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Issue 1447
Issue 1447: September 18, 2019


TOP STORIES

IAC HANDOUTS


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING

 


TOP STORIES


CDC reports increases in cases of hepatitis A, B, and C during 2017 were mainly due to unsafe drug injections and lack of vaccine protection

On September 10, CDC published a comprehensive report titled Surveillance for Viral Hepatitis—United States, 2017 detailing increases in the number of cases of hepatitis A, B, and C during 2017. CDC attributed the increase in cases mainly to unsafe drug injections and low vaccination coverage among populations for whom vaccination is recommended. Vaccines continue to be the best way to prevent both hepatitis A and hepatitis B infections. Access the full report below.

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California governor signs bill toughening medical vaccine exemptions

On September 9, California Governor Gavin Newsom signed a bill limiting medical exemptions for vaccines for children attending school. He also signed a bill that would allow a child with a medical exemption before the new law goes into effect to continue to be enrolled until the child enters the next grade span (i.e., birth to preschool, kindergarten, grades 1–6, and grades 7–12). These laws will go into effect on January 1, 2020.

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Hawaii adds Tdap, HPV, and MenACWY to list of immunizations required by July 2020

On August 27, the Hawaii Department of Health issued a press release announcing new school immunization requirements that would begin July 1, 2020. The additional vaccinations include Tdap, HPV, and MenACWY for all incoming seventh-grade students.

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IAC updates Ask the Experts: Influenza Q&A web page 

IAC and CDC recently reviewed and revised the Ask the Experts: Influenza web page. Updates included changes in the 2019–20 influenza vaccine strains and changes in vaccines available for young children and the dosing for vaccination of children age 6–35 months old.  

IAC’s Ask the Experts web section is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. Answers are provided by Andrew T. Kroger, MD, MPH; Mark S. Freedman, DVM, MPH, DACVPM; Tina S. Objio, MSN, MHA, RN; Candice L. Robinson, MD, MPH; Raymond A. Strikas, MD, MPH, FACP, FIDSA; and JoEllen Wolicki, BSN, RN, all from the National Center for Immunization and Respiratory Diseases, CDC.

Some of the most frequently visited sections of Ask the Experts Q&As include the following:

Each year, IAC Express publishes five special editions of Ask the Experts Q&As answered by CDC experts. You can access the four most recent IAC Express Ask the Experts sets of Q&As from the main web page of Ask the Experts, in the right-hand column.

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CDC publishes "Notes from the Field: Interventions to Reduce Measles Virus Exposures in Outpatient Health Care Facilities—New York City, 2018" in this week's MMWR

CDC published Notes from the Field: Interventions to Reduce Measles Virus Exposures in Outpatient Health Care Facilities—New York City, 2018 in the September 13 issue of MMWR (pages 791–792). A summary for the press is reprinted below.

New York City has experienced the largest measles outbreak in the United States since 1992. The NYC Department of Health and Mental Hygiene (DOHMH) surveyed outpatient health care facilities that reported one or more suspected measles cases during September 30–December 10, 2018 to understand infection control procedures in outpatient facilities and to share best practices. The essential common element in the implemented strategies was early awareness that a patient might have measles, optimally before they enter the health care facility. This highlights the importance of performing measles screening and rapidly identifying patients with suspected measles.

  • MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements

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August's Technically Speaking column by IAC Executive Director Dr. Deborah Wexler is titled “Newly designed and easy to navigate—visit Give2MenACWY.org to enhance your efforts to increase rates for MenACWY booster doses and other adolescent vaccinations”

Technically Speaking is a monthly column written by IAC Executive Director Dr. Deborah Wexler for Vaccine Update, a monthly e-newsletter from the Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP). The column covers practical topics in immunization, such as vaccine administration, immunization scheduling, vaccine storage and handling, and vaccine recommendations.

August's column is titled Newly designed and easy to navigate—visit Give2MenACWY.org to enhance your efforts to increase rates for MenACWY booster doses and other adolescent vaccinations and is reprinted below.

