Issue 1041: February 26, 2013







New! February 2013 issue of Vaccinate Adults now online
The February 2013 issue of Vaccinate Adults is now online.
Download the February issue of Vaccinate Adults

Note: Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed.

This issue of Vaccinate Adults gives healthcare professionals up-to-date information on Tdap vaccination during pregnancy and CDC's new guidelines for vaccine storage and handling. It also includes a newly updated version of the popular Summary of Recommendations for Adult Immunization. As always, the issue features the "Ask the Experts" column from CDC medical epidemiologist Andrew T. Kroger, MD, MPH; nurse educator Donna L. Weaver, RN, MN; and medical officer Iyabode Akinsanya-Beysolow, MD, MPH. And last but not least, Litjen (L.J) Tan, MS, PhD, joins the staff of IAC as chief strategy officer.

Back to top

Reminder: February 2013 issue of Needle Tips available online
The February 2013 issue of Needle Tips is now online.
Download the February issue of Needle Tips

Back to top

CDC publishes updated recommendations for use of Tdap in pregnant women
CDC published Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012 in the February 22 issue of MMWR (pages 131-135). The section titled "ACIP Recommendations for Pregnant Women" is reprinted below.

ACIP Recommendations for Pregnant Women

ACIP recommends that providers of prenatal care implement a Tdap immunization program for all pregnant women. Health-care personnel should administer a dose of Tdap during each pregnancy, irrespective of the patient's prior history of receiving Tdap.

Guidance for Use
To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks' gestation although Tdap may be given at any time during pregnancy. For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, Tdap should be administered immediately postpartum.

Special Situations
Pregnant women due for tetanus booster. If a tetanus and diphtheria booster vaccination is indicated during pregnancy (i.e., >10 years since previous Td), then Tdap should be administered. Optimal timing is between 27 and 36 weeks' gestation to maximize the maternal antibody response and passive antibody transfer to the infant.

Wound management for pregnant women. As part of standard wound management to prevent tetanus, a tetanus toxoid–containing vaccine might be recommended for wound management in a pregnant woman if ≥5 years have elapsed since the previous Td booster. If a Td booster is recommended for a pregnant woman, health-care providers should administer Tdap.

Pregnant women with unknown or incomplete tetanus vaccination. To ensure protection against maternal and neonatal tetanus, pregnant women who never have been vaccinated against tetanus should receive three vaccinations containing tetanus and reduced diphtheria toxoids. The recommended schedule is 0, 4 weeks, and 6 through 12 months. Tdap should replace 1 dose of Td, preferably between 27 and 36 weeks' gestation to maximize the maternal antibody response and passive antibody transfer to the infant.

ACIP recommends that adolescents and adults (e.g., parents, siblings, grandparents, child-care providers, and health-care personnel) who have or anticipate having close contact with an infant aged <12 months should receive a single dose of Tdap to protect against pertussis if they have not received Tdap previously. Guidance will be forthcoming on revaccination of persons who anticipate close contact with an infant, including postpartum women who previously have received Tdap.

Back to top

New! offers information on vaccine-preventable diseases, including those associated with international travel
The recent relaunch of www.vaccineinformation.orgVaccine Information You Need website – features a section devoted to vaccine-preventable diseases. The Vaccine-Preventable Diseases web section provides accurate information on 21 vaccine-preventable diseases, including those associated with international travel. On the Diseases main page, you will also find links to lesson plans about vaccines for teachers and related resources for students. The individual disease pages include a bulleted summary of the disease and information about the vaccine, as well as links to relevant video clips, resources, personal stories, trusted websites, and other resources, such as those from CDC and state health departments.

We hope you'll take the time to explore

If you have a website, we'd appreciate your creating a link on it to

Back to top

Correction: IAC corrects error in an "Ask the Experts" answer in the February 2013 issue of Needle Tips
The answer to the following "Ask the Experts" question was incorrect in the February 2013 issue of Needle Tips.

A 7-year-old who needed a tetanus shot for wound management came into our emergency department. My question is, if a child has received the complete 5-dose series of DTaP but has never had Tdap, should the child receive Tdap or Td for wound management?

The correct answer is as follows:

Neither. A child who has completed 5 doses of DTaP has by definition received the fifth dose on or after his/her fourth birthday. In this child’s case, it has been less than four years since receipt of the complete series, so the child does not need either Tdap or Td. The child is fully vaccinated against tetanus according to CDC tetanus wound management guidelines.

To access the corrected version, see the bottom of the left column of page 20 of the "Ask the Experts" section in the online version of the February 2012 issue Needle Tips (see the Related Links section below).

IAC extends thanks to the readers who spotted the error and notified us. We regret any inconvenience the error has caused Needle Tips readers.

Related Links

Back to top

IAC Spotlight! Eleven more healthcare organizations join IAC's Honor Roll for Patient Safety
IAC urges qualifying healthcare organizations to apply for its Honor Roll for Patient Safety. The honor roll recognizes hospitals, medical practices, professional organizations, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel. More than 250 organizations are now enrolled.

Since January 15, when IAC Express last reported on the Honor Roll for Patient Safety, the following 11 organizations have been enrolled.

