Issue 1192: July 7, 2015

Ask the Experts
Ask the Experts—Question of the Week: If a patient began the human papillomavirus (HPV) vaccine series with 4-valent HPV…read more


California passes legislation that eliminates personal belief and religious exemptions for vaccination to attend public or private schools

On June 30, California Governor Edmund (Jerry) Brown signed a bill into law (SB 277) requiring all California children without a medical exemption to be fully vaccinated in order to attend public or private school, eliminating personal and religious belief exemptions. Governor Brown's signing statement included the following:

The science is clear that vaccines dramatically protect children against a number of infectious and dangerous diseases. While it's true that no medical intervention is without risk, the evidence shows that immunization powerfully benefits and protects the community.

Mississippi and West Virginia are the other two states that allow only medical exemptions.

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U.S. experiences first measles death in twelve years

On July 2, the Washington State Department of Health released a press statement titled Measles led to death of Clallam Co. woman; first in U.S. in a dozen years. The first three paragraphs are reprinted below.

The death of a Clallam County woman this spring was due to an undetected measles infection that was discovered at autopsy.

The woman was most likely exposed to measles at a local medical facility during a recent outbreak in Clallam County. She was there at the same time as a person who later developed a rash and was contagious for measles. The woman had several other health conditions and was on medications that contributed to a suppressed immune system. She didn’t have some of the common symptoms of measles such as a rash, so the infection wasn’t discovered until after her death. The cause of death was pneumonia due to measles.

This tragic situation illustrates the importance of immunizing as many people as possible to provide a high level of community protection against measles. People with compromised immune systems often cannot be vaccinated against measles. Even when vaccinated, they may not have a good immune response when exposed to disease; they may be especially vulnerable to disease outbreaks. Public health officials recommend that everyone who is eligible for the measles, mumps, and rubella (MMR) vaccine get vaccinated so they can help protect themselves, their families, and the vulnerable people in their community.

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VFC resolution for meningococcal vaccination updated to include use of serogroup B meningococcal vaccines

On June 24, the Advisory Committee on Immunization Practices (ACIP) voted to update the VFC resolution for vaccines to prevent meningococcal disease. VFC resolutions passed by ACIP form the basis for VFC program policies on vaccine availability and usage. Vaccine procured through the VFC program must be administered according to the guidelines outlined by the ACIP in VFC resolutions, and may also be administered in accordance with state school attendance laws. The purpose of the revision is to update the resolution to allow individual clinical decision-making regarding the use of serogroup B meningococcal vaccines in children and young adults age 16 through 18 years (at its June meeting, ACIP voted to approve a Category B [permissive] recommendation for meningococcal B vaccine to include children and young adults age 16–23 years, with a preferred age of vaccination of 16–18 years). This means that the VFC program will make available meningococcal serogroup B vaccine for children 16 through 18 years old who are VFC eligible. The VFC program is a federally funded program that provides vaccines at no cost to children who might not otherwise be vaccinated because of inability to pay. CDC buys vaccines at a discount and distributes them to grantees such as state health departments and certain local and territorial public health agencies, which in turn distribute them at no charge to those private physicians' offices and public health clinics registered as VFC providers. Children who are eligible for VFC vaccines are entitled to receive those vaccines recommended by the ACIP. For more information on the program, visit the VFC web page.

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Pennsylvania pharmacists now permitted by law to vaccinate children as young as age nine years against influenza

On June 26, Pennsylvania Governor Tom Wolf signed a bill into law that allows pharmacists to vaccinate children as young as age nine years against influenza. The stated goal by the bill's sponsors is to expand access to influenza vaccine. The Philadelphia Inquirer wrote:

During the 2013–14 flu season, nearly 40 percent of Pennsylvania children did not receive vaccination, according to the Centers for Disease Control and Prevention, nearly matching the national average.The Pennsylvania Department of State estimates there are 8,816 licensed pharmacists with the authority to administer immunizations. Previously, patients getting vaccines from those pharmacists had to be at least 18.

