Issue 1152: November 18, 2014

Ask the Experts–Question of the Week: What is the maximum number of hepatitis B vaccine doses a dialysis patient can … read more

World Health Organization warns that progress towards the elimination of measles has stalled

On November 13, the World Health Organization (WHO) posted a news release titled WHO warns that progress towards eliminating measles has stalled—2015 targets will not be met. Three paragraphs are reprinted below.

The World Health Organization (WHO) warned today that progress towards the elimination of measles has stalled. The number of deaths from measles increased from an estimated 122,000 in 2012 to 145,700 in 2013, according to new data published in the WHO Weekly Epidemiological Report and the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The estimated number of measles deaths in 2013 represents a 75% decline in mortality since 2000, significantly below the target of a 95% reduction in deaths between 2000 and 2015.

“Poor progress in increasing measles vaccination coverage has resulted in large outbreaks of this highly contagious disease, throwing the 2015 elimination targets off-track,” said Dr. Peter Strebel from the WHO Department of Immunization, Vaccines, and Biologicals.…

While the increase in the disease in 2013 was in large part due to outbreaks in China, the Democratic Republic of the Congo, and Nigeria, sizeable outbreaks were also reported in other parts of the world. Progress is stalled in the WHO Eastern Mediterranean region, where weak health systems and conflict and population displacement have hampered vaccination efforts. Meanwhile, the European region has seen measles re-emerge with outbreaks in a number of countries including Georgia, Turkey, and Ukraine, and renewed high-level political commitment is needed to reverse this trend.

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

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.
  • Beth Israel Deaconess Medical Center, Boston, MA (91%)
  • Bridgton Hospital, Bridgton, ME (92%)
  • Falmouth Hospital, Falmouth, MA (93%)
  • Franciscan St. Elizabeth Health, Lafayette, IN (100%)
  • Indiana University Health Arnett Hospital, Lafayette, IN (100%)
  • Indiana University Health North Hospital, Carmel, IN (100%)
  • Indiana University Health West Hospital, Avon, IN (100%)
  • Stephens Memorial Hospital, Norway, ME (90%)
In addition, the following four institutions are being recognized for a second year:
  • Ephraim McDowell Regional Medical Center, Danville, KY (99%)
  • Habersham Medical Center, Demorest, GA (93%)
  • Methodist Le Bonheur Healthcare-South, Memphis, TN (98%)
  • Regional Medical Center, San Jose, CA (95%)
The Honor Roll now includes 146 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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IAC Spotlight! Eleven more healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

IAC urges qualifying healthcare organizations to apply for its Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel. More than 450 organizations are now enrolled.

Since October 28, when IAC Express last reported on the Influenza Vaccination Honor Roll, 11 healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, health departments, and government entities
  • Columbus Public Health, Columbus, OH
  • Greater Lawrence Family Health Center, Lawrence, MA
  • Health Delivery, Inc., Saginaw, MI
  • Iroquois Memorial Hospital, Watseka, IL
  • Marshfield Clinic, Marshfield, WI
  • Mountain States Health Alliance, Johnson City, TN
  • Saint Vincent Hospital, Erie, PA
  • Sanford Health of Northern Minnesota, Bemidji, MN
  • Sanford Health Vermillion, Vermillion, SD
  • Sanford Jackson Medical Center, Jackson, MN
  • St. Joseph's Hospital Health Center, Syracuse, NY
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IAC updates its parent handout titled "Top Ten Reasons to Protect Your Child by Vaccinating"

IAC added new artwork to its parent education handout, Top Ten Reasons to Protect Your Child by Vaccinating. This piece is an easy-to-read, ready-to-copy handout that highlights the seriousness of vaccine-preventable diseases and the importance of vaccination.

Access the same handout in Spanish: Las diez razones principales para proteger a su hijo con las vacunas.

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 posts additional translations of VISs for influenza vaccines in Bengali, Polish, Urdu, and Yiddish

IAC recently posted Vaccine Information Statements (VISs) for the inactivated influenza vaccine (IIV) and the live attenuated influenza vaccine (LAIV) in Bengali, Polish, Urdu, and Yiddish. IAC thanks the New York City Department of Health and Mental Hygiene for the translations.

Inactivated influenza vaccine (IIV) VIS Live attenuated influenza vaccine (LAIV) VIS Related Links Back to top

CDC releases guidance for screening and caring for pregnant women with Ebola

CDC recently posted a new information online titled Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals. The "Key Points" section is reprinted below.

