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Issue 1341
Issue 1341: December 13, 2017

Ask the Experts
Ask the Experts—Question of the Week: A 17-year-old received two doses of Twinrix, separated by one month. The second . . . read more


TOP STORIES


IAC HANDOUTS


VACCINE INFORMATION STATEMENTS


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING


CONFERENCES AND MEETINGS



TOP STORIES


Please donate to the Immunization Action Coalition!

The Immunization Action Coalition (IAC) is proud to be a trusted resource for the nation’s immunization healthcare professionals.

Our talented staff of 21 is the largest of any nonprofit immunization organization in the United States and is dedicated exclusively to providing healthcare professionals, the public, and policymakers, as well as the media, up-to-date immunization information and materials.

IAC Express subscribers are invaluable allies in educating the public about the importance of vaccination.

As 2017 draws to a close, we are asking our subscribers to make a tax-deductible donation to support IAC’s important work.

Please donate at www.immunize.org/support.

Every week throughout the year, IAC Express provides you with the critical immunization information you need in your work. Thus far in 2017, we have produced 58 issues with 820 articles that advance your immunization practice. Continuously since November 1997, we have published a total of 1,340 issues of IAC Express.

We've brought you news of updated ACIP recommendations, newly released VISs, helpful patient handouts, new staff education materials, and much more.

Throughout the year, our “Ask the Experts” feature brings answers to your questions from experts at CDC.

Our greatest satisfaction comes from believing that IAC Express plays an important role in your ability to prevent disease and save lives.

If you feel the same way, please make a donation at www.immunize.org/support.

More than 90 cents of every dollar IAC receives goes to our immunization projects.

We wish you happiness in this holiday season, and we look forward to continuing our work together in the new year.

Happy Holidays!

Deborah L. Wexler, MD, executive director, and the entire staff of the Immunization Action Coalition

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IAC's new 142-page book, Vaccinating Adults: A Step-by-Step Guide, describes how to implement adult vaccination services in your healthcare setting and provides a review for staff who already vaccinate adults; IAC Guide available for free download or purchase

IAC releases newly updated 142-page book, Vaccinating Adults: A Step-by-Step Guide—available for free downloading or purchase.

The Immunization Action Coalition (IAC) is delighted to announce the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).



This completely updated guide on adult immunization (originally published in 2004) provides easy-to-use, practical information covering important “how-to” activities to help providers enhance their existing adult immunization services or introduce them into any clinical setting, including:
  • setting up for vaccination services,
  • storing and handling vaccines,
  • deciding which people should receive which vaccines,
  • administering vaccines,
  • documenting vaccinations (including legal issues), and
  • understanding financial considerations and billing information. 

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

Two options are available to obtain a copy of the updated Guide:

  • Purchase a copy
    A limited number of printed editions of this 142-page book are available for purchase at www.immunize.org/shop. The Guide’s lie-flat binding and 10 tabbed sections make it easy to locate the information being sought. Purchased copies are delivered in a box that includes Immunization Techniques: Best Practices with Infants, Children, and Adults, a 25-minute training DVD developed by the California Department of Public Health. Also included are several selected IAC print materials, such as the "Skills Checklist for Vaccine Administration," an assessment tool to assist in evaluating the skill level of staff who administer vaccines.
  • Download for free and print it yourself
    The entire Guide is available to download/print free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. Options are available online to download the entire book or selected chapters.

The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.

The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!

Related Links

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CDC publishes “Update: Influenza ActivityUnited States, October 1–November 25, 2017” in this week’s MMWR

CDC published Update: Influenza Activity—United States, October 1–November 25, 2017 in the December 8 issue of MMWR (pages 1318–1326). A media summary is reprinted below.

Since influenza activity is just beginning to increase, receiving influenza vaccine at this time should still offer substantial public health benefit. Health care providers should recommend influenza vaccine now and throughout the influenza season to all unvaccinated people 6 months and older who do not have contraindications. Prescription antiviral medications can treat influenza illness and are recommended for use in patients who are very sick with influenza or who are sick and at high risk of serious influenza complications. Influenza antiviral drugs can lessen duration and severity of illness and help prevent more severe illness. Influenza activity in the United States remained low during October 2017 but has been increasing since early November with influenza A (H3N2) viruses being most frequently identified. Almost all influenza viruses collected so far are similar to the cell-derived reference viruses representing 2017–18 season influenza vaccines. Annual vaccination varies in its effectiveness but it is the best available method for preventing influenza and its complications. Since the 2017­–18 influenza season is just beginning, receiving an influenza vaccine now should still offer substantial public health benefit. Anyone who has not yet been vaccinated should get vaccinated as soon as possible. 

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CDC publishes three online reports in FluVaxView on U.S. flu vaccination coverage in 2017 for three groups in U.S.

