Issue 1143: September 23, 2014
Ask the Experts–Question of the Week: If the top of a single dose vial of diluent or vaccine is popped off and not used, is there a … read more

CDC publishes ACIP recommendations for use of PCV13 and PPSV23 vaccines in adults age 65 and older

CDC published Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP) in the September 19 issue of MMWR (pages 822–825). A portion of the "ACIP Recommendations for PCV13 and PPSV23 Use" section is reprinted below.

ACIP Recommendations for PCV13 and PPSV23 Use

Both PCV13 and PPSV23 should be administered routinely in series to all adults aged ≥65 years.

Pneumococcal vaccine-naïve persons. Adults aged ≥65 years who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The dose of PPSV23 should be given 6–12 months after a dose of PCV13. If PPSV23 cannot be given during this time window, the dose of PPSV23 should be given during the next visit. The two vaccines should not be coadministered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks.

Previous vaccination with PPSV23. Adults aged ≥65 years who have previously received ≥1 doses of PPSV23 also should receive a dose of PCV13 if they have not yet received it. A dose of PCV13 should be given ≥1 year after receipt of the most recent PPSV23 dose. For those for whom an additional dose of PPSV23 is indicated, this subsequent PPSV23 dose should be given 6–12 months after PCV13 and ≥5 years after the most recent dose of PPSV23.

Potential Time-Limited Utility of Routine PCV13 Use Among Adults ≥65 Years. The recommendations for routine PCV13 use among adults aged ≥65 years will be reevaluated in 2018 and revised as needed.

ACIP recommendations for routine use of PCV13 in adults aged ≥19 years with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implants remain unchanged.

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CDC reports on influenza vaccination coverage of healthcare personnel during 2013–14 influenza season

CDC published Influenza Vaccination Coverage Among Healthcare Personnel—United States, 2013–14 Influenza Season in the September 19 issue of MMWR (pages 805–811). The first paragraph is reprinted below.

The Advisory Committee on Immunization Practices recommends that all healthcare personnel (HCP) be vaccinated annually against influenza. Vaccination of HCP can reduce influenza-related morbidity and mortality among both HCP and their patients. To estimate influenza vaccination coverage among HCP during the 2013–14 season, CDC analyzed results of an opt-in Internet panel survey of 1,882 HCP conducted during April 1–16, 2014. Overall, 75.2% of participating HCP reported receiving an influenza vaccination during the 2013–14 season, similar to the 72.0% coverage among participating HCP reported in the 2012–13 season. Coverage was highest among HCP working in hospitals (89.6%) and lowest among HCP working in long-term care (LTC) settings (63.0%). By occupation, coverage was highest among physicians (92.2%), nurses (90.5%), nurse practitioners and physician assistants (89.6%), pharmacists (85.7%), and "other clinical personnel" (87.4%) compared with assistants and aides (57.7%) and nonclinical personnel (e.g., administrators, clerical support workers, janitors, and food service workers) (68.6%). HCP working in settings where vaccination was required had higher coverage (97.8%) compared with HCP working in settings where influenza vaccination was not required but promoted (72.4%) or settings where there was no requirement or promotion of vaccination (47.9%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (61.6%) or multiple days (80.4%) compared with HCP working in settings not offering free on-site vaccination (49.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might be needed to increase vaccination coverage among HCP and minimize the risk for influenza to HCP and their patients.

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CDC reports on influenza vaccination coverage of pregnant women during 2013–14 influenza season

CDC published Influenza Vaccination Coverage Among Pregnant Women—United States, 2013–14 Influenza Season in the September 19 issue of MMWR (pages 816–821). A summary made available to the press is reprinted below.