Newly designed and easy to navigate—visit Give2MenACWY.org to enhance your efforts to increase rates for MenACWY booster doses and other adolescent vaccinations

Published August 2019

The Immunization Action Coalition (IAC) has announced a major upgrade to its collaborative website www.Give2MenACWY.org promoting the importance of receiving a booster dose of meningococcal ACWY (MenACWY) vaccine.

Aimed at healthcare professionals, the site has been revised to incorporate newly updated materials and to highlight the importance of all recommended vaccines for 16-year-olds. A simplified navigation structure makes locating information a breeze.

The colorful new Give2MenACWY.org website is divided into five easy-to-access sections:
  • Vaccinate Teens – The tools included on this web page offer helpful information on teen vaccination schedules and tips for improving adolescent immunization rates.
  • Give 2 Doses – Fewer than half of teens have received the recommended second dose of MenACWY vaccine. This web page offers tools to help providers improve second dose coverage.
  • 16-year-old Visit – These resources help both providers and their patients remember the important vaccines recommended for 16-year-olds.
  • Tools for Providers – These tools from CDC, IAC, and other organizations explain meningococcal ACWY vaccine recommendations and assist in improving adolescent coverage for all recommended vaccines.
  • Resources – This section contains a wealth of information to assist provider efforts to improve adolescent immunization rates. The materials are subdivided into the following subsections:
     

Additional time savings are provided by the site’s single location where all website materials are listed according to whether they are primarily of interest to providers or to patients/parents. Other sections relate to general adolescent immunization, as well as meningococcal disease and vaccine information.

Visit Give2MenACWY.org and enjoy browsing (and hopefully deploying) its terrific resources. The site is brought to you by IAC, in collaboration with Sanofi Pasteur.

Related Links

You can access the current and past issues of Technically Speaking in the following ways: from a box in the middle of the immunize.org home page, from the "Guide to immunize.org" at the bottom of every web page, or by going directly to the www.immunize.org/technically-speaking main page.

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IAC Spotlight! IAC’s "Package Inserts & FDA Product Approvals" web page on immunize.org is a popular destination for finding FDA-approved language for all vaccines

Immunization providers around the country have given IAC feedback that the Package Inserts & FDA Product Approvals web page on immunize.org is one of the most valuable resources for busy clinics that administer vaccines. This IAC web page provides direct links to the package inserts for each vaccine.

Check this page out and see how easy it is to access the current information for any vaccine! The direct link is www.immunize.org/fda.

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No new measles cases reported to CDC in week ending September 12; total cases for 2019 remain at 1,241 across 31 states

CDC has posted its latest update on 2019 measles cases in the U.S. on its Measles Cases and Outbreaks web page, showing that no new cases have been reported since last week. The web page shows a preliminary estimate of 1,241 cases across 31 states as of September 12. This year's total is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated from the U.S. in 2000.

Access additional information about U.S. measles cases in 2019 on CDC's Measles Cases and Outbreaks web page.

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IAC HANDOUTS


IAC updates its educational resource "Influenza Vaccine Products for the 2019–2020 Influenza Season"

IAC recently updated its educational resource Influenza Vaccine Products for the 2019–2020 Influenza Season. Changes were made to incorporate CVX codes, the 0.25 mL Afluria Quadrivalent option for children 6–35 months old, and the option for dosing of Fluzone Quadrivalent at either 0.25 mL or 0.5 mL for children 6–35 months of age.

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IAC revises “Standing Orders for Administering Influenza Vaccine to Children and Teens” and “Standing Orders for Administering Influenza Vaccine to Adults”

IAC recently revised the following two standing orders templates related to influenza vaccination:

1. Standing Orders for Administering Influenza Vaccine to Children and Teens: Changes were made to add a 0.5 mL dose of Fluzone and also a 0.25 mL dose of Afluria to the influenza vaccine options for children age 6–35 months, to address a third category of young children that may need a second dose of influenza vaccine, to add baloxavir as another influenza antiviral medication that would be a contraindication for LAIV, and to update links to several references.

