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Issue 1302
Issue 1302: April 26, 2017

Ask the Experts
Ask the Experts—Question of the Week: My 11-year-old patient received a dose of Tdap when he was 7 years old . . . read more


TOP STORIES


IAC HANDOUTS


OFFICIAL RELEASES AND ANNOUNCEMENTS


WORLD NEWS


FEATURED RESOURCES


EDUCATION AND TRAINING


CONFERENCES AND MEETINGS

 


TOP STORIES


CDC publishes ACIP recommendations titled "General Best Practice Guidelines for Immunization" to replace "General Recommendations on Immunization"

On April 20, CDC published General Best Practice Guidelines for Immunization Best Practices: Guidance of the Advisory Committee on Immunization Practices (ACIP). This guidance is also available as a 194-page PDF document. This document replaces ACIP's "General Recommendations on Immunization," published in 2011.
 
The "General Best Practice Guidelines for Immunization" goes beyond vaccination recommendations to give providers guidelines on vaccination practice. The document will help vaccination providers to assess vaccine benefits and risks, use recommended administration practices, understand the most effective strategies for ensuring that vaccination coverage in the population remains high, and communicate the importance of vaccination to reduce the effects of vaccine-preventable disease.
 
By releasing "General Best Practice Guidelines for Immunization" as an online report, ACIP will be able to update the document more quickly, giving vaccination providers the most up-to-date guidance on vaccination practice.
 
The updated guidelines include:

  1. Confirmation that if a patient is not acutely, moderately, or severely ill, vaccination during hospitalization is a best practice.
  2. New information on simultaneous vaccination and febrile seizures.
  3. Enhancement of the definition of “precaution” to include any condition that might confuse diagnostic accuracy.
  4. More descriptive characterization of anaphylactic allergy.
  5. Incorporation of protocols for management of anaphylactic allergy.
  6. Allowances for alternate route (subcutaneous instead of intramuscular) for hepatitis A vaccination.
  7. An age cutoff of 12 years through 17 years for validating a dose of intradermal influenza vaccine.
  8. Deletion of much of the storage and handling content, including information on storage units, temperature monitoring, and expiration dates (this content is now contained and continually updated in CDC’s Vaccine Storage and Handling Toolkit, available at https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html).
  9. Incorporation of the Infectious Diseases Society of America guidance on vaccination of persons with altered immunocompetence.
  10. Timing of intramuscular administration in patients with bleeding disorders.
  11. Updated data on vaccination record policy.
  12. Additional impacts of the Affordable Care Act on adult vaccination.
  13. Updated programmatic contact information on source material for vaccine information.

Continuing education (CE) credit is available for reading "General Best Practice Guidelines for Immunization."

Vaccination providers, immunization managers, and anyone interested in updates to "General Best Practice Guidelines for Immunization" may sign up to receive e-mail notifications whenever new information is released. Submit your email address in the appropriate box in the left column here.

Access General Best Practice Guidelines for Immunization on CDC's website as an HTML document.

Download General Best Practice Guidelines for Immunization as a PDF document (194 pages).

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It's National Infant Immunization Week; CDC names Childhood Immunization Champion Award winners

National Infant Immunization Week (NIIW) is being celebrated this year from April 22–29. In accordance with annual tradition, CDC has released the names of the 2017 Childhood Immunization Champion Award recipients during this week. The CDC Childhood Immunization Champion Award is an annual award given jointly by the CDC Foundation and CDC to recognize individuals who make a significant contribution towards improving public health through their work in childhood immunization. Each year, one CDC Immunization Champion from each of the 50 states, 8 U.S. territories and freely associated states, and the District of Columbia may be honored. The award recipients for 2017 can be viewed at https://www.cdc.gov/vaccines/events/niiw/champions/profiles-2017.html.

Related Links

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Reminder: April issues of Needle Tips and Vaccinate Adults are available online

The April issues of Needle Tips and Vaccinate Adults are available online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed. These issues highlight IAC’s updated summaries of immunization recommendations, as well as the 2017 U.S. immunization schedules. 

