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Issue 1171: March 17, 2015

Ask the Experts–Question of the Week: Can varicella vaccine be used as postexposure prophylaxis for a 9-month-old who…read more

Reminder: March issues of Needle Tips and Vaccinate Adults available online

The March 2015 issues of Needle Tips and Vaccinate Adults are available online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed.

Click on the images below to download the entire March issues (PDF) of Needle Tips and/or Vaccinate Adults.

Download the March issue of Needle TipsDownload the March issue of Vaccinate Adults

Needle Tips: View the table of contentsmagazine viewer, and back issues.

Vaccinate Adults: View the table of contentsmagazine viewer, and back issues.

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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Now available! IAC's sturdy laminated versions of the 2015 U.S. child/teen immunization schedule and the 2015 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2015 U.S. child/teen immunization schedule and the 2015 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. The child and adolescent schedule has eight pages (i.e., four double-sided pages) and is folded to measure 8.5" x 11". The adult immunization schedule has six pages (i.e., three double-sided pages) and is folded to measure 8.5" x 11". Laminated Child and Teen Laminated Schedule Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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Reminder: National Infant Immunization Week is April 18–25; many resources available from CDC

National Infant Immunization Week (NIIW) will be held this year on April 18–25. NIIW is an annual observance to promote the benefits of childhood immunizations and improve the health of children age two years and younger.

Visit the NIIW website to find promotional and educational materials to help you plan your NIIW activities, and tailor them to the needs of your community.

CDC would like to hear from organizations planning a 2015 NIIW activity. Please complete the NIIW Activity Form so others can learn what you're doing to educate and inspire parents and providers to protect infants and toddlers from vaccine-preventable diseases. If you're looking for ideas, you can access events scheduled for 2015, and NIIW events held in 2012, 2013, and 2014 from CDC's NIIW Activities around the World web page.

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IAC enrolls four more birthing institutions into its Hepatitis B Birth Dose Honor Roll

The Immunization Action Coalition (IAC) is pleased to announce that four 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.
  • Mercer Health, Coldwater, OH (92%)
  • Mercy Health Muskegon–Hackley Campus, Muskegon, MI (92%)
  • Morton Hospital, Taunton, MA (93%)
  • St. Mary-Corwin Medical Center, Pueblo, CO (93%)
The Honor Roll now includes 187 birthing institutions from 30 states and Puerto Rico. Forty-two institutions have qualified twice.

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! "Like" IAC on Facebook and "follow" IAC on Twitter!

IAC invites you to connect with us on Facebook and Twitter. IAC's Facebook page is designed to help parents and all interested Facebook users learn about vaccines and their importance. If you have a personal or organizational Facebook page, please take a minute to "like" IAC on Facebook. If you have an account on Twitter, please take a minute to "follow" @ImmunizeAction on Twitter. Also, you and your patients are invited to view and repost videos available from IAC's YouTube account.

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FDA approves change in diluent storage temperature for Rotarix vaccine

On February 27, FDA approved a supplemental license application for Rotarix rotavirus vaccine. The package insert wording will be changed to indicate that the diluent in oral applicators should be stored at 2–8°C or at controlled room temperature up to 25°C instead of the current recommendation for storage at 20–25°C. Back to top

IAC updates "Guide to Contraindications and Precautions to Commonly Used Vaccines" and "Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults"

IAC recently revised the following handouts. 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 guidelines for the prevention, care, and treatment of persons with chronic hepatitis B infection

In March, the World Health Organization (WHO) published its first guidelines for the prevention, care, and treatment of people with chronic hepatitis B infection. This publication complements similar published guidance by WHO on the hepatitis C virus. The "Background" section of the related policy brief is reprinted below.

