Issue 1138: August 19, 2014

Ask the Experts–Question of the Week: Would you include obstructive sleep apnea as chronic pulmonary…read more


CDC publishes 2014–15 influenza vaccination recommendations in MMWR

CDC published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)—United States, 2014–15 Influenza Season in the August 15 issue of MMWR. The first paragraph of the report is reprinted below.

This report updates the 2013 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding use of seasonal influenza vaccines. Updated information for the 2014–15 influenza season includes 1) antigenic composition of U.S. seasonal influenza vaccines; 2) vaccine dose considerations for children aged 6 months through 8 years; and 3) a preference for the use, when immediately available, of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 years, to be implemented as feasible for the 2014–15 season but not later than the 2015–16 season. Information regarding issues related to influenza vaccination not addressed in this report is available in the 2013 ACIP seasonal influenza recommendations…

The report includes the preferential recommendation to use LAIV in healthy children 2 through 8 years of age when the nasal spray flu vaccine is immediately available and if the child has no contraindications or precautions to that vaccine. However, if the nasal spray vaccine is not immediately available, children in this age group should get the flu shot (IIV). Vaccination should not be delayed to obtain the nasal spray flu vaccine.
Note: CDC will be releasing updated influenza Vaccine Information Statements, and IAC will be releasing updated influenza-related educational materials in the upcoming weeks. IAC will announce the availability of any new and updated resources in IAC Express.

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New! CDC issues VISs for the 2014–15 influenza vaccines—stay tuned for translations

On August 19, CDC issued two new influenza vaccine Vaccine Information Statements (VISs) for use during the 2014–15 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.

Translations of the 2014–15 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 2014–15 influenza VISs will be available in the near future.

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ACIP votes to recommend a dose of pneumococcal conjugate vaccine (PCV13) in addition to pneumococcal polysaccharide vaccine (PPSV23) for all adults age 65 years and older

At its special meeting on August 13, ACIP voted to recommend a dose of PCV13 for all adults age 65 years and older; recommendations for the use of PPSV23 in adults age 65 years and older were updated as well. The main points of the new vaccine recommendations that were presented and voted upon at the August 13 ACIP meeting appear below:
  • Adults age 65 years of age and older who have not previously received pneumococcal vaccine or whose previous pneumococcal vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The PPSV23 dose should be given 6 to 12 months following the PCV13 dose. If a dose of PPSV23 cannot be given in this time window, give it at the next visit. Do not administer the PCV13 and PPSV23 at the same visit.
  • Adults age 65 and older who have not received PCV13 and who have previously received one or more doses of PPSV23 should receive a dose of PCV13. The PCV13 dose should be given one year after receipt of the most recent dose of PPSV23. For those for whom an additional dose of PPSV23 is indicated, this dose should be given 6 to 12 months after PCV13 and at least 5 years after the most recent dose of PPSV23.
Once they are reviewed and approved by the CDC’s Director and the U.S. Department of Health and Human Services, ACIP recommendations are published in the Morbidity and Mortality Weekly Report (MMWR). The MMWR publication represents the final and official CDC recommendations for immunization of the U.S. population.

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IAC corrects table in its new handout: "DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age"

In last week's edition of IAC Express, IAC announced the availability of a new resource for healthcare professionals to assist when "catching up" children, adolescents, and adults with DTaP, Tdap, and Td who have fallen behind schedule or are unvaccinated. Unfortunately, the table included incorrect information related to the vaccination of people age 7 years and older who have never received any DTaP, Td, or Tdap vaccines or whose vaccination history is unknown. If you printed the previous version, please discard it and use this version: DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age. 

Thanks to alert readers Rebecca from Washington and Karen from Indiana for pointing out this error. IAC apologizes for any inconvenience. We value the careful reviewing of materials by our readers and appreciate that you notify us when you see a problem.

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IAC Spotlight! Use IAC’s new series of educational handouts about recommended vaccines for children and adults 

IAC wants to remind you that during the past year we have expanded our selection of patient-friendly schedules, as well as our series of easy-to-read handouts for patients and parents, and added Spanish translations. Please review them to see if they might be of help to you in your work setting. They are copyright-free!

