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Issue 1164: January 27, 2015

Ask the Experts–Question of the Week: A pediatric surgeon's 12-month-old child received the varicella vaccine and two…read more

2015 U.S. recommended immunization schedules for birth through 18 years and "catch up" now available

On January 26, CDC published online the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, United States, 2015.
Each year, the Advisory Committee on Immunization Practices (ACIP) updates the immunization schedules to reflect current recommendations for licensed vaccines. In October 2014, ACIP approved the recommended immunization schedules for 2015. The 2015 recommended immunization schedules are effective January 1, 2015; the MMWR notice about the schedules’ publication date will be published February 6, 2015.

The recommended birth through 18 years and catch-up immunization schedules have been approved by the ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

According to CDC, the 2015 recommended immunization schedule for adults will be published online on February 3.

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CDC's Health Alert Network issues a health advisory about a multi-state outbreak of measles linked to Disneyland

On January 23, the CDC Health Alert Network (HAN) issued a CDC Health Advisory titled U.S. Multi-state Measles Outbreak, December 2014–January 2015. The United States is experiencing a large multi-state measles outbreak that started in California in December 2014 and has spread to six additional states and Mexico. The "Summary" section of the HAN is reprinted below.

The Centers for Disease Control and Prevention (CDC) and State Health Departments are investigating a multi-state outbreak of measles associated with travel to Disneyland Resort Theme Parks (which includes Disneyland and Disney California Adventure). The purpose of this HAN Advisory is to notify public health departments and healthcare facilities about this measles outbreak and to provide guidance to healthcare providers. Healthcare providers should ensure that all of their patients are current on MMR (measles, mumps, and rubella) vaccine. They should consider measles in the differential diagnosis of patients with fever and rash and ask patients about recent international travel or travel to domestic venues frequented by international travelers. They should also ask patients about their history of measles exposures in their community. Please disseminate this information to healthcare providers in hospitals and emergency rooms, to primary care providers, and to microbiology laboratories.

Other sections of the advisory include "Background," "Recommendations for Health Care Providers," and a collection of links to obtain more information. Access the complete HAN advisory to read more.
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California Department of  Public Health confirms 59 cases of measles; issues health advisory

On January 21, the California Department of Health issued a health advisory titled Measles Update: 59 Confirmed Measles Cases in the State of California—Look for Signs of this Highly Contagious Disease. The first three paragraphs are reprinted below.

Measles has been confirmed in 59 California residents since late December 2014. Related cases have occurred in three Utah residents, two Washington residents, one Colorado resident, one Oregon resident, and one resident of Mexico. A number of additional suspect cases are under investigation. The California measles patients reside in 11 local health jurisdictions (Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, Santa Clara and Ventura Counties and the cities of Long Beach and Pasadena). Patients range in age from 7 months to 70 years. Vaccination status is documented for 34 of the 59 cases. Of these 34, 28 were unvaccinated (six of whom were infants too young to be vaccinated), 1 had received one dose and 5 had received two or more doses of MMR vaccine. Many large contact investigations are ongoing.

Of the confirmed cases, 42 have been linked to Disneyland or Disney California Adventure Park in Anaheim, California. The confirmed cases include five Disney employees; four of whom worked at the parks and one who is believed to have been infected as a guest. Initial exposures occurred in December but additional confirmed cases visited Disney parks while infectious in January.

CDPH recommends that any patient with a measles-compatible illness who has visited venues where international travelers congregate, such as theme parks, airports, etc., be considered to have a plausible exposure to measles. Also, because there have been cases in persons who have not visited such venues, measles should be considered in any patient with clinically compatible symptoms at this time.

The complete document includes much important information to help clinicians diagnose and report measles cases.

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CDC requests nominations for its Childhood Immunization Champion Awards

The CDC Childhood Immunization Champion Award is an annual award that recognizes individuals who make a significant contribution toward improving public health through their work in childhood immunization.
Each year, up to one CDC Immunization Champion from each of the 50 U.S. states, eight U.S. territories and freely associated states, and the District of Columbia will be honored. Champions can include coalition members, parents, healthcare professionals (e.g., physicians, nurses, physicians’ assistants, nurse practitioners, medical assistants), and other immunization leaders who meet the award criteria. Immunization program managers, state and federal government employees paid by state or federal immunization funding, individuals who have been affiliated with and/or employed by pharmaceutical companies, and those who have already received the award are not eligible to apply (for details, see page 3 of the nomination packet).

Awardees will be announced during National Infant Immunization Week (NIIW), which runs April 18–25 this year. Champions will receive a certificate of recognition, will be featured on CDC’s web site, and may be recognized by their immunization program during NIIW.

All nomination forms are due to respective immunization programs. The suggested due date is February 6, 2015, but states may select a different deadline. Please contact your state immunization program to confirm your state’s deadline.

