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Issue 1334
Issue 1334: November 8, 2017

Ask the Experts
Ask the Experts—Question of the Week: My 36-year-old patient was diagnosed with idiopathic thrombocytopenic purpura and . . . read more


TOP STORIES


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING

 


TOP STORIES


The final issue of Vaccinate Adults is available online

After publishing 52 issues since 1997, IAC has now placed the final edition (November 2017) of Vaccinate Adults online.

The lead story, "20 Years Later—the Final Issue of Vaccinate Adults" by Dr. Deborah Wexler, reviews the 20-year history of Vaccinate Adults—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 one-page CDC-reviewed patient handouts for adults and pregnant women, newly translated in seven languages.

Click on the image below to download the entire November issue of Vaccinate Adults (15-page, 7.8 MB PDF).

Download the November issue of Vaccinate Adults

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

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Reminder: The final issue of Needle Tips is available online

After publishing 61 issues since 1994, IAC has 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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CDC reports on vaccination coverage of children 19–35 months old during 2016 in MMWR 

CDC published Vaccination Coverage Among Children Aged 19–35 Months—United States, 2016 in the November 3 issue of MMWR (pages 1171–7). A summary made available to the press is reprinted below.

Vaccination is the best way to reduce illness and death from vaccine-preventable diseases in young children. Data from the 2016 National Immunization Survey-Child (NIS-Child) were used to assess vaccination coverage with recommended vaccines among children aged 19–35 months in the United States. Based on the data, coverage with recommended vaccines for children aged 19–35 months continues to be high and stable, but remains below 90 percent for vaccines that require booster doses during the second year of life and for more recently recommended vaccines. Differences in coverage by race/ethnicity, poverty status, and insurance status indicate that improvements are needed in the immunization safety net (that is, access to and delivery of age-appropriate immunization to all children, regardless of insurance or financial status).

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Two Colorado hepatitis A cases linked to California outbreak that has killed 20 people; unrelated outbreak in Michigan has claimed 19

As the number of hepatitis A cases continues to rise in San Diego, Colorado has reported two deaths from hepatitis A with the cases linked to the San Diego outbreak. The large majority of people infected in San Diego have been homeless, use illicit drugs, or provide services to those who are homeless. In Colorado, where 58 cases have been reported so far this year, the two people who died had experienced homelessness.

The number of hepatitis A cases in San Diego has risen to 536, an increase by about 20 in one week, with 20 deaths. In Los Angeles (LA)—in an outbreak related to San Diego’s—after a police officer contracted the disease, the police union president urged the LA County Board of Supervisors to provide hepatitis A vaccination to the more than 1,000 police officers who may be at risk for contracting hepatitis A on their work assignments.

Southeast Michigan has also been experiencing an outbreak of hepatitis A since August 2016—unrelated to that in California—with 486 cases and 19 deaths. Michigan activated its State Emergency Operations Center this week to help coordinate local responses to hepatitis A.
 
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IAC Spotlight! “Ask the Experts” web page with influenza Q&As is newly updated by CDC experts

IAC recently updated its "Ask the Experts" web page featuring questions and answers from CDC experts relating to influenza vaccination. It was updated to ensure the section provides the most up-to-date information, including the new ACIP recommendations for the 2017–18 influenza season.

Access the updated "Ask the Experts" Q&As related to influenza.

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IAC enrolls five new birthing institutions into its Hepatitis B Birth Dose Honor Roll; four previously honored institutions qualify for additional years' honors

The Immunization Action Coalition (IAC) is pleased to announce that five new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Cape Cod Hospital, Hyannis, MA (95%)
  • CarolinaEast Medical Center, New Bern, NC (94%)
  • Franciscan Health Michigan City, Michigan City, IN (95%)
  • Hunt Regional Medical Center, Greenville, TX (96%)
  • MHP Medical Center, Shelbyville, IN (100%)

The following two institutions are being recognized for a second year:

  • St. David's Georgetown Hospital, Georgetown, TX (98%)
  • Warren General Hospital, Warren, PA (93%)

In addition, the following two institutions are being recognized for a third year:

  • Lowell General Hospital, Lowell, MA (97%)
  • The Medical Center of Aurora, Aurora, CO (95%)

The Honor Roll now includes 365 birthing institutions from 39 states, Puerto Rico, and Guam. Seventy-six institutions have qualified for two years, 42 institutions have qualified three times, 11 institutions have qualified four times, and 4 institutions have qualified five times.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give birth to the end of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90 percent or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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WORLD NEWS


National Geographic publishes article about why vaccines are so critical in poor countries

In its November issue, National Geographic magazine published a photo-journalism piece titled Here’s Why Vaccines Are So Crucial, with the sub-head: "If children in poor countries got the shots that rich countries take for granted, hundreds of thousands of young lives could be saved." The article features the stories of children and young adults whose lives were forever changed by a vaccine-preventable disease, as well as information about the healthcare workers out in the field and the organizations trying to improve access to vaccines. The photographs are breathtaking and sometimes heartbreaking.

