Issue 1148: October 21, 2014

Ask the Experts–Question of the Week: A nurse had a leftover drawn-up syringe of influenza vaccine taken from a multi-dose vial. Can we use … read more

Reminder: October issue of Needle Tips is now available online

The October 2014 issue of Needle Tips is now online.

Click on the image below to download the entire October issue (PDF) of Needle Tips.
October issue of Needle Tips
This issue features important information about the recently released ACIP recommendations for influenza and pneumococcal vaccine. In addition, it presents an array of immunization materials that healthcare professionals can use in their practice settings, including a new how-to guide about the use of standing orders for administering vaccines. It also features the "Ask the Experts" column from CDC medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, RN, MN.

Related Links If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit IAC's subscribe page to sign up.

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"Dear Colleague" letter urges healthcare professionals to recommend influenza and Tdap vaccines to their pregnant patients

On October 9, CDC released a "Dear Colleague" letter that encourages influenza and Tdap vaccination of pregnant women. The entire letter is reprinted below.

Dear Colleague,

Pregnant women and their babies are at increased risk for influenza-related complications, including premature labor and preterm birth. Additionally, pertussis outbreaks continue to occur in the United States with infants at highest risk of severe illness, including hospitalization and death. Influenza vaccination is recommended in any trimester for all women who are pregnant or who plan to become pregnant during the influenza season, and a pertussis vaccination (Tdap) is recommended between 27 and 36 weeks of each pregnancy. Immunization rates for these vaccines are low, leaving many pregnant women and their infants unprotected against these serious vaccine-preventable diseases.

We ask you to recommend the influenza vaccine to your pregnant patients throughout the current influenza season. We ask that you also recommend the Tdap vaccination to your pregnant patients as they enter their third trimester. Studies confirm that your recommendation and offer of vaccines are essential. One study showed that patients who were offered influenza vaccination during an office visit were 7 times more likely to be vaccinated for influenza than patients who reported their provider did not recommend or offer vaccination. Patients who received a recommendation alone were twice as likely to be vaccinated as those that received no recommendation.

We encourage you to adopt the National Adult Immunization Practice Standards to help ensure that your patients receive influenza and Tdap vaccinations as well as all other indicated vaccinations. We ask you to complete the following steps at each patient encounter:
  • Assess the immunization status of each patient
  • Recommend the indicated vaccines to each patient
  • Administer any necessary vaccines or, if you do not stock the vaccine, refer the patient to a provider or location that can vaccinate the patient
  • Document the vaccinations that your patient is given, ideally in your state or local immunization registry
Your pregnant patients might be concerned about receiving a vaccination while pregnant. Influenza and Tdap vaccines are safe and important for pregnant women and their infants. Infants in the first several months of life are at the greatest risk of severe illness from influenza and pertussis but are too young to be directly immunized, thus vaccination during pregnancy is critical.

You play a crucial role in helping keep pregnant women and their newborns healthy. Assuring your patients are protected by recommended vaccines is key. For more information about the influenza vaccine, please visit: For more information about the Tdap vaccine and pregnancy, please visit: For information about all vaccines for pregnant women visit:

We thank you for your dedication to ensure the health and safety of pregnant women and their infants.

The letter is signed by representatives of the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, March of Dimes Foundation, American Academy of Physician Assistants, National Medical Association, Association of Women's Health, Obstetric and Neonatal Nurses, National Foundation for Infectious Diseases, Society for Maternal-Fetal Medicine, American Pharmacists Association, American Academy of Pediatrics, American Nurses Association, National Hispanic Medical Association, American College of Nurse-Midwives, and CDC.

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CDC reports on vaccination coverage among children in kindergarten during the 2013–14 school year

CDC published Vaccination Coverage Among Children in Kindergarten—United States, 2013–14 School Year in the October 17 issue of MMWR. The first paragraph is reprinted below.

