Issue 1139: August 26, 2014

Ask the Experts–Question of the Week: We have a patient with a severe allergy to vancomycin who wants to…read more


CDC publishes update on the recommendations for the use of zoster vaccine

CDC published Update on Recommendations for Use of Herpes Zoster Vaccine in the August 22 issue of MMWR (pages 729–731). The first paragraph is reprinted below.

Herpes zoster vaccine (Zostavax [Merck & Co., Inc.]) was licensed in 2006 and recommended by the Advisory Committee on Immunization Practices (ACIP) in 2008 for prevention of herpes zoster (shingles) and its complications among adults aged ≥60 years. The Food and Drug Administration (FDA) approved the use of Zostavax in 2011 for adults aged 50 through 59 years based on a large study of safety and efficacy in this age group. ACIP initially considered the use of herpes zoster vaccine among adults aged 50 through 59 years in June 2011, but declined to recommend the vaccine in this age group, citing shortages of Zostavax and limited data on long-term protection afforded by herpes zoster vaccine. In October 2013, ACIP reviewed the epidemiology of herpes zoster and its complications, herpes zoster vaccine supply, short-term vaccine efficacy in adults aged 50 through 59 years, short- and long- term vaccine efficacy and effectiveness in adults aged ≥60 years, an updated cost-effectiveness analysis, and deliberations of the ACIP herpes zoster work group, all of which are summarized in this report. No vote was taken, and ACIP maintained its current recommendation that herpes zoster vaccine be routinely recommended for adults aged ≥60 years. Meeting minutes are available at

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FDA approves use of a needle-free injection system for use with Afluria and issues updated communication to healthcare professionals on use of jet injectors for inactivated influenza vaccine

On August 15, FDA approved the administration of Afluria for use with one jet injector device, the PharmaJet Stratis Needle-free Injection System (manufactured by PharmaJet Inc.) for intramuscular injection in adults 18 through 64 years of age. On the same day, the FDA issued related information for healthcare professionals titled "FDA Updated Communication on Use of Jet Injectors with Inactivated Influenza Vaccines," which includes guidance on the use of one jet injector device for the administration of the inactivated influenza vaccine, Afluria. The section "Recommendations/Actions" is reprinted below.


Afluria may be administered to adults ages 18 through 64 intramuscularly via the PharmaJet Stratis Needle-Free Injection System or by sterile needle and syringe.

Afluria, for use in children and adolescents 5 through 17 years of age, is approved for intramuscular injection with a sterile needle and syringe only.

Afluria, for use in adults 65 years of age and older, is approved for intramuscular injection with a sterile needle and syringe only.

If a vaccine is approved for administration with a jet injector, information specifically addressing vaccine use with the specific jet injector will appear in the vaccine labeling.

FDA recommends that all approved vaccines, including influenza, be administered in accordance with their approved labeling.

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New York Times features editorial by Dr. Paul Offit about HPV vaccination discussions with parents of preteens

On August 19, the New York Times published an editorial by Paul Offit, MD, director, Vaccine Education Center at the Children's Hospital of Philadelphia, titled Let’s Not Talk About Sex. In this column, Dr. Offit stresses the importance of HPV vaccination, and suggests that providers might be more comfortable promoting HPV vaccine to parents of preteens if they think of their conversation as a "cancer talk" rather than a "sex talk."

The New York Times allows a number of free views each month to non-subscribers. If you haven't exceeded this allotment, or if you are a subscriber, you can access the complete editorial here.

Related Links

From AAFP, AAP, ACOG, ACP, CDC, and IAC HPV Resources from IAC HPV Resources from CDC HPV Resources from the Vaccine Education Center
HPV resources from AAP
HPV Resources from Voices for Vaccines
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CDC reports on vaccine-associated paralytic poliomyelitis in an immigrant child

In the August 22 issue of MMWR (pages 721–724), CDC published Vaccine-Associated Paralytic Poliomyelitis and BCG-osis in an Immigrant Child with Severe Combined Immune Deficiency Syndrome—Texas, 2013. A summary made available to the press is reprinted below.

The identification of immune-deficiency-associated polio in an immigrant child underscores the need for U.S. pediatricians to understand that vaccine schedules vary in different parts of the globe. Knowing the immunization history of foreign-born children presenting with unusual illnesses helps to ensure inclusion of vaccine-related diseases in the differential diagnosis. This helps ensure that appropriate specimens are collected and appropriate diagnostic tests are ordered. By being vigilant, vaccine-associated diseases can be diagnosed early, the spread of disease can be prevented by immunization of contacts and exposed individuals in the community, and appropriate treatment can be given in a timely manner to reduce morbidity and mortality.

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IAC Spotlight! Ten 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 August 12, when IAC Express last reported on the Influenza Vaccination Honor Roll, ten healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, and medical practices
  • Cole Memorial, Coudersport, PA
  • Community Hospital Anderson, Anderson, IN
  • Group Health, Seattle, WA
  • Hancock Regional Hospital, Greenfield, IN
  • Hospital San Juan, San Juan, PR
  • Illinois Valley Community Hospital, Peru, IL
  • Kanakanak Hospital, Dillingham, AK
  • Mercy Hospital Ardmore, Ardmore, OK
  • Mott Children's Health Center, Flint, MI
  • Saint Mary's Regional Medical Center, Reno, NV
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CDC publishes information on the closure of the varicella-zoster virus-containing vaccines pregnancy registry

CDC published Closure of Varicella-Zoster Virus-Containing Vaccines Pregnancy Registry in the August 22 issue of MMWR (pages 732–733). A summary made available to the press is reprinted below.