The April issue also features the always popular “Ask the Experts” column, with Q&As by experts from CDC’s National Center for Immunization and Respiratory Diseases.

Click on the images below to download the April issues (PDF) of Needle Tips and/or Vaccinate Adults.

Download the November issue of Needle TipsDownload the November issue of Vaccinate Adults

Needle Tips: View the Table of Contents, Ask the Experts section, magazine viewer, and back issues.

Vaccinate Adults: View the Table of Contents, Ask the Experts section, magazine viewer, and back issues.

If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit IAC's subscribe page to sign up.

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Twenty cases of measles reported in Minnesota children

Minnesota's Hennepin County is currently experiencing an outbreak of measles cases. All of the cases are confirmed to be Somali-American children age 0 through 5 years of age. Sixteen of the cases are confirmed to be unvaccinated; vaccination status of the remaining cases has not yet been determined. The local Somali community has been targeted for years with misinformation about a connection between vaccination and autism, including a 2011 visit from Andrew Wakefield, the controversial physician whose license to practice medicine was revoked by Britain's General Medical Council as a result of ethical and financial misconduct.

Related Links

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CDC reports on a varicella death on a cargo ship in Puerto Rico

CDC published Notes from the Field: Varicella Fatality on a Cargo Vessel—Puerto Rico, 2015 in the April 21 issue of MMWR (page 410). Sections of the report are reprinted below.

The U.S. Code of Federal Regulations (42 §71.21) requires that the master of a ship destined to a U.S. port of entry report certain illnesses, as well as any death on board to the nearest CDC Quarantine Station. On December 30, 2015, the U.S. Coast Guard notified CDC of the death of a crew member of a foreign cargo vessel off the coast of Puerto Rico. ... Lung tissue and skin lesion specimens collected at autopsy were positive for varicella-zoster virus DNA by polymerase chain reaction at CDC. The cause of death was reported as varicella pneumonia. No other medical conditions were reported....

Per CDC recommendations, all 24 shipmates were considered contacts of the index patient; the master of the ship instituted daily temperature and rash surveillance for 21 days (i.e., one incubation period) after the death.... 

This investigation highlights the importance of early notification of illness or death to CDC by ships arriving to U.S. ports of entry, and the use of CDC’s varicella management guidance to prevent further transmission, including surveillance for febrile rash illness, isolation of cases, screening for varicella immunity, and vaccination of nonimmune persons. Collaboration with the U.S. Coast Guard was critical for expediting communication with the master of the ship. Assistance from the Puerto Rico Department of Health and the Puerto Rico Forensic Sciences Institute was instrumental in ensuring a thorough and timely investigation and public health response. Keeping a stock of acyclovir onboard was added to the CDC maritime varicella management guidance.


Related Links

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World Meningitis Day celebrated on April 24

World Meningitis Day is celebrated every year on April 24, with organization by the Confederation of Meningitis Organisations (CoMO). CoMO is an international member organization that works to reduce the incidence and impact of meningitis worldwide. CoMO brings together patient groups, health professionals and organizations, meningitis survivors and families from more than 25 countries to help prevent meningitis.

The theme of the 2017 campaign is "24 Hours—Trust your instincts." The key messages of the 2017 campaign are: 

  • Meningitis is a potentially deadly disease that affects more than 1 million people worldwide each year
  • Meningitis can affect people of all ages and cause death within 24 hours
  • Some forms of meningitis are vaccine preventable
  • Don’t wait until it threatens the life of someone you care about, learn what to look for and trust your instincts

Visit the Confederation of Meningitis Organisations website for more information on World Meningitis Day 2017, including resources to help spread awareness of meningococcal disease.

Related Links

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IAC Spotlight! Archived webinar of Dr. William L. Atkinson presenting “Adolescent Immunization: Where We Are Now and How We Can Do Better” can be viewed on IAC website; slide set and speaker notes also available

In July 2016, Dr. William L. Atkinson, MD, MPH, IAC’s associate director for immunization education, presented a webinar titled “Adolescent Immunization: Where We Are Now and How We Can Do Better.” Dr. Atkinson reviewed the recommendations for each adolescent vaccine, provided strategies to improve coverage rates in this population, and listed available resources to assist immunization providers in their efforts to improve coverage rates.

