Issue 1160: December 23, 2014

Ask the Experts–Question of the Week: We offer the quadrivalent inactivated influenza vaccine in our office. Will it protect…read more

Happy holidays from all of us at IAC!

All of us at the Immunization Action Coalition (IAC) wish you, our readers, a safe, happy, and relaxing holiday season. Because of the holiday schedule, we will not publish another issue of IAC Express until January 6.

In observance of the upcoming holidays, the IAC office will be closed on Wednesday, December 24 (Christmas Eve), Thursday, December 25 (Christmas), and Friday, December 26. We will be resuming normal business hours on December 29. Our office will also be closed on January 1 (New Year’s Day).

Happy holidays!

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FDA approves quadrivalent formulation of Fluzone Intradermal inactivated influenza vaccine

On December 11, FDA announced the approval of a quadrivalent formulation of Fluzone Intradermal, inactivated influenza vaccine (Sanofi Pasteur). Fluzone Intradermal vaccine, which has been available in trivalent formulation for three years, is now available in a quadrivalent formulation to help protect against four strains of influenza virus. Fluzone Intradermal Quadrivalent vaccine is indicated for adults 18 through 64 years of age for active immunization for the prevention of influenza caused by influenza A subtype viruses and type B viruses contained in the vaccine.

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Host a screening of the new documentary about cervical cancer and HPV

A documentary on human papillomavirus (HPV) infection and cervical cancer, Someone You Love, was released in September. The documentary is narrated by Vanessa Williams and features women who have experienced cervical cancer due to HPV infection. The first paragraph of a summary from the film's web page is reprinted below.

“I wish the cancer would have killed you!” These are the chilling words of Susie’s husband when he learned that her cancer was caused by HPV, a sexually transmitted virus. Narrated by Vanessa Williams, this poignant documentary takes a look into the lives of five women affected by HPV, the widely misunderstood and controversial virus that causes several types of cancer, including cervical. Each of these women has an intimate story to tell. For Susie, Tamika and Christine, it’s a story of survivorship that comes with misconceptions, stigma, shame, heartbreak, pain and triumph. For the Forbes’ family, it’s about coping with the loss of their daughter Kristen and trying to prevent it from happening to others like her. [Others, like Kelly, began the cancer journey at age 31.] The cameras follow Kelly on her epic battle to save her marriage, her career, her family and ultimately, her life. There may be a screening of Someone You Love coming to a theater near you in January, or you can consider hosting a screening. 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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Voices for Vaccines to host a call about nurse advocacy for immunization on January 13

Nurses are on the front lines of vaccine advocacy, both as vaccine administrators and also as a source for parents who have questions. On the next Voices for Vaccines (VFV) conference call, Nurses Who Vaccinate founder Melody Butler will discuss how nurses can make a difference in encouraging vaccination. This call is scheduled for January 13, 12:00 p.m. (ET) (9:00 a.m. [PT]).

No matter who you are or what you do, you are welcome to join VFV for an interesting discussion about the critical role nurses play in keeping our communities safe from preventable disease.
To register for this call, please email

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!
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IAC enrolls seven more birthing institutions into its Hepatitis B Birth Dose Honor Roll; two previously honored institutions qualify 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.
  • Daviess Community Hospital, Washington, IN (99%)
  • Faxton St. Luke's Healthcare, Utica, NY (96%)
  • Indiana University Health, Indianapolis, IN (100%)
  • Mercy Hospital Washington, Washington, MO (94%)
  • Penobscot Valley Hospital, Lincoln, ME (100%)
  • Spectrum Health Grand Rapids Hospital, Grand Rapids, MI (90%)
  • St. Dominic-Jackson Memorial Hospital, Mount Olive, MS (97%)
In addition, the following two institutions are being recognized for a second year.
  • Liberty Hospital, Liberty, MO (93%)
  • Mother/Baby Unit Grady Health Systems, Atlanta, GA (100%)
The Honor Roll now includes 159 birthing institutions from 28 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! IAC's "Video of the Week" feature enters its seventh year of showcasing vaccine-related videos

IAC’s Video of the Week showcases videos that promote education and awareness of immunization issues to healthcare professionals, their patients, the public, and the media. The featured videos cover a range of topics and appeal to different audiences. Each week, the selected video is featured in IAC Express and on the home page. 

