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Issue 1207: September 29, 2015

Ask the Experts
Ask the Experts—Question of the Week: A child in our practice received her first dose of varicella vaccine when she was 12…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, recently 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

Three videos added to IAC's MCV4: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection initiative

The Immunization Action Coalition, in collaboration with Sanofi Pasteur, recently 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 meningococcal conjugate vaccine (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.

The initiative's website,, offers important resources for health care providers, including fact sheets, talking points, an overview of adolescent immunization recommendations, Q&As, and other great materials. A new 3-part video series was just added to the website, providing vital information about meningococcal disease and the importance of the booster dose of MCV4 at 16 years of age. The series features Tina Tan, MD, a pediatric infectious disease specialist in Chicago, and Thomas Kuhls, MD, a pediatrician in private practice in Norman, Oklahoma, discussing why a booster dose of MCV4 is important.

Summary of the three videos:

Part 1: Meningococcal Disease (2:21 min)
This video details the epidemiology and risk factors of meningococcal meningitis.

Part 2: Why ACIP Recommends a Booster Dose (2:39 min)
This video shows immunization rates for MCV4 and explains the clinical reasoning behind the ACIP-recommended second (booster) dose at age 16–18. It also reviews the details of the January 2011 ACIP recommendation.

Part 3: Ways to Improve Immunization Rates (3:29 min)
This video explores protocols that providers can implement to increase immunization rates. It focuses on ways to avoid missed vaccination opportunities. Drs. Tan and Kuhls urge the viewer to take action and seek additional resources at

The videos can be accessed from the home page of the website.

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. 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 MCV4.

Be sure to visit the initiative website,, and download and use the free, helpful materials available there!

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CDC issues corrections and clarifications for the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases

CDC has issued corrections, revisions, and clarifications for the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). These have been listed on a new "Errata, Updates, and Clarifications" page, which can be found at

When noted, changes have been incorporated into the online HTML and PDF versions.

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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 September 15, 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
  • Barrett Hospital & HealthCare, Dillon, MT
  • OakLeaf Surgical Hospital, Altoona, WI
  • Portage Medical Center, Ravenna, OH
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Reminder: Physicians can earn CME credit for watching the Someone You Love documentary

"Someone You Love: The HPV Epidemic" is a feature-length documentary that presents the struggles and triumphs of five women whose lives were changed forever by this deadly virus. Directed by Frederic Lumiere and narrated by Vanessa Williams, the film interweaves personal stories with facts about this common and potentially deadly virus. The goal of this project is to raise awareness of HPV and cervical cancer.

The Indiana Immunization Coalition, in partnership with the Indiana School of Medicine and Lumiere Media, is offering CME credits to physicians nationwide for viewing the film. The film is available at no charge through the Indiana University (IU) School of Medicine as an online CME activity worth 1.5 AMA PRA Category 1 Credits. Access the film and obtain CMEs on the IU website. Continuing education credit for other health care professionals will be available soon.

NOTE: Groups wishing to inquire about sponsoring a screening of this film should contact Lumiere Media at

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IAC releases "Influenza Vaccine Products for the 2015–2016 Influenza Season"

IAC has released Influenza Vaccine Products for the 2015–2016 Influenza Season. This popular staff resource has been updated with current information about influenza vaccine products and codes for the 2015–2016 season.

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 screening checklists for contraindications and precautions to vaccination for children/teens and adults

IAC recently revised its Screening Checklist for Contraindications to Vaccines for Children and Teens and Screening Checklist for Contraindications to Vaccines for Adults. These screening checklists can be completed by the patient or parent/guardian before an appointment to help determine what vaccines can be given. Both pieces were redesigned and updated with new references.