Influenza vaccination protects both pregnant women and their babies from serious illness during and after pregnancy. The Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists recommend all pregnant women receive influenza vaccination, regardless of trimester. In the 2013–14 influenza season, 52.2% of pregnant women were vaccinated before or during pregnancy. Women who received a recommendation and offer of influenza vaccination from their provider were more likely to be vaccinated than those who did not receive a recommendation or a recommendation but no offer, even among women with negative attitudes towards influenza vaccination. This season, 65.1% of pregnant women reported receiving a clinician recommendation and offer of influenza vaccination, an increase of about 10 percentage points from the 2012–13 influenza season. Clinicians should emphasize to their pregnant patients the risk of influenza infection and the benefits and safety of influenza vaccination for both mom and baby. Clinicians should strongly recommended and offer influenza vaccination to their pregnant patients.

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CDC publishes data on influenza vaccination of healthcare personnel in acute care hospitals

CDC published Influenza Vaccination Performance Measurement Among Acute Care Hospital-Based Healthcare Personnel—United States, 2013–14 Influenza Season in the September 19 issue of MMWR (pages 812–815). The first paragraph is reprinted below.

Annual influenza vaccination is recommended for all healthcare personnel (HCP). In August 2011, the Centers for Medicare and Medicaid Services (CMS) published a final rule requiring acute care hospitals that participate in its Hospital Inpatient Quality Reporting Program to report HCP influenza vaccination data through the National Healthcare Safety Network (NHSN) beginning January 1, 2013. Data reported by 4,254 acute care hospitals, covering the period October 1, 2013, through March 31, 2014, were analyzed to collect estimates of the proportion of HCP vaccinated nationally and by state for three groups: 1) employees, 2) licensed independent practitioners (LIPs), and 3) adult students/trainees and volunteers. Overall in the United States, 81.8% of hospital-based HCP were reported vaccinated, with the highest proportion (86.1%) among employees and the lowest (61.9%) among LIPs. The proportion reported vaccinated varied widely by state, with ranges of 69.0%–97.6% for employees, 33.8%–93.6% for LIPs, and 50.3%–96.3% for adult students/trainees and volunteers. Public reporting of vaccination data has been shown to increase HCP influenza vaccination coverage. These new NHSN data provide a baseline for measuring changes in future hospital-based reporting of HCP influenza vaccination.

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CDC posts final 2013–14 influenza vaccination coverage estimates

CDC published Announcement: Now Available Online: Final 2013–14 Influenza Vaccination Coverage Estimates for Selected Local Areas, States, and the United States in the September 19 issue of MMWR (page 826). Among all people age 6 months and older, flu vaccination coverage during the 2013–14 flu season was 46.2%, which was 1.2 percentage points higher than the 2012–13 season (45.0%). State-specific flu vaccination coverage among all people age 6 months and older ranged from 36.4% (Nevada) to 57.4% (South Dakota).The first paragraph is reprinted below. 

Final 2013–14 influenza season vaccination coverage estimates are now available online at FluVaxView ( The online information includes estimates of the cumulative percentage of persons vaccinated by the end of each month, from July 2013 through May 2014, for select local areas, each state, each U.S. Department of Health and Human Services region, and the United States overall.

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NFID releases summary of September 18 news conference on influenza and pneumococcal disease

On September 18, the National Foundation for Infectious Diseases (NFID) hosted an Influenza/Pneumococcal News Conference at the National Press Club in Washington, DC. In collaboration with CDC and other leading medical and public health groups who rallied together to show their strong support for influenza immunization, the event served to communicate critical messages including a call to action for everyone to get vaccinated. The introductory bullet points from a related September 18 press release are reprinted below.
  • Latest U.S. flu vaccination coverage estimates show highest coverage in youngest and oldest age groups with gains in school-aged children, but coverage remains low for most adult age groups
  • Flu vaccination coverage in pregnant women increased following 2009 pandemic and holding steady; highest rates seen when healthcare providers recommend and offer the vaccine in their offices
  • Vaccination coverage at 90 percent or higher among doctors and nurses; however, low rates persist in long-term care workers putting patients at risk
  • Today, CDC published new recommendations adding pneumococcal conjugate vaccine for adults age 65 years and older; pneumococcal disease can be a deadly complication of influenza
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CDC publishes "Summary of Notifiable Diseases—United States, 2012"

CDC published Summary of Notifiable Diseases—United States, 2012 in a special issue of MMWR on September 19. The first three sentences are reprinted below.

