Issue 1141: September 9, 2014

Ask the Experts–Question of the Week: Can someone with hepatitis C receive zoster vaccine? The prescribing information indicates  … read more


New! Spanish-language translations of the 2014–15 influenza vaccine Vaccine Information Statements now available

IAC recently posted Spanish translations of the 2014–15 inactivated influenza vaccine (IIV) Vaccine Information Statement (VIS), as well as the 2014–15 live, intranasal influenza vaccine (LAIV) VIS on its website.

Please note: The 2014–15 influenza vaccine VISs will be available in many additional languages in the weeks ahead. IAC Express will announce the availability of translations as soon as they are ready.

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CDC publishes report on expired live attenuated influenza vaccine being administered

CDC published Notes from the Field: Reports of Expired Live Attenuated Influenza Vaccine Being Administered—United States, 2007–2014 in the September 5 issue of MMWR (page 773). The complete article is reprinted below.

Annual influenza vaccination is recommended for all persons aged ≥6 months. Two vaccine types are approved in the United States, injectable inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV), which is administered intranasally. Influenza vaccine typically becomes widely available beginning in late summer or early fall. IIV has a standard expiration date of June 30 for any given influenza season (July 1 through June 30 of the following year). In contrast, after release for distribution, LAIV generally has an 18-week shelf life. Because of its relatively short shelf life, LAIV might be more likely than IIV to be administered after its expiration date. To assess that hypothesis, CDC analyzed reports to the Vaccine Adverse Event Reporting System (VAERS) of expired LAIV administered during July 1, 2007, through June 30, 2014.

Of the 4,699 LAIV reports, 866 (18.4%) involved administration of expired vaccine; 97.5% of these reports did not document any adverse health event. In 95.1% of expired LAIV reports, vaccination occurred after the first week in November, which is approximately 18 weeks from July 1. Historically, by early November, most vaccine has been administered for the season. In contrast, of the 49,695 IIV reports, only 96 (0.02%) involved administration of expired vaccine. VAERS is a national, passive surveillance system that accepts reports from anyone (including vaccine recipients, providers, and manufacturers); because of this, it is not possible to definitively conclude that LAIV is more likely to be administered after its expiration date. However, the magnitude of disproportional reporting for this error in expired LAIV use compared with IIV supports the hypothesis.

As a passive surveillance system, VAERS likely captures only a small fraction of expired LAIV administered, so this error might be more common than VAERS data indicate. Most reports had a vaccination date in November or later. Health care providers need to be aware of the short shelf life of LAIV and implement measures to avoid administering expired LAIV, especially from November and onward, when this error appears to be more common. Although the data do not indicate that administration of expired LAIV poses a health risk, revaccination with a valid dose is advised. Replacement options for expired LAIV are available at

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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 Spotlight! Visit "What's New at IAC" to find just-released handouts and translations of Vaccine Information Statements

Looking for just-released handouts for staff and patients or for new Vaccine Information Statements and their translations from IAC? Look no further. The What's New at IAC section on offers visitors a chronological list of new and revised materials.

To help users find selected materials of interest, the "What's New" section on is also organized in the following categories: Back to top

PKIDs launches Value of Vaccination movement

On September 3, PKIDs launched the Value of Vaccination movement. This campaign is supported by a host of volunteers, along with financial support from PKIDs, which receives funding from parents of children affected by disease, individuals, corporations, government, and foundations. An excerpt from the press release titled New Movement Spotlights the Value of Vaccination follows.

An ever-growing body of individuals and organizations has come together for the purpose of highlighting that which is well-known but seldom stated: vaccination adds value to our lives.

Building upon a groundswell of public support for vaccination, the Value of Vaccination movement is garnering attention to the benefits that vaccines bring to every community. The initiative features the sharing of personal stories, videos demonstrating the positive impacts of vaccination, and easy-to-understand guides to the science behind vaccines and the immune system.

The movement is expanding beyond the website to include social media platforms, including Facebook, Twitter, and Pinterest. The goal is to encourage conversation at home, at work, and at school about the value of vaccination.

Access the Value of Vaccination website at PKIDs urges other pro-vaccination organizations and individuals to promote this new movement. If you have something to contribute to the movement, or wish to obtain a list of sample messages for Facebook, Twitter, and other social media platforms, please email

PKIDs (Parents of Kids with Infectious Diseases) is a nonprofit organization with the mission to educate the public about infectious diseases, the methods of prevention and transmission, the latest advances in medicine, and the elimination of social stigma borne by the infected. PKIDs also provides emotional, financial, and informational support to the families of the children living with hepatitis, HIV/AIDS, or other chronic, viral infectious diseases. 

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IAC updates six influenza staff resources, including screening checklists, sample standing orders, a guide for patients with egg allergy, and an algorithm for determining the number of vaccine doses needed by children

IAC has updated the following influenza-related staff resources for the 2014–15 influenza vaccination season.
  1. Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination
  2. Screening Checklist for Contraindications to Live Attenuated Influenza Vaccination
  3. Standing Orders for Administering Influenza Vaccines to Children and Adolescents
  4. Standing Orders for Administering Influenza Vaccine to Adults
  5. Influenza Vaccination of People with a History of Egg Allergy
  6. Guide for determining the number of doses of influenza vaccine to give to children age 6 months through 8 years during the 2014–2015 influenza season
The screening checklists and standing orders were updated to match the new ACIP recommendations regarding 1) a preference for use of live attenuated influenza vaccine (LAIV) over inactivated influenza vaccine (IIV) in children age 2 through 8 years when LAIV is readily available, and 2) changes related to LAIV precautions and contraindications. "Influenza Vaccination of People with a History of Egg Allergy" received minor edits. "Guide for determining the number of doses of influenza vaccine to give to children age 6 months through 8 years during the 2014–2015 influenza season" was reformatted and updated with the current ACIP algorithm.

