HEP EXPRESS
Viral hepatitis news from the Immunization Action Coalition
===========================================================
Issue Number 26 February 22, 2005

CONTENTS OF THIS ISSUE

1. CDC's draft ACIP hepatitis B recommendations
available online for your review and comments
2. Dr. John Ward accepts position as director of CDC's
Division of Viral Hepatitis
3. CDC reports on hepatitis A vaccination coverage among U.S.
children ages 24-35 months during 2003
4. National Institutes of Health releases Action Plan for
Liver Disease Research
5. DHHS adds HBV and HCV to list of known carcinogens
6. CDC reports African Americans have twice the incidence rate
for hepatitis B and Streptococcus pneumoniae as whites
7. EPA publishes updated guidance about safe needle/sharps
disposal
8. Hepatitis B Foundation establishes new research institute
9. New resources about preventing occupational exposure to
bloodborne pathogens available
10. Resources for safer tattooing in prisons available online
11. Journal articles you may have missed
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ABBREVIATIONS: ACIP, Advisory Committee on Immunization
Practices; CDC, Centers for Disease Control and Prevention; DVH,
Division of Viral Hepatitis; HAV, hepatitis A virus; HBV,
hepatitis B virus; HCV, hepatitis C virus; IAC, Immunization
Action Coalition; IDU, injection drug user; MMWR, Morbidity and
Mortality Weekly Report; MSM, men who have sex with men; STD,
sexually transmitted disease; VIS, Vaccine Information
Statement; WHO, World Health Organization.
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(1 of 11)
February 22, 2005
CDC'S DRAFT ACIP HEPATITIS B RECOMMENDATIONS AVAILABLE ONLINE
FOR YOUR REVIEW AND COMMENTS

CDC's Division of Viral Hepatitis has posted draft hepatitis B
recommendations online at
http://www.cdc.gov/ncidod/diseases/hepatitis/b/HBV_ACIP_Recs.pdf

The hepatitis B working group of the ACIP developed the proposed
recommendations. A discussion vote to adopt the recommendations
is scheduled for the June 29-30 ACIP meeting. CDC is currently
encouraging feedback from health professionals and the public on
the proposed statement. Please email comments to
aciprecs@... before March 4, 2005.
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(2 of 11)
February 22, 2005
DR. JOHN WARD ACCEPTS POSITION AS DIRECTOR OF CDC'S DIVISION OF
VIRAL HEPATITIS

[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 01/18/05.]

On January 6, Dr. James M. Hughes, director of the National
Center for Infectious Diseases (NCID), announced that Dr. John
Ward has accepted the position of director, Division of Viral
Hepatitis. The text of Dr. Hughes' announcement is reprinted
below in its entirety.

****************

I am pleased to announce that Dr. John Ward has accepted the
position of director, Division of Viral Hepatitis (DVH). Dr.
Ward most recently served as editor of the Morbidity and
Mortality Weekly Report (MMWR) and as acting director of the
Division of Scientific Communications, in the proposed National
Center for Health Marketing, National Coordinating Center for
Health Information and Service.

Dr. Ward received his MD from the University of Alabama School
of Medicine in Birmingham and completed an internship and
residency in internal medicine at the University of Alabama
Hospitals. In addition to his EIS [Epidemic Intelligence
Service] training, he received postgraduate training in tropical
medicine at the London School of Tropical Medicine and Hygiene,
in pediatric immunology at the Royal Children's Hospital in
Melbourne, Australia, and in infectious diseases as a CDC
assignee at the University of Washington Medical Center in
Seattle. He joined CDC in 1984 as an EIS officer in the
Epidemiology Section of what was then known as the AIDS
Activity, NCID. He remained in CDC's evolving AIDS program
through 1998, working on many high-profile investigations and
serving in various leadership positions including section chief
and then later branch chief of the Surveillance Branch in the
Division of HIV/AIDS, NCID. He became editor of the MMWR in
1998.

The recipient of numerous CDC and PHS [Public Health Service]
awards, Dr. Ward is a member of the Emory University School of
Medicine clinical faculty and is active on many public health
planning and steering committees. He is the author or coauthor
of more than 100 scientific publications and serves as a peer
reviewer for numerous journals including the American Journal of
Public Health, JAMA [Journal of the American Medical
Association], and Annals of Internal Medicine.

