Issue 1140: September 2, 2014

Ask the Experts–Question of the Week: My office recently changed HPV vaccine brands from Gardasil to Cervarix. We have…read more

ACIP publishes compendium of recommendations for the use of human papillomavirus (HPV) vaccines

CDC published Human Papillomavirus Vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP) in an August 29 MMWR Recommendations and Reports. The "Summary" section is reprinted below.

This report summarizes the epidemiology of human papillomavirus (HPV) and associated diseases, describes the licensed HPV vaccines, provides updated data from clinical trials and postlicensure safety studies, and compiles recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of HPV vaccines.

Persistent infection with oncogenic HPV types can cause cervical cancer in women as well as other anogenital and oropharyngeal cancers in women and men. HPV also causes genital warts. Two HPV vaccines are licensed in the United States. Both are composed of type-specific HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein using recombinant DNA technology produces noninfectious virus-like particles (VLPs). Quadrivalent HPV vaccine (HPV4) contains four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18. Bivalent HPV vaccine (HPV2) contains two HPV type-specific VLPs prepared from the L1 proteins of HPV 16 and 18. Both vaccines are administered in a 3-dose series.

ACIP recommends routine vaccination with HPV4 or HPV2 for females aged 11 or 12 years and with HPV4 for males aged 11 or 12 years. Vaccination also is recommended for females aged 13 through 26 years and for males aged 13 through 21 years who were not vaccinated previously. Males aged 22 through 26 years may be vaccinated. ACIP recommends vaccination of men who have sex with men and immunocompromised persons (including those with HIV infection) through age 26 years if not previously vaccinated.

As a compendium of all current recommendations for use of HPV vaccines, information in this report is intended for use by clinicians, vaccination providers, public health officials, and immunization program personnel as a resource. ACIP recommendations are reviewed periodically and are revised as indicated when new information and data become available.

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CDC publishes report on 2013 national, state, and local vaccination coverage among children age 19–35 months

CDC published National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months—United States, 2013 in the August 29 issue of MMWR (pages 741–748). A summary made available to the press is reprinted below.

The vast majority of parents are making sure that their children get vaccinated against potentially serious diseases, according to data from CDC’s 2013 National Immunization Survey (NIS) published in this week’s Morbidity and Mortality Weekly Report (MMWR). The NIS monitors vaccination coverage among children aged 19–35 months in the United States. Vaccination coverage increased or remained stable for all routinely recommended childhood vaccines in 2013. However, coverage varies by state, and low coverage levels can leave states and communities vulnerable to outbreaks of potentially serious vaccine-preventable diseases. Even states with high vaccine coverage levels may have groups of people who are unvaccinated, leaving communities vulnerable to disease outbreaks.

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IAC Spotlight! Access IAC's collection of PowerPoint presentations from IAC, CDC, and other trusted sources

Looking for slides for an upcoming presentation on immunization? Look no further. The PowerPoint Presentations section on includes many immunization-related slide sets from IAC, CDC, AAP, Autism Science Foundation, California Immunization Coalition, and WHO. Browse IAC’s collection of presentation slides for ideas and content for your next educational offering on improving immunization practices. They are posted in PDF format, and four of IAC's slide sets are available in PowerPoint format upon request.

IAC recently added a new slide set titled Common Immunization Myths and Misconceptions: Talking Points and Resources for Busy Healthcare Professionals.

To obtain any of IAC's four slide sets in PowerPoint format, simply request them from IAC by sending an email to

IAC’s Presentations section on immunization and vaccine-preventable diseases is part of IAC’s online Directory of Immunization Resources.

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CDC releases statement regarding its 2004 Pediatrics study on MMR vaccination and autism

On August 25, CDC released a statement titled CDC Statement Regarding 2004 Pediatrics Article, "Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-matched Control Subjects: A Population-Based Study in Metropolitan Atlanta," in response to a 2014 article that was described as a reanalysis of CDC data from the 2004 study. The article, which was published in the August issue of the journal Translational Neurodegeneration, was subsequently removed on August 27 by the journal's publishers.

