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2006 Immunization News Archive

Revised Meningococcal Vaccine Information Statement

The Bureau of Immunization is pleased to announce the release of the revised Meningococcal Vaccine Information Statement (VIS). Several additional cases of Guillain-Barré Syndrome (GBS) have been associated with meningococcal conjugate vaccine (see MMWR Update from October 2006). The VIS reflects the statement that "some" cases have been reported, rather than "a few" cases. The VIS has a new date (11/16/06), but existing stocks of the 10/7/05 edition may be used up. No other changes were made. Once a VIS is available, it should be used effective immediately. The VIS can be viewed online at: http://www.cdc.gov/vaccines/pubs/vis/default.htm.
To access a ready-to-print (PDF) version of the interim VIS (dated 11/16/06) from the National Immunization Program (NIP) website, go to: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mening.pdf [44K PDF]. To access the VIS from the Immunization Action Coalition (IAC) VIS web section, go to: http://www.immunize.org/vis/menin06.pdf [45K PDF].

Reminder - Vaccine Information Statements: A federal statute requires all healthcare providers who administer vaccines covered by the National Vaccine Injury Compensation Program (NVICP) to give patients or parents a copy of the relevant VIS. The VIS must be provided prior to vaccination. While the CDC develops VIS statements for all vaccines, and encourages their use, it is a legal requirement that healthcare providers give patients or parents a VIS only if the vaccine is covered by NVICP. Also, the name of the statute, the National Childhood Vaccine Injury Act (NCVIA), can be confusing because the statute is not focused just on children. A vaccine receives coverage when the CDC recommends a particular vaccine for routine administration to children. However, once the vaccine is in the program, the NVICP covers injuries to anyone who receives it, child or adult. More information about VIS statements can be found on the CDC’s website at: http://www.cdc.gov/vaccines/pubs/vis/vis-facts.htm.


MMWR:Notice to Readers - Improved Supply of Meningococcal Conjugate Vaccine, Recommendation to Resume Vaccination of Children 11 to 12 Years of Age

At the request of the Centers for Disease Control and Prevention (CDC) and the National Immunization Program (NIP), please ensure that MMWR Weekly: November 3, 2006/55(43);1177, regarding the supply of and recommendations for Meningococcal Conjugate Vaccine (MCV4), is shared with colleagues, members, coalitions, and partners with an interest in the administration of meningococcal vaccine.

In May 2006, the CDC, in consultation with the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, American Academy of Family Physicians, American College Health Association, and Society for Adolescent Medicine, recommended deferral of MCV4 vaccination of children 11 to 12 years of age in response to vaccine supply limitations. Currently, Sanofi Pasteur reports that limitations in the MCV4 supply have resolved.

Therefore, the CDC recommends resuming routine vaccination for all recommended groups according to the ACIP recommendations, including children 11 to 12 years of age and, if not previously vaccinated with MCV4, of adolescents at high school entry (at approximately 15 years of age), of college freshmen living in dormitories, and of other persons at increased risk for meningococcal disease. Where possible, providers who deferred vaccination of children 11 to 12 years of age should recall those patients for vaccination. This MMWR Weekly can be viewed online at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5543a5.htm.

Please note: The Bureau of Immunization will provide the MCV4 (Menactra) to all VFC-eligible adolescents 11 to 18 years of age. We will monitor usage in order to assure an adequate supply to all the age groups.


A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices, Part II: Immunization of Adults

The Bureau of Immunization is pleased to announce the release of A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP), Part II: Immunization of Adults in the MMWR Recommendations and Reports, Volume 55, No. RR-16, December 8, 2006.

This report, the second of a two-part statement from the Advisory Committee on Immunization Practices (ACIP), provides updated recommendations to increase hepatitis B vaccination of adults at risk for hepatitus B virus (HBV) infection. The first part of the ACIP statement, which provided recommendations for immunization of infants, children, and adolescents, was published previously (CDC. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP]. Part 1: immunization of infants, children, and adolescents. MMWR 2005;54[No. RR-16]:1--33).