CDC published three reports in its FluVaxView web section on vaccination coverage for three groups in the United States: the general population, healthcare professionals, and pregnant women.

1. General population: National Early Season Flu Vaccination Coverage, United States, November 2017

Key findings:

  • Only approximately two of every five children and adults in the United States had received an influenza (flu) vaccination by early November 2017:
  • 38.6% of all persons 6 months and older
  • 38.8% of children 6 months through 17 years
  • 38.5% of adults 18 years and older
  • Early 2017–18 flu season vaccination coverage was similar to coverage at the same time last flu season for children, adults, and all persons 6 months and older.
  • Among children, flu vaccination coverage was similar across all racial/ethnic groups with one exception—non-Hispanic children of other or multiple races had higher flu vaccination coverage than non-Hispanic black children.
  • Among adults, flu vaccination coverage among adults 18-49 years decreased by 3.7 percentage points compared with the same time last season.
  • Flu vaccination coverage among Hispanic adults decreased by 7.7 percentage points compared with the same time last season.
  • Among adults, non-Hispanic persons of other or multiple races had higher flu vaccination coverage this early season than non-Hispanic whites, non-Hispanic blacks, and Hispanics.
  • Among both adults and children, the most common places reported for receiving flu vaccination were medical locations (children: 86.5%, adults: 49.2%). Retail settings (28.2%) and workplaces (17.0%) were other important venues for adults.

View the complete report.

2. Healthcare professionals: Health Care Personnel and Flu Vaccination, Internet Panel Survey, United States, November 2017

Conclusions/Recommendation:

  • Vaccination continues to be low among assistants, aides, nonclinical support staff, and HCP working in LTC settings.
  • Providing free, on-site, and actively promoted influenza vaccination in the workplace can lead to improved coverage. Efforts to improve HCP coverage are most needed in LTC settings, where residents are at high risk of severe complications from flu.
  • The highest vaccination coverage was reported among HCP with an employer requirement for vaccination

View the complete report.

3. Pregnant women: Pregnant Woman and Flu Vaccination, Internet Panel Survey, United States, November 2017

Conclusions/Recommendation:

  • Almost two thirds of pregnant women have not been vaccinated against flu as of early November 2017.
  • Health care providers are encouraged to continue to strongly recommend and offer flu shots to pregnant women throughout the flu season to protect mothers and their infants.
  • Almost two thirds of pregnant women have not been vaccinated against flu as of early November 2017.
  • Health care providers are encouraged to continue to strongly recommend and offer flu shots to pregnant women throughout the flu season to protect mothers and their infants

View the complete report.

Related Links

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Having some difficulty getting your adolescent patients vaccinated? Here are some useful tools

As healthcare providers, we place great emphasis on immunizing children age 0–5 years, and during influenza season, we often prioritize vaccinating older adults. But what about adolescents?

Data published by CDC from its 2016 National Immunization Survey-Teen (NIS-Teen) helps shed some light on how our teens are doing. On the positive side, during 2015–2016, adolescents in the U.S. had coverage rates above 85% for >1 Tdap (88.0%), >2 varicella (85.6%), >2 MMR (90.9), and >3 hepatitis B (91.4).

Unfortunately, the picture is discouraging for other important ACIP-recommended vaccines. In the survey, less than one-half (43.4%) of adolescents received 3 doses of HPV vaccine. And only 39.1% of teens who were age 16 or 17 at the time of the interview had received the recommended second dose of meningococcal conjugate vaccine (known as MenACWY or MCV4). This important booster is recommended at age 16 to boost waning immunity. In addition, a relatively new vaccine against meningococcal serogroup B disease is recommended at age 16, but MenB vaccine coverage data is not yet available through NIS-Teen.

Where can providers go for tools to help increase coverage for these important vaccines? Check out MCV4: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection. This website was developed by the Immunization Action Coalition, in collaboration with Sanofi Pasteur. The title features MCV4, but this page is filled with free tools to help providers increase rates for ALL recommended adolescent vaccines, not just MCV4. Items found on the site include the Top 10 Ways to Improve Adolescent Immunization Rates, an educational handout for 16-year-olds, slide sets, Q&As, and other useful tools.

The Give2MCV4.org website is a great place to download and use helpful materials for improving adolescent immunizations!

Related Links

General Tools for Increasing Adolescent Immunization Rates in Your Setting

Tools for Increasing MCV4 (MenACWY) Dose #2 Coverage

General Information

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BuzzFeed reports on 20-year-old Arizona mother of two who dies one day after receiving flu diagnosis

BuzzFeed reported that a 20-year-old mother of two young children from Arizona died on November 28, one day after receiving a flu diagnosis from an urgent care center. Alani Murrieta died from pneumonia caused by the flu. After experiencing difficulty breathing, she went to the hospital, where she received IV antibiotics. While being moved to the ICU, her heart stopped beating. Doctors were able to resuscitate her, but her heart stopped again while she was in the ICU, and her doctors were not able to resuscitate her a second time. She was not known to have any pre-existing health conditions.

