immunizations Should rotavirus vaccine be recommended for universal use? The Journal of Family Practice 1999;48:146-148. 5. CDC. Varicella-Related Deaths Among Children United States, 1997. MMWR 1998;47:18, 365-368. More information, copies, feedback, and comments: If you have comments or questions, please feel free to call the Minnesota Immunization Hotline at (612) 676-5100 or (800) 657-3970. The materials cited above and many others are available at http:// www.health.state.mn.us/divs/dpc/ adps/adps.htm or by calling the Hotline. You can also obtain the ACIP recommendations by calling CDC at (800) 232-2522 between 8:00 a.m. and 10:00 p.m., Monday through Friday or via the CDC web site at http://www.cdc.gov/epo/ mmwr/mmwr.html. Head lice (Pediculus humanus capitis) infestations are a major public concern in Minnesota and across the United States. While head lice are not known to be vectors of disease, the public looks to medical providers and public health workers for effective treatment options against these small insects. Currently, significant public health resources at state and local levels are used to address this problem. Head lice are obligate parasites of humans that are found primarily on the scalp (especially occipital and postauricular areas). The adult female louse lives 3-5 weeks and lays between 5-10 eggs (nits) per day. Nits are attached near the bases of hair shafts, and t viable nits will be found within 1/4 inch of the scalp. Nymphal head lice emerge from the nits after 6-10 days and feed daily on human blood. After about 10 days (and three molts) the nymphs become sexually mature adult head lice. Head lice are transmitted primarily through direct head to head contact between people (especially children). Transmission from fomites occurs but is thought to be less important. Shared objects such as combs, brushes, hats, towels, and bedding have been suspected in many infestations. Update on Head Lice However, t head lice die of starvation or desiccation within two days off of the host. Several over-the-counter head lice treatment options are available. Products containing permethrin and pyrethrin are the current treatments of choice. Both have been shown to be effective against head lice. However in recent years there has been widespread suspicion that head lice may have increasing levels of resistance to these materials. This apparent resistance has not been well studied or documented yet. Many providers prescribe Lindane for patients with chronic infestations of head lice. While these treatments are often effective, Lindane is more toxic to humans, and some populations of head lice have been shown to be resistant to this pesticide. Many alternatives to the over-thecounter or prescription head lice treatments have become more popular in recent years. Some of the more widely used products include petroleum jelly (Vaseline), mayonnaise, and various oils (e.g. olive, vegetable). In theory, when applied to the hair and scalp, these treatments either suffocate or create a habitat unfavorable to the head lice. While there is anecdotal 5 evidence that many of these treatments may work, there are little if any carefully collected efficacy data for t of these products. Mechanical removal of live lice and potentially viable nits (those within 1/4 inch of the scalp) is an important supplement to all head lice treatments. None of the treatments are 100% effective against live lice and are even less efficacious on the nits. Many of the permethrin and pyrethrin head lice treatments recommend a follow up treatment 7-10 days after the first treatment to eliminate freshly hatched head lice nymphs, and lice that survived the initial treatment. Regular grooming with a louse comb or finger nails will remove many of these lice and potentially viable nits. These regular checks also help the patient monitor the status of their infestation. If remaining nits are greater than ½ inch out on the hair shafts, and no live lice have been seen for two weeks, the infestation is likely gone. As overuse of the over-thecounter products appears to be a common practice, these checks will help to reduce unnecessary treatments. Many apparent chronic infestations of head lice are actually reinfestations. If continued...
the infestation returns after being gone for two or more weeks, the patient has probably been reinfested. Children are often exposed to the same child that gave them their infestation initially. While reducing transmission is difficult, parents should be encouraged to speak with their children about reducing direct head-to-head contact with other children, and avoiding shared objects such as brushes and combs. Parents should also be encouraged to communicate with the parents of children that may have been exposed to their infested child. Web Publications of the Minnesota Department of Health http://www.health.state.mn.us Introduction Healthcare providers and the public are using the Internet to access health information at an increasing rate. Of the general population that accesses the Web, 36.7% retrieve health and medical information, and a study done a year and a half ago identified over 10,000 health-related Web sites. 1 Of 7.6 million searches done on PubMed and Internet Grateful Med in March of 1998, 70% were done by health care providers and researchers; a notable 30% were done by the general public seeking health information. 2 In an effort to respond to those searching for Webbased public health information, the Minnesota Department of Health (MDH) has been publishing information for providers and the public on its Web site http://www.health.state.mn.us for about 2½ years. Since early 1998, the number of users of the MDH site per day has alt doubled. Disease Prevention and Control has a variety of resources online including health education materials, other health care provider resources, a variety of other publications, and links to credible sources outside of MDH. Some of the information available is reviewed below. Disease Prevention and Control Web Resources The Food Safety Center (FSC) works to prevent, monitor, and control foodborne disease in Minnesota. Visit this site for information about outbreaks of foodborne illness, product recalls, health education materials directed toward safe handling of food in the home and the use of irradiation to protect the food supply, and links to information about the Minnesota Food Code. Lyme disease and the newly licensed vaccine are of interest to both health care providers and the public. Resources include interim information for health care