Please join me both in thanking Dr. Eric Mast for his excellent
service as acting director, DVH, for the past six months and in
congratulating John and supporting him in his new position.

****************
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(3 of 11)
February 22, 2005
CDC REPORTS ON HEPATITIS A VACCINATION COVERAGE AMONG U.S.
CHILDREN AGES 24-35 MONTHS DURING 2003

[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 02/21/05.]

CDC published "Hepatitis A Vaccination Coverage Among Children
Aged 24-35 Months--United States, 2003" in the February 18 issue
of MMWR. The article is reprinted below in its entirety with the
exception of one table, one figure, and references.

***********************

Hepatitis A vaccine was first licensed in the United States in
1995. In 1996, the Advisory Committee on Immunization Practices
(ACIP) recommended vaccination of children aged >=24 months in
populations with the highest incidence of hepatitis A (e.g.,
American Indian/Alaska Native [AI/AN], Asian/Pacific Islander,
and selected Hispanic and religious communities). In 1999, these
guidelines were expanded to recommend routine vaccination for
children residing in 11 states where average annual hepatitis A
incidence during 1987-1997 was at least 20 per 100,000
population (twice the national average) and to consider routine
vaccination for children in six states where average annual
incidence was 10-20 per 100,000 population. This report is the
first national analysis of hepatitis A vaccination coverage
among children. The results indicate that, in 2003, vaccination
coverage levels with at least 1 dose of hepatitis A vaccine for
children aged 24-35 months varied from 6.4% to 72.7% in areas
where routine vaccination is recommended. In addition, hepatitis
A vaccination coverage rates for children aged 24-35 months are
lower than overall rates for other vaccines recommended for
children. Sustaining and improving vaccination coverage among
young children is needed to ensure continued declines in
hepatitis A incidence in the United States.

The National Immunization Survey (NIS) provides annual estimates
of vaccination coverage as of the time of household interview
among children aged 19-35 months for the 50 states and 28
selected urban areas. In 2003, NIS began to collect data
regarding hepatitis A vaccination coverage. Hepatitis A vaccine
is a 2-dose regimen (administered at least 6 months apart)
licensed for use in children aged >=24 months. Hepatitis A
vaccination coverage data were limited to children aged 24-35
months and calculated by considering children who had received
at least 1 vaccine dose. To collect vaccination data for all
age-eligible children, NIS uses a quarterly, random-digit-
dialing sample of telephone numbers for each of the 78 survey
areas and determines vaccination status from healthcare provider
records. During 2003, information on vaccination history was
collected from telephone interviews for 19,979 children;
provider verified vaccination records were available for 13,731
(68.7%).

Among children aged 24-35 months residing in the 11 states where
routine hepatitis A vaccination is recommended, 50.9% (95%
confidence interval [CI] = 47.6%-54.2%; range among states:
6.4%-72.7%) received at least 1 dose of hepatitis A vaccine.
Among children aged 24-35 months residing in the six states
where routine hepatitis A vaccination should be considered,
25.0% (CI = 21.8%-28.2%; range: 0.6%-32.3%) had received at
least 1 dose of hepatitis A vaccine. Among children aged 24-35
months residing in the 33 states without a specific
recommendation, 1.4% (CI = 1.0%-1.8%; range: 0.0%-4.3%) had
received at least 1 dose of hepatitis A vaccine. Two states
(Alaska and Arizona) and four urban areas had coverage estimates
>60%. Hispanic and AI/AN children had higher coverage rates than
non-Hispanic white or black children in areas where routine
vaccination is recommended or should be considered.

Editorial Note:

The national hepatitis A vaccination coverage estimates
described in this report indicate that, in 2003, current
hepatitis A childhood vaccination recommendations were being
implemented in many states. However, coverage varied among areas
and populations, likely because of targeted programs within
these states. For example, higher coverage in El Paso County,
Texas (71%), compared with the overall Texas coverage rate
(32%), likely is attributable to vaccination requirements in
Texas border counties for all children attending child care
programs.

Vaccination coverage also varied by race/ethnicity. Higher
coverage among Hispanic and AI/AN children than among children
of other racial/ethnic populations might be related to greater
disease recognition in these populations and local and national
vaccination recommendations that have identified these
populations as having higher hepatitis A rates.