Since launching Video of the Week in December 2008, IAC has presented television programs and films in which vaccine-preventable diseases and immunization topics figure prominently, relevant webcasts from government agencies, and immunization-specific continuing education programs and public service announcements. To view the complete collection of IAC’s Video of the Week from the past, visit the video archive at

Do you have a video about immunization or vaccine-preventable diseases to promote via IAC's Video of the Week? Please submit it by email to at IAC.

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In 2015, National Infant Immunization Week will be held April 18–25

CDC has announced that in 2015, National Infant Immunization Week (NIIW) will be held April 18–25. In the upcoming months, additional information and resources will be added to the NIIW website.

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IAC updates its handout for healthcare professionals, "Pneumococcal Vaccines—CDC answers your questions"

IAC recently updated Pneumococcal Vaccines—CDC answers your questions, a resource for healthcare professionals, to include information about ACIP's August recommendations for the use of pneumococcal vaccines in people 65 years and older.

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IAC updates four important screening checklists for contraindications and precautions to vaccination

IAC recently revised the following four patient screening checklists. The age indication for egg-free recombinant influenza vaccine (FluBlok, Protein Sciences) was updated on page 2 to include adults age 18 years and older.
  1. Screening Checklist for Contraindications to Vaccines for Children and Teens
  2. Screening Checklist for Contraindications to Vaccines for Adults
  3. Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination
  4. Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination (also included an edit to page 1, question #5, to add [including asthma] to "lung disease")
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IAC updates statistics about vaccine-preventable diseases in its "Vaccines Work!" handout

IAC recently updated the resource titled Vaccines work! CDC statistics demonstrate dramatic declines in vaccine-preventable diseases when compared with the pre-vaccine era with the most recently available statistics (2013). This handout may be useful when discussing vaccine effectiveness with vaccine-hesitant patients and parents.

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CDC publishes "Mission Critical—2014 Year in Review"

On December 15, CDC released a document to the press titled "Mission Critical—2014 Year in Review" that summarized the ten most challenging public health threats of 2014. The introductory paragraphs are reprinted below.

It’s been an unprecedented year for the Centers for Disease Control and Prevention (CDC), as America’s public health agency continues its emergency response to the most complex Ebola epidemic in history. Ebola, however, is far from the only critical mission CDC undertook in 2014.

“CDC’s Ebola response is the largest global effort in the agency’s history, but we’re carrying out many other public-health missions crucial to protecting American lives,” said CDC Director Tom Frieden, MD, MPH. “We’re taking action on a wide range of health threats.”

The retrospective is divided into the four following "Missions":
  1. Mission: New Infectious Disease Threats
  2. Mission: Continued Fight Against Infectious Diseases (includes the work on global polio eradication)
  3. Mission: Lab Safety
  4. Mission: Leading Causes of Death
To learn more about these missions and the top ten public health threats of 2014 according to CDC, visit the Mission: Critical—2014 Year in Review web page. This page includes many useful links to additional resources for each item.

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Report on the Global Vaccine Action Plan shows that progress on vaccination rate improvement is slowing

The 2014 progress report on the Global Vaccine Action Plan, a road map developed by the Strategic Advisory Group of Experts on Immunization, shows that progress on improving vaccination rates is slowing. The report highlights persistent gaps in coverage that threaten the lives of millions of children around the world, especially the most vulnerable. Three paragraphs from the "Executive Summary" are reprinted below.

The Global Vaccine Action Plan has two great ambitions. First, to deliver vaccination to all—because 1.5 million children still die every year of diseases that can be prevented by the vaccines that humankind has developed. Second, to unleash vaccines’ vast future potential—because their impressive history is just the foundation stone of greater achievements to come.

The Global Vaccine Action Plan set six key immunization targets with deadlines at the end of 2014 or 2015. Just one of these six is on track to be achieved. Some have been missed multiple times before. The targets each relate to different vaccines and diseases, but common threads run throughout: failure to extend vaccination services to people who cannot currently access them at all, and failure to strengthen the healthcare system so that all doses of vaccine are reliably provided.

