Issue 1158: December 16, 2014

Ask the Experts–Question of the Week: My patient is a 14-year-old girl who has received one dose of bivalent HPV vaccine …read more

FDA approves the use of Gardasil 9 (Merck) 9-valent HPV vaccine in the U.S.

On December 10, FDA announced the approval of Gardasil 9 (Merck), a human papillomavirus (HPV) 9-valent vaccine. The first two paragraphs of the FDA press release are reprinted below.

The U.S. Food and Drug Administration today approved Gardasil 9 (Human Papillomavirus 9-valent Vaccine, Recombinant) for the prevention of certain diseases caused by nine types of Human Papillomavirus (HPV). Covering nine HPV types, five more HPV types than Gardasil (previously approved by the FDA), Gardasil 9 has the potential to prevent approximately 90 percent of cervical, vulvar, vaginal and anal cancers.

Gardasil 9 is a vaccine approved for use in females ages 9 through 26 and males ages 9 through 15. It is approved for the prevention of cervical, vulvar, vaginal and anal cancers caused by HPV types 16, 18, 31, 33, 45, 52 and 58, and for the prevention of genital warts caused by HPV types 6 or 11. Gardasil 9 adds protection against five additional HPV types—31, 33, 45, 52 and 58—which cause approximately 20 percent of cervical cancers and are not covered by previously FDA-approved HPV vaccines.

ACIP has not yet made any recommendations for the use of Gardasil 9.

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CDC publishes estimates of illnesses and hospitalizations averted by vaccination during the 2013–14 influenza season

CDC published Estimated Influenza Illnesses and Hospitalizations Averted by Vaccination—United States, 2013–14 Influenza Season in the December 12 issue of MMWR (pages 1151–1154). The first paragraph is reprinted below.

The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all persons aged ≥6 months to reduce morbidity and mortality caused by influenza in the United States. CDC previously developed a model to estimate that annual influenza vaccination resulted in 1.1–6.6 million fewer cases and 7,700–79,000 fewer hospitalizations per season during the 2005–2013 influenza seasons. For the 2013–14 influenza season, using updated estimates of vaccination coverage, vaccine effectiveness, and influenza hospitalizations, CDC estimates that influenza vaccination prevented approximately 7.2 million illnesses, 3.1 million medically attended illnesses, and 90,000 hospitalizations associated with influenza. Similar to prior seasons, fewer than half of persons aged ≥6 months are estimated to have been vaccinated. If influenza vaccination levels had reached the Healthy People 2020 target of 70%, an estimated additional 5.9 million illnesses, 2.3 million medically attended illnesses, and 42,000 hospitalizations associated with influenza might have been averted. For the nation to more fully benefit from influenza vaccines, more effort is needed to reach the Healthy People 2020 target.

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IAC’s Dr. L.J Tan interviewed on PBS NewsHour about influenza

On December 11, Litjen (L.J) Tan, MS, PhD, chief strategy officer, Immunization Action Coalition, was interviewed on the national PBS NewsHour in a segment titled What you need to know about this year’s elevated flu threat. The video and transcript of the interview with PBS's Gwen Ifill are available online. The segment includes valuable information for healthcare professionals and their patients.

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IAC Spotlight! Subscribe to immunization-related email news services from CDC, AAP, VEC, and more

The Email News Services section on includes descriptions and subscription information for more than 25 immunization-related e-newsletters and email updates published by governmental and non-governmental agencies, professional societies, academic centers, and nonprofit organizations.

IAC's listing of email news offerings includes CDC's Email Subscription service, AAP's Immunization Initiative Newsletter, Vaccine Education Center's (VEC) Vaccine Update and Parent PACK Newsletters, email news updates, and many more. Browse IAC's selection of e-newsletters and email updates for healthcare professionals, and subscribe to one or more of these helpful resources.

If you have additional email news services to recommend for inclusion on, please send your suggestion(s) by email to

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"Ask the Experts" web section about pneumococcal vaccines updated

The Pneumococcal Vaccines (PCV13 and PPSV23) web section of Ask the Experts was recently updated.

IAC’s Ask the Experts web section is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. The experts are Andrew T. Kroger, MD, MPH, medical officer, and Donna L. Weaver, RN, MN, nurse educator. Both are at CDC's National Center for Immunization and Respiratory Diseases. The Q&As have been featured in previous issues of IAC ExpressNeedle Tips, and Vaccinate Adults.

