Issue 1151: November 11, 2014

Ask the Experts–Question of the Week: A 4-year-old patient came in with a rash and a low-grade fever. The first MMR … read more

We Are Proud to Participate in Minnesota’s Give to the Max Day!
Charitable giving is critical to the nonprofit organizations that serve our communities. The Immunization Action Coalition (IAC) is proud to be headquartered in a state that values charitable giving through a commitment to make the giving process simple, rewarding, and fun. November 13 is Give to the Max Day in Minnesota. Beginning last week and through the end of the year, thousands of Minnesotans and others are visiting the Give to the Max Day website to donate millions of dollars to the causes they believe in and love.
We wanted to take this opportunity to gratefully recognize all of our subscribers—in Minnesota and across the nation—who support worthy charities with unwavering generosity. Your contributions are valuable to the charities you support—and invaluable to the communities they serve. If you’d like to see what all the excitement is about, we invite you to experience the contagious spirit of Minnesota’s Give to the Max Day for yourself at
Finally, we want to tell you what an honor it is to have you as a subscriber to IAC Express and to provide you with resources to help prevent the spread of vaccine-preventable disease. Your dedication to immunization is vital to our mission of helping to protect communities across the nation. We applaud your commitment to the patients you serve. Thank you!

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Reminder: October issues of Needle Tips and Vaccinate Adults available online

The October 2014 issues of Needle Tips and Vaccinate Adults are available online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed.

Click on the images below to download the entire October issue (PDF) of Needle Tips and/or Vaccinate Adults.
Download the November issue of Needle TipsDownload the November issue of Vaccinate Adults
Needle Tips: View the table of contentsmagazine viewer, and back issues.

Vaccinate Adults: View the table of contentsmagazine viewer, and back issues.

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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World Pneumonia Day is November 12

Established in 2009, World Pneumonia Day is marked every year on November 12. The day was established to:
  • Raise awareness about pneumonia, the world’s leading killer of children under the age of five
  • Promote interventions to protect against, prevent, and treat pneumonia
  • Generate action to combat pneumonia
Pneumonia is one of the most solvable problems in global health, yet a child dies from pneumonia every 20 seconds. Visit the World Pneumonia Day website to see how you can help in the effort to end child pneumonia worldwide.

CDC published World Pneumonia Day—November 12, 2014 in the November 7 issue of MMWR (page 1014). The first two paragraphs are reprinted below.

The sixth annual World Pneumonia Day is being observed November 12, 2014, to raise awareness about pneumonia's toll and to promote interventions to protect against, treat, and prevent the disease globally. The United States has made great strides in protecting children from the serious, and sometimes deadly, effects of pneumonia through recent vaccination efforts. Tennessee, for example, is experiencing historically low rates of pneumonia hospitalizations in children aged <2 years since pneumococcal conjugate vaccines were introduced in 2000. Data suggest that this progress also is being seen across the country. In spite of this success, however, pneumonia still kills approximately 50,000 people in the United States each year, 85% of whom are adults aged ≥65 years. In response, this year CDC recommended pneumococcal conjugate vaccine for adults aged ≥65 years.

Globally, pneumonia kills nearly 1 million children aged <5 years each year. In addition to bacterial pathogens, many viruses such as respiratory syncytial virus, influenza, and measles also are major causes of pneumonia globally. Many deaths and illnesses from pneumonia can be prevented with the use of 1) pneumococcal,
Haemophilus influenzae type b (Hib), influenza, and measles vaccines; 2) appropriate antimicrobial therapy; and 3) supportive health care, among other strategies.

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CDC releases statement about LAIV effectiveness studies and vaccination of children; ACIP and CDC have not changed the current influenza vaccination recommendations

On November 6, CDC released a statement titled: CDC Statement on LAIV Effectiveness and Vaccination of Children. It is reprinted below in its entirety.

Recent Finding

CDC conducts vaccine effectiveness (VE) studies with the U.S. Influenza Vaccine Effectiveness (Flu VE) Network each season to estimate flu vaccine VE. Mid-season VE estimates for the 2013–2014 season were published on February 20, 2014, in a Morbidity and Mortality Weekly Report entitled: "Interim Estimates of 2013–14 Seasonal Influenza Vaccine Effectiveness—United States." Final overall VE estimates were similar to the interim published estimates. However, end of season data evaluated during the summer by the Flu VE Network also allowed separate estimates for the live attenuated influenza vaccine (LAIV, or the "nasal spray vaccine") and inactivated influenza vaccine (IIV or "the flu shot). During 2013–2014 there was no measurable effectiveness for LAIV against influenza A (H1N1) among children enrolled in the study.

While it is well-known that VE can vary by age group, season, circulating influenza viruses and by vaccine, this finding is unexpected and different from some previous studies, which suggested that LAIV may be more effective for younger children. Since 2008, ACIP and CDC have recommended that all children 6 months and older (with rare exceptions) receive influenza vaccine annually, using any licensed age-appropriate vaccine. During the summer of 2014, however, ACIP and CDC recommended that beginning during the 2014–2015 influenza season, LAIV should be used for healthy children 2 through 8 years of age when immediately available and when there are no contraindications or precautions against getting that vaccine. This decision was based on previous data showing that LAIV offered superior protection against influenza virus infection compared to IIV in young children.

The reasons behind the lack of effectiveness against H1N1infections for LAIV during the 2013–14 season are not fully understood. It is possible that results may be specific to the H1N1 component of LAIV. Influenza H1N1 viruses predominated during the 2013–2014 season for the first time since their emergence in 2009 when they caused a pandemic. It also is possible—though less likely—that there is an unidentified issue with the study methods or analysis plan.

CDC is working with ACIP and other partners to collect more information to better understand these data and to determine what actions might be appropriate.

2014–2015 Season

The 2013–2014 season LAIV VE estimates against H1N1 for children suggest that LAIV may not protect against H1N1 viruses during the 2014–2015 season because the same H1N1 vaccine virus from 2013–2014 is included in the 2014–2015 vaccine. All LAIV is designed to protect against four different influenza viruses: Influenza A (H1N1), A (H3N2) and two influenza B viruses.

CDC has been monitoring surveillance data closely. So far, U.S. seasonal surveillance data as reported in FluView indicate substantially greater circulation of H3N2 and B viruses and little circulation of H1N1 viruses. (Of the subtyped viruses reported to CDC from the week ending October 5 through the week ending October 25, 2014, 387 (31%) have been H3N2 viruses, 387 (31%) have been influenza B viruses and 16 (1%) have been H1N1 viruses. Another 466 influenza A viruses were not subtyped.)

In addition, some of the influenza A (H3N2) viruses have been drifted from the H3N2 vaccine virus used in this season’s vaccine. (An October 3 Morbidity and Mortality Weekly Report "Influenza Update" reported that CDC antigenically characterized 391 viruses collected worldwide during May 18 through September 20, 2014, including 70 A (H1N1) viruses, 141 influenza A (H3N2) viruses, and 180 influenza B viruses. Of the 141 influenza A (H3N2) viruses characterized, 69 (49%) were antigenically similar to A/Texas/50/2012, the influenza A (H3N2) component of the 2014–2015 influenza vaccine for the Northern Hemisphere. Only 10 A (H3N2) viruses collected in the United States since October 1 have been characterized so far this season. Seven of these (70%) are like the A (H3N2) vaccine virus, 3 (30%) have been characterized as A/Switzerland/9715293/2013, an antigenic variant virus which has been selected for the 2015 Southern Hemisphere influenza vaccine.) It is important to note that there are some data to suggest that LAIV may offer better protection than IIV against antigenically drifted viruses.

As of October 31, manufacturers reported having distributed more than 132 million doses of the 151 million to 156 million total doses projected to be available for the U.S. market this season. (The manufacturer of LAIV projected that as many as 18 million doses of LAIV would be produced for the U.S. market this season.) Vaccine uptake data for this season are not yet available, however, past trends suggest that more than half of flu vaccines given to children are administered by the end of October, suggesting that many children may have already gotten vaccinated.


1. Surveillance shows that there is substantially more circulation of influenza A (H3N2) and B viruses and very little circulating H1N1 so far;

2. LAIV has been shown to offer good protection against influenza A (H3N2) and influenza B viruses in the past;

3. LAIV may offer better protection than IIV against antigenically drifted viruses that may circulate this season; and,

4. Vaccine providers have received their vaccine for the 2014–2015 season and have likely administered a good proportion of it;

ACIP and CDC have not changed the current influenza vaccination recommendations.

People who have not been vaccinated yet this season should get vaccinated now. Parents should seek to get their children immunized with whatever vaccine is immediately available and indicated. Influenza vaccination should not be delayed to procure a specific vaccine preparation. The HealthMap Vaccine Finder can be used to locate vaccine.

CDC is in discussions with the manufacturer of LAIV, the Department of Defense, the Food and Drug Administration, and other partners to better understand the data from last season, and to determine causes and ways to address the low VE of LAIV against H1N1. For the current season, the U.S. Flu VE Network has expanded enrollment of children and will continue ongoing studies of serologic outcomes after vaccination in children getting IIV and LAIV. This additional data collected during 2014–2015 will help inform discussion about this matter further.

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CDC publishes "Vital Signs" report on cervical cancer; related town hall teleconference will be held on November 12

CDC published Vital Signs: Cervical Cancer Incidence, Mortality, and Screening—United States, 2007–2012 in the November 7 issue of MMWR (pages 1004–1009). Two paragraphs from a related CDC press release are reprinted below.

Despite evidence that cervical cancer screening saves lives, about eight million women ages 21 to 65 years have not been screened for cervical cancer in the past five years, according to a new Vital Signs ( report from the Centers for Disease Control and Prevention. More than half of new cervical cancer cases occur among women who have never or rarely been screened...

Using the human papillomavirus (HPV) vaccine as a primary prevention measure could also help reduce cervical cancer and deaths from cervical cancer. Another recent CDC study showed that the vaccine is underused; only 1 in 3 girls and 1 in 7 boys had received the 3-dose series in 2013. The HPV vaccine is recommended as a routine vaccine for children 11–12 years old. Modeling studies have shown that HPV vaccination and cervical cancer screening combined can prevent as many as 93 percent of new cervical cancer cases.

Town Hall Teleconference

Each month, CDC hosts a town hall teleconference about the topic of the latest CDC Vital Signs report. On November 12 from 2:00–3:00 p.m. (ET), CDC will host a Vital Signs teleconference titled:  Cervical Cancer Prevention: State Perspectives on Screening and HPV Vaccination. To participate, call 800-857-0764 (USA only) and enter participant passcode: 795-4413.

Speakers include:
  • Steven L. Reynolds, MPH, deputy director, Office for State, Tribal, Local and Territorial Support, CDC
  • Vicki Benard, PhD, epidemiologist and team lead, Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC
  • Cheley Grigsby, program director, Alaska Breast and Cervical Health Check, Division of Public Health, Alaska Department of Health and Social Services
  • Heather Hirsch, program coordinator, Comprehensive Cancer Control Program, Minnesota Department of Health and Minnesota Cancer Alliance
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IAC Spotlight! Unprotected People Reports about vaccine-preventable diseases; powerful story about a college student's struggle with meningococcal disease

For years, IAC has published Unprotected People Reports, real-life accounts of people who have suffered or died from vaccine-preventable diseases. The Unprotected People Report web section on provides access to more than 100 personal testimonies, remembrances, case reports, and newspaper articles, as well as to opinion pieces about the value of immunization.

IAC recently posted a new Unprotected People Report, titled Overlooked Casualties: Jamie Schanbaum. Ms. Schanbaum thinks it's important that others understand what meningococcal disease is and what it can do to a person. "I went into the hospital thinking it's not that serious. I wasn't thinking my legs are going to come off or anything like that. I'm thinking I'll only be there a brief moment, not seven months," she recalls.

Additionally, the Unprotected People Reports web section offers direct links to similar resources from our immunization partners, including personal stories from Every Child By Two, California Immunization Coalition’s "Shot by Shot" website, Children's Hospital of Philadelphia Vaccine Education Center, Families Fighting Flu, National Foundation for Infectious Diseases, National Meningitis Association, and the book The Forgotten Story from the Texas Children’s Hospital.

IAC offers personal accounts about vaccine-preventable diseases on both of our websites: and

Related Links Do you have a personal account, remembrance, or patient story to share with others? Please upload your photo and document via IAC's Submit Report form.

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Voices for Vaccines releases online Community Immunity Toolkit

Voices for Vaccines (VFV), a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters, has released a new resource online. VFV's Community Immunity Toolkit provides ideas and resources to help inform, inspire, and motivate daycare, school, and community program leaders, as well as parents, to protect all those in their communities by achieving and maintaining a high rate of vaccination.

VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to join VFV!
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IAC posts Indonesian translation of inactivated influenza vaccine VIS

IAC recently posted the Vaccine Information Statement (VIS) for the inactivated influenza vaccine (IIV) in Indonesian. IAC thanks Wentworth-Douglass Hospital, Dover, NH, for donating this translation.

