Issue 1191: June 30, 2015

Ask the Experts
Ask the Experts—Question of the Week: Does a patient living in the U.S. who has documentation of having had meningococcal vaccine…read more

IAC provides summary of June ACIP meeting votes on vaccine recommendations

The most recent meeting of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) was held June 24–25 in Atlanta. Although the ACIP-approved recommendations do not become official until they are approved by the CDC Director and published in the Morbidity and Mortality Weekly Report (MMWR), the following provides a summary of the decisions as they were voted on at the meeting.
Influenza vaccine
ACIP approved another revision of the algorithm for determining the number of influenza doses needed for children 6 months through 8 years of age. The revised algorithm is simpler because consideration of doses of the 2009 monovalent H1N1 influenza vaccine has been removed. 
Meningococcal B vaccine
ACIP had an extensive discussion (including more than 45 minutes of public comment) about the use of serogroup B meningococcal (MenB) vaccine among healthy adolescents (that is, those who do not have conditions that put them at increased risk of meningococcal disease—persistent complement component deficiency, anatomic or functional asplenia, certain microbiologists and people identified to be at increased risk because of a meningococcal B outbreak). Recommendations for MenB vaccination of persons at increased risk of meningococcal disease were published in the June 12 issue of MMWR, pages 608–612.
ACIP voted to recommend that a MenB vaccine series may be administered to persons 16 through 23 years of age with a preferred age of vaccination of 16 through 18 years. This Category B (permissive) recommendation allows for individual clinical decision-making, and will enable coverage of MenB vaccines by the Vaccines For Children program and most insurance plans.
No preference was stated for the use of either of the two currently licensed MenB vaccines, Bexsero (Novartis) or Trumenba (Pfizer). However, because the vaccines are antigenically different, the same product should be used to complete the series for each of the vaccines. Bexsero is a 2-dose series and Trumenba is 3 doses.
Pneumococcal vaccine
ACIP is aware that the different recommended intervals between pneumococcal conjugate (PCV13) and pneumococcal polysaccharide (PPSV23) vaccines for different ages and risk conditions are confusing to clinicians. For instance, currently the recommended interval between PCV13 and PPSV23 for healthy persons age 65 years and older is 6–12 months but the recommended interval if PPSV23 is given first is 1 year. The recommended interval between any sequence of PCV13 and PPSV23 for children age 2 through 18 years at increased risk of invasive pneumococcal disease is 8 weeks.
ACIP discussed this issue at length in an attempt to harmonize the intervals between risk groups and ages. Unfortunately there are few studies that have systematically examined the immunologic effect of various intervals between PCV13 and PPSV23. After discussing the available evidence on the issue, ACIP voted to change the recommended interval between PCV13 and PPSV23 from the current “6–12 months” to “1 year or longer” for healthy persons age 65 years and older (that is, the interval will be 1 year or longer regardless of whether PCV13 or PPSV23 is given first). The recommended interval between PCV13 and PPSV23 for persons younger than age 65 years at increased risk of invasive pneumococcal disease was not changed. ACIP reiterated that PCV13 and PPSV23 should not be administered at the same visit. However, doses given at an interval shorter that the recommended interval do not need to be repeated.
Smallpox vaccine
The only smallpox (vaccinia) vaccine currently available in the U.S. is ACAM2000 (Acambis). The most recent recommendations for the use of smallpox vaccine among laboratory personnel were published in 2001. ACIP approved a revised document on smallpox vaccination of laboratory personnel who directly handle either cultures or animals contaminated or infected with replication-competent vaccinia virus, recombinant vaccinia viruses derived from replication-competent vaccinia, or other orthopoviruses that infect humans, such as monkeypox, cowpox or variola (smallpox). ACIP also recommends that vaccination can be offered to healthcare personnel whose contact with replication-competent vaccinia viruses is limited to contaminated materials (such as dressings) or those who administer ACAM2000.
General Recommendations on Immunization
The ACIP statement titled General Recommendations on Immunization is revised every 3 to 5 years. Revision of this important document has been in progress since the current version was published in 2011. ACIP approved the final sections of the revised document (altered immunocompetence, vaccination programs, vaccination records, and sources of vaccine information). The full revised document will now enter internal CDC clearance. Publication of the revised document is anticipated to be mid-2016.
HPV vaccine
At their February 2015 meeting, ACIP voted to include the newly licensed 9-valent human papillomavirus (9vHPV, Gardasil 9, Merck) vaccine to the vaccines available for use within the current HPV recommendations. These recommendations were published in the March 27 issue of MMWR, pages 300–302.
During the weather-shortened February 2015 meeting, time did not allow a discussion of the use of 9vHPV vaccine for persons who have previously completed a full HPV vaccine series. This issue was discussed at the June meeting, and ACIP did not take a vote either to recommend or to not recommend routine revaccination of persons who have previously received a full series of either the 2- or 4-valent HPV vaccine. The benefit of protection against the 5 additional types included in 9vHPV is primarily for females for protection against cervical cancers and precancers. Only a small percentage (about 4%) of HPV-associated cancers in males are caused by the 5 additional types included in the 9-valent vaccine. However, a study has shown no serious safety concerns among females revaccinated with 9vHPV after a series of 4vHPV.
No ACIP recommendation means that the Vaccines For Children (VFC) program and insurance plans probably won’t cover revaccination. At the conclusion of the discussion ACIP requested that the HPV Work Group reconsider a permissive recommendation (Category B-similar to the recommendation made for MenB vaccine for healthy adolescents) for revaccination, which would enable coverage by the VFC program and some insurance plans for clinicians or patients who wish to be revaccinated. This issue will likely be discussed again at the October 2015 meeting.
The official minutes and presentation slides from the June meeting will be available on the ACIP Meeting Information web page within the next few weeks. Registration is now open for in-person attendance of the October meeting. Registration is not required to view the meeting via web stream.