This presentation is available on the home page of IAC’s main website at www.immunize.org. To view it, scroll down to the middle of the page to Dr. Atkinson’s photo and click on the link.

In addition, the slide presentation and speakers notes are available on IAC’s PowerPoint Slide Set web page. At this link, you can request the full PowerPoint slide set and speaker's notes to create your own adolescent immunization presentation.

Related Links

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IAC HANDOUTS


IAC posts Spanish translations of four updated HPV handouts for parents, teens, or adults 

Earlier this year, IAC revised four fact sheets for parents and teens about human papillomavirus (HPV) infection and vaccination. Changes included new data on cervical cancer and the number of doses in the schedule, since it can be either two or three. The Spanish-language versions of these resources have now been updated to match the English-language versions.

  1. HPV is a serious disease...Make sure your child is protected!  (Spanish-language version)
  2. Protect yourself from HPV...Get vaccinated!  (Spanish-language version)
  3. Human Papillomavirus (HPV): A Parent's Guide to Preteen and Teen HPV Vaccination (Spanish-language version)
  4. HPV Vaccine: A Guide for Young Adults  (Spanish-language version)

Related Links

IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC corrects a small error on its "Screening Checklist for Contraindications to Vaccines for Adults"

IAC recently corrected a small error on page 2 of its Screening Checklist for Contraindications to Vaccines for Adults. The abbreviation "IIV" was changed to "IPV" in the item #9 question on the second page ("For women: Are you pregnant or is there a chance you could become pregnant during the next month? [HPV, IPV, MMR, LAIV, VAR, ZOS]").

Page 2 is where explanations are provided for healthcare professionals as to why the screening questions are asked and what should be considered. This change does not in any way affect page 1, which is the checklist given to patients to fill out.

Related Link

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OFFICIAL RELEASES AND ANNOUNCEMENTS


CDC publishes community mitigation guidelines to prevent pandemic influenza

CDC published Community Mitigation Guidelines to Prevent Pandemic Influenza—United States, 2017 as a MMWR Recommendations and Reports on April 21. The "Summary" section is reprinted below.
 
When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.

These guidelines replace the 2007 
Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States—Early, Targeted, Layered Use of Nonpharmaceutical Interventions. Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).

Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).


Related Link

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WORLD NEWS


Immunization campaign protects 5 million children from polio and measles in Yemen

The World Health Organization (WHO), UNICEF, and the World Bank are sponsoring a campaign to vaccinate children against polio in war-torn Yemen. A 2-year conflict has all but destroyed the country's health system, including the immunization program. A section of an April 8 joint press release from these organization is reprinted below.

In an effort to keep Yemen polio-free, nearly 5 million children under the age of five have been vaccinated in a nationwide campaign covering all governorates in the country. The campaign was supported by a partnership between the World Bank, UNICEF, and WHO launched in February 2017.
 
Despite intensifying violence in Sa'ada governorate, more than 369,000 children between the ages of 6 months and 15 years were immunized against measles—a highly contagious and potentially fatal disease—and over 155,000 children under the age of 5 were vaccinated against polio. 


Read the complete press release: Nationwide immunization campaign protects 5 million children against polio in war-torn Yemen.

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WHO publishes global strategy on eliminating yellow fever epidemics

The World Health Organization (WHO) published Eliminate Yellow fever Epidemics (EYE): a global strategy, 2017–2026 in the April 21 issue of its Weekly Epidemiological Record. The goal of the EYE strategy is to eliminate yellow fever epidemics globally by 2026. The "Strategic objectives" are reprinted below:

With a view towards achieving the goal of the EYE strategy, 3 objectives have been defined

  1. To protect at-risk populations.
  2. To prevent international spread of the disease.
  3. To contain outbreaks rapidly.

