Issue 1205: September 15, 2015

Ask the Experts
Ask the Experts—Question of the Week: I have never seen a case of hepatitis A in my pediatric population, even before hepatitis A…read more

IAC announces the "Take a Stand™" initiative: Register today for workshop launch in Louisville on October 13

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. 

Seating is limited for the fast-approaching workshop in Louisville, Kentucky, on October 13. If you are a medical staff member in a clinic serving adults near Louisville, register today for this free educational workshop.

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

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 practices.
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

AAP reaffirms its support for mandatory influenza immunization policies for health care personnel

On September 7, the American Academy of Pediatrics (AAP) released a policy statement online titled Influenza Immunization for All Health Care Personnel: Keep It Mandatory. The "Introduction" section is reprinted below.

Health care–associated influenza is a common and serious public health problem, contributing significantly to patient morbidity and mortality and creating a financial burden on health care systems. Immunization (used interchangeably with vaccination in this statement) of health care personnel (HCP) annually is a matter of patient safety and is crucial in efforts to reduce health care–associated influenza infections. Optimal prevention of influenza in the health care setting depends on the vaccination of at least 90% of HCP, which is consistent with the national Healthy People 2020 target for annual influenza vaccination among HCP. Although increasing, overall immunization rates for this group remain consistently below this goal.

Mandatory influenza immunization programs for all HCP should be implemented nationwide. During the 2013 to 2014 influenza season, 36% of all HCP and 58% of HCP working in hospitals reported an influenza vaccination requirement at their institution. Mandating influenza vaccine for all HCP is ethical, just, and necessary. Because individuals are embedded in societies and populations, their risk of illness cannot be considered in isolation from the disease risk of the population to which they belong. Employees of health care institutions are obligated to honor the requirement of causing no harm and to act in the best interests of the health of their patients. Medical exemptions to required influenza immunization (e.g., life-threatening allergic reaction after receiving an influenza vaccine or severe allergy to a vaccine component) should be kept at a minimum to ensure high coverage rates and granted only on an individual basis. Rigorous standards, such as requiring counseling, detailing the benefits of influenza vaccination, and insisting on a signed affidavit stating an acceptable reason for opting out, will place a higher burden on nonadherent HCP and would make it more difficult for HCP to impose unnecessary risks on their patients. Granting specific medical exemptions is constitutionally required, but states do not have to grant philosophical or religious opt-outs. Consistent policies also must be developed for management of exempted HCP during influenza season. For example, although scientific evidence supporting the medical concept of unvaccinated employees wearing a mask is limited, some institutions have required such an approach throughout the influenza season.

Access the complete policy statement: Influenza Immunization for All Health Care Personnel: Keep It Mandatory

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IAC Spotlight! Three health care organizations join IAC's Influenza Vaccination Honor Roll for mandatory health care worker vaccination

More than 500 organizations are now enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for health care personnel. 

Since August 4, when IAC Express last reported on the Influenza Vaccination Honor Roll, three health care organizations have been enrolled.

IAC urges qualifying health care organizations to apply.

Newly added health care organizations, hospitals, government agencies, and medical practices
  • Hendrick Medical Center, Abilene, TX
  • Lakeland Health Hospital, St. Joseph, MI
  • University of Mississippi Medical Center, Jackson, MS
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CDC encourages organizations to become Flu Prevention Partners

CDC encourages immunizations providers to become Flu Prevention Partners and work with CDC to promote influenza vaccination within their communities, coordinate or host influenza vaccination clinics, and increase awareness about the importance and benefits of annual influenza vaccination. CDC's Resources for Flu Prevention Partners website features partner success stories and photos, campaign highlights for both general audience and disparate populations, new tools for promotion efforts, information on media events, free resources, services for staying connected, and information about becoming a partner. Back to top

National Influenza Vaccination Week will be held December 6–12

National Influenza Vaccination Week (NIVW) will be held this year on December 6–12. This event highlights the importance of continuing influenza vaccination throughout the season. CDC will be featuring useful related resources on its NIVW web section. This site will be updated as December approaches, so check back frequently.