2. Standing Orders for Administering Influenza Vaccine to Adults: Changes were made to add baloxavir as another influenza antiviral that would be a contraindication for LAIV and to update links to several references.

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IAC updates "How to Administer Intramuscular and Intranasal Influenza Vaccines"

IAC recently updated its educational resource How to Administer Intramuscular and Intranasal Influenza Vaccines. Changes included using the terms "dominant" and "non-dominant" hand instead of "right" and "left" hand in the directions. 



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IAC revises "Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months through 8 Years"

IAC revised its Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months through 8 Years by addressing a third category of young children who may need a second dose, i.e., children who turned 9 years old during the current season and already received one influenza vaccine dose during the current season when they were 8 years old. The guide advises healthcare providers: “Administer a second dose to a 9-year-old child who received their first dose in the current season when they were age 8 years, if they haven’t or don’t know if they have received 2 doses in prior years.”

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IAC updates "Influenza Vaccination of People with a History of Egg Allergy"

IAC has updated Influenza Vaccination of People with a History of Egg Allergy. Changes included a clarifying statement regarding trace amounts of egg protein in its first bulleted statement: "Most influenza vaccines, with the exception of RIV4 and ccIIV4, are cultured in eggs and might contain trace amounts of egg protein (e.g., ovalbumin)." 

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IAC updates “Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination” and “Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination”

IAC recently updated its two screening checklists for contraindications for influenza vaccination: Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination and Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination.

1. Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination: Changes were made to reference the new season (i.e., 2019–2020), and to update links to references. 

2. Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination: Changes were made to remove anemia or another blood disorder and to add "cochlear implant, spinal fluid leak, or no spleen" to question #5 and its response, to indicate a lower age for children on aspirin or salicylate-containing medicine, to add baloxavir as another influenza antiviral that would be a contraindication for LAIV, and to update links to references.

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Available now! Seven translations of IAC's recently updated “Screening Checklist for Contraindications to Vaccines for Children and Teens” and “Screening Checklist for Contraindications to Vaccines for Adults” 

IAC posted new Arabic, Chinese-Traditional, French, Korean, Russian, Spanish, and Vietnamese translations of its recently updated Screening Checklist for Contraindications to Vaccines for Children and Teens and Screening Checklist for Contraindications to Vaccines for Adults. Access the new translated versions below.

Screening Checklist for Contraindications to Vaccines for Children and Teens

Screening Checklist for Contraindications to Vaccines for Adults

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IAC posts Spanish translation of its handout "Hepatitis B Shots Are Recommended for All New Babies"

IAC has posted the Spanish translation for the handout titled Hepatitis B Shots are Recommended for All New Babies. 

Access the Spanish-language version: Se recomienda vacunar a todo recién nacido contra la hepatitis B. La vacuna contra la hepatitis B le ayuda a proteger el futuro de su bebé.

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WORLD NEWS


WHO and European Commission join forces to promote the benefit of vaccines

The World Health Organization (WHO) and the European Commission issued a joint press release on September 12 to publicize their combined efforts to fight the spread of vaccine-preventable diseases through intensified global action. They have been co-hosting the world's first Global Vaccination Summit, based in Brussels. A statement by Jean-Claude Juncker, President of the European Commission, excerpted from the press release, is reprinted below.

“It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands but it is not being put to full use. Vaccination already prevents 2–3 million deaths a year and could prevent a further 1.5 million if global vaccination coverage improved. Today's summit is an opportunity to address this gap. The Commission will continue to work with the EU's Member States in their national efforts and with our partners here today. This is a global challenge we must tackle together, and now.”

Read the complete press release: Vaccination: European Commission and World Health Organization Join Forces to Promote the Benefits of Vaccines (9/12/19)

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FEATURED RESOURCES

IAC’s new FLU VACCINE buttons and stickers flew out the door! But don't worry. We ordered more. Stock up for flu season!

