Please send items of interest for the E-News -- and any other feedback -- to E-News editor Kevin Sherin, MD, MPH.  . Thanks!


1) Your AAPHP general meeting at APHA in San Diego
3) In memoriam: Michael Gregg, MD, MPH, Former MMWR editor
4) AAPHP member published in MMWR
5) Proposed resolutions for AMA interim meeting in Orlando
6) Health Care Notification Network (HCNN)
7) Rabies Vaccine Supply Update

1. Your AAPHP general meeting at APHA in San Diego:

Your AAPHP will have a general meeting on SUNDAY, OCTOBER 26, 2008 from 10 am to 12 noon and again from
2 pm to 3:30 pm, at the SAN DIEGO MARRIOTT HOTEL AND MARINA, LAGUNA ROOM, San Diego, California.  We will start with a Business Meeting at 10 am, before the APHA opening session.
After the APHA opening session, AAPHP will reconvene for a
1.5 hour forum, from 2-3:30 PM.  Our invited speaker is the Deputy Secretary of Health for the State of California, Dr.
Bonnie Sorenson. Dr. Sorenson is an endocrinologist and expert on diabetes and obesity as a risk factor for chronic diseases, as well as a tobacco control expert who oversees California's huge tobacco control program.



SPECIAL ALERT- THE FDA TOBACCO BILL PASSED THE HOUSE. AAPHP OFFICIALLY NOW IS ASKING FOR MODIFICATIONS OF THIS LEGISLATION IN THE SENATE.  HOPEFULLY A STRONGER, MORE SCIENTIFICALLY SOUND BILL CAN BE FORTHCOMING NEXT YEAR.  TO LEARN MORE ABOUT THE FDA TOBACCO LEGISLATION AND STEPS TO PROTECT AMERICA'S YOUTH, please see all of the updates from the AAPHP Tobacco Control Task Force example letters to the editor and review of the 160 page plus legislation as well as the AAPHP positions and explanations.  These can be found under "Tobacco issues"
on our website at


3. Michael B. Gregg, M.D., 1930-2008:

Our colleagues at ProMED-Mail sent a memorial note on a distinguished public health physician:

Michael B. Gregg, M.D., a retired MMWR Editor, died on [9 Jul 2008], in Brattleboro, Vermont. He was 78. Although he was widely accomplished in epidemiology and public health, Dr. Gregg was best known for his service as Editor of MMWR for 21 years, and for his editorship of the widely read textbook, Field Epidemiology.

As MMWR Editor during 1967-1988, Dr. Gregg strengthened the publication's ability to provide accurate and timely public health information to health-care and public health professionals and oversaw expansion of MMWR to accommodate a widening scope of public health topics (ref 1).  In 1981, Dr. Gregg made the decision to publish a report in MMWR about a cluster of 5 cases of a then-rare disease, _Pneumocystis carinii_ pneumonia, among previously healthy young men in Los Angeles, California.  The report appeared in the [5 Jun 1981] issue of MMWR (ref 2).  The accompanying Editorial Note said the case histories suggested a "cellular-immune dysfunction related to a common exposure" and a "disease acquired through sexual contact."  Later, the report was recognized as the harbinger of what later became known as the HIV/AIDS epidemic (ref 3).  Other benchmarks during Dr. Gregg's MMWR editorship included citation of MMWR reports in Index Medicus and increased accessibility to MMWR articles through reproduction by the Massachusetts Medical Society and collaborative reprinting in the Journal of the American Medical Association, practices that continue today.

Dr. Gregg joined CDC, then known as the Communicable Disease Center, in 1966 as Chief Epidemic Intelligence Service Officer (EISO) under Alexander Langmuir.  At CDC he held a series of leadership positions until his retirement in 1990 as Acting Director of the Epidemiology Program Office.
He was author of approximately 80 publications and book chapters, and his textbook, Field Epidemiology, now near publication in its 3rd edition, has remained a standard in the discipline.  Among his enduring legacies was his influence on hundreds of young EISOs, many of whom later served in key positions in medicine, epidemiology, and public health.  Dr. Gregg was known for his skill at imbuing each incoming class of EISOs with an understanding of applied epidemiology and especially the epidemic investigation.  He is remembered by his students as a mentor who was kind, polite, and gentlemanly, but also direct in imparting his high expectations of excellence.

