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Issue 1163: January 20, 2015

Ask the Experts–Question of the Week: If Kinrix (DTaP-IPV, GlaxoSmithKline) is inadvertently given to a child age 15 through 18 months…read more

CDC releases early estimates of seasonal influenza vaccine effectiveness

CDC published Early Estimates of Seasonal Influenza Vaccine Effectiveness—United States, January 2015 in the January 16 issue of MMWR (pages 10–15). A related press release from CDC is reprinted below.

A report published in the January 16 Morbidity and Mortality Weekly Report (MMWR) estimates that getting a flu vaccine this season reduced a person’s risk of having to go to the doctor because of flu by 23 percent among people of all ages.

Since CDC began conducting annual flu vaccine effectiveness (VE) studies in 2004–2005, overall estimates for each season have ranged from 10 percent to 60 percent effectiveness in preventing medical visits associated with seasonal influenza illness. The
MMWR report says this season’s vaccine offers reduced protection and this underscores the need for additional prevention and treatment efforts this season, including the appropriate use of influenza antiviral medications for treatment.

“Physicians should be aware that all hospitalized patients and all outpatients at high risk for serious complications should be treated as soon as possible with one of three available influenza antiviral medications if influenza is suspected, regardless of a patient’s vaccination status and without waiting for confirmatory testing,” says Joe Bresee, branch chief in CDC’s Influenza Division. “Health care providers should advise patients at high risk to call promptly if they get symptoms of influenza.”

One factor that determines how well a flu vaccine works is the similarity between the flu viruses used in vaccine production and the flu viruses actually circulating. During seasons when vaccine viruses and circulating influenza viruses are well matched, VE between 50 and 60 percent has been observed. H3N2 viruses have been predominant so far this season, but about 70 percent of them have been different or have “drifted” from the H3N2 vaccine virus. This likely accounts for the reduced VE.

Flu viruses change constantly and the drifted H3N2 viruses did not appear until after the vaccine composition for the Northern Hemisphere had been chosen.

Another factor that influences how well the flu vaccine works is the age and health of the person being vaccinated. In general, the flu vaccine works best in young, healthy people and is less effective in people 65 and older. This pattern is reflected in the current season early estimates. VE was highest—26 percent—for children age 6 months through 17 years. While not statistically significant, VE estimates for other age groups were 12 percent for ages 18 to 49 years and 14 percent for people age 50 years and older.

CDC recommends that people get a flu vaccine even during seasons when drifted viruses are circulating because vaccination can still prevent some infections and can reduce severe disease that can lead to hospitalization and death. Also, the flu vaccine is designed to protect against three or four influenza viruses and some of these other viruses may circulate later in the season. Flu activity so far this season has been similar to the 2012–2013 flu season, a “moderately severe” flu season with H3N2 viruses predominating.

Antiviral Supply Update

While manufacturers of antiviral medications have stated that there is no national shortage of antiviral medications at this time, and that there is sufficient product available to meet high demand, there are anecdotal reports of spot shortages of these drugs. CDC’s advice for patients and doctors is that it may be necessary to contact more than one pharmacy to fill a prescription for an antiviral medication. Pharmacies that are having difficulty getting orders filled should contact their distributor or the manufacturer directly.

For large institutional outbreaks this season, CDC is taking new measures to help match demand with supply, working with commercial partners to facilitate filling of large orders of antivirals for long-term care facilities or institutions having difficulty accessing antiviral supplies in outbreak settings. More information is available at