Access Here’s Why Vaccines Are So Crucial online. 

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Worldwide, measles-related deaths dropped 84% over 16 years 

On October 26, Gavi, UNICEF, WHO, and CDC issued a joint press release titled Substantial decline in global measles deaths, but disease still kills 90,000 per year. Selections from this release are reprinted below.

In 2016, an estimated 90,000 people died from measles—an 84 percent drop from more than 550,000 deaths in 2000—according to a new report published today by leading health organizations. This marks the first time global measles deaths have fallen below 100,000 per year....

Since 2000, an estimated 5.5 billion doses of measles-containing vaccines have been provided to children through routine immunization services and mass vaccination campaigns, saving an estimated 20.4 million lives....

The world is still far from reaching regional measles elimination goals. Coverage with the first of two required doses of measles vaccine has stalled at approximately 85 percent since 2009, far short of the 95 percent coverage needed to stop measles infections, and coverage with the second dose, despite recent increases, was only 64 percent in 2016.

Far too many children—20.8 million—are still missing their first measles vaccine dose. More than half of these unvaccinated children live in six countries: Nigeria (3.3 million), India (2.9 million), Pakistan (2.0 million), Indonesia (1.2 million), Ethiopia (0.9 million), and Democratic Republic of the Congo (0.7 million). Since measles is a highly contagious viral disease, large outbreaks continue to occur in these and other countries in Europe and North America, putting children at risk of severe health complications such as pneumonia, diarrhoea, encephalitis, blindness, and death....


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Harvard School of Health and NPR's forum on eradicating polio now available to view online

On October 20, the Harvard T.H. Chan School of Public Health and National Public Radio (NPR) jointly sponsored a forum titled "Eradicating Polio: Reaching Every Last Child." The 1-hour video of this presentation can now be viewed online. A description of the discussion is provided below.

Once a global scourge, polio is tantalizingly close to eradication with only 11 wild poliovirus cases reported worldwide in 2017. In this Forum event—held in advance of World Polio Day—experts from the Government of Pakistan, UNICEF, Rotary International, and the Harvard Opinion Research Program explained what factors contributed to this remarkable progress. Where were we five years ago in the effort to end transmission? What challenges emerged and how were they overcome? And where do we go from here? Looking specifically at the latest findings from Pakistan, Afghanistan, and Nigeria, speakers described the key roles of polling and data collection, community and family engagement, new communication efforts and more in building trust to enable widespread vaccinations. They explored what brought us to this “last mile” of polio eradication, and what needs to be done to fully eradicate this ancient, debilitating, and entirely preventable disease.

Access Eradicating Polio: Reaching Every Last Child on YouTube.

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International Vaccine Access Center releases 2017 edition of its “Pneumonia & Diarrhea Progress Report” as part of World Pneumonia Day

For World Pneumonia Day, the International Vaccine Access Center (IVAC) released the 2017 Pneumonia and Diarrhea Progress Report: Driving Progress through Equitable Investment and Action. This is the eighth such annual report from IVAC.

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FEATURED RESOURCES


AAPCHO offers toolkit to help reduce stigma related to hepatitis B infection 

The Association of Asian Pacific Community Health Organizations (AAPCHO) has developed a toolkit titled "Understanding And Combating Stigma: A Toolkit For Improving Care And Support For People Affected By HBV." This toolkit is written for healthcare providers and community health advocates who want to improve care and support for people affected by the hepatitis B virus (HBV). The aim of this toolkit is to confront and reduce the stigma associated with HBV, and to promote increased prevention, care, and treatment of hepatitis B.

To download the toolkit, you must first provide some basic information to AAPCHO.

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BuzzFeed offers fun list of reasons for getting vaccinated against influenza to share with patients and parents

BuzzFeed, the popular social news company, recently posted 13 Facts About The Flu Shot Everyone Should Know. The list is not only factual, but fun, with lively graphics and humor, and would be an engaging way to promote influenza vaccination to patients and parents. The bottom line is: "As flu season kicks off in the U.S., you may be wondering if you should get the flu shot. The short answer is yes."



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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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Free app of The Vaccine Handbook available from the Immunization Action Coalition

A new app of The Vaccine Handbook is now available from the Immunization Action Coalition. The free app, which is available for Apple iPhones and iPads only, contains the complete 2017 (6th) edition of The Vaccine Handbook (“The Purple Book”), by Dr. Gary Marshall, professor of pediatrics and chief of the Division of Pediatric Infectious Diseases at the University of Louisville. The app is fully searchable, with functionality that includes bookmarking, highlighting, user annotation, and links to important vaccination resources.