Dr. Gregg was born in Paris, France, in 1930 and was educated at Stanford University and Western Reserve University School of Medicine.  He completed a residency in internal medicine at Columbia Presbyterian Hospital in New York City before entering the Public Health Service in 1959, and 1st served at the National Institutes of Health Rocky Mountain Laboratory.  After further training in infectious diseases and work in Lahore, Pakistan, he began his career at CDC.
During his years at CDC, he served as CDC's unofficial poet laureate, and he was an avid jazz drummer.  He is survived by his wife Lila, 3 daughters, 2 brothers, a sister,
7 grandchildren, and many nieces and nephews.

A memorial service was held at 2 p.m. on [3 Aug 2008] at Guilford Community Church in Guilford, Vermont.
Contributions in the memory of Dr. Gregg can be made to the Epidemic Intelligence Service Association fund in care of the CDC Foundation at <>, or by mail at The CDC Foundation, 55 Park Place, Suite 400, Atlanta, GA 30303.

1.  CDC. Michael B. Gregg, M.D., in honor of 21 years'
service as Editor, MMWR. MMWR 1989; 38:15. [Available at <>]
2.  CDC. Pneumocystis pneumonia -- Los Angeles. MMWR 1981;
30:250-2 [Available at:
3.  CDC. First report of AIDS. MMWR 2001; 50:429. [Available at:


4. AAPHP member published in MMWR:

Illegal fentanyl claimed over 1,000 lives between 2005 and 2007.

The Wall Street Journal (7/25, A12, Fuhrmans) reports, "A two-year wave of deaths caused by an illegal street version of the powerful painkiller fentanyl claimed more than 1,000 lives," according to findings published in the Centers for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report.  The drug "is prescribed to cancer patients or others suffering from severe, chronic pain.  But, it also can be made by rogue chemists into a lethal narcotic powder that is much more powerful than heroin," explained T. STEPHEN JONES, M.D., M.P.H., a consultant and former CDC official who was the report's lead author.  It "can be sold mixed with cocaine or heroin, or as a substitute for heroin."

The CDC's report "puts the toll at 1,013 deaths from early April 2005 through late March 2007," the AP (7/25, Stobbe) adds.  The spike in overdoses, which "first came to light in Chicago in 2005," appears to have "ended after authorities shut down a fentanyl-making operation in Toluca, Mexico, in May 2006," Dr. Jones said.  The AP notes that "the investigators did not count cases in every city.  The tally covers only two states -- New Jersey and Delaware -- and the cities of Chicago, Detroit, Philadelphia, and St. Louis."

New Jersey's Star-Ledger (7/25, Campbell) reports that the CDC study "described the deaths as 'the largest NPF (non-pharmaceutical fentanyl) epidemic ever reported.'"


5. Proposed resolutions for AMA interim meeting in Orlando:

Your Delegate and Alternate Delegate are hard at work developing resolutions for the November meeting of the AMA.
Membership input is welcome.  If you have ideas for AMA policy on any public health issue, please E-mail your ideas before September 24, 2008 to AAPHP's AMA Delegate ARVIND K. GOYAL, MD, MPH at <>.


