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Issue 1181: May 5, 2015

Ask the Experts–Question of the Week: A 60 year-old patient will be starting corticosteroid therapy. He will start at 20 mg per…read more

The Pan American Health Organization declares rubella eliminated in the Americas

On April 29, the Pan American Health Organization (PAHO), in conjunction with CDC, UNICEF, and the United Nations Foundation, announced that rubella had been eliminated from the WHO Americas region. The first three paragraphs of a press release from PAHO and World Health Organization (WHO) are reprinted below.

The Americas region has become the first in the world to be declared free of endemic transmission of rubella, a contagious viral disease that can cause multiple birth defects as well as fetal death when contracted by women during pregnancy.

This achievement culminates a 15-year effort that involved widespread administration of the vaccine against measles, mumps and rubella (MMR) throughout the Western Hemisphere. The announcement comes as 45 countries and territories of the Americas are participating in the 13th annual Vaccination Week in the Americas (April 25 to May 2).

The declaration of elimination, made by an international expert committee during a meeting at the Pan American Health Organization/World Health Organization (PAHO/WHO) last week, makes rubella and congenital rubella syndrome (CRS) the third and fourth vaccine-preventable diseases to be eliminated from the Americas, following the regional eradication of smallpox in 1971 and the elimination of polio in 1994.
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IAC Spotlight! Online listing provides easy access to the entire catalog of IAC's handouts for patients and staff

Looking for a listing of the entire catalog of IAC's handouts for patients and staff? Look no further. IAC's Handouts web section features an online table that allows visitors to sort more than 250 handouts alphabetically by title, and also by language, issue date, and item number. In addition, IAC now provides the table sorted by audience: Handouts for Staff and Handouts for Patients. 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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Public Health Law Program releases a summary of state statutes and regulations regarding school vaccines

CDC's Public Health Law Program has posted new information on its State School and Childcare Vaccination Laws web page. The page includes a link to a PDF document titled State School Immunization Requirements and Vaccine Exemption Laws. This document summarizes select state vaccination laws collected to date.

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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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Join the Voices for Vaccines' May 19 conference call featuring Tara Haelle on journalism and vaccines

You are invited to join Voices for Vaccines on May 19 at 12:00 p.m. (ET) for a special conversation about journalism and vaccines, featuring veteran health reporter Tara Haelle.

Tara Haelle's work has appeared in Forbes, Scientific American, Washington Post, Politico, Slate, NOVA, Wired, Science, HealthDay, Frontline Medical Communications, and her blog Red Wine & Apple Sauce. She is currently co-authoring an evidence-based parenting book to be released in late 2015. She also teaches journalism at Bradley University in Peoria, IL.

To register for this call, email

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!
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IAC and ACOG update their "Vaccinations for Pregnant Women" patient handout

In 2013, IAC, in partnership with the American College of Obstetricians and Gynecologists (ACOG), developed "Vaccinations for Pregnant Women." This patient handout informs pregnant women about which vaccinations are specifically recommended, which are allowed if indicated, and which are contraindicated during pregnancy. The information is presented in a simple table format that is easy to read and understand. This handout has just been updated to reflect current ACIP recommendations on Hib, PCV, PPSV, and varicella vaccination. "Vaccinations for Pregnant Women" is part of a suite of handouts that focuses on adults in risk groups for vaccination.

Here are the other handouts currently in the suite: Visit IAC's Patient Schedules web page to access all schedules for patients and parents.

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IAC updates “Hepatitis B and Healthcare Personnel,” a CDC-answered Q&A about hepatitis B vaccination, testing, and pre- and post-exposure management of HCP

IAC recently updated Hepatitis B and Healthcare Personnel: CDC answers frequently asked questions about how to protect healthcare personnel. Sections in the FAQ include: Hepatitis B Vaccination, Post-vaccination Anti-HBs Testing, Non-responders or HCP with Chronic HBV infection, and Post-exposure Management. Figure 1 titled "Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing" was added, Table 1 was updated, and both are now in accordance with CDC Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management (December 2013). 

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 updates its staff education materials: "Current Dates of Vaccine Information Statements" and "It's Federal Law! You must give your patients current Vaccine Information Statements"

IAC recently revised Current Dates of Vaccine Information Statements as well as It's Federal Law! You must give your patients current Vaccine Information Statements to reflect the 4/24/2015 date of the recently updated Pneumococcal Polysaccharide VIS.

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WHO issues position paper on hepatitis E vaccine

The May 1 issue of the WHO periodical Weekly Epidemiological Record includes the first WHO position paper on hepatitis E vaccine.

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UNICEF announces five immunization campaigns in Syria, Guinea, Liberia, Sierra Leone, and Sudan

In April, UNICEF announced the launch of five major immunization campaigns to protect children in Syria, Sudan, Guinea, Liberia, and Sierra Leone. The titles and first paragraphs of the related press releases from UNICEF follow.

