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Issue 1195: July 21, 2015

Ask the Experts
Ask the Experts—Question of the Week: A physician ordered a 40-µg dose of hepatitis B vaccine for a hemodialysis…read more


Ideas and resources to help you promote National Immunization Awareness Month in August; free posters available from CDC

Every year in August, National Immunization Awareness Month (NIAM) provides an opportunity to raise awareness of the importance of immunization and the need for improving national vaccination coverage levels. The National Public Health Information Coalition, in collaboration with CDC, has developed a National Immunization Awareness Month Communication Toolkit that includes key messages, vaccine information, sample news releases and articles, sample social media messages, and links to web resources from CDC and other organizations.

The observance features a different group each week of August:
  • Week 1 (Aug. 2–8)—Preteens and Teens: Ensure a healthy future with vaccines 
  • Week 2 (Aug. 9–15)—Pregnant Women: Protect yourself and pass protection on to your baby  
  • Week 3 (Aug. 16–22)—Adults: Vaccines are not just for kids
  • Week 4 (Aug. 23–30)—Infants and Children: A healthy start begins with on-time vaccinations
CDC has provided the following suggestions to help you promote vaccination during each week of NIAM.
  1. Update your materials with the latest information and key messages that are provided in the toolkit.
  2. Place matte articles (i.e., formatted, ready-to-print articles that are free to use in any publication) in newsletters, on your website, or in local news outlets. The articles provided in the toolkit assist in educating and motivating consumers to talk to their healthcare professional and get vaccinated, and also encourage healthcare professionals to strongly recommend the vaccines patients need. You can tailor the articles to your particular audience(s) to maximize their impact.
  3. Place NIAM logos and banners on your website and/or social media platforms to highlight your participation in NIAM.
  4. Create buzz for NIAM by using the social media messages in the toolkit. The messages are crafted in a way that enables you to use them as they are—or tailor them as you see fit for your audience(s).

Free Posters

To help you promote childhood immunization during NIAM and year round, NCIRD has printed additional copies of several of its childhood immunization posters. Limited quantities of these materials are available to order for free from the CDC warehouse.
These materials were developed based on formative research with parents and are co-branded with the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP). You can order copies of these materials at CDC-INFO On Demand-Publications. (Enter the PubID numbers below in the “Search for Text” field): Related Links Back to top

National Vaccine Program Office publishes Annual Report of the State of the National Vaccine Plan (2014)

On July 7, the National Vaccine Program Office (NVPO) announced the release of the Annual Report of the State of the National Vaccine Plan (2014), which is now available online. This report highlights accomplishments and progress of HHS agencies and offices, as well as the work of other partners across the immunization system toward meeting the goals and objectives in the 2010 National Vaccine Plan and Implementation Plan.

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Association of Immunization Managers (AIM) announces the winners of its Bull’s Eye Award and Natalie J. Smith Award for 2015
The 2015 winners of AIM's Bull’s-Eye Awards are the Illinois, New Jersey and Nevada Immunization Programs.
The AIM Bull’s-Eye Award for Innovation and Excellence in Immunization is presented to three state, territorial, or urban area immunization programs (awardees) annually in recognition of an outstanding immunization initiative. The award recognizes immunization strategies that "hit their mark," achieving goals and increasing awareness by encouraging replication in other programs. 
The winner of the 2015 Natalie J. Smith Award is Dr. Jane Zucker of New York City. Dr. Zucker’s nomination read, “Dr. Jane Zucker is a visionary leader committed to using data and technology to advance the mission of protecting people from vaccine-preventable diseases. Under her leadership, NYC has become a national model for using Immunization Information Systems to manage and improve the performance of immunization programs and increase immunization coverage.”
More information about the awards and the winners can be found in the press releases and on the AIM website at  

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Promote the powerful documentary "Someone You Love: The HPV Epidemic" by joining the social media "Thunderclap" planned for July 22 

"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 the film is to raise awareness of HPV and cervical cancer. Viewing and promoting this film is currently being encouraged in several ways, as summarized below:
  • Join the Thunderclap planned for July 22, which will simultaneously promote the film on social media accounts (Facebook, Twitter, and Tumblr). Please let others know about the campaign by sharing this link: Access a FAQ about Thunderclap social media campaigns.
  • 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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World Hepatitis Day is July 28!
Every year on July 28th, World Hepatitis Day aims to increase the awareness and understanding of viral hepatitis as a major global health threat. All types of viral hepatitis can cause inflammation of the liver; however, hepatitis B and C infection can result in a lifelong, chronic infection.

