Issue 1167: February 17, 2015

Ask the Experts–Question of the Week: How does being born before 1957 confer immunity to measles?…read more

CDC publishes "Measles Outbreak—California, December 2014–February 2015" in a MMWR Early Release

On February 13, CDC published Measles Outbreak—California, December 2014–February 2015 in a MMWR Early Release. As of February 11, a total of 125 measles cases had been confirmed among U.S. residents in an ongoing measles outbreak linked to two Disney theme parks in Orange County, California. The entire text of the article is reprinted below (acknowledgements, references, and figure not included). 

On January 5, 2015, the California Department of Public Health (CDPH) was notified about a suspected measles case. The patient was a hospitalized, unvaccinated child, aged 11 years, with rash onset on December 28. The only notable travel history during the exposure period was a visit to one of two adjacent Disney theme parks located in Orange County, California. On the same day, CDPH received reports of four additional suspected measles cases in California residents and two in Utah residents, all of whom reported visiting one or both Disney theme parks during December 17–20. By January 7, seven California measles cases had been confirmed, and CDPH issued a press release and an Epidemic Information Exchange (Epi-X) notification to other states regarding this outbreak. Measles transmission is ongoing.

As of February 11, a total of 125 measles cases with rash occurring during December 28, 2014–February 8, 2015, had been confirmed in U.S. residents connected with this outbreak. Of these, 110 patients were California residents. Thirty-nine (35%) of the California patients visited one or both of the two Disney theme parks during December 17–20, where they are thought to have been exposed to measles, 37 have an unknown exposure source (34%), and 34 (31%) are secondary cases. Among the 34 secondary cases, 26 were household or close contacts, and eight were exposed in a community setting. Five (5%) of the California patients reported being in one or both of the two Disney theme parks during their exposure period outside of December 17–20, but their source of infection is unknown. In addition, 15 cases linked to the two Disney theme parks have been reported in seven other states: Arizona (seven), Colorado (one), Nebraska (one), Oregon (one), Utah (three), and Washington (two), as well as linked cases reported in two neighboring countries, Mexico (one) and Canada (10).

Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status, and one (1%) had immunoglobulin G seropositivity documented, which indicates prior vaccination or measles infection at an undetermined time. Twelve of the unvaccinated patients were infants too young to be vaccinated. Among the 37 remaining vaccine-eligible patients, 28 (67%) were intentionally unvaccinated because of personal beliefs, and one was on an alternative plan for vaccination. Among the 28 intentionally unvaccinated patients, 18 were children (aged <18 years), and 10 were adults. Patients range in age from 6 weeks to 70 years; the median age is 22 years. Among the 84 patients with known hospitalization status, 17 (20%) were hospitalized.

The source of the initial Disney theme park exposure has not been identified. Specimens from 30 California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines, but has also been detected in at least 14 countries and at least six U.S. states in the last 6 months.

Annual attendance at Disney theme parks in California is estimated at 24 million, including many international visitors from countries where measles is endemic. The December holiday season coincides with the exposure period of interest. Since 2011, six confirmed measles cases have been reported to CDPH in persons whose notable exposure was to large theme parks that attract international tourists. International travel to countries where measles is endemic is a well-known risk factor for measles, and measles importations continue to occur in the United States; the number of measles cases reported to CDC is updated weekly at However, U.S. residents also can be exposed to measles in the United States at venues with large numbers of international visitors, such as other tourist attractions and airports. This outbreak illustrates the continued importance of ensuring high measles vaccination coverage in the United States.

Related Links Back to top

Experts provide valuable editorials and interviews during measles outbreak

As the measles outbreak continues in the United States, the media have been busy providing information (and some misinformation) about measles and vaccination rates and exemption policies. Fortunately, many vaccine advocates have answered the media's call and dedicated valuable time to answering questions and providing basic science-based information and opinions. The following is just a tiny sampling. Back to top

Voices for Vaccines provides resources for anyone who wants to promote vaccination

Voices for Vaccines has developed resources for parents and others looking to make a difference in countering anti-vaccine forces, especially during this time of intense interest in the subject due to the multi-state measles outbreak.
  • Parents who want to make sure their children's day cares and schools are protected from vaccine-preventable diseases should bring the Community Immunity Toolkit to their school nurses and principals
  • People who want information about what the law can do about immunization rates should download the Vaccines and the Law manual
  • The Parent Advocate Toolkit enables anyone—from the everyday parent to the practicing physician—to gather a group of people of any size to discuss how vaccines are important and why we must all speak up for them
  • Writing an Op-Ed for Publication provides guidance for those who wish to write op-eds for local newspapers or magazines about the importance of immunization or any other issue under the umbrella of vaccine hesitancy
Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of parents who support immunization. VFV invites everyone who appreciates vaccines (parents and otherwise) to join. Please spread the word to your friends and colleagues to join VFV!
Related Links Back to top

Organizations offer free educational materials about measles for healthcare professionals and patients

Please refer to the following information and resources as we all work together to help stop the spread of measles during this multi-state outbreak.



From IAC: From CDC:
  • Resources for Vaccine Conversations with Parents—developed by CDC, AAP, and AAFP to help assess parents' needs, identify the role they want to play in making decisions for their child’s health, and then communicate in ways that meet their needs
From the Vaccine Education Center: From PBS/NOVA: Back to top

IAC Spotlight! Ten 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 500 organizations are now enrolled.

