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Issue 1069: July 30, 2013







New: CDC issues VISs for the 2013–14 influenza vaccines—stay tuned for translations
On July 26, CDC issued two new influenza vaccine VISs for use during the 2013–14 influenza season. The VIS for inactivated influenza vaccine (IIV) is intended for use with all non-live virus formulations—trivalent, quadrivalent, cell-culture, recombinant, intradermal, and high-dose. The VIS for live attenuated intranasal influenza vaccine (LAIV) is intended for use when administering nasal-spray vaccine. A large-print version of the VIS for inactivated influenza vaccine is also available.

Translations of the 2013–14 influenza vaccine VISs will be available in several additional languages in the weeks ahead. IAC Express will announce the availability of translations as soon as they are ready.

Provider Information documents from CDC for the 2013–14 influenza VISs will be available in the near future.

Visit IAC's VIS web section for VISs in more than 35 languages

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Report summarizes HPV vaccination coverage of teen girls and HPV vaccine postlicensure safety monitoring
CDC published Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013—United States in the July 26 issue of MMWR (pages 591–595). Portions of the article's editorial note are reprinted below.

IAC Express editor's note: On July 25, CDC held a related press telebriefing on human papillomavirus (HPV) vaccination coverage and vaccine safety monitoring. The presenters were Tom Frieden, MD, MPH, director, CDC; Anne Schuchat, MD, director, NCIRD, CDC, and Thomas K. McInerny, MD, FAAP, president, AAP. Links to the transcript and audio recording of the telebriefing are given at the end of this IAC Express article.

Also on July 25, CDC issued a press release titled "HPV vaccine: Safe, effective, and grossly underutilized." Links to it and a related HPV vaccine digital press kit are given at the end of this IAC Express article, as are links to an article published in the August issue of AAP News and to related resources.

MMWR Editorial Note:
Although HPV vaccination coverage has lagged behind that of other vaccines recommended for adolescents, coverage among adolescent girls increased each year during 2007–2011; 2012 is the first year with no observed increase. In 2012, only 53.8% of girls had received ≥1 dose of HPV vaccine, and only 33.4% had received all 3 doses of the series. Despite the availability of safe and effective HPV vaccines, approximately one quarter of surveyed parents did not intend to vaccinate their daughters in the next 12 months. Missed vaccination opportunities remain high. Every health-care visit, whether for back-to-school evaluations or acute problems, should be used to assess teenagers' immunization status and provide recommended vaccines if indicated. . . .

In addition to prelicensure HPV4 clinical trials that demonstrated safety and efficacy among thousands of patients, nearly 7 years of postlicensure vaccine safety monitoring provide further evidence of the safety of HPV4. Syncope can occur among adolescents who receive vaccines, including HPV4. To decrease the risk for falls and other injuries that might follow syncope, ACIP recommends that clinicians consider observing patients for 15 minutes after vaccination.

This report highlights three areas that need to be addressed to improve HPV vaccination coverage. The first area is education of parents. Three of the five main reasons parents reported for not intending to vaccinate their daughters (i.e., vaccine not needed, lack of knowledge, and daughter not sexually active) indicate gaps in understanding, including why vaccination is recommended by age 13 years. Parents also reported vaccine safety concerns as a main reason for not vaccinating. Updated educational materials that address these issues are available from CDC at

Second, health-care providers must increase the consistency and strength of HPV vaccination recommendations. Studies have documented that, especially when counseling younger adolescents or their parents, providers give weaker recommendations for HPV vaccination compared with other vaccinations recommended for adolescents. Because provider counseling and recommendations greatly influence parental acceptance of vaccines, CDC has recently developed a tip sheet (available at to help providers respond to parents' questions and communicate strong, clear HPV vaccination recommendations.

Finally, missed vaccination opportunities need to be reduced. Although providers cite infrequent preventive health-care visits among the adolescent population as a vaccination barrier, these data demonstrate that health-care access is not the main impediment. The increase in missed opportunities observed during 2007–2012 is attributable to higher and steadily increasing coverage for other vaccines recommended for adolescents. The 2012 NIS-Teen shows that 84% of unvaccinated girls had a health-care encounter where another vaccine was administered. Had the 3-dose HPV series been initiated at these visits, coverage for ≥1 dose could be as high as 92.6%.

