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Issue 1204: September 8, 2015

Ask the Experts
Ask the Experts—Question of the Week: My patient is a 16-year-old male who has asthma and is on corticosteroid therapy…read more

New! Registration is now open for IAC's Standing Orders Workshops: October slots filling fast in Louisville and Chicago; register today! 

The Immunization Action Coalition (IAC), with support from Pfizer, has just launched "Take a Stand™," a new national effort designed to improve adult immunization rates by increasing the use of standing orders in medical practices.*
The core of this project is a no-cost, interactive workshop led by national experts, including L.J Tan, MS, PhD, William Atkinson, MD, MPH, and Deborah Wexler, MD, from IAC, and Alexandra Stewart, JD, from George Washington University. These workshops will be presented in 22 cities across the United States beginning in October 2015 and continuing through June 2016. 

Physicians, clinic managers, nurse practitioners, physician assistants, and nurses in medical practices that serve adults are encouraged to attend. 
Wondering if these workshops are coming to a city near you? You can find details about the workshop locations and schedule, a preliminary agenda, and online registration information on the Take a Stand website
Seating is limited for the fast-approaching workshop in Louisville, Kentucky. If you are a medical staff member in a clinic serving adults near Louisville, now is the right time to register for this free educational workshop

About the Workshops
Adult vaccine-preventable diseases contribute to significant morbidity, mortality, and cost in the United States, but adult immunization rates remain low. Strong evidence supports the use of standing orders programs to improve these rates, and their use is recommended by numerous agencies and provider associations. However, adoption of this important intervention may be inhibited by poor understanding of the benefits of standing orders programs or the misperception that they are difficult to implement. The workshops are designed to help physicians and their practice staff easily obtain the information and training they need to overcome these perceived barriers. An additional unique feature of the training is the availability of one year of direct support for workshop attendees as they install or enhance a standing orders program in their practice.
Please “take a stand” with us and spread the word about this unique opportunity for medical clinics to improve their adult immunization rates while empowering staff and streamlining facility operations.
* Standing orders are written protocols approved by a physician or other authorized practitioner that allow qualified health care professionals (who are eligible to do so under state law, such as registered nurses or pharmacists) to assess the need for vaccination and to vaccinate patients meeting certain criteria. 
Workshop Information Related Links Back to top

CDC publishes updated ACIP recommendations regarding the intervals between PCV13 and PPSV23 vaccines for use in immunocompetent adults age 65 years and older

In the September 4 issue of MMWR (pages 944–947), CDC published Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

On June 25, 2015, ACIP changed the recommended interval between PCV13 followed by PPSV23 (PCV13–PPSV23 sequence) from 6–12 months to ≥1 year for immunocompetent adults aged ≥65 years. Recommended intervals for all other age and risk groups remain unchanged. The report outlines the rationale for this change and summarizes the evidence considered by ACIP to make this recommendation. The "Summary" section is reprinted below in its entirety.


What is currently recommended? 

The Advisory Committee on Immunization Practices (ACIP) currently recommends that both 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) be given to all immunocompetent adults aged ≥65 years. ACIP recommends that PCV13 be given first followed by PPSV23 6–12 months later. ACIP also recommends that adults aged ≥65 years who already received a dose of PPSV23, should also receive a dose of PCV13 ≥1 year after the dose of PPSV23. Among persons aged ≥2 years with medical indications to receive both PCV13 and PPSV23 in a series, including adults aged ≥65 years with immunocompromising conditions, functional or anatomic asplenia, cochlear implants, or cerebrospinal fluid leaks, a dose of PPSV23 should be given ≥8 weeks after a dose of PCV13. 

Why are the recommendations being modified now? 

To simplify the recommendations for PCV13 and PPSV23 use among immunocompetent adults aged ≥65 years, ACIP recommended harmonization of recommended intervals between PCV13 and PPSV23 regardless of the order in which the two vaccines are given. 

What are the new recommendations? 

ACIP recommends that both PCV13 and PPSV23 be given in series to adults aged ≥65 years. A dose of PCV13 should be given first followed by a dose of PPSV23 at least 1 year later to immunocompetent adults aged ≥65 years. The two vaccines should not be co-administered. If a dose of PPSV23 is inadvertently given earlier than the recommended interval, the dose need not be repeated.

Read the full-text article to access the complete recommendations; a PDF version of the entire issue is also available.

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In this week's MMWR, CDC publishes an article about the licensure of Quadracel (DTaP and inactivated poliovirus combination vaccine) and guidance for its use as a booster dose

CDC published Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine and Guidance for Use as a Booster Dose in the September 4 issue of MMWR (pages 948–949). A summary of the article, which is provided to the media, is reprinted below.

A new vaccine is available for immunization against four diseases: diphtheria, tetanus, pertussis (whooping cough), and polio. On March 24, 2015, the Food and Drug Administration approved the use of Quadracel (Sanofi Pasteur Inc., Swiftwater, PA) in children 4 through 6 years old. This is the age when children are recommended to get their fifth dose of the diphtheria, tetanus and acellular pertussis (DTaP) vaccine series and their fourth dose of the inactivated poliovirus (IPV) vaccine series. Quadracel offers clinicians an additional choice of vaccines to make sure their patients have protection from these life-threatening diseases according to the recommended immunization schedule.