Translational Neurodegeneration released this statement regarding the action: “This article has been removed from the public domain because of serious concerns about the validity of its conclusions. The Journal and publisher believe that its continued availability may not be in the public interest. Definitive editorial action will be pending further investigation.”

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IAC enrolls seven more birthing institutions into its Hepatitis B Birth Dose Honor Roll; seven previously honored institutions qualify for a second year

The Immunization Action Coalition (IAC) is pleased to announce that seven 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.
  • Brooks Memorial Hospital, Dunkirk, NY (97%)
  • Hospital Episcopal San Lucas Ponce, Ponce, PR (98%)
  • Kosciusko Community Hospital, Warsaw, IN (100%)
  • Memorial Medical Center, Springfield, IL (98%)
  • Niagara Falls Memorial Medical Center, Niagara Falls, NY (93%)
  • Oswego Hospital, Oswego, NY (93%)
  • Sturdy Memorial Hospital, Attleboro, MA (99%)
In addition, the following seven institutions are being recognized for a second year.
  • Albany Medical Center, Albany, NY (93%)
  • Pipestone County Medical Center, Pipestone, MN (90%)
  • Myrtue Medical Center, Harlan, IA (96%)
  • Spectrum Health Ludington Hospital, Ludington, MI (95%)
  • West Jefferson Medical Center, Marrero, LA (98%)
  • Wilson Memorial Hospital Sidney, OH (93%)
  • Women & Infants Hospital, Providence, RI (97%)
The Honor Roll now includes 115 birthing institutions from 25 states and Puerto Rico.

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 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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Reminder: PBS's NOVA program to air documentary on vaccines on September 10

NOVA, PBS's popular science series, will premiere a film titled "Vaccines—Calling the Shots" on September 10. The one-hour film interviews many experts, explores the history and science behind vaccinations, and sheds light on the risks of opting out. The program's description from the NOVA web page is reprinted below.

Diseases that were largely eradicated in the United States a generation ago—whooping cough, measles, mumps—are returning, in part because nervous parents are skipping their children’s shots. NOVA’s “Vaccines—Calling the Shots” takes viewers around the world to track epidemics, explore the science behind vaccinations, hear from parents wrestling with vaccine-related questions, and shed light on the risks of opting out.

According to PBS, NOVA is the most-watched prime time science series on American television, reaching an average of five million viewers weekly. This new documentary is a great opportunity to provide evidence-based information about the safety and efficacy of vaccines to a large audience. Spread the word!

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IAC updates two popular influenza staff resources: "Influenza Vaccine Products for the 2014–2015 Influenza Season" and "Declination of Influenza Vaccination"

IAC has updated the following influenza-related staff resources for the 2014–15 influenza vaccination season.
  1. Influenza Vaccine Products for the 2014–2015 Influenza Season—IAC updated this summary table with current information about influenza vaccine products and codes for the 2014–2015 season.
  2. Declination of Influenza Vaccination—IAC reviewed the information and updated the date.
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 its handout for parents titled "Keep your kids safe—get them vaccinated every fall or winter!"

IAC recently updated its handout for parents titled Keep your kids safe—get them vaccinated every fall or winter! with new information about the nasal-spray flu vaccine.

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IAC updates its staff education materials: "Current Dates of Vaccine Information Statements (VISs)" and "It's Federal Law! You must give your patients current Vaccine Information Statements (VISs)"

IAC recently revised Current Dates of Vaccine Information Statements (VISs) as well as It's Federal Law! You must give your patients current Vaccine Information Statements (VISs) to reflect the 8/19/14 release date of the recently updated VISs for inactivated influenza vaccine (IIV) and live attenuated intranasal influenza vaccine (LAIV).

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National Foundation for Infectious Diseases and Council of State and Territorial Epidemiologists release Call to Action on HPV vaccination

In August 2014, the National Foundation for Infectious Diseases (NFID) and Council of State and Territorial Epidemiologists (CSTE) released a Call to Action titled HPV Vaccination as a Public Health Priority. This Call to Action is part of a broader initiative to educate healthcare professionals about the importance of HPV vaccination for cancer prevention and to offer resources to support HPV vaccination in practice.
NFID has also developed an online HPV Resource Center. The resource center provides easy access to a wide range of HPV information and tools for healthcare professionals. 