In settings in which a high proportion of adults have risks for HBV infection, the ACIP recommends universal hepatitis B vaccination for all unvaccinated adults. In other primary care and specialty medical settings in which adults at risk for HBV infection receive care, healthcare providers should inform all patients about the health benefits of vaccination. This information should include risks for HBV infection and persons for whom vaccination is recommended. Healthcare providers should vaccinate adults who report risks for HBV infection and any adults requesting protection from HBV infection. To promote vaccination in all settings, healthcare providers should implement standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine clinical services, not require acknowledgment of an HBV infection risk factor for adults to receive vaccine, and use available reimbursement mechanisms to remove financial barriers to hepatitis B vaccination.

Please ensure that the Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection is widely distributed to colleagues, members, coalitions, and partners with an interest in the supply, distribution, management and administration of Hepatitis B vaccine. You may access the document online at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5516a1.htm [470K PDF]. Additionally, the CDC launched a website to promote implementation of revised hepatitis B immunization recommendations for adults. The new website is titled Hepatitis B Recommendations for Adults. To access the website, go to: http://www.cdc.gov/ncidod/diseases/hepatitis/recs/index.htm.


Provisional Recommendations for Use of Quadrivalent Human Papillomavirus Vaccine

The Bureau of Immunization is pleased to announce the release of the Provisional Recommendations for Use of Quadrivalent Human Papillomavirus (HPV) Vaccine by the Centers for Disease Control and Prevention (CDC) and the National Immunization Program (NIP). Please ensure that the Advisory Committee on Immunization Practices (ACIP) provisional recommendations are shared with colleagues, members, coalitions, and partners with an interest in the prevention of HPV infection and administration of HPV vaccine. The recommendations may be viewed at: http://www.cdc.gov/vaccines/recs/provisional/default.htm [31K PDF].

The ACIP issued provisional recommendations that this vaccine be routinely administered to girls 11 to 12 years of age and used for catch-up immunization in females 13 to 26 years of age. Gardasil™, manufactured by Merck, is the first HPV vaccine approved by FDA to prevent cervical cancer. Gardasil is licensed as a three-dose series, with dose number two given two months after dose number one, and dose number three given four months after dose number two. The minimum interval between doses number one and two is four weeks, and between doses number two and three is 12 weeks. The vaccine should be administered intramuscular, in the deltoid. For more information on the use of HPV vaccine, see the recommendations.

Clinicians should be prepared to discuss prevention of HPV infection with their adolescent patients. The interim HPV Vaccine Information Statement (VIS), dated 9/5/06, is attached and can be found at: http://www.cdc.gov/vaccines/pubs/vis/default.htm.
VISs are information sheets produced by the CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given.

The ACIP recommendations do not become official until they are published in the CDC's Morbidity and Mortality Weekly Report (MMWR), which is expected to occur later this year. While no MMWR has been issued as yet, providers can begin using HPV vaccine with the provisional ACIP recommendation. Providers should also observe indications and contraindications listed in the manufacturer's package insert.


Important Vaccines for Children Program Information

Florida's Vaccines for Children (VFC) Program will provide HPV vaccine effective December 4, 2006. Due to limited vaccine supply, VFC HPV vaccine is presently available only to Florida VFC-eligible female clients who are 11-12 years of age. At this time, there are no federal or state funds available to provide HPV vaccine to non-VFC-eligible clients who do not meet these criteria. Please note: Vaccine supply is based on product availability. This may result in County Health Departments receiving fewer doses of HPV vaccine than originally requested. The updated order form will be posted on the internet in time for December 4, 2006 orders.


General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices December 1, 2006

The Bureau of Immunization is pleased to announce the release of the new General Recommendations on Immunization, Recommendations of the Advisory Committee on Immunization Practices (ACIP) in the MMWR Recommendations and Reports, December 1, 2006 / 55(RR15);1-48.

This report updates the 2002 General Recommendations and is intended to serve as a general reference on vaccines and immunization. The principal changes include: 1) expansion of the discussion of vaccination spacing and timing; 2) increased emphasis on the importance of injection technique/age/body mass in determining appropriate needle length; 3) expansion of the discussion of storage and handling of vaccines, with a table defining appropriate storage temperature range for inactivated and live vaccines; 4) expansion of the discussion of altered immunocompetence, including new recommendations about use of live-attenuated vaccines with therapeutic monoclonal antibodies; and 5) minor changes to the recommendations about vaccination during pregnancy and vaccination of internationally adopted children, in accordance with new ACIP vaccine-specific recommendations for use of inactivated influenza vaccine and hepatitis B vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for comprehensive discussion. This report, ACIP recommendations for each vaccine, and other information about vaccination can be accessed at the CDC's National Center for Immunization and Respiratory Diseases (proposed) (formerly known as the National Immunization Program) website at: http://www.cdc.gov/vaccines.

Please ensure that the General Recommendations on Immunization is widely distributed to colleagues, members, coalitions, and partners with an interest in the supply, distribution, management and administration of immunizations. You can access the document online at: http://www.cdc.gov/mmwr/PDF/rr/rr5515.pdf [1,340K PDF].


Shingles Vaccine Information Statement

The Bureau of Immunization is pleased to announce the release of an interim shingles (herpes zoster) Vaccine Information Statement (VIS) dated 9/11/06. The Food and Drug Administration (FDA) licensed a new vaccine to reduce the risk of shingles , Zostavax®, on May 25, 2006. A single dose of shingles vaccine is indicated for adults 60 years of age and older. When the Advisory Committee on Immunization Practices (ACIP) votes and releases their recommendations, a final VIS edition will be published. Once a VIS is available, it should be used effective immediately. The VIS can be viewed online at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf [83K PDF] and http://www.cdc.gov/vaccines/pubs/vis/default.htm.

VISs are information sheets produced by the Centers for Disease Control and Prevention (CDC) that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given.

For more details about VISs, access the CDC and Immunization Action Coalition (IAC) VIS web pages at: http://www.cdc.gov/vaccines/pubs/vis/default.htm and http://www.immunize.org/vis/.

Please note: The shingles vaccine is not distributed by the Florida Vaccines for Children (VFC) program.

Call Phyllis Yambor of the Bureau of Immunization with questions regarding the vaccine recommendations at 850-245-4342.


National Adult Immunization Awareness Week 2006

National Adult Immunization Awareness Week - Link opens in new windowAwareness Week (NAIAW) 2006. The National Foundation for Infectious Diseases (NFID) spearheads this annual observance to coordinate awareness-raising activities that focus on adult and adolescent immunization. This year marks the nineteenth consecutive observance of NAIAW, and provides an excellent opportunity for individuals and organizations to promote the importance of adult and adolescent immunization. "Adult Immunization: It's Your Best Shot" is the theme for National Adult Immunization Awareness Week 2006. For more information, visit: http://www.cdc.gov/vaccines/events/naiaw/default.htm.


Human Papillomavirus Vaccine Information Statement

The Bureau of Immunization is pleased to announce the release of the Human Papillomavirus (HPV) Vaccine Information Statement (VIS), dated 9/5/06. Once a VIS is available, it should be used effective immediately. The VIS can be viewed online at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-hpv.pdf [52K PDF] and http://www.cdc.gov/vaccines/pubs/vis/default.htm

While three doses of HPV vaccine are routinely recommended for girls 11 to 12 years of age, the vaccine is licensed for vaccination of girls and women 9 through 26 years of age.

Please note: The vaccine is not presently available through the Florida Vaccines for Children (VFC) program. The VFC program will notify providers when the vaccine is available for order. There are no plans at this time to add HPV to the Florida school entry requirement.

Call Robert Griffin, VFC Coordinator, with questions regarding the Human Papillomavirus VFC vaccine supply, and Phyllis Yambor, Executive Community Health Nursing Director, with questions regarding the vaccine recommendations. These Bureau of Immunization representatives can be reached at 850-245-4342.