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IAC enrolls one new birthing institution into its Hepatitis B Birth Dose Honor Roll; two previously honored institutions qualify for additional years

The Immunization Action Coalition (IAC) is pleased to announce that one new institution has been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institution is listed below with its reported hepatitis B birth dose coverage rates in parentheses.
  • St. Luke's Cornwall Hospital, Newburgh, NY (95%)
The following institution is being recognized for a second year:
  • Sturdy Memorial Hospital, Attleboro, MA (90%)
In addition, the following institution is being recognized for a third year:
  • Laughlin Memorial Hospital, Greeneville, KY (98%)
The Honor Roll now includes 209 birthing institutions from 34 states and Puerto Rico. Fifty-one institutions have qualified for a second year and two institutions have qualified three times.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give birth to the end of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying health care organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90% or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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AAP publishes updated recommendations for prevention and control of influenza in children

On September 7, the American Academy of Pediatrics (AAP) released a policy statement online titled Recommendations for Prevention and Control of Influenza in Children, 2015–2016. The abstract is reprinted below.

The purpose of this statement is to update recommendations for routine use of seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The American Academy of Pediatrics recommends annual seasonal influenza immunization for all people 6 months and older, including all children and adolescents. Highlights for the upcoming 2015–2016 season include the following:

1. Annual universal influenza immunization is indicated with either a trivalent or quadrivalent vaccine (no preference).

2. The 2015–2016 influenza A (H3N2) and B (Yamagata lineage) vaccine strains differ from those contained in the 2014–2015 seasonal vaccines.
  • Trivalent vaccine contains an A/California/7/2009 (H1N1) pdm09-like virus; an A/Switzerland/9715293/2013 (H3N2)-like virus; and a B/Phuket/3073/2013-like virus (B/Yamagata lineage)
  • Quadrivalent vaccine contains an additional B virus (B/Brisbane/60/2008-like virus [B/Victoria lineage])
3. The dosing algorithm for administration of influenza vaccine to children 6 months through 8 years of age has been updated to reflect that virus strains in the vaccine have changed from last season.

With an increasing number of organizations mandating influenza vaccine, all health care personnel should receive influenza vaccine each season and fully promote influenza vaccine use and infection-control measures. In addition, pediatricians should promptly identify children clinically presumed to have influenza disease for rapid antiviral treatment, when indicated, to reduce morbidity and mortality.

Access the complete policy statement: Recommendations for Prevention and Control of Influenza in Children, 2015–2016

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WHO publishes conclusions and recommendations of the Immunization and Vaccine-related Implementation Research Advisory Committee

The September 11 issue of the WHO periodical Weekly Epidemiological Record (WER) includes a report titled Immunization and Vaccine-related Implementation Research Advisory Committee (IVIR-AC): summary of conclusions and recommendations, 9–11 June 2015 meeting.

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WHO reports on acute flaccid paralysis surveillance in its Weekly Epidemiological Record

The September 11 issue of the WHO periodical Weekly Epidemiological Record (WER) includes a report titled Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2015.

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

Vaccination remains 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

August issue of CDC's Immunization Works newsletter now available

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

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CDC reports on pneumonia associated with an influenza A H3 outbreak at a skilled nursing facility in Florida

CDC published Notes from the Field: Pneumonia Associated with an Influenza A H3 Outbreak at a Skilled Nursing Facility—Florida, 2014 in the September 11 issue of MMWR (pages 985–986). The first and last two paragraphs of the article are reprinted below.

In December 2014, the Florida Department of Health, Bureau of Epidemiology, was notified that 18 of 95 (19%) residents at a skilled nursing facility had radiographic evidence of pneumonia and were being treated with antibiotics. Two residents were hospitalized, one of whom died. A second resident died at the facility. The Florida Department of Health conducted an outbreak investigation to ascertain all cases through active case finding, identify the etiology, provide infection control guidance, and recommend treatment or prophylaxis, if indicated.