The World Health Organization (WHO) estimates that nearly 400 million people have chronic viral hepatitis worldwide and most of them do not know they are infected. More than 1 million people die each year from causes related to viral hepatitis, commonly cirrhosis and liver cancer. 

The date of July 28 was chosen for World Hepatitis Day in honor of the birthday of Nobel Laureate Professor Baruch Samuel Blumberg, who discovered the hepatitis B virus.

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IAC updates its "Questions and Answers" handout about human papillomavirus (HPV)

IAC recently updated its "Human Papillomavirus (HPV): Questions and Answers" handout for patients, parents, and the general public. The handout was redesigned and information was added regarding HPV9 vaccine (Gardasil 9, Merck).

Access Human Papillomavirus (HPV): Questions and Answers 

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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IAC posts Marshallese language translation of the Td VIS

IAC recently posted Marshallese language of the Td VIS. IAC thanks the Office of Community Health and Research at the University of Arkansas for Medical Sciences for providing the translation. Visit IAC's VIS web section for VISs in more than 35 languages.

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New! 2015 Red Book Online now available

The newly revised and updated Red Book: 2015 Report of the Committee on Infectious Diseases, 30th edition (American Academy of Pediatrics), is now available on Red Book Online, which provides up-to-date information about pediatric infectious diseases. All members of AAP receive Red Book Online as a free member benefit. Refer to the Summary of Major Changes to quickly see all the new and updated content in Red Book 2015.

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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
  • Foreign-language terms: aids to translating foreign immunization records
  • 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
  • 101–500 books: 15% + shipping
  • 501–1000 books: 20% + shipping
For quotes on larger quantities, email

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World Health Organization publishes report on latest meeting of the Global Vaccine Advisory Committee on Vaccine Safety

The July 17 issue of the WHO periodical Weekly Epidemiological Record features a report titled Global Advisory Committee on Vaccine Safety, 10–11 June 2015

The Committee examined WHO’s experience with monitoring the dissemination of vaccine safety information via the internet and methodological issues related to developing and maintaining information sheets on vaccine safety. It also reviewed recent data related to the safety of novel vaccines against Ebola virus and dengue and preparation for the introduction of a vaccine against malaria.

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CDC EPIC study estimates the burden of community-acquired pneumonia hospitalizations among U.S. adults

This two-and-a-half year study conducted by researchers at CDC, three hospitals in Chicago, and two hospitals in Nashville estimated the burden of community-acquired pneumonia hospitalizations among U.S. adults. When U.S. adults are hospitalized with pneumonia, viruses are more often to blame than bacteria, according to a study by the Centers for Disease Control and Prevention (CDC) released in the July 14 issue of the New England Journal of Medicine. The NEJM article is the third publication from CDC's Etiology of Pneumonia in the Community (EPIC) study, which was conducted from January 1, 2010–June 30, 2012. The "Results" and "Conclusions" sections are reprinted below.

From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and 
Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age.

The incidence of community-acquired pneumonia requiring hospitalization was highest among the oldest adults. Despite current diagnostic tests, no pathogen was detected in the majority of patients. Respiratory viruses were detected more frequently than bacteria. (Funded by the Influenza Division of the National Center for Immunizations and Respiratory Diseases.)