The Summary of Notifiable Diseases—United States, 2012 contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States for 2012. Unless otherwise noted, the data are final totals for 2012 reported as of June 30, 2013. These statistics are collected and compiled from reports sent by state health departments and territories to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). Back to top

Reminder: October 15 is deadline to apply to host the 2016 National Conference on Immunization and Health Coalitions

If you are an immunization coalition, please consider hosting the 2016 National Conference on Immunization and Health Coalitions. Applications are due October 15, and can be downloaded from the conference website at This biennial conference provides a unique opportunity to network with colleagues and learn up-to-date immunization and coalition-building skills.
Please share this widely with potentially interested coalitions. The planning team at WithinReach would be happy to discuss any questions or ideas you have. Contact Sara Jaye Sanford, MPH, at or (206) 830-5175.

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Study about the etiologies of seizures around the time of vaccination published in Pediatrics

The September issue of the journal Pediatrics published an article titled Etiologies for Seizures Around the Time of Vaccination. This study assessed the incidence, course, and etiology of epilepsy with vaccination-related seizure onset in a population-based cohort of children. The "Conclusions" section of the abstract is reprinted below.

Our results suggest that in most cases, genetic or structural defects are the underlying cause of epilepsy with onset after vaccination, including both cases with preexistent encephalopathy or benign epilepsy with good outcome. These results have significant added value in counseling of parents of children with vaccination-related first seizures, and they might help to support public faith in vaccination programs. 

Access the abstract for Etiologies for Seizures Around the Time of Vaccination.

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IAC Spotlight! IAC's collection of practical and clinically relevant journal articles on vaccination

Looking for help searching through the current medical literature to find practical articles about vaccines and immunization? Look no further. IAC’s Journal Articles section on provides a chronological catalog of more than 4,000 vaccine-related, peer-reviewed articles organized by vaccine and topic area.

This section offers users live links to the abstracts or full text of thousands of practical and clinically relevant journal articles on vaccine-related topics.

Some of the journal article sections and topics include Back to top

IAC enrolls seven more birthing institutions into its Hepatitis B Birth Dose Honor Roll; one previously honored institution qualifies 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.
  • A.O. Fox Memorial Hospital, Oneonta, NY (93%)
  • Auburn Community Hospital, Auburn, NY (91%)
  • Kent Hospital, Warwick, RI (99%)
  • Lewis County General Hospital, Lowville, NY (93%)
  • Massena Memorial Hospital, Massena, NY (93%)
  • UHS Chenango Memorial Hospital, Norwich, NY (97%)
  • Upstate University Hospital Community Campus, Syracuse, NY (94%)
In addition, the following institution is being recognized for a second year.
  • The Medical Center of Aurora, Aurora, CO (99%)
The Honor Roll now includes 122 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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PBS's NOVA "Vaccines—Calling the Shots" is now available for viewing online

On September 10, NOVA, PBS's popular science series, premiered a film titled "Vaccines—Calling the Shots." The one-hour film interviewed many experts, explored the history and science behind vaccinations, and shed light on the risks of opting out. If you missed watching this documentary in real time, you can now access it online. Go to the "Vaccines—Calling the Shots" web page and click on the green "Watch the Program" button on the right.

This new documentary is a great opportunity to provide evidence-based information about the safety and efficacy of vaccines to a large audience. A DVD of the show is also available for purchase.