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Reminder: Register now for the new CDC webinar series on "Pink Book" chapter topics

CDC will be presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of one-hour webinars that will start on July 8 and end on October 14. All sessions will begin at 12:00 p.m. (ET). Continuing education credit will be available for each session.

Read more about the series.

Participation in this series requires advance registration. Virtual seats are available for the first 500 registrants, but each session will also be archived and available within two weeks after each event.

Download Epidemiology and Prevention of Vaccine-Preventable Diseases  Order Epidemiology and Prevention of Vaccine-Preventable Diseases  Back to top

IAC Spotlight! 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 May 26, when IAC Express last reported on the Influenza Vaccination Honor Roll, 6 healthcare organizations have been enrolled.

Newly added healthcare organizations, hospitals, government agencies, and medical practices
  • Boys Town National Research Hospital, Omaha, NE
  • Chester County Hospital, West Chester, PA
  • Family Medical Clinic, Poteau, OK
  • Genesis Healthcare, Towson, MD 
  • Heavener Medical Clinic, Heavener, OK
  • Valley Children's Hospital, Madera, CA 
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Voices for Vaccines provides toolkits for anyone who wants to advocate for vaccination

Voices for Vaccines (VFV) is a national organization of parents and others who are dedicated to raising the level of the voices of parents who support immunization. The VFV philosophy is that advocating should be easy to do for anyone, so they have created a number of toolkits to take the difficulty out of promoting immunization. By visiting the VFV tools page, you can:
VFV 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 (parents and otherwise) to join. Please spread the word to your friends and colleagues to join VFV!
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New: IAC develops screening checklist for contraindications to HPV, MCV4, and Tdap vaccines for teens

IAC has developed a new screening checklist specifically for teen vaccination titled Screening Checklist for Contraindications to HPV, MCV4, and Tdap Vaccines for Teens. The first page consists of questions for the teen's parent or guardian to answer and the second page (not for parents) contains information for healthcare professionals about why each of the screening questions is asked.

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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New: IAC posts Spanish translation of "HPV Vaccine: A Guide for Young Adults"

IAC has posted a Spanish translation of its handout for teens and young adults titled "HPV Vaccine: A Guide for Young Adults." This user-friendly handout answers frequently asked questions about the HPV (human papillomavirus) vaccine, such as "Do I need it if I haven't had sex yet?" and "Should I get HPV vaccine if I've already had sex?" Healthcare professionals can use this resource to help guide their conversations with teens and young adults about the importance of HPV vaccination.

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IAC makes changes to its recently posted standing orders for administering Haemophilus influenzae type b vaccine to children and adults

IAC recently made the following changes to its two standing orders handouts for Haemophilus influenzae type b vaccine. Related Links Back to top

IAC updates Spanish translation of "Protect yourself from pneumococcal disease...Get vaccinated!"

IAC has updated the Spanish translation of its summary handout for adults "Protect yourself from pneumococcal disease...Get vaccinated!" The Spanish version, Protéjase de la enfermedad neumocócica...¡Vacúnese! was revised to match the English version, which was updated in February to include information about ACIP's recommendation for PCV13 vaccination of all adults age 65 and older.

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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 reports on measles transmission in a U.S. airport in April 2014

CDC published Notes from the Field: Measles Transmission in an International Airport at a Domestic Terminal Gate—April–May 2014 in the June 26 issue of MMWR (page 679). The first paragraph is reprinted below.

On April 22, 2014, the Minnesota Department of Health notified CDC of a case of measles in a child aged 19 months who had documentation of receiving 1 dose of measles, mumps, and rubella vaccine at age 12 months. The child's illness was clinically compatible with measles, which was confirmed by polymerase chain reaction and immunoglobulin M serology at the Minnesota Department of Health Public Health Laboratory. The child was febrile and developed a rash on April 17 while on an international flight from India to the United States before taking a connecting flight from Chicago to Minneapolis. Persons with measles are infectious from 4 days before to 4 days after rash onset. Therefore, travelers were exposed on both the international and domestic flights. CDC's Division of Global Migration and Quarantine was contacted and provided information on potentially exposed persons to relevant health departments for follow-up. No documented transmission was reported as a result of the two flight exposures.

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NFID to offer July 1 webinar on adult immunization and latest ACIP updates

The National Foundation for Infectious Diseases (NFID) will offer a webinar titled "Adult Immunization and Advisory Committee on Immunization Practices (ACIP) Updates" on July 1, at 12:00 p.m. (ET). William Schaffner, MD, NFID medical director and liaison to ACIP, will discuss the importance of immunization for adults, the latest ACIP updates and recommendations for adult vaccination, and best practices for increasing adult vaccination rates. Back to top

CDC offers new Medscape Expert Commentary on 9-valent HPV vaccine

On June 22, CDC published a new Medscape Expert Commentary titled "Common Questions about 9-Valent HPV Vaccine" (both video and transcript are available). This session features CDC medical epidemiologist Lauri Markowitz, MD, 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. Dr. Markowitz will address HPV vaccine safety and other comment provider questions about the 9-valent HPV vaccine ACIP recommendations. Back to top

CDC's Public Health Grand Rounds presentation, "Working to Eliminate Measles Around the Globe," now available online

On June 16, CDC's Public Health Grand Rounds presented "Working to Eliminate Measles Around the Globe." The video of the session, as well as the presentation slides, are now available on CDC's website. This session is available for continuing education credit. Back to top

Question of the Week

Does a patient living in the U.S. who has documentation of having had meningococcal vaccine at age 2 and 5 years in Saudi Arabia still need to have doses at ages 11–12 years and age 16 years or are the previous doses sufficient?  
Even though Saudi Arabia uses a quadrivalent meningococcal vaccine routinely at those ages, doses given to a healthy child prior to the 10th birthday should not be counted as part of the U.S. series. The child should still receive meningococcal vaccine according to the routine U.S. schedule.


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.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
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  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
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