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Issue 1106: February 25, 2014

CDC holds telebriefing about seriousness of influenza this season, especially among adults age 18–64; MMWR publishes three related reports on influenza cases and deaths, seasonal influenza activity, and influenza vaccine effectiveness

On February 20, CDC held a telebriefing to share new information about the seriousness of this influenza season. The 2013–14 influenza season has been particularly hard on younger- and middle-age adults, with people age 18–64 years representing 61% of all hospitalizations due to influenza—up from the previous three seasons when this age group represented only about 35% of all such hospitalizations.

Related Links In the February 21 issue of MMWR, CDC published the following three articles about influenza in the United States. Information from these reports, summarized below, formed the basis of the February 20 telebriefing.
  • Interim Estimates of 2013–14 Seasonal Influenza Vaccine Effectiveness—United States, February 2014 was summarized for the press as follows: CDC recommends yearly flu vaccination for children 6 months old or older and adults. Because flu viruses change from season to season, CDC conducts studies each year to determine how well the flu vaccine works against the specific flu viruses that are circulating. This mid-season report presents data on 2,319 children and adults enrolled in the U.S. Flu Vaccine Effectiveness Network from December 2, 2013 to January 23, 2014. The study found that getting flu vaccine this season reduced the risk of flu-related doctor’s visits by 61 percent for all age groups. Influenza vaccination offered substantial protection against the flu virus circulating this season, pH1N1, and the same virus that emerged in 2009 and spread in a worldwide pandemic.
  • Update: Influenza Activity—United States, September 29, 2013–February 8, 2014 was summarized for the press as follows:
    This is a reminder that influenza can cause severe illness in people of any age and that everyone aged 6 months and older should be vaccinated. When people do get the flu, antiviral treatment can reduce severe outcomes, especially when administered early. Influenza activity in the United States began increasing in mid-November and remained elevated as of February 8; elevated activity will likely continue for several more weeks. Surveillance data provide a reminder that while some age groups are at increased risk of influenza complications every year, influenza can cause severe illness in persons of any age, even in adults 18–64 years. CDC recommends that health-care providers continue to offer vaccine to all unvaccinated persons ≥6 months now and throughout the season.
  • Influenza-Associated Intensive-Care Unit Admissions and Deaths—California, September 29, 2013–January 18, 2014 was summarized for the press as follows:
    To learn more about severe cases of influenza, the California Department of Public Health has observed cases in people who either died or were admitted to ICU since the 2009 H1N1 influenza virus pandemic. Among people younger than 65 with influenza-associated death or ICU admission, 93 percent had underlying medical conditions predisposing them to severe influenza infection. People between the ages of 41 and 64 years were more likely to die from influenza or be admitted to ICU. There have been few reported fatal or ICU cases in the pediatric population. Overall, influenza vaccination in the state has been underutilized, and, in most cases, antiviral treatment was not given as soon as recommended. Early recognition of influenza illness and initiation of antiviral treatment is needed for high-risk individuals and should not be delayed for results of confirmatory testing. Vaccination is the most effective approach for preventing severe illness and death from influenza.
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"Dear Colleague" letter from CDC and professional societies urges healthcare professionals caring for pregnant women to administer influenza vaccination and treat influenza with antivirals

On February 3, CDC posted a "Dear Colleague" letter authored by Anne Schuchat, MD, director, NCIRD, CDC, as well as eleven professional societies. The letter urges healthcare professionals to protect all pregnant and postpartum women against influenza with vaccination, and also to instigate prompt antiviral treatment for pregnant women with influenza.

The complete text of the letter is reprinted below.

Dear Colleague,

We are asking for your help in protecting all pregnant and postpartum women against influenza. Influenza activity in the U.S. remains high overall and may continue for weeks. H1N1 viruses have been dominant so far. This is the H1N1 virus that caused the 2009 pandemic, which was especially hard on pregnant women. CDC has received reports of flu hospitalizations and deaths in pregnant women with influenza virus infection this season. It is important that we be vigilant in protecting pregnant and postpartum women from flu. The first and most important step for flu prevention is getting a flu vaccine; prompt antiviral treatment is our second line of defense in reducing flu complications and death.