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CDC announces publication of two vaccination-related recommendations from the Community Preventive Services Task Force in this week's MMWR

In the "Announcements" section of this week's MMWR, CDC published Recommendations Regarding Interventions to Increase Appropriate Vaccination—Community Preventive Services Task Force. The notice appears on page 959 of the September 4 issue of MMWR and is reprinted below in its entirety.

The Community Preventive Services Task Force posted new information about two recommendations to increase appropriate vaccination on its website: 1) “Community-Based Interventions Implemented in Combination,” and 2) “Health Care System-Based Interventions Implemented in Combination."

Established in 1996 by the U.S. Department of Health and Human Services, the task force is an independent, nonfederal, uncompensated panel of public health and prevention experts whose members are appointed by the Director of CDC. The task force provides information for a wide range of decision makers on programs, services, and policies aimed at improving population health. Although CDC provides administrative, research, and technical support for the task force, the recommendations developed are those of the task force and do not undergo review or approval by CDC.

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IAC Spotlight! Access all vaccine package inserts on

Looking for vaccine product information? IAC's Package Inserts web section provides up-to-date product information for all vaccines licensed for use in the United States.

This handy listing is part of IAC’s online Directory of Immunization Resources, which is a compendium of helpful immunization resources—such as apps (applications for mobile devices), blogs, books and periodicals, state and local immunization coalitions, email news services, and more—from a variety of organizations: government, professional associations, nonprofit organizations, private industry, and others.

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Reminder: NFID Clinical Vaccinology Course scheduled for November 13–15 in Bethesda, MD 

The National Foundation of Infectious Disease's Fall 2015 Clinical Vaccinology Course will be held November 13–15 in Bethesda, MD. This 2.5-day course focuses on new developments and issues related to the use of vaccines. Expert faculty provide the latest information on vaccines, including updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate immunization. Continuing education credit is available for attendees. Back to top

IAC updates its "Questions and Answers" handout about meningococcal disease and vaccines

IAC recently updated its "Meningococcal: Questions and Answers" handout for patients, parents, and the public. The handout was redesigned and information was added regarding serogroup B meningococcal vaccination.

Related Links 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 "How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines"

IAC has updated its resource for health care professionals titled How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines. The information for how to administer intranasal influenza vaccines was edited to align with CDC information on this topic.

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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. The weight range for the use of 1"–1-1/2" needles in females and males has been revised in the chart titled "Injection Site and Needle Size." 

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New! Khmer (Cambodian) translations of the 2015–16 influenza Vaccine Information Statements are now available

IAC recently posted Khmer (Cambodian) 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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FDA publishes "Vaccines for Children—A Guide for Parents and Caregivers" on its website

On September 1, the Food and Drug Administration's Centers for Biologics Evaluation and Research published Vaccines for Children—A Guide for Parents and Caregivers on its website. The free guide, intended for consumers, covers the following topic areas: benefits and risks of vaccination, types of routinely administered vaccines for children, steps to take when your child is vaccinated, routinely administered vaccines for children, and common questions about vaccines from parents and caregivers.

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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 resource 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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Influenza is serious; many resources are available to help health care professionals in vaccinating

Vaccination is the single most effective means of preventing influenza, and is recommended for everyone age six months and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

Following is a list of resources related to influenza disease and vaccination for health care professionals and the public: Back to top

Report from the first World Health Organization meeting on seasonal influenza vaccine composition for tropical and subtropical countries is now available

The first World Health Organization (WHO) meeting on seasonal influenza vaccine composition for tropical and subtropical countries was held in Geneva on April 24–25, 2015. The objectives of the meeting were to review evidence of influenza seasonality and evolution of influenza viruses in the tropics and subtropics and to initiate the development of practical guidance on timing of vaccination and choice of vaccine composition for countries that plan to introduce or revise influenza immunization practice, according to an article published in the September 4 issue of WHO's Weekly Epidemiological Record (pages 474–476).

Read the complete article titled: Seasonal influenza vaccine composition for tropical and subtropical countries: WHO Expert group meeting, 23–24 April 2015 [PDF].

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CDC publishes two articles about Ebola in Early Release editions of MMWR on September 3

On September 3, CDC published the following two Early Release articles related to Ebola in the MMWR: Related Link Back to top

CDC's "You Call The Shots" series adds second module on DTaP/DT; free CE credit available

CDC recently added "Diphtheria, Tetanus and Pertussis (DTaP and DT) module" in the web-based training course You Call the Shots. This module is the second in a series, which focuses on DTaP and DT vaccines. 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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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 eight 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
Order "The Pink Book" from the Public Health Foundation for $40 (plus shipping and handling)

Email CDC with comments, questions, or suggestions about the contents of this book.

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Question of the Week

My patient is a 16-year-old male who has asthma and is on corticosteroid therapy, which is inhaled. Should he receive a meningococcal conjugate vaccine (MCV4) booster dose every 5 years as is recommended for people who are immunosuppressed with asplenia or HIV? He had the first dose of MCV4 at age 11. 
The Advisory Committee on Immunization Practices (ACIP) does not consider inhaled corticosteroids to be immunosuppressive for the purposes of MCV4 revaccination. The patient should receive a routine second dose of MCV4 at 16 years or older, and needs no further doses.

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 health care 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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