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IAC Spotlight! Twelve 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 January 6, when IAC Express last reported on the Influenza Vaccination Honor Roll, 12 healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, and medical practices
  • Alexian Brothers Health System, Arlington Heights, IL
  • Amery Hospital and Clinic, Amery, WI
  • Children's National Medical Center, Washington DC
  • Cottage Hospital, Woodsville, NH
  • Masonic Villages, Elizabethtown, PA
  • Mercy Hospital Oklahoma City, Oklahoma City, OK
  • Myrtue Medical Center, Harlan, IA
  • Sanford Aberdeen Medical Center, Aberdeen, SD
  • Sanford Health Bismarck, Bismarck, ND
  • Sanford Health Fargo, Fargo, ND
  • Southern NH Internal Medicine Associates, Derry, NH
  • UCSF Benioff Children's Hospital Oakland, Oakland, CA
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IAC enrolls seven more birthing institutions into its Hepatitis B Birth Dose Honor Roll; nine 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.
  • Calais Regional Hospital, Calais, ME (90%)
  • Mercy Hospital Jefferson, Crystal City, MO (95%)
  • Mercy Health Saint Mary's, Grand Rapids, MI (90%)
  • North Mississippi Medical Center West Point, West Point, MS (98%)
  • OCH Regional Medical Center, Starkville, MS (94%)
  • South Central Regional Center, Laurel, MS (97%)
  • UMMC-Grenada, Grenada, MS (95%)
In addition, the following nine institutions are being recognized for a second year.
  • Holy Family Hospital, Methuen, MA (96%)
  • Hospital Bella Vista, Mayaguez, PR (99%)
  • Golden Plains Community Hospital, Borger, TX (98%)
  • Lincoln Medical and Mental Health Center, Bronx, NY (98%)
  • Mary Greeley Medical Center, Ames, IA (93%)
  • Miami Valley Hospital, Dayton, OH (90%)
  • Miami Valley Hospital South, Centerville, OH (90%)
  • Palo Pinto General Hospital, Mineral Wells, TX (99%)
  • Queens Hospital Center, Jamaica, NY (99%)
The Honor Roll now includes 166 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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Nominations are now open for the National Adult and Influenza Immunization Summit excellence awards; deadline is February 13

The National Adult and Influenza Immunization Summit (NAIIS) is now soliciting nominations for the 2015 NAIIS Immunization Excellence Awards. The 2015 awards recognize individuals and organizations that made extraordinary contributions towards improving vaccination rates within their communities during 2014. The awards focus on individuals and organizations that exemplify the meaning of the “immunization neighborhood” (collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases). The "Adult Immunization Publication Award" has been added this year, making a total of six categories. Unless specifically indicated in the award description, the immunization activities should be broader than influenza activity. A National Winner and possibly an Honorable Mention recipient will be selected for each award category.

Award Categories
  • Overall Flu Season Activities
  • Healthcare Personnel Campaign
  • “Immunization Neighborhood” Champion
  • Adult Immunization Champion
  • Corporate Campaign
  • Adult Immunization Publication Award – New!
The award winners will be announced at the 2015 National Adult and Influenza Immunization Summit meeting in Atlanta. The national winner in each category will be invited to present their programs at the National Adult and Influenza Immunization Summit meeting.

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IAC revises the Spanish translations of its influenza vaccination screening checklists for contraindications and precautions

In December, IAC updated its Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination as well as its Screening Checklist for Contraindications toLive Attenuated Intranasal Influenza Vaccination. The age indication for egg-free recombinant influenza vaccine (FluBlok, Protein Sciences) was updated on page 2 of both pieces to include adults age 18 years and older. The checklist for live attenuated intranasal influenza vaccine also included an edit to page 1, question #5, to add [including asthma] to "lung disease." The Spanish-language versions of these updated screening questionnaires have now been posted on IAC's website.
  1. Updated Spanish translation of "Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination": Cuestionario de contraindicaciones para la vacuna inyectable contra la gripe
  2. Updated Spanish translation of "Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination": Cuestionario de contraindicaciones para la vacuna intranasal viva atenuada contra la influenza
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CDC announces updates to the overseas immunization program for refugees bound for the United States

CDC published Announcement: Updates to the Overseas Immunization Program for United States-Bound Refugees in the January 16 issue of MMWR (page 31). The entire announcement is reprinted below (excluding references).

Refugees being resettled in the United States, unlike immigrants seeking residency, have not been subject to immunization requirements. Without immunization, refugee communities overseas and in the United States are vulnerable to outbreaks of vaccine-preventable diseases that can disrupt the resettlement process and require costly public health responses. CDC's Division of Global Migration and Quarantine has regulatory authority to prevent communicable disease importation among the approximately 70,000 refugees resettled in the United States each year.

Historically, logistical challenges prevented overseas routine vaccination of refugees scheduled for resettlement in the United States. However, in December 2012, CDC began implementation of an overseas program that resulted in the routine vaccination of United States-bound refugees in six countries: Thailand and Nepal (initiated December 2012), Malaysia and Kenya (initiated September 2013), Ethiopia (initiated November 2013), and Uganda (initiated August 2014). Refugees vaccinated through this program began arriving in the United States in 2013. The program covers approximately 50% of refugees who arrive in the United States annually and likely will be expanded to include countries from which other refugees originate.

