Issue 1170: March 10, 2015

Ask the Experts–Question of the Week: We have a 63-year-old patient who states she had tetanus as a child. She does not know whether…read more

New! March issue of Vaccinate Adults available online

The March 2015 issue of Vaccinate Adults is now online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed.

Click on the image below to download the entire March issue of (PDF) Vaccinate Adults.

Download the March 2015 issue of Vaccinate Adults

This issue features important information about the ongoing multi-state measles outbreak. It presents an array of immunization materials that healthcare professionals can use in their practice settings, including IAC's popular "Summary of Recommendations for Adult Immunization." It also features the "Ask the Experts" column from CDC medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, RN, MN.

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Reminder: March issue of Needle Tips available online

The March 2015 issues of Needle Tips is available online. If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit IAC's subscribe page to sign up.

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IAC provides summary of February ACIP meeting votes on vaccine recommendations

The February 2015 meeting of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) was abbreviated due to weather concerns in Atlanta. This caused discussion on some topics to be delayed until the next meeting of ACIP on June 24–25, but several important issues were decided. Although the ACIP-approved recommendations do not become official until they are approved by the CDC Director and published in the Morbidity and Mortality Weekly Report (MMWR), the following provides a summary of the decisions as they were voted on at the meeting.
ACIP voted on its annual influenza vaccine recommendations for the 2015–2016 influenza season. The committee reaffirmed the need for annual vaccination for all people age 6 months and older. Based on new data, ACIP removed the previously-stated preference for the use of live attenuated influenza vaccine (LAIV, Flumist, MedImmune/AstraZeneca) in children age 2 through 8 years, noting that both LAIV and inactivated influenza vaccine (IIV) are acceptable.
Meningococcal B
ACIP voted that a serogroup B meningococcal vaccine (MenB) series should be administered to people 10 years of age and older who are at increased risk of meningococcal disease. These include:
  • People with persistent complement component deficiencies, including inherited or chronic deficiencies in C3, C5-9, properdin, factor D, factor H, or taking eculizumab 
  • People with anatomic or functional asplenia, including sickle cell disease 
  • Microbiologists routinely exposed to isolates of Neisseria meningitidis 
  • People identified to be at increased risk because of a meningococcal B outbreak 
No preference was stated for the use of either of the two currently licensed MenB vaccines, Trumenba (Pfizer) and Bexsero (Novartis). Both vaccines are approved for people age10 through 25 years, so use in people age 26 years or older is off-label.
ACIP delayed discussion of routine use of MenB in adolescents and college students until the June meeting.
ACIP voted to add the newly licensed 9-valent human papillomavirus (9vHPV, Gardasil 9, Merck) vaccine to the vaccines available for use within the current HPV recommendations, i.e., vaccination at age 11 or 12 years, with vaccine use recommended through age 26 for females and age 21 for males, as well as through age 26 for men  who are immunocompromised (including HIV infection) and men who have sex with men. For females, the 2-valent (Cervarix, GSK), 4-valent (Gardasil, Merck), or 9-valent HPV vaccine may be used, while males should receive either 4-valent or 9-valent HPV vaccine. 9vHPV vaccine is not yet approved by the FDA for males age 16 through 26 years, so use in this age group is off-label.
The addition of 9vHPV vaccine to the options of vaccines that may be used to prevent HPV infection had no impact on the recommended vaccine intervals or contraindications for use in pregnant women.  
Any HPV vaccine, including 9vHPV, may be used to complete a previously begun HPV vaccine series. ACIP delayed discussion on the use of 9vHPV vaccine for persons who have previously completed a full HPV vaccine series until the June meeting.
Yellow Fever
ACIP voted to recommend that a single dose of yellow fever (YF) vaccine (YF-VAX, sanofi) provides long-lasting protection and is adequate for most travelers. ACIP also stated that additional doses of YF vaccine may be indicated for certain populations as follows: 
  • Women who were pregnant when they received their initial dose of YF vaccine should receive one additional dose prior to their next travel that puts them at risk for yellow fever virus infection. 
  • Individuals who received a hematopoietic stem cell transplant after receiving a dose of yellow fever vaccine and who are sufficiently immunocompetent to be safely vaccinated should be revaccinated prior to their next travel that puts them at risk for yellow fever virus infection. 
  • Individuals who were HIV-infected when they received their last dose of YF vaccine should receive a dose every ten years if they continue to be at risk for yellow fever infection. 
Finally, a booster dose of YF vaccine may be considered for travelers who received their last dose of YF vaccine at least 10 years previously and who will be in a higher-risk setting based on season, location, activities, and duration of their travel. This would include travelers who plan to spend a prolonged period of time in endemic areas or those traveling to highly endemic areas such as rural West Africa during peak transmission season or areas with ongoing outbreaks.
The official minutes and presentation slides from the February meeting will be available on the ACIP Meeting Information web page within the next few weeks.