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FDA approves the use of Bexsero, the second vaccine licensed in the U.S. to prevent serogroup B meningococcal disease

On January 23, FDA announced the approval of Bexsero (Novartis), the second vaccine licensed in the United States to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B in people age 10 through 25 years. The following is an excerpt from a related FDA news release.

The U.S. Food and Drug Administration today approved Bexsero, a vaccine to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B in individuals 10 through 25 years of age.

Bexsero is the second vaccine approved by the FDA in the past three months to prevent this disease. The agency approved the first meningococcal serogroup B vaccine in October 2014. Before these approvals, existing approved meningococcal vaccines in the U.S. covered only four of the five main serogroups of N. meningitidis bacteria that cause meningococcal disease: A, C, Y and W.

Meningococcal disease is a life-threatening illness caused by bacteria that can infect the bloodstream (sepsis) and the lining that surrounds the brain and spinal cord (meningitis).
N. meningitidis is a leading cause of bacterial meningitis. The bacteria are transmitted from person to person through respiratory or throat secretions (e.g., by coughing, kissing or sharing eating utensils). According to the Centers for Disease Control and Prevention, about 500 total cases of meningococcal disease were reported in the U.S. in 2012, of which 160 were caused by serogroup B....

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Twelve new videos added to the video library; our searchable collection now numbers more than 180 videos about vaccine-preventable diseases and the importance of immunization

IAC's website for the general public, www.vaccineinformation.orgfeatures an impressive Video Library. This month, 12 new videos have been added to IAC's collection of more than 180 videos,including "Mom Knows Best " and "Reduce the Pain of Vaccination in Babies!" The video library is searchable by keyword and by a preset "Popular Searches" drop-down menu, which offers more than 10 categories of topics to choose from. The results of a video search can be sorted by date of posting or by title of the video.

Some popular search categories include: Videos in this curated collection include personal testimonies from parents who have suffered the tragic loss of a child, public service announcements about the importance of immunization, and videos about vaccine-preventable diseases, as well as animation to help illustrate the concepts of immunization. The featured videos are from many sources, including the following trusted organizations: CDC, PKIDs, California Immunization Coalition’s Shot-by-Shot project, Families Fighting Flu, state health departments, and local immunization coalitions.

We urge you to link to IAC’s website,, from your website, blog, and/or Facebook page.

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Join the Voices for Vaccines' February 17 conference call featuring journalist Andy Marso

Voices for Vaccines (VFV) will be sponsoring a conference on February 17 at 1:00 p.m. (ET) that will feature Andy Marso, an award-winning journalist who has written for the Washington Post and the Topeka Capital-Journal.

Just three weeks before his college graduation, Marso went to bed feeling like he had the flu. The next morning, he woke up unable to walk and covered in a rash. He spent the next four months in the hospital battling bacterial meningitis. Andy Marso's 2013 memoir is titled Worth the Pain: How Meningitis Nearly Killed Me—Then Changed My Life for the Better.

Please join Voices for Vaccines for this special event. To register for this call, you must 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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Reminder: 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
  • Influenza Season Campaign
  • 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.

Related Links Anyone interested in possibly attending the 2015 NAIIS meeting should contact Dr. Litjen Tan at

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IAC updates three influenza vaccination handouts for healthcare professionals

IAC recently revised its influenza-related handouts as follows: the age indication for egg-free recombinant influenza vaccine (FluBlok, Protein Sciences) was updated to include adults age 18 years and older; "Influenza Vaccine Products for the 2014–2015 Influenza Season" also received edits to the Medicare billing codes and footnotes.
  1. Influenza Vaccine Products for the 2014–2015 Influenza Season
  2. Standing Orders for Administering Influenza Vaccine to Adults
  3. Influenza Vaccination of People with a History of Egg Allergy
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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WHO publishes report on latest meeting of the Global Vaccine Advisory Committee on Vaccine Safety

The January 23 issue of the WHO periodical Weekly Epidemiological Record features a report titled Global Advisory Committee on Vaccine Safety, 3–4 December 2014.
A collection of WHO position papers on vaccines is available in alphabetical order.
They are available in chronological order, vaccine listing, and topic listing on the IAC website.

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California's Department of Public Health develops handout on adult pneumococcal vaccine timing

The California Department of Public Health has developed a helpful new resource for healthcare professionals titled Pneumococcal Vaccine Timing. This one-page handout provides an easy-to-read summary of the correct timing for administering PCV13 and PPSV23 vaccines to adults age 19–64 years with underlying health conditions and also all adults age 65 years and older.

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Photographer Anne Geddes features survivors of meningococcal disease in new exhibit

Photographer Anne Geddes is known for her creative photographs of infants. As a March of Dimes global ambassador, Geddes has worked for years on issues related to children’s health, including vaccination. Recently, she used her talents for a meaningful new project, Protecting Our Tomorrows: Portraits of Meningococcal Disease, a series of fifteen portraits of children and young adults who are survivors of meningococcal disease. The photos are currently on exhibit at the Toolbox Art Gallery in Washington DC. A book of the photos can be downloaded without charge from the Apple iBooks store.