Newly added healthcare organizations and public health agencies
Healthcare organizations and health agencies: Boulder County Public Health, Boulder, CO; Valley Health Care, Rome, GA; Access Community Health Network, Chicago, IL; CarolinaEast Health System, New Bern, NC; FirstHealth of the Carolinas, Pinehurst, NC; Wilson Medical Center, Wilson, NC; The Christ Hospital Health Network, Cincinnati, OH; Cherokee Nation W. W. Hastings Hospital, Tahlequah, OK; Communities at Indian Haven, Indiana, PA; North Penn Visiting Nurse Association, Lansdale, PA; and Texas Health Presbyterian Hospital Flower Mound, Flower Mound, TX.

Related Links
  • Listing of all honorees by state
  • Position statements from professional societies and leading healthcare organizations in support of mandatory influenza vaccination
  • Honor roll web section, which includes access to the application form (see the gold trophy cup in right column, and click on the words "Apply for the Honor Roll")
Back to top


IAC updates patient Q&A handouts on polio and Hib
IAC recently revised its Polio: Questions and Answers and Haemophilus influenzae type b (Hib): Questions & Answers handouts for patients and parents. Both pieces received minor updates.

Related Link
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.

Back to top


Join Voices for Vaccines! Add your name to the membership list of this newly launched pro-vaccine organization!
Voices for Vaccines (VFV) is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV has strong, direct support from scientists, healthcare professionals, and public health officials in its mission to provide parents, caregivers, and others opportunities to advocate for on-time immunization.

Launched initially in 2008, VFV is being revitalized by Karen Ernst and Ashley Shelby, two young Twin Cities parents who have volunteered to lead the organization. In 2010, Shelby and Ernst founded the blog Moms Who Vax, which offers vaccine information, resources, commentary, and first-person stories from parents who immunize.

Voices for Vaccines invites everyone who appreciates vaccines to join them. Please spread the word to your friends and colleagues.
Back to top

Influenza continues to spread and is serious; vaccination is recommended for nearly everyone, so please keep vaccinating your patients
Vaccination remains the single most effective means of preventing influenza. Vaccination is recommended for everyone age 6 months and older, so please continue to vaccinate your patients. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

If you are seeking influenza vaccine for your clinic, check the Influenza Vaccine Availability Tracking System (IVATS), which is a resource for healthcare settings looking to purchase influenza vaccine. The IVATS chart contains information from approved, enrolled, and participating wholesale vaccine distributors or manufacturers of U.S. licensed influenza vaccine. Information is updated on an ongoing basis.

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


CDC publishes interim adjusted estimates of influenza vaccine effectiveness
CDC published Interim Adjusted Estimates of Seasonal Influenza Vaccine Effectiveness — United States, February 2013 in the February 22 issue of MMWR (pages 119-123). A summary made available to the press is reprinted below.

This report provides updated and adjusted influenza vaccine effectiveness (VE) estimates of 56 percent (95 percent confidence interval = 47 percent-63 percent) for this season. VE was consistent across age groups, except among people 65 and older, where little or no benefit against H3 could be confirmed in this study. The 2012-2013 influenza vaccine provided substantial protection against influenza for most people who got vaccinated, underscoring the public health value of vaccination. However, the findings also indicate that some vaccinated persons will get influenza and better vaccines, especially for seniors, are needed. Clinicians and the public should remember that influenza antiviral medications are a second line of defense against flu and should be used as recommended for treatment of high risk patients regardless of their vaccination status.

Back to top

CDC publishes update on U.S. influenza activity
CDC published Update: Influenza Activity — United States, September 30, 2012–February 9, 2013 in the February 22 issue of MMWR (pages 124-130). The first paragraph of the Editorial Note is reprinted below.

The 2012–13 influenza season began early, and influenza activity remained elevated across the United States as of February 9, 2013; during the most recent weeks, decreases have been observed in the South and East, while increases have continued in the West. Although the timing of influenza activity is not predictable, substantial activity can occur as late as May. During September 30, 2012–February 9, 2013, influenza A (H3N2) viruses were identified most frequently, followed by influenza B viruses, but a small number of pH1N1 viruses also were reported. Antigenic characterization of influenza-positive respiratory specimens submitted to CDC indicated that the majority of these specimens were like the 2012–13 influenza vaccine components. As of February 9, 2013, more than half of influenza-associated hospitalizations were reported to have occurred in adults aged ≥65 years, and rates of influenza-associated hospitalization among adults aged ≥65 years increased sharply from late December through January. The weekly percentage of deaths attributed to P&I [pneumonia and influenza] was above the epidemic threshold beginning early in January, with the majority of the P&I deaths occurring in adults aged ≥65 years.

Back to top


Idaho Immunization Program to sponsor Shot Smarts in three locations in May
The Idaho Immunization Program will sponsor a conference titled Shot Smarts in three locations around the state in May. Healthcare professionals from other states are welcome to attend.

Dates and locations
  • May 21, Idaho Falls
  • May 22, Boise
  • May 24, Coeur d' Alene
For more information on the agenda, speakers, and registration, go to the conference web page or email Andy Noble.

Back to top

About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

IZ Express Disclaimer
ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

This page was updated on .