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IAC revises "How to Administer IM and Subcut Vaccine Injections to Adults"

IAC recently revised its resource for health care professionals, How to Administer IM and Subcut Vaccine Injections to Adults. Besides a new format, updates include:

  • Changing "SC" to "Subcut"
  • Changing "acromion" to "acromion process"
  • Adding description regarding the anatomical location for IM vaccine injections
  • Adding meningococcal serogroup B vaccines
Related Links

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IAC revises table in recently updated "Standing Orders for Administering Influenza Vaccine to Children and Adolescents"

IAC has made a small change to the recently updated Standing Orders for Administering Influenza Vaccine to Children and Adolescents. A row was added to the table listed under Step 4 to provide the option of the anterolateral thigh muscle as an injection site for children age three years and older.

Both influenza standing orders templates are ready to use as is or to be modified as you wish. Related Links Back to top

IAC updates and combines information to create new handout: "Supplies You May Need at an Immunization Clinic"

IAC has combined two handouts, one detailing supplies needed at an immunization clinic and one listing such supplies needed for an adult immunization clinic, into one handout titled Supplies You May Need at an Immunization Clinic. This updated resource features an easy-to-use checklist to ensure that nothing essential is forgotten. Categories of supplies include vaccines, documentation, emergency supplies, miscellaneous vaccination supplies, Vaccine Information Statements, and office supplies.

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WHO issues updated position paper on reducing pain at time of vaccination

The September 25 issue of the WHO periodical Weekly Epidemiological Record includes a new position paper titled Reducing pain at the time of vaccination: 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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CDC notifies users of an issue with its immunization schedule app for Apple devices

CDC has reported that some iOS (Apple) device users who have downloaded the iOS 9 operating system report that they cannot use the back button in the "CDC Vaccine Schedules" app. Apple is aware that several apps have issues with this operating system.

CDC is developing a fix for the vaccine schedules app while Apple works to fix the issues within the operating system. CDC expects to release the fix, version 2.0.2, in mid-October.

Note that schedules presented through the app remain unaffected. The only reported problem is the back button when using iOS 9. Users can still navigate back by using the "home" icon.

To receive an email notice when this app and/or the immunization schedules are updated or changed, be sure to subscribe to CDC's immunization schedule email updates. Go to and enter your email address in the right-hand column box for “Get email updates."

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CDC and WHO report on global progress toward rubella and congenital rubella syndrome control and elimination in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Global Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination in the September 25 issue of MMWR (pages 1052–1055). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Rubella and congenital rubella syndrome control and elimination—global progress, 2000–2014. The first paragraph of the MMWR article is reprinted below.

Rubella virus usually causes a mild fever and rash in children and adults. However, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national routine immunization schedules, including an initial vaccination campaign usually targeting children aged 9 months–15 years. The Global Vaccine Action Plan endorsed by the World Health Assembly in 2012 and the Global Measles and Rubella Strategic Plan (2012–2020) published by Measles and Rubella Initiative partners in 2012 both include goals to eliminate rubella and CRS in at least two WHO regions by 2015, and at least five WHO regions by 2020. This report updates a previous report and summarizes global progress toward rubella and CRS control and elimination during 2000–2014. As of December 2014, RCV had been introduced in 140 (72%) countries, an increase from 99 (51%) countries in 2000 (for this report, WHO member states are referred to as countries). Reported rubella cases declined 95%, from 670,894 cases in 102 countries in 2000 to 33,068 cases in 162 countries in 2014, although reporting is inconsistent. To achieve the 2020 Global Vaccine Action Plan rubella and CRS elimination goals, RCV introduction needs to continue as country criteria indicating readiness are met, and rubella and CRS surveillance need to be strengthened to ensure that progress toward elimination can be measured.

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

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

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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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 eleven 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

A child in our practice received her first dose of varicella vaccine when she was 12 months old and her second dose when she was 14 months old, rather than at age 4–6 years. Is the second dose valid or does it need to be repeated? 
The recommended minimum interval between two doses of varicella vaccine for children 12 months through 12 years of age is 12 weeks. However, the second dose of varicella vaccine does not need to be repeated if it was separated from the first dose by at least 28 days, which is the "minimum interval." For more information, access CDC's table: Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines.

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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