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Issue 1188: June 16, 2015

Ask the Experts
Ask the Experts—Question of the Week: An 8-year-old child received three doses of oral polio vaccine before his first birthday…read more

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

The May 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 May issues (PDF) of Needle Tips and/or Vaccinate Adults.

Download the March issue of Needle TipsDownload May 2015 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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ACIP publishes recommendations for use of serogroup B meningococcal vaccines in people age ten years and older at increased risk for serogroup B meningococcal disease

CDC published Use of Serogroup B Meningococcal Vaccines in Persons Aged ≥10 Years at Increased Risk for Serogroup B Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices, 2015 in the June 12 issue of MMWR (pages 608–612). The first paragraph and the sections titled "Rationale for Recommendations" and "Recommendations" are reprinted below.

In October 2014, the Food and Drug Administration (FDA) licensed the first serogroup B meningococcal (MenB) vaccine (MenB-FHbp [Trumenba, Wyeth Pharmaceuticals, Inc.]) as a 3-dose series. In January 2015, FDA licensed a second MenB vaccine (MenB-4C [Bexsero, Novartis Vaccines]) as a 2-dose series. Both vaccines were approved for use in persons aged 10–25 years. Following outbreaks of serogroup B meningococcal disease on two college campuses in 2013, both MenB vaccines were granted Breakthrough Therapy designations, which expedites drug development and review by FDA, and were licensed based on accelerated approval regulations. On February 26, 2015, the Advisory Committee on Immunization Practices (ACIP) recommended use of MenB vaccines among certain groups of persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease. This report summarizes information on MenB administration and provides recommendations and guidance for use of these vaccines among persons aged ≥10 years in certain groups who are at increased risk for serogroup B meningococcal disease, and reviews the evidence considered by ACIP to make these recommendations. Recommendations for broader use of MenB vaccines in adolescents and college students will be considered separately by ACIP.

Rationale for Recommendations

Certain groups of persons known to be at increased risk for meningococcal disease are recommended to be routinely vaccinated with a quadrivalent meningococcal conjugate vaccine (MenACWY), which protects against serogroups A, C, W, and Y. Many of these groups are also at increased risk for serogroup B meningococcal disease. Available immunogenicity and safety data support the use of MenB vaccines in groups at increased risk for serogroup B meningococcal disease.

Both MenB vaccines are approved for use in persons aged 10–25 years; however, because there are no theoretical differences in safety for persons aged >25 years compared with those aged 10–25 years, ACIP supported routine use of MenB vaccines in persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease. These recommendations do not apply to children aged <10 years.


Certain persons aged ≥10 years who are at increased risk for meningococcal disease should receive MenB vaccine. These persons include:
  • Persons with persistent complement component deficiencies
  • Persons with anatomic or functional asplenia
  • Microbiologists routinely exposed to isolates of Neisseria meningitidis
  • Persons identified as at increased risk because of a serogroup B meningococcal disease outbreak
Certain other groups are included in the MenACWY recommendations for persons at increased risk, but are not included in this recommendation. MenB vaccines are not licensed for children aged <10 years and are not currently recommended for children aged 2 months–9 years who are at increased risk for serogroup B meningococcal disease. MenB vaccine is not recommended for persons who travel to or reside in countries where meningococcal disease is hyperendemic or epidemic because the risk for meningococcal disease in these countries generally is not caused by serogroup B. The vaccine is not currently recommended for routine use in first-year college students living in residence halls, military recruits, or all adolescents. Recommendations for broader use of MenB vaccines in adolescents and college students will be considered separately by the ACIP.

MenB vaccine should be administered as either a 2-dose series of MenB-4C or a 3-dose series of MenB-FHbp. The same vaccine product should be used for all doses. Based on available data and expert opinion, MenB-4C or MenB-FHbp may be administered concomitantly with MenACWY vaccines, but at a different anatomic site, if feasible.

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American Medical Association adopts new policy that supports ending non-medical vaccine exemptions, including those for healthcare professionals

At its annual meeting in June, the American Medical Association (AMA) adopted a new policy that supports ending non-medical exemptions to immunization mandates. An AMA press release from June 8 is reprinted below.

Addressing the re-emergence of vaccine-preventable diseases in the United States requires states to move toward barring non-medical exemptions to immunization mandates, according to new policy adopted by the nation's physicians at the American Medical Association's annual meeting. Under new policy, the AMA will seek more stringent state immunization requirements to allow exemptions only for medical reasons. 

Immunization programs in the Unites States are credited with having controlled or eliminated the spread of epidemic diseases, including smallpox, measles, mumps, rubella, diphtheria and polio. Immunization requirements vary from state to state, but only two states bar non-medical exemptions based on personal beliefs.

"When people are immunized, they also help prevent the spread of disease to others, said AMA Board Member Patrice A. Harris, MD. "As evident from the recent measles outbreak at Disneyland, protecting community health in today's mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience."

New AMA policy recommends that states have in place an established decision mechanism that involves qualified public health physicians to determine which vaccines will be mandatory for admission to schools and other public venues. States should only grant exemptions to these mandated vaccines for medical reasons.

In recognition that highly transmissible diseases could pose significant medical risks for vulnerable patients and the health care workforce, new AMA policy also states that physicians and other health professionals who have direct patient care responsibilities have an obligation to accept immunization unless there is a recognized medical reason.

The AMA also intends to support the dissemination of materials on vaccine efficacy to states as part of the effort to eliminate non-medical exemptions.

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CDC reports on serogroup B meningococcal disease outbreak and carriage evaluation at a college

CDC published Serogroup B Meningococcal Disease Outbreak and Carriage Evaluation at a College—Rhode Island, 2015 in the June 12 issue of MMWR (pages 606–607). A summary made available to the press is reprinted below.

In response to a serogroup B meningococcal disease outbreak at a college in Rhode Island, targeted antibiotic chemoprophylaxis of close contacts and a mass vaccination campaign with a recently-licensed serogroup B meningococcal (MenB) vaccine were implemented. No further cases have been identified. Additionally, an evaluation of asymptomatic nasopharyngeal carriage of Neisseria meningitidis, the bacteria that causes meningococcal disease, found that 25 percent of the 717 student participants carried N. meningitidis, 4 percent specifically carried serogroup B, and none carried the outbreak strain. This baseline carriage prevalence is higher than previous U.S. estimates of 1 percent to 8 percent among the general population, but is comparable to prevalences observed in United Kingdom university students. Two additional carriage evaluations will assess MenB vaccination impact on carriage over time in this college population.

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IAC Spotlight! Vaccine Information Statements in up to 40 languages are ready for your use 

If you provide vaccination services for people who don’t speak or read English, the Immunization Action Coalition (IAC) is the “go-to” place for translations of Vaccine Information Statements (VISs). For more than 15 years, IAC has made VIS translations available on In 2011, IAC entered into a cooperative agreement with the Centers for Disease Control and Prevention (CDC) to establish IAC’s role as the official source of VIS translations. 

For the 18 languages listed below, IAC has up-to-date VIS translations for all routinely recommended vaccines. You can download all translations in a particular language from the links listed below:  For VISs in other languages, visit

Thanks to IAC’s Partners Who Provide Translations 

Many of the VISs available on are donated to IAC by generous partners. We count on our partners to provide translation services every time new or updated VISs are released by CDC and are deeply grateful to the following organizations and individuals for their time and dedication to providing VIS translations: Arkansas Department of Health; Asian Pacific Health Care Venture, Los Angeles, CA; California Department of Public Health; Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases; DSMA Ethiopian Orthodox Church, Minneapolis, MN; Family Medicine Health Center, Refugee Screening Clinic, Boise, ID; Hawaii Department of Health; Healthy Roads Media, Falcon Heights, MN; Mustafa Kozanolgu, MD, Toronto, Canada; Massachusetts Department of Health and Human Services; Minnesota Department of Health; New York City Department of Health and Mental Hygiene; St. Peter’s Health Partners, Albany, NY; Don Shuwarger, MD, FACOP, MBA, Alamogordo, NM; Swedish Medical Center, Seattle, WA; and Wentworth Douglass Hospital, Dover, NH. 

Would you like to donate translations for IAC? 

If you are interested in becoming a translation partner of IAC, please visit to find out details about how it works. Contact us at, if you would like additional information. 

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Reminder: 13th edition of CDC's "Pink Book" now available to order or download

CDC has just released the 13th edition of its book, Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). The previous edition was published in 2012. Developed by CDC’s National Center for Immunization and Respiratory Diseases, this edition provides updated immunization and vaccine information to public health practitioners, healthcare providers, health educators, pharmacists, nurses, and others involved in administering vaccines. The following information is reprinted from the Public Health Foundation (PHF), the distributor of the print version of Epidemiology and Prevention of Vaccine-Preventable Diseases.

Current, credible, and comprehensive, "The Pink Book" contains information on each vaccine-preventable disease and delivers immunization providers with the latest information on:
  • Principles of vaccination
  • General recommendations on immunization
  • Vaccine safety
  • Child/adult immunization schedules
  • International vaccines/Foreign language terms
  • Vaccination data and statistics
The 13th edition offers an easy-to-read format for immunization professionals to use and reference. Updates include:
  • New vaccine administration guidelines
  • New recommendations regarding selection of storage and temperature monitoring tools
  • New recommendations for vaccine transport
  • Updated information on available influenza vaccine products
  • Use of Tdap in pregnancy
  • Use of Tdap in persons 65 years of age or older
  • Use of PCV13 and PPSV23 in adults with immunocompromising conditions
  • New licensure information for varicella-zoster immune globulin
Download the "Pink Book" Order the "Pink Book" Email CDC with comments, questions, or suggestions about the contents of this book.

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Check out IAC’s series of vaccine summaries for patients and parents

IAC wants to remind readers that we offer a series of easy-to-read summaries on all routine vaccines for patients and parents. Please review them to see if they might be of help to you in your work setting.