Key Points
  • Healthcare providers caring for pregnant women in U.S. hospitals need to be prepared to screen patients for Ebola and have a plan in place to triage these patients
  • Obstetric management of pregnant women with Ebola, particularly decisions about mode of delivery for women in labor, needs to consider risks to the woman, risks of exposure for healthcare providers, and potential benefits to the neonate.
  • Healthcare workers who are pregnant should not care for patients with Ebola.
  • Pregnant women with known or suspected Ebola should be hospitalized, and CDC guidance for hospitalized patients with known or suspected Ebola should be followed.
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CDC issues a new travel health notice concerning Ebola cases in Mali, and updates travel health notices about Ebola in Liberia, Sierra Leone, and Guinea 

On November 13, CDC Travelers' Health issued a new travel health notice concerning Ebola in Mail. The purpose of this new alert is to notify travelers that a few Ebola cases have been reported in Bamako, Mali, and to inform them of actions they can take to reduce their risk of getting the disease. On the same day, CDC also issued updated travel health notices about Ebola in Liberia, Sierra Leone, and Guinea. CDC urges all US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of unprecedented outbreaks of Ebola in those countries.

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CDC publishes six articles about Ebola as MMWR Early Releases

On November 14, CDC published the following six MMWR Early Releases about Ebola in Africa and the United States:
  1. Evidence for a Decrease in Transmission of Ebola Virus—Lofa County, Liberia, June 8–November 1, 2014; [PDF version].
  2. Evidence for Declining Numbers of Ebola Cases—Montserrado County, Liberia, June–October 2014; [PDF version].
  3. Ebola Virus Disease Cases Among Health Care Workers Not Working in Ebola Treatment Units—Liberia, June–August 2014; [PDF version].
  4. Ebola Epidemic—Liberia, March–October 2014; [PDF version].
  5. Ebola Virus Disease Cluster in the United States—Dallas County, Texas, 2014; [PDF version].
  6. Response to Importation of a Case of Ebola Virus Disease—Ohio, October 2014; [PDF version].
The first three paragraphs of a related CDC press release are reprinted below.

CDC Releases New Reports on Ebola Cases in Liberia and the United States

The effort to contain the Ebola epidemic in Liberia is showing preliminary signs of progress in some counties, but maintaining and extending these trends will require sustained efforts, according to three early-release articles in CDC’s 
Morbidity and Mortality Weekly Report (MMWR) on November 14. The three reports are among six MMWR articles on Ebola released by CDC today.

One of the six reports provides an overview of the complex and rapidly changing situation in Liberia. There is widespread distribution of disease in urban and rural settings. Containing the epidemic will require more intensive efforts to identify new cases and perform contact tracing in the densely populated capital city of Monrovia while rapidly containing outbreaks in hard-to-reach and newly affected areas.

Two other reports document a significant decrease in new Ebola cases in two of Liberia’s 15 counties. Nevertheless, new cases continue to occur in these areas. United States, Liberian and international partners are now responding to new outbreaks in remote parts of the country as opposed to the larger outbreaks primarily occurring in more accessible areas. In recent weeks, there has been approximately one new outbreak or cluster per day. For comparison, during the past four decades, CDC has responded to approximately one Ebola outbreak every one to two years.

Access the complete press release: CDC Releases New Reports on Ebola Cases in Liberia and the United States

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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 progress towards global measles elimination

CDC published Progress Toward Regional Measles Elimination—Worldwide, 2000–2013 in the November 14 issue of MMWR (pages 1034–1038). A summary made available to the press is reprinted below.

During 2000–2013, measles declined 72% worldwide preventing an estimated 15.6 million deaths. During 2013, 205 million children were vaccinated against measles during supplementary immunization activities. Despite this progress, the African, Eastern Mediterranean, and European regions are not on track to achieve measles elimination targets by 2020, and progress in the Western Pacific Region is at-risk.

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New study published on the safety of Tdap vaccine in pregnancy

On November 12, the Journal of the American Medical Association published an article by Elyse O. Kharbanda, MD, MPH, and colleagues, titled Evaluation of the Association of Maternal Pertussis Vaccination With Obstetric Events and Birth Outcomes. A related news bulletin from CDC is reprinted below in its entirety.

New Study Finds Tdap Vaccine During Pregnancy Not Associated With Increased Risk of Preterm Delivery or Small Birth Size

A study looking at safety of the Tdap vaccine during pregnancy was published in the Journal of the American Medical Association today.

