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Issue 1208: October 6, 2015

Ask the Experts
Ask the Experts—Question of the Week: Do you recommend staff who provide immunizations be certified in cardiopulmonary…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. 
Workshop Information Related Links Back to top

CDC updates and expands its vaccine safety website

CDC's Immunization Safety Office has revamped its vaccine safety site to create a better user experience. The newly updated website includes six distinct modules to connect all audiences to the most relevant information. The first four modules focus on different areas of vaccine safety, including research, in-depth vaccine and burden information, and answers to common concerns. The other two modules are separated by audience with content for parents and caregivers and a newly created section for health care providers. Please visit the redesigned Vaccine Safety website to learn more about vaccine safety and to take a look at these new modules.

CDC's Immunization Safety Office identifies possible vaccine side effects and conducts studies to determine whether health problems are caused by vaccines.

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CDC posts new report about global norovirus burden and vaccine development

CDC has posted a new report on its website titled Global Burden of Norovirus and Prospects for Vaccine Development on its website. The report brings together the work of norovirus researchers and vaccination experts from around the world to describe the burden of norovirus globally and outline further research needed to fill gaps in knowledge and move towards making norovirus vaccines a reality.
Norovirus causes almost one-fifth of all diarrheal disease globally and is estimated to cause up to 200,000 deaths annually. Incidence of norovirus infection is highest in young children, and severe outcomes, including hospitalization and deaths, are common among both children and the elderly. Considering the substantial disease burden and the difficulty in controlling norovirus, vaccination may be the best way to effectively control norovirus in the wider community. This report outlines the compelling need for a norovirus vaccination program and explains how technical challenges might be overcome in order to develop a vaccine that will benefit the populations who need it most.

Access Global Burden of Norovirus and Prospects for Vaccine Development.

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IAC Spotlight! Check out the recently updated "Ask the Experts" archive of online Q&As for influenza vaccine

IAC recently updated the following section of its online "Ask the Experts" feature: IAC’s Ask the Experts web section is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. The experts are Andrew T. Kroger, MD, MPH, medical officer, and Donna L. Weaver, RN, MN, nurse educator. Both are at CDC's National Center for Immunization and Respiratory Diseases. The Q&As have been featured in previous issues of IAC Express, Needle Tips, and Vaccinate Adults.

Related Links Subscribe to IAC Express and receive a new "Ask the Experts" Q&A every week, as well as several special editions of "Ask the Experts" throughout the year.

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IAC revises two of its most popular staff education materials, "Summary of Recommendations for Child/Teen Immunization" and "Summary of Recommendations for Adult Immunization"

IAC recently updated its Summary of Recommendations for Child/Teen Immunization and Summary of Recommendations for Adult Immunization to incorporate new ACIP recommendations related to HPV9, influenza, and meningococcal serogroup B vaccination. These summaries include the indications, schedule (including minimum intervals), and contraindications and precautions for all routinely recommended vaccines. The child/adult piece covers age birth through age 18 years, while the adult piece covers age 19 years and older.

Related Link IAC's Handouts for Patients & Staff web section offers health care professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC updates "Standing Orders for Administering Pneumococcal Vaccines (PCV13 and PPSV23) to Adults"

IAC recently updated Standing Orders for Administering Pneumococcal Vaccines (PCV13 and PPSV23) to Adults to include all the new ACIP recommendations related to routine PCV13 and PPSV23 vaccination of adults age 65 years and older as well as the recommendations for groups at risk.

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IAC revises two signs in English and Spanish related to vaccine storage and handling: "Do Not Turn Off Circuit Breaker" and "Do Not Unplug Refrigerator or Freezer"

IAC has updated the following two pieces related to vaccine handling and storage that can be used as handouts, stickers, or signs.

The signs include text in both English and Spanish. The Spanish word "immediately" was misspelled and is now corrected in both pieces. Thanks to Jennifer S. from New Jersey for pointing this out!