Your recommendations make a difference to your patients. Here are some key points to consider during discussions with your patients about the importance of flu vaccination and prompt treatment for flu:

1. Pregnant women should receive seasonal influenza vaccine.
  • Influenza is more likely to cause severe illness in pregnant and postpartum women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women more prone to severe illness from influenza.
  • Risk of premature labor and delivery is increased in pregnant women with influenza.
  • Vaccination during pregnancy has been shown to protect both the mother and her baby (up to 6 months old) from influenza-related illness and hospitalizations.
2. Influenza vaccine is safe.
  • Influenza vaccines have been given to millions of pregnant women over several decades and have not been shown to cause harm to pregnant women or their babies.
  • Influenza vaccine can be given to pregnant women in any trimester.
  • Pregnant women should get a flu shot; NOT the live attenuated vaccine (nasal spray).
  • Postpartum women, even if they are breastfeeding, can receive either type of vaccine.
3. Antiviral drugs can treat flu illness and are recommended for pregnant women who get the flu.
  • When used for treatment, antiviral drugs can lessen symptoms and shorten the time your patients are sick by 1 or 2 days. They also can prevent serious flu complications, like pneumonia.
  • During the 2009 H1N1 pandemic, prompt antiviral treatment of hospitalized pregnant women was shown to prevent respiratory failure and death.
  • Studies show that flu antiviral drugs work best for treatment when they are started within 2 days of getting sick. However, starting them later can still be helpful.
Your role in ensuring your patients are protected against influenza is crucial. We hope this information will be beneficial to you to encourage and/or offer flu vaccination to your pregnant patients. More information can be found at:

The letter is signed by leaders from the following organizations:
  • American Academy of Pediatrics
  • American Academy of Family Physicians
  • American College of Nurse-Midwives
  • American College of Obstetricians and Gynecologists
  • Society for Maternal-Fetal Medicine
  • National Hispanic Medical Association
  • National Foundation for Infectious Diseases
  • American Pharmacists Association
  • Association of Women's Health, Obstetric and Neonatal Nurses
  • March of Dimes Foundation
  • National Medical Association
  • Centers for Disease Control and Prevention
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National Vaccine Advisory Committee publishes "Standards for Adult Immunization Practice"

The National Vaccine Advisory Committee’s (NVAC) Standards for Adult Immunization Practice were released on September 10, 2013, and published in the March/April 2014 issue of Public Health Reports. The following information is provided courtesy of the National Adult and Influenza Immunization Summit website.

The NVAC standards recognize the importance of the healthcare provider recommendation for patients to receive needed vaccines, the current low vaccination rates among U.S. adults, and reflect the changed environment within which adult vaccines are now given. 

ALL healthcare professionals should take the following steps to ensure that adult patients are fully immunized and have maximum protection from serious diseases.
  • ASSESS immunization status of all patients in every clinical encounter.
  • SHARE a strong recommendation for vaccines that patients need.
  • ADMINISTER needed vaccines or REFER to a provider who can immunize.
  • DOCUMENT vaccines administered or received by your patients.
These standards were approved by the National Vaccine Advisory Committee in 2013 and are supported by the Centers for Disease Control and Prevention (CDC) as well as national medical provider associations. For more information and related resources, visit CDC’s new website in support of the Standards.

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California Department of Public Health issues health advisory: 14 measles cases in state since beginning of 2014
On February 19, 2014, the California Department of Public Health (CDPH) issued a health advisory titled 14 Measles Cases in State of California in 2014. CDPH asks that healthcare professionals look for signs of measles, a highly contagious disease.
An excerpt from the advisory is reprinted below.