The findings in this report are subject to at least three
limitations. First, NIS is a telephone survey; although
statistical weights adjust for nonresponse and households
without telephones, some bias might remain. Second, although NIS
relies on provider-verified vaccination histories, incomplete
records or reporting could result in underestimates of coverage.
Finally, although national estimates are reliable, estimates for
states and urban areas and for racial/ethnic populations should
be interpreted with caution.
The 1999 ACIP hepatitis A prevention recommendations encouraged
state and local immunization programs to analyze their
surveillance data and implement vaccination strategies that
address the epidemiology of hepatitis A in their areas. The
variation by state in coverage among children aged 24-35 months
likely reflects the varying vaccination strategies adopted by
state and local public health officials in response to the ACIP
recommendations. Higher coverage among Hispanic and AI/AN
children is one indication that vaccination efforts targeting
children at higher risk for illness have been successful.

These data do not provide information on why hepatitis A
vaccination coverage for children aged 24-35 months remains
below that for other childhood vaccinations in most areas where
it is recommended. Low coverage rates for young children might
be the result of (1) a focus by healthcare providers and
immunization programs on vaccinating older children, (2) the few
areas with hepatitis A vaccine mandates, or (3) the lack of a
licensed hepatitis A vaccine that can be administered to
children aged <24 months. Sustaining and improving vaccination
coverage among young children is needed to ensure continued
declines in hepatitis A incidence in the United States.

***********************

To access a web-text (HTML) version of this article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5406a1.htm

To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5406.pdf

To receive a FREE electronic subscription to MMWR (which
includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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(4 of 11)
February 22, 2005
NATIONAL INSTITUTES OF HEALTH RELEASES ACTION PLAN FOR LIVER
DISEASE RESEARCH

The National Institutes of Health (NIH) has developed an Action
Plan for Liver Disease Research. The goal of the Action Plan is
to advance research on liver and biliary diseases with the aim
of decreasing the burden of liver and biliary diseases in the
United States.

At present, an estimated 5.5 million Americans have chronic
liver disease or cirrhosis, and more than 20 million have
gallbladder disease. The impact of liver and biliary diseases
is considerable, whether viewed in terms of the number of
individuals affected; the severity of the disease and its
frequency of fatality; the economic costs to the U.S. health
system; as well as those disease outcomes that are less readily
quantifiable, but are important on a personal scale, such as
disability and quality of life.

The Action Plan for Liver Disease Research can be downloaded
from the National Institute of Diabetes & Digestive & Kidney
Diseases website at
http://www.niddk.nih.gov/fund/divisions/ddn/ldrb/ldrb_action_plan.htm

Free single copies can be ordered by calling 800-891-5389, or by
emailing nddic@... and providing your name,
mailing address, telephone number, and email address.
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(5 of 11)
February 22, 2005
DHHS ADDS HBV AND HCV TO LIST OF KNOWN CARCINOGENS

The U.S. Department of Health and Human Services (DHHS) has
added 17 new substances to the list of cancer-causing agents
included in the Eleventh Edition of the Report on Carcinogens.
The report now lists 246 carcinogens, 58 of which are "known" to
cause cancer in humans and 188 of which are "reasonably
anticipated" to cause cancer.

For the first time, the report includes three viruses, the
hepatitis B virus (HBV), the hepatitis C virus (HCV), and the
human papillomavirus (HPV), all added to the "known" carcinogen
category.

To read or download the Eleventh Edition of the Report on
Carcinogens go to: http://ntp.niehs.nih.gov/ntp/roc/toc11.html
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(6 of 11)
February 22, 2005
CDC REPORTS AFRICAN AMERICANS HAVE TWICE THE INCIDENCE RATE FOR
HEPATITIS B AND STREPTOCOCCUS PNEUMONIAE AS WHITES

[The following is cross posted from the Immunization Action
Coalition's "IAC EXPRESS" electronic newsletter, 01/18/05.]

CDC published "Racial Disparities in Nationally Notifiable
Diseases--United States, 2002" in the January 14 issue of MMWR.
The January 14 issue is the third in a MMWR series that focuses
on racial/ethnic health disparities. An analysis of surveillance
data collected in 2002 indicates that incidence rates are at
least two times greater for African Americans than for white
Americans for eight of 42 nationally notifiable diseases. Among
those are two vaccine-preventable diseases, hepatitis B and
Streptococcus pneumoniae. Portions of an article dealing with
these issues are reprinted below.