Researchers used administrative and electronic health record data from two California Vaccine Safety Datalink sites to study whether maternal Tdap vaccination during pregnancy is associated with increased risks of health problems for the mother or baby.

The study found that Tdap vaccination during pregnancy was not associated with increased risk for hypertensive disorders of pregnancy, preterm birth, or having a baby who is small for his or her gestational age.

This study adds important information on the safety of Tdap vaccination during pregnancy, following continued widespread pertussis transmission and current recommendations to routinely vaccinate during pregnancy.

For more information on Tdap vaccination during pregnancy, see

For more information on Tdap vaccine safety, see

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CDC reports on possible eradication of wild poliovirus type 3

CDC published Possible Eradication of Wild Poliovirus Type 3—Worldwide, 2012 in the November 14 issue of MMWR (pages 1031–1033). The first paragraph is reprinted below.

In 1988, the World Health Assembly resolved to eradicate polio worldwide. Since then, four of the six World Health Organization (WHO) regions have been certified as polio-free: the Americas in 1994, the Western Pacific Region in 2000, the European Region in 2002, and the South-East Asia Region in 2014. Currently, nearly 80% of the world's population lives in areas certified as polio-free. Certification may be considered when ≥3 years have passed since the last isolation of wild poliovirus (WPV) in the presence of sensitive, certification-standard surveillance. Although regional eradication has been validated in the European Region and the Western Pacific Region, outbreaks resulting from WPV type 1 (WPV1) imported from known endemic areas were detected and controlled in these regions in 2010 and 2011, respectively. The last reported case associated with WPV type 2 (WPV2) was in India in 1999, marking global interruption of WPV2 transmission. The completion of polio eradication was declared a programmatic emergency for public health in 2012, and the international spread of WPV1 was declared a public health emergency of international concern in May 2014. The efforts needed to interrupt all indigenous WPV1 transmission are now being focused on the remaining endemic countries: Nigeria, Afghanistan, and Pakistan. WPV type 3 (WPV3) has not been detected in circulation since November 11, 2012. This report summarizes the evidence of possible global interruption of transmission of WPV3, based on surveillance for acute flaccid paralysis (AFP) and environmental surveillance.

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CDC's Clinician Outreach and Communication webinar on November 20 will provide important information about cervical cancer detection and prevention; free continuing education credit available

On November 20 at 2:00 p.m. (ET), CDC's Clinician Outreach and Communication Activity (COCA) offers a free one-hour webinar titled Taking Action Against Cervical Cancer Through Early Detection and Vaccination. During this COCA Webinar, clinicians will learn about CDC’s human papillomavirus (HPV) vaccination recommendations and the USPSTF cervical cancer screening recommendations. 

COCA provides timely, accurate, and credible information to clinicians related to emergency preparedness and response and emerging public health threats. COCA fosters partnerships with national clinician organizations to strengthen information-sharing networks before, during, and after a public health emergency. To sign up for COCA Updates, call announcements, clinical reminders, and other COCA clinician resources, send an email to

Webinar Details

Date: Thursday, November 20, 2014 
Time: 2:00 p.m –3 p.m. (ET)
Dial-in number: 800-779-5194 (U.S. Callers)
Passcode: 1197478
Webinar link:
Presenters: Mona Saraiya, MD, MPH, associate director, Office of International Cancer Control, Division of Cancer Prevention and Control, CDC; George Sawaya, MD, professor in Obstetrics, Gynecology and Reproductive Sciences, San Francisco General Hospital; and Francisco Garcia MD, MPH, director of Public Health, Pima County Health Department

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National Conference on Vaccine Research scheduled for April 13–15; abstract submission deadline is December 1

The National Foundation for Infectious Diseases (NFID) is hosting its Conference on Vaccine Research in Bethesda, MD, on April 13–15. Now in its 18th year, the conference has become the largest scientific meeting devoted exclusively to research on vaccines and associated technologies for disease prevention and treatment through immunization.

Abstract submissions for oral or poster presentations at the 2015 Annual Conference on Vaccine Research will be accepted until 11:59 p.m. (ET), December 1. 

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Question of the Week

What is the maximum number of hepatitis B vaccine doses a dialysis patient can receive? 
Answer: There is no maximum number of booster doses a dialysis patient can receive. Serology should be performed once a year and a booster dose given if serology is negative (less than 10 mIU/mL). Serology is not recommended more frequently than once a year, so boosters wouldn’t be given more than once a year. See, pages 27-29.

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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