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Issue 1203: September 1, 2015

Ask the Experts
Ask the Experts—Question of the Week: I was taught that gloves should be worn when giving vaccines. Other nurses say that this…read more

Reminder! IAC announces new initiative: MCV4: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection

Recent data published by CDC from its National Immunization Survey-Teen report found that only 28.5 percent of adolescents who were age 17 years at the time of the interview had received the recommended second dose of meningococcal (A, C, W, Y) conjugate vaccine (MCV4). This important booster is recommended at age 16 years to help prevent meningococcal meningitis. Although 79.3 percent of teens aged 13–17 years received the first recommended MCV4 vaccination, less than one-third had received the important second dose to help boost their protection against this devastating illness at a time in life when they are at greatest risk for meningococcal disease.
To help educate providers with important resources about the MCV4 booster vaccination, the Immunization Action Coalition, in collaboration with Sanofi Pasteur, launched a new initiative titled MCV4: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection. This initiative was developed to raise awareness about the extremely low immunization rates for MCV4 booster doses, help health care providers know their second dose MCV4 coverage rate, and supply tools for providers to increase rates and help close the MCV4 booster gap.
Why Focus on Improving Booster Vaccination Rates?
CDC recommends that a child receive one dose of MCV4 vaccine at age 11 or 12 years, followed by a second (or booster) vaccination at age 16, as the protection provided by the first dose wanes within five years in many teens. This means teens might have decreased protection from ages 16–21 years, when they are at greatest risk of meningococcal disease. 
Be sure to visit the website,, and download and use the free, helpful materials available there, including fact sheets, talking points, an overview of adolescent immunization recommendations, Q&As, and other great materials.
Want to share news about this important initiative with others? Copy and share this information in your newsletter or other communications. In addition, check out these social media post resources to copy and share widely.
Check out the new MCV4 website and help strengthen protection against meningococcal meningitis! You can find important resources for health care providers. Remember—You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection! 

New @immunizeaction project reminds health care providers about the importance of the 2nd meningococcal vaccination:

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CDC publishes report on 2014 national, state, and local vaccination coverage among children age 19–35 months

CDC published National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months—United States, 2014 in the August 28 issue of MMWR (pages 889–896). The first paragraph is reprinted below.

The reduction in morbidity and mortality associated with vaccine-preventable diseases in the United States has been described as one of the 10 greatest public health achievements of the first decade of the 21st century. A recent analysis concluded that routine childhood vaccination will prevent 322 million cases of disease and about 732,000 early deaths among children born during 1994–2013, for a net societal cost savings of $1.38 trillion. The National Immunization Survey (NIS) has monitored vaccination coverage among U.S. children aged 19–35 months since 1994. This report presents national, regional, state, and selected local area vaccination coverage estimates for children born from January 2011 through May 2013, based on data from the 2014 NIS. For most vaccinations, there was no significant change in coverage between 2013 and 2014. The exception was hepatitis A vaccine (HepA), for which increases were observed in coverage with both ≥1 and ≥2 doses. As in previous years, <1% of children received no vaccinations. National coverage estimates indicate that the Healthy People 2020 target of 90% was met for ≥3 doses of poliovirus vaccine (93.3%), ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.5%), ≥3 doses of hepatitis B vaccine (HepB) (91.6%), and ≥1 dose of varicella vaccine (91.0%). Coverage was below target for ≥4 doses of diphtheria, tetanus, and acellular pertussis vaccine (DTaP), the full series of Haemophilus influenzae type b (Hib) vaccine, hepatitis B (HepB) birth dose, ≥4 doses pneumococcal conjugate vaccine (PCV), ≥2 doses of HepA, the full series of rotavirus vaccine, and the combined vaccine series. Examination of coverage by child's race/ethnicity revealed lower estimated coverage among non-Hispanic black children compared with non-Hispanic white children for several vaccinations, including DTaP, the full series of Hib, PCV, rotavirus vaccine, and the combined series. Children from households classified as below the federal poverty level had lower estimated coverage for almost all of the vaccinations assessed, compared with children living at or above the poverty level. Significant variation in coverage by state was observed for several vaccinations, including HepB birth dose, HepA, and rotavirus. High vaccination coverage must be maintained across geographic and sociodemographic groups if progress in reducing the impact of vaccine-preventable diseases is to be sustained.