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Join the Voices for Vaccines' March 20 conference call featuring Dr. Paul Offit

Voices for Vaccines (VFV) will be sponsoring a conference call on March 20 at 12:00 p.m. (ET) that will feature Paul Offit, MD, director of the Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia. Dr. Offit is passionate about preventing disease and death in children by vaccination, and has been outspoken during the recent measles outbreak. The call is intended to give parents, providers, and public health workers an opportunity to ask Dr. Offit questions about vaccines, infectious disease, and his recent books and articles, including his new book, Bad Faith.

Please email to register for this call.

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!

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CDC publishes report on current influenza activity in the United States

CDC published Update: Influenza Activity—United States, September 28, 2014–February 21, 2015 in the March 6 issue of MMWR (pages 206–212). A summary made available to the press is reprinted below.

The 2014–15 influenza season began early and is likely to continue for several more weeks. Influenza A (H3N2) viruses have been the predominant circulating strain this season, though detections of influenza B have been increasing. The vast majority of circulating influenza A (H3N2) viruses are different from the influenza A (H3N2) component of the 2014-15 Northern Hemisphere vaccine. This season has been particularly severe for adults 65 years and older, with the highest rate of hospitalization recorded since this type of surveillance began in 2005. Antiviral medications are more important than usual as an adjunct to vaccination in the prevention and treatment of influenza.

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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

Reminder: Vaccine Education Center Current Issues in Vaccines webinar scheduled for March 18

The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia will present a free one-hour webinar, beginning at noon (ET) on March 18. Continuing education credits will be available. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit will discuss the following topics:
  • The serogroup B meningococcal vaccine: Who should get it?
  • The 9-valent HPV vaccine: New recommendations
  • Influenza vaccines: An update
  • The measles epidemic: A turning point?
Registration (required) is open now.

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IAC revises "Healthcare Personnel Vaccination Recommendations"

IAC recently made a revision to its summary handout titled Healthcare Personnel Vaccination Recommendations. The edit related to recommendations for healthcare personnel who were vaccinated against hepatitis B virus in childhood. IAC thanks Pat Fineis, perinatal hepatitis B coordinator, Division of Immunization, Michigan Department of Community Health, for bringing this issue to our attention.

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 announces composition of seasonal influenza vaccine for the 2015–2016 northern hemisphere influenza season; FDA endorses WHO's recommendation

On February 26, the World Health Organization (WHO) released information about the composition of the strains that will be used for seasonal influenza vaccination in the northern hemisphere in 2015–2016.

It is recommended that trivalent vaccines for use in the 2015–2016 influenza season (northern hemisphere winter) contain the following:
  • an A/California/7/2009 (H1N1)pdm09-like virus
  • an A/Switzerland/9715293/2013 (H3N2)-like virus
  • a B/Phuket/3073/2013-like virus
It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/60/2008-like virus.

On March 4, FDA's Vaccines and Related Biological Products Advisory Committee met and voted to endorse WHO's recommendation regarding strains for seasonal influenza vaccination in the northern hemisphere in 2015–2016.

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Sign up to receive WHO's Vaccine Safety Net Newsletter

In response to the growing number of websites providing misinformation regarding vaccine safety, the World Health Organization (WHO) launched the Vaccine Safety Net, a project aiming at improving global dissemination of reliable web-based vaccine safety information. Through VSN, WHO identifies websites that provide information on vaccine safety and evaluates them against good information practices criteria established by the Global Advisory Committee on Vaccine Safety (GACVS). As a result of their combined efforts, VSN and its membership help to ensure that key stakeholders, including parents and other caregivers, public health authorities, health professionals, and the media have access to balanced evidence-based vaccine safety information via the internet.
The Vaccine Safety Net Newsletter aims to disseminate news and information regarding the VSN, foster communication and synergy among VSN members, and promote good information practices for websites providing information on vaccine safety.

To subscribe to the VSN newsletter, send an email to LISTSERV@LISTSERV.WHO.INT with the following exact text in the body of your email message: subscribe vsn. Confirm your subscription by clicking on the link you will receive following your request.