Everyone wants to display flu shot support—don’t be left out! Jump-start your preparations for the 2019–20 influenza season by ordering IAC's new “FLU VACCINE” buttons and stickers from SHOP IAC. These popular new resources are modeled after “I Voted” stickers, which are given to voters in many states as they leave the polls on Election Day. The flu vaccine buttons and stickers are bright red to help broadcast your important vaccination message. And the cost is low!



“FLU VACCINE” BUTTONS

Demonstrate your clinic-wide support for protecting everyone from influenza by purchasing buttons for all of your staff to wear. Measuring 1.25" across, the button is understated in size but carries a bold message! Brightly colored red, round button with white text and a metal pin that clasps on the back.

Pin on your lab coat, uniform, other clothing, tote bag, or backpack to show support for influenza vaccination. Wear it when flu vaccine is available in your clinic to remind patients and the public to protect themselves from influenza.
 
Buttons are delivered in bags of 10 buttons per bag. Click here for pricing and ordering information.

“FLU VACCINE” STICKERS
 
These brightly colored red, round stickers measure 1.5" across. Printed on Avery labels, they adhere well to clothing and have an easy-peel-off back.
 
Wearing these brightly colored stickers, your patients will be letting their communities know that influenza vaccination is important.

Suitable for clinic staff, too! Urge all staff to wear them at work during flu vaccination season. This sends a powerful reminder to patients to get vaccinated.
 
Stickers are delivered to you cut individually (not on rolls)—available in bundles of 100. Click here for pricing and ordering information.

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Hepatitis B Foundation releases new #justB video titled "DeWayne's Story" to empower people affected by hepatitis B, raise awareness, and end stigma

The Hepatitis B Foundation continues its storytelling campaign: #justB: Real People Sharing their Stories of Hepatitis B.

Watch the August video, DeWayne's Story, about a man who became infected with hepatitis B as a child from a blood transfusion following an accident. At that time, the blood supply wasn't tested for hepatitis B. He first became symptomatic at age 7 and eventually became acutely ill. At that point, he got insurance through his disability and agreed to medical care. DeWayne began to feel better and now says he's looking forward to seeing his son graduate from high school. 

Watch this and other compelling videos by going to the Hepatitis B Foundation's web section: #justB: Real People Sharing their Stories of Hepatitis B

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The new edition of The Vaccine Handbook: A Practical Guide for Clinicians app is now available free of charge from the Pediatric Infectious Diseases Society

The Pediatric Infectious Diseases Society (PIDS) is pleased to make available a new edition of The Vaccine Handbook app. This mobile app for iOS devices contains the 2018 (7th) edition of The Vaccine Handbook: A Practical Guide for Clinicians (also known as The Purple Book), by Dr. Gary S. Marshall, professor of pediatrics at the University of Louisville School of Medicine. This authoritative, practical tool is available free of charge from the Apple iTunes App Store (purchase of the print edition is not required). 

Please help PIDS spread the word to members of your organization, partner organizations, vaccine providers, trainees, and others.

The Vaccine Handbook is a readable, comprehensive source of up-to-date information for vaccine providers and educators. It 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 app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to useful content on the Internet. It includes:

  • Scientific foundations of vaccinology
  • Information on every vaccine licensed in the United States
  • The rationale behind authoritative vaccine recommendations
  • Contingencies encountered in everyday practice
  • An entire chapter on addressing vaccine concerns
  • Background on vaccine infrastructure and policy-making
  • Standards and regulations
  • Office logistics, billing procedures, and much more

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

Additional information about The Purple Book is available through the publisher, Professional Communications, Inc. (West Islip, NY) at https://pcibooks.com/books/view/49.    

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IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide is available for free download either by chapter or in its entirety (142 pages)

In late 2017, the Immunization Action Coalition (IAC) announced the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).



This completely updated "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting. Topics include:

  • 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.

The Guide is available to download/print either by chapter or in its entirety free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.

