Issue 1180: April 28, 2015

Ask the Experts–Question of the Week: If MMR vaccine is given at 9 months of age, it will not count as the first dose. Is this…read more

CDC releases Pneumococcal Polysaccharide Vaccine Information Statement

On April 27, CDC announced the availability of an updated Vaccine Information Statement (VIS) for pneumococcal polysaccharide vaccine (PPSV23). The PPSV23 VIS (dated April 24, 2015) does not differ significantly from the previous version, which may be used until stocks are depleted.

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IAC Spotlight! Twenty-six 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 March 24, when IAC Express last reported on the Influenza Vaccination Honor Roll, 26 healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, government agencies, and medical practices
  • Crestwood Pediatric Associates, Manassas, VA
  • Los Angeles County Department of Health Services, CA, representing the second largest municipal healthcare system in the United States
    • Los Angeles County and USC Medical Center
    • Harbor and UCLA Medical Center
    • Olive View and UCLA Medical Center
    • Rancho Los Amigos National Rehabilitation Center
    • High Desert Regional Health Center
    • Martin Luther King, Jr. Outpatient Center
    • Antelope Valley Health Center
    • Bellflower Health Center
    • Dollarhide Health Center
    • Edward R. Roybal Comprehensive Health Center
    • El Monte Comprehensive Health Center
    • Glendale Health Center
    • H. Claude Hudson Comprehensive Health Center
    • Hubert H. Humphrey Comprehensive Health Center
    • Lake Los Angeles Community Clinic
    • La Puente Health Center
    • Littlerock Community Clinic
    • Long Beach Comprehensive Health Center
    • Mid-Valley Comprehensive Health Center
    • San Fernando Health Center
    • South Valley Health Center
    • Vaughn School-Based Clinic
    • Wilmington Health Center
  • Sturgis Hospital, Sturgis, MI
  • University Health Conway, Monroe, LA
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FDA finds no association between venous thromboembolism and Gardasil vaccination in large “Sentinel" study

On April 23, the U.S. Food & Drug Administration (FDA) posted FDA Sentinel study finds no association between venous thromboembolism and Gardasil vaccination on its website. The text is reprinted below.

On December 7, 2010, the Food and Drug Administration (FDA) presented a comprehensive postlicensure safety evaluation of Gardasil (Merck Inc. & Co.) to FDA’s Pediatric Advisory Committee (PAC). In this review, FDA presented safety data from the Vaccine Adverse Event Reporting System (VAERS) and the Centers for Disease Control and Prevention’s Vaccine Safety Datalink (VSD) suggesting that more venous thromboembolism (VTE) cases were being observed than expected after vaccination with Gardasil. Venous thromboembolism is a condition where blood clots form in the deep veins of the body, especially the lungs and extremities. Because both the VAERS and VSD data were inconclusive, FDA conducted a follow-up study in the Sentinel system. This FDA update provides a summary of the final analysis, which did not find any evidence of an association between venous thromboembolism and Gardasil vaccination.

Summary of Results
The Sentinel study evaluated the risk of venous thromboembolism in more than 650,000 females aged 9 through 26 years of age, totaling more than 1.4 million doses of Gardasil evaluated. The study identified only 30 medical record confirmed cases of venous thromboembolism in the 8–9 week observation period after each dose administered in the 3-dose series. The VTE cases were identified from 5 Sentinel data partners during the time period of 2006–2013. The study evaluated the risk of VTE 1–28 days after Gardasil vaccination compared to a period approximately one to two months after vaccination. The study did not identify any evidence of an increased risk of VTE in the 1–28 days after any of the 3 doses of Gardasil vaccination.  The study also scanned the entire 8–9 week observation period and did not find any unusual VTE clusters appearing after Gardasil vaccination, further strengthening the conclusion that there is no increased risk of VTE.

FDA Conclusions
The Sentinel study is the largest study of VTE after Gardasil in the United States to date and builds upon other published studies, including those from Denmark and Sweden that also found no evidence of an increased risk for venous thromboembolism after Gardasil vaccination. FDA is not requesting any changes to Gardasil labeling as a result of this new safety information. 

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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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IAC is selling The Vaccine Handbook: A Practical Guide for Clinicians, 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 book 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
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.

The newly released fifth edition of this invaluable guide is now available on IAC’s website at

The price of the handbook is $29.95 each, plus shipping charges. Discount pricing is available for more than 10 copies. Order copies for your staff or for distribution at an upcoming conference.

Quantity Discount Pricing
  • 1–10 books: no discount + shipping
  • 11–50 books: 5% + shipping
  • 51–100 books: 10% + shipping
  • 101–500 books: 15% + shipping
  • 501–1000 books: 20% + shipping
For quotes on larger quantities, email

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Medscape offers new module about how to recommend vaccination to adult patients

On April 16, Medscape posted a new module titled How to Give a Strong Recommendation to Adult Patients Who Require Vaccination. This training module includes both text and video footage, and covers zoster, influenza, pneumococcal (both PCV13 and PPSV23), and Tdap vaccines, as well as vaccination for patients with certain medical conditions.

Research has repeatedly verified that that most adults believe that vaccines are important and are willing to receive them if recommended by their healthcare professional. This module will help healthcare professionals make such recommendations appropriately and effectively.

There is no charge to use Medscape, but you must register to use this service.