Related Links Subscribe to IAC Express and receive a new "Ask the Experts" Q&A every week, as well as several special editions of "Ask the Experts" throughout the year.

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CDC requests public comment on proposed new VAERS form; comments must be received by January 23

CDC published a request for public comment in the Federal Register on November 24. The "Summary" section of the notice is published below in its entirety.

The Centers for Disease Control and Prevention (CDC), located within the Department of Health and Human Services (HHS), is publishing this notice requesting public comment on the proposed VAERS 2.0 form, which is intended to replace the current VAERS-1 form ( CDC and the U.S. Food and Drug Administration (FDA) co-administer the Vaccines Adverse Event Reporting System (VAERS), a post-licensure (i.e., after vaccines have been licensed by the FDA and are being used in the community) reporting system that accepts submitted reports of adverse events that occur after vaccination from healthcare providers, manufacturers, and the public. Healthcare providers and vaccine manufacturers are required to submit VAERS reports. The National Childhood Vaccine Injury Act of 1986, section 2125 of the Public Health Service Act (42 U.S.C. 300aa-25) authorized VAERS. The current VAERS form has been used since 1990.

Access the entire Federal Register notice, which includes information about how to submit a comment.

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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 global surveillance of bacterial vaccine-preventable diseases

CDC published Global Invasive Bacterial Vaccine-Preventable Diseases Surveillance—2008–2014 in the December 12 issue of MMWR (pages 1159–1162). A summary made available to the press is reprinted below.

Meningitis and pneumonia are leading causes of morbidity and mortality in children globally. Since 2007, the World Health Organization (WHO) has recommended using pneumococcal conjugate vaccine (PCV) in childhood immunization programs. The WHO Invasive Bacterial and Vaccine Preventable Disease (IB-VPD) surveillance network includes sentinel hospitals and laboratories that report clinical and laboratory data on cases of suspected meningitis, pneumonia or sepsis among children <5 years old to the national ministries of health and WHO. IB-VPD syndromic surveillance with case-based data and laboratory case confirmation provides important data to guide decisions to introduce PCV. As more countries introduce PCV, it is important for this network to continue to improve to be able to assess the impact of this vaccine globally and act as a platform for surveillance of other diseases.

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CDC publishes two new Ebola reports as MMWR Early Releases

On December 12, CDC published the following two articles about Ebola as MMWR Early Releases. Related Link Back to top

CDC reprints four articles about Ebola that were previously published as MMWR Early Releases

CDC published the following four articles about Ebola in the December 12 issue of MMWR. The first three articles were previously published as MMWR Early Releases on December 9; the last article was published as an MMWR Early Release on December 5 and covered in IAC Express on December 9.
  1. Airport Exit and Entry Screening for Ebola—August–November 10, 2014
  2. Ebola Virus Disease in Health Care Workers—Sierra Leone, 2014
  3. Rapid Assessment of Ebola Infection Prevention and Control Needs—Six Districts, Sierra Leone, October 2014
  4. Clinical Inquiries Regarding Ebola Virus Disease Received by CDC—United States, July 9–November 15, 2014
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Abstract submission deadline for 2015 NACCHO conference is December 21

The 2015 annual National Association of County & City Health Officials (NACCHO) conference, Envisioning the Future: Creating Our Path, will be held in Kansas City, MO, on July 7–9, 2015. The deadline to submit abstracts for this conference is December 21, 11:59 p.m. (PT). Back to top

Save the date for the 2015 California Immunization Coalition Summit to be held April 26–27

The 2015 California Immunization Coalition Summit will be held April 26–27, 2015 in Riverside, CA. The Summit will focus on communicating the power of vaccines and readiness to deal with and communicate about new vaccine issues as they arise. The deadline for abstract submissions is January 23. Back to top

Question of the Week

My patient is a 14-year-old girl who has received one dose of bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) and now wants to change over to quadrivalent HPV vaccine (HPV4, Gardasil, Merck). What is the recommendation to be followed? 

Answer: You can complete the series with HPV4 (two more doses), which will assure protection against HPV types 16 and 18 (those types most likely to cause cervical and other cancers and that are in both HPV2 and HPV4). However, receiving only two doses of HPV4 may provide less protection against genital warts than the usual 3 doses. More information is available at

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.

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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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