Read the complete BuzzFeed article: A 20-year-old Arizona woman died from the flu one day after being diagnosed (12/4/17)

Related Link

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Voices for Vaccines releases new podcast, "Get Your Flu Shot," to answer your questions about the flu

Voices for Vaccines (VFV) has released a new podcast in its Vax Talk podcast series: Get Your Flu Shot. In this podcast, William Schaffner, MD, professor of infectious diseases at Vanderbilt University and medical director at the National Foundation for Infectious Diseases, and Serese Marotta, Chief Operating Officer of Families Fighting Flu and a mother of a five-year-old who died of H1N1 influenza, will discuss questions related to this year's flu season.

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who values vaccines to become a member. Please spread the word to your friends and colleagues to join VFV!

Related Links

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IAC HANDOUTS


IAC updates its healthcare professional information sheet titled "Vaccines with Diluents: How to Use Them"

IAC recently updated Vaccines with Diluents: How to Use Them. Changes were made to incorporate an option for storing the diluent for yellow fever vaccine at room temperature, to incorporate the newly-licensed recombinant zoster vaccine (RZV; Shingrix) in the table, and to change the abbreviation for the live zoster vaccine (Zostavax) from HZV to LZV.

Related Links

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

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IAC updates "Notification of Vaccination Letter Template" for use when vaccinating someone else's patients

IAC recently revised Notification of Vaccination Letter Template. Changes were made to remove vaccines no longer in use (e.g., Hib-HepB [Comvax], Hib-Mency [MenHibrix], HPV2 [Cervarix], HPV4 [Gardasil], MPSV4 [Menomune], to add the recently-licensed recombinant zoster vaccine (RZV; Shingrix), and to change the abbreviation for the live zoster vaccine (Zostavax) from HZV to LZV.

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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VACCINE INFORMATION STATEMENTS


IAC posts new and updated Turkish translations of VISs

IAC recently posted new Turkish translations of the VISs for the following vaccines:

IAC also posted updated Turkish translations of the VISs for the following vaccines:

IAC thanks Betül Polatdemir, MD, Lokman Hekim Hospital Group, Ankara and Sibel Bostancıoğlu, MD, Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey, for the translations.

Related Links

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WORLD NEWS


Diphtheria spreading fast among Rohingya refugees in Cox’s Bazar, Bangladesh; WHO working with partners to contain outbreak

Diphtheria has spread among Rohingya refugees living in cramped settlements in Cox’s Bazar, Bangladesh, with over 110 suspected cases of diphtheria and six deaths. According to WHO, over 600,000 Rohingya refugees have fled violence in Myanmar since late August 2017, and the numbers continue to rise. UNICEF’s Bangladesh Chief of Health estimates that vaccination rates among arriving children are as low as 3%. WHO, the Bangladesh Ministry of Health and Family Welfare, and UNICEF are among the partners trying to contain the current spread of diphtheria. Previous campaigns that vaccinated over 700,000 refugees against cholera and over 350,000 children against measles-rubella have now turned to a focus on diphtheria and other diseases.

Related Links

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WHO, UNICEF, and other partners combat diphtheria outbreak in Yemen with vaccinations and medicines following war-related closure of air and sea ports 

Responding to a diphtheria outbreak in war-torn Yemen, WHO, UNICEF, and other partners have been delivering vaccines and medicines there, now that a three-week closure of air and sea ports has ended. WHO reported sending 1,000 vials of anti-toxins and 17 tons of medical supplies to fight the disease. When the ports opened, WHO and its partners began their effort to vaccinate 300,000 infants; this month, they aim to vaccinate another 3 million children and young adults. By November 27, WHO reported that the outbreak had risen to 189 cases and 20 deaths due to diphtheria within three months.

Read the full WHO news release from November 27.

Related Link

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FEATURED RESOURCES


CDC slide presentation, “10 Ways to Create a Culture of Immunization within Our Pediatric Practice,” now available online for free downloading

CDC has made a new slide presentation, "10 Ways to Create a Culture of Immunization within Our Pediatric Practice," available for free downloading at the bottom of its Provider Resources for Vaccine Conversations with Parents web page. This 23-slide presentation, intended for use by healthcare professionals during staff meetings or lunch-and-learn presentations, suggests concrete ways that your practice can create a culture of immunization during all steps of a well-child visit, from check-in to check-out.

The slide deck can be customized with your own slide template, logo, and practice-specific information, and it is embedded with directions for doing so along with explanatory notes for your presentation.

Visit CDC's Provider Resources for Vaccine Conversations with Parents web page and scroll to the bottom of the page to download the slide deck.