High HPV vaccination coverage with existing infrastructure and health-care utilization is possible in the United States. Taking advantage of every health-care encounter, including acute-care visits, to assess every adolescent's vaccination status can help minimize missed opportunities. Potential strategies include using vaccination prompts available through electronic health records or checking local and state immunization information systems to assess vaccination needs at every encounter. Series completion also can be promoted through scheduling appointments for second and third doses before patients leave providers' offices after receipt of their first HPV vaccine doses and with automated reminder-recall systems.

Related Links

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CDC announces third annual World Hepatitis Day was observed July 28; presidential proclamation issued
CDC published World Hepatitis Day—July 28, 2013 in the July 26 issue of MMWR (page 581). It is reprinted below. On July 25, "Proclamation—World Hepatitis Day, 2013" was issued; a link to it is given at the end of this IAC Express article.

Established by the World Health Assembly in 2010, the third annual World Hepatitis Day will be observed July 28, 2013. Viral hepatitis is a leading cause of infectious disease mortality globally, each year causing approximately 1.4 million deaths. Most of these deaths occur among the approximately 400 million persons living with chronic hepatitis B virus (HBV) or hepatitis C virus infection who die from cirrhosis or liver cancer years and decades after their infection. In addition to HBV, hepatitis A virus is a leading cause of vaccine-preventable death globally. Hepatitis E virus (HEV) also causes significant morbidity and mortality, particularly in Asia and Africa.

HBV and HEV infection are important yet largely neglected causes of maternal and infant morbidity and mortality in resource-constrained settings. This issue of
MMWR includes a report describing the investigation of a hepatitis E outbreak among refugees in South Sudan, where a significant proportion of affected pregnant women died from HEV infection. A second report from Laos describes missed opportunities for vaccination of newborns to protect them from mother-to-child transmission of HBV.

Prevention of both new infections and mortality from viral hepatitis are the goals of global control efforts. Additional information on viral hepatitis for health professionals and the public is available at

Related Link

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IAC Spotlight! Like IAC on Facebook and follow IAC on Twitter!
IAC invites you to connect with us on Facebook and Twitter. IAC's Facebook page is targeted to the public. The page is intended for parents and all interested Facebook users to learn about vaccines and their importance. If you have a personal or organizational Facebook page, please take a minute to Like IAC on Facebook. If you have an account on Twitter, please take a minute to Follow@ImmunizeAction on Twitter. Thanks!

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IAC updates Q&As on three diseases and vaccines: tetanus, diphtheria, and pertussis
IAC recently revised the following three patient-and-parent handouts.
  1. Tetanus: Questions and Answers
  2. Diphtheria: Questions and Answers
  3. Pertussis (Whooping Cough): Questions and Answers
The three were revised to reflect the ACIP recommendation to give Tdap vaccine to pregnant women during each pregnancy.

Related Link
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VISs for Tdap and HPV (Gardasil) vaccines now available in simplified Chinese
IAC recently posted the VISs for the Tdap vaccine and the human papillomavirus (HPV) vaccine Gardasil in simplified Chinese.

Simplified Chinese is preferred in China, Singapore, and Malaysia. Traditional Chinese is preferred in Hong Kong, Macau, and Taiwan. In the future, IAC will supply simplified Chinese files of VISs for each routinely recommended vaccine and will continue to offer VISs in traditional Chinese. IAC Express will notify readers when simplified Chinese and traditional Chinese files become available.
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If you vaccinate children and teens, be sure to download AAP's revised immunization training guide and procedure manual
Newly updated, AAP's Immunization Training Guide & Practice Procedure Manual is designed to assist pediatric office staff in all aspects of immunizing patients. Intended to be used by physicians, nurse practitioners, physician assistants, nurses, medical assistants, and office managers, the guide covers an array of topics, all of which are summarized on AAP's Immunization web page.

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Adolescent immunization resources from AAP, CDC, and others are available on AAP's website
AAP, CDC, and others have developed print materials and Web resources to help practitioners increase adolescent immunization rates and families get answers to their questions about adolescent immunization. In addition to materials developed by CDC and AAP, the adolescent resources include materials developed by Families Fighting Flu, Immunization Action Coalition, National Foundation for Infectious Diseases, PKIDS, and others.

