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8/27/2001

Immunization Campaign Targets Influenza, Meningitis, Tetanus

Kate Traynor

Influenza is not the only vaccine-preventable illness on the minds of a group of public health professionals who recently helped launch a campaign promoting adherence to national vaccination guidelines.

The National Partnership for Immunization (NPI), a joint project of the National Healthy Mothers, Healthy Babies Coalition and the National Foundation for Infectious Diseases, designated this past August as National Immunization Awareness Month. NPI Director David A. Neumann said that August was chosen because of its proximity to influenza season and because immunization is on the minds of families preparing for the start of the school year.

Walter A. Orenstein, director of the Centers for Disease Control and Prevention (CDC) National Immunization Program, said that the point of promoting immunization is simple.

"We want to prevent disease, not fight disease," Orenstein said during an NPI press conference held August 1 in Washington, D.C.

Orenstein and Neumann were among eight speakers who outlined the need to immunize young children, adolescents, and adults who are at risk for contracting vaccine-preventable diseases. One topic of discussion was the meningococcal vaccine, which can prevent meningitis and meningococcemia in young adults.

Promoting protection against a deadly infection. CDC, through its Advisory Committee on Immunization Practices (ACIP), recommended last year that incoming college freshmen and their families be advised about the availability of the meningococcal vaccine.1

"The infection appears to be increasing among college-age individuals—and we don’t know why," said James C. Turner, who chairs the Vaccine-Preventable Disease Task Force of the American College Health Association and is also a professor at the University of Virginia’s School of Medicine.

"Though meningococcal infection is a relatively rare occurrence," Turner said, "I have personally stood at the bedside of five University of Virginia students who suffered from this disease in the mid-1990s and saw the anguish that families went through as the students clung to life."

"Fortunately," he said, "there is a vaccine that can prevent four of the five common strains of this infection, and it’s very safe and highly effective. College students and their parents need to learn more about this disease and consider the benefits of vaccination before going off to college this fall."

A personal perspective on Turner’s comments was offered by Lynn Bozof, whose 20-year-old son died from meningococcal disease while attending college in 1998—two years before ACIP made its recommendation on meningococcal vaccination.

"We know that if we had been advised about the vaccine, our son would have received it," Bozof said.

A recent report in the Journal of the American Medical Association concluded that college freshmen who live in dormitories are at greater risk than other college students for meningococcal disease.2 Another report in the same issue of the journal found that nearly one in four Maryland residents 15–24 years old who contracted a meningococcal infection during the 1990s died of the disease.3 The death rate was about 5% for children younger than 15 years and 17% for people 25 years or older.

The researchers speculated that the unusually high frequency of meningococcemia—40%—among the older teenagers and young adults contributed to their high death rate from meningococcal infection.

Vaccinating during a shortage. In addition to promoting the meningococcal vaccine, the NPI speakers discussed the challenges of meeting vaccination goals when vaccines are in short supply.

Orenstein, who is also an assistant surgeon general, reassured the audience that "at the present time, the vaccines used for young children should be in adequate supply." But he described the current shortage of a tetanus toxoid formulation used for older children and adults as "significant."

"We went from two manufacturers to one," Orenstein said, adding that the remaining tetanus toxoid manufacturer is "gearing up to have adequate supply."

He noted that, although boosters are important, "the great majority of cases of tetanus in this country are not people whose boosters have lapsed, but people who never received the initial primary vaccination in childhood."

As with tetanus toxoid, one cause of the recent shortages of influenza vaccine has been a drop in the number of vaccine manufacturers.

"There are three manufacturers instead of four," said Martin G. Myers, director of the Department of Health and Human Services’ National Vaccine Program Office. The comment referred to last year’s exit of Parkedale Pharmaceuticals Inc. from the influenza vaccine market.

"The timing of the [influenza] vaccine supply and the fragility of the vaccine supply present great challenges," Myers said. "This year, the distribution of 27 million doses, or about a third [of the projected supply], will not be until November or December."

"To assist planning this year, the manufacturers have been providing their projections to the Public Health Service," Myers said, noting that such information is considered confidential by the manufacturers. "It’s been wonderful to see the collaboration of the manufacturers providing proprietary information.

Influenza vaccine recommendations and related information for health care professionals are available online from the National Immunization Program.

Still, the fact that much of the 2001–02 influenza vaccine supply will not be distributed until late in the season troubled CDC’s Orenstein.

"We are concerned that, when vaccine becomes available late, people will not want it, and so we will have a decrease in coverage," he said.

To combat this, Orenstein said, "We need to change the behavior of the public and the providers to look for...vaccine through November, December—even later if they haven’t gotten the vaccine."

"Last year," Orenstein said, "we were relatively lucky. Last year was an unusual year in that it was an extremely mild influenza season. Whether we will have another mild one or not is very difficult to say."

Only 4 of the past 19 influenza seasons peaked in December, usually in the middle to latter part of the month, "making December vaccination fine," he said. "The other 15 of them peaked in January or later—10 of them in February or later."

ASHP is part of the 68-member NPI National Immunization Council.

  1. Centers for Disease Control and Prevention. Meningococcal disease and college students: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000; 49(RR07):11-20.
  2. Bruce MG, Rosenstein NE, Capparella JM et al. Risk factors for meningococcal disease in college students. JAMA. 2001; 286:688-93.
  3. Harrison LH, Pass MA, Mendelsohn AB et al. Invasive meningococcal disease in adolescents and young adults. JAMA. 2001; 286:694-9.