Issue 1209: October 13, 2015


Familiar with and its materials? Join IAC as a website content manager!

Our website at has a vast collection of highly maintained educational materials and a wealth of other immunization information that we are dedicated to keeping up to date. We currently need an experienced professional with a background in immunization or public health to assist in maintaining the content and organization of
This long-term, contract consultant position is available immediately, and there is no need to reside in the Twin Cities. The number of hours per week is open to discussion.
A good background, but not a requirement, would be experience in nursing or public health. We seek someone who is excited by organizing immunization information for dissemination online to a mass audience. Inherent skills involve excellent writing and command of grammar, attention to detail and accuracy, being highly organized and a talented communicator, and being a person who enjoys working with a team.
If you or someone you know might be interested in working closely with Dr. Deborah Wexler, Dr. William Atkinson, and all the other IAC web content experts, please contact us today.
Send an email message to Julie Murphy at with a summary description of your background and how your skills and experience can help us maintain the content of
Looking forward to hearing from you.
Deborah L. Wexler, MD
Executive Director
Immunization Action Coalition

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Join the IAC Web Team!

IAC is looking for an experienced web designer to help us maintain and expand our websites at and This long-term position is for a contract consultant who can assist us in the technical maintenance of these sites. The number of hours per week is open to discussion, you can start immediately or when available, and there is no need to reside in the Twin Cities.
Here are some principal requirements and duties of the position: 
  • Formal design training as well as background in designing for websites
  • Competent in use of Adobe Photoshop and Illustrator
  • Continue and expand current designs of and
  • Create images, buttons, and other design elements appropriate for placement online
  • Create and modify existing web pages that use HTML tables for layout
  • Create and adjust existing HTML source code including styling with CSS
  • Skilled in using any HTML editor, such as Dreamweaver
  • No programming experience needed, although light familiarity with JavaScript a plus 
We believe you will find the creative and friendly people at IAC to be great to work with and will gain great satisfaction in serving health care professionals and others who visit and
If you or someone you know might be interested in working for IAC, please send an email message to Julie Murphy at with a summary description of your background and how your skills align with our needs.
We look forward to hearing from you.
IAC Web Team 

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CDC updates recommendation for timing of postvaccination serologic testing of infants born to HBsAg-positive women

CDC published Update: Shortened Interval for Postvaccination Serologic Testing of Infants Born to Hepatitis B-Infected Mothers in the October 9 issue of MMWR (pages 1118–1120). A summary provided to the press is reprinted below.

An estimated 25,000 infants are born to HBV-positive mothers each year in the United States. However, post-exposure prophylaxis (PEP) is highly effective in preventing perinatal HBV transmission; only 1 percent of infants receiving PEP develop infection. Infants born to HBV-infected mothers should receive hepatitis B vaccine (consisting of a 3- or 4-dose series) and hepatitis B immune globulin within 12 hours of birth to prevent perinatal HBV transmission. In order to determine whether the infant requires revaccination, [postvaccination serologic testing] PVST was previously recommended at age 9–18 months. Because new evidence suggests that hepatitis B antibody levels decline following vaccination, CDC now recommends that PVST take place earlier—at age 9–12 months, or 1–2 months after the final dose of the hepatitis B vaccine series—in order to ensure antibodies are detected. Benefits to this shortened interval include a reduction in the time that non-responders are at risk for transmission from close contacts with HBV infection, opportunity for prompt revaccination when needed, and conservation of public health resources. Additionally, the authors note that a shortened interval might increase adherence with recommendations for timely completion of PVST.

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Reminder! Register today for IAC’s "Take a Stand™” Workshops; next up: Chicago on October 23

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 Chicago, Illinois, on October 23. If you are a medical staff member in a medical practice serving adults near Chicago, register today for this free educational workshop.