Fourteen cases of measles with onset in 2014 have been reported to California Department of Public Health. Among the California cases, four case-patients had traveled outside of North and South America, with three traveling to the Philippines. Nationally, an increase has been noted in the proportion of measles cases with travel to the Philippines. Measles cases from recent years have reported travel to Germany, France, England, India, and China, among other destinations.
Of the 2014 California case-patients without international travel, three had contact with known measles cases, two had contact with international travelers and five are under investigation to identify potential sources.
Of the 12 cases with known measles vaccination status, 8 were unvaccinated (7 were intentionally unvaccinated and 1 was too young to be vaccinated)....

Related Links
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U.S. Preventive Services Task Force issues draft recommendations for HBV screening of high-risk populations; comments solicited

On February 10, the U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement titled Screening for Hepatitis B Virus Infection in Nonpregnant Adolescents and Adults: U.S. Preventive Services Task Force Recommendation Statement.

This statement recommends testing everyone who is at high risk for hepatitis B infection, and rates this recommendation a "B" grade. A "B" grade is defined as follows: "The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial." This is an importance change, as the current related USPSTF recommendation is a “D” grade, which means hepatitis B screening is not recommended for anyone except pregnant women.

The new draft statement recommends hepatitis B screening for:
  • People who were born in countries where hepatitis B is common
  • People who were not vaccinated against hepatitis B when they were infants and whose parents came from countries where hepatitis B is common
  • People with HIV infection
  • Injection drug users
  • People living with or having sex with people infected with hepatitis B
  • Men who have sex with men
  • Patients who have a weakened immune system or undergo treatment for kidney failure
See the full draft recommendations for more detailed definitions of these risk categories.

USPSTF recommendations are important as they increase awareness and ensure that recommended services are covered by most private and public payers. Please take the time to send a statement of support for the proposed "B" grade, especially if you work with at-risk populations. Submit your comments to USPSTF by 5:00 p.m. (ET), March 10.

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CDC's March 12 NetConference to focus on the 2014 childhood and adult immunization recommendations and on adult immunization practice standards

CDC will present a Current Issues in Immunization NetConference on March 12 from noon to 1:00 p.m. (ET).

The featured topics and speakers:
  • "Updates on Childhood and Adolescent Immunization Schedules 2014," presented by Iyabode (Yabo) Beysolow, MD, MPH, FAAP
  • "Updates on Adult Immunization Recommendations and Standards for Adult Immunization Practice," presented by Carolyn B. Bridges, MD, FACP
Both speakers are from CDC's National Center for Immunization and Respiratory Diseases. Andrew Kroger, MD, MPH, will moderate the conference.

This is a limited registration event. Registration (required) will close on March 11 or when the course is full.

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IAC enrolls nine more birthing institutions into its Hepatitis B Birth Dose Honor Roll

The Immunization Action Coalition (IAC) is pleased to announce that nine new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.
  • Baptist Easley Hospital, Easley, SC (92%)
  • Columbus Regional Health, Columbus, IN (98%)
  • Liberty Hospital, Liberty, MO (93%)
  • Nicholas H. Noyes Memorial Hospital, Dansville, NY (95%)
  • Olney Hamilton Hospital, Olney, TX (97%)
  • Queens Hospital Center, Jamaica, NY (99%)
  • Self Regional Healthcare, Greenwood, SC (97%)
  • Spring Valley Hospital Medical Center, Las Vegas, NV (90%)
  • University Medical Center, Las Vegas, NV (91%)
The Honor Roll now includes 67 birthing institutions from 21 states.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give birth to the end of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90% or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.

Please visit the new Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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IAC Spotlight! "IAC's Most Popular Web Sections and Downloads" are easy to find on home page

The home page offers links to this month’s top 15 web sections and to the top 10 downloaded handouts and publications for patients and staff. On the left side of IAC’s newly redesigned home page, you will find this handy list of links.

Top web sections include those for Ask the Experts, Clinic ResourcesVaccine Information Statements, and Handouts for Patients & Staff. Top downloads include the Summary of Recommendations for Adult Immunization, Summary of Recommendations for Child/Teen Immunization, and Vaccinations for Adults: You're never too old to be immunized.

