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Issue 1212: November 4, 2015

Ask the Experts
Ask the Experts—Question of the Week: A 16-year-old female came to us prior to having an elective splenectomy…read more










New! November issue of Needle Tips available online

The November 2015 issue of Needle Tips is now online.

Click on the image below to download the entire November issue of Needle Tips (PDF).

Download the November issue of Vaccinate Adults

The focus of this issue is meningococcal vaccine recommendations for MenB and MenACWY, including many new related "Ask the Experts" Q&As from CDC medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, RN, MN. Updated versions of IAC's 5-page "Summary of Recommendations for Child/Teen Immunization" and "Summary of Recommendations for Adults" are also included, along with several additional items.

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Reminder! Register today for IAC’s "Take a Stand™” workshops; next up: Portsmouth, VA (Nov. 10); Nashville, TN (Nov. 18); and Little Rock, AR (Nov. 19) 

The Immunization Action Coalition (IAC), with support from Pfizer, has launched Take a Stand™, a new national effort designed to improve adult immunization rates by increasing the use of standing orders in medical practices.*
At the core of this project are free workshops 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 next three fast-approaching workshops:

If you are a medical staff member in a medical practice serving adults near Portsmouth, Nashville, or Little Rock, 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 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

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AAP reaffirms its support for policies that support mandatory influenza vaccination of health care personnel

The American Academy of Pediatrics (AAP) published Influenza Immunization for All Health Care Personnel: Keep It Mandatory in the October issue of the journal Pediatrics. The "Abstract" and "Introduction" sections are reprinted below.

The purpose of this statement is to reaffirm the American Academy of Pediatrics’ support for a mandatory influenza immunization policy for all health care personnel. With an increasing number of organizations requiring influenza vaccination, coverage among health care personnel has risen to 75% in the 2013 to 2014 influenza season but still remains below the Healthy People 2020 objective of 90%. Mandatory influenza immunization for all health care personnel is ethical, just, and necessary to improve patient safety. It is a crucial step in efforts to reduce health care–associated influenza infections.

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

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

Read the statement in its entirety: Influenza Immunization for All Health Care Personnel: Keep It Mandatory

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CDC updates its set of meningococcal vaccine Q&As for health care professionals, as well as its set for parents

CDC has added two sets of Q&As about meningococcal vaccination to its website, including recommendations for use of both serogroups ACWY meningococcal vaccines (Menactra; Sanofi Pasteur and Menveo; GSK) and serogroup B meningococcal vaccines (Bexsero; GSK and Trumenba; Wyeth Pharmaceuticals, Inc.). One set of questions is targeted to health care professionals and the other to parents.

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IAC collaborates with Med-IQ to offer two new continuing education opportunities

IAC has collaborated with Med-IQ to develop two new courses that offer CME credit for physicians; one also provides CPE credits for pharmacists. Both relate to vaccinating adults with chronic health conditions, and are available online at no charge.

Med-IQ is a full-service, accredited medical education company that provides learning experiences for physicians, nurses, pharmacists, and other healthcare professionals.

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CDC reports on HPV vaccination coverage among female adolescents in managed care plans

CDC published Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans—United States, 2013 in the October 30 issue of MMWR (pages 1185–1189). A summary made available to the press is reprinted below.

To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV Vaccine for Female Adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who complete the recommended HPV vaccination series by age 13 years. In 2013, in the United States, the median HPV vaccination coverage level for female adolescents among commercial and Medicaid plans was 12% and 19%, respectively (ranges = 0%–34% for commercial plans, 5%–52% for Medicaid plans). The results of this study indicate that there are significant opportunities for improvement as HPV vaccination coverage among female adolescents was low for both commercial and Medicaid plans.