Physicians, practice managers, nurse practitioners, physician assistants, and nurses in medical offices 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 practices 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 study finds anaphylactic reactions rare after immunization

A recently published CDC-authored study based on a large population group that received currently used vaccines confirmed the rarity of anaphylaxis after vaccination. Risk of Anaphylaxis after Vaccination in Children and Adults was published online on October 7 in the Journal of Allergy and Clinical Immunology. The "Abstract" is reprinted below.

Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children.

We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis.

Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines.

We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90–1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65–2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22–6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases).

Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat.

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Vaccine Facts and Policy website updated with new information 

The Vaccine Facts and Policy (VFAP) website,, makes available an expansive compilation of detailed immunization data for use by immunization programs, partners, researchers, government, and the general public. The VFAP website, launched in November 2014, includes information within five major topic areas related to immunization law and policy, including demographics and rates, fiscal environment, law and policy, strategies and initiatives, and the structure of immunization programs.

The website has recently been updated with the latest Association of Immunization Managers (AIM), Immunization Action Coalition (IAC) and national information that characterizes the immunization environment of 64 United States jurisdictions for the following topics:
  • Coverage rates (source: National Immunization Survey)
  • Exemption policies from school entry requirements (source: Immunization Action Coalition)
  • Medical and non-medical exemption rates (source: Vaccination Coverage Among Children in Kindergarten)
  • Immunization program activities to address vaccine hesitancy/confidence (source: 2015 AIM Annual Survey) 
Users may customize their experience by searching the data by jurisdiction or topic.

The VFAP website is a collaboration of George Washington University, AIM, and IAC. You are urged to spread word of the VFAP project to your stakeholders through newsletters, emails, and social media. The FAQs and a one-page VFAP information sheet provided below may be used in these communications. This partnership has been supported by funding from Pfizer Inc., Merck & Co., and GlaxoSmithKline, none of which provide any input into the content of the project.

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IAC Spotlight! Four 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 29, when IAC Express last reported on the Influenza Vaccination Honor Roll, four additional 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
  • Mercy Hospital Ardmore, Ardmore, OK
  • Cass County Health Department, Logansport, IN
  • Snake River Pediatrics, Ontario, OR
  • Springfield-Greene County Health Department, Springfield, MO
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IAC updates "Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months Through 8 Years During the 2015–2016 Influenza Season." CDC simplifies its guidance.

IAC has updated its handout for health care professionals titled Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months Through 8 Years During the 2015–2016 Influenza Season

The updated resource is based on ACIP's recommendations for the 2015–16 influenza season, which greatly simplify the algorithm. 

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IAC updates "Influenza Vaccination of People with a History of Egg Allergy"

IAC has updated its handout for health care professionals titled Influenza Vaccination of People with a History of Egg Allergy for the 2015–16 influenza season based on updated guidance from Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2015–16 Influenza Season.

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IAC updates its standing orders templates for administering hepatitis B, Td/Tdap, and zoster vaccines to adults

IAC recently redesigned and updated the following three standing orders templates for adult vaccination:
  1. Standing Orders for Administering Hepatitis B Vaccine to Adults
  2. Standing Orders for Administering Tdap/Td Vaccine to Adults
  3. Standing Orders for Administering Zoster Vaccine to Adults
Related Links IAC's Handouts for Patients & Staff web section offers health care professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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WHO announces recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season

The World Health Organization (WHO) recently released information about the composition of the strains that will be used for seasonal influenza vaccination in the southern hemisphere in 2016.

It is recommended that trivalent vaccines for use in the 2016 influenza season (southern hemisphere winter) contain the following:
  • An A/California/7/2009 (H1N1)pdm09-like virus
  • An A/Hong Kong/4801/2014 (H3N2)-like virus
  • A B/Brisbane/60/2008-like virus
It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus.

Read WHO's Recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season.

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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

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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CDC reports on measles in a person with presumed immunity in California

CDC published Notes from the Field: Measles in a Patient with Presumed Immunity—Los Angeles County, 2015 in the October 9 issue of MMWR (page 1123). Selected portions of the article are reprinted below.