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CDC reports on vaccination coverage of children in kindergarten in the 2014–15 school year

CDC published Vaccination Coverage Among Children in Kindergarten—United States, 2014–15 School Year in the August 28 issue of MMWR (pages 897–904). The first paragraph is reprinted below.

State and local jurisdictions require children to be vaccinated before starting school to maintain high vaccination coverage and protect schoolchildren from vaccine-preventable diseases. State vaccination requirements, which include school vaccination and exemption laws and health department regulations, permit medical exemptions for students with a medical contraindication to receiving a vaccine or vaccine component and may allow nonmedical exemptions for religious reasons or philosophic beliefs. To monitor state and national vaccination coverage and exemption levels among children attending kindergarten, CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs. This report describes vaccination coverage estimates in 49 states and the District of Columbia (DC) and vaccination exemption estimates in 46 states and DC that reported the number of children with at least one exemption among kindergartners during the 2014–15 school year. Median vaccination coverage was 94.0% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 94.2% for the local requirements for diphtheria, tetanus, and acellular pertussis vaccine (DTaP); and 93.6% for 2 doses of varicella vaccine among the 39 states and DC with a 2-dose requirement. The median percentage of any exemptions was 1.7%. Although statewide vaccination coverage among kindergartners was high during the 2014–15 school year, geographic pockets of low vaccination coverage and high exemption levels can place children at risk for vaccine-preventable diseases. Appropriate school vaccination coverage assessments can help immunization programs identify clusters of low coverage and develop partnerships with schools and communities to ensure that children are protected from vaccine-preventable diseases.

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AAP launches new online site for collaboration and discussion of immunization topics

The American Academy of Pediatrics (AAP) Childhood Immunization Support Program (CISP) is launching a new online site for collaboration and discussion among immunizers. This SharePoint website, to be known as the "Community of Immunizers," will be a way to provide education, resources, practice improvement projects, and a connection to colleagues who are passionate about immunization. The site will introduce a new topic approximately every July and January, but older materials will continue to be available to users.

Initial scheduled topics include:
  • Vaccine storage and handling (Summer 2015)
  • Vaccine hesitancy (Winter 2016)
  • Vaccinating patients with influenza vaccine (Summer 2017)
For each topic, the AAP Community of Immunizers site will provide:
  • Practical resources
  • A webinar, online course, or other education piece—most will include CME credits
  • A section of the Immunization Initiatives newsletter dedicated to the topic
  • A discussion board to pose/answer questions and discuss successes and challenges with peers
  • A suggested practice improvement project with possible measures
AAP invites all clinical and office staff involved in the pediatric immunization delivery process to join this community. To sign up, you will need to identify or create a Microsoft Live ID (email address). Guidance on creating a Microsoft Live ID can be found here. When you have an ID, email and ask to be added to the site. Be sure to include your Microsoft Live ID and put "Community of Immunizers" in the subject line.

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Join the September 17 Thunderclap social media campaign on influenza vaccination

CDC and the National Foundation for Infectious Diseases (NFID) are sponsoring a Thunderclap campaign to coincide with the Annual Flu Season Press Event which is being held on September 17. Thunderclap is a platform that uses the power of crowds to amplify a single important message across supporter social media profiles, allowing supporters to sign up in advance to share a unified message at a specific time via their individual social media accounts. The collective action creates a wave of support—or “thunderclap”—across social media.

