MINNESOTA
DEP
AR
TMENT
DEPAR
ARTMENT
OF HEALTH
DISEASE CONTROL NEWSLETTER
January-April 1999
Volume 27, Number 1 (pages 1-8)
Recommended Childhood Immunization
Schedule - Minnesota, 1999
In this issue you will find the Recommended Childhood Immunization
Schedule – Minnesota, 1999 which is
based on recommendations1 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 EngerixB) 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 ACIP2 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
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
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
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
Varicella – the leading cause of
vaccine-preventable deaths in
U.S. children5
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 7th 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:
•
•
•
3.
2
•
•
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 4th
grade during the current (i.e.,199899) school year. They will be the
first cohort affected by the 7th 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...
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.
Age
▲
z▲
Vaccine
Birth
Hepatitis B1
1
mo
2
mos
4
mos
6
mos
12
mos
15
mos
18
mos
2
yrs
Hepatitis B - 3
Diphtheria, Tetanus,
Pertussis2
DTaP
DTaP
DTaP
Haemophilus influenzae
type b3
Hib
Hib
Hib3
Polio4
IPV
IPV
Rotavirus5
Rv
Rv
11-12
yrs
14-18
yrs
Hepatitis B1
(1-3)
Hepatitis B - 1
Hepatitis B - 2
4-6
yrs
DTaP2
Td
DTaP
Hib3
Polio4
Polio
Rv
Measles, Mumps,
Rubella6
MMR-26 MMR-26
MMR - 1
Varicella7
Varicella
Varicella
Vaccines
Vaccinesbelow
belowline
lineare
are for
for selected
selected populations
populations.
Hepatitis A8
Hepatitis A
Influenza9
Influenza (yearly)
Pneumococcal
Pneumococcal10
1. Hepatitis B (HBV): Regardless of the mother’s HBsAg status, give 2nd dose >4
wks after 1st dose and 3rd dose >6 mos 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 mos 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 mos 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 mos 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 mos of age if at least 6 mos have passed since DTaP-3, and if the
child is considered unlikely to return at 15-18 mos 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 mos of age, a dose at 6 mos 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 mos 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 mos 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 mos of age.
7. Varicella: Administer varicella vaccine to all susceptible children at 12-18 mos of
age. Unvaccinated children >18 mos 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
mos after the initial dose.
9. Influenza: Administer influenza vaccine annually to children >6 mos 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 mos 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
Minnesota Immunization Hotline at (612) 676-5100 or toll-free (800) 657-3970.
Web site: www.health.state.mn.us/divs/dpc/adps/adps.htm
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
Doses to be given and minimum intervals
Number of
previous doses
of each vaccine
First dose
None
DTaP
DTaP: 4 weeks after 1st dose
Polio1
Polio: 4 weeks after 1st dose
HBV
HBV: 4 weeks after 1st dose
Hib2
Hib: 4 wks if 1st dose given at
<12mos of age; 8 wks (as final dose)
if 1st dose given 12-14 mos of age;
no more are needed if 1st dose given
>15 mos of age.
MMR3
Varicella4
Second dose
MMR3: 4 weeks after 1st dose
One
Third dose
Fourth dose
DTaP: 4 weeks after 2nd dose
DTaP: 6 months after 3rd dose
Polio: 4 weeks after 2nd dose5
Polio: 4 weeks after 3rd dose7
HBV: 8 weeks after 2nd dose6
Hib8: Only necessary for children
age 12 months to <5 years who
received 3 doses <12 months of
age.
Hib: If current age <12 mos, 4 wks after
2nd dose (exception: see #8 below). If
current age 12 mos to <5 yrs & 2nd dose
given either (a) <15 mos, give final dose
8 wks after 2nd dose or (b) >15 mos of
age, no more are needed.
Fifth dose
DTaP9: 6 months
after 4th dose
Two
Three
Four
Table 2. Catch-up schedule for children age 7 through 18 years
Number of
previous doses
of each vaccine
None
Doses to be given and minimum intervals
First dose
Td
Second dose
Td: 4 weeks after 1st dose
Polio
Polio: 4 weeks after 1st dose
HBV
HBV: 4 weeks after 1st dose
MMR
MMR: 4 weeks after 1st dose
Varicella4
Varicella4: 4 weeks after 1st dose
1,10
Third dose
Booster dose
Td: 6 months after 2nd dose
Td: every 10 years (exception, see #2 on
reverse side)
Polio: 4 weeks after 2nd dose
HBV: 8 weeks after 2nd dose6
Polio7
One
Two
Three
1.
2.
3.
4.
5.
6.
7.
Polio: Those who begin the series >6 months of age may receive an all-OPV schedule to reduce the number of injections.
Hib: Vaccine is not generally recommended for children >5 years.
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.
Varicella: Do not administer varicella vaccine before 12 months of age. Give 2 dose series to all susceptible adolescents >13 years of age.
Polio: For those receiving IPV alone, an interval of 6 months between IPV-2 and IPV-3 will provide optimal response and is preferred.
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.
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.
Special Notes on Immunization
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).
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.
4
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;48:816.
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, 365368.
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 .
Update on Head Lice
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 most 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.
However, most 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 most 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 almost 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.
email message with a link to the
appropriate site whenever a new issue
is published.
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 most recent
addition to this site is the Health Guide
for Refugees in Minnesota. This 75page 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.
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.
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 most
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
6
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.
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 email your comments to
[email protected] .
1.
2.
Criteria for Assessing the Quality of
Health Information on the Internet.
Mitretek Systems, Health
Information Technology Institute
(HITI), McLean, VA, October 1997.
Who is doing MEDLINE
Searching? National Library of
Medicine Newsline, January-March
1998.
Subject Index for the Disease Control Newsletter, 1998
EMERGING INFECTIONS
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,
most 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!
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
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.
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