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CDC provides travel advice for colleges and universities regarding the Ebola outbreak in West Africa

CDC recently developed a new set of online Q&As titled Advice for Colleges, Universities, and Students about Ebola in West Africa. CDC recommends that people avoid non-essential travel to Guinea, Liberia, and Sierra Leone at this time, which includes education-related travel.

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NFID partners with Major League Soccer to raise awareness about the prevention and treatment of influenza

The National Foundation for Infectious Diseases (NFID) and Major League Soccer (MLS) have partnered to raise awareness about the prevention and treatment of influenza. This partnership, aimed at soccer fans throughout North America, includes important influenza messaging at all nationally broadcast games between October and December 2014. Fans attending the games, as well as those viewing at home, will see messages reminding them to get their annual influenza vaccine and encouraging them to visit to learn more about how to fight influenza. Back to top

Influenza is serious; many resources are available to aid 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

CDC reports on declines in pneumococcal hospitalizations of children associated with use of pneumococcal conjugate vaccines

CDC published Declines in Pneumonia Hospitalizations of Children Aged <2 Years Associated With the Use of Pneumococcal Conjugate Vaccines—Tennessee, 1998–2012in the November 7 issue of MMWR (pages 995–998). A summary made available to the press is reprinted below.

Pneumonia hospitalizations in young children in Tennessee are at a historically low level, having declined over 70% from years prior to 2000. A pneumococcal conjugate vaccine (PCV7) was first introduced into the infant immunization program in the U.S. in 2000. In 2010, an expanded version (PCV13) was substituted, which protects children against 13 types of the pneumococcal bacteria that is a major cause of childhood pneumonia. PCV7 was associated with a 43% decline in pneumonia hospitalizations in US children aged <2 years by 2009. Using hospital discharge data in Tennessee, researchers found that PCV13 was associated with a further 27% decline in pneumonia hospitalizations in children aged <2 years by 2012.

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CDC publishes article about establishment of a community care center for Ebola patients in Liberia

CDC published Establishment of a Community Care Center for Isolation and Management of Ebola Patients—Bomi County, Liberia, October 2014, in the November 7 issue of MMWR (pages 1010–1012). This article was previously published as an MMWR Early Release on November 4. The first four sentences are reprinted below.

As of October 29, 2014, a total of 6,454 Ebola virus disease (Ebola) cases had been reported in Liberia by the Liberian Ministry of Health and Social Welfare, with 2,609 deaths. Although the national strategy for combating the ongoing Ebola epidemic calls for construction of Ebola treatment units (ETUs) in all 15 counties of Liberia, only a limited number are operational, and most of these are within Montserrado County. ETUs are intended to improve medical care delivery to persons whose illnesses meet Ebola case definitions, while also allowing for the safe isolation of patients to break chains of transmission in the community. Until additional ETUs are constructed, the Ministry of Health and Social Welfare is supporting development of community care centers (CCCs) for isolation of patients who are awaiting Ebola diagnostic test results and for provision of basic care (e.g., oral rehydration salts solutions) to patients confirmed to have Ebola who are awaiting transfer to ETUs.

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Registration deadline for February 25–26 ACIP meeting is February 2 for non-U.S. citizens and February 9 for citizens

CDC's Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on February 25–26 in Atlanta at CDC's Clifton Road campus. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens is February 2; it's February 9 for U.S. citizens. Registration is not required to watch the live webcast of the meeting.

More information available from the CDC website.

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Question of the Week

A 4-year-old patient came in with a rash and a low-grade fever. The first MMR dose was given 10 days ago. Her measles IgM was positive. Can the child have the disease or are the IgM results from the vaccination? After the rash resolves, how long is the patient contagious?  
Answer:  If there is no one else known to have measles in the community, or to have had contact with the child, the rash and positive IgM test are most likely related to the vaccination and the child is not contagious. We also recommend a viral specimen (nasopharyngeal swab) for PCR, to determine the genotype, which would be the only way to distinguish between wild-type virus and vaccine virus. If there is ANY possibility the child has been in contact with someone with measles, he/she should be isolated at home, and deemed possibly contagious until 4 days after the onset of the rash.

If you suspect measles disease for any reason, please also contact your local health department for assistance with contact tracing and disease control.

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 questions 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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