You can support the #FightFlu initiative hosted by the @CDCFlu Twitter account by accessing this link: You will then be able to authorize Thunderclap to send out a message through your Facebook, Twitter, and/or Tumblr accounts on September 17.

Questions? Email CDC at

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IAC Spotlight! Visit "What's New at IAC" to find just-released handouts and translations of Vaccine Information Statements

Looking for just-released handouts for staff and patients or new Vaccine Information Statements and their translations from IAC? Look no further. The What's New at IAC section on offers visitors a chronological list of new and revised materials.

To help users find selected materials of interest, the "What's New" section on is also organized in the following categories: Back to top

IAC updates its screening checklists for contraindications to IIV and LAIV influenza vaccination

IAC recently updated its screening checklists for contraindications to inactivated influenza vaccination and live, intranasal influenza vaccination to match the ACIP recommendations for the 2015–16 influenza season. Related link IAC's Handouts for Patients & Staff web section offers health care professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC updates its standing orders templates for administering influenza vaccines to children and adolescents, as well as to adults

IAC recently updated its standing orders for administering influenza vaccines to children and adolescents, as well as to adults, to match the ACIP recommendations for the 2015–16 influenza season. The standing orders templates are newly designed and are ready to use as is or to be modified as you wish. Related Links Back to top

IAC revises "Vaccines with Diluents: How to Use Them"

IAC recently updated its professional-education resource Vaccines with Diluents: How to Use Them to include new information about Rotarix diluent storage. This resource for health care professionals contains a chart that lists the vaccines that require reconstitution with a diluent before they can be administered. It also includes information about each diluent and the maximum time allowed between reconstituting each vaccine and having to discard it, and the general steps to follow when reconstituting vaccines.

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IAC revises "Administering Vaccines to Adults: Dose, Route, Site, and Needle Size"

IAC recently revised its resource for health care professionals titled Administering Vaccines to Adults: Dose, Route, Site, and Needle Size. Information was added about meningococcal serogroup B vaccines and two abbreviations were changed ("SC" is now "SubCut" and "intransasal" is now "NAS").

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"It’s Federal Law! You must give your patients current Vaccine Information Statements (VISs)" is fully updated and redesigned

IAC has updated and redesigned It’s Federal Law! You must give your patients current Vaccine Information Statements (VISs) to reflect new VIS dates and to provide you with new information about the use of VISs and the ways they can be distributed. CDC released updated VISs for both inactivated and live influenza vaccines on 8/7/2015, and a VIS for meningococcal serogroup B vaccines on 8/14/2015.

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IAC revises "Vaccinations for Adults without a Spleen"

IAC has revised Vaccinations for Adults without a Spleen to include information about meningococcal serogroup B vaccination.

"Vaccinations for Adults without a Spleen" is part of a suite of handouts that focuses on adults in risk groups for vaccination.

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

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New! Spanish, Chinese, and Vietnamese translations of the 2015–16 influenza Vaccine Information Statements are now available

IAC recently posted Spanish, Chinese, and Vietnamese translations of the Vaccine Information Statement (VIS) for use with the 2015–16 inactivated influenza vaccine (IIV), as well as the VIS for use with the 2015–16 live, intranasal influenza vaccine (LAIV) on its website. IAC thanks Shoo the Flu of Oakland, CA, for these translations. Please note: The 2015–16 influenza vaccine VISs will be available in many additional languages in the weeks ahead. IAC Express will announce the availability of translations as soon as they are ready.

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WHO issues updated position paper on pertussis vaccines

The August 28 issue of the WHO periodical Weekly Epidemiological Record includes an article titled Pertussis vaccines: WHO position paper—September 2015.
A collection of WHO position papers on vaccines is available in alphabetical order on the WHO website.
They are available in chronological order, vaccine listing, and topic listing on the IAC website.