***********************

Infectious diseases are a major cause of morbidity, mortality,
and disability in the United States and often affect
racial/ethnic populations disproportionately. Eliminating racial
disparities is a goal of many of the national health objectives
for 2010. To estimate racial disparities in the incidence of
nationally notifiable infectious diseases by race/ethnicity, CDC
reviewed 2002 data from the Nationally Notifiable Diseases
Surveillance System (NNDSS), collected through the National
Electronic Telecommunications System for Surveillance (NETSS).
This report summarizes the results of that analysis, which
indicated that incidence rates were at least two times greater
for blacks than whites for eight of 42 nationally notifiable
diseases . . . . for hepatitis B, [the rates were] 3.9 for
blacks and 1.5 for whites; and for Streptococcus pneumoniae
(i.e., invasive, drug resistant), 1.5 for blacks and 0.7 for
whites.

***********************

To access a web-text (HTML) version of the complete article, go
to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a4.htm

To access a ready-to-copy (PDF) version of this issue of MMWR,
go to: http://www.cdc.gov/mmwr/PDF/wk/mm5401.pdf
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(7 of 11)
February 22, 2005
EPA PUBLISHES UPDATED GUIDANCE ABOUT SAFE NEEDLE/SHARPS DISPOSAL

[The following is excerpted with thanks from the SIGNPost
electronic newsletter, 01/12/05.]

In December 2004, the Environmental Protection Agency (EPA)
issued new guidance about how the general public should handle
syringes and other sharps generated at home or at locations not
in healthcare facilities.

The new guidance is in two brochures:

"Protecting Your Community from Sharps: Options for Safe
Disposal of Sharps"
http://www.epa.gov/epaoswer/other/medical/med-govt.pdf

"Protect Yourself, Protect Others: Safe Options for Needle
Disposal"
http://www.epa.gov/epaoswer/other/medical/med-home.pdf

The guidance suggests that syringe users dispose of used
syringes in ways that keep the sharps out of the trash/solid
waste. The goal for keeping the sharps out of solid waste is to
protect workers along the solid waste "stream" and at land
fills.

The previous EPA guidance recommended collecting used
sharps/syringes in containers and placing the sharps-filled
containers in household trash. . .

****************

"SIGNpost" is a free weekly electronic forum about safe and
appropriate use of injections. To subscribe, go to:
http://www.who.int/injection_safety/newsletter/SIGNPost/en

To visit the SIGN Alliance website, go to:
http://www.who.int/injection_safety/sign/en
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(8 of 11)
February 22, 2005
HEPATITIS B FOUNDATION ESTABLISHES NEW RESEARCH INSTITUTE

The Hepatitis B Foundation (HBF) recently announced the opening
of its new research partner, the Institute for Hepatitis and
Virus Research (IHVR), also known as the Pennsylvania
Commonwealth Institute.

The IHVR mission is to use discovery science to find new
therapies and early detection markers for viral hepatitis and
liver cancer. The innovative programs of IHVR include an 80,000-
compound library and screening program for anti-hepatitis drug
discovery, and a proteomics facility that utilizes sophisticated
technology to examine proteins from those infected with
hepatitis B and C for use as potential markers for early
detection of disease.

For more information about this new research institute, visit
http://www.ihvr.org
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(9 of 11)
February 22, 2005
NEW RESOURCES ABOUT PREVENTING OCCUPATIONAL EXPOSURE TO
BLOODBORNE PATHOGENS AVAILABLE

The following are two new resources for those interested in
preventing occupational exposure to bloodborne pathogens.

"Eye of the Needle: Surveillance of Significant Occupational
Exposure to Bloodborne Viruses in Healthcare Workers. Centre for
Infections; England, Wales and Northern Ireland Seven-Year
Report: January 2005" is a publication of the U.K.'s Health
Protection Agency.

To download this document, go to:
http://www.hpa.org.uk/infections/topics_az/bbv/pdf/eye_of_the_needle.pdf

"Preventing Occupational Exposures to Bloodborne Pathogens:
Articles from Advances in Exposure Prevention, 1994-2003" is a
new book from the International Healthcare Worker Safety Center
at the University of Virginia. The book includes 70 collected
articles of interest, and practical information on reducing
bloodborne exposures in the workplace and complying with OSHA
standards.

