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Issue 1333
Issue 1333: November 1, 2017

Ask the Experts
Ask the Experts—Question of the Week: I am a pharmacist who administers vaccines. I was recently told by a colleague . . . read more


TOP STORIES


IAC HANDOUTS


OFFICIAL RELEASES AND ANNOUNCEMENTS


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING

 


TOP STORIES


Now online! Needle Tips, the final issue

After publishing 61 issues since 1994, IAC has now placed the final edition (November 2017) of Needle Tips online.

The lead story, "Thoughts on the final issue of Needle Tips" by Dr. Deborah Wexler, reviews the 23-year history of Needle Tips—how it began, how it grew over the years, and what’s next.
 
The final issue also features the highly popular "Ask the Experts" column, focused on influenza, with questions answered by experts from CDC’s National Center for Immunization and Respiratory Diseases.
 
You'll also find a new patient handout for 16-year-olds—"You're 16 . . . we recommend these vaccines for you" from IAC and the Society for Adolescent Health and Medicine.

Click on the image below to download the entire November issue of Needle Tips (19-page, 8.58 MB PDF).

Download the November issue of Vaccinate Adults

Access the Table of Contents (HTML) to download individual sections or pages.

For the future, to be informed when new or revised IAC pieces, ACIP recommendations, VISs and translations, educational opportunities, and other resources are available, subscribe to our free weekly newsletter, IAC Express.

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IAC provides summary article about votes taken at October 24–25 ACIP meeting

The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on October 24–25. During the meeting, votes were taken on two vaccines and the two U.S. immunization schedule updates for 2018, as described below. In addition, ACIP discussed a new hepatitis B vaccine (Heplisav-B, Dynavax) currently under review by the FDA, hepatitis A outbreaks occurring around the country, a presentation on a new educational campaign to prevent Shoulder Injury Related to Vaccine Administration, a report on items being discussed by the human papillomavirus (HPV) vaccine workgroup, adverse event surveillance for Japanese encephalitis vaccine, descriptions of the impact of pneumococcal conjugate vaccine (PCV13) on nasopharyngeal carriage and invasive pneumococcal disease, and information on anthrax vaccine. Also, the committee received summaries of influenza surveillance and coverage, as well as an update on live attenuated influenza vaccine (LAIV). Additional information on LAIV will be presented at the February 2018 ACIP meeting. However, at this time, ACIP continues to recommend that LAIV not be used during the current influenza season.

Herpes Zoster Vaccine

On October 20, the Food and Drug Administration approved Shingrix (GlaxoSmithKline) vaccine for use in persons age 50 and older for the prevention of shingles. Shingrix is a herpes zoster subunit (HZ/su) vaccine that contains an adjuvant to enhance the immune response. It is a recombinant vaccine, which differs from the previously licensed zoster vaccine live (Zostavax; Merck). In addition, Shingrix requires two doses of vaccine given a minimum of 8 weeks apart, rather than the single dose recommended for Zostavax.
 
Based on the data indicating substantial benefits in disease prevention, ACIP considered 3 separate recommendations related to use of this vaccine. Specifically, ACIP voted and approved that Shingrix is recommended for the prevention of herpes zoster and related complications for immunocompetent adults age 50 years and older; recommended for the prevention of herpes zoster and related complications for immunocompetent adults who previously received Zostavax; and preferred over Zostavax for the prevention of herpes zoster and related complications.
 
Several issues related to implementation of this new vaccine recommendation will be clarified when the final guidance is issued by CDC.

Mumps Vaccine in Outbreak Settings
 
Although the 2-dose measles-mumps-rubella (MMR) vaccination recommendation has led to a significant decline in reported mumps cases in the United States, a dramatic increase in mumps outbreaks has been reported in recent years, likely due to waning immunity.
 
ACIP voted that persons previously vaccinated with two doses of mumps-containing vaccine (includes MMR and MMRV) who are identified by public health as at increased risk for mumps because of an outbreak should receive a third dose of mumps-containing vaccine to improve protection against mumps disease and its complications.
 
In making the recommendation, ACIP members stressed that this vote is intended to provide guidance during outbreaks and does not require that public health departments mount a vaccination campaign or use funding to purchase the vaccine during a mumps outbreak. 

Revisions to the U.S. 2018 Child/Adolescent and Adult Recommended Schedules
 
ACIP voted to approve multiple revisions to the 2018 schedules for children/adolescents and adults, which are scheduled for publication in February 2018. The majority of these revisions are related to changes in formatting/layout in an effort to simplify the recommendations, while other revisions involve updates to reflect new ACIP policies or the discontinuation of some vaccines in the marketplace (e.g., meningococcal polysaccharide (Menomune) and combination vaccine meningococcal serogroup CY-Hib (MenHibrix). 