The revised strategy is both global—extending beyond the established endemic areas in Africa and the Americas, and comprehensive—covering activities beyond vaccination. It emphasizes surveillance and laboratory capacity strengthening, the application of the International Health Regulations (2005) (IHR), and the involvement of the private sector, especially the mining, forestry, and agro-industries.

Related Link

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World Malaria Day was commemorated on April 25

CDC published Announcement: World Malaria Day—April 25, 2017 in the April 21 issue of MMWR (page 412). The first paragraph is reprinted below.

World Malaria Day is commemorated each year on April 25, the date in 2000 when leaders of 44 African nations met in Abuja, Nigeria, and committed their countries to reducing the number of malaria-related deaths. Approximately 90% of all malaria deaths occur in Africa. During the last 15 years, donors have collectively supported the procurement and distribution of billions of insecticide-treated bed nets and courses of artemisinin-based combination therapy globally. These improvements in malaria control are estimated to have saved an estimated 6.8 million lives, mostly among children aged <5 years. From 2010 to 2015, the World Health Organization (WHO) reported that the estimated number of malaria deaths worldwide declined by approximately 60%, including a 69% decline among children aged <5 years. This year, as in 2016, the theme of World Malaria Day is “End Malaria for Good,” reflecting the increased interest in and commitment to eliminating malaria.

Related Link

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FEATURED RESOURCES


CDC launches a new childhood immunization quiz for parents

As part of National Infant Immunization Week, CDC has launched a new childhood immunization quiz. Parents can answer the questions in the quiz to create a personalized list of vaccines recommended for their child based on the child’s health history and age. Parents can then print the list to discuss with their child's healthcare professional. The quiz is designed to provide vaccine recommendations for all children from birth through 18 years old.

Access CDC's Childhood Vaccine Quiz web page.

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New edition of The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall available for purchase from IAC; free app for iPhones and iPads available from IAC

The 6th edition of The Vaccine Handbook: A Practical Guide for Clinicians ("The Purple Book") is considered a vital source of practical, up-to-date information for vaccine providers and educators. Now printed in color and updated with the latest vaccine information through early 2017, "The Purple Book" draws together the latest vaccine science and guidance into a concise, user-friendly, practical resource for the private office, public health clinic, academic medical center, and hospital.

The sixth edition of this valuable guide (592 pages) is available on IAC's website at www.immunize.org/vaccine-handbook. The price of the handbook is $34.95 per copy, plus shipping charges. Order copies for your staff or for distribution at an upcoming conference.

Discount pricing is available for more than 10 copies. For quotes on larger quantities, email admininfo@immunize.org.

Order your copy today! Click on the image below to visit the "Shop IAC: The Vaccine Handbook" web page.
Order your copy of The Vaccine Handbook today!

The Vaccine Handbook App for Apple iPhones and iPads is available free from IAC. Sorry, the app is not available for android devices. Book purchase is not necessary but registration to obtain the app is required.

The app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to valuable content from nonprofit and governmental sources.

Click on the image below to visit the The Vaccine Handbook App page in the iTunes store.

Download new app!

About the Author
Gary S. Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the Division of Pediatric Infectious Diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

Related Links

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Now available! IAC's sturdy laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11". 

Laminated Child and Teen Laminated Schedule

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

PRICING
1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email admininfo@immunize.org.

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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EDUCATION AND TRAINING


CDC to present a May 8 "train the trainer" webinar on how to use its "You Are the Key to HPV Cancer Prevention" slide set 
 
On May 8, CDC will present a "train the trainer" webinar on the You Are the Key to HPV Cancer Prevention slide set at 2:30 p.m. (ET). A group of HPV infection, cancer, and vaccination experts from CDC and partner organizations will walk through how they present the information in the "You Are the Key to HPV Cancer Prevention" slide set. Participants will improve their own presentations on the material and also learn how to train others to effectively present these slides.

Registration information

Related Link

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Reminder: CDC's NetConference series about adult immunization runs every Wednesday, April 12–May 31

CDCis sponsoring a 6-part NetConference series on vaccinating adults that will address key issues related to protecting adults from vaccine-preventable diseases. A collaborative effort between CDC and Maryland’s adult immunization coalition and state immunization program, the "Vaccinating Adults" series will feature 6 presentations by experts in promoting, administering, and securing reimbursement for adult immunizations.

