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Issue 1126: June 10, 2014

Ask the Experts–Question of the Week: For the purpose of vaccine spacing, what constitutes a month: 28 days (4 weeks), 30 days… read more

Remembering Dr. Ciro de Quadros, global public health immunization giant 

Ciro de Quadros, MD, MPH, executive vice president and director of advocacy and education at the Sabin Vaccine Institute, died on May 28. Dr. de Quadros worked to help eradicate smallpox in the 1970s and led efforts in the Americas to eliminate polio and measles.

In April 2013, Dr. de Quadros wrote an article titled Harnessing the Power of Vaccines to End Polio for The Huffington Post in which he said: “Medicine, sanitation, nutrition, education—all are necessary and interrelated components of preventing and curing sickness. But there is one tool that stands out as the most effective: vaccines. Every child—no matter where he or she is born—has a fundamental right to vaccines.”

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IAC Spotlight! IAC's "State Information" web section: We've added a new table and map covering exemptions to school and childcare immunization requirements

IAC's State Information web section is the "go-to" spot for up-to-date information about state immunization mandates. IAC tracks vaccination mandates for vaccine-preventable diseases in child-care facilities, schools, colleges, and long-term care facilities. The immunization mandate data are compiled for the 50 states and presented in table and/or map formats.

In June 2014, IAC made an important addition to the State Laws web section: new data in table and map format titled Exemptions Permitted to School and Childcare Immunization Requirements.

If you note any updates from your state that should be made to IAC's web section on "State Mandates on Immunization," please notify Diane Peterson at We appreciate receiving the very latest information from IAC Express readers.

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CDC publishes report on measles in the U.S.; same article previously published as an MMWR Early Release in late May

CDC published Measles—United States, January 1–May 23, 2014 in the June 6 issue of MMWR (pages 496–499). This report was previously published as an MMWR Early Release on May 29, and was covered in a special edition of IAC Express on May 30.

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Review measles assessment, diagnosis, and patient management guidelines in light of the measles outbreaks in the U.S.

On May 29, CDC published an MMWR Early Release titled Measles—United States, January 1–May 23, 2014 that provided details on the 288 confirmed measles cases reported to CDC between January 1 and May 23. As of May 30, there have been a total of 334 cases reported in the U.S. from 16 separate outbreaks. CDC urges healthcare professionals to consider measles when evaluating patients with febrile rash and ask about a patient's recent travel history and contact with individuals who have recently traveled abroad.

If you are a clinician who would appreciate a review of measles disease and treatment, visit CDC's Measles (Rubeola) for Healthcare Professionals web page. This page includes the following sections:
  • Clinical Features
  • The Virus
  • Background
  • Complications
  • People at High Risk for Complications
  • Transmission
  • Diagnosis and Laboratory Testing
  • Evidence of Immunity
  • Vaccination
  • Post-exposure Prophylaxis
  • Isolation
  • Treatment
  • Photos
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CDC publishes report on the 2013–14 influenza season and composition of the 2014–15 influenza vaccines

CDC published Influenza Activity—United States, 2013–14 Season and Composition of the 2014–15 Influenza Vaccines in the June 6 issue of MMWR (pages 483–490). The first paragraph and the "Composition of the 2014–15 Influenza Vaccine" paragraph are reprinted below.

During the 2013–14 influenza season in the United States, influenza activity increased through November and December before peaking in late December. Influenza A (H1N1)pdm09 (pH1N1) viruses predominated overall, but influenza B viruses and, to a lesser extent, influenza A (H3N2) viruses also were reported in the United States. This influenza season was the first since the 2009 pH1N1 pandemic in which pH1N1 viruses predominated and was characterized overall by lower levels of outpatient illness and mortality than influenza A (H3N2)–predominant seasons, but higher rates of hospitalization among adults aged 50–64 years compared with recent years. This report summarizes influenza activity in the United States for the 2013–14 influenza season (September 29, 2013–May 17, 2014) and reports recommendations for the components of the 2014–15 Northern Hemisphere influenza vaccines.

The Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee has determined that the 2014–15 influenza vaccines used in the United States have the same antigenic composition as those used in 2013–14. The trivalent vaccines should contain an A/California/7/2009-like (2009 H1N1) virus, an A/Texas/50/2012-like (H3N2) virus, and a B/Massachusetts/2/2012-like (B/Yamagata lineage) virus. The committee also recommended that quadrivalent vaccines contain a B/Brisbane/60/2008-like (B/Victoria lineage) virus. These recommendations were based on global influenza virus surveillance data related to epidemiology, antigenic and genetic characteristics, serologic responses to 2013–14 seasonal vaccines, and the availability of candidate vaccine viruses and reagents.

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Save the date! National Immunization Conference scheduled for September 29–30 in Atlanta

CDC, the Task Force for Global Health, and the CDC Foundation will host the National Immunization Conference—"U.S. Immunization in a Time of Change"—September 29–30, in Atlanta, Georgia. This two-day conference will include four plenary sessions, 18 breakout sessions, two immunization Q&A sessions, and the Hilleman Lecture, and will highlight the following major topics:
  • Immunization communications with partners and the general public
  • Issues related to the immunization of adults
  • Current status of vaccine-preventable diseases in the United States
  • Global immunization
  • HPV vaccine communication, science, and safety
  • Advances in information technology
  • Improving vaccine management and accountability
  • Quality improvement in vaccine programs
conference registration link and additional information will be posted here when it becomes available.  Please note that this conference will be much smaller in scale than previous National Immunization Conferences, with attendance limited to approximately 800 people.