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"Someone You Love: The HPV Epidemic" film available for just $1 in July; physicians can earn CME credit for watching this documentary

"Someone You Love: The HPV Epidemic" is a feature-length documentary that presents the struggles and triumphs of five women whose lives were changed forever by this deadly virus. Directed by Frederic Lumiere and narrated by Vanessa Williams, the film interweaves personal stories with facts about this common and potentially deadly virus. The goal of this project is to raise awareness of HPV and cervical cancer.  Viewing and promoting this film is currently being encouraged in several ways, as summarized below:
  • During the month of July, anyone can purchase the complete film online for only $1. You can buy as many digital copies of the film as you'd like for $1 and watch it anytime, forever! Watch this powerful film with your friends or encourage them to buy their own copy.
  • The Indiana Immunization Coalition, in partnership with the Indiana School of Medicine and Lumiere Media, is now offering CME credits to physicians nationwide for viewing the film. The film is available at no charge through the Indiana University School of Medicine as an online CME activity worth 1.5 AMA PRA Category 1 Credits. Physicians should use this link to view the film and obtain CMEs. Continuing education credit for nurses is not available now, but may be in the future.
  • Interested individuals or groups can sponsor a screening (unlimited audience) for $300, which covers the licensing fee. Smaller groups that can't afford the $300 fee can contact Lumiere Media at to negotiate a reasonable fee relative to the audience size. The film's website also provides a way for groups that want to host a screening and groups/individuals willing to provide financial support to get together. Right now, more financial sponsors are needed.
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Spanish translations of six routinely recommended vaccine VISs are now available in rich text format (RTF)

If your organization utilizes an electronic medical records system such as GE Centricity or Epic you may need Vaccine Information Statements (VISs) in a format other than a PDF file. To accommodate the need for electronic record-friendly formats, IAC has added VIS Spanish translations in rich text format (otherwise known as RTF) for the following recently updated VISs—Hib, PPSV, Rotavirus, Td, Tdap, and HPV9. Providing Spanish translations of VISs in RTF is possible because of IAC's five-year cooperative agreement with CDC to support IAC’s role as the official clearinghouse of VIS translations. CDC provides English VISs in RTF on their website.

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CDC and WHO report on changes in worldwide polio vaccination recommendations in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Introduction of Inactivated Poliovirus Vaccine and Switch from Trivalent to Bivalent Oral Poliovirus Vaccine—Worldwide, 2013–2016 in the July 3 issue of MMWR (pages 699–702). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Introduction of inactivated polio vaccine and switch from trivalent to bivalent oral poliovirus vaccine worldwide, 2013–2016. A summary of the MMWR article made available to the press by CDC is reprinted below.

Spread of wild poliovirus has been interrupted in almost all countries. No polio cases caused by wild poliovirus type 2, one of the three poliovirus types, have been identified anywhere since 1999. This progress has been achieved with oral poliovirus vaccine (OPV), primarily trivalent OPV that protects against types 1, 2, and 3 polioviruses. However, OPV polioviruses can undergo genetic changes during replication, and in extremely rare circumstances in areas with low vaccination coverage, such changes can result in vaccine-derived polioviruses capable of causing paralysis. While use of trivalent OPV has prevented millions of paralytic polio cases from wild polioviruses since 2006, during that time approximately 670 cases of polio have been caused by circulating vaccine-derived poliovirus type 2. Since the world is nearing the eradication of all wild polioviruses, and because eradicating polio requires eradicating both wild and vaccine-derived polioviruses, even the extremely small risks from continued use of trivalent oral polio vaccine have begun to outweigh its benefits. These risks can be substantially reduced further by replacing trivalent OPV with bivalent OPV, which contains only weakened types 1 and 3 polioviruses. Such a replacement will be most effective if all countries using trivalent OPV simultaneously switch to bivalent OPV. Consequently, a global switch from trivalent OPV to bivalent OPV has been scheduled for April 2016. This global, synchronized switch will affect all 156 countries currently using or stockpiling trivalent OPV and will be one of the largest coordinated public health efforts in history.

The July 3 issue of the Weekly Epidemiological Record also includes an article titled Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015.