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Shot by Shot program releases new video that encourages adult influenza vaccination

Shot by Shot: Stories of Vaccine-Preventable Diseases is a collection of stories from people who have been touched by vaccine-preventable diseases. With national attention on outbreaks of measles, influenza, and pertussis, it's a great time to use these true stories as a way to tell the human side behind the numbers. The program recently added Gigi's Story to its online collection. Gigi, a teacher, thought she was immune to everything possible due to her job and didn't get vaccinated against influenza. This young and healthy woman's frightening experience with influenza can be a valuable lesson for all adults on the importance of vaccination.

The Shot by Shot program is sponsored by the California Immunization Coalition.

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ReadyVax app from Emory University provides easy access to evidence-based information about vaccines

ReadyVax is a new app that contains up-to-date information about vaccines and vaccination. With regularly updated data on vaccine recommendations and vaccine safety, and the ability to notify users in real-time of important vaccine information, ReadyVax provides easy access to evidence-based information about vaccines. ReadyVax was designed to be used by both healthcare providers and healthcare users, and users can customize the presentation of data with a single click to suit their information needs.

ReadyVax was developed by experts at Emory University.

Download this app from the iTunes 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 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

Pediatrics publishes article about physician response to parental requests to spread out the vaccine schedule

On March 2, the journal Pediatrics published Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule online. The abstract is reprinted below.

OBJECTIVES: To assess among US physicians (1) frequency of requests to spread out recommended vaccination schedule for children <2 years, (2) attitudes regarding such requests, and (3) strategies used and perceived effectiveness in response to such requests.

METHODS: An e-mail and mail survey of a nationally representative sample of pediatricians and family physicians from June 2012 through October 2012.

RESULTS: The response rate was 66% (534 of 815). In a typical month, 93% reported some parents of children <2 years requested to spread out vaccines; 21% reported ≥10% of parents made this request. Most respondents thought these parents were putting their children at risk for disease (87%) and that it was more painful for children (84%), but if they agreed to requests, it would build trust with families (82%); further, they believed that if they did not agree, families might leave their practice (80%). Forty percent reported this issue had decreased their job satisfaction. Most agreed to spread out vaccines when requested, either often/always (37%) or sometimes (37%); 2% would often/always, 4% would sometimes, and 12% would rarely dismiss families from their practice if they wanted to spread out the primary series. Physicians reported using a variety of strategies in response to requests but did not think they were effective.

CONCLUSIONS: Virtually all providers encounter requests to spread out vaccines in a typical month and, despite concerns, most are agreeing to do so. Providers are using many strategies in response but think few are effective. Evidence-based interventions to increase timely immunization are needed to guide primary care and public health practice.

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CDC publishes article about Ebola detection and treatment

CDC published Systems for Rapidly Detecting and Treating Persons with Ebola Virus Disease—United States in the March 6 issue of MMWR (pages 222–225). This article was previously published on March 3 as an MMWR Early Release. The "Conclusion" section is reprinted below.

As the Ebola outbreak in West Africa continues, the United States will need to maintain capabilities to detect and manage persons with possible or confirmed Ebola. Current efforts to improve health care facility readiness for Ebola will continue to be responsive to the current situation in West Africa and will continue to evolve as the situation changes. The efforts and infrastructure being developed to rapidly identify, evaluate, and treat persons with possible Ebola in the United States will likely improve the outcomes of these patients, reduce the spread of Ebola to others, and also help prepare for future emerging infectious disease threats.

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Registration deadline for June 24–25 ACIP meeting is June 3 for non-U.S. citizens and June 10 for citizens

CDC's Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on June 24–25 in Atlanta at CDC's Clifton Road campus. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens is June 3; it's June 10 for U.S. citizens. Registration is not required to watch the live webcast of the meeting.

More information available from the CDC website.

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Two conferences on vaccination planned for June in Annecy, France

Fondation Mérieux will be sponsoring the following two programs in June at Les Pensières Conference Center in Annecy, France. Back to top

Question of the Week

We have a 63-year-old patient who states she had tetanus as a child. She does not know whether she ever had any tetanus-containing vaccines in her lifetime. Should Tdap be given to this patient, and is it safe? 

A history of tetanus disease is not a reason to avoid tetanus-containing vaccines. Tetanus disease does not produce immunity because of the very small amount of toxin required to produce illness. As long as your patient has no other contraindications she should receive Tdap now. If she has no documentation of prior tetanus vaccination, she should receive a complete 3-dose primary series (dose #1 of Tdap, followed by dose #2 of Td 4 to 8 weeks later, and dose #3 of Td 6-12 months after dose #2).

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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