Since January 20, when IAC Express last reported on the Influenza Vaccination Honor Roll, 10 healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, and government agencies
  • Columbia County Department of Health, Hudson, NY
  • Dayton Children's Hospital, Dayton, OH
  • Fort Wayne Medical Education Program/Family Medicine Center, Fort Wayne, IN
  • Grandview and Southview Medical Centers, Dayton, OH
  • Hillsboro Area Hospital, Hillsboro, IL
  • Kent County Health Department, Grand Rapids, MI
  • Putnam County Department of Health, Brewster, NY
  • Wayne Healthcare, Greenville, OH
  • Western Maine Health, Norway, ME
  • Western Michigan University School of Medicine, Kalamazoo, MI
Related Links Back to top

Deadline for National Adult and Influenza Immunization Summit awards extended to March 1

The National Adult and Influenza Immunization Summit (NAIIS) has extended the deadline to submit nominations for the 2015 NAIIS Immunization Excellence Awards to March 1. 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
  • New! Adult Immunization Publication Award
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 program 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

Back to top

IAC develops two new patient schedules for adults in risk groups for vaccination: "Vaccinations for Men Who Have Sex with Men" and "Vaccinations for Adults without a Spleen"

In the past year, IAC's series of patient-friendly vaccination schedules has been expanded to include a new suite of schedules that focuses on adults who are in risk groups with specific recommendations for vaccination. IAC recently developed and posted the following two new vaccination guides for adults:
  1. Vaccinations for Men Who Have Sex with Men
  2. Vaccinations for Adults without a Spleen
Visit IAC's Patient Schedules web page to access all handouts in this series, which includes schedules for all other age groups and available translations.

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.

Back to top

IAC updates its suite of patient-friendly vaccination schedules for adults to align with recent ACIP recommendations for the use of both pneumococcal vaccines, PCV13 and PPSV23

IAC recently updated its patient-friendly schedules to align with the 2014 ACIP recommendations for use of pneumococcal vaccines (pneumococcal conjugate vaccine [PCV13] and pneumococcal polysaccharide vaccine [PPSV23]) in adults age 65 and older. The guides focus on adult vaccination needs and identify risk groups who have specific recommendations for vaccination. Visit IAC's Patient Schedules web page to access all handouts in this series, as well as schedules for all other age groups and available translations.

Back to top

IAC updates three patient screening questionnaires related to hepatitis A and B vaccination and hepatitis C testing

IAC recently made minor edits and formatting changes to the following screening questionnaires for adult patients/clients. Related Links Back to top

Society of Teachers of Family Medicine releases 2015 versions of  "Shots Immunizations" mobile app and "Shots Online" for PCs

The Group on Immunization Education of the Society of Teachers of Family Medicine (STFM) has released 2015 versions of its "Shots Immunizations" mobile app for iPhone and Android devices and its "Shots Online" for PCs.

The Shots Immunizations mobile app is a downloadable application (app) for iPhones and Android devices that was developed to serve as a point-of-care tool. Previously available for purchase, it is now being offered for free.

Shots Online is a free, personal computer-based program covering every aspect of the current CDC immunization schedules.

For more information, visit or contact Judith Troy, project coordinator of the Group on Immunization Education of STFM at  

Related Links Back to top

National Meningitis Association offers two PSAs that encourage parents to vaccinate their children against meningococcal disease 

The National Meningitis Association (NMA) recently developed two new public service announcements (PSAs) that are available for other groups to share via their websites and social media outlets. Both PSAs follow the stories of NMA advocates who lost their children to meningococcal disease. There are two versions: Related Links Back to top

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 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 publishes two articles about Ebola in MMWR

CDC published the following two articles about Ebola in the February 13 issue of MMWR. Related Links Back to top

VICNetwork offers March 4 webinar on protecting infants from pertussis

The VICNetwork has scheduled a webinar on March 4 titled A New Campaign to Protect Babies from Whooping Cough: Resources for National Infant Immunization Week and Beyond. This webinar will provide an overview of National Infant Immunization Week and available planning resources, as well as introduce a new campaign, Born With Protection, aimed at protecting babies from pertussis

Speakers for this webinar are Jenny Mullen, lead for the Childhood Immunizations Communication Team in CDC's National Center for Immunization and Respiratory Diseases (NCIRD) Health Communication Science Office and Allison Kennedy Fisher, a health communications specialist with NCIRD.

The one-hour webinar begins at 2:00 p.m. (ET).

The Virtual Immunization Communication (VIC) Network is a project of the National Public Health Information Coalition and the California Immunization Coalition. 

Registrations are being accepted.

Back to top

CDC offers Public Health Grand Rounds webinar on global polio eradication

On February 17, at 1:00 p.m. (ET), CDC will be offering a Public Health Grand Rounds webinar titled Global Polio Eradication: Reaching Every Last Child. This session should be archived and posted to the Grand Rounds archive page within 48–72 hours after the live version for later viewing. Continuing education credit is available. Preregistration is not required for viewing either the live or archived version.

Back to top

Meeting minutes from October 2014 ACIP meeting now available; watch the February ACIP meeting webcast 

ACIP recently posted the minutes from the ACIP meeting held on October 29–30. Presentation slides and archived video broadcast footage from this meeting are also available.

The next ACIP meeting will be held February 25–26. The meeting is available online via live webcast. Registration is not required to watch the live webcast of the meeting; the call-in information is located on the "Register for a Meeting" web page. The live meeting recording and presenter slides are always made available online after the meeting as well.

Related Links Back to top

Question of the Week

How does being born before 1957 confer immunity to measles?  

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles (see Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered. Additional 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.

Related Links Back to top

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

This page was updated on .