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PA Bulletin, Doc. No. 07-1406


Immunization Practices for Children in Child Care Group Settings

[37 Pa.B. 4263]
[Saturday, August 4, 2007]

   In accordance with 28 Pa. Code § 27.77(c) (relating to immunization requirements for children in child care group settings), the Department of Health (Department), Bureau of Communicable Diseases, Division of Immunization, is updating the list of Morbidity and Mortality Weekly Report (MMWR) publications that contain the Advisory Committee on Immunization Practices (ACIP) recommendations that meet the standards of 28 Pa. Code § 27.77(c). Children in child-care group settings as defined by 28 Pa. Code § 27.77(c) are required to be immunized in accordance with the recommendations included in the following publications, as well as those included in previous notices. The Department is providing a summary of the publications for the ease of reference of the public:

July 13, 2007/Vol. 56/No. RR-06

Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007

   This report updates the 2006 recommendations by ACIP regarding the use of influenza vaccine and antiviral agents. Prevention and control of influenza: recommendations of the ACIP. MMWR 2006;55 [No. RR-10]. The 2007 recommendations include new and updated information. Principal updates and changes include the following: (1) reemphasizing the importance of administering 2 doses of vaccine to all children aged 6 months--8 years if they have not been vaccinated previously at any time with either live, attenuated influenza vaccine (doses separated by >6 weeks) or trivalent inactivated influenza vaccine (doses separated by >4 weeks), with single annual doses in subsequent years; (2) recommending that children aged 6 months--8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year, with single annual doses in subsequent years; (3) highlighting a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated; (4) emphasizing that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season; (5) recommending that health-care facilities consider the level of vaccination coverage among HCP to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination); and (6) using the 2007--2008 trivalent vaccine virus strains A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like and B/Malaysia/2506/2004-like antigens. This report and other information are available at CDC's influenza website

June 22, 2007/Vol. 56/No. RR-4

Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

   In June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated varicella vaccines for prevention of varicella. This report revises, updates and replaces the 1996 and 1999 ACIP statements for prevention of varicella. The new recommendations include the following: (1) implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12--15 months and the second dose at age 4--6 years; (2) a second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose; (3) routine vaccination of all healthy persons aged >13 years without evidence of immunity; (4) prenatal assessment and postpartum vaccination; (5) expanding the use of the varicella vaccine for HIV-infected children with age-specific CD4+T lymphocyte percentages of 15%--24% and adolescents and adults with CD4+T lymphocyte counts >200 cells/µL; and (6) establishing middle school, high school and college entry vaccination requirements. ACIP also approved criteria for evidence of immunity to varicella.

May 11, 2007/Vol. 56/No. 18

Notice to Readers: Update on Supply of Vaccines Containing Varicella-Zoster Virus

   In February 2007, CDC received notice from Merck & Co., Inc. that because of lower than expected amounts of varicella-zoster virus (VZV) in its recently manufactured bulk vaccine, Merck was prioritizing production of varicella (Varivax®) and zoster vaccines (Zostavax®) over production of MMR-V vaccine (ProQuad®) (1).

   In May 2007, CDC received further notice from Merck that current projections of orders indicate ProQuad will be unavailable beginning in July 2007, although timing will depend on market demand. This might cause extended back orders for the next few months. After depletion of the existing supply, ProQuad is not expected to be available for the remainder of 2007. Merck is requesting that customers begin transitioning from ProQuad to M-M-R II® and Varivax at their earliest convenience.

   Merck expects to continue to meet demands for Varivax and M-M-R II to fully implement the recommended immunization schedule. This will allow for continued use of varicella vaccine for all age groups, including the routine 2-dose schedule for children aged 12--15 months and 4--6 years, catch-up vaccination with the second dose for children or adolescents who received only 1 dose, and vaccination with 2 doses for other children, adolescents, and adults without evidence of immunity (2--4). For zoster vaccine, the supply of Zostavax is expected to be adequate for routine vaccination of adults aged >60 years (5). Questions regarding the supply of these Merck products should be addressed to Merck's National Service Center at (800) 637-2590. Updates on vaccine shortages and delays are available from CDC at

April 20, 2007/Vol. 56/No. 15

Notice to Readers: National Infant Immunization Week--April 21--28, 2007

   The week of April 21--28, 2007, is National Infant Immunization Week (NIIW) and Vaccination Week in the Americas (VWA). During this week, hundreds of communities throughout the United States are expected to participate in NIIW-VWA by sponsoring activities emphasizing the importance of timely infant and childhood vaccination.

   Immunization is one of the most effective ways to protect infants and children from potentially serious diseases. Approximately 11,000 infants are born each day in the United States; according to the recommended immunization schedule, each infant requires approximately 27 doses of vaccine (such as, administered in 21 or 22 injections of combination vaccines) before age 2 years for protection from 14 vaccine-preventable diseases.

March 23, 2007/Vol. 56/No. RR-2

Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

   These recommendations represent the first statement by ACIP on the use of a quadrivalent human papillomavirus (HPV) vaccine licensed by the United States Food and Drug Administration on June 8, 2006. This report summarizes the epidemiology of HPV and associated diseases, describes the licensed HPV vaccine, and provides recommendations for its use for vaccination among females aged 9--26 years in the United States.

   Additional information relating to vaccinations may be obtained from the Department's website at www.dsf. and from the National Immunization Program of the Centers for Disease Control and Prevention at the following website

   Persons with a disability who require an alternative format of this notice (for example, large print, audiotape, Braille) should contact Department of Health, Heather Stafford, Acting Director, Division of Immunization, Room 1026, Health and Welfare Building, Harrisburg, PA 17120, (717) 787-5681 or for speech and/or hearing impaired persons at V/TT (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).


[Pa.B. Doc. No. 07-1406. Filed for public inspection August 3, 2007, 9:00 a.m.]

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