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JOURNAL ARTICLES AND NEWSLETTERS


November issue of CDC's Immunization Works newsletter now available

CDC recently released the November 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 and a variety of resources about current topics. The information is in the public domain and can be reproduced and circulated widely.

Related Links

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Pediatrics publishes 10-year study confirming HPV vaccine effective and safe for participants, ages 9–15

In its December issue, Pediatrics published a 10-year study confirming HPV vaccine is effective and safe for young people 9–15 years old. The conclusions of the study, 4-Valent Human Papillomavirus (4vHPV) Vaccine in Preadolescents and Adolescents After 10 Years, by D.G. Ferris, et. al, are reprinted below.

CONCLUSIONS: A 3-dose regimen of the 4vHPV vaccine was immunogenic, clinically effective, and generally well tolerated in preadolescents and adolescents during 10 years of follow-up. These long-term findings support efforts to vaccinate this population against HPV before exposure.


View the abstract on the American Academy of Pediatricians publications website.

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Study from Emory University finds that vaccine hesitancy among parents associated with beliefs about liberty and purity rather than fact

A study titled Association of moral values with vaccine hesitancy, by A.B. Amin, et. al, was published in the "Letters" section of Nature Human Behaviour on December 4. The beginning of the lead paragraph is reprinted below.

Clusters of unvaccinated children are particularly susceptible to outbreaks of vaccine-preventable disease. Existing messaging interventions demonstrate short-term success, but some may backfire and worsen vaccine hesitancy. Values-based messages appeal to core morality, which influences the attitudes individuals then have on topics like vaccination. We must understand how underlying morals, not just attitudes, differ by hesitancy type to develop interventions that work with individual values. Here, we show in two correlational studies that harm and fairness foundations are not significantly associated with vaccine hesitancy, but purity and liberty foundations are. . . .

Read the full article: Association of moral values with vaccine hesitancy (PDF).

Related Link

Shot of Prevention blog: Vaccine hesitancy often tied to moral foundations of liberty and purity (12/5/17)

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EDUCATION AND TRAINING



NFID and mdBriefCase Group Inc. offering on-demand CME activity: "Seasonal Influenza Immunization in the U.S.: Strategies for Protecting Older Adults"

The National Foundation for Infectious Diseases (NFID) and mdBriefCase Group Inc. are offering a free, online CME training titled "Seasonal Influenza Immunization in the U.S.: Strategies for Protecting Older Adults." This training can be accessed on demand until February 18, 2018.

Upon completion of this activity, participants will be able to:

  • Describe the benefit of influenza vaccination in adults age 65 years and older
  • List the vaccine options available for seasonal influenza vaccination of adults age 65 years and older
  • Differentiate vaccine products approved for seasonal influenza in adults age 65 years and older
  • Effectively counsel older adult patients about the importance of seasonal influenza vaccination

View the information page for more details about this activity. You can log on to the training at the bottom of the information page.

Related Link

NFID's Online Education web page

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NFID inviting abstracts by January 4 for presentations at 2018 Annual Conference on Vaccinology Research, April 23–25 in Bethesda; applications open for 2018 Maurice R. Hilleman Early-Stage Career Investigator Award

The National Foundation for Infectious Diseases (NFID) is inviting abstracts for its 2018 Annual Conference on Vaccinology Research (ACVR), which will be held April 23–25 in Bethesda, Maryland. The deadline for submitting an abstract is January 4, 2018. Access additional information on the 2018 Annual Conference on Vaccinology Research (ACVR) Call for Abstracts web page.

Access the ACVR abstract submission site.

NFID also invites researchers in the early stages of their career, in any field of vaccinology, to apply for the 2018 Maurice R. Hilleman Early-Stage Career Investigator Award to support future research activities with a $10,000 grant. View the submission guidelines by scrolling towards the bottom of the 2018 Annual Conference on Vaccinology Research (ACVR) Call for Abstracts web page.

Related Links

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ASK THE EXPERTS

Question of the Week

A 17-year-old received two doses of Twinrix, separated by one month. The second dose was six months ago and she is now 18 years old. Can she receive the third dose of Twinrix to complete the series?

Yes. This was a vaccine administration error since Twinrix, a combination hepatitis A/hepatitis B vaccine, is not licensed for people younger than 18. However, the hepatitis A and hepatitis B components can be counted as valid doses. The third dose of the Twinrix series should be given at least five months after the second dose.


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

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Video of the Week
You've Gotta Do It Now: Cape Cod Healthcare in Massachusetts and TeamMaureen sponsored this video urging all 1112-year-olds to get HPV vaccine. Preteens tell their stories as if they were adults affected by HPV disease because they or their loved one had not been not vaccinated. To protect yourself as an adult, get the HPV vaccine when you are 11 or 12.
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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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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.