State and local vaccination requirements for school entry are implemented to maintain high vaccination coverage and protect schoolchildren from vaccine-preventable diseases. Each year, to assess state and national vaccination coverage and exemption levels among kindergartners, CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs. This report describes vaccination coverage in 49 states and the District of Columbia (DC) and vaccination exemption rates in 46 states and DC for children enrolled in kindergarten during the 2013–14 school year. Median vaccination coverage was 94.7% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 95.0% for varying local requirements for diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine; and 93.3% for 2 doses of varicella vaccine among those states with a 2-dose requirement. The median total exemption rate was 1.8%. High exemption levels and suboptimal vaccination coverage leave children vulnerable to vaccine-preventable diseases. Although vaccination coverage among kindergartners for the majority of reporting states was at or near the 95% national Healthy People 2020 targets for 4 doses of DTaP, 2 doses of MMR, and 2 doses of varicella vaccine, low vaccination coverage and high exemption levels can cluster within communities. Immunization programs might have access to school vaccination coverage and exemption rates at a local level for counties, school districts, or schools that can identify areas where children are more vulnerable to vaccine-preventable diseases. Health promotion efforts in these local areas can be used to help parents understand the risks for vaccine-preventable diseases and the protection that vaccinations provide to their children.

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IAC enrolls eight more birthing institutions into its Hepatitis B Birth Dose Honor Roll

The Immunization Action Coalition (IAC) is pleased to announce that eight 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.
  • California Hospital Medical Center, Los Angeles, CA (99%)
  • Community Hospital Anderson, Anderson, IN (95%)
  • Fort Hamilton Hospital, Hamilton, OH (100%)
  • Highlands Regional Medical Center, Prestonburg, KY (97%)
  • Oneida Healthcare, Oneida, NY (96%)
  • St. Anthony Regional Hospital, Carroll, IA (97%)
  • Union Hospital, Terre Haute, IN (100%)
  • Wyckoff Heights Medical Center, Brooklyn, NY (95%)
The Honor Roll now includes 138 birthing institutions from 27 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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CDC develops a new, faster lab test for enterovirus D68 and releases new resources for parents about EV-D68

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. On October 14, CDC issued a press release sharing news about a new lab test developed by CDC for EV-D68, which will allow more rapid testing of specimens. Because of this new test, confirmed cases of EV-D68 will appear to rise rapidly over the next 7–10 days as specimen testing accelerates, however, changes in case counts won’t represent a real-time influx of new cases, according to CDC.

Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children, many of whom had asthma or a history of wheezing. Many parents continue to be worried about the outbreak and want information about what they can do to prevent illness and protect themselves and their families. In response, CDC has developed the following new resources for parents about EV-D68. Please share this information with parents directly and via traditional and social media. Related Links Back to top

CDC announces new initiatives to protect healthcare personnel in the U.S. from Ebola

On October 14, CDC held a press conference at which Thomas Frieden, MD, MPH, director, CDC, announced new measures to protect healthcare workers caring for patients with Ebola. In Dallas, where three cases of Ebola have been confirmed, CDC is making specific improvements in the following process and procedures:
  • Personal protective equipment
  • Oversight and monitoring
  • Enhanced training
  • Establishing a dedicated CDC response team
  • Ensuring healthcare workers and facilities are prepared
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Three articles about Ebola republished in this week's MMWR

CDC published the following three articles in the October 17 issue of MMWR. All three were previously published as MMWR Early Releases on October 14. Related Links Back to top

IAC Spotlight! One-stop access to more than 50 educational handouts related to adult vaccination for patients and staff

IAC's new Adult Vaccination Handouts section on features more than 50 educational pieces for healthcare professionals and their patients. From screening checklists to patient information materials, this collection helps you carry out your vaccination activities. Several patient handouts are also available in Spanish and other languages. 