For more information about the National Immunization Conference, please contact the conference planning team at (404) 639-8225 or via email at

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IAC updates nine translations of "Screening Checklist for Contraindications to Vaccines for Children and Teens"

In May, IAC updated its Screening Checklist for Contraindications to Vaccines for Children and Teens. Changes were made to the second page only, the reference page for healthcare professionals that explains why certain questions on the screening checklist are asked. Updates on page 2 include facts related to new influenza vaccine products such as the recombinant influenza vaccine, and changing the terminology from trivalent influenza vaccine (TIV) to inactivated influenza vaccine (IIV). This week, IAC posted updated Spanish, Arabic, Chinese, French, HmongKorean, Russian, Turkish, and Vietnamese translations of this screening checklist. Only the second page (in English) was changed. The screening checklists themselves (page 1) are unchanged except for the date.

Access all IAC's screening checklists and questionnaires.

IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 300 handouts, including translations, which we encourage website users to print out, copy, and distribute widely.

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Michigan's Alliance for Immunization website is redesigned to offer you easier access to its free immunization resources

The Alliance for Immunization in Michigan (AIM) coalition has announced the launch of its new and improved AIM Toolkit website. While the website address ( remains the same, the look and feel of the new site is completely different. The home page is separated into two sections, information for healthcare personnel and for individuals and families. In the "Information for Health Care Professionals" section, you will find sections on clinical information, education and training, storage and handling, patient education, and news. In the "Information for Individuals and Families" section, you will find information by age (infants and children, adolescents, adults), common topics, vaccine schedules, social media, and frequently asked questions.

The AIM Toolkit has been developed specifically for healthcare professionals and citizens in Michigan; however, there are many resources that immunization providers everywhere will find of interest.

Access the revised AIM coalition website.

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Voices for Vaccines creates new flyer to encourage vaccine advocates to join together

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 recently created a new flyer with a scannable QR code that can be posted anywhere people gather. The flyer states, "Unite with us to advocate for on-time vaccination. There are many ways to join the cause—and it’s free to join VFV. Sign up today to help protect yourself, your children, and your community."

Healthcare providers and public health officials are encouraged to display the flyer in offices and clinics; parents can help promote VFV by posting the flyer in day care facilities, schools, stores, and other meeting places.  VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to join VFV!

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IAC's sturdy laminated versions of the 2014 U.S. child/teen immunization schedule and the 2014 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2014 U.S. child/teen immunization schedule and the 2014 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given.

The child and adolescent schedule has eight pages (i.e., four double-sided pages) and is folded to measure 8.5" x 11". The adult immunization schedule has six pages (i.e., three double-sided pages) and is folded to measure 8.5" x 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

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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May issue of CDC's Immunization Works newsletter now available

CDC recently released the May issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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ACOG in partnership with AAP to offer immunization business strategies webinar on July 30

The American College of Obstetricians and Gynecologists (ACOG) will be offering a free webinar from noon–1:00 p.m. (ET) on July 30 titled Immunization Business & Clinical Strategies for Ob-Gyn Practices. The webinar is sponsored by ACOG’s Immunization Program in collaboration with the American Academy of Pediatrics.

Topics covered will include:
  • Strategies for coding/billing procedures, product ordering, and global fee negotiations
  • High-priority vaccines, relevance to the patient population, and guidelines for administration
  • Role of an immunization champion, including responsibilities for managing the office immunization program
  • Benefits of being connected to states' immunization registries and where to access additional information regarding specific state registries
To register you must create an account on the ACOG webinar platform, however, there are no restrictions on who can register.

Access more details on the webinar, including registration information.

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Ask the Experts

Question of the Week

For the purpose of vaccine spacing, what constitutes a month: 28 days (4 weeks), 30 days, or 31 days? 
Answer: For intervals of 3 months or less, you should use 28 days (4 weeks) as a “month." For intervals of 4 months or longer, you should consider a month a “calendar month”: the interval from one calendar date to the next a month later. This is a convention that was introduced on the childhood schedule in 2002 and discussed in the paper “Evaluation of Invalid Vaccine Doses” (Stokley S, Maurice E, Smith PJ, et al. American Journal of Preventive Medicine, 2004: 26[1]: 34–40). 

About IAC's Question of the Week

This week's issue of IAC Express includes a new feature called "Question of the Week." Each week, IAC Express will highlight a new, topical, or important-to-reiterate Q&A. This new feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, will select a new Q&A every week based on common or especially intriguing questions that come to CDC.
We hope you enjoy this new feature and find it helpful when dealing with difficult real-life scenarios in your vaccination practice. Please encourage your healthcare professional colleagues to sign up to receive IAC Express at

If you have a question for the CDC immunization experts, you can email them directly at There is no charge for this service.

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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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