A collaboration with two other agencies (the U.S. State Department's Bureau of Population, Refugees, and Migration and the International Organization for Migration), the overseas vaccination program is intended to reduce U.S. disease outbreaks by ensuring that refugees arrive in the United States protected against vaccine-preventable diseases. Depending on age and individual risk factors, refugees now receive 2 to 3 doses of the following vaccines while overseas: polio; measles, mumps, and rubella; hepatitis B; pneumococcal conjugate; and
Haemophilus influenzae type b. Initial doses are given during the immigration medical examination 2–6 months before departure for the United States. These vaccines were selected after considering disease risk and the cost and availability of the vaccines in refugee camp settings.

Information on participating countries and current vaccine schedules is available by clicking here or by contacting CDC at Vaccines administered to refugees through this program are documented in the Division of Global Migration and Quarantine's Electronic Disease Notification System and are accessible to clinics conducting postarrival refugee medical examinations. More information on the notification system is available by contacting the help desk at

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CDC adds new MMR module and updates two others in its "You Call the Shots" training course

CDC recently announced that it had added a module about MMR and updated two other modules, "Vaccines for Children" and "Vaccine Storage and Handling," in its web-based training course You Call the Shots. Continuing education credit is available for viewing a module and completing an evaluation.

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NFID offers HPV infographic to help improve HPV vaccination rates

As part of Cervical Cancer Awareness Month, the National Foundation for Infectious Diseases (NFID) has released a new infographic, 5 Key Steps to Improve HPV Vaccination Rates, to encourage healthcare professionals to spread the message about the importance of vaccinating against HPV to help prevent cervical and other cancers.  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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Influenza is spreading and serious; please keep vaccinating your patients

According to CDC, U.S. influenza activity is high across most of the country with flu illnesses, hospitalizations, and deaths elevated. Flu season will probably continue for several weeks. While the influenza vaccine may not work as well as usual against some H3N2 viruses, vaccination can still offer protection for some people, reduce hospitalizations and deaths, and will protect against other influenza viruses. Influenza vaccination is recommended for everyone age six months of age 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. Influenza antiviral drugs can treat influenza illness. CDC has issued guidance for clinicians on the use of antiviral treatment for the 2014–15 flu season. Early antiviral treatment works best.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public: Back to top

CDC reports on incidence of notifiable diseases among American Indians/Alaska Natives

CDC published Incidence of Notifiable Diseases Among American Indians/Alaska Natives—United States, 2007–2011 in the January 16 issue of MMWR (pages 16–19). The first two sentences and the third paragraph of the "Discussion" section are reprinted below.

The findings in this report document disparities in the reported incidence of selected notifiable infectious diseases among AI/ANs [American Indians/Alaska Natives] compared with whites. When compared with whites, AI/AN incidence rates were higher for 14 of 26 diseases.

Among potentially vaccine-preventable diseases, incidence rates were lower among AI/ANs than among whites for varicella, acute hepatitis A, acute hepatitis B, meningococcal disease, and pertussis; rates were slightly higher for
Haemophilus influenza type b and invasive pneumococcal disease. These results suggest that, overall, the AI/AN population is receiving the full benefit of immunization programs.

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CDC publishes two articles about Ebola in Sierra Leone; both previously published as MMWR Early Releases

CDC published the following two articles about Ebola in Sierra Leone in the January 16 issue of MMWR. Both were previously published as MMWR Early Releases on January 13.
  1. Improving Burial Practices and Cemetery Management During an Ebola Virus Disease Epidemic—Sierra Leone, 2014
  2. Use of a Nationwide Call Center for Ebola Response and Monitoring During a 3-Day House-to-House Campaign—Sierra Leone, September 2014
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NFID's Annual Conference on Vaccine Research scheduled for April 13–15 in Bethesda

The Annual Conference on Vaccine Research, hosted by the National Foundation for Infectious Diseases (NFID), brings together diverse disciplines involved in the research and development of vaccines and associated technologies for disease control through immunization. The 18th annual conference will be held April 13–15 in Bethesda, MD. Back to top

Question of the Week

If Kinrix (DTaP-IPV, GlaxoSmithKline) is inadvertently given to a child age 15 through 18 months, as the fourth DTaP dose and the third IPV dose, do the DTaP and IPV doses need to be repeated? 

Answer: Since Kinrix is licensed and recommended only for children ages 4 through 6 years, you should take measures to prevent this error in the future. However, you can count this as a valid dose for DTaP and IPV as long as you met the minimum interval between administering dose #3 and dose #4 of DTaP (6 months) and dose #2 and dose #3 of IPV (4 weeks).

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
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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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