Easy-to-read Vaccine Summaries for Parents
Use these one-page handouts to teach parents about the dangers of vaccine-preventable diseases and the value of vaccination. Access the entire series of Vaccine Summaries.

Easy-to-read Vaccine Summaries for Teens and Adults
IAC's series of one-page, easy-to-read handouts that emphasize the dangers of the vaccine-preventable diseases and the importance of vaccination. Access the entire series of Vaccine Summaries for teens and adults.

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CDC issues updated interim infection prevention and control recommendations for hospitalized patients with Middle East Respiratory Syndrome Coronavirus

CDC recently posted an update of its July 2014 guidance, Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV), which highlighted the key infection control recommendations including standard, contact, and airborne precautions. The updated guidance continues to recommend standard, contact, and airborne precautions. In addition, it emphasizes additional elements of infection prevention and control programs that should be in place to prevent the transmission of any infectious agents including respiratory pathogens such as MERS-CoV in healthcare settings. Since May 2015, the Republic of Korea has been investigating an outbreak of MERS. It is the largest known outbreak of MERS outside the Arabian Peninsula. Only two patients in the U.S. have ever tested positive for MERS-CoV infection, both in May 2014. CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented.

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Medical Assistants Resources and Training on Immunization releases newsletter that focuses on HPV vaccination

Medical Assistants Resources and Training on Immunization (MARTi) is an organization that provides excellent immunization-related information and links to training opportunities for medical assistants. MARTi just released a newsletter on HPV vaccination that includes basic information and links to additional resources.

MARTi is funded through a cooperative agreement between CDC and the Association for Prevention Teaching and Research (APTR).

Visit the MARTi website at and be sure to recommend it to the medical assistants with whom you work and all others who administer vaccines! 

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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 makes available 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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CDC and WHO report on measles elimination in the Southeast Asia Region in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Progress Toward Measles Elimination—Southeast Asia Region, 2003–2013 in the June 12 issue of MMWR (pages 613–617). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards measles elimination—Southeast Asia Region, 2003–2013. A summary of the MMWR article made available to the press by CDC is reprinted below.

In 2013, after rigorous prior consultations, the 66th session of the Regional Committee of the World Health Organization (WHO) Southeast Asia Region (SEAR) adopted the goal of measles elimination and CRS control by 2020. This report updates previous reports and summarizes progress toward measles elimination in SEAR during 2003–2013. Coverage with the first dose of a measles-containing vaccine (MCV1) increased from 67 percent to 78 percent and an estimated 286 million children (93 percent of the target) were vaccinated in SIAs. Measles incidence decreased 73 percent, from 59 to 16 cases per million population and estimated measles deaths decreased 63 percent.

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Join CDC for a June 26 webinar on topics related to adolescent immunization

On June 26 at 12:00 p.m. (ET), CDC will sponsor its next #PreteenVaxScene webinar.

Scheduled Speakers
  • Cindy Weinbaum, MD, MPH, acting executive secretary of ACIP, will provide an overview of the following topics that are currently on the draft agenda for the June 24–25 ACIP meeting: the policy options, evidence, and considerations for routine use of MenB vaccines in adolescents; an overview of 9-valent HPV vaccination for persons who have completed an HPV vaccination series, cost-effectiveness, as well as GRADE and proposed guidance for use of 9-valent HPV vaccine; and, updates to the child/adolescent immunization schedule
  • Ian Branam, health communication specialist, TEKsystems Inc., National Center for Immunization and Respiratory Disease's (NCIRD), will discuss plans and activities for National Immunization Awareness Month and what organizations and practices can do to help promote immunizations throughout the month of August
  • Jill Roark MPH, health communication specialist, NCIRD, will present "Beating the Back to School Rush," including ideas to help parents and clinicians to take advantage of early summer break for vaccinations
Register for the webinar

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Reminder: CDC's Epidemiology & Prevention of Vaccine-Preventable Diseases course to be held in Tacoma, Washington, on September 16–17

The State of Washington's immunization coalition, WithinReach, will sponsor CDC's live two-day Epidemiology & Prevention of Vaccine-Preventable Diseases course (also known as the "Pink Book" course) on September 16–17, in Tacoma, Washington. The course provides a comprehensive review of immunizations and the diseases they prevent. Continuing education credits are available. Additionally, a selection of pre-course workshops will be offered on September 15, with topics including HPV, vaccine hesitancy, and the Washington State Immunization Information System. Back to top

Agenda for June ACIP meeting available; listen to the meeting if you are unable to attend

CDC has released a new draft agenda for the next Advisory Committee on Immunization Practices (ACIP) meeting, which will be held June 24–25 at CDC's Clifton Road campus in Atlanta. Registration is now closed for attending this meeting in person, but interested individuals can listen to the meeting live. Registration is not required to listen to the meeting; the call-in information page is listed below. The live meeting recording and presenter slides are always made available online after the meeting as well.

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Question of the Week

An 8-year-old child received three doses of oral polio vaccine before his first birthday. Should he receive an additional dose of inactivated poliovirus vaccine (IPV)? 
Yes. This patient should receive a dose of IPV now. The final dose of the polio series should be received on or after the fourth 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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