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IAC develops new handout for parents: "Top Ten Reasons to Protect Your Child by Vaccinating"

IAC recently developed a new handout for healthcare professionals to share with parents who may be questioning vaccination. Top Ten Reasons to Protect Your Child by Vaccinating is a user-friendly, easy-to-read handout that highlights the seriousness of vaccine-preventable diseases and the importance of vaccination.

Related Links 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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Use "Skills Checklist for Immunization" to review and promote proper standards with immunization staff

Reviewed in February, Skills Checklist for Immunization was found to be current and in need of no updates. The skills checklist is a self-assessment tool for healthcare staff who administer immunizations. Supervisors can use the checklist to clarify responsibilities and expectations for staff who administer vaccines.

The skills checklist handout was developed by the California Department of Public Health, Immunization Branch.

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WHO requests nominations for current and future vacancies for its Strategic Advisory Group of Experts (SAGE) on immunization

The World Health Organization (WHO) regularly solicits proposals for nominations for vacancies for its Strategic Advisory Group of Experts (SAGE) on immunization. SAGE is the principal advisory group to WHO for vaccines and immunization. SAGE reports directly to the Director-General and advises WHO on overall global policies and strategies.
  • Information on SAGE, including member qualification and application forms
  • SAGE website, including information about current members, description of functions, and meeting reports
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Influenza is serious; vaccination is recommended for nearly everyone, so please keep vaccinating your patients

Vaccination remains the single most effective means of preventing influenza, and is recommended for everyone age six months and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

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

Bulk quantities of laminated pocket guides for pneumococcal vaccine are available—free—from the National Adult and Influenza Immunization Summit and IAC

Although IAC has distributed all available Influenza Vaccine Pocket Guides, healthcare providers can still order bulk quantities of the Pneumococcal Vaccine Pocket Guide. This guide was developed with IAC in collaboration with the National Adult and Influenza Immunization Summit (NAIIS).

The laminated, 3.75" x 6.75", two-color card serves as a convenient reference for front-line healthcare professionals who vaccinate patients against pneumococcal disease. Place a bulk order now, and hand them out to healthcare professionals at your workplace or at conferences.

These pocket guides are designed to be used by healthcare professionals only; they are NOT patient handouts.

Related Link How to Order

Place your order today using IAC's online order form. There is no cost for the pocket guide, shipping, or handling within the U.S.

If you have questions, email

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CDC publishes report of varicella-associated death of vaccinated child with leukemia

CDC published Notes from the Field: Varicella-Associated Death of a Vaccinated Child with Leukemia—California, 2012 in the February 21 issue of MMWR (page 161). The first paragraph is reprinted below.

Varicella, a contagious viral disease, is typically self-limited but can result in serious complications, especially among persons who are immunocompromised. On April 10, 2012, a girl aged 4 years with acute lymphoblastic leukemia (ALL) was exposed to a mildly ill cousin who developed a varicella rash 2 days later. The episode was reported to the child's oncologist after 13 days. The girl was prescribed 7 days of oral acyclovir for prophylaxis and concurrently began her scheduled chemotherapy, which included a 5-day course of dexamethasone (prednisone equivalent dose of 23 mg/day). Twenty-two days after her varicella exposure, the girl was taken to an emergency department for fever and abdominal pain. She was treated symptomatically; her caretakers were instructed to discontinue chemotherapy and to follow up with her oncologist. Two days later, the girl returned to the emergency department with a generalized rash. She was hospitalized and treated with intravenous acyclovir and antibiotics. However, she developed multiorgan failure and died on May 7. Varicella was confirmed by polymerase chain reaction testing, and no alternative diagnoses were found for her acute illness.

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Registration now open for 2014 STD Prevention Conference; early bird registration ends April 15

The 2014 STD Prevention Conference, More STD Prevention for the Money: Maximizing Impact, Efficiency, and Return on Program Investments, will be held June 9–12, 2014, in Atlanta, GA. Conference registration rates and forms, as well as sponsored participant applications are now available. Early bird registration ends April 15.

Registration information

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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.

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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
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    Kayla Ohlde

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