Issue 1175: March 31, 2015

Ask the Experts–Question of the Week: I have a female patient who has a history of immune thrombocytopenia and had a…read more

CDC publishes ACIP recommendations for use of 9-valent HPV vaccine in MMWR

CDC published Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices in the March 27 issue of MMWR (pages 300–304). The first sentence and the section titled "Recommendations for Use of HPV Vaccines" are reprinted below.

During its February 2015 meeting, the Advisory Committee on Immunization Practices (ACIP) recommended 9-valent human papillomavirus (HPV) vaccine (9vHPV) (Gardasil 9, Merck and Co., Inc.) as one of three HPV vaccines that can be used for routine vaccination.

Recommendations for Use of HPV Vaccines

ACIP recommends that routine HPV vaccination be initiated at age 11 or 12 years. The vaccination series can be started beginning at age 9 years. Vaccination is also recommended for females aged 13 through 26 years and for males aged 13 through 21 years who have not been vaccinated previously or who have not completed the 3-dose series. Males aged 22 through 26 years may be vaccinated. Vaccination of females is recommended with 2vHPV, 4vHPV (as long as this formulation is available), or 9vHPV. Vaccination of males is recommended with 4vHPV (as long as this formulation is available) or 9vHPV.

2vHPV, 4vHPV, and 9vHPV all protect against HPV 16 and 18, types that cause about 66% of cervical cancers and the majority of other HPV-attributable cancers in the United States. 9vHPV targets five additional cancer-causing types, which account for about 15% of cervical cancers. 4vHPV and 9vHPV also protect against HPV 6 and 11, types that cause anogenital warts.

Read the complete article for more information on indications, administration, contraindications and precautions, and other issues.

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CDC publishes new ACIP recommendations for typhoid vaccination in MMWR

CDC published Updated Recommendations for the Use of Typhoid Vaccine—Advisory Committee on Immunization Practices, United States, 2015 in the March 27 issue of MMWR (pages 305–308). The "Vaccine Usage" and "Choice of Vaccine" sections are reprinted below.

Vaccine Usage

Routine typhoid vaccination is not recommended in the United States.

Vaccination is recommended for the following groups:
  • Travelers to areas where there is a recognized risk for exposure to Salmonella serotype Typhi (the most recent guidelines are available at Risk is greatest for travelers who have prolonged exposure to possibly contaminated foods and beverages, although short-term travelers are also at risk. Most travel-associated typhoid fever cases in the United States occur among travelers who are visiting friends or relatives; many travelers in this group do not seek pre-travel health care. Multidrug-resistant strains of Salmonella serotype Typhi have become common in many regions, and cases of typhoid fever that are treated with drugs to which the organism is resistant can be fatal. Travelers should be cautioned that typhoid vaccination is not a substitute for careful selection of food and beverages. Typhoid vaccines are not 100% effective, and vaccine-induced protection can be overwhelmed by large inocula of Salmonella serotype Typhi.
  • Persons with intimate exposure (e.g., household contact) to a documented Salmonella serotype Typhi chronic carrier (defined as excretion of Salmonella serotype Typhi in urine or stool for >1 year).
  • Microbiologists and other laboratory workers routinely exposed to cultures of Salmonella serotype Typhi or specimens containing this organism or who work in laboratory environments where these cultures or specimens are routinely handled.
Choice of Vaccine

Parenteral Vi polysaccharide and oral Ty21a are both acceptable forms of typhoid vaccine.

The Vi polysaccharide vaccine is administered as a single injection and is approved for adults and children aged ≥2 years. The oral Ty21a vaccine is administered in 4 doses on alternating days over 1 week and is approved for adults and children aged ≥6 years. Immunocompromised persons should not use Ty21a because it is a live-attenuated vaccine. Because antibacterial drugs might be active against the vaccine strain and reduce immunogenicity, the Ty21a vaccine should not be administered to persons taking these medications.

Read the complete article for more information on indications, administration, contraindications and precautions, and other issues.

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IAC Spotlight! IAC promotes The Vaccine Handbook, a.k.a. "The Purple Book," by Dr. Gary Marshall

The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book;” 2015, 560 pages) is a uniquely comprehensive source of practical, up-to-date information for vaccine providers and educators. Its author, Gary S. Marshall, MD, has drawn together the latest vaccine science and guidance into a concise, user-friendly, practical resource for the private office, public health clinic, academic medical center, and hospital.
 Order your copy of The Vaccine Handbook today!
IAC Executive Director Deborah Wexler, MD, is enthusiastic about helping get this resource circulated as widely as possible. “During more than 20 years in the field of immunization education, I have not seen a book that is so brimming with state-of-the-science vaccine information,” she states. "This book belongs in the hands of every medical student, physician-in-training, doctor, nursing student, and nurse who provides vaccines to patients.”
The Vaccine Handbook provides:
  • Information on every licensed vaccine in the United States
  • Rationale behind authoritative vaccine recommendations
  • Contingencies encountered in everyday practice
  • A chapter dedicated to addressing vaccine concerns
  • Background on how vaccine policy is made
  • Standards and regulations
  • Office logistics, including billing procedures, and much more
The newly released fifth edition of this invaluable guide is now available on IAC’s website at
About the Author
Gary Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the division of pediatric infectious diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.
Order your copy today! Back to top

FDA approves Quadracel, a new combination DTaP+IPV vaccine for use in children age 4–6 years

On March 24, FDA announced the approval of Quadracel (Sanofi Pasteur), a DTaP-IPV combination vaccine. A single dose of Quadracel is approved for use in children age 4 through 6 years as a fifth dose in the diphtheria, tetanus, pertussis vaccination (DTaP) series, and as a fourth or fifth dose in the inactivated poliovirus vaccination (IPV) series, in children who have received 4 doses of Pentacel and/or DAPTACEL vaccine.
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CDC releases final editions of Vaccine Information Statements for Td and Tdap Vaccines

On March 27, CDC posted final revised versions of the Td and Tdap Vaccine Information Statements (VISs), both dated 2/24/2015.