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CDC reports on receipt of selected preventive services, including hepatitis A and hepatitis B vaccination, by U.S. adults during 2011–2012

CDC published Receipt of Selected Clinical Preventive Services by Adults — United States, 2011–2012 in the July 17 issue of MMWR (pages 738–742). The responses to questions about the receipt of nine clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) or the Advisory Committee on Immunization Practices (ACIP) were analyzed to identify receipt rates for the clinical services. A excerpt of the MMWR article is reprinted below.

For the nine services examined, prevalence of receipt of service in the queried timeframe was as follows: hepatitis A vaccination, 12.7%; colon cancer screening, 23.6%; diet counseling, 26.9%; hepatitis B vaccination, 38.8%; diabetes screening, 45.3%; cervical cancer screening, 59.4%; breast cancer screening, 61.6%; cholesterol screening, 70.0%; and blood pressure screening, 82.9% (Table 2). A statistically significant higher percentage of adults with health insurance received each of nine clinical preventive services compared with those who were uninsured. Among the nine services, the service receipt prevalence ratio for those with insurance compared with those without insurance ranged from 1.39 for hepatitis B vaccination to 3.13 for colon cancer screening.

Persons with family incomes >200% of the FPL received clinical preventive services at a statistically significant higher prevalence compared with those with incomes below that threshold for eight of nine services (all but hepatitis A vaccination). Among those eight services, the service receipt prevalence ratio for those with family incomes >200% of the FPL compared with those with incomes ≤200% of the FPL ranged from 1.06 for hepatitis B vaccination to 1.43 for breast cancer screening.

Persons with private health insurance received preventive services at a statistically significant higher prevalence for two of nine services, and at a lower prevalence for four of nine services, compared with those with only public insurance.

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Following 2013 ACIP recommendations, Tdap vaccination rates among pregnant women in Wisconsin have increased but plateaued near 50%, according to this week's MMWR

CDC published Pertussis and Influenza Vaccination Among Insured Pregnant Women—Wisconsin, 2013–2014 in the July 17 issue of MMWR (pages 746–750). A summary of the MMWR article made available to the press by CDC is reprinted below.

Healthcare providers should strongly recommend and offer tetanus-diphtheria-acellular pertussis vaccine (Tdap) and influenza vaccination to every pregnant patient to prevent severe illness and complications among mothers and infants. Pertussis (whooping cough) incidence is increasing in the U.S., including among infants who are at highest risk for hospitalization and death. To prevent pertussis among newborn infants, in February 2013 the Advisory Committee on Immunization Practices recommended pregnant women receive Tdap during every pregnancy, a strategy that provides passive protection to the newborn infant. Additionally, pregnant women are recommended to receive influenza vaccine to prevent influenza-associated complications among mothers and infants. Using health insurance claims data, this report evaluated vaccination rates among insured pregnant women in Wisconsin. After the 2013 recommendation, Tdap vaccination rates among pregnant women in Wisconsin increased but plateaued near 50%, similar to influenza vaccination rates. Collaboration is needed to identify and overcome barriers to vaccinating pregnant women.

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NFID to offer August 5 webinar about vaccination for young adults

The National Foundation for Infectious Diseases (NFID) will offer a webinar titled "Vaccines for Young Adults" on August 5, at 12:00 p.m. (ET). Carol J. Baker, MD, NFID past-president and professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine, will discuss important vaccines recommended for young adults, including meningococcal and human papillomavirus (HPV). Dr. Baker will answer questions about the new meningococcal B and 9-valent HPV vaccine recommendations. Back to top

Presentation slides from June ACIP meeting now available

ACIP recently posted the presentation slides from the ACIP meeting held on June 24–25.

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Question of the Week

A physician ordered a 40-µg dose of hepatitis B vaccine for a hemodialysis patient. The clinic does not stock the Recombivax HB (40 µg/dose) formulation and would like to give 2 adult doses of Engerix B (20 µg/dose) for each dose in the series. Is this acceptable?

Yes. If given on the same day as separate injections in separate sites, the Energix B doses can be counted as the equivalent of one 40-µg dose. According to the package insert, Engerix B is licensed for use in this manner. Vaccine package inserts are available at
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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