Rotavirus Recommendations and Immunization Updates

At the request of the Centers for Disease Control and Prevention (CDC), the Bureau of Immunization is pleased to announce the release of the MMWR (Morbidity and Mortality Weekly Report) Recommendations and Reports, Volume 55, No. RR-12, August 11, 2006, Prevention of Rotavirus Gastroenteritis Among Infants and Children Recommendations of the Advisory Committee on Immunization Practices (ACIP). (more)


Provisional Recommendations for Varicella Vaccine 2nd Dose

The Advisory Committee for Immunization Practices (ACIP) updated the Provisional Recommendations for the prevention of varicella on August 3, 2006. The Provisional Recommendations were first posted in November 2005. In June 2005 and June 2006, the ACIP made policy changes for use of live, attenuated varicella-containing vaccines for prevention of varicella...(more)


Vote and Vaccinate

Fight the FluThe Florida Department of Health (DOH) is partnering with the Florida Board of Elections, individual counties, and county Supervisors of Elections to implement a "Vote and Vaccinate" campaign, to be held in conjunction with the November general election... (more)

 


Important Vaccine Storage Information Review

Vaccines valued over $700,000 were reported as "not usable" during the 2004 hurricane season. While a certain amount of loss is unavoidable, we are responsible for careful planning and action in order to minimize loss.

Please review the Emergency Vaccine Storage and Handling Advisory [30K PDF] guidelines and share your emergency vaccine storage plan and this advisory with all staff who are responsible for the storage and handling of vaccine.


Department of Health's Division of Disease Control Builds Better Health for Florida's Future

TALLAHASSEE - The Florida Department of Health's (DOH) Division of Disease Control (DDC) is supporting major public health functions; among them, Improved Health Outcomes, Health Information and Public Health Preparedness; following the theme, "Building Better Health for Florida's Future." The DDC is comprised of the following programs and Bureaus: Epidemiology, Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and Hepatitis, Sexually Transmitted Diseases (STD), Immunization, Tuberculosis (TB) and Refugee Health, and the A.G. Holley State Hospital.
(more) [42K PDF].


Bureau Receives Awards at National Immunization Conference

The Florida Immunization Program received two awards from the National Immunization Program in March 2006 recognizing Extraordinary Accomplishment in Achieving 88.5% Coverage [438K PDF] for the basic 4:3:1:3:3* immunization series and Outstanding Achievement in Improvement of Immunization Coverage of 17.4% Since 2001 [366K PDF].

Charles Alexander recieves award from Dr. Anne Schuchat, MD - Director, National Immunization ProgramThe next step toward surpassing the Healthy People 2010 goal is to achieve a 90% coverage rate for the 4:3:1:3:3:1** immunization series by June 2007. The early childhood immunization initiative includes expansion of the Vaccines for Children Program, which provides free vaccines to public and private healthcare providers; promotes the simultaneous administration of all vaccine doses for which a child is eligible at each office visit; and encourages community-based initiatives through local coalitions of public and private partners.

*(4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B)
**(4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B, and 1 Varicella


Department of Health Encourages Floridians to Know Status of Their Vaccinations

TALLAHASSEE - The Florida Department of Health (DOH) advises all Floridians to become aware of their immunity status for the measles, mumps, rubella (MMR) vaccine in light of the recent mumps outbreak in the Midwest...(more) [45K PDF]


Department of Health Florida SHOTS Program Comes Closer to Goal - Updated Information in Database Allows for More Efficient Vaccination Tracking

www.flshots.com - Opens in new windowTALLAHASSEE - The Florida Department of Health (DOH) and the Florida State Health Online Tracking System (SHOTS), is proud to announce that over 1,000,000 immunization records have been added to the state system that tracks the immunization history of Florida's children...
(more [39K PDF])


Introducing Promotional Material for the "Complete the Coverage: 90 by '07" Campaign.