  • Wednesday, April 12—Burden of Vaccine-Preventable Diseases in Adults: Medical, Social, and Economic Costs
  • Wednesday, April 19—Provider Reimbursement for Adult Immunizations
  • Wednesday, April 26—Immunizing Adults: Immunization Schedule, Coverage, and Challenges
  • Wednesday, May 17—Immunizing Older Adults and the Chronically Ill
  • Wednesday, May 24—Immunizing Pregnant Women, Health Care Personnel, and in the Workplace
  • Wednesday, May 31—Clinic Logistics: Vaccine Administration, Storage, and Handling

Each session will start at 12:00 p.m. (ET).

Continuing education will be available for each event. The series will be archived later on CDC's website.

Advanced registration is required to participate.

Related Link

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CONFERENCES AND MEETINGS


CDC and the Viral Hepatitis Action Coalition to sponsor a summit on April 27–28 to discuss the recommendations of the National Strategy for the Elimination of Hepatitis B and C

The CDC Foundation and the Viral Hepatitis Action Coalition will convene a summit on April 27–28 in Atlanta to provide the opportunity for diverse stakeholders to come together to discuss the recommendations of the National Strategy for the Elimination of Hepatitis B and C of the National Academies of Science, Engineering, and Medicine.
 
The summit will be open to the public for viewing via a live webcast. No advance registration is necessary for the webcast. Information on the summit, including the latest agenda and information on how to access the live webcast, can be found on its web page at http://viralhepatitisaction.org/Hepatitis-B-and-C-Elimination-Summit.

Related Links

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ASK THE EXPERTS

Question of the Week

My 11-year-old patient received a dose of Tdap when he was 7 years old. He also received a dose of Td 6 months later in order to finish a primary series of tetanus-toxoid. Can I give him a dose of Tdap now?

Yes. Footnote 12 of the 2017 child and adolescent immunization schedule (available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html) states that a child who receives a dose of Tdap between 7 through 10 years of age as part of the catch-up series (as in this case), may receive another dose of Tdap at age 11 or 12 years.


About IAC's Question of the Week

Each week, IAC Express highlights a new, topical, or important-to-reiterate Q&A. This feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, chooses a new Q&A to feature every week from a set of Q&As prepared by experts at CDC’s National Center for Immunization and Respiratory Diseases.

We hope you enjoy this feature and find it helpful when dealing with difficult real-life scenarios in your vaccination practice. Please encourage your healthcare professional colleagues to sign up to receive IAC Express at www.immunize.org/subscribe.

If you have a question for the CDC immunization experts, you can email them directly at nipinfo@cdc.gov. There is no charge for this service.

Related Links

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.

If you have trouble receiving or displaying IAC Express messages, visit our online help section.

IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; bioCSL Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.
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Meningitis B Shatters Dreams: These four students' future dreams were shattered when they contracted meningococcal serogroup B disease and died. They were vaccinated against meningococcal ACWY types only. The Kimberly Coffey Foundation and The Emily Stillman Foundation worked together to produce this video about making sure teens and young adults received MenB as well as MenACWY vaccines.
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Editorial Information
Editor: Deborah L. Wexler, MD
Managing Editor: Teresa Anderson, DDS, MPH
Consulting Editor: Marian Deegan, JD
Assistant Managing Editor: Liv Augusta Anderson, MPP
Issue Abbreviations
AAFP: American Academy of Family Physicians
AAP: American Academy of Pediatrics
ACIP: Advisory Committee on Immunization Practices
CDC: Centers for Disease Control and Prevention
FDA: Food and Drug Administration
IAC: Immunization Action Coalition
MMWR: Morbidity and Mortality Weekly Report
NCIRD: National Center for Immunization and Respiratory Diseases
VIS: Vaccine Information Statement
WHO: World Health Organization
 
 
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.