| Epidemiological Bulletin: Fall 2001 (Part 2 of 4)
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Influenza Update
Sam Stebbins, MD, MPH (TB and STD Control Officer)
Once again the flu season approaches. And once again, the CDC is predicting delays in shipment of vaccine. Estimates are that 50 million doses will be available by the end of October 2001, which is 26 million doses fewer than were available by October 31st 2 years ago. An additional 27 million doses will be distributed in November and December, bringing the total up to what is typically needed in an average year.
Similar to last year, but hopefully with more lead time and an improved distribution process, CDC's Advisory Committee on Immunization Practices (ACIP) once again recommends prioritizing early influenza shots to those at higher risk (see list below), and delaying shots for those at lower risk until later in November or early December. [See Morbidity and Mortality Weekly Report (07/13/01) Vol. 50, No. 27, P. 582 available on the CDC website, www.cdc.gov/mmwr].
Highest Risk Groups
- Persons 65 years of age and older
- Nursing home and other chronic-care facility residents
- Adults of any age and children with chronic disorders of the pulmonary and cardiovascular systems, including asthma
- Adults and children who required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes), renal dysfunction, hemoglobinopathies, or immunosuppression, including that caused by medications or human immunodeficiency virus
- Children and teenagers (aged 6 months to 18 years) who receive long-term aspirin therapy
- Women who will be in the second or third trimester of pregnancy during the influenza season (December - March)
- Health Care Providers and staff who work with high-risk groups
We recommend that providers check with their influenza vaccine vendors and plan flu campaigns in accordance with the high-risk groups above the additional recommendations noted below.
Additional Recommendations from the CDC:
- The optimal time for vaccinating high-risk persons is October through November. To avoid missed opportunities, vaccine also should be offered to high-risk persons when they access medical care in September, if vaccine is available.
- Additional information that may help providers implement a reminder/recall system is available at http://www.cdc.gov/nip/flu. This site will also provide updates on the flu season and vaccine availability throughout the fall and winter.
- Beginning in November, providers should offer vaccine to contacts of high-risk persons, healthy persons aged 50 - 64 years, and any other persons wanting to reduce their risk for influenza.
- Providers should continue vaccinating patients, especially those at high risk and in other target groups, in December and should continue as long as there is influenza activity and vaccine is available.
Other Influenza News:
JULY, 2001 - An FDA advisory panel has recommended against approving a nasal spray flu vaccine. For its review, the FDA advisory committee studied the results of clinical trials involving thousands of adults and children who received the vaccine. However, the FDA felt that there was insufficient evidence to show it was safe. The panel said that while Aviron's FluMist nasal spray did ward off influenza, there was insufficient evidence to allay concerns about using a live flu virus in the spray. The committee also said there was insufficient evidence that the vaccine was safe when used in combination with other childhood vaccines. Aviron, which said it will continue to work with the FDA, still hopes to offer the spray in the future as an easy way for healthy people between the ages of one and 64 to get yearly flu vaccinations
Update on HIV Infection Reporting
Sarah Cottrell, MPH (Epidemiologist) & Tanya Perez (Communicable Disease)
As the discussions and debates on HIV reporting and it's implementation continue, the DCPU is working to keep hospitals and providers aware and up to date on the situation. The State Department of Health Services has closed the Public Comment Period for HIV Reporting Regulations (R-19-00), which began March 31, 2001, and ended May 21, 2001. Comments received are currently under consideration by DHS. Comments ranged from support of complete abandonment of HIV Reporting (an option NOT under consideration by CA DHS) to mandatory names reporting. Support for names reporting was most commonly based upon that method's expected enhanced accuracy and completeness of reporting. The most frequent comments made are outlined below (n=105):
- 39% in support of non-name reporting
- 36% included recommendation to report by name
- 31% desired an exclusion of the last four digits of the SSN from the unique identifier
- 30% wanted to shift the creation of the unique identifier from providers to the labs
- 22% requested institution of partner notification for HIV positive persons
In addition to the above, other significant issues raised during the public comment period included recommendations to adopt San Francisco's unique record number system; concerns about confidentiality; concerns about resource availability, (particularly regarding access to such institutions as the CA Department of Corrections); the need for technical assistance; and questions about funding. The monetary queries in particular regarded funding availability, not only to public health officials, but also to medical providers, laboratories, and services agencies.
Providers who serve substantial numbers of HIV-positive clients or who have related interests may wish to review the developing materials on the HIV Reporting regulations. Current versions of the proposed regulations and program flow chart can be found on the DHS - Office of AIDS website.
Readers who have questions regarding this material and San Mateo's efforts to implement the program can call Sarah Cottrell at 573-2974 with any questions.
Condom Update
Sam Stebbins, MD, MPH (w/ thanks to the State STD branch and CDC)
Condom Report- In June 2001, a meeting to determine the scientific evidence on condom effectiveness and STD prevention was held. The summary report of this meeting was issued this past summer, and can be found on the web at: http://www.niaid.nih.gov/dmid/stds/condomreport.pdf. As most of you know, it has been the subject of considerable debate, with advocates for abstinence-only education claiming that the results show that condoms are ineffective.
The summary of key points from the report is as follows:
- Abstinence is the most effective strategy for preventing HIV, STDs and pregnancy, but only as long as you're not sexually active. If you're sexually active, condoms are an effective strategy.
- Condoms are highly effective against HIV if used correctly.
- Condoms may not be 100% effective against certain infections transmitted through skin-to-skin contact because the organism may be found in areas that are not covered by condoms. However, the report concluded that condoms appear to reduce the risk of HPV-associated disease, including genital warts in men and cervical cancer in women
- This report stated that there is not enough research to definitively say whether condoms prevent other STDs.
The report warned that, this should not be proof of the adequacy or inadequacy of the condom to reduce the risk
Nonoxynol-9- The CDC recently sent out an advisory that nonoxynol-9 (N-9), a product widely used in spermicides, not be recommended as an effective means of HIV prevention. The studies that formed the basis for this recommendation were based on women of very high risk (prostitutes in Africa) and who used N-9 gel repeatedly. There is, however, no evidence that the small amount contained in condom lubrication is harmful. Therefore, the CDC is recommending that previously purchased condoms continue to be used as long as the expiration date has not passed. However, the CDC recommends that after that, no condoms with N-9 be purchased. These condoms cost more and offer no additional protection against HIV.
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