Influenza A H3N2 was the predominant influenza virus strain circulating in the United States during the 2014–15 influenza season, and the majority of H3N2 viruses tested have drifted from the H3N2 vaccine strain. Three of the 10 swabs that tested positive for influenza A H3 were forwarded to CDC for further analysis; two of these samples were the nondrifted strain (A/Texas/50/2012-LIKE (H3N2) GP). Among the 44 ill residents, 19 (43%) had documentation of receipt of influenza vaccination during the 2014–15 influenza season, including two patients who were hospitalized (one of whom died). Among 51 unaffected residents, 33 (65%) had documentation of receipt of influenza vaccination.

As of January 24, 2015, widespread influenza activity and 76 reported influenza-like illness outbreaks had occurred in Florida, including this severe outbreak that resulted in a 46% attack rate and four deaths. The 2014–15 influenza season was moderately severe overall, especially in older adults, and reduced vaccine effectiveness was widely reported. Neither influenza testing nor prescription of antiviral medications occurred during the initial cluster, which was followed by extensive secondary transmission. Preventing transmission of influenza viruses within long-term care facilities requires a multifaceted approach that includes yearly vaccination of all residents and health care workers; prompt testing when any resident has signs and symptoms that could be due to influenza; standard and droplet precautions for residents with suspected or confirmed influenza; empirical antiviral treatment of all residents with confirmed or suspected influenza, regardless of vaccination status; and antiviral chemoprophylaxis for residents as soon as an outbreak is identified.

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CDC publishes two articles about Ebola; both previously published as MMWR Early Releases

CDC published the following two articles about Ebola in the September 11 issue of MMWR. These reports were previously published as MMWR Early Releases on September 3, and were previously covered in IAC Express on September 8.
  1. Elimination of Ebola Virus Transmission in Liberia—September 3, 2015 
  2. Ebola Virus Disease—Sierra Leone and Guinea, August 2015
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CDC updates its "You Call the Shots" module on influenza; free CE credit available

CDC recently added an "Influenza 2015" module to 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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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 nine 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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Registration now open for Michigan's fall immunization conferences; offered in eight MI cities this October and November

Registration is now open for Michigan's 2015 fall immunization conferences to be held in Marquette (10/13), Gaylord (10/15), Lansing (11/3), Grand Rapids (11/5), Flint (11/6), Kalamazoo (11/17), Dearborn (11/19), and Troy (11/20). A keynote speaker from CDC will present a vaccine update and participate in a troubleshooting panel at each conference location. In addition, Marcus DeGraw, MD, and P. Ann Ryan, DO, PhD, will take turns giving a presentation called “Recommending HPV Vaccination—What are the magic words?” The session is designed to motivate and empower health care providers to confidently and effectively recommend HPV vaccination.

More information on conference agenda and registration

Questions? Contact Rosemary Franklin at

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Agenda for October ACIP meeting available; call-in information for the live meeting (listen only) is now available

CDC has released a draft agenda for the next Advisory Committee on Immunization Practices (ACIP) meeting, which will be held October 21 at CDC's Clifton Road campus in Atlanta. If you plan on attending the meeting in person, the registration deadline for non-U.S. citizens is September 30, and October 7 for U.S. citizens.

Registration is not required to listen to the meeting; the call-in information page is listed below. The live meeting recording and presenter slides are always made available online after the meeting as well.

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Question of the Week

I have never seen a case of hepatitis A in my pediatric population, even before hepatitis A vaccine was licensed. Is this vaccine necessary among pediatric patients? 

One reason you may not have seen hepatitis A in your pediatric patients is because the likelihood of having symptoms with hepatitis A infection is related to age. In children younger than age 6 years, 70 percent of infections are asymptomatic. When illness does occur in young children, it is typically not accompanied by jaundice. In older children and adults, infection typically is symptomatic, with jaundice occurring in more than 70 percent of patients. However, in 2000, children age 0 through 9 years had the highest rate of acute hepatitis A (6.56 per 100,000 persons). Rates were particularly high in states west of the Mississippi. In 2006, hepatitis A was recommended as a routine vaccine for all children. Since that time, hepatitis A has become very rare in pediatric patients.
 In 2013, there were 0.14 cases of acute hepatitis A per 100,000 children age 0 through 9 years of age. This dramatic decline is the result of the hepatitis A vaccination program.

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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