Hepatitis B infection is caused by the hepatitis B virus (HBV), an enveloped DNA virus that infects the liver, causing hepatocellular necrosis and inflammation. Chronic hepatitis B (CHB)—defined as persistence of hepatitis B surface antigen (HBsAg) for six months or more—is a major public health problem. Worldwide, there are an estimated 240 million chronically infected persons, particularly in low and middle-income countries (LMICs). The major complications of CHB are cirrhosis and hepatocellular carcinoma (HCC). Between 20% and 30% of those who become chronically infected will develop these complications, and an estimated 650,000 people will die annually from HCC and cirrhosis due to CHB. The majority of people are unaware of their HBV infection, and therefore often present with advanced disease. Universal hepatitis B immunization programmes that target infants, with the first dose at birth, have been highly effective in reducing the incidence and prevalence of hepatitis B in many endemic countries. However, these programmes will not have an impact on HBV-related deaths until several decades after their introduction.

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WHO publishes the recommended composition of influenza virus vaccines for use in the 2015–2016 northern hemisphere influenza season in its Weekly Epidemiological Record

The March 13 issue of the WHO periodical Weekly Epidemiological Record (WER) includes an article titled Recommended composition of influenza virus vaccines for use in the 2015–2016 northern hemisphere influenza season. This information was first released as a WHO press release on February 26, and covered in IAC Express on March 10.

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Updated chapter on measles released early online from the soon-to-be-published 2015 edition of the Red Book

Due to the recent measles outbreaks, the American Academy of Pediatrics (AAP) has published the complete chapter on measles from the upcoming Red Book: 2015 Report of the Committee on Infectious Diseases as an early release on the Red Book Online website. The 2015 edition of the Red Book is scheduled for publication in May. Highlights of the changes include:
  • Evidence of measles immunity
  • Use of immune globulin products for measles prevention
  • Vaccination recommendations for health care personnel born before 1957 and for patients with human immunodeficiency virus infection
  • Management of susceptible patients exposed to measles
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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

Influenza is serious; vaccination is recommended for nearly everyone, so please keep vaccinating your patients

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. 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 missed opportunities for tetanus postexposure prophylaxis

CDC published Missed Opportunities for Tetanus Postexposure Prophylaxis—California, January 2008–March 2014 in the March 13 issue of MMWR (pages 243–246). The first paragraph is reprinted below.

Tetanus is an acute and sometimes fatal disease characterized by sudden muscle contractions. The number of tetanus cases reported annually in the United States has declined significantly since the 1930s and 1940s as a result of the introduction of tetanus vaccines. However, sporadic cases continue to occur in persons who are not up-to-date with tetanus toxoid-containing vaccinations (TT) and do not receive appropriate postexposure prophylaxis (PEP). To assess the extent of these cases, the California Department of Public Health reviewed all tetanus cases reported during January 2008–March 2014. A total of 21 tetanus patients were reported; five (24%) died. An average of three cases were reported each year during 2008–2013; the average annual incidence among patients aged ≥65 years (0.23 cases per 1 million population) was twice that among patients aged 21–64 years (0.10 cases per 1 million population). Of 16 patients with an acute injury before illness and diagnosis, nine (56%) sought medical care, and two (22%) of the nine received appropriate PEP. Although tetanus is rare, it is a life-threatening disease that is preventable. Health care providers should ensure that their patients are up-to-date with TT vaccination and provide appropriate postexposure prophylaxis for patients with wounds.

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Question of the Week

Can varicella vaccine be used as postexposure prophylaxis for a 9-month-old who was exposed to herpes zoster? 

Varicella vaccine is neither approved nor recommended for children younger than age 12 months. Assuming that the child is not immunocompromised, varicella zoster immune globulin (VariZIG, Emergent BioSolutions Inc.) is also not recommended. If the child had a condition which was considered to place the child at greater risk for complications than the general population, then VariZIG could be considered (see, page 574).

The Advisory Committee on Immunization Practices (ACIP) does not have a recommendation for acyclovir as varicella postexposure prophylaxis, although the American Academy of Pediatrics does provide some guidance on this issue in the 2012 edition of the Red Book.

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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