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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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Medical Assistants Resources and Training on Immunization (MARTi) releases newsletter on back-to-school vaccination and new ACIP recommendations
Medical Assistants Resources and Training on Immunization (MARTi) is an organization that provides immunization-related information and links to training opportunities for medical assistants. MARTi just released a newsletter that focuses on back-to-school vaccination and new ACIP recommendations.

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.

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CDC publishes article in MMWR about WHO guidelines for biocontainment of poliovirus following type-specific polio eradication

CDC published World Health Organization Guidelines for Biocontainment of Poliovirus Following Type-Specific Polio Eradication—Worldwide, 2015 in the August 28 issue of MMWR (pages 913–917). This information was previously published in the August 7 issue of the WHO periodical Weekly Epidemiological Record as Plans for containment of poliovirus following type-specific polio eradication worldwide, 2015, and covered in IAC Express on August 11.

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CDC to offer webinar on HPV vaccination quality improvement projects on September 18

The CDC Adolescent Immunization Communications Team will offer a webinar on September 18 at 11:00 a.m. (ET) titled HPV Vaccination Quality Improvement Projects and Implementation Science Working Together, For the Win! (#FTW).

Scheduled speakers:
  • Brian Mittman, PhD, will provide a brief introduction about implementation science theory and principles, and an overview of considerations influencing physician behavior and making practice-level changes
  • Alix Casler, MD, FAAP, will summarize her practice’s quality improvement project to increase HPV vaccination rates, and discuss the practice's multi-level approach and experience integrating changes in a large pediatric office
  • Kia Redwine, clinical management consultant, will present on a collaborative quality improvement project between WellStar Health System and the Georgia Department of Public Health to increase HPV vaccination rates. Ms. Redwine will highlight the variety of interventions that that were incorporated and lessons learned.
Registration information

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Register now for the CDC webinar series on "The Pink Book" chapter topics or listen to any archived sessions soon; opportunity to earn continuing education credit ends 30 days after posting

CDC is 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 started on July 8. All sessions begin at 12:00 p.m. (ET).

Continuing education credit will be available for each session. However, please note that continuing education will only be available for 30 days after each session is posted, so if you are interested in obtaining credit, plan accordingly.

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. The following seven sessions are now archived and can be viewed online; a transcript of each broadcast is also available: 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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Iowa Immunization Summit to take place October 28–29 in Des Moines

Registration is now open for the 2015 Iowa Immunization Summit, to be held in Des Moines on October 28–29. On October 28, Donna Weaver, RN, MN, nurse educator, National Center for Immunization and Respiratory Diseases, CDC, and Ray Strikas, MD, MPH, FACP, senior advisor, Immunization Services Division, CDC, will present "Epidemiology and Prevention of Vaccine-Preventable Diseases ("The Pink Book Course")." On October 29, there will be presentations by a number of nationally recognized experts. Back to top

Nevada Health Conference set for November 9–10 in Las Vegas

The annual Nevada Health Conference is scheduled to take place November 9–10 in Las Vegas. The keynote speaker, Tara Haelle, owner of Red Wine & Apple Sauce, an evidence-based parenting blog and a writer for Forbes magazine, will set the tone for the conference theme, "Building Healthy Communities—Touching one life at a time"   Back to top

Mid America Immunization Coalition to sponsor symposium on November 13 in Overland Park, KS

The Mid America Immunization Coalition will be sponsoring Immunization Symposium 2015: Who Calls the Shots? on November 13 in Overland Park, KS. Featured speakers are Paul Offit, MD, director, Vaccine Education Center at the Children's Hospital of Philadelphia, and William Atkinson, MD, MPH, associate director for immunization education, Immunization Action Coalition. Back to top

Question of the Week

I was taught that gloves should be worn when giving vaccines. Other nurses say that this is not necessary. Which is correct?

Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations are likely to come into contact with potentially infectious body fluids or have open lesions on their hands. If gloves are worn, they should be changed between patients. For more information on vaccine administration, see ACIP's General Recommendations on Immunization.

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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