The Bureau of Immunization is pleased to announce the release of an introductory brochure for the 90 by '07 two-year-old immunization initiative. This single-fold information flyer outlines the "Complete the Coverage" campaign by defining the immunization series being tracked and by listing the goals of Florida's Early Childhood Initiative.

The immunization series being tracked during this campaign is the 4:3:1:3:3:1 series.

This series is comprised of 4 DTaP, 3 Polio, 1 MMR, 3 Hib, 3 Hep B and 1 varicella immunizations, the sum of which is recommended for all children by the age of 24 months. The goal is for the coverage rate of two-year-olds to reach or exceed 90% by June 2007.

Community partners can help us reach this goal by:

  • Promoting awareness that early childhood immunizations have a significant role in preventing disease.
  • Encouraging community-based initiatives through local coalitions of public and private partners and providing training for coalition members.
  • Encouraging providers to utilize each clinic visit to screen and, when indicated, immunize children.
  • Promoting simultaneous administration of all vaccine doses for which a child is eligible at each office visit.
  • Promoting implementation and use of reminder/recall systems to minimize missed opportunities for vaccination.

Complete the Coverage: 90 by '07 brochure [617K PDF].

For more information about the 90 by '07 Immunization Initiative, contact the Florida Department of Health, Bureau of Immunization, (850) 245-4342, or 90by07@doh.state.fl.us. (Under Florida law, e-mail addresses are public records.  If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity.  Instead, contact this office by phone or in writing.)


Hepatitis A Vaccine

The Bureau of Immunization is pleased to announce the addition of Hepatitis A vaccine to the list of products available for eligible children through the Vaccines For Children (VFC) Program. Hepatitis A vaccine is now recommended for administration to all infants beginning at 12 months of age.

An advisory committee to the Centers for Disease Control and Prevention (CDC) has recommended that all children in the United States receive Hepatitis A vaccine. The previous recommendation of the Advisory Committee on Immunization Practices (ACIP), in 1999, called for vaccinations in states with the highest rates of Hepatitis. About two-thirds of cases are now reported from states in which Hepatitis A vaccination of children was not recommended. The ACIP recommendation is for children to receive the first dose of a two-dose series of Hepatitis A vaccine between one and two years of age, and the vaccine be integrated into the routine childhood vaccination schedule. Provisional Recommendations by the Advisory Committee on Immunization Practices (ACIP) for Hepatitis A Vaccination of Children can be accessed at: http://www.cdc.gov/vaccines/recs/provisional/default.htm.

The ACIP continues to recommend Hepatitis A vaccination for: travelers to countries with a high prevalence of Hepatitis A; men who have sex with men; illegal drug users; and persons with chronic liver disease.

Please remember that by Federal law, all vaccine providers must give patients, or their parents, or legal representatives the appropriate Vaccine Information Statement (VIS) whenever a vaccination is given. The VIS for Hepatitis A can be found at the following website: http://www.cdc.gov/vaccines/pubs/vis/default.htm.


The Initiative Continues

Complete the Coverage - Link opens in new windowThe next step toward surpassing Healthy People 2010 goals is to ensure that our children are protected against vaccine-preventable diseases.

What is the next challenge? That Florida achieves complete vaccine coverage for the 4:3:1:3:3:1 series for 90% of all two-year-olds by June 2007. The CDC/NIS measures this goal and provides results in July 2007.
(more).


Combination Vaccines to Help Protect Adolescents Against Pertussis

The Food and Drug Administration (FDA) approved the first combination vaccines that provide a booster immunization against pertussis (whooping cough), in combination with tetanus and diphtheria for adolescents. The vaccines will be marketed as Boostrix® by GlaxoSmithKline (GSK) and Adacel® by Sanofi Pasteur.

Pertussis is a highly communicable disease of the respiratory tract that can be especially serious for infants less than one year old, and may even be fatal. Pertussis can cause coughing and choking spells that make breathing difficult. It is thought that adolescents might transmit the disease to susceptible infants and other family members. Rates of pertussis infection have been increasing in very young infants who have not received all of their immunizations, and in adolescents and adults.

