Issue 1127: June 17, 2014

Ask the Experts–Question of the Week: Is there any harm in giving an extra dose of MMR to a child of age seven years whose record is lost … read more


California experiencing a pertussis epidemic; 800 new cases reported in the last two weeks

On June 13, the California Department of Public Health (CDPH) declared that the number of pertussis (whooping cough) cases in the state had reached epidemic proportions. More than 800 new cases have been reported in the last two weeks, according to the CDPH news release of June 13 titled California Experiencing a Whooping Cough Epidemic.

An excerpt from the news release is reprinted below.

As of June 10, there have been 3,458 cases of pertussis reported to CDPH in 2014, more than were reported in all of 2013. Over 800 new cases have been reported in the past two weeks. Pertussis is cyclical and peaks every 3–5 years. The last peak in California occurred in 2010, so it is likely another peak is underway.

“Preventing severe disease and death in infants is our highest priority,” says Dr. Chapman. “We urge all pregnant women to get vaccinated. We also urge parents to vaccinate infants as soon as possible.”

Infants too young to be fully immunized remain most vulnerable to severe and fatal cases of pertussis. Two-thirds of pertussis hospitalizations have been in children four months or younger. Two infant deaths have been reported.

The Tdap vaccination for pregnant women is the best way to protect infants who are too young to be vaccinated. All pregnant women should be vaccinated with Tdap in the third trimester of each pregnancy, regardless of previous Tdap vaccination. In addition, infants should be vaccinated as soon as possible. The first dose of pertussis vaccine can be given as early as 6 weeks of age.

Older children, pre-adolescents, and adults should also be vaccinated against pertussis according to current recommendations. It is particularly important that persons who will be around newborns also be vaccinated....

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IAC Spotlight! Seven more healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

IAC urges qualifying healthcare organizations to apply for its Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel. More than 400 organizations are now enrolled.

Since May 13, when IAC Express last reported on the Influenza Vaccination Honor Roll, seven healthcare organizations have been enrolled.

Newly added healthcare organizations, medical practices, and public health agencies
  • Avera McKennan Hospital and University Health Center, Sioux Falls, SD
  • Clinica de Salud del Valle de Salinas, Salinas, CA
  • Douglas County Memorial Hospital and Prairie Health Clinics, Armour, SD
  • IU Health Tipton Hospital, Tipton, IN
  • Jackson County Memorial Hospital, Altus, OK
  • Putnam County Department of Health, Brewster, NY
  • Wareham Pediatrics Associates, Wareham, MA
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Study shows rotavirus vaccines are reducing diarrhea-associated hospitalizations in the U.S.

On June 9, Pediatrics, the official journal of the American Academy of Pediatrics, published Rotavirus Vaccines and Health Care Utilization for Diarrhea in the United States (2007–2011) online. The study found continued reductions in diarrhea-associated healthcare utilization and cost with increasing rotavirus vaccine coverage during recent years. The "Results" and "Conclusions" sections of the abstract are reprinted below.

RESULTS: Among children aged <5 years, RV5 and RV1 rotavirus vaccine coverage rates reached 58% and 5%, respectively, by December 31, 2010. [Note: RV5 (RotaTeq, Merck) was licensed for use in the U.S. in 2006 and RV1 (Rotarix, GlaxoSmithKline) was licensed for use in the U.S. in 2008.] Compared with the average rate of rotavirus-coded hospitalizations in 2001–2006, rates were reduced by 75% in 2007–2008, 60% in 2008–2009, 94% in 2009–2010, and 80% in 2010–2011. Compared with unvaccinated children, in 2010–2011, the rate of rotavirus-coded hospitalizations was reduced by 92% among RV5 recipients and 96% among RV1 recipients. Rotavirus-coded hospitalization rate reductions among RV5 recipients versus unvaccinated children ranged from 87% among <1-year-olds to 81% among 4-year-olds. Compared with prevaccine rates in 2001–2006, rotavirus-coded hospitalization rates among unvaccinated children decreased by 50% in 2007–2008, 77% in 2009–2010, and 25% in 2010–2011.

CONCLUSIONS: Implementation of rotavirus vaccines has substantially reduced diarrhea health care utilization in U.S. children. Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; RV5 conferred durable protection through the fourth year of life. Vaccination also conferred indirect benefits to unvaccinated children.

Access the complete article.

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IAC releases new handout: "Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing"

IAC has developed a new handout titled Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing. It was adapted from Figure 6 of "CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management," (MMWR 2013; 62[RR-10], p. 13), available at This resource provides an algorithm to help providers and employers properly manage healthcare workers who did not receive post-vaccination testing after their hepatitis B vaccine series.

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IAC updates "Human Papillomavirus (HPV): Questions and Answers" and "Hepatitis A: Questions and Answers"

IAC recently updated Human Papillomavirus (HPV): Questions and Answers and Hepatitis A: Questions and Answers to include new statistics and minor changes in wording. 

These two handouts are part of a series of Q&A pieces for healthcare professionals, patients, and parents about vaccine-preventable diseases and the vaccines that prevent them.

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CDC releases updated VIS for adenovirus vaccine

On June 11, CDC issued an updated Vaccine Information Statement (VIS) for adenovirus vaccine.

The vaccine is intended for use only among military personnel. Back to top

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 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 progress toward measles elimination in the Eastern Mediterranean region

CDC published Progress Toward Measles Elimination—Eastern Mediterranean Region, 2008–2012 in the June 13 issue of MMWR (pages 511–515). A summary made available to the press is reprinted below.

Despite substantial progress and a 90 percent decrease in measles mortality in the EMR, the goal of measles elimination by 2010 was not achieved and the target date was revised to 2015. During 2008–2012, estimated first dose of measles-containing vaccine coverage in EMR was unchanged overall at 83 percent. Approximately 185 million children were vaccinated against measles during supplementary immunization activities (SIAs) and 38 (41 percent) of the 93 measles SIAs conducted had ≥95 percent national level administrative coverage. However, an increase occurred in reported measles cases from 12,196 in 2008 to 35,788 in 2012, primarily because of large measles outbreaks in high-burden countries. With resurgence of measles in some EMR countries, the Region’s target of measles elimination by 2015 is not likely to be achieved on time.

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CDC announces recommendation related to use of immunization information systems

CDC published Announcement: Recommendation Regarding Increasing Vaccination Rates Through Use of Immunization Information Systems—Community Preventive Services Task Force in the June 13 issue of MMWR (page 518). The announcement is reprinted below.

The Community Preventive Services Task Force recently posted new information on its website: "Increasing Appropriate Vaccination: Immunization Information Systems." The information is available at

Established in 1996 by the U.S. Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC.

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Ask the Experts

Question of the Week

Is there any harm in giving an extra dose of MMR to a child of age seven years whose record is lost and the mother is not sure about the last dose of MMR?
Answer: In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Receiving excessive doses of tetanus toxoid (e.g., DTP, DTaP, DT, Tdap, or Td) can increase the risk of a local adverse reaction, however. For details, consult the ACIP’s General Recommendations on Immunization at, page 8.

Vaccination providers frequently encounter people who do not have adequate documentation of vaccinations. Providers should only accept written, dated records as evidence of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should not be accepted. An attempt to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record.

If records cannot be located or will definitely not be available anywhere because of the patient's circumstances, children without adequate documentation should be considered susceptible and should receive age-appropriate vaccination. Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, hepatitis A, diphtheria, and tetanus).

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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