Vaccines that contain live attenuated varicella-zoster virus, (Varivax, ProQuad, and Zostavax [Merck & Co., Inc.]) are contraindicated during pregnancy. Merck and CDC established a registry in 1995 to monitor the pregnancy outcomes of women inadvertently vaccinated with vaccines containing live attenuated varicella-zoster virus immediately before or during pregnancy. Through March 2012, no cases of congenital varicella syndrome and no increased prevalence of other birth defects have been detected among registrants. Although a small risk for congenital varicella syndrome cannot be ruled out, the number of exposures being registered each year is now too low to improve on the current estimate of the risk. Consequently, new patient enrollment was discontinued as of October 2013. Varivax, ProQuad, and Zostavax remain contraindicated during pregnancy. To report new cases of exposure during pregnancy or other adverse events, health-care providers may contact Merck at 1-877-888-4231. CDC and FDA will continue to monitor adverse events after vaccination with varicella-zoster virus-containing vaccines through the Vaccine Adverse Event Reporting System.

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Reminder: Vaccine Education Center's Current Issues in Vaccines webinar scheduled for September 10

The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia will present a free one-hour webinar, beginning at noon (ET) on September 10. Continuing education credits will be available. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit will discuss the following topics:
  • Yellow fever vaccine: Can one dose last a lifetime?
  • Influenza vaccine: Is LAIV better than IIV?
  • HPV vaccine: Are two doses as good as three?
  • HPV vaccine: New 9-valent vaccine
  • Vaccine safety: Febrile seizures
  • PCV13: What about adults?
  • Measles: Update on recent outbreak
Registration (required) is open now.

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Join the Voices for Vaccines' September 16 conference call featuring Dorit Reiss: What Can the Law Do About Immunization Rates?

Dorit Reiss, a leading expert on the intersection of the law and vaccination issues in the United States, will be the speaker on the September 16 Voices for Vaccines (VFV) conference call at noon (ET). The discussion will focus on what the law can do to increase immunization rates. Dorit Reiss is a professor of law at the University of California, Hastings, and a member of VFV's Parent Advisory Board.

To register for this call, you must email

Click here for more information about this conference call: What Can the Law Do About Immunization Rates?

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!
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IAC updates its Combination Vaccines "Ask the Experts" web section

Based on a content review by vaccine experts at CDC, IAC recently updated the Combination Vaccines web section of Ask the Experts.

IAC’s Ask the Experts web section is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. The experts are Andrew T. Kroger, MD, MPH, medical officer, and Donna L. Weaver, RN, MN, nurse educator. Both are at CDC's National Center for Immunization and Respiratory Diseases. The Q&As have been featured in previous issues of IAC ExpressNeedle Tips, and Vaccinate Adults.

Related Links Subscribe to IAC Express and receive a new Ask the Experts Q&A every week, as well as several special editions of Ask the Experts throughout the year.

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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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Important findings from two studies on HPV vaccination published online in Pediatrics on August 18

On August 18, Pediatrics (the official journal of the American Academy of Pediatrics) published two new studies on HPV vaccine with important implications for healthcare providers.

In the first study titled "Long-term Study of a Quadrivalent Human Papillomavirus Vaccine [HPV4]," researchers found that "when administered to adolescents, the HPV4 vaccine demonstrated durability in clinically effective protection and sustained antibody titers over 8 years."

The second study, titled "Missed Opportunities for HPV Vaccination in Adolescent Girls: A Qualitative Study," explores the content of provider-patient conversations that either create or prevent opportunities for HPV vaccination. The authors conclude that "missed opportunities result from assumptions about the timing of vaccination relative to sexual activity. Routinely recommending HPV vaccination as cancer prevention to be coadministered with other vaccines at age 11 years can improve vaccination rates."

Dr. Tom Frieden, director of the CDC, released a related video commentary on Medscape "Protect the Next Generation: Recommend the HPV Vaccine." Dr. Frieden notes that "the vaccine works, even better than we had hoped" while expressing concern at low vaccination rates. He urges doctors to make strong recommendations for the HPV vaccine. 

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CDC adds HPV module to its "You Call the Shots" training course

CDC recently announced that it had added a Human Papillomavirus (HPV) vaccine module in the web-based training course "You Call the Shots." Continuing education credit is available for viewing a module and completing an evaluation.

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Reminder: Clinical Vaccinology course to be held in Houston on November 7–9

The National Foundation for Infectious Diseases, the Emory Department of Medicine, Division of Infectious Diseases, and the Emory Vaccine Center are sponsoring a Clinical Vaccinology Course on November 7–9 in Houston, TX. This course focuses on new developments and issues related to the use of vaccines. Expert faculty will provide the latest information on both current and prospective vaccines, updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination. Continuing education credits are available.

Access more information about the meeting.

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Ask the Experts
Question of the Week

We have a patient with a severe allergy to vancomycin who wants to receive zoster vaccine. According to the prescribing information, an allergy to neomycin would be a contraindication to vaccination but we are not sure about allergy to vancomycin.  
Answer: Vancomycin and neomycin belong to different classes of antibiotics. An allergy to vancomycin is not a contraindication to zoster vaccine.

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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