Posted on AAP's website, the adolescent resources are organized under the following headings. 
  • For Parents and Teens
  • Key Messages to Share with Families
  • Adolescent Vaccine Recommendations (including those for Tdap, MCV4, HPV, and flu)
  • Strategies to Increase Coverage
  • Adolescent Catch-up Vaccines
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CDC's newly posted vaccine price lists include prices for 2013–14 pediatric and adult influenza vaccines
On July 24, CDC posted updated information to the CDC Vaccine Price List web page. The web page includes updates on the following four price lists: (1) pediatric/VFC vaccines, (2) adult vaccines, (3) pediatric influenza vaccines, and (4) adult influenza vaccines. The pediatric influenza vaccine price list and the adult influenza vaccine price list reflect new contracts for the 2013–14 influenza vaccines.

The CDC Vaccine Price List web page includes this important note:

The CDC Vaccine Price Lists posted on this website provide current vaccine contract prices and list the private sector vaccine prices for general information. Contract prices are those for CDC vaccine contracts that are established for the purchase of vaccines by immunization programs that receive CDC immunization grant funds (i.e., state health departments, certain large city immunization projects, and certain current and former U.S. territories). Private providers and private citizens cannot directly purchase vaccines through CDC contracts. Private sector prices are those reported by vaccine manufacturers annually to CDC. All questions regarding the private sector prices should be directed to the manufacturers.

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Order IAC's popular full-size laminated versions of the 2013 U.S. immunization schedules today!
IAC's laminated versions of the 2013 U.S. child/teen and adult immunization schedules are covered with a tough, washable coating that lets them stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Each has six pages (i.e., three double-sided pages) and is folded to measure 8.5" by 11".

IAC's Laminated Child and Teen Immunization SchedulesIAC's Laminated Adult Immunization Schedules
Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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CDC publishes report on hepatitis B birth dose practices in Laos during December 2011–February 2012
CDC published Hepatitis B Vaccine Birthdose Practices in a Country Where Hepatitis B is Endemic—Laos, December 2011–February 2012 in the July 26 issue of MMWR (pages 587–590). A press summary of the article is reprinted below.

An analysis of multiple health facilities in Laos finds low coverage for the first of three hepatitis B vaccine doses provided to newborns at birth (HepB-BD) in order to prevent mother-to-child transmission. Hepatitis B is commonly transmitted in highly endemic countries such as Laos from mother-to-child at birth and during early childhood. In 2012, the World Health Organization and the Laos Ministry of Health surveyed 37 facilities in Laos to assess gaps in HepB-BD coverage and identify possible areas for improvement. Researchers found only 74 percent HepB-BD vaccination coverage, as well as multiple challenges in implementing vaccination of newborns. Many facilities reported vaccine stock outages (49 percent) and a lack of trained staff to provide the vaccine (29 percent). Many sites relied on untrained staff members to administer the vaccine. Of the facilities surveyed, 89 percent described facility policies for vaccination that indicated a misunderstanding of when the vaccine should be used. Low rates of medical attendance of home births also led to missed opportunities for vaccination. Authors identified several opportunities to further increase vaccination coverage, including each facility designating a staff member to implement vaccination and ensure proper training is provided, as well as ensuring availability of the vaccine stock. Also key are vaccinating all infants born in health facilities and improving outreach for home births.

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CDC publishes report on a hepatitis E outbreak among refugees in South Sudan in 2012–13
CDC published Investigation of Hepatitis E Outbreak Among Refugees—Upper Nile, South Sudan, 2012–2013 in the July 26 issue of MMWR (pages 581–586). A press summary of the article is reprinted below.

Hepatitis E virus outbreaks are difficult to control in crowded populations with poor access to water and sanitation. Improving water, sanitation and hygiene conditions is essential to reduce the transmission of hepatitis E. It is also essential to determine the efficacy of a hepatitis E vaccine in outbreak settings. In mid-2012, Sudanese fearing conflict in their country fled to Upper Nile State, South Sudan. The refugees faced crowded and flooded living conditions as the rainy season arrived leading to a humanitarian emergency. From July 2012 through January 27, 2013, an outbreak of hepatitis E sickened 5,080 refugees. The outbreak strained available health resources. It required increased humanitarian assistance especially in the areas of water supply, sanitation and hygiene. Hepatitis E virus is a leading cause of acute hepatitis globally with approximately 3.4 million cases per year. A person can become infected with hepatitis E virus by drinking water or food contaminated with fecal matter. Hepatitis E outbreaks have commonly occurred in crowded settings with poor hygiene and limited access to clean drinking water. In the future, hepatitis E vaccine may play an important role in controlling outbreaks, but an evaluation is urgently needed to determine the vaccine's efficacy in outbreak settings.

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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

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