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IAC posts nine new translations of the VIS for meningococcal serogroup B vaccines

IAC recently posted the Vaccine Information Statement (VIS) for meningococcal serogroup B vaccines in Arabic, Burmese, Chinese (simplified), Chinese (traditional), French, Russian, Somali, Spanish, and Vietnamese. Back to top

IAC posts eight translations of the IIV VIS and three new translations of the LAIV VIS

IAC recently posted translations of the Vaccine Information Statement (VIS) for the 2015–16 inactivated influenza vaccine (IIV) in Armenian, Burmese, Chinese, Farsi, Hmong, Korean, Somali, and Tagalog on its website. IAC thanks the California Department of Public Health for the IIV translations in Armenian, Farsi, Hmong, Korean, and Tagalog.
In addition, translations of the VIS for the 2015–16 live, intranasal influenza vaccine (LAIV) are now available in Burmese, Chinese (simplified), and Somali translations on its website. 

IIV VIS LAIV VIS Related Links Back to top

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

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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September issue of CDC's Immunization Works newsletter now available

CDC recently released the September 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 a measles outbreak associated with vaccine failure in the Federated States of Micronesia

CDC published Measles Outbreak Associated with Vaccine Failure in Adults—Federated States of Micronesia, February–August 2014 in the October 2 issue of MMWR (pages 1088–1093). A summary made available to the press is reprinted below.

After 20 years with no measles, the Federated States of Micronesia experienced a large outbreak. Although measles outbreaks usually affect unvaccinated children and adolescents, in this atypical outbreak two thirds of cases occurred among adults, half of whom had received at least two doses of vaccine. The unusual amount of vaccine failure among adults may have been the result of historical lapses in the vaccine "cold chain," which is the continuous maintenance of vaccines at refrigerator temperatures to protect their potency. Childhood vaccination coverage achieved in recent years provided excellent protection, as younger age groups had limited cases and minimal vaccine failure. This suggests the cold chain has been adequate in recent years and highlights the importance of maintaining high coverage to protect children from measles, even in areas when measles has not been seen for years.

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CDC reports on Ebola disease in health care workers in Guinea

CDC published Ebola Virus Disease in Health Care Workers—Guinea, 2014 in the October 2 issue of MMWR (pages 1083–1087). The first paragraph is reprinted below.

An outbreak of Ebola virus disease (Ebola) began in Guinea in December 2013 and has continued through September 2015. Health care workers (HCWs) in West Africa are at high risk for Ebola infection owing to lack of appropriate triage procedures, insufficient equipment, and inadequate infection control practices. To characterize recent epidemiology of Ebola infections among HCWs in Guinea, national Viral Hemorrhagic Fever (VHF) surveillance data were analyzed for HCW cases reported during January 1–December 31, 2014. During 2014, a total of 162 (7.9%) of 2,210 laboratory-confirmed or probable Ebola cases among Guinean adults aged ≥15 years occurred among HCWs, resulting in an incidence of Ebola infection among HCWs 42.2 times higher than among non-HCWs. The disproportionate burden of Ebola infection among HCWs taxes an already stressed health infrastructure, underscoring the need for increased understanding of transmission among HCWs and improved infection prevention and control measures to prevent Ebola infection among HCWs.

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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 twelve 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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Conference on increasing HPV vaccination, a collaboration of NCI-designated cancer centers, scheduled for November 5–6

A conference titled "Increasing HPV Vaccination in the U.S.: A Collaboration of NCI-designated Cancer Centers" is scheduled for November 5–6 in Houston, TX. The National Cancer Institute (NCI) Cancer Centers Program is one of the anchors of the nation’s cancer research effort. The goals of the meeting are:
  • Provide a snapshot of actions to support HPV vaccination uptake from national partners working in this area
  • Share results from the grant supplements to advance HPV vaccination via environmental scans and local collaborations
  • Identify opportunities for cancer centers to collectively engage in cancer control activities related to HPV vaccination
  • Identify research opportunities related to HPV vaccination
Access more information on the agenda, including a registration link.

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Question of the Week

Do you recommend staff who provide immunizations be certified in cardiopulmonary resuscitation (CPR) training or only have some CPR training?

ACIP's General Recommendations on Immunization states that all vaccination providers should be familiar with the office emergency plan and be currently certified in CPR. Epinephrine and equipment for maintaining an airway should be available for immediate use. Access the recommendations (see page 12) at

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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