providers about Lyme disease vaccine, fact sheets for the public on Lyme disease and on the Lyme disease vaccine, a Minnesota map of cases by county of exposure, a slide presentation, information for clinicians about diagnosis, treatment, and epidemiology, and links to other sites. The Refugee Health Program site includes English and translated versions of immunization materials, an online version of the A Guide to Your Refugee Health Assessment brochure, and an extensive list of links to refugee health resources. The t recent addition to this site is the Health Guide for Refugees in Minnesota. This 75- page booklet includes information for refugees about paying for health care, what health services are available and how they should be used, and chapters on pregnancy, dental and eye care, mental health, and a glossary of words used in health care settings. MDH immunization resources online are directed primarily toward health care providers. The list of United States and foreign vaccines has proved to be a valuable resource for school nurses and others interpreting immunization records from other countries. Also included on this site are results of the kindergarten retrospective study of immunization levels in the state, resources for immunization registry operators, links to the t recent CDC Vaccine Information Materials in English and other languages, and travel health resources for health care providers and the public. Got Your Shots? News is an immunization update for health care providers. Current and past issues are available online in addition to a subject index for all issues. By sending an online request, you will receive an email message with a link to the appropriate site whenever a new issue is published. Current and past issues of the Disease Control Newsletter can be viewed online or, by submitting the online order form, you may request hard copies. HIV/AIDS Surveillance Reports are also available. Web Resources in the Event of Public Health Alerts The recent meningitis outbreak in Cloquet and the milk recall due to Listeria contamination gave us the opportunity to use the MDH Web site to communicate to health care providers, public health agencies, and the public during public health alerts. Plans are underway to incorporate Web communication into the influenza pandemic planning, bioterrorism preparedness, and other threats to the public s health. Navigating the MDH Web Site The MDH Web site currently contains more than 1,400 documents. A key word search is available in addition to menus of programs, health statistics, and topics. Because consistent headers and footers are used throughout, visitors should be able to find their way without difficulty. We request suggestions from readers for useful additions to the site. You may e- mail your comments to immunize@health.state.mn.us. 1. Criteria for Assessing the Quality of Health Information on the Internet. Mitretek Systems, Health Information Technology Institute (HITI), McLean, VA, October 1997. 2. Who is doing MEDLINE Searching? National Library of Medicine Newsline, January-March 1998. 6
EMERGING INFECTIONS Subject Index for the Disease Control Newsletter, 1998 Surveillance for Community-Acquired MRSA... Sept/Oct FOODBORNE & ZOONOTIC DISEASES Update: Lyme Disease Vaccine... May/June Rabies: Current Epidemiology and Post-Exposure Prophylaxis Recommendations... May/June Psittacosis Case Report... Sept/Oct Cryptosporidiosis Associated with Recreational Water Facilities... Sept/Oct GENERAL SURVEILLANCE ISSUES Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, 1997... July/Aug HEPATITIS Viral Hepatitis Prevention: What Providers Can Do... April Hepatitis B Vaccination - New School Requirements... May/June A Targeted Lookback for Recipients of Blood or Blood Components From Donors Who Subsequently Tested Positive for Antibody to the Hepatitis C Virus (HCV)... Nov/Dec Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease... Nov/Dec SEXUALLY TRANSMITTED DISEASES 1998 Guidelines for Treatment of Sexually Transmitted Diseases: Syphilis... March 1998 Guidelines for Treatment of Sexually Transmitted Diseases: Chlamydia and Gonorrhea... April VACCINE-PREVENTABLE DISEASES Immunization of Health-Care Workers - Recommendations of the Advisory Committee on Immunization Practices (ACIP)... Jan/Feb Recommended Childhood Immunization Schedule, Minnesota, 1998... May/June Hepatitis B Vaccination - New School Requirements... May/June Update: Lyme Disease Vaccine... May/June Prevention of Influenza: Summary of 1998 ACIP Recommendations... Sept/Oct Prevention of Pneumococcal Disease: Summary of 1997 ACIP Recommendations... Sept/Oct Tips for Improving Vaccination Rates of Adult Populations... Sept/Oct Additional Resources on Adult Immunization... Sept/Oct 7
Acute Disease Epidemiology Section Changes at MDH On March 2, Michael T. Osterholm, Ph.D., M.P.H. resigned after many years of service at the Minnesota Department of Health. Dr. Osterholm had been with the department since 1975. He had served as Manager of the Acute Disease Epidemiology Section since 1979 and as State Epidemiologist since 1981. He is entering private business in Minnesota and will remain as a consultant to the department. In another move, Kristine A. Moore, M.D., M.P.H. resigned her position on March 9. Dr. Moore had been with the department since 1984, t recently serving as Assistant Section Manager for the Acute Disease Epidemiology Section and as Assistant State Epidemiologist. She also will be a consultant to the department but will eventually be re-locating to Colorado. Best wishes to both Mike and Kris in their new endeavors! Richard Danila, Ph.D., M.P.H. has been appointed Acting Section Manager for the Acute Disease Epidemiology Section and as Acting State Epidemiologist. He has been with the department for 14 years. A search is underway for permanent replacements. Taking over for Dr. Moore as editor of the Disease Control Newsletter will be Kirk Smith, D.V.M., Ph.D., who first came to the department in 1996. Jan K. Malcolm Commissioner of Health Division of Disease Prevention and Control Agnes T. Leitheiser, R.N., M.P.H.... Division Director Kirk Smith, D.V.M., Ph.D... Editor Sheril Arndt...Production Editor Richard N. Danila, Ph.D., M.P.H.... Acting State Epidemiologist CHANGING YOUR ADDRESS? Please correct the address below and send it to: DCN MAILING LIST Minnesota Dept. of Health 717 Delaware Street SE Minneapolis, MN 55414 The Disease Control Newsletter is available on the MDH Acute Disease Epidemiology Section web site at www.health.state.mn.us/divs/dpc/ades/pub.htm