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Issue 1222: January 6, 2016

Ask the Experts
Ask the Experts—Question of the Week: 
If a patient received Trumenba (MenB; Pfizer) two months ago and Bexsero…read more








Reminder: December issues of Needle Tips and Vaccinate Adults are available online

The December issues of Needle Tips and Vaccinate Adults are now available online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed. Both publications focus on influenza and pneumococcal vaccination, 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. You’ll also find new and updated vaccination resources for patients and staff, including standing orders templates, screening checklists, administration guides, and other ready-to-copy educational materials.

Click on the images below to download the December issues (PDF) of Needle Tips and/or Vaccinate Adults.

Download the November issue of Needle TipsDownload the November issue of Vaccinate Adults

Needle Tips: View the table of contentsAsk the Experts section, magazine viewer, and back issues.

Vaccinate Adults: View the table of contentsAsk the Experts section, magazine viewer, and back issues.

If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit IAC's subscribe page to sign up.

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IAC’s “Take a Stand™” workshops proving highly successful around the country: Register NOW for the next sessions in California (January 19–23, 2016) 

The Immunization Action Coalition (IAC), with support from Pfizer, has implemented Take a Stand™, a 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, PhDWilliam Atkinson, MD, MPH; and Deborah Wexler, MD, from IAC, and Alexandra Stewart, JD, from George Washington University. These workshops already have been conducted in Louisville, KY; Chicago, IL; Portsmouth, VA; Nashville, TN; and Little Rock, AR. To illustrate how these have been going, here is a small sampling of comments received from attendees:
“Not only does this workshop provide great education, but it provides you with the tools and resources you need to implement this within your practice.” J.M., APN, MPH (Chicago, IL)
“This workshop gave us great ideas and information. Can’t wait to go back and start this process to get our Standing Orders going.” 
T.S., clinical manager (Fredericksburg, VA)
“Fantastic—great expertise, resources, tools and advice.” 
D.S. (Nashville, TN)
“This workshop is excellent for nursing directors/managers in the ambulatory setting. Excellent resources for preventive services.” 
L.R., primary care service line nursing director (Little Rock, AR)
Don’t miss your chance to join these satisfied attendees. The next workshops are scheduled for 2016 in four California cities.

Be sure to note that these are one-time-only events in each city. 

Who should attend? Clinicians, nurses, and practice managers in medical offices that serve adults, as well as pharmacists and quality improvement managers, will benefit from the workshops.
In addition to the California sessions, other workshop locations and schedules, a sample agenda, and online registration are available on the Take a Stand™ website at

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 healthcare 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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January is Cervical Health Awareness Month

Cervical Health Awareness Month (CHAM) is an annual observance in January that can be used to highlight the need to improve HPV vaccination coverage.

CDC has provided the following tips on ways to promote HPV vaccination during CHAM:

  1. Ensure your HPV vaccine web content is up to date by using content syndication to populate your organization’s web pages. Send an email to for information about using web buttons to show your support and partnership.
  2. Link to and share CDC materials with your audiences (HPV Vaccine for Preteens and Teens, More Information about HPV and HPV Vaccine, Supplemental information and guidance for vaccination providers regarding use of 9-valent HPV vaccine).
  3. Contact local medical society chapters (e.g., AAP, AAFP, ACOG), immunization coalitions, cancer centers, and American Cancer Society local offices to enlist their partnership during your activities and reach their audiences with the materials you are promoting.  
  4. Determine your practice's HPV vaccination rates and consider a quality improvement project to raise the rates. 
  5. Submit op-eds or letters to the editor to raise awareness and highlight the importance of vaccinating adolescents at age 11 or 12, and encourage other organizations to submit letters as well. Some good blog posts that you could use as examples are from Dr. Nathan “Peds Geek” Boonstraand Dr. Wendy Sue “Seattle Mama Doc” Swanson.
  6. Recruit a local clinician to act as a spokesperson or “champion” for HPV vaccination. This may also include reaching out to local news outlets and coordinating earned media focusing on HPV vaccine as cancer prevention. 
  7. Customize and disseminate matte articles through community publications, e-blasts, or other communications with your constituents.  
  8. Share one of CDC's HPV Vaccine Awareness videos with your membership and/or constituents.
  9. Register for CDC's #PreteenVaxScene webinar miniseries in January, and promote the series among your colleagues and partners. [Information about this webinar series can be found in the December 23 issue of IAC Express.]
  10. Participate in the #PreventCancerTogether Thunderclap campaign. Thunderclap is a social media tool that allows supporters to sign up in advance to share a unified message at a specific time via their individual Facebook, Twitter, or Tumblr accounts. On January 18, Thunderclap will release the message on the timelines of all those that signed up, thus creating a social media Thunderclap of support. Lend your social support by signing up now at

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Avoid vaccine administration and storage and handling errors such as those documented in the December MMWR

On December 18, CDC published Notes from the Field: Injection Safety and Vaccine Administration Errors at an Employee Influenza Vaccination Clinic—New Jersey, 2015. The article detailed the vaccine administration and storage and handling errors committed by a health services company contracted to hold an onsite employee influenza vaccination clinic, and how the state immunization program responded to the situation. Although the report was covered in the December 23 issue of IAC Express, due to the seriousness of the errors and the holiday week timing of the publication, we have chosen to revisit this issue. The following resources can help vaccine providers avoid administration and storage and handling errors as described in the MMWR article:

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Study underscores value of child getting two doses of influenza vaccine the first season they are vaccinated

The Pediatric Infectious Disease Journal recently published an article titled Influenza Vaccine Effectiveness for Fully and Partially Vaccinated Children 6 months to 8 Years Old during 2011–2012 and 2012–2013: The Importance of Two Priming Doses online. CDC subsequently released related information; the first paragraph from the CDC document is reprinted below.

