REQUEST FORM
Seasonal Influenza and PPSV Vaccination Pocket Guides
 
Dear Colleague,
In order to facilitate vaccination against seasonal influenza, the National Influenza Vaccine Summit is once again producing a laminated seasonal influenza vaccination pocket guide to assist healthcare professionals in vaccinating patients against seasonal influenza. This is the seventh consecutive year that the Summit has produced and distributed such a pocket guide.
Secondly, the CDC's Advisory Committee on Immunization Practices (ACIP) continues to recommend vaccination against pneumococcal infections with either pneumococcal polysaccharide vaccine (PPSV) or, for children younger than 5 years, pneumococcal conjugate vaccine (PCV). Indications for each of these vaccines have not changed due to the current circulation of the pandemic influenza virus; however, the risk of acquiring bacterial community-acquired pneumonia following influenza infection has been reported to be greater during pandemics. Healthcare providers should be alerted to this increased need to administer PPSV to all unvaccinated persons ages 65 years and older as well as younger persons with risk conditions. The National Influenza Vaccine Summit is pleased to be able to print and distribute quantities of a laminated PPSV pocket guide to aid in this effort. PPSV pocket guides will be shipped at the same time as the seasonal influenza pocket guides.
The purpose of each of these pocket guides is to provide front-line healthcare personnel with information on:
indications and contraindications for the vaccines

information on targeted populations to be vaccinated

details on how to administer the vaccines
talking points for patients
The pocket guides are NOT intended to be distributed to patients. They are for the use of healthcare professionals only. We will not accept orders for less than 100 copies of either of the pocket guides as we have neither staff nor the funding to fill such orders.
Each of these pocket guides are available at no cost to your agency or organization. We encourage you to distribute the pocket guides to your members or constituents along with your encouragement to use the pocket guides to avoid missed opportunities.
 
Diane C. Peterson
Associate Director for Immunization Projects
Immunization Action Coalition
On behalf of the National Influenza Vaccine Summit
Information About  the 2009-2010 Pocket Guides
Seasonal Influenza Pocket Guides
The seasonal influenza pocket guides are laminated for durability, printed in easy-to-spot orange and black, and sized to fit in a shirt or lab coat pocket (3-3/4" x 6-3/4").
View the seasonal influenza pocket guide
PPSV Pocket Guides
The PPSV pocket guides are laminated for durability, printed in easy-to-spot lime green and black, and sized to fit in a shirt or lab coat pocket (3-3/4" x 6-3/4").
View the PPSV pocket guide
Request Form
If you would like to order a bulk number of free pocket guides, please fill out the online form below.
We encourage you to fill out this form as soon as possible as quantities are limited. Pocket guides are projected to be shipped in August and September via USPS and are available for distribution only within the U.S. and U.S. territories.
Items in red are required. You will be sent an email message containing a copy of the information you enter.

  Seasonal Influenza Pocket Guides
 
  Quantity of seasonal influenza pocket guides:
(minimum 100)
 

If requesting seasonal influenza pocket guides,
please write a sentence or two about how you
will use them. We MUST have this information:

   
PPSV Pocket Guides
 
  Quantity of PPSV pocket guides:
(minimum 100)
 

If requesting PPSV pocket guides, please write
a sentence or two about how you will use them.
We MUST have this information:

   
Contact Information
  First Name:
  Last Name:
  Job Title:
  Email Address:
  Confirm Email Address:
  Organization:

  Address1:

  Address2:
  City:

  State:
  Zip:

  Phone:
     
  Shipping contact information (if different from above)
  Name:
  Email Address:
  Organization:
  Address1:

  Address2:
  City:

  State:
  Zip:

  Phone:
   


 
 
 
 
Internal use only