"The Purple Book" is a comprehensive source of vaccine information, drawing together vaccine science, guidance, and practice into a user-friendly resource for the private office, public health clinic, academic medical center, classroom, and hospital. The first section provides background on vaccine immunology, development, infrastructure, policy, standards, implementation, special circumstances, and—perhaps most importantly—addressing concerns. The second section contains details about every vaccine currently licensed in the U.S., including the burden and epidemiology of the respective disease, history of the immunization program, vaccine constituents, efficacy, safety, and recommendations.

The free app may be found by searching the iTunes App Store for “The Vaccine Handbook App” or clicking on the following link:
https://itunes.apple.com/us/app/the-vaccine-handbook-app/id1043246009?ls=1&mt=8.

Print copies of the book ($34.95 each; bulk discounts are available from the publisher) can be ordered from the Immunization Action Coalition website at www.immunize.org/vaccine-handbook.

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JOURNAL ARTICLES AND NEWSLETTERS


October issue of CDC's Immunization Works newsletter now available

CDC recently released the October issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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Study finds that vaccine refusal has an impact on other routine medical care

In September, Military Medicine published an article titled The Impact of Vaccine Refusal on Physician Office Visits During the Subsequent 12 Months. The abstract is reprinted below.

We hypothesized that families who are nonadherent to the routine vaccination schedule (RVS) present less frequently for physician visits. We conducted a retrospective chart review to compare the number of visits made over the subsequent 12-month period by families that refused the RVS versus those who were adherent. Subjects were aged 0 to 4 years, enrolled to Keller Army Hospital, and had a diagnosis indicating the RVS was refused. Age-matched controls, who were adherent to the RVS, were randomly chosen for each case. Subjects made significantly more total visits than CASES: 7 (interquartile range [IQR] = 1-20) versus 6 (IQR = 2-17), p = 0.0049. When each visit type was compared independently, there was no significant difference in the number of acute (p = 0.494) or emergency department (p = 0.077) visits between groups. However, subjects who refused to follow the RVS made significantly fewer routine care visits during the 1-year follow-up period compared to those that adhered to the RVS (p < 0.001).


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CDC publishes report on progress in childhood vaccination data in immunization information systems

CDC published Progress in Childhood Vaccination Data in Immunization Information Systems—United States, 2013–2016 in the November 3 issue of MMWR (pages 1178–81). A summary made available to the press is reprinted below.

IISs [Immunization Information Systems] are computerized, population-based systems that consolidate vaccination data from providers for clinical and public health use. Data from 2013–2016 were analyzed to assess progress made in four priority areas: 1) pediatric data completeness, 2) bidirectional data exchange with electronic health records, 3) pediatric clinical decision support for immunizations, and 4) ability to generate jurisdictional and provider-level vaccination coverage estimates. Progress was noted since 2013, but continued effort is needed to implement these functionalities among all IISs. Success in these priority areas bolsters public health practitioners’ ability to attain high childhood vaccination coverage and prepares IISs to develop more advanced functionalities. Success also supports the achievement of federal immunization objectives, including using IISs as supplemental sampling frames for vaccination coverage surveys.

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CDC and WHO publish information about rotavirus surveillance and vaccine introduction in the African Region countries 

CDC published Implementation of Rotavirus Surveillance and Vaccine Introduction—World Health Organization African Region Countries, 2007–2016 in the November 3 issue of MMWR (pages 1192–6). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress with the implementation of rotavirus surveillance and vaccines in countries of the WHO African Region, 2007–2016. A media summary of the MMWR article is reprinted below.

Rotavirus is a leading cause of severe childhood diarrhea globally, estimated to have caused 120,000 deaths among children ages <5 years in sub-Saharan Africa in 2013. In 2009, the World Health Organization (WHO) recommended routine rotavirus vaccination of all children worldwide. As of December 2016, 31 of 47 (66 percent) countries in the WHO African Region had introduced rotavirus vaccination into their national schedules, with an overall coverage of 77 percent for a full vaccine series. In 12 countries with available data before and after rotavirus vaccine introduction, the proportion of childhood diarrhea hospitalizations that were rotavirus-positive declined 33 percent, from 39 percent to 26 percent. These results support introduction of rotavirus vaccine in the remaining countries in the region and continuation of rotavirus surveillance to monitor impact.

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CDC and WHO provide update on vaccine-derived polioviruses in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Update on Vaccine-Derived Polioviruses—Worldwide, January 2016–June 2017 in the November 3 issue of MMWR (pages 1185–91). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Update on vaccine-derived polioviruses worldwide, January 2016–June 2017. A media summary of the MMWR article is reprinted below.