Child/Adolescent Schedule
Several formatting changes will be apparent in the 2018 child/adolescent schedule, including that the footnotes will use bullets to simplify the text, and the cover page will include a table of vaccine types, abbreviations, and brand names. The catch-up schedule will provide additional information on timing of rotavirus vaccination, clarification on the recommended intervals between doses of polio vaccine depending upon the age of the recipient, and a refinement of the wording on the birth dose of hepatitis B vaccine.
 
Adult Schedule
Like the format changes in the child/adolescent schedule, the presentation of the footnotes will also be bullets rather than paragraphs. The cover page will include additional information on special populations (e.g., pregnant women and persons with asplenia or immunocompromising conditions), as well as updated abbreviations for vaccines included in the schedule. The footnotes for MenACWY and MenB will be separated to clarify the guidance for these two vaccines. Revisions also will be made to reflect ACIP recommendations such as the herpes zoster and MMR vaccine votes taken during the October meeting. 

All recommendations approved by ACIP are provisional until they are approved by the CDC director and published in MMWR. Presentation slides from the October meeting should be posted on the ACIP website in the next 4–6 weeks.
 
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CDC's Health Alert Network issues advice for providers treating patients currently in or recently returned from hurricane-affected areas

On October 24, the CDC Health Alert Network (HAN) issued a CDC Health Advisory titled Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands. The "Summary" section is reprinted below.

Summary
The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the U.S. Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.


Access the complete CDC HAN Health Advisory, which includes "Background" and "Recommendations" sections, as well as additional resource links.

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CDC reports on timeliness of vaccination among children of immigrants in Minnesota

CDC published Timeliness of Receipt of Early Childhood Vaccinations Among Children of Immigrants—Minnesota, 2016 in the October 27 issue of MMWR (pages 1125–9). A summary made available to the press is reprinted below.

This study used data from the Minnesota Immunization Information Connection (MIIC) and the Office of Vital Records to measure childhood vaccination coverage and examine coverage differences across selected demographic characteristics at ages 2, 6, 18, and 36 months for children born in Minnesota in 2011 and 2012. Coverage levels were higher for children with two U.S.-born parents compared with children having at least one foreign-born parent at all four ages. When children were divided into groups by mother’s country of birth, some groups were vaccinated at higher rates than were children of U.S.-born mothers (Mexico, Central and South America), and others at much lower rates (Somalia, Eastern Europe). Outreach to groups with lower vaccination rates may be needed to improve vaccination coverage in young children.

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CDC reports that 47 states and the District of Columbia have reported 4,667 mumps cases in 2017

From January 1 to October 7, 47 states and the District of Columbia reported mumps infections in 4,667 people to CDC. Although it is not mandatory to report mumps outbreaks to CDC, many health departments will contact CDC when they experience an unusually high number of cases. In 2016 and 2017, a number of cases and outbreaks have been reported to CDC, primarily associated with college settings. These outbreaks have ranged in size from a few to several hundred cases, have mostly affected young adults, and are likely due to a combination of factors. These factors include the known effectiveness of the vaccine, waning immunity following vaccination, and the intensity of exposure to the virus in close-contact settings along with behaviors that increase the risk of transmission.




See the second article in this issue of IAC Express for information about the recent ACIP recommendation about providing a third dose of MMR to people previously vaccinated with two doses of a mumps-containing vaccine who are identified by public health as at increased risk for mumps because of an outbreak.
 
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CDC announces 2017 HPV Vaccine is Cancer Prevention Champion award winners

CDC has announced the ten regional winners of the 2017 HPV Vaccine is Cancer Prevention Champion award. The HPV Vaccine Is Cancer Prevention Champion is an annual award given jointly by CDC, the American Cancer Society, and the Association of American Cancer Institutes. The award recognizes clinicians, clinics, practices, groups, and health systems that are effectively working to protect their adolescent patients against human papilloma (HPV) cancers by achieving high HPV vaccination rates among 11- and 12-year-old patients.

Click on the image below to access information about the 2017 awardees.



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CDC releases new podcast in its "Defining Moments in MMWR  History" series about its response to the 2001 intentional release of anthrax 

CDC has been releasing a series of podcasts that highlight the leading role MMWR has played in reporting on health-related issues through the years. The most recent podcast in this "Defining Moments in MMWR History" series is vaccine-related: CDC’s Response to Intentional Release of Anthrax—2001.

Access all the podcasts in this series.

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CDC publishes report about postexposure prophylaxis for rabies for two people who ate a prepackaged salad containing a partial bat carcass

CDC published Notes from the Field: Postexposure Prophylaxis for Rabies After Consumption of a Prepackaged Salad Containing a Bat Carcass—Florida, 2017 in the October 27 issue of MMWR (pages 1154–5). Three paragraphs are reprinted below.