Patient-friendly Schedules

IAC's series of patient-friendly vaccination schedules has been expanded to include all age groups and to include a new suite of schedules that focuses on adults in risk groups for vaccination.

For Infants and Children

For Preteens and Teens
For Adults
Visit IAC's Patient Schedules web page to access all handouts in this series, as well as available translations.

Easy-to-read Handouts for Parents about Childhood Vaccines

Use these one-page handouts to teach parents about the dangers of vaccine-preventable diseases and the value of vaccination. Make copies for the parents of your patients! Access the entire series of Vaccine Summaries.

Easy-to-read Vaccine Handouts for Teens and Adults

IAC's series of one-page, easy-to-read handouts emphasize the dangers of vaccine-preventable diseases and the importance of vaccination. Make sure to make copies for your patients! Access the entire series of Vaccine Summaries for teens and adults.

IAC's Handouts for Patients & Staff section on 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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Idaho and California experience significant pertussis outbreaks

The Idaho Department of Health and Welfare has reported that nearly twice as many cases of pertussis have been reported in the state compared to 2013, with 241 cases reported in the first half of the year. Officials are urging everyone for whom DTaP or Tdap vaccine is recommended to get immunized.

In California, San Diego County reports 1,183 pertussis cases to date in 2014, surpassing the previous record high of 1,179 cases in 2010, while Monterey County official report 88 confirmed cases.

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IAC updates "Vaccinations for Adults…You're never too old to get immunized!"

IAC recently revised the patient-education handout Vaccinations for Adults…You're never too old to get immunized! to include recommendations for Hib vaccination of certain adults as well as edits to the Tdap information. 

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.

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IAC updates "Vaccines with Diluents: How to Use Them"

IAC has updated its educational resource for immunization providers, Vaccines with Diluents: How to Use Them. The storage requirement for yellow fever vaccine diluent was changed, and the piece received other minor edits. This handout features a table of vaccines requiring reconstitution prior to administration, including information about the diluent and about the time allowed between reconstitution and use.

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CDC offers new hepatitis B PSAs directed toward Asian Pacific Islanders

CDC has released new 30- and 60-second video public service announcements (PSAs) for Asian Pacific Islanders about the importance of testing for hepatitis B. The videos are part of the multi-lingual Know Hepatitis B campaign, conducted in partnership with Hep B United. Each PSA features English, Cantonese, Mandarin, Vietnamese, and Korean native speakers. One in 12 Asian Americans has hepatitis B, but most infected people don't know it. All foreign-born people from Asia, the Pacific Islands, Africa, and regions in the world with high rates of hepatitis B virus (HBV) infection (including immigrants, refugees, asylum seekers, and internationally adopted children) should be tested for HBV infection, even if they’ve been vaccinated.

Access these new videos as well as all the Know Hepatitis B materials.

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IAC's sturdy laminated version of the 2014 U.S. adult immunization schedule is still available for purchase—order a supply for your healthcare setting today!

Limited quantities of IAC's 2014 U.S. adult immunization schedule are still available for purchase. IAC's laminated schedules 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 adult immunization schedule has six pages (i.e., three double-sided pages) and is folded to measure 8.5" x 11".
IAC'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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Ask the Experts
Question of the Week

Would you include obstructive sleep apnea as chronic pulmonary disease which would require PPSV23 vaccination once for adults under the age of 65? 
Answer: Obstructive sleep apnea alone is not an indication for vaccination with PPSV23 for persons 2 through 64 years of age. People with obstructive sleep apnea often have other pulmonary conditions (such as chronic obstructive pulmonary disease) that would put them at increased risk for invasive pneumococcal disease, for which they should be vaccinated. A table listing risk conditions and pneumococcal vaccine recommendations can be found at

About IAC's Question of the Week

Each week, IAC Express highlights a new, topical, or important-to-reiterate Q&A. This feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, chooses a new Q&A to feature every week from a set of Q&As prepared by experts at CDC’s National Center for Immunization and Respiratory Diseases.

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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