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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:
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CDC reports on investigation of contacts of a healthcare worker with pertussis

CDC published Notes from the Field: Investigation of Contacts of a Health Care Worker Who Worked While Ill with Pertussis—Maryland, August–September 2014 in the January 23 issue of MMWR (page 45). The first and last paragraphs and one sentence from the second paragraph are reprinted below.

On September 5, 2014, the public health department of a Maryland hospital was notified of a case of Bordetella pertussis infection confirmed by polymerase chain reaction (PCR) in a staff health care worker (HCW). The HCW experienced onset of diarrhea and malaise (nonrespiratory symptoms atypical of the catarrhal phase of pertussis) on August 26. By September 2, paroxysms of coughing led the HCW to consult a colleague, who ordered the PCR test, prescribed a 5-day course of azithromycin, and advised avoidance of patient care until treatment completion. Contrary to the hospital's infection control policy, neither the HCW nor the colleague reported the presumptive diagnosis of pertussis to the hospital's public health department. The HCW continued to work in the outpatient department until the positive PCR result was received on September 5, at which time the hospital's public health department was first notified. The hospital barred the HCW from further work at the hospital while ill, and, in collaboration with local and state public health counterparts, began a contact investigation and stratified patient and HCW contacts by level of exposure.

In all, 47 persons were identified as being exposed to the HCW, including 31 patients ranging in age from 7 days to 12 years (six of whom were too young to receive diphtheria, tetanus, and acellular pertussis vaccine [DTaP]) and 15 HCWs.

HCW presenteeism (i.e., working while sick) can jeopardize the well-being of patients and coworkers. Because of the need to investigate and limit exposures, clinical activities in a facility can be disrupted when staff members are potentially exposed to transmissible disease. HCWs should not work while ill with a potentially contagious condition.

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CDC posts collection of journal articles about the Advisory Committee on Immunization Practices

CDC recently posted a collection of journal articles describing the history of the Advisory Committee on Immunization Practices (ACIP), its role in the development and dissemination of vaccine recommendations and policies, and information on conflicts of interest and ACIP work groups. Back to top

Pediatrics publishes article about geographic clusters of underimmunized children

On January 19, the journal Pediatrics published Geographic Clusters in Underimmunization and Vaccine Refusal online. The "Background and Objective" and "Results" sections of the abstract are reprinted below.

BACKGROUND AND OBJECTIVE: Parental refusal and delay of childhood vaccines has increased in recent years and is believed to cluster in some communities. Such clusters could pose public health risks and barriers to achieving immunization quality benchmarks. Our aims were to (1) describe geographic clusters of underimmunization and vaccine refusal, (2) compare clusters of underimmunization with different vaccines, and (3) evaluate whether vaccine refusal clusters may pose barriers to achieving high immunization rates.

RESULTS: We identified 5 statistically significant clusters of underimmunization among children who turned 36 months old during 2010–2012. The underimmunization rate within clusters ranged from 18% to 23%, and the rate outside them was 11%. Children in the most statistically significant cluster had 1.58 (P < .001) times the rate of underimmunization as others. Underimmunization with measles, mumps, rubella vaccine and varicella vaccines clustered in similar geographic areas. Vaccine refusal also clustered, with rates of 5.5% to 13.5% within clusters, compared with 2.6% outside them.

Pediatrics has made the complete text of this article available online.

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CDC publishes three articles about Ebola as MMWR Early Releases

On January 23, CDC published the following three articles as MMWR Early Releases. Back to top

Agenda for February ACIP meeting available; watch the meeting online if you are unable to attend

CDC has released a draft agenda for the next Advisory Committee on Immunization Practices (ACIP) meeting, which will be held February 25–26 at CDC's Clifton Road campus in Atlanta. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-citizens is February 2; for citizens it is February 9.

Meetings are open to the public and available online via live webcast. During committee meetings, members present findings and discuss vaccine research and scientific data related to vaccine effectiveness and safety, clinical trial results, and manufacturer's labeling or package insert information. Outbreaks of vaccine-preventable disease or changes in vaccine supply also are reviewed during these meetings. Registration is not required to watch the live webcast of the meeting; the call-in information is located on the registration page. The live meeting recording and presenter slides are always made available online after the meeting as well.

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Question of the Week

A pediatric surgeon's 12-month-old child received the varicella vaccine and two days later developed a varicella-like rash. The surgeon had chickenpox as a child and had a positive varicella titer several years ago. Is it okay for the surgeon to continue to see patients? Also, is the varicella virus in the rash that develops following vaccination as virulent as the wild-type virus? 

Answer: Because the surgeon is immune, the child’s rash is not a problem and there is no need for the surgeon to restrict activity. In comparing a vaccine rash to wild-type chickenpox infection, transmission is less likely with a vaccine rash and, in general, there are fewer skin lesions.

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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