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

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JOURNAL ARTICLES AND NEWSLETTERS


September's Parents PACK newsletter from Vaccine Education Center features article clarifying the position of Pontifical Academy for Life on fetal cells and two other important stories

Parents PACK (Possessing, Accessing, and Communicating Knowledge about vaccines) from the Vaccine Education Center at Children's Hospital of Philadelphia offers an electronic newsletter for parents. The September issue features an article clarifying the position of the Pontifical Academy for Life concerning fetal cells in vaccines and the importance of vaccines. The issue also includes an article discussing the safety and effectiveness of HPV vaccine in preventing cancer and another on Pinterest now providing vaccine information only from specific, credible public health organizations. Healthcare providers should check out the issue and encourage parents to subscribe to the free Parents PACK newsletter.

To find more information about their resources and subscribe to their newsletter, visit the Parents PACK web page.

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EDUCATION AND TRAINING


AAP and CDC are collaborating to present a free webinar titled "2019–2020 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers" to be aired September 26
 
The American Academy of Pediatrics (AAP) and CDC are collaborating to present a free Clinical Outreach and Communication Activity (COCA) webinar titled 2019–2020 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers on September 26 from 2:00–3:00 p.m. (ET). The presenters will be Flor Munoz, MD, MSc, FAAP, member of Baylor College of Medicine, AAP Committee on Infectious Diseases; and Fatimah Dawood, MD, medical officer, Epidemiology and Prevention Branch, CDC National Center for Immunization and Respiratory Diseases, Influenza Division.

During this COCA call, the presenters will discuss strategies pediatric providers can use to improve influenza prevention and control in children for the 2019–2020 influenza season. The presenters also will:
  • examine data from the 2018–2019 U.S. influenza season to inform preparations for the 2019–2020 influenza season,
  • highlight key recommendations in the AAP influenza policy statement, “Recommendations for Prevention and Control of Influenza in Children, 2019–2020” and in the CDC Advisory Committee on Immunization Practices’ document, “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2019–2020 Influenza Season,” and
  • discuss recommendations for using influenza antivirals in children.
Access more information about this webinar, including how to register: 2019–2020 Recommendations for Influenza Prevention and Treatment in Children: An Update for Pediatric Providers. Free continuing education credits are available.

Related Link

CDC’s Current Issues in Immunization webinar titled “Influenza Update–2019–2020” is scheduled for October 2

CDC will present a Current Issues in Immunization NetConference on October 2 at 12:00 p.m. (ET). The topic will be "Influenza Update—2019–2020," and the speaker will be Lisa Grohskopf, MD, MPH, medical officer, Influenza Division, NCIRD, CDC.

Immunization NetConferences are live, 1-hour presentations combining an online visual presentation with simultaneous audio via telephone conference call, plus a live question and answer session. On-demand replays and presentations will be available shortly after each event.

Registration is required and limited. Should you miss the live event, you can watch the archived version when it is posted later on CDC’s website.

Related Link


Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics will conclude on September 25; “Influenza” is the topic on September 25

On September 25, CDC's will conclude its 15-part, live CE-accredited series of 1-hour webinars designed to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). The webinar series has provided an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.  

All sessions begin at 12:00 p.m. (ET). The final webinar of this series will be:
  • September 25: Influenza
A recording of the session will be available online within 2 weeks after the webinar.

Information on registration and program details are available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at www.cdc.gov/vaccines/pubs/pinkbook/index.html. You can also order this resource from the Public Health Foundation for $40 plus shipping and handling.
 
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
Pioneering the Use of Fetal Cells to Make Rubella Vaccine: Dr. Stanley Ploktin describes how witnessing devastating birth defects, miscarriages, and pregnancy terminations due to rubella in the 1960s led him to develop a vaccine to against it. He explains why he believed using fetal cells was the best choice at that time. Because of the vaccine, rubella was eliminated from the U.S. in 2005. (Source: Vaccine Makers Project)
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Editorial Information
Editor:
Deborah L. Wexler, MD
Managing Editor:
Teresa Anderson, DDS, MPH

Consulting Editors:
Marian Deegan, JD
Courtnay Londo, MA
Jane Myers, MA, 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
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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.