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Issue 1226: January 27, 2016

Ask the Experts
Ask the Experts—Question of the Week: What is the schedule for hepatitis B vaccination for infants weighing…read more








Reminder: CDC requests nominations for its Childhood Immunization Champion Awards

CDC recently requested nominations for its CDC Childhood Immunization Champion Award, 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’s “Take a Stand™” workshops proving highly successful around the country: Register NOW for the next sessions in Texas (February 16–19)

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; Little Rock, AR; and San Francisco, Sacramento, Los Angeles, and San Diego, CA. 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 in three Texas 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 Texas 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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"Ask the Experts" web sections about influenza and pneumococcal vaccines updated

The Influenza and Pneumococcal Vaccines (PCV13 and PPSV23) web sections of "Ask the Experts" were recently updated.

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

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

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Enter the National Adult and Influenza Immunization Summit adult vaccine video contest

The National Adult and Influenza Immunization Summit (NAIIS) is asking the public to help educate adults about the importance of adult vaccination. Help raise awareness about the importance of adult vaccines by making a short, creative video that promotes adult immunization. The top videos will be posted on the Summit website and the public will have the opportunity to vote for their favorite. In addition to a monetary prize of $750 and $350 for the first and second-place video respectively, the top three videos will receive recognition from NAIIS, the National Foundation for Infectious Diseases, IAC, and other partners.

All submissions must include at least one of these messages:

  • Vaccines aren’t just for kids; adults need vaccines too
  • Adults can’t afford to risk getting sick
  • Adults can protect their health and the health of those around them by getting the recommended vaccines
  • Adults should talk to their healthcare professional to make sure they are up to date with the vaccines recommended for them

Access rules and guidelines for the video contest.

Deadline for submission is March 21, 2016, 11:59 p.m. (ET).

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There's still time to apply for the Gerontological Society of America's 2016 ICAMP Academies; application deadline for first academy is January 31

The Gerontological Society of America (GSA) reminds healthcare professionals to apply to its ICAMP Academy—a multidisciplinary leadership component of GSA’s Immunization Champions, Advocates, and Mentors Program (ICAMP). ICAMP Academy is a 1.5-day multidisciplinary program for healthcare professionals who are committed to increasing adult vaccination rates, improving their patients’ health, and improving quality metrics in their organization. Through this program, participants are not instructed how to vaccinate, but rather how to improve organizational performance on immunization quality metrics and lead their organization’s immunization efforts.

The ICAMP Academy was developed by GSA’s National Adult Vaccination Program (NAVP) for multidisciplinary providers including physicians, nurses, pharmacists, physician assistants, and nurse practitioners. The program provides insights on how to implement the National Vaccine Advisory Committee (NVAC) Standards for Adult Immunization Practice through the use of practical tools and sharing of best practices. 

Coach air travel, hotel room, travel expenses, and program fees for participants are fully covered by ICAMP sponsors. We encourage you to refer and recommend this opportunity to individuals in your organization who actively support adult immunization. Applications will be reviewed by the NAVP workgroup, and participants will be chosen based upon their dedication to improving adult health through immunization and their interest in quality healthcare delivery performance outcomes. Apply now, as space is limited!

GSA ICAMP Academies in 2016 

  • February 15–16, 2016 in Los Angeles, CA; application deadline is Sunday, January 31, 2016
  • March 28–29, 2016 in Atlanta, GA; application deadline is Sunday, January 31, 2016
  • May 16–17, 2016 in Washington, DC; application deadline is Sunday, March 31, 2016
  • June 20–21, 2016 in Phoenix, AZ; application deadline is Sunday, April 3, 2016

Go to for additional information about NAVP’s ICAMP Academy. Please direct any questions to

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CMS has initiated a National Coverage Analysis process for adding hepatitis B screening as a covered Medicare preventive service; comments accepted until February 20 

The Centers for Medicare & Medicaid Services (CMS) has accepted a formal request to initiate a National Coverage Analysis for adding hepatitis B screening as a covered Medicare preventive service for persons at high risk for infection. There is a 30-day public comment period that runs 1/21/16–2/20/16.

The Association of Asian Pacific Community Health Organizations, Hep B United, the Hepatitis B Foundation, the National Task Force on Hepatitis B: Focus on Asian and Pacific Islander Americans, and the National Viral Hepatitis Roundtable requested this process. The second paragraph of their letter of request is reprinted below.