A study in the Pediatric Infectious Disease Journal underscores the value of a child getting two doses of vaccine the first season they are vaccinated and indicates that flu vaccination can provide residual immunity in children during subsequent seasons. CDC recommends that children aged 6 months through 8 years of age get two doses of flu vaccine, at least one month apart, the first year they are vaccinated against flu. The first dose “primes” the immune system; the second dose provides immune protection. The study found that children 2 years to 8 years of age who got the recommended first-time two doses of flu vaccine during a prior season had higher flu vaccine effectiveness (VE) than those who had not.

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HHS shares report from September technical consultation about eliminating perinatal hepatitis B transmission in the United States

On September 29, the U.S. Health and Human Services (HHS) Office of HIV/AIDS and Infectious Disease Policy convened a technical consultation focused on the goal of eliminating perinatal hepatitis B virus (HBV) transmission in the United States. The multidisciplinary group of experts met to share best practices, identify and better understand challenges, and strategize collectively about how to move forward. The consultation participants included representatives of professional medical societies, health departments, nonprofits, and advocacy networks, as well as colleagues from numerous federal agencies whose work touches on this issue.

In December, HHS released a report from this meeting titled Technical Consultation on the Elimination of Perinatal Hepatitis B in the U.S.

Perinatal transmission of HBV is especially serious because approximately 90 percent of HBV-infected newborns develop chronic infection; and up to 25 percent of these children will die prematurely from cirrhosis, liver failure, or liver cancer later in life. With fewer than 1,000 estimated cases of perinatal HBV infection occurring each year in the U.S., many see elimination as an achievable goal.

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HHS requests information from stakeholders for report on viral hepatitis; deadline for submissions is February 8

The U.S. Health and Human Services (HHS) Office of HIV/AIDS and Infectious Disease Policy will be developing a first-ever Viral Hepatitis Community Stakeholder Report that will share information about related activities of non-federal partners in 2014 and 2015. To collect such information, the Office has published a Request for Information (RFI) in the Federal Register. Selected information collected in response to this RFI will be compiled into a report highlighting innovative actions in support of the goals of the Viral Hepatitis Action Plan.

HHS encourages partners to respond to this request for information, and to pass the link along to colleagues. Submissions are due on or before 5:00 p.m. (ET) on February 8, 2016.

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IAC Spotlight! Find the latest additions to by going to "What's New" 

The Immunization Action Coalition (IAC) continually updates and adds resources to its website for healthcare professionals, If you want to check out what's been added most recently, click on the "What's New at IAC" button on the top of the home page. This section lists everything updated on the website in reverse chronological order, including IAC handouts, Vaccine Information Statements and translations, quarterly publications such as Needle Tips, and newly reviewed web sections.

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Limited number of single dose vials of yellow fever vaccine now available from Sanofi 

CDC recently posted Announcement: Yellow Fever Vaccine Shortage on its Traveler's Health website. The text of this announcement is reprinted below.

The manufacturer of yellow fever vaccine (YF-Vax), Sanofi Pasteur (Swiftwater, PA), has informed CDC that single-dose vials of YF-Vax are now available. Orders are currently limited to 5 boxes of 5 vials each (25 vials total) per customer every 30 days. The 5-dose vials are still unavailable but are expected to be back in stock in February 2016. For more information, contact Sanofi Pasteur at 1-800-VACCINE (1-800-822-2463).

Healthcare providers should refer to the section titled Yellow Fever and Malaria Information, by Country in CDC Health Information for International Travel 2016 (the “Yellow Book”) for information about which countries require yellow fever vaccination for entry and for which countries CDC recommends yellow fever vaccination. In the absence of a country requirement, CDC does not recommend yellow fever vaccination if the traveler’s itinerary does not include travel to a yellow fever–endemic area.

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Influenza is serious; many resources are available to help healthcare 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 healthcare professionals and the public:

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

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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December issue of CDC's Immunization Works newsletter now available

CDC recently released the December 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 posts a new training video on the 2015–2016 influenza recommendations; continuing education credit available 
CDC has posted a new online video titled Influenza Vaccination Recommendations, 2015–2016. This video is targeted toward all immunization providers, and includes important information about influenza, the various influenza vaccines, ACIP recommendations, vaccine storage and handling requirements, and administration considerations. Continuing education credit is available for participants who watch the video and complete the required paperwork.

CDC Public Health Grand Rounds to present session about public health decision-making on January 19

CDC's Public Health Grand Rounds will present Staying Ahead of the Curve: Modeling and Public Health Decision-Making on January 19 at 1:00 p.m. (ET). Those interested in viewing this one-hour session should go to the live external webcast link during the scheduled time.

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Question of the Week

If a patient received Trumenba (MenB; Pfizer) two months ago and Bexsero (MenB, GSK) yesterday, should they complete the series with two additional doses of Trumenba or one more of Bexsero since the two brands are not interchangeable? What would be the interval from the Bexsero to the next dose?   

The patient can complete the series with either vaccine. If Bexsero is chosen, the next dose (Bexsero #2) should be administered at least one month after yesterday’s dose. The Bexsero #2 would be the final dose. If Trumenba is chosen, the next dose (Trumenba #2) should be administered at least one month after yesterday’s Bexsero dose. The one-month interval between doses of Trumenba and Bexsero is recommended because one component (FHbp) is contained in both of the vaccine products and there is concern about potential interference. The final dose (Trumenba #3) should be administered four months after Trumenba #2.

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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