There is some reason for hope. There has been success in introducing new vaccines, and positive achievements in some countries. Major change is possible. The Global Vaccine Action Plan was created to end the inequity in vaccination worldwide, and hence to save millions of lives. This need remains as important and urgent as ever. It is not acceptable that the plan is failing to deliver at the scale that is required.
The Strategic Advisory Group of Experts (SAGE) on Immunization was established by the Director-General of the World Health Organization in 1999 to provide guidance on the work of WHO. SAGE is the principal advisory group to WHO for vaccines and immunization.

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CDC adds two new resources to its Provider Resources for Vaccine Conversations with Parents suite

CDC recently posted the following two parent-friendly resources to its Provider Resources for Vaccine Conversations with Parents suite of materials. Access other resources from the Provider Resources for Vaccine Conversations with Parents web section. These materials have been developed by CDC in collaboration with the American Academy of Family Physicians and the American Academy of Pediatrics.

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Trust for America's Health publishes report on the nation's ability to manage severe infectious disease threats

In December, the Trust for America's Health published a report titled Outbreaks: Protecting Americans from Infectious Diseases. The report found that the Ebola outbreak exposed serious gaps in the nation's ability to manage severe infectious disease threats. A summary of the key findings from the Vaccinations section is reprinted below.

Vaccinations: More than 2 million preschoolers, 35 percent of seniors and a majority of adults do not receive all recommended vaccinations.
  • Only 14 states vaccinated at least half of their population against the seasonal flu (from fall 2013 to spring 2014)
  • Only 35 states and Washington, D.C. met the goal for vaccinating young children against the hepatitis B virus (Healthy People 2020 target is 90 percent of children ages 19 to 35 months receiving at least 3 doses)
Besides Vaccinations, other sections in the report include Preparing for Emerging Threats, Healthcare-Associated Infections, Sexually Transmitted Infections and Related Disease Treatment and Prevention, and Food Safety.

Trust for America's Health is a nonprofit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

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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

New study finds no safety concerns with inadvertent HPV vaccination during pregnancy

A CDC study looking at HPV vaccination during pregnancy was published in the journal Vaccine online on December 8. A news bulletin from CDC is reprinted below.

A new CDC study looking at human papillomavirus (HPV) vaccination during pregnancy was published in the journal Vaccine this week.

Researchers reviewed reports to the Vaccine Adverse Event Reporting System (VAERS) about women who received the HPV vaccine Gardasil while they were pregnant. Gardasil® is not currently recommended for pregnant women, given the limited available safety data in pregnancy. However, because catchup vaccination is recommended for women through age 26, there is a possibility that some women will receive the vaccine before realizing that they are pregnant. This study found no patterns of safety concerns for pregnant woman who received Gardasil, or for their babies.

This study adds to the literature on the safety of HPV vaccination during pregnancy. Gardasil’s manufacturer, Merck, maintained a Gardasil® Pregnancy Registry from 2006 to 2012. No safety concerns were noted in this registry.

For more information on HPV vaccine safety, see: Back to top

CDC reports on influenza activity in the United States from September 28–December 6

CDC published Update: Influenza Activity—United States, September 28–December 6, 2014 in the December 19 issue of MMWR (pages 1189–1194). A summary made available to the press is reprinted below.

During September 28–December 6, 2014, influenza activity in the United States has been increasing. Influenza A (H3N2) viruses were the most frequently identified and more than half of the influenza A (H3N2) viruses characterized thus far have evidence of reduced reactivity to the H3N2 component of this season’s influenza vaccine. Despite less-than-optimal match between circulating viruses and the vaccine virus, vaccination remains the most effective method to prevent influenza and its complications. Healthcare providers should recommend vaccination to all unvaccinated persons 6 months of age or older now and throughout the influenza season. Treatment with influenza antiviral medications can also reduce severe outcomes of influenza when initiated as early as possible in patients with confirmed or suspected influenza.

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CDC reports on measles transmission in an international airport

CDC published Notes from the Field: Measles Transmission at a Domestic Terminal Gate in an International Airport—United States, January 2014 in the December 19 issue of MMWR (page 1211). The first two sentences and the last paragraph are reprinted below.

In March 2014, CDC identified a possible cluster of four laboratory-confirmed measles cases among passengers transiting a domestic terminal in a U.S. international airport. Through epidemiologic assessments conducted by multiple health departments and investigation of flight itineraries by CDC, all four patients were linked to the same terminal gate during a 4-hour period on January 17, 2014....

Measles transmission has occurred in airports, an environment in which travelers from measles-endemic areas or areas where outbreaks are occurring are likely to be present. The exposures in this report were not prolonged and occurred in a domestic rather than an international terminal, highlighting the fact that measles is highly contagious and that measles continues to pose a risk for infection among unvaccinated persons in the United States. Ensuring that all susceptible travelers are vaccinated against measles is an important way to decrease the spread and importation of measles in the United States. Airports and other travel venues should be considered as potential exposure settings when investigating cases.

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CDC publishes four articles about the Ebola epidemic in West Africa; two previously published as MMWR Early Releases

CDC published the following four articles about Ebola in the December 19 issue of MMWR. The first two were previously published as MMWR Early Releases on December 16. The last two were published as MMWR Early Releases on December 12 and covered in IAC Express on December 16.
  1. Update: Ebola Virus Disease Epidemic—West Africa, December 2014
  2. Challenges in Responding to the Ebola Epidemic—Four Rural Counties, Liberia, August–November 2014
  3. Support Services for Survivors of Ebola Virus Disease—Sierra Leone, 2014
  4. Reintegration of Ebola Survivors into Their Communities—Firestone District, Liberia, 2014
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ACOG to sponsor January 21 webinar on Tdap vaccination in pregnancy

The American College of Obstetricians and Gynecologists (ACOG) is sponsoring a one-hour webinar at 12:00 p.m. (ET) on January 21 titled "Tdap Vaccination in Pregnancy: A Mother’s Gift to Her Baby." The course is free, offers one CME credit, and is open to all (not just ACOG fellows). The webinar will detail ACOG and ACIP’s Tdap immunization recommendations, describe the safety and common side effects of Tdap vaccination, and explain the importance of and optimal timing for Tdap immunization during pregnancy.

Related Links Email ACOG at with any questions about this webinar.

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Archived video broadcast of the October 2014 ACIP meeting now available

ACIP recently posted the archived video broadcast footage from the ACIP meeting held on October 29–30.

Presentation slides from this meeting are also available.

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Shot@Life invites vaccine advocates to apply to attend its 2015 Champion Summit from March 2–4

Shot@Life is a campaign of the United Nations Foundation that educates and empowers U.S. supporters to advocate for global childhood immunization programs. The campaign invites interested parties to apply to attend Shot@Life’s 2015 Champion Summit from March 2–4 in Washington, DC. Summit attendees will gain and refine the skills needed to be effective advocates within their communities and make their voices heard among policymakers to protect children worldwide by providing life-saving vaccines where they are needed most.

Accepted applicants will be responsible for a $99 registration fee and travel expenses; Shot@Life will cover hotel accommodations. Limited travel scholarships are available. The deadline to apply is January 9, 2015. Back to top

Question of the Week

We offer the quadrivalent inactivated influenza vaccine in our office. Will it protect our patients against the drifted H3N2 influenza virus?  

Answer: The additional strain in the quadrivalent formulations of the inactivated influenza vaccine is an influenza-B strain. The drifted H3N2 viruses aren’t precisely matched in influenza vaccines distributed in the United States. However, antibodies made in response to vaccination with one influenza virus may provide some protection against different but related viruses. A less than optimal match may result in reduced vaccine effectiveness but it can still provide some protection against influenza illness. In addition, even when there is a less than optimal match or lower effectiveness against one virus, it is important to remember that influenza vaccine contains three or four influenza virus strains, depending on the vaccine. There are presently B influenza viruses circulating, as well as the A/H3N2 viruses. For these reasons, even during seasons when there is a less than optimal match, CDC continues to recommend vaccination. This is particularly important for people at high risk for serious complications and their close contacts.

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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