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HPV Resources from IAC

HPV Resources from CDC

HPV Resources from the Vaccine Education Center

HPV Resources from AAP
HPV resources from ACOG
HPV Resources from Voices for Vaccines

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IAC Spotlight: Check out the Vaccine-Related Journal Articles section on

Some readers may not be aware that IAC maintains a selected listing of journal articles that relate to the practical aspects of vaccination. The Vaccine-Related Journal Articles web section, found at, includes links to abstracts or articles about 22 vaccines/diseases, as well as topics such as "Talking with parents," "Alternative medicine," "Autism," "Pharmacists," "Pregnant women," "Vaccination in schools," "Exemptions," and more. 

Visit IAC's Vaccine-Related Journal Articles web section.

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Reminder: Abstract deadline for the 12th National Conference for Immunization Coalitions and Partnerships is December 11

Just a reminder that the planners of the 12th National Conference for Immunization Coalitions and Partnerships will be accepting abstract submissions until December 11. The conference, Ready. Set. Vaccinate!, will take place in Indianapolis, May 25–27, 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.

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 corrects word omission in "Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination"

IAC corrected a word omission in its Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination that was previously updated in August. The word "metabolic" had been inadvertently left out from Question #5.

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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November is American Diabetes Month; make sure your patients with diabetes are up to date with all recommended vaccines

November is American Diabetes Month, and a good time to assess the vaccination status of your patients with diabetes. The following information is reprinted from the October issue of CDC's publication Immunization Works.

November is American Diabetes Month and also the month in which many adults seek influenza vaccine. It provides the ideal time to perform a complete immunization assessment to ensure patients are up to date on the recommended vaccines. This is especially important for patients with chronic health conditions, including diabetes, as they are at increased risk for complications from certain vaccine-preventable diseases.

Diabetes can suppress the immune response, making it harder to fight infections, so people with diabetes may be more at risk for more serious complications from an illness than people without diabetes. Influenza can raise blood glucose to dangerously high levels, putting people with diabetes at risk of serious complications. People with diabetes are also at increased risk of death from pneumonia and other infections, and have higher rates of hepatitis B than the rest of the population. Outbreaks of hepatitis B associated with blood glucose monitoring procedures have occurred among people with diabetes, so it is important to ensure that they receive all recommended vaccines, including:

  • Annual influenza vaccine
  • Pneumococcal polysaccharide vaccine
  • Hepatitis B vaccine series

In addition, all adults need:

  • Tdap vaccine
  • Zoster vaccine if they are 60 years and older
  • [Editor's addition: Pneumococcal conjugate vaccine if they are age 65 or older and haven't already received a dose]

For more information on adult vaccines, visit the Adult Vaccination Resources web page.

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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:

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IAC makes available The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall

The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book,” 2015, 560 pages) is a uniquely comprehensive source of practical, up-to-date information for vaccine providers and educators. Its author, Gary S. Marshall, MD, has drawn together the latest vaccine science and guidance into a concise, user-friendly, practical resource for the private office, public health clinic, academic medical center, and hospital.
Order your copy of The Vaccine Handbook today!
IAC Executive Director Deborah Wexler, MD, is enthusiastic about helping get this book circulated as widely as possible. “During more than 20 years in the field of immunization education, I have not seen a book that is so brimming with state-of-the-science vaccine information,” she states. "This book belongs in the hands of every medical student, physician-in-training, doctor, nursing student, and nurse who provides vaccines to patients.”
The Vaccine Handbook provides:

  • Information on every licensed vaccine in the United States
  • Rationale behind authoritative vaccine recommendations
  • Contingencies encountered in everyday practice
  • A chapter dedicated to addressing vaccine concerns
  • Background on how vaccine policy is made
  • Standards and regulations
  • Office logistics, including billing procedures, and much more

About the Author
Gary Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the division of pediatric infectious diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

The newly released fifth edition of this invaluable guide is now available on IAC’s website at

The price of the handbook is $29.95 each, plus shipping charges. Discount pricing is available for more than 10 copies. Order copies for your staff or for distribution at an upcoming conference.

Quantity Discount Pricing

  • 1–10 books: no discount + shipping
  • 11–50 books: 5% + shipping
  • 51–100 books: 10% + shipping
  • 101–500 books: 15% + shipping
  • 501–1000 books: 20% + shipping

For quotes on larger quantities, email

Order your copy today!

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October issue of CDC's Immunization Works newsletter now available

CDC recently released the October 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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New issue of Breakthroughs in Bioscience titled "Vaccines: Essential Weapons in the Fight Against Disease"

The Breakthroughs in Bioscience series is a collection of illustrated articles, developed by the Federation of American Societies for Experimental Biology, to educate the general public about the benefits of fundamental biomedical research. A recently published issue is titled Vaccines: Essential Weapons in the Fight Against Disease. The first paragraph and part of the second paragraph are reprinted below.

Imagine a world in which playgrounds and pools are closed because of polio epidemics, and elementary school playmates are dying from diphtheria or whooping cough, while others are permanently left deaf, blind, or sterile due to measles, mumps, or meningitis. Only a generation or two ago that world was a frightening reality that contributed to one out of five children never reaching adulthood in the United States. Repeated epidemics swept through the world, killing as many as one-quarter of the population, many of whom were healthy and vibrant before an infectious disease led them to their graves.

Fortunately, that world no longer exists because of tremendous progress made in vaccine development and application. There are now more than two dozen vaccines that can prevent death or disability from infectious diseases such as influenza, polio, meningitis, and measles. Vaccines have prevented more than 100 million cases of disease in this country alone and continue to prevent 2.5 million deaths worldwide each year—the equivalent of averting about 7,000 deaths each day.

Access the complete 13-page Vaccines: Essential Weapons in the Fight Against Disease and share with parents and patients who may appreciate the information.

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Listen to any of the archived sessions of CDC's webinar series on "The Pink Book" chapter topics; opportunity to earn continuing education credit ends 30 days after posting

CDC has just completed a 15-part webinar series that provided a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). 

Read more about the series.

All 15 sessions are now archived and can be viewed online; a transcript of each broadcast is also available. Continuing education credit is available for 30 days after each session was posted. If you are interested in obtaining credit, plan to view the last two sessions before the dates listed.

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 addressing antimicrobial resistance through vaccines on November 18

The National Foundation for Infectious Diseases (NFID) will offer a webinar titled "Addressing Antimicrobial Resistance through Vaccines" on November 18, at 12:00 p.m. (ET). Scott K. Fridkin, MD, from the National Center for Emerging and Zoonotic Infectious Diseases at CDC, and Jane M. Knisely, PhD, from the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, will discuss the promise and challenges of vaccines to prevent antibiotic-resistant bacterial infections and support antimicrobial stewardship. Vaccines in the pipeline to prevent various bacterial infections will also be reviewed.

Access registration information.

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2016 Annual Conference on Vaccine Research to be held April 18–20 in Baltimore; abstract submission ends December 1

The National Foundation for Infectious Diseases (NFID) is hosting its Conference on Vaccine Research in Baltimore, MD, on April 18–20. Now in its 19th year, the conference has become the largest scientific meeting devoted exclusively to research on vaccines and associated technologies for disease prevention and treatment through immunization.

Abstract submissions for oral or poster presentations at the 2016 Annual Conference on Vaccine Research will be accepted until 11:59 p.m. (ET), December 1. 

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Question of the Week

A 16-year-old female came to us prior to having an elective splenectomy for a congenital splenic cyst. Her primary doctor has given her PCV13, Menactra brand MCV4, and a dose of meningococcal B vaccine—all on the same day. Since PCV13 and Menactra were given on the same day, should I give her another dose of PCV13 and if so, when? She will also receive PPSV23 8 weeks after PCV13.  

While it is ideal if all recommended doses are given prior to splenectomy, this schedule is acceptable, since PCV13 is being given before PPSV23 and splenectomy. The recommendation to separate PCV13 and Menactra applies only to asplenic persons. When she received the vaccines she was not asplenic.

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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