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The NAIIS makes slide sets available to facilitate education about the revised Standards for Adult Immunization Practice

The National Adult and Influenza Immunization Summit (NAIIS) has developed three slide sets that educators, providers, and public health representatives can use to educate the public, healthcare providers, or public health professionals on the Standards for Adult Immunization Practices. These standards were published by the National Vaccine Advisory Committee (NVAC) in 2014. The three available slide sets are as follows:
  • Healthcare Provider Slides—to educate healthcare providers about the Standards for Adult Immunization Practice and implementation of the Standards
  • Patient or Consumer Slides—to educate the general public about adult immunizations, what people can to do protect themselves and loved ones from vaccine-preventable diseases, barriers adults may face when seeking vaccination, and how to find out what vaccines people need
  • Public Health Professional Slides—to educate public health partners or professionals on the role they play in adult immunization
Download one or more of these slide sets from the NAIIS website.

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New booklet highlights important CDC immunization resources for healthcare professionals and their patients

CDC has put together a compilation of their most important immunization resources in a new user-friendly booklet titled CDC Immunization Resources for You & Your Patients. This 13-page handout includes links to CDC resources related to immunization schedules; Vaccine Information Statements; vaccine administration; storage and handling; continuing education and other training opportunities; guidelines for vaccinating special groups such as pregnant women, adolescents, and adults; and resources for parents and patients. 

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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: 13th edition of CDC's Epidemiology and Prevention of Vaccine-Preventable Diseases now available to order or download

CDC has just released the 13th edition of its Epidemiology and Prevention of Vaccine-Preventable Diseases book (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 immunizations. 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 Epidemiology and Prevention of Vaccine-Preventable Diseases Order Epidemiology and Prevention of Vaccine-Preventable Diseases Email CDC with comments, questions, or suggestions about the contents of this book.

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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&nndash;500 books: 15% + shipping
  • 501–1000 books: 20% + shipping
For quotes on larger quantities, email

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WithinReach, a Washington state nonprofit, offers toolkit for community meetings about immunization with Russian-speaking parents 

WithinReach has developed a toolkit for organizers to use at community meetings with Russian-speaking parents who may have questions about the safety and efficacy of vaccination. The WithinReach Immunization Program promotes and protects the health of all Washington families. A portion of the summary of the Toolkit for Community Forums Addressing Vaccine Hesitancy is reprinted below.

Coordinating a meeting for Russian speakers regarding childhood immunizations requires multiple skills, including relationship building, budgeting, and decision making. This toolkit is designed to provide the reader with a step-by-step guide to organizing the meeting.  Related Links Back to top

June issue of CDC's Immunization Works newsletter now available

CDC recently released the June 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. This information is in the public domain and can be reproduced and circulated widely.

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CDC publishes two articles about Ebola in MMWR

CDC published the following two articles related to Ebola in the July 3 issue of MMWR: Related Link Back to top

CDC updates its "You Call the Shots" modules on HPV, hepatitis A, and polio vaccination

CDC recently announced that it had updated the following three modules in the web-based training course You Call the Shots. The training series is funded through a cooperative agreement between CDC and the Association for Prevention Teaching and Research (APTR). Continuing education credit is available for viewing a module and completing an evaluation.

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Registration deadline for October 21–22 ACIP meeting is September 30 for non-U.S. citizens and October 7 for citizens

CDC's Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on October 21–22 in Atlanta at CDC's Clifton Road campus. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens is September 30; it's October 7 for U.S. citizens. Registration is not required to watch the live webcast of the meeting.

More information available from the CDC website.

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Question of the Week

If a patient began the human papillomavirus (HPV) vaccine series with 4-valent HPV vaccine (4vHPV, Gardasil, Merck), can the series be completed with 9-valent HPV vaccine (9vHPV; Gardasil 9)? Should a booster dose of 9vHPV be given to persons who have already completed the 4vHPV series? 

ACIP recommendations, published in March 2015 (, page 300), state that 9vHPV may be used to complete a series begun with a different HPV vaccine. There is currently no recommendation for supplemental doses of 9vHPV following a completed series of 2vHPV or 4vHPV.

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

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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