Vaccine-derived polioviruses (VDPVs) are strains genetically divergent from the oral poliovirus vaccine (OPV) that fall into three categories: 1) circulating VDPVs (cVDPVs) from outbreaks, 2) immunodeficiency-associated VDPVs (iVDPVs) from patients with primary immunodeficiencies, and 3) ambiguous VDPVs (aVDPVs) that cannot be more definitively identified. During January 2016–June 2017, new cVDPV outbreaks were identified in the Democratic Republic of the Congo and Syria, and residual cVDPV2 circulation was detected in Nigeria and Pakistan. Fourteen newly identified persons in 10 countries were found to excrete iVDPVs. Because >94 percent of cVDPVs since 2006 and 69 percent of iVDPVs since OPV introduction are type 2, WHO coordinated worldwide replacement of trivalent OPV with bivalent OPV (types 1 and 3) in April 2016.

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EDUCATION AND TRAINING


CDC to offer two-part "Surveillance of Vaccine-Preventable Diseases (VPDs): Update 2017" course on November 28 and December 5
 
CDC is offering a two-part "Surveillance of Vaccine-Preventable Diseases (VPDs): Update 2017" course on the following dates:
  • Session I: Viral VPDs—November 28, 2:00–3:30 p.m. (ET) 
  • Session II: Bacterial VPDs—December 5, 2:00–3:30 p.m. (ET) 

These live, interactive sessions will provide updates for VPD surveillance, case investigation, and outbreak control. Both sessions will feature a question and answer segment in which participants can address questions to the presenters.  

Registration (required) is open now.

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CDC's "You Are the Key to HPV Cancer Prevention—Train the Trainer" course now available as a web-on-demand video

On October 26, CDC released You Are the Key to HPV Cancer Prevention—Train the Trainer as a web-on-demand video course. Continuing education is available until October 26, 2019. CDC's description of the course is reprinted below:

Low HPV vaccination rates are leaving another generation of boys and girls vulnerable to devastating HPV cancers. Vaccination could prevent most of these cancers. CDC is looking to you to make an effective recommendation for HPV vaccination when kids are 11 and 12 years old. Provided in this presentation is up-to-date information on HPV infection/disease, HPV vaccine, ACIP recommendations, and ways to successfully communicate with patients and their parents about HPV vaccination. Find out how to reduce missed opportunities by recommending HPV vaccine the same way and same day you recommend other routinely recommended adolescent vaccines.

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CDC updates its "You Call the Shots" module on influenza; free CE credit available

CDC recently updated the Influenza module of its web-based training course You Call the Shots. The nurse education training program has 16 modules on a variety of immunization topics (e.g., DTaP, Hepatitis A, Influenza, Vaccine Storage and Handling, Vaccines for Children). Continuing education credit is available for viewing a module and completing an evaluation. The training course is supported by CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

The Influenza module was updated in September to reflect the 2017–18 ACIP recommendations . Participants can access information about obtaining CE credit from the You Call the Shots main page.

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ASK THE EXPERTS

Question of the Week

My 36-year-old patient was diagnosed with idiopathic thrombocytopenic purpura and had a splenectomy three weeks ago. Prior to the splenectomy, the patient had one dose each of Hib, MenB, PCV13, MenACWY (Menactra), and PPSV23 (separated from the PCV13 by 9 weeks). What vaccines are recommended now? 

Since the patient is asplenic, the second dose of the primary series of MenACWY should be given 8–12 weeks after the first dose. He/she will need a dose of MenACWY every 5 years for the rest of his/her life. The patient has already received the one dose of PCV13 recommended for adults, so another dose of this vaccine is not needed. A second dose of PPSV23 is recommended at least 8 weeks after the dose of PCV13 AND at least 5 years since the last dose of PPSV23. A third (and final) dose of PPSV should be given after the patient turns age 65. The series of MenB (whether Trumenba or Bexsero) should be completed. The same MenB vaccine should be used for all doses in the series. Based on the patient’s age, the previous dose of Hib vaccine was administered when the patient was old enough to require only one dose of Hib vaccine, so another dose is not needed. The patient should receive influenza vaccine annually.

Any of these vaccines can be given simultaneously (at the same appointment, not in the same syringe) except for PCV13 and PPSV23, and PCV13 and Menactra. If Menactra is used for an asplenic person it should be separated from the PCV13 by at least 4 weeks. Menveo has no spacing restriction.


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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Pneumonia Awareness in Pidgin: This fast-paced, entertaining video by Dr. Mbee Olemabu MacNelson won the video challenge contest for World Pneumonia Day in Nigeria. Dr. Mbee chose pidgin, the most commonly understood language in Nigeria, to reach the broadest possible audience in order to raise public awareness and active participation for preventing and treating pneumonia.
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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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