Also, don’t miss IAC’s series of standing orders for adult vaccination; all are available at

Related Links

Handouts for Patients and Staff: Adult Vaccination Back to top

IAC updates sample standing orders for administering pneumococcal vaccines to adults

IAC recently updated Standing Orders for Administering Pneumococcal (PPSV23 and PCV13) Vaccine to Adults to incorporate the new ACIP recommendations related to routine PCV13 vaccination of adults age 65 years and older.

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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CDC updates its easy-to-read adult immunization schedule

CDC recently updated its easy-to-read adult immunization schedule to include the new ACIP pneumococcal recommendations. This schedule is designed to help adult patients identify their need for vaccination due to age, lifestyle, high-risk conditions, type and locations of travel, and previous immunizations. Back to top

California Department of Public Health updates parent fact sheet about vaccine concerns

The California Department of Public Health has updated its fact sheet for parents titled Vaccine Safety: Answers to Parents’ Top Questions. This handout is recommended as a resource that providers can share with parents who may be vaccine-hesitant, or simply to help answer common questions or concerns about vaccinating infants and young children.

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Influenza is serious; many resources are available to help healthcare professionals in vaccinating

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

WHO publishes article about development of possible vaccines for pandemic preparedness

The World Health Organization (WHO) published Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness in the October 17 issue of WHO's Weekly Epidemiological Record.

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Hep B United to offer video chat about hepatitis B virus screening on October 29

Hep B United will present an interactive one-hour video chat titled Hep B Hangout: Best Practices in Community-Based Hepatitis B Screening at 3:00 p.m. (ET) on October 29. Speakers will discuss effective strategies to address hepatitis B screening and education, including helpful tools, resources, and best practices to address hepatitis B virus infection in at-risk communities. 

  • Jane Pan, executive director, Hepatitis B Initiative of Washington, DC
  • Hong Liu, PhD, executive director, Midwest Asian Health Association, Chicago, IL
  • Binh Tran, PharmD, MBA, executive director, Asian Pacific Health Foundation, San Diego, CA
  • Tresa Zacharias, co-director, Dallas-Fort Worth Hepatitis B Free Project, University of Texas Southwestern Medical Center, Dallas, TX
The session will be moderated by Kate Moraras, MPH, program director, Hepatitis B Foundation; director, Hep B United

Registration is required.

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New Medscape resources released to help providers discuss HPV vaccination with parents; CME credit available

Medscape has recently added the following two resources to help healthcare professionals learn about the importance of a strong recommendation for HPV vaccination, and how to make such a recommendation.
  1. A CDC Expert Commentary, Protect the Next Generation: Recommend the HPV Vaccine, features Tom Frieden, MD, MPH, director, CDC.
  2. A CDC course, Framing the Conversation With Parents About the HPV Vaccine, educates clinicians on the importance of HPV vaccine for children approaching adolescence and provides strategies to educate parents about the importance of the vaccine for their child’s well-being. CME credit is available for taking this course.
Registration (free) is required to access Medscape online courses. You can also search Medscape's CME & Education section for topics of interest.

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 ACOG
HPV Resources from Voices for Vaccines
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CDC Expert Commentary on Medscape provides information about using antiviral drugs for influenza

Medscape has posted a new CDC Expert Commentary titled When to Give Antiviral Drugs for the Flu that features Angela Campbell, MD, MPH. from CDC's Influenza Division.

Registration (free) is required to access Medscape online courses.

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Meeting on vaccination ecosystem is planned for January 19–21 in Annecy, France

A program titled Vaccination Ecosystem Health Check: Achieving Impact Today and Sustainability for Tomorrow is planned for January19–21 at Les Pensieres Conference Center, Annecy, France. This event is sponsored by Fondation Mérieux.

Online registration is available.

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Ask the Experts
Question of the Week

A nurse had a leftover drawn-up syringe of influenza vaccine taken from a multi-dose vial. Can we use the vaccine the next day?
Answer: Once a provider draws up a dose of vaccine into a syringe, the dose should be administered that day or discarded at the end of the clinic day. 

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.

Related Links
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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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