6. Health Care Notification Network (HCNN)

Adapted from a notice recently sent us by Henry DePhillips MD:

The HCNN is a service developed over the past few years with the FDA, US liability carriers, AMA and medical societies, as well as other partners, that delivers FDA mandated drug alerts instantly online -- replacing the current paper process of notifying doctors via U.S. mail.  Most doctors now get a few important drug alerts mailed to them each month in a process that is slow, ineffective and, according to the FDA and liability carriers, a threat to patient safety and professional liability.  The HCNN network will deliver these alerts immediately online.  It is operated by Medem and under the governance and control of a not-for-profit organization chaired by Nancy Dickey, MD, former AMA president.  There is no advertising, selling of physician data, or disclosing physician data to pharmaceutical companies.  The HCNN is used only to send the FDA-required drug alerts to doctors.

The HCNN has been the subject of national press since its recent launch.  Liability carriers nationally have been aggressively promoting this service to their insured because of its ability to improve patient safety and decrease professional liability.  The service is free to physicians and is funded by those who use the network to send alerts; the FDA; and drug manufacturers.  Nearly all of the top-20 pharmaceutical firms are now engaged with the HCNN.

In addition:

1.    Physicians are free to opt out at any time.

2.    Physicians can have a copy of the Alerts sent to
their office staff.

3.    Alerts to physicians are targeted by specialty so
that not all physicians get all Alerts (this is the same for the current paper/mail process).

The primary motivation for physician participation seems to be improved patient safety and decreased member liability.

Henry DePhillips, MD | Chief Medical Officer HCNN | Health Care Notification Network Working Together to Protect Patients Medem, Inc.


7. Rabies vaccine supply situation

 From the CDC, Posted September 4, 2008:

Effective immediately, Novartis Vaccines will no longer be shipping supplies of RabAvertR.  Novartis will be re-directing any customers back to their state/local public health authorities to obtain a passcode to process their order through Sanofi.  Novartis will retain doses for emergency consideration on a case by case basis in case of adverse events to alternative vaccination.

As of August 29, 2008, Sanofi Pasteur in coordination with the Centers for Disease Control and Prevention (CDC) has resumed shipping IMOVAXR Rabies, a rabies vaccine for post-exposure prophylaxis only.

To obtain IMOVAX rabies vaccine you must first contact your Rabies State Health Official so that a risk assessment can be conducted for the suspected exposure.  If your Rabies State Health Official determines that rabies post-exposure prophylaxis is indicated they will provide you with a passcode to place on the Sanofi Pasteur Rabies Post-Exposure Form.  The form must be filled out in its entirety, including the required physician's signature and passcode provided by your Rabies State Health Official.  Please contact Sanofi Pasteur at 1-800-VACCINE to obtain the required form.

Q: Why is there an interruption in supply?

Starting in June 2007, Sanofi Pasteur began renovating its IMOVAX Rabies vaccine production facility in France to maintain compliance with the most current requirements from FDA and the French regulatory body.  Prior to these renovations, Sanofi Pasteur established an inventory based on historical levels of sales and projected market demand.  The facility is scheduled to be approved and operational by mid-to-late 2009.
Until the facility is operational, Sanofi Pasteur has a finite amount of IMOVAX Rabies vaccine.

After the renovations began, Novartis, the other supplier of rabies vaccine for the United States, was unable to meet projected rabies vaccine supplies.

Since early 2008, Novartis has been supplying its rabies vaccine, RabAvert, for post-exposure use only.  Consequently, Sanofi Pasteur has been supplying nearly all of the market for rabies vaccine.  The increase in demand for IMOVAX is outpacing the company?s historical levels of supply.

Q: How does this affect current rabies vaccination recommendations?

Persons at increased risk for rabies exposure should take appropriate precautions to avoid rabies exposure.

Vaccine is available for post-exposure prophylaxis (PEP).
Providers should consult with their local or state public health department to ensure appropriate use of PEP.

General rabies awareness and prevention messages should be emphasized to avoid exposure (e.g., avoid wildlife contact; vaccinate pets/livestock; capture/observe/test exposing animal; etc.).


If you have any questions or comments about AAPHP and this E-News, please contact the AAPHP President and E-News editor KEVIN M. SHERIN, MD, MPH by phone 321-239-2718 or e-mail <>.

Thank you for your support

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