Specifically, we ask that the Centers for Medicare & Medicaid Services (CMS) provide hepatitis B screening coverage for Medicare beneficiaries who are at high risk for HBV infection as defined by the United States Preventive Services Task Force (USPTF), including those born in countries and regions with a high prevalence of HBV infection (>2%); people born in the United States who were not vaccinated as infants and whose parents were born in a region with a very high prevalence of hepatitis B infection (>8%), such as sub-Saharan Africa, and southeast and central Asia; HIV-positive individuals; injection drug users; men who have sex with men and household partners and sexual partners of people who are HBV infected. 

For more information, and/or to comment, go to National Coverage Analysis (NCA) Tracking Sheet for Screening for Hepatitis B Virus (HBV) Infection (CAG-00447N).

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IAC enrolls one new birthing institution into its Hepatitis B Birth Dose Honor Roll; nine previously honored institutions qualify for additional years

The Immunization Action Coalition (IAC) is pleased to announce that one new institution has been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institution is listed below with its reported hepatitis B birth dose coverage rate in parentheses.

  • UMass Memorial Medical Center, Worchester, MA (94%)

In addition, the following eight institutions are being recognized for a second year:

  • Baptist Medical Center South, Montgomery, AL (99%)
  • Bluffton Regional Medical Center, Bluffton, IN (94%)
  • BSA Health System, Amarillo, TX (95%)
  • Harrison Memorial Hospital, Cynthiana, KY (99%) 
  • Nicholas H. Noyes Memorial Hospital, Dansville, NY (98%)
  • OCH Regional Medical Center, Starkville, MS (92%) 
  • Sabetha Community Hospital, Sabetha, KS (93%) 
  • St. Dominic-Jackson Memorial Hospital, Jackson, MS (99%)

The following two institutions are being recognized for a third year:

  • Spectrum Health Ludington Hospital, Ludington, MI (91%)
  • St. Dominic-Jackson Memorial Hospital, Jackson, MS (98%)

[Note: St. Dominic-Jackson Memorial Hospital applied for two periods at once.]

The Honor Roll now includes 221 birthing institutions from 34 states and Puerto Rico. Seventy-one institutions have qualified for a second year and six institutions have qualified three times.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give birth to the end of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90 percent or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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IAC Spotlight! Many handouts and VISs are available for patients and parents who don't read English  

The Immunization Action Coalition offers its most popular handouts for patients and parents in languages other than English, including Arabic, Chinese, French, Hmong, Korean, Russian, Spanish, Tagalog, Turkish, and Vietnamese. These translations are always listed under the English version in the main handout section, and also can be accessed directly from the Handout Language Index.

In addition, IAC's Vaccine Information Statement (VIS) web section includes VISs in more than 35 languages.

Some of these translations are available through a cooperative agreement between IAC and CDC, while others have been generously donated by other organizations. If you are interested in becoming a translation partner of IAC, please contact

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WHO reports on December meeting of the Global Advisory Committee on Vaccine Safety

WHO published Global Advisory Committee on Vaccine Safety, 2–3 December 2015 in the January 22 issue of its Weekly Epidemiological Record. This report summarizes the December meeting of the Global Advisory Committee on Vaccine Safety (GACVS). GACVS is an independent expert clinical and scientific advisory body that provides WHO with scientifically rigorous advice on vaccine safety issues of potential global importance.

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Influenza is spreading and serious; please keep vaccinating your patients

According to this week's FluView report from CDC, seasonal influenza activity increased slightly in the United States. While influenza A (H3N2) viruses have been most common since October 1, in the past 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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Study finds HPV vaccination rates highest in low-income and Hispanic communities 

On January 14, the journal Cancer Epidemiology, Biomarkers & Prevention published Geographic Factors and Human Papillomavirus (HPV) Vaccination Initiation Among Adolescent Girls in the United States online. The "Conclusion" section of the abstract and the first sentences of the "Discussion" section are reprinted below.

Initiation rates of HPV vaccination among teen girls were highest in the poorest communities and among Hispanics living in communities where the racial–ethnic composition was predominantly Hispanic or mixed race.