On April 3, 2017, two Florida residents consumed part of the same prepackaged salad before reportedly discovering the partial remains of a bat carcass in the salad. Bats are known reservoirs for rabies virus, which causes rabies disease in both animals and humans. The persons who ate the salad contacted the Florida Department of Health (FLDOH), which notified CDC’s Poxvirus and Rabies Branch. CDC and FLDOH determined that the immediate concern was for potential rabies virus exposure, because approximately 6% of bats submitted to U.S. public health departments annually test positive for rabies virus.

Although percutaneous exposures are more likely to result in successful transmission of rabies virus to humans, transmission can occur when infectious material, such as saliva or nervous tissue from an infected animal, comes into direct contact with human mucosa. Infection with rabies virus causes an acute, progressive encephalitis that is nearly always fatal once clinical signs have begun. The disease is preventable if exposed persons receive timely postexposure prophylaxis (PEP), which includes human rabies immunoglobulin and 4 doses of inactivated rabies vaccine administered over 14 days....

Several factors likely reduced the risk for rabies virus transmission to the two Florida consumers. No rabies virus was detected in the specimen, the bat’s cranium was intact, and the salad was rinsed before packaging, thereby diluting any potential virus. In addition, mucosal membrane exposures have rarely been proven to result in rabies disease, and rabies virus does not survive more than a few days outside a host. Although this exposure was likely of low risk, this investigation was an example of effective industry and government collaboration to remove a product of concern from the marketplace rapidly to protect consumers.


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IAC HANDOUTS


IAC posts updated handout for the public titled "Influenza: Questions and Answers"

IAC recently revised its handout for the public titled Influenza: Questions and Answers. Changes were made to update the information for the 2017–18 influenza season and a question was added to respond to the 2017 study that suggested an increase in miscarriage among women who received inactivated influenza vaccine.

Access all IAC's Questions and Answers handouts for 18 vaccine-preventable diseases.

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 updates “Standing Orders for Administering Hepatitis B Vaccine to Children and Teens"

IAC has updated its staff resource Standing Orders for Administering Hepatitis B Vaccine to Children and Teens. Changes were made to reformat and expand the text to include more information displayed in charts, and to incorporate a slight change in needle length for administering IM injections to children and teens.

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IAC updates “Standing Orders for Administering Pneumococcal Polysaccharide Vaccine to Children and Teens"

IAC has updated its staff resource Standing Orders for Administering Pneumococcal Polysaccharide Vaccine to Children and Teens. Changes were made to reformat and expand the text to include more information displayed in charts, and to incorporate a slight change in needle length for administering IM injections to children and teens.

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OFFICIAL RELEASES AND ANNOUNCEMENTS


CDC releases national progress report on hepatitis elimination 

On October 27, CDC published a report online titled Progress Toward Viral Hepatitis Elimination in the United States, 2017. Part of a letter from John W. Ward, MD, director, Division of Viral Hepatitis, CDC, is reprinted below:

In this inaugural report, CDC highlights recent progress made by the nation towards reducing the burden of hepatitis A virus, hepatitis B virus, and hepatitis C virus infections and highlights the strategies for improving prevention of transmission and mortality.... 

Unique to this national progress report is the inclusion of a new set of seven standardized viral hepatitis indicators with accompanying 2020 goals and annual targets for each indicator. This year’s report measures the Nation’s progress toward meeting these goals using data from 2015, the most recent data available. Only one indicator (“reduce the rate of HBV-related deaths”) met the 2015 target. For two indicators (“increase hepatitis A vaccination in children” and “reduce the rate of HCV-related deaths”), progress was made towards achieving the 2020 goal, but the 2015 target was not met. Annual targets were not met for the remaining four indicators; for these, either no change occurred, or data appear to trend further away from the goal. 

As demonstrated by the national progress report, much work remains for the nation to improve prevention and advance toward the elimination of viral hepatitis as a public health threat....


Access the complete report: Progress Toward Viral Hepatitis Elimination in the United States, 2017 (PDF; 44 pages).

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WORLD NEWS


CDC and WHO report on progress toward regional measles elimination in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Progress Toward Regional Measles Elimination—Worldwide, 2000–2016 in the October 27 issue of MMWR (pages 1148–53). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards regional measles elimination—worldwide, 2000–2016. A media summary of the MMWR article is reprinted below.

During 2000–2016, measles vaccination prevented an estimated 20.4 million deaths worldwide. The number of countries providing the second dose of measles-containing vaccine through routine immunization services increased to 85 percent; in 2016, global MCV2 coverage was 64 percent. Also during 2000–2016, annual reported measles cases decreased 87 percent and annual measles deaths decreased 84 percent. Despite advances, the WHO 2015 milestones haven’t been met. Only one WHO region, the Americas, has been declared free of measles. To eliminate measles, countries and their partners need to focus on increasing vaccination coverage through sustained investments in health systems, strengthening surveillance systems, using surveillance data to drive programmatic actions, securing political commitment, raising the visibility of measles elimination goals, and mitigating the threat of decreasing resources once polio eradication is achieved.

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FEATURED RESOURCES


CDC adds selections to its #HowIRecommend video series about HPV vaccination 

#HowIRecommend is a new video series produced by CDC that highlights real healthcare providers responding to a variety of questions about HPV vaccine. In these short videos, clinicians make an effective HPV vaccine recommendation, answer the questions parents have about HPV vaccine, and explain how their office helps empower and educate parents. Currently, you can see pediatricians Dr. Alix Casler and Dr. Sharon Humiston answer the most common questions they hear about HPV vaccination. More videos in this series are in production and will be posted in the upcoming months.

Access the 15 videos currently available in the #HowIRecommend series.

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AIM releases “Engaging Teens Directly” resource to provide insight into immunization program activities that engage adolescents to take part in decisions about their own health

The Association of Immunization Managers (AIM) has added a second chapter to its Adolescent Immunization Resource Guide titled Engaging Teens Directly. An introduction to this material is provided on AIM's website:

CDC recently released its annual report on adolescent vaccination coverage, showing millions of teens are still under-vaccinated against serious infectious diseases. Rates are particularly low for those vaccines that need to be administered as multi-dose series—just 39.1% of teens received the recommended second dose of quadrivalent meningococcal conjugate vaccine (MenACWY) and only 49.5% of girls and 37.5% of boys completed the human papillomavirus (HPV) vaccination series (NIS–Teen, 2016).

To help increase adolescent awareness, AIM has released Chapter 2 “Engaging Teens Directly” to provide insight into Immunization Program activities that engage adolescents to take part in decisions about their own health. This can be approached in a variety of ways, such as social media campaigns and community initiatives (schools, college fairs, community centers). Providing adolescents vital information about vaccines directly encourages them to participate in the critical health care decisions that will govern their health for many years to come.


Access Chapter Two: Engaging Teens Directly.

Access Chapter One: Reach Teens via School-Related Efforts.

Access AIM's Adolescent Immunization Resource Guide web page.

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Influenza is serious; many resources are available to help healthcare professionals vaccinate patients

Influenza vaccination is recommended for everyone six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:

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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.

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JOURNAL ARTICLES AND NEWSLETTERS


Vaccine Education Center’s November newsletter for healthcare professionals now online

The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia publishes a monthly immunization-focused newsletter titled Vaccine Update for Healthcare Professionals. The November issue includes the following articles:

Additional resources and news items are available in the full newsletter.

Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.

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EDUCATION AND TRAINING


CDC to host a “Current Issues in Immunization NetConference” on November 8; session will cover the new ACIP zoster vaccine recommendations and guidance regarding hepatitis A outbreaks

CDC will present a one-hour "Current Issues in Immunization NetConference" on November 8 at 12:00 p.m. (ET). The speakers will discuss the new ACIP recommendation regarding herpes zoster vaccines, and will also provide information about hepatitis A prevention in light of recent outbreaks and current constraints related to the hepatitis A vaccine supply. The NetConference will be moderated by Andrew Kroger, MD, MPH, medical officer, National Center for Immunization and Respiratory Diseases, CDC.

This is a limited registration event. Registration is required.

Related Link

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Registration now open for Vaccine Education Center's "Current Issues in Vaccines" webinar on November 15 with Dr. Paul Offit

The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, beginning at 1:00 p.m. (ET) on November 15. Part of its "Current Issues in Vaccines" series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit's topic for this webinar will be: 
  • Shingrix vs. Zostavax
  • Hepatitis A vaccine: Updates
  • Mumps: What to do about the increased rates
  • Influenza vaccine: Will FluMist return?

Free continuing education credits (CME, CEU, and CPE) will be available for both the live and archived events. 

Registration (required) is open now.

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ASK THE EXPERTS

Question of the Week

I am a pharmacist who administers vaccines. I was recently told by a colleague that pregnant healthcare personnel were not to administer live vaccines to others. I had never heard that in school or practice. Is that true? 

This is not true. Pregnant healthcare personnel may administer any vaccine except smallpox vaccine. 


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.

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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.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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Influenza Vaccine 2017–18: Vaccine Storage, Handling‎, and Administration FAQs: This CDC video identifies the recommended procedures that all healthcare personnel who store, prepare, and administer flu vaccine should follow. New flu vaccines for this season are also discussed.
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Editorial Information
Editor:
Deborah L. Wexler, MD
Managing Editor:
Teresa Anderson, DDS, MPH

Consulting Editors:
Marian Deegan, JD
Jane Myers, EdM

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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