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Issue 1206: September 22, 2015

Ask the Experts
Ask the Experts—Question of the Week: The Advisory Committee on Immunization Practices now designates a vaccine…read more

Reminder! Register today for IAC’s "Take a Stand™” Workshops; first up: 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. 
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CDC reports on influenza activity in the United States from May 24–September 5, 2015

CDC published Update: Influenza Activity—United States and Worldwide, May 24–September 5, 2015 in the September 18 issue of MMWR (pages 1011–1016). The first paragraph is reprinted below.

During May 24–September 5, 2015, the United States experienced typical low levels of seasonal influenza activity. Influenza A (H1N1)pdm09 (pH1N1), influenza A (H3N2), and influenza B viruses were detected worldwide and were identified sporadically in the United States. All of the influenza viruses collected from U.S. states and other countries during that time have been characterized antigenically and/or genetically as being similar to the influenza vaccine viruses recommended for inclusion in the 2015–16 Northern Hemisphere vaccine. During May 24–September 5, 2015, three influenza variant virus infections were reported: one influenza A (H3N2) variant virus (H3N2v) from Minnesota in July, one influenza A (H1N1) variant (H1N1v) from Iowa in August, and one H3N2v from Michigan in August.

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CDC reports on influenza vaccination coverage of health care personnel during 2014–15 influenza season

CDC published Influenza Vaccination Coverage Among Health Care Personnel—United States, 2014–15 Influenza Season in the September 18 issue of MMWR (pages 993–999). The first paragraph is reprinted below.

The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all health care personnel (HCP) to reduce influenza-related morbidity and mortality among both HCP and their patients and to decrease absenteeism among HCP. To estimate influenza vaccination coverage among U.S. HCP for the 2014–15 influenza season, CDC conducted an opt-in Internet panel survey of 1,914 HCP during March 31–April 15, 2015. Overall, 77.3% of HCP survey participants reported receiving an influenza vaccination during the 2014–15 season, similar to the 75.2% coverage among HCP reported for the 2013–14 season. Vaccination coverage was highest among HCP working in hospitals (90.4%) and lowest among HCP working in long-term care (LTC) settings (63.9%). By occupation, coverage was highest among pharmacists (95.3%) and lowest among assistants and aides (64.4%). Influenza vaccination coverage was highest among HCP who were required by their employer to be vaccinated (96.0%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for 1 day (73.6%) or multiple days (83.9%) and lowest among HCP working in settings where vaccine was neither required, promoted, nor offered on-site (44.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might help increase vaccination coverage among HCP and reduce the risk for influenza to HCP and their patients.

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CDC reports on influenza vaccination coverage of pregnant women during 2014–15 influenza season

CDC published Influenza Vaccination Coverage Among Pregnant Women—United States, 2014–15 Influenza Season in the September 18 issue of MMWR (pages 1000–1005). The first paragraph is reprinted below.

Pregnant women and infants are at increased risk for influenza-related complications and hospitalization. Influenza vaccination can reduce the risk for influenza-related illness among pregnant women and their infants. Since 2004, the Advisory Committee on Immunization Practices (ACIP) and the American College of Obstetricians and Gynecologists (ACOG) have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester of pregnancy. To assess influenza vaccination coverage among pregnant women during the 2014–15 influenza season, CDC analyzed data from an Internet panel survey conducted during March 31–April 6, 2015. Among 1,702 survey respondents who were pregnant at any time during October 2014–January 2015, 50.3% reported receiving influenza vaccination before or during pregnancy, similar to the reported coverage in the preceding season. Overall, 64.9% of respondents reported receiving a provider offer of influenza vaccination, 14.8% received a recommendation but no offer, and 20.3% received no recommendation. Vaccination coverage among these groups of women was 67.9%, 33.5%, and 8.5%, respectively. Reminder systems and standing orders that allow health care personnel other than the attending provider to assess vaccination status and administer vaccination can help to ensure that influenza vaccination is recommended and offered to a pregnant woman at each provider visit to increase pregnant women's vaccination coverage.

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CDC provides final 2014–15 influenza vaccination coverage estimates for the United States

CDC published Announcement: Available Online: Final 2014–15 Influenza Vaccination Coverage Estimates for Selected Local Areas, States, and the United States in the September 18 issue of MMWR (page 1017). The complete announcement is reprinted below.