On February 14, 2015, patient A, aged 17 years, was seen in an emergency department for evaluation of reactive airway disease. In the waiting room at the same time were two siblings, aged 6 months, presenting with fever and rash; these two children (patients B and C) were later confirmed to have measles. Patient A began a 5-day course of oral prednisone (50 mg per day); however, symptoms continued, and patient A returned to the emergency department the next day and received 125 mg of intravenous (IV) methylprednisolone. Patient A had documentation of receipt of 2 doses of measles, mumps, and rubella (MMR) vaccine at ages 12 months and 4 years.

On March 2, 16 days after the first emergency department visit, patient A was hospitalized for vomiting and dehydration. Patient A was also found to be febrile and to have a confluent papular rash that began on the face and spread to trunk and extremities and had small vesicular oral lesions. Measles was confirmed by laboratory testing, and patient A received supportive treatment with anti-emetics and IV fluids.

Patient A had received 2 doses of MMR vaccine and did not meet criteria for being severely immunocompromised, however, this patient did develop measles after being exposed in the setting of a hospital emergency department to patients with laboratory-confirmed measles. Although it is not known whether patient A developed immunity to measles in response to the 2 administered doses of MMR vaccine, or whether patient A had an unrecognized immunocompromising condition, the recent steroid use might have weakened the patient's immune response and rendered patient A susceptible to wild measles strain. The diagnosis of measles in patient A highlights the concern that immunocompromised and susceptible persons might be exposed in a health care setting. More information is needed concerning the effect of immunomodulating drugs on vaccine-induced immunity to measles and other vaccine-preventable diseases.

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CDC publishes report of the establishment of an Ebola treatment unit and laboratory in Sierra Leone

CDC published Establishment of an Ebola Treatment Unit and Laboratory—Bombali District, Sierra Leone, July 2014–January 2015 in the October 9 issue of MMWR (pages 1108–1111). A summary made available to the press is reprinted below.

Bombali district was among the hardest hit districts in Sierra Leone in the ongoing Ebola epidemic, but outbreak control was achieved. Improvements in timeliness of Ebola control measures were seen after the establishment of an Ebola Treatment Unit (ETU) and laboratory in Bombali; however, these facilities were not available until five months after the outbreak began there. Data from the Viral Hemorrhagic Fever database revealed that after the establishment of the ETU and laboratory in Bombali, the processes for initiating case investigations and determining laboratory results for Ebola patients occurred more rapidly, which coincided with outbreak control. These findings support that establishing capacity for Ebola testing, isolation, and treatment at the onset of an outbreak, is a critical component of outbreak control.

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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 thirteen 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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NFID to offer webinar on the role of rapid diagnostic testing in influenza treatment on October 28

The National Foundation for Infectious Diseases (NFID) will offer a webinar titled "The Role of Rapid Diagnostic Testing in Influenza Treatment" on October 28, at 12:00 p.m. (ET). Sheldon M. Campbell, MD, PhD, associate professor of Laboratory Medicine, Yale University School of Medicine and director, Clinical Laboratories, VA Connecticut Healthcare Systems, and William Schaffner, MD, NFID medical director and professor of Preventive Medicine and Infectious Diseases, Vanderbilt University School of Medicine will discuss advances in rapid influenza diagnostic testing and clinical approaches to influenza diagnostic testing.

Access registration information.

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Final agenda for October 21 ACIP meeting available; you can listen to the meeting if you are unable to attend 

CDC has released the final 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. The registration deadline for attending the meeting in person has passed, but 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

If a child only received a half dose of live attenuated influenza vaccine (LAIV, FluMist, MedImmune), I understand they are not considered immunized. Can the child receive inactivated influenza vaccine (IIV) on the same day?  

You are correct that a half dose of LAIV (or any other vaccine) is a non-standard dose and should not be counted. If you weren’t able to give the second half of the LAIV at that same appointment, you will need to provide another full dose of influenza vaccine at another visit. If you want to try using a different type of vaccine, you can give IIV any time after the partial dose of LAIV. If you want to give LAIV again, you should wait four weeks because it is a live vaccine.

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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