Related Links 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's parent handout "Measles, mumps, and rubella are serious diseases...make sure your child is protected!" now available in Russian

IAC's parent handout Measles, mumps, and rubella are serious diseases...make sure your child is protected! is now available in Russian. IAC thanks Pediatric Associates, Plantation, Florida, for the translation.

For your reference: English-language version

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WHO issues roadmap for international response to the Ebola outbreak in Africa

On August 28, WHO issued a roadmap to guide and coordinate the international response to the Ebola outbreak in West Africa. Two paragraphs from the related press release are reprinted below.

The aim is to stop ongoing Ebola transmission worldwide within 6–9 months, while rapidly managing the consequences of any further international spread. It also recognizes the need to address, in parallel, the outbreak’s broader socioeconomic impact.

It responds to the urgent need to dramatically scale up the international response. Nearly 40% of the total number of reported cases have occurred within the past three weeks.
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ACOG releases HPV vaccination toolkit for physicians who provide healthcare to women

The American College of Obstetricians and Gynecologists (ACOG) has developed a toolkit titled Human Papillomavirus Vaccination 2014. The first paragraph of the accompanying "Dear Colleague" letter from ACOG is reprinted below.

The American College of Obstetricians and Gynecologists (ACOG) is dedicated to increasing adult immunizations provided by obstetrician-gynecologists. As you know, we now have a vaccine that helps prevent cancer in many cases. Human papillomavirus (HPV) vaccination is recommended for girls, young women, and boys (see the enclosed ACOG Committee Opinion No. 588, Human Papillomavirus Vaccination, for specific recommendations). If your patient is a mother, talk to her about the importance of vaccinating her child(ren) against HPV. This three-dose vaccine series has the potential to prevent up to 70% of cases of cervical cancer. It has been shown that the most effective way to increase immunization rates among patients is for the physician to directly recommend the vaccines. If your patient does not accept your recommendation initially, continue to offer immunizations to her on subsequent office visits. I highly encourage you to incorporate HPV vaccination into your routine well-woman care. 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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Michigan Department of Community Health releases updated toolkit of influenza vaccination resources for colleges and universities

The Michigan Department of Community Health (MDCH) has released an updated version of its College and University Flu Vaccination Toolkit to assist college health centers, medical practices, health departments, pharmacists, and other immunization providers in promoting the importance of annual influenza vaccination to students. The toolkit includes strategies to increase rates, key messages, email templates, news release templates, social media messages, and websites, plus an assortment of posters and flyers.

Many of the materials in this toolkit are Michigan-specific, but could serve as a source of inspiration for other locales. If you are interested in adapting any of the resources for use in your area, contact Courtnay Londo, MA, Adolescent & Adult Immunization Coordinator at MDCH by email at

MDCH College and University Flu Vaccination Toolkit web page

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CDC publishes article about fatal meningococcal disease in a laboratory worker

CDC published Fatal Meningococcal Disease in a Laboratory Worker—California, 2012 in the September 5 issue of MMWR (pages 770–772). The first paragraph is reprinted below.

Occupationally acquired meningococcal disease is rare. Adherence to recommendations for safe handling of Neisseria meningitidis in the laboratory greatly reduces the risk for transmission to laboratory workers. A California microbiologist developed fatal serogroup B meningococcal disease after working with N. meningitidis patient isolates in a research laboratory (laboratory A). The California Department of Public Health (CDPH), the local health department, the California Division of Occupational Safety and Health (CalOSHA), and the federal Occupational Safety and Health Administration (OSHA) collaborated on an investigation of laboratory A, which revealed several breaches in recommended laboratory practice for safe handling of N. meningitidis, including manipulating cultures on the bench top. Additionally, laboratory workers had not been offered meningococcal vaccine in accordance with Advisory Committee on Immunization Practices (ACIP) recommendations and CalOSHA Aerosol Transmissible Diseases Standard requirements. In accordance with OSHA and CalOSHA regulations, laboratory staff members must receive laboratory biosafety training and use appropriate personal protective equipment, and those who routinely work with N. meningitidis isolates should receive meningococcal vaccine.

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Minnesota Department of Health immunization conference to be held October 27–28

The Minnesota Department of Health's "Got Your Shots?" immunization conference will be held in St. Cloud, MN, on October 27–28. Access more information on the conference web page.

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Ask the Experts
Question of the Week

Can someone with hepatitis C receive zoster vaccine? The prescribing information indicates persons with immunosuppression should not get the vaccine, including people with HIV/AIDS, but hepatitis C is not specifically mentioned.
Answer: Hepatitis C infection is not a contraindication for zoster vaccine. However, if someone with hepatitis C is receiving a medication that can cause immunosuppression, they should consult with their healthcare provider and consider delaying vaccination until they have completed treatment.

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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