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IAC updates its "Questions and Answers" handouts about Hib, measles, and polio

IAC recently updated the following three "Question and Answer" handouts for patients, parents, and the general public.
  1. Haemophilus influenzae type b (Hib): Questions and Answers was re-designed and information was added regarding use of Hib vaccine for adults with asplenia.
  2. Measles: Questions and Answers was re-designed and updated with current statistics.
  3. Polio: Questions and Answers was re-designed and updated with current statistics.
Related Links 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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World Immunization Week to be celebrated April 24–30

World Immunization Week (WIW) is scheduled this year for April 24–30. The campaign aims to promote the use of vaccines to protect people of all ages against disease with the theme: "Close the Immunization Gap." The U.S. Department of Health and Human Services recently posted information about WIW on its website. Two paragraphs are reprinted below.

World Immunization Week 2015 will signal a renewed global, regional, and national effort to accelerate action to increase awareness and demand for immunization by communities, and improve vaccination delivery services.

This year’s campaign focuses on closing the immunization gap and reaching equity in immunization levels as outlined in the Global Vaccine Action Plan (GVAP). The Plan—endorsed by the 194 Member States of the World Health Assembly in May 2012—is a framework to prevent millions of deaths by 2020 through universal access to vaccines for people in all communities.
The World Health Organization offers more information and useful resources on its 2015 WIW campaign website. The website is available in English, Arabic, Chinese, French, Russian and Spanish.

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NACCHO publishes guide to HPV resources for local health departments

The National Association of County and City Health Officials (NACCHO) has released Guide to HPV Resources for Local Health Departments to assist health departments with increasing HPV vaccination rates. The "Background" section is reprinted below.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States with approximately 79 million people currently infected. HPV infection is also a leading cause of cervical cancer and a contributing factor to cancers of the anus, vagina, vulva, penis, and throat. However, despite the availability of an HPV vaccine, vaccination rates remain low, with only 38 percent of females and 14 percent of males completing the three dose series.

In 2014, the National Association of County and City Health Officials (NACCHO) received funding from the Centers for Disease Control and Prevention (CDC) for a project to support local health departments to identify strategies to improve HPV vaccination rates. As a result of this project, NACCHO developed this 
Guide to HPV Resources for Local Health Departments to provide a collection of helpful resources and practice-based tools for HPV vaccination projects and facilitate information sharing among local health departments and other organizations. Related Links

From AAFP, AAP, ACOG, ACP, CDC, and IAC HPV Resources from IAC HPV Resources from CDC HPV Resources from the Vaccine Education Center
HPV Resources from AAP
HPV resources from ACOG
HPV Resources from Voices for Vaccines
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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

New study confirms lack of connection between MMR vaccination and development of autism

On April 21, the Journal of the American Medical Association published an article titled Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism online. Three sections of the abstract are reprinted below.

Despite research showing no link between the measles-mumps-rubella (MMR) vaccine and autism spectrum disorders (ASD), beliefs that the vaccine causes autism persist, leading to lower vaccination levels. Parents who already have a child with ASD may be especially wary of vaccinations.

To report ASD occurrence by MMR vaccine status in a large sample of US children who have older siblings with and without ASD.

Conclusions and Relevance 
In this large sample of privately insured children with older siblings, receipt of the MMR vaccine was not associated with increased risk of ASD, regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.
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CDC reports on polio eradication progress worldwide

CDC published Tracking Progress Toward Polio Eradication—Worldwide, 2013–2014 in the April 24 issue of MMWR (pages 415–420). A summary made available to the press is reprinted below.

There are only three countries where poliovirus circulation has never been interrupted: Afghanistan, Nigeria, and Pakistan. Outbreaks occurred during 2013 and 2014 as a result of spread from these countries. Monitoring the progress of the Global Polio Eradication Initiative requires sensitive and timely polio surveillance. This report presents 2013 and 2014 poliovirus surveillance data, focusing on reports during 2010–2014 from 29 countries with at least one case of wild or circulating vaccine-derived poliovirus. In 2013, 25 of the 29 countries met the two primary surveillance quality indicators: sensitivity and timeliness; in 2014, the number decreased to 21. To complete and certify polio eradication, gaps in surveillance must be identified and surveillance activities, including supervision, monitoring, and proper specimen collection, must be further strengthened.

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WHO publishes reports about polio and acute flaccid paralysis surveillance

On April 24, WHO published the following reports in its Weekly Epidemiological Record.
  • Polio surveillance: tracking progress towards eradication worldwide, 2013–2014
  • Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015
Access both reports in the April 24 issue of the Weekly Epidemiological Record.

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CDC, ACOG, and AAP to sponsor April 30 webinar on improving HPV vaccination rates

CDC has been working closely with the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), among other clinician organizations to increase HPV vaccination rates. The CDC Adolescent Immunization Communications Team will sponsor a webinar on April 30 at 11:00 a.m. (ET) titled, “Partnering for Prevention: A First-Look at the HPV is Cancer Prevention Clinician Engagement Initiative.”

Scheduled speakers:
  • Rebecca B. Perkins, MD, MSc, FACOG, will highlight the importance of this effort from her perspective as an Ob-Gyn, including an overview of why HPV vaccination is a critical cancer prevention tool
  • Sharon G. Humiston, MD, MPH, FAAP, will provide tips for successful recommendations focusing on how clinicians in pediatrics can increase acceptance and uptake of HPV vaccine
  • Jill Roark, MPH, Health Communication Specialist, CDC/NCIRD will introduce the three key pillars of the HPV Vaccine is Cancer Prevention clinician engagement effort and share information about new tools and resources available through CDC
Access registration information.

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Question of the Week

If MMR vaccine is given at 9 months of age, it will not count as the first dose. Is this because immunity at this age may not develop?
Studies indicate that about 86% of children vaccinated at 9 months of age respond to the vaccine while the estimate is about 97% for children vaccinated at 12 months or older. Maternal antibodies against measles virus may persist up to 11 months. For these reasons children vaccinated between 6 and 11 months of age should receive two more doses of MMR after their first birthday.

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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