Boostrix® and Adacel® are Tetanus Toxoid (T), Reduced Diphtheria Toxoid (d) and Acellular Pertussis Vaccines (ap), Adsorbed. Although booster vaccines for adolescents containing T and d are currently licensed and marketed for use in these age groups, none contain a pertussis component. Boostrix® is licensed for use in adolescents 10 through 18 years of age and Adacel® for persons 11 through 64 years of age.


Meningococcal 10/7/05 Vaccine Information Statement (Interim)

On October 7th, 2005, the Centers for Disease Control and Prevention (CDC) National Immunization Program (NIP) issued the "Meningococcal 10/7/05 Vaccine Information Statement (Interim)."  The interim Vaccine Information Statement (VIS) is revised to reflect Guillain-Barr Syndrome (GBS) risk.  In light of reports of several cases of GBS following vaccination with meningococcal conjugate vaccine (Menactra), the VIS has been revised to include information about the potential association between the vaccine and the disease.

The revised VIS should be used. To access a ready-to-print (PDF) version of the interim VIS (dated 10/7/05) from the NIP website, go to: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mening.pdf [44K PDF]. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given.  For information about the use of VISs, and for VISs in a total of 33 languages, visit the NIP and Immunization Action Coalition (IAC) VIS web section at: http://www.immunize.org/vis.

Please report all cases of GBS and other significant events following administration of MCV4 to the Vaccine Adverse Event Reporting System (VAERS) at www.vaers.hhs.gov or by phone (800) 822-7967. In addition, prior to submitting the report electronically, please fax a copy of the VAERS report to Phyllis Yambor of the Bureau of Immunization at: 850-922-4195.

Alert on Menactra® Meningococcal Vaccine and Guillain Barre Syndrome

Read the FDA/CDC release here
Read the CDC Health Advisory statement here
Read the October 6 CDC MMWR Dispatch here


Department of Health Encourages Floridians to Make an Appointment to Get Their Flu Vaccine Today

Link Florida's Fight the Flu WebsiteYou can still receive vaccine in December and later. Flu season comes to Florida late, with the peak in January and February. We have more time than some states to prepare. There is still time to locate a provider.

For more information, visit our Flu and Pneumococcal Prevention Website


Hepatitis B Immune Globulin Availability

The Florida Department of Health, Bureau of Immunization, is aware of recent concerns regarding spot shortages of 0.5mL syringes of Hepatitis B Immune Globulin (HBIG). The Centers for Disease Control and Prevention (CDC), Division of Viral Hepatitis, has been communicating with the Food and Drug Administration (FDA) about this issue. The FDA notes that Talecris (formerly Bayer) released a quantity of 0.5mL HBIG syringes in November and will be releasing more of this size syringe in January. Talecris also released 5 mL vials of HBIG. Health departments and hospitals should be able to obtain Talecris/Bayer HBIG through their distributors, or through Talecris directly at telephone 800-243-4153.

Please ensure this information is distributed to colleagues, members, coalitions, and partners with an interest in the supply, distribution, management and administration of HBIG. For further information, or if a health department or hospital experiences problems obtaining HBIG, please contact Cathy Mellinger of the Bureau of Immunization at (850) 245-4342.


New Pneumococcal Brochure: "Get It and Forget It!"

Get it and Forget it! Link opens in new windowThe Bureau of Immunization is pleased to announce the availability of the new pneumococcal vaccine brochure, "Get It, and Forget It!" [93K PDF], is available to download.

This brochure, along with other immunization-related items, is available through the Department of Health Publication and Supply Distribution Center at (850) 414-8086. It is supplied in quantities of 50 per package. Please refer to the following when ordering: DH 150-886, 6/05, Stock Number 5730-886-0150-0. For further information regarding this brochure, please contact John Keegan of the Bureau of Immunization at (850) 245-4342.