This study examined the relationship between HPV vaccine initiation and individual- and community-level geographic factors among teen girls in the United States. Overall the odds of initiation were highest among older girls, girls with SCHIP or Medicaid health insurance, girls with younger mothers, and those whose mothers had lower levels of education and incomes below the federal poverty level. Receipt of a provider recommendation was one of the factors most strongly associated with HPV vaccination initiation.

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CDC reports on tetanus cases after voluntary male circumcision for HIV prevention in Eastern and Southern Africa 

CDC published Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention—Eastern and Southern Africa, 2012–2015 in the January 22 issue of MMWR (pages 36–37). The first two paragraphs are reprinted below.

Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President’s Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.

During April 2012–November 2015, PEPFAR’s VMMC program reported 12 tetanus cases in five sub-Saharan African countries. Three cases occurred in 2012–2013 (one in Uganda and two in Zambia), six in 2014 (one each in Kenya, Rwanda, and Tanzania and three in Uganda), and three in 2015 (one in Rwanda and two in Uganda). Eight patients received conventional VMMC surgery, and four received PrePex, a nonsurgical male circumcision device. No other VMMC-related tetanus cases had been previously reported. Intensified adverse event and death monitoring and reporting were instituted in July 2014 in all 14 PEPFAR-supported countries providing VMMC for HIV prevention.

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CDC updates its "You Call the Shots" modules on vaccine storage and handling and the VFC program; free CE credit available

CDC recently updated the vaccine storage and handling and Vaccines for Children (VFC) program modules of its web-based training course You Call the Shots. The nurse education training program has 11 modules on a variety of immunization topics (e.g., DTaP, Hepatitis A, Influenza, HPV, and General Recommendations on Immunization). Continuing education credit is available for viewing a module and completing an evaluation. The training course is supported by CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

Participants can access information about obtaining CE credit from the You Call the Shots main page.

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Earn CME credit for reading a journal article about sustained transmission of pertussis in vaccinated children in a Florida daycare

Medscape is providing online continuing medical education for the recent Emerging Infectious Diseases article titled Sustained Transmission of Pertussis in Vaccinated, 1–5-Year-Old Children in a Preschool, Florida, USAallowing clinicians the opportunity to earn CME credit. The abstract is reprinted below.

In September 2013, local county health officials in Tallahassee, Florida, USA, were notified of a laboratory-confirmed pertussis case in a 1-year-old preschool attendee. During a 5-month period, 26 (22%) students 1–5 years of age, 2 staff from the same preschool, and 11 family members met the national case definition for pertussis. Four persons during this outbreak were hospitalized for clinical management of pertussis symptoms. Only 5 students, including 2 students with pertussis, had not received the complete series of vaccinations for pertussis. Attack rates in 1 classroom for all students who received the complete series of vaccinations for pertussis approached 50%. This outbreak raises concerns about vaccine effectiveness in this preschool age group and reinforces the idea that recent pertussis vaccination should not dissuade physicians from diagnosing, testing, or treating persons with compatible illness for pertussis.

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NFID Clinical Vaccinology Course scheduled for March 18–20 in Phoenix  

The National Foundation of Infectious Disease's Spring 2015 Clinical Vaccinology Course will be held March 18–20 in Phoenix, AZ. This 2.5-day course focuses on new developments and issues related to the use of vaccines. Expert faculty provide the latest information on vaccines, including updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate immunization. Continuing education credit is available for attendees.

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Question of the Week

What is the schedule for hepatitis B vaccination for infants weighing less than 2000 grams? I read that the birth dose should still be given in the hospital, but what would be the schedule after that?   

Decreased seroconversion rates might occur among preterm infants with low birth (less than 2,000 grams) after administration of hepatitis B vaccine at birth. However, by the chronological age of one month, all preterm infants, regardless of initial birth weight, are likely to respond as adequately as larger infants.
Preterm infants born to HBsAg-positive women and women with unknown HBsAg status must receive hepatitis B vaccine within 12 hours after birth. The initial vaccine dose should not be counted toward completion of the hepatitis B series, and three additional doses of hepatitis B vaccine should be administered, beginning when the infant is age one month. For mothers with unknown HBsAg status, attempts should be made to determine HBsAg status. The infant also must be given HBIG within 12 hours of birth unless the mother is found to be HBsAg negative. Infants weighing less than 2,000 grams born to HBsAg-negative mothers should receive the first dose of the hepatitis B series at chronological age one month or at hospital discharge.

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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