Press release—April 24: Measles vaccination campaign aims to immunize over 2.6 million Syrian children
A 10-day measles immunization campaign is underway in Syria to protect children from this deadly disease. Launched on 19 April, the campaign is aimed at children between six months and five years of age. Vaccination will be provided in 1,209 health centres, and nearly 6,000 health staff and mobile teams are participating in the campaign.

Press release—April 24: Immunization drive under way for 3 million children in Ebola-hit countries
For the first time since the start of the Ebola outbreak, Guinea, Liberia and Sierra Leone are conducting major nationwide immunization campaigns to protect millions of children against preventable but potentially deadly diseases.

Press release—April 22: Nearly 8 million children in Sudan to be immunized against measles following deadly outbreak
Following one of the worst measles outbreaks in Sudan’s recent history, the Ministry of Health with support from UNICEF, the Measles and Rubella Initiative (M&RI) and national partners, is launching a massive campaign to immunize 7.9 million children aged six months to 15 years against this life-threatening disease.

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April issue of CDC's Immunization Works newsletter now available

CDC recently released the April issue of its monthly newsletter, Immunization Works, and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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Journal of Adolescent Health publishes supplement on adolescent vaccination

The May issue of Journal of Adolescent Health includes a supplement with three editorials and eight articles about adolescent vaccination. The journal has provided the full text of these articles online. Go to the supplement index and click on any title of interest to get the abstract. Click the "Full text" tab on the top of the abstract to open the full article, or click the PDF link in the right column.

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CDC publishes report of laboratory-acquired vaccinia virus infection

CDC published Laboratory-Acquired Vaccinia Virus Infection in a Recently Immunized Person—Massachusetts, 2013 in the May 1 issue of MMWR (pages 435–438). A summary made available to the press is reprinted below.

This is the first report of a laboratory-acquired vaccinia virus infection in a recently vaccinated laboratory worker. Through collaboration between the local and federal health agencies, the laboratory, and the university, the patient was rapidly assessed and received appropriate treatment. The health agencies also identified areas in the laboratory requiring improvements in occupational safety. Finally, though this is a rare report of an appropriately vaccinated laboratory worker exhibiting symptoms of infection after inadvertent inoculation, the preventative recommendations for laboratory personnel who handle cultures or animals infected with wildtype vaccinia virus are smallpox vaccination and appropriate training in laboratory-safety protocols.

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CDC publishes MMWR Early Release about possible sexual transmission of the Ebola virus

CDC published Possible Sexual Transmission of Ebola Virus—Liberia, 2015 in an MMWR Early Release published on May 1. The first paragraph is reprinted below.

On March 20, 2015, 30 days after the most recent confirmed Ebola Virus Disease (Ebola) patient in Liberia was isolated, Ebola was laboratory confirmed in a woman in Monrovia. The investigation identified only one epidemiologic link to Ebola: unprotected vaginal intercourse with a survivor. Published reports from previous outbreaks have demonstrated Ebola survivors can continue to harbor virus in immunologically privileged sites for a period of time after convalescence. Ebola virus has been isolated from semen as long as 82 days after symptom onset and viral RNA has been detected in semen up to 101 days after symptom onset. One instance of possible sexual transmission of Ebola has been reported, although the accompanying evidence was inconclusive. In addition, possible sexual transmission of Marburg virus, a filovirus related to Ebola, was documented in 1968. This report describes the investigation by the Government of Liberia and international response partners of the source of Liberia's latest Ebola case and discusses the public health implications of possible sexual transmission of Ebola virus. Based on information gathered in this investigation, CDC now recommends that contact with semen from male Ebola survivors be avoided until more information regarding the duration and infectiousness of viral shedding in body fluids is known. If male survivors have sex (oral, vaginal, or anal), a condom should be used correctly and consistently every time.

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Within Reach and Washington State Department of Health offer new free online course about promoting HPV vaccination with CE credit

WithinReach, in partnership with the Washington State Department of Health and Cardea, has announced a new continuing education course, You Are the Key to HPV Cancer Prevention. This free, hour-long course is designed for physicians, pharmacists, advanced practice clinicians, nurses, and other staff who work with children, adolescents, and their parents in primary care settings.

Research shows that clinicians underestimate the value parents place on the HPV vaccine and that one of the top five reasons cited by parents for not vaccinating is that the vaccine was not recommended. This course helps providers frame the HPV vaccine conversation, encourages providers to make a strong vaccination recommendation, and offers responses for the most common concerns and questions held by parents. Back to top

Question of the Week

A 60-year-old patient will be starting corticosteroid therapy. He will start at 20 mg per day for 4 days, and then taper to 15 mg for 3 weeks. He will continue therapy for a year, but the dosing will change depending on his response. Should I administer zoster vaccine now or wait until he is taking a lower dose of corticosteroids? And if the patient should wait, what dose of corticosteroids would be safe for administration of the shingles vaccine? 
Give the zoster vaccine now. Live vaccines should be deferred if a person is taking 20 mg or more of prednisone per day for 2 weeks or longer. An individual can receive a live virus vaccine (zoster in this case) one month after he is below 20 mg of prednisone (or equivalent) per day.

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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