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Issue 1173: March 24, 2015

Ask the Experts–Question of the Week: I need information about the administration of vaccines to 3-month-old conjoined twins…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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Oregon Health Authority confirms six cases of meningococcal serogroup B disease, including one death, at the University of Oregon since mid-January

On March 19, the Oregon Health Authority (OHA) issued a news release about a sixth case of confirmed meningococcal serogroup B disease at the University of Oregon in Eugene. The latest case is a 20-year-old male University of Oregon sophomore who lives off campus. The five previous cases all have fallen ill since mid-January. On February 17, an 18-year-old female freshman (the fourth case) died from the disease.

In response to the meningococcal disease outbreak, Oregon Governor Kate Brown and the OHA will release a public service announcement (PSA) next week. The PSA underscores the critical importance of getting vaccinated against the illness before or during spring break for students at the university. So far, more than 9,000 University of Oregon students have received the meningococcal serogroup B vaccine. The goal is to vaccinate 22,000 undergraduate students.

On February 26, 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, including people identified to be at increased risk because of a meningococcal B outbreak (see ACIP meeting summary in the March 10 issue of IAC Express).

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CDC launches Born with Protection vaccination campaign for National Infant Immunization Week

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. As part of NIIW, CDC has recently launched a Born with Protection campaign to raise awareness of the third trimester Tdap vaccine recommendation among pregnant women and prenatal healthcare professionals. By getting vaccinated in the third trimester of each pregnancy, mothers can pass antibodies to their babies to help protect them during their first few months of life when they are most vulnerable to pertussis disease and complications.

For more information on the recommendation for Tdap vaccine during pregnancy, visit the CDC’s Pregnancy and Whooping Cough web page. Materials are available for pregnant women, healthcare professionals, and Spanish speakers. Resources include fact sheets, e-cards, posters, infographics, public service announcements, continuing education opportunities for healthcare professionals, and more.

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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 February 17, when IAC Express last reported on the Influenza Vaccination Honor Roll, ten healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, and government agencies
  • Baptist Memorial Hospital - Union County, New Albany, MS
  • Clark Regional Medical Center, Winchester, KY
  • Clinica Family Health, Lafayette, CO
  • Iroquois Memorial Hospital, Watseka, IL
  • Macon County General Hospital, Lafayette, TN
  • Middlesex Hospital, Middletown, CT
  • Reading Health System, West Reading, PA
  • Skiff Medical Center, Newton, IA
  • Terre Haute Regional Hospital, Terre Haute, IN
  • Wheaton Franciscan Healthcare, Racine, WI
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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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Just published: Bad Faith: When Religious Belief Undermines Modern Medicine is the latest book by Dr. Paul Offit

In his latest book, Bad Faith: When Religious Belief Undermines Modern Medicine, Paul A. Offit, MD, explores the tangled relationship between medicine and religion in the United States, including discussion of religious vaccine exemptions. Dr. Offit is the chief of Infectious Diseases and the director of the Vaccine Education Center at the Children's Hospital of Philadelphia, as well as the Maurice R. Hilleman Professor of Vaccinology and professor of pediatrics at the University of Pennsylvania School of Medicine.

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WHO publishes information on zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness

The World Health Organization (WHO) published Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness in the March 20 issue of the Weekly Epidemiological Record.
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CDC releases new measles resources related to international travel

In response to the 2015 multi-state measles outbreak, CDC continues to develop new resources for healthcare professionals and their patients. With the spring/summer travel season approaching, recent offerings emphasize the importance of MMR vaccination for international travelers.

Recently developed CDC resources related to international travel and MMR vaccination
  • For everyone: A measles travel web feature Don’t Let Measles Be Your Travel Souvenir that explains the importance of measles vaccination before international travel       
  • For everyone: An infographic showing how easily measles spreads and that vaccination is the key to stopping measles outbreaks
  • For college-age travelers: An infographic encouraging measles vaccination before spring or summer international travel
  • For everyone: The TravWell app helps in planning for safe and healthy international travel
  • For everyone: The CDC Health Information for International Travel (commonly called the Yellow Book) serves as a reference for those who advise international travelers about health risks     
  • For everyone: Travelers’ Health has specific guidance for audiences that may be at higher risk for measles, such as humanitarian aid workers, long-term travelers, and people visiting friends and relatives in another country
Suggested social media messages to promote the new travel resources 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

Study published in JAMA indicates that low vaccination rates were likely the cause of Southern California measles outbreak

On March 16, the Journal of the American Medical Association (JAMA) published a research letter online titled Substandard Vaccination Compliance and the 2015 Measles Outbreak. Lead author Maimuna S. Majumder, MPH, Massachusetts Institute of Technology, and colleagues from Harvard Medical School and Boston Children's Hospital present a preliminary analysis of the measles outbreak linked to the Disneyland Resort in Anaheim, California, and conclude that substandard vaccination compliance is likely to blame. Related Links

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

CDC publishes report on fatal yellow fever vaccine-associated viscerotropic disease

CDC published Notes from the Field: Fatal Yellow Fever Vaccine-Associated Viscerotropic Disease—Oregon, September 2014 in the March 20 issue of MMWR (pages 279–281). The last paragraph is reprinted below.

Although most persons have no or mild adverse events after yellow fever vaccination, the benefits of vaccination among travelers who have a limited exposure period need to be weighed against risk for adverse events. Yellow fever can range in severity from a mild febrile illness to severe disease with jaundice and hemorrhage; the case-fatality ratio for severe yellow fever disease is 20%–50%. An estimated 200,000 yellow fever cases occur worldwide annually, with approximately 87% in Africa. The live, attenuated vaccine is recommended for persons living in or traveling to tropical South America and sub-Saharan Africa; proof of yellow fever vaccination can be required for entry into certain countries. When determining whether a patient should receive yellow fever vaccine, the patient and clinician should discuss the risk for travel-associated yellow fever disease as indicated by season, destinations and duration of travel, likelihood of exposure to mosquitoes while traveling, and vaccination status, and weigh them against risks associated with vaccination.

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Southwest Florida Immunization Workshop to be held May 21

The 7th annual Southwest Florida Immunization Workshop, Creative Ideas for Increasing HPV & Other Adolescent Vaccination Rates, will be held May 21 in Sarasota. Featured speakers will be Donna Weaver, RN, MN, nurse educator, CDC, and Jorge Lujan-Zilbermann, MD, Hill-Top Research, Inc. Back to top

Question of the Week

I need information about the administration of vaccines to 3-month-old conjoined twins (joined at the buttocks). The mother states that a hepatitis B vaccine was given at birth but there is no record of this. For their routine immunization, do we provide one set of vaccinations or two, given that they are conjoined at the buttock but share no major organs? 
ACIP does not address this issue. However, CDC recommends that these children should each be vaccinated, notwithstanding they are conjoined. We believe even in conjoined twins who share organs and/or blood supply, vaccination of each child would also be indicated. The rationale is one cannot be sure, even in the latter case, that the common organs/blood supply would eliminate vaccine antigens less quickly, or the immune system(s) would respond adequately, to one dose of each vaccine for the two children.  Therefore two doses seems appropriate, that is, one dose of each vaccine for each child.

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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