The book costs $25, including shipping and handling. The table
of contents and ordering information can be accessed at
http://www.healthsystem.virginia.edu/internet/epinet/AEPBookWebsiteBlurb.cfm
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(10 of 11)
February 22, 2005
RESOURCES FOR SAFER TATTOOING IN PRISONS AVAILABLE ONLINE

Prisoners' HIV/AIDS Support Action Network (PASAN), a
Canadian community-based network of prisoners, ex-prisoners,
organizations, and activists working together to provide
advocacy, education, and support to prisoners on HIV/AIDS, HCV,
and related issues, offers online resources on safer tattooing
in prison.

Specific print pieces include

"Driving the Point Home: A Strategy for Safer Tattooing in
Canadian Prisons"
http://www.pasan.org/Publications/Driving_The_Point_Home.pdf

"Tattooing and You: The Safeguards within Prison"
http://www.pasan.org/Publications/Tattooing_&_You.pdf

"Safe Tattooing"
http://www.pasan.org/Publications/Safe_Tattooing.pdf

PASAN also offers information for injecting drug users and for
those infected with HIV/AIDS. Visit their website at
http://www.pasan.org and click on "Library."
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(11 of 11)
February 22, 2005
JOURNAL ARTICLES YOU MAY HAVE MISSED

The following recent journal articles present research related
to viral hepatitis prevention or treatment.

"Effects of an Intensive Street-Level Police Intervention on
Syringe Exchange Program Use in Philadelphia, Pa."
Authors: Davis CS, Burris S, Kraut-Becher J, Lynch KG, Metzger D
Source: American Journal of Public Health, February 2005,
Vol. 95(2):233-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15671455

"Social Context, Sexual Networks, and Racial Disparities in
Rates of Sexually Transmitted Infections"
Authors: Adimora AA, Schoenbach VJ
Source: Journal of Infectious Diseases, February 1, 2005,
Vol. 191(Suppl 1):S115-122
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15627221

"Vaccination in the County Jail as a Strategy to Reach High Risk
Adults During a Community-Based Hepatitis A Outbreak Among
Methamphetamine Drug Users"
Authors: Vong S, Fiore AE, Haight DO
Source: Vaccine, January 11, 2005, Vol. 23(8):1021-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15620475

"Incidence of Hepatitis C Virus and HIV Among New Injecting Drug
Users in London: Prospective Cohort Study"
Authors: Judd A, Hickman M, Jones S, McDonald T, Parry JV,
Stimson GV, Hall AJ
Source: BMJ, January 1, 2005, Vol. 330(7481):24-5
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=1553385\
4

"Inmate Peer Education Programs: 101"
Author: Simmons TM
Source: Infectious Diseases in Corrections Report, Brown
University Medical School, December 2004
http://www.idcronline.org/archives/dec04/peered.html

"Co-occurring Hepatitis C, Substance Use, and Psychiatric
Illness: Treatment Issues and Developing Integrated Models of
Care"
Authors: Sylvestre DL, Loftis JM, Hauser P, et al.
Source: Journal of Urban Health, December 2004, Vol.81(4):
719-734
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15466851

"Sudden Rise in Uptake of Hepatitis B Vaccination Among
Injecting Drug Users Associated with a Universal Vaccine
Programme in Prisons"
Authors: Hutchinson SJ, Wadd S, Taylor A
Source: Vaccine, November 25, 2004, Vol. 23(2):210-214
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15531039

"Frequent Hepatitis C Virus Superinfection in Injection Drug
Users"
Authors: Herring BL, Page-Shafer K, Tobler LH, Delwart EL
Source: Journal of Infectious Diseases, October 15, 2004,
Vol. 190(8):1396-1403
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstra\
ct&list_uids=15378431

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We hope you will forward this e-newsletter to others.

Managing editor: Teresa A. Anderson, DDS, MPH
Copy editor: Dale Thompson
Editorial assistant: Janelle Tangonan Anderson
ISSN: 1547-6375

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This publication is supported by Grant No. U50/CCU523259 from
the Division of Viral Hepatitis at the Centers for Disease Control
and Prevention. Its contents are solely the responsibility of IAC
and do not necessarily represent the official views of CDC.
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