Final 2014–15 influenza season vaccination coverage estimates are available online at FluVaxView ( as of 10 a.m. Thursday, September 17, 2015. The online information includes estimates of the cumulative percentage of persons vaccinated by the end of each month, from July 2014 through May 2015, for selected local areas, each state, each U.S. Department of Health and Human Services region, and the United States overall.

Analyses were conducted using National Immunization Survey influenza vaccination data for children aged 6 months–17 years and Behavioral Risk Factor Surveillance System influenza vaccination data for adults aged ≥18 years. Estimates are provided by age group and race/ethnicity. These estimates are presented in an interactive report ( and are complemented by an online summary report (

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NFID releases summary of September 17 news conference on influenza and pneumococcal disease

On September 17, the National Foundation for Infectious Diseases (NFID) hosted the 2015 Influenza/ Pneumococcal News Conference in collaboration with CDC and other leading medical and public health groups who rallied together to show their strong support for influenza immunization. The event served to communicate critical messages, including a call to action for everyone to get vaccinated. Two paragraphs from a related September 17 press release are reprinted below.

Each season, flu causes millions of illnesses, hundreds of thousands of hospitalizations and thousands or sometimes tens of thousands of deaths. A flu vaccine is currently the best defense available against getting the flu. “Vaccination is the single most important step people can take to protect themselves from influenza,” said CDC Director Tom Frieden, MD, MPH. “Flu can be serious and it kills tens of thousands of Americans each year. Vaccination is easier and more convenient than ever, so get yourself and your family protected.”

Overall, CDC estimates that 47 percent of the U.S. population age 6 months and older was vaccinated during the 2014–2015 season, similar to the 2013–2014 season and up from an estimated 41 percent five years ago. Coverage remains highest among children age 6 months through 23 months at 75 percent, the only age group that met the public health vaccination coverage goal of 70 percent. Children age 2 years through 4 years followed at 68 percent. Although vaccination coverage decreases in older children, vaccination among children age 5 years through 12 years is still above the national average, at 62 percent. In contrast to younger children, the estimated vaccination rate for adults age 18 years through 49 years has yet to top 40 percent. Similar to young children, coverage rates for adults age 65 years and older also remained high at an estimated 67 percent.

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AAP and CDC to sponsor October 1 webinar on preventing and controlling pediatric influenza; free continuing education offered

The American Academy of Pediatrics (AAP) and CDC will present a free one-hour webinar on October 1 at 2:00 p.m. (ET) titled How to Prevent and Control Pediatric Influenza. Presenters will be Henry H. Bernstein, DO, MHCM, FAAP, and Lisa A. Grohskopf, MD, MPH.

Objectives of this webinar:
  • Describe strategies to assist in preparing for the 2015-2016 influenza season
  • Identify gaps and opportunities to improve influenza prevention and control for children with chronic medical conditions
  • Discuss the importance of promptly identifying children clinically presumed to have influenza disease for rapid antiviral treatment, when indicated, to reduce morbidity and mortality
  • Identify ways to improve preparedness for infectious disease outbreaks within the office practice
Access registration information.

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Twelfth National Conference for Immunization Coalitions and Partnerships scheduled for May 25–27 in Indianapolis; abstract deadline is December 11

The 12th National Conference for Immunization Coalitions and Partnerships, Ready. Set. Vaccinate!, will take place in Indianapolis from May 25 through 27, 2016. This is a great opportunity for coalition leaders to learn from expert speakers and network with members of immunization coalitions from around the nation.

The planners are accepting abstract submissions until December 11. Abstracts are welcome from representatives of all disciplines, including coalition staff and members, community-based providers, health care providers, social workers, researchers, government agencies, health communication specialists, and others. Go to the Call for Abstracts page to learn more.

Note: This conference was formerly known as the National Conference on Immunization and Health Coalitions. The goal of the National Conference for Immunization Coalitions and Partnerships is to improve community health by enhancing the effectiveness of coalitions and partners through training in relevant coalition management and health promotion topics, as well as to provide networking and professional development opportunities.

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IAC Spotlight! "Apps for Immunization" web section on

Looking for immunization-related applications (apps) for your mobile device? Look no further. IAC's Apps for Immunization web section is a listing of apps related to immunization from trusted sources that are available from iTunes and Google. The apps help make it easy for healthcare professionals to check the latest vaccine recommendations and immunization schedules on their mobile devices, and to help parents keep their children up to date on their vaccinations.