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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New CDC resources help educate adults with chronic health conditions about vaccination

CDC states: "It is especially important for patients with chronic health conditions to be up to date on recommended vaccinations as they are at increased risk for complications from certain vaccine-preventable diseases." CDC has recently updated the following resources for adults with chronic health conditions to help them understand which vaccines they might need. Access all these pieces as well as related web buttons on CDC's Educating Adults with Chronic Health Conditions: Vaccination Resources web page.

IAC has developed the following suite of handouts for adults with chronic health conditions. Access all these handouts, as well as others on IAC's Patient Schedules web page, on

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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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CDC publishes report on assessment of rabies exposure risk among U.S. Air Force basic trainees

CDC published Assessment of Rabies Exposure Risk in a Group of U.S. Air Force Basic Trainees—Texas, January 2014 in the August 29 issue of MMWR (pages 749–752). A summary made available to the press is reprinted below.

In January 2014, a number of Mexican free-tailed bats were seen in the sleeping quarters of a U.S. Air Force basic military training dormitory at Joint Base San Antonio, Lackland, Texas. Exposure to bats while sleeping is a known risk for acquiring rabies, a viral disease that is almost uniformly fatal if not treated before symptoms begin. In this outbreak investigation, over 900 U.S. Air Force basic trainees and training instructors were interviewed for potential exposure to bats, and 200 trainees received rabies postexposure prophylaxis, consisting of one injection of human rabies immune globulin and the four-dose rabies vaccination series. There were no serious adverse effects and no rabies cases have occurred.

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CDC publishes information about the risks of polio outbreaks in polio-free countries

CDC published Assessing and Mitigating the Risks for Polio Outbreaks in Polio-Free Countries—Africa, 2013–2014 in the August 29 issue of MMWR (pages 756–761). The first paragraph is reprinted below.

Since 1988, when the Global Polio Eradication Initiative (GPEI) began, the annual number of polio cases has decreased by >99%. Only three countries remain that have never interrupted wild poliovirus (WPV) transmission: Afghanistan, Nigeria, and Pakistan. Since 2001, outbreaks have occurred in 31 formerly polio-free counties in Africa, with outbreaks in 25 countries caused by WPV originating in Nigeria. After the declaration of the World Health Assembly of polio eradication as a programmatic emergency in 2012, efforts to identify areas at high risk for importation-associated outbreaks and to reduce that risk have been intensified. This report updates the 2013 assessment of the risk for outbreaks attributable to importation of poliovirus in 33 countries in Africa, using indicators of childhood susceptibility to poliovirus and proximity to countries currently affected by polio. From January 2013 to August 12, 2014, outbreaks occurred in five African countries. Four of the five (Cameroon, Equatorial Guinea, Ethiopia, and Somalia) have had recent transmission (cases within the previous 12 months). Based on the current risk assessment, 15 countries are considered to be at high risk for WPV outbreaks, five at moderate-to-high risk, seven at moderate risk, and six at low risk. In 15 of the 33 countries, less than half of the population resides in areas where surveillance performance indicators have met minimum targets. Enhanced, coordinated activities to raise childhood immunity are underway in 2014 to prevent additional WPV spread. Although substantial progress toward polio eradication has occurred in Nigeria, all African countries remain at risk for outbreaks as long as WPV continues to circulate anywhere on the continent.

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Ask the Experts
Question of the Week

My office recently changed HPV vaccine brands from Gardasil to Cervarix. We have several males who received doses of Cervarix instead of Gardasil. Do the males who received Cervarix need to be revaccinated?
Answer: Yes. Cervarix (HPV2, GlaxoSmithKline) is not approved or recommended for use in males. Doses of HPV2 administered to males should not be counted and need to be repeated using Gardasil (HPV4, Merck). 

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

This page was updated on .