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Issue 1224: January 13, 2016

Ask the Experts
Ask the Experts—Question of the Week: If an egg-free influenza vaccine (FluBlok, Protein Sciences) was given inadvertently…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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CDC requests nominations for its Childhood Immunization Champion Awards

The CDC Childhood Immunization Champion Award is an annual award that recognizes individuals who make a significant contribution toward improving public health through their work in childhood immunization.
Each year, up to one CDC Immunization Champion from each of the 50 U.S. states, eight U.S. territories and freely associated states, and the District of Columbia will be honored. Champions can include coalition members, parents, healthcare professionals (e.g., physicians, nurses, physicians’ assistants, nurse practitioners, medical assistants, etc.), and other immunization leaders who meet the award criteria. Immunization program managers, state and federal government employees paid by state or federal immunization funding, individuals who have been affiliated with and/or employed by pharmaceutical companies, and those who have already received the award are not eligible to apply (for details, see page 3 of the nomination packet).

Awardees will be announced during National Infant Immunization Week (NIIW), which runs April 16–23 this year. Champions will receive a certificate of recognition, will be featured on CDC’s web site, and may be recognized by their immunization program during NIIW.

All nomination forms should be submitted to respective immunization programs. The suggested due date is January 29, 2016, but states may select a different deadline. Please contact your state immunization program to confirm your state’s deadline.

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IAC teams up with Med-IQ to offer two free CME courses on adult immunization

IAC is proud to partner with one of the nation’s premiere continuing medical education (CME) providers, Med-IQ, winner of 22 industry awards, the most of any CME company.
The collaboration is currently offering two online courses, Vaccinating Adults With Chronic Disorders: The Specialist’s Role and Vaccinating Adults With Chronic Disorders: Insights for the Primary Care Clinician.
IAC’s Dr. L.J Tan recruited stellar faculty members for a guided roundtable discussion on which course audio clips are based. You will hear from experts in immunization, a cardiologist, an endocrinologist, a pharmacist, and a nurse practitioner.

The trainings focus on the challenges of vaccinating adults with chronic disease, from either a specialist’s perspective or from that of primary care physicians and pharmacists. The frontline perspectives and practical strategies offered will educate and empower you to be a more effective vaccinator.
The 30-minute specialist’s course offers 0.5 AMA PRA Category 1 credit.
The one-hour primary care clinician course offers 1.0 AMA PRA Category 1 credit and 1.0 Accreditation Council for Pharmacy Education (ACPE) credit.

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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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CDC reports on percentage of adolescents who didn't receive a well-child checkup in the past 12 months

CDC published QuickStats: Percentage of Youths Aged 10–17 Years Who Did Not Receive a Well-Child Checkup in the Past 12 Months, by Metropolitan Status of Residence—National Health Interview Survey, United States, 2008–2014 in the January 8 issue of MMWR (page 1410). The article consists of a graph and the following accompanying text:

From 2008 to 2014, the percentage of youths aged 10–17 years who had not received a well-child checkup in the past 12 months decreased overall (31.3% to 21.2%) and in both metropolitan (29.3% to 20.1%) and nonmetropolitan (41.8% to 28.2%) areas. In 2014, youths aged 10–17 years residing in nonmetropolitan areas were more likely to have not received a well-child checkup in the past 12 months compared with those residing in metropolitan areas.

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IAC Spotlight! Visit the "Clinic Resources" web section to find a wide variety of practical resources for vaccine providers

The Immunization Action Coalition (IAC) maintains an entire website section of helpful resources for healthcare professionals who provide vaccination services. Go to to investigate practical resources from CDC, IAC, other nonprofits, professional societies, state health departments, and more sources. Topics include:

  • Administering Vaccines
  • Coding & Billing
  • Documenting Vaccination
  • Scheduling Vaccines
  • Screening for Contraindications
  • Storage & Handling
  • Vaccine Recommendations

Be sure to bookmark IAC's Clinic Resources main page for future reference.

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IAC reformats the Spanish translations of its screening questionnaires for hepatitis A and hepatitis B vaccination 

IAC recently reformatted the Spanish translations of its screening questionnaires for adults about hepatitis A and hepatitis B vaccination. The design now matches the English-language versions that were last updated in February 2015.

Should You Be Vaccinated Against Hepatitis A? (English)
¿Se debe vacunar contra la hepatitis A? (Spanish)

Should You Be Vaccinated Against Hepatitis B? (English)
¿Se debe vacunar contra la hepatitis B? (Spanish)

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Minor correction made to Spanish-language version of "Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination"

IAC recently corrected the wording on one line of the Spanish-language version of its "Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination." Previously both signature lines read "Formulario llenado por" ("Form completed by"); now the second line correctly reads "Formulario revisado por" ("Form reviewed by"). Thanks to sharp-eyed reader John of Virginia for pointing this out!

IAC's Handouts for Patients & Staff web section offers healthcare 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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Influenza is spreading and serious; please keep vaccinating your patients

The U.S. influenza season is just getting started. However, CDC has reported six influenza-associated pediatric deaths in the 2015–2016 season. Flu activity most often peaks in February and can last into May. While influenza A (H3N2) viruses have been most common since October 1, in the past three weeks, influenza A (H1N1)pdm09 viruses have predominated. The vast majority of circulating influenza viruses analyzed this season remain similar to the vaccine virus components for this season's influenza vaccines.

Influenza vaccination is recommended for everyone six months of age 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. Influenza antiviral drugs can treat influenza illness. CDC has issued guidance for clinicians on the use of antiviral treatment in the 2015–16 flu season. Early antiviral treatment works best.

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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Pediatrics publishes article on characteristics of physicians who dismiss families for refusing vaccines

The December issue of the journal Pediatrics published an article titled Characteristics of Physicians Who Dismiss Families for Refusing Vaccines. The abstract is reprinted below.

Physicians dismissing families who refuse vaccines from their practices is controversial. We assessed the following among pediatricians (Peds) and family physicians (FPs): (1) reported prevalence of parental refusal of 1 or more vaccines in the infant series; (2) physician response to refusal; and (3) the association between often/always dismissing families and provider/practice characteristics and state exemption laws.

Nationally representative survey conducted June to October 2012. A multivariable analysis assessed association of often/always dismissing families with physician/practice characteristics, state philosophical exemption policy, and degree of difficulty obtaining nonmedical exemptions.

The response rate was 66% (534/815). Overall, 83% of physicians reported that in a typical month, ≥1% of parents refused 1 or more infant vaccines, and 20% reported that >5% of parents refused. Fifty-one percent reported always/often requiring parents to sign a form if they refused (Peds 64%, FP 29%, P < .0001); 21% of Peds and 4% of FPs reported always/often dismissing families if they refused ≥1 vaccine. Peds only were further analyzed because few FPs dismissed families. Peds who dismissed families were more likely to be in private practice (adjusted odds ratio [aOR] 4.90, 95% confidence interval [CI] 1.40–17.19), from the South (aOR 4.07, 95% CI 1.08–15.31), and reside in a state without a philosophical exemption law (aOR 3.70, 95% CI 1.74–7.85).

Almost all physicians encounter parents who refuse infant vaccines. One-fifth of Peds report dismissing families who refuse, but there is substantial variation in this practice. Given the frequency of dismissal, the impact of this practice on vaccine refusers and on pediatric practices should be studied.

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Study investigates physicians' perspectives on HPV vaccination

On January 4, the journal Pediatrics published Primary Care Physicians' Perspectives About HPV Vaccine online. The study showed that pediatricians and family physicians do not always strongly recommend HPV vaccination to patients and their parents. The abstract is reprinted below.

Because physicians' practices could be modified to reduce missed opportunities for human papillomavirus (HPV) vaccination, our goal was to: (1) describe self-reported practices regarding recommending the HPV vaccine; (2) estimate the frequency of parental deferral of HPV vaccination; and (3) identify characteristics associated with not discussing it.

A national survey among pediatricians and family physicians (FP) was conducted between October 2013 and January 2014. Using multivariable analysis, characteristics associated with not discussing HPV vaccination were examined.

Response rates were 82% for pediatricians (364 of 442) and 56% for FP (218 of 387). For 11–12 year-old girls, 60% of pediatricians and 59% of FP strongly recommend HPV vaccine; for boys, 52% and 41% strongly recommended. More than one-half reported ≥25% of parents deferred HPV vaccination. At the 11–12 year well visit, 84% of pediatricians and 75% of FP frequently/always discuss HPV vaccination. Compared with physicians who frequently/always discuss, those who occasionally/rarely discuss (18%) were more likely to be FP (adjusted odds ratio [aOR]: 2.0 [95% confidence interval (CI): 1.1–3.5), be male (aOR: 1.8 [95% CI: 1.1–3.1]), disagree that parents will accept HPV vaccine if discussed with other vaccines (aOR: 2.3 [95% CI: 1.3–4.2]), report that 25% to 49% (aOR: 2.8 [95% CI: 1.1–6.8]) or ≥50% (aOR: 7.8 [95% CI: 3.4–17.6]) of parents defer, and express concern about waning immunity (aOR: 3.4 [95% CI: 1.8–6.4]).

Addressing physicians' perceptions about parental acceptance of HPV vaccine, the possible advantages of discussing HPV vaccination with other recommended vaccines, and concerns about waning immunity could lead to increased vaccination rates.

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Fourth edition of WHO's Vaccine Safety Net quarterly newsletter is now online

The World Health Organization (WHO) published the fourth edition of its quarterly Vaccine Safety Net newsletter in December. This issue includes an update on the revised Global Advisory Committee on Vaccine Safety's criteria for assessing websites with vaccine safety content. As for each edition, a special focus is given to one of the VSN members: this month VSN shines the spotlight on Murcia Salud, a member since 2004.
The Vaccine Safety Net newsletter aims to disseminate news and information regarding the VSN, foster communication and synergy among VSN members, and promote good information practices for websites providing information on vaccine safety.

To subscribe to the VSN newsletter, send an email to with the text "subscribe vsn" in the body of your email message. 

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Archived video broadcast of the October 2015 ACIP meeting now available; ACIP will meet next on February 24–25

ACIP recently posted the archived video broadcast footage from the ACIP meeting held October 21. Presentation slides from this meeting are also available.

Reminder: CDC's Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on February 24–25 in Atlanta. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens is February 3; for U.S. citizens it's February 10. Registration is not required to watch the live webcast of the meeting. 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 an egg-free influenza vaccine (FluBlok, Protein Sciences) was given inadvertently to a person younger than 18 years, can it be counted? Would there be any adverse side effects from this error? 

Flublok is not licensed for persons younger than 18 years of age, so there are no data regarding safety and efficacy in this age group. However, no serious side effects would be expected. The dose does not need to be repeated. Even if no adverse reaction occurs, we request that vaccine administration errors like this be reported to the Vaccine Adverse Events Reporting System 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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