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IAC posts thirteen additional translations of the 2014–15 influenza VISs

IAC recently posted Armenian, Burmese, Farsi, Hmong, Korean, and Tagalog translations of the 2014–15 inactivated influenza vaccine (IIV) Vaccine Information Statement (VIS), as well as Armenian, Burmese, Farsi, Hmong, Korean, Tagalog, and Thai translations of the 2014–15 live, intranasal influenza vaccine (LAIV) VIS on its website. The Thai translation of the IIV VIS was previously posted.

New translations of the 2014–15 inactivated influenza vaccine (IIV) VIS New translations of the 2014–15 live, intranasal influenza vaccine (LAIV) VIS IAC thanks the California Department of Public Health for the Armenian, Farsi, Hmong, Korean, and Tagalog translations and Asian Pacific Health Care Venture, Los Angeles, CA, for the Thai translation.

IAC posted other translations of the influenza VISs, including Spanish, in previous weeks. Visit IAC's VIS section to see what is currently available.

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

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Error corrected in recently released Arabic translations of IIV and LAIV influenza VISs

Last week, IAC posted Arabic translations for the 2014–15 inactivated influenza vaccine (IIV) and the 2014–15 live, intranasal influenza vaccine (LAIV) VIS on its website. Unfortunately, the translations incorrectly read "from 6 to 8 months" under the third paragraph in Section 2. The corrected translations now read "6 months through 8 years of age." A physician in Egypt discovered this error and kindly notified us. IAC greatly appreciates the people who take the time to provide such valuable feedback! Back to top

CDC details its global influenza work in new annual report

CDC recently released an annual report on its international influenza activities. It highlights the progress made over the past two fiscal years in establishing, expanding, and maintaining influenza surveillance and laboratory capacity in more than 50 countries where CDC has provided support. The report illustrates the growing international capacity to track seasonal influenza activity and to quickly respond to emerging influenza- and non-influenza viruses such as influenza A (H7N9) and MERS-CoV. Back to top

Texas Children's Hospital develops compelling video to promote influenza vaccination

Texas Children's Hospital has developed an educational and compelling video that conveys the importance of receiving the influenza vaccine. The six-and-a-half-minute video features three families that have experienced trials, loss, and hardship due to influenza. These families share their stories in the hope of helping others understand the seriousness of the disease and the importance of being vaccinated. Related Links Back to top

CDC releases updated toolkit for businesses to help promote influenza vaccination

To help businesses, employers, and their employees learn about strategies for preventing influenza, CDC has updated Make It Your Business To Fight The Flu: A Toolkit for Businesses and Employers. This resource includes flyers, posters, and other materials to post and distribute in the workplace. Back to top

Influenza is serious; many resources are available to help you vaccinate your patients

Vaccination remains the single most effective means of preventing influenza, and is recommended for everyone age six months and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public: Back to top

Agenda for October ACIP meeting available; follow the meeting online if you are unable to attend

CDC has released a draft agenda for the next Advisory Committee on Immunization Practices (ACIP) meeting, which will be held October 29–30 at CDC's Clifton Road campus in Atlanta. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-citizens is October 6; for citizens it's October 13.

Meetings are open to the public and available online via live webcast. During committee meetings, members present findings and discuss vaccine research and scientific data related to vaccine effectiveness and safety, clinical trial results, and manufacturer's labeling or package insert information. Outbreaks of vaccine-preventable disease or changes in vaccine supply also are reviewed during these meetings. Registration is not required to watch the live webcast of the meeting; the call-in information is located on the registration page. The live meeting recording and presenter slides are always made available online after the meeting as well.

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Ask the Experts
Question of the Week

If the top of a single dose vial of diluent or vaccine is popped off and not used, is there a time limit as to when it must be used?  We are just discussing whether the efficacy of the vaccine will be compromised with the passing of time. 
Answer: Once the protective cap has been removed from a single-dose vial, it may not be possible to determine if the rubber seal has been punctured. Therefore, unused single-dose vials without a protective cap should be discarded at the end of the workday.

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
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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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