According to CDC, the updated versions are not significantly different than the previous editions, which may be used while existing stocks last.

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Institute for Safe Medication Practices provides recommendations to reduce the risk of vaccine errors

On March 26, the Institute for Safe Medication Practices (ISMP) published an article titled Recommendations For Practitioners To Prevent Vaccine Errors Part 2: Analysis Of ISMP Vaccine Errors Reporting Program (VERP). This article is a follow-up to its December 4 report titled Confusion Abounds! 2-year Summary of the ISMP National Vaccine Errors Reporting Program (Part 1). This new article provides valuable recommendations to help vaccine providers avoid errors in the following areas:
  • Errors with age-specific formulations
  • Wrong patient errors due to confusion between siblings
  • Invalid doses (given too soon) or missed opportunities to vaccinate
  • Wrong route errors caused by unfamiliarity with the vaccine
  • Errors with combination vaccines or vaccines with diluents
  • Wrong vaccine errors related to vaccine nomenclature
  • Wrong vaccine and dose errors related to labeling and packaging
  • Errors related to unsafe vaccine storage
  • Administration of an expired drug
Read Recommendations For Practitioners To Prevent Vaccine Errors Part 2: Analysis Of ISMP Vaccine Errors Reporting Program (VERP) for many useful tips on preventing vaccines errors.

The Institute for Safe Medication Practices is the nation’s only 501(c)(3) nonprofit organization devoted entirely to medication error prevention and safe medication use. The Vaccine Error Reporting Program (VERP) was created to allow healthcare professionals and patients to report vaccine errors confidentially. By collecting and quantifying information about these errors, ISMP will be better able to advocate for changes in vaccine names, labeling, or other appropriate modifications that could reduce the likelihood of vaccine errors in the future. Reporting vaccination administration errors via this link will help improve health care for everyone.

Note: If an adverse event occurs following a vaccine administration error, a report should also be sent to Vaccine Adverse Event Reporting System (VAERS). Adverse events should be reported to VAERS regardless of whether a healthcare professional thinks the event is related to the vaccine or not, as long as it follows administering a dose of vaccine.

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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! CDC's webinar on updated HPV vaccination recommendations rescheduled for April 3

CDC has rescheduled its previously postponed March 6 “HPV Vaccine Recommendation Update Webinar" to April 3 at 11:00 a.m. (ET). Lauri Markowitz, MD, will be the presenter. Dr. Markowitz is the team leader of epidemiology research in the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, and the CDC lead for the HPV Vaccine Working Group of ACIP. Back to top

IAC updates its vaccination checklist for adults: "Do I Need Any Vaccinations Today?"

IAC recently updated Do I Need Any Vaccinations Today?, a handout that patients and healthcare providers can use to assess an adult's vaccination needs. The pneumococcal vaccine section of this resource was updated to align with current ACIP recommendations.

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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IAC revises its algorithm handout: "Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing"

IAC recently revised the healthcare professional handout, Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing. The first sentence of the first footnote was changed from "Routine pre-exposure serologic testing is not recommended for all previously vaccinated HCP who were not tested 1 to 2 months after the third dose (such as people vaccinated as children or adolescents)" to "Pre-exposure serologic testing may be recommended for all previously vaccinated HCP who were not tested 1 to 2 months after the third dose (such as people vaccinated as children or adolescents)."

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World Immunization Week scheduled for April 24–30

The World Health Organization (WHO) has announced that World Immunization Week (WIW) will be held April 24–30. The WIW 2015 campaign website is now up and running, and is available in English, Chinese, French, and Russian. Additional languages will be added shortly.

This year’s campaign focuses on closing the immunization gap and reaching equity in immunization levels as outlined in the Global Vaccine Action Plan.

Visit the campaign website to access resources, including a poster and an infographic that illustrate closing the immunization gap.

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CDC releases new measles resources for Spanish speakers

In response to the 2015 multi-state measles outbreak, CDC continues to develop new resources for healthcare professionals and their patients. This week, CDC added resources for patients and parents who speak Spanish. 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

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

Question of the Week

I have a female patient who has a history of immune thrombocytopenia and had a splenectomy as treatment. This patient responded to the treatment. She is not currently on medication for this condition. How long after a splenectomy should a person wait before they get an MMR vaccination? 

A history of thrombocytopenia is a precaution for MMR vaccine. If there is a risk of disease, the benefit of vaccination would outweigh the risk of vaccination, particularly since the thrombocytopenia has been treated. For more information on vaccination of persons with asplenia, see the "Question of the Week" for January 6, 2015.

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
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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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