Several new and updated apps have been added to the listing in the past year, including apps from the Society of Adolescent Health and Medicine (SAHM) and HLN Consulting.

Apps for Immunization is the latest addition to IAC’s online Directory of Immunization Resources.

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IAC posts French, Russian, and Thai translations of the 2015–16 influenza Vaccine Information Statements

IAC recently posted French, Russian, and Thai 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 Asian Pacific Health Care Venture for the Thai translations. Please note: The 2015–16 influenza vaccine VISs will be available in additional languages in the weeks ahead. IAC Express will announce the availability of translations as soon as they are ready.

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CDC issues corrections and revisions for the latest edition of CDC Health Information for International Travel 2016 ("The Yellow Book")

Several updates have been made to the online text of CDC Health Information for International Travel 2016 ("The Yellow Book") since its July release. These changes include: Access the complete 2016 edition of "The Yellow Book" online at

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Society of Adolescent Health and Medicine develops app to help parents improve their adolescent's health

The Society of Adolescent Health and Medicine (SAHM), supported by Pfizer, Inc. and Unity Consortium, has developed a new free app to provide parents of teens and young adults with a mobile, interactive resource for managing teen health. The THRIVE (Teen/Young Adult Health Resources, Information & Vaccine Education) app is available for iOS and Android devices and includes guided health information, supportive tips, and conversation starters to help parents answer tough questions and prepare their teens and young adults to take ownership of their health. Back to top

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

CDC reports on clinical inquiries received regarding suspected Ebola virus disease in children in the United States

CDC published Clinical Inquiries Received by CDC Regarding Suspected Ebola Virus Disease in Children—United States, July 9, 2014–January 4, 2015 in the September 18 issue of MMWR (pages 1006–1010). A summary made available to the press is reprinted below.

CDC responded to Ebola-related inquiries for 89 children from July 9, 2014 through January 4, 2015. No children tested positive for Ebola, but many had common illnesses, including malaria and flu. Overall, 33 children had traveled to an Ebola-affected country and 32 children had clinical signs or symptoms that could be consistent with Ebola. Unique concerns arose with these pediatric patients, such as if and how parents should be allowed in an examination room with their child. Records suggest clinical care was delayed for at least five children, either because of difficulty finding a hospital to evaluate a child with signs and symptoms consistent with Ebola or hospital reluctance to perform laboratory tests for illnesses such as malaria and influenza because of concerns about lab contamination.

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White House Initiative on Asian Americans and Pacific Islanders and Hep B United to sponsor October 8 webinar on CDC's enhanced viral hepatitis surveillance programs

The White House Initiative on Asian Americans and Pacific Islanders and Hep B United will sponsor a one-hour webinar on CDC's enhanced viral hepatitis surveillance programs on October 8 at 3:00 p.m. (ET).

In 2012, CDC's Division of Viral Hepatitis funded sites across the U.S. to conduct enhanced surveillance for viral hepatitis. Enhanced surveillance involves the collection of more extensive and complete information than is possible through the current national surveillance system. State and local epidemiologists will share their experiences and findings from enhanced hepatitis B surveillance in Michigan and Philadelphia.

Access registration information.

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NFID to offer October 14 webinar on maternal immunization

The National Foundation for Infectious Diseases (NFID) will offer a webinar titled "Maternal Immunization: Protecting Mother and Baby" on October 14, 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 and Richard H. Beigi, MD, MS, associate professor, Magee-Womens Hospital, University of Pittsburgh Medical Center, will discuss important vaccines recommended for pregnant women, including Tdap and influenza, and will address cocooning to protect vulnerable young infants. The speakers will also provide tips and strategies for increasing vaccine uptake in pregnant women.

Access 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 ten 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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Question of the Week

The Advisory Committee on Immunization Practices now designates a vaccine recommendation as either "A" or "B." My interpretation is that an A recommendation means the vaccine is routinely recommended for all children in an age or risk group, and a B recommendation is for permissive use (at the clinician’s discretion). Does the Affordable Care Act (ACA) require health plans (non-grandfathered) to provide benefit coverage on permissive B recommended vaccines?

Your understanding of A and B recommendations is correct. ACA requires coverage of vaccines with both A and B recommendations. The Vaccines for Children program also includes vaccines with a B recommendation.

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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