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Issue 1234: March 16, 2016

Ask the Experts
Ask the Experts—Question of the Week: We have a 61-year-old patient who is taking 500 mg of valacyclovir (Valtrex) daily…read more








New! March issue of Needle Tips is available online

The March 2016 issue of Needle Tips is now online.

Click on the image below to download the entire March issue of Needle Tips (16-page, 9.95 MB PDF).

Access the Table of Contents (HTML) to download individual sections or pages.

Download the November issue of Vaccinate Adults

This issue features a review of CDC pneumococcal recommendations for adults starting at age 65. It also covers a range of other adult vaccination topics, as well as child and teen vaccination issues. You’ll 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.

Also featured is the ever-popular column "Ask the Experts" from CDC medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, RN, MN, both with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.

Related Links

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

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WHO reports on recommended composition of influenza virus vaccines for use in the 2016–2017 Northern Hemisphere influenza season

On March 11, WHO's Weekly Epidemiological Record published Recommended composition of influenza virus vaccines for use in the 2016–2017 Northern Hemisphere influenza season. A summary of the recommendation provided in the article is reprinted below. 
It is recommended that trivalent vaccines for use in the 2016–2017 Northern Hemisphere influenza season contain the following:

  • an A/California/7/2009 (H1N1)pdm09-like virus;
  • an A/Hong Kong/4801/2014 (H3N2)-like virus;
  • a B/Brisbane/60/2008-like virus.

It is recommended that quadrivalent vaccines containing 2 influenza B viruses contain the above 3 viruses and a B/Phuket/3073/2013-like virus.

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Reminder: National Infant Immunization Week to be held April 16–23

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. NIIW will be held this year on April 16–23.

Visit CDC's updated NIIW website to find promotional and educational materials to help you plan your NIIW activities, and tailor them to the needs of your community.

CDC would like to hear from organizations planning a 2016 NIIW activity. Please complete the NIIW Activity Form so others can learn what you're doing to educate and inspire parents and providers to protect infants and toddlers from vaccine-preventable diseases. If you're looking for ideas, you can access events scheduled for 2016, and NIIW events held in 2013, 2014, and 2015 from CDC's NIIW Activities around the World web page.

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IAC updates multiple web pages about state laws and mandates related to vaccines

IAC recently updated multiple pages of its State mandates on immunization and vaccine-preventable diseases web section. The eleven updated pages are listed below:

If you have any additions or corrections for these pages, please email

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IAC Spotlight! Six healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

Nearly 600 organizations are now enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel. 

Since February 24, when IAC Express last reported on the Influenza Vaccination Honor Roll, six additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

Newly added healthcare organizations, hospitals, government agencies, and medical practices

  • Hays Medical Center, Hays, KS
  • Hiawatha Community Hospital and Family Practice, Hiawatha, KS
  • Nanticoke Health Services, Seaford, DE
  • Rooks County Health Center, Plainville, KS
  • St. Francis Healthcare, Wilmington, DE
  • William Newton Hospital, Winfield, KS

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IAC’s “Take a Stand™” workshops are highly successful across the nation: Register NOW for a session in Orlando, Fort Lauderdale, or Atlanta in April

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; San Francisco, Sacramento, Los Angeles and San Diego, CA; Fort Worth, San Antonio, and Houston, TX; Seattle, WA; and Phoenix and Tucson, AZ. To illustrate how these have been going, here is a small sampling of comments received from attendees:
"The workshop was over and beyond what I expected...I recommend these workshops to anyone involved in immunizations." H.A.C.H., RN (California)
"Our workshop was…led by a deep field of nationally ranked authorities who literally wrote the book on vaccine-preventable diseases. Everyone was very knowledgeable, down to earth, and friendly. A well-paced, informal workshop with great audience participation. This is everything you need if starting from square one to implement standing orders for vaccines." 
S.P, MD (Pasadena, CA)
"As a new manager and nursing supervisor, this workshop was instrumental in helping me understand setting up standing orders and implementation."
T.B., BSN, MSN, APN, CNS, nursing supervisor (San Diego, CA)
"The information in this workshop was very timely. Increasing access to adult vaccination is challenging. These standing orders greatly simplify the process for clinicians."
J.D., PharmD, pharmacist (Sacramento, CA)
"The workshop was informative and made me feel motivated and ready to implement strategies to improve on our delivery service."
M.M.G., clinic supervisor (San Antonio, TX)
"The Take A Stand workshop will prepare you with everything you need to implement standing orders for vaccination and overcome any barriers that previously stood in your way."
G.B.K, RN, (Houston, TX)
Don’t miss your chance to join these satisfied attendees. The next workshops are scheduled in the following three 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 Florida and Georgia 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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Join Voices for Vaccines on March 17 for a conference call with three mothers who will discuss their children's battles with vaccine-preventable diseases

Join Voices for Vaccines (VFV) on March 17 at 12:00 p.m. (ET) for a conference call with three mothers who will discuss their children's battles with vaccine-preventable diseases. 

Ariel Loop's son, Mobius, was too young to be immunized when he caught measles at Disneyland. Alicia Stillman's daughter, Emily, succumbed to meningitis B before the vaccine was available in the United States. And Melissa Hamilton's son, Nathan, was hospitalized with H1N1 influenza before that vaccine was available to him. Please call in to listen to these brave mothers and their children's stories.

To register for this call, you must email

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!
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CDC publishes errata on February 19 report on administration errors involving Menveo meningococcal conjugate vaccine

CDC published Errata: Vol. 65, No. 6 in the March 11 issue of MMWR. These corrections pertain to the February 19 MMWR article titled Notes from the Field: Administration Error Involving a Meningococcal Conjugate Vaccine—United States, March 1, 2010–September 22, 2015. The complete errata notice is reprinted below.

In the report, “Notes from the Field: Administration Error Involving a Meningococcal Conjugate Vaccine—United States, March 1, 2010–September 22, 2015,” on page 162, the end of the first paragraph should contain an additional sentence as follows: “However, because serogroup A meningococcal disease is rare in the United States, patients only receiving the liquid MenCYW-135 component of Menveo might not need revaccination, unless international travel is anticipated (especially travel to Africa).”

On page 162, in the list of references, an additional reference should be added as follows: “6. MacNeil JR, Meyer SA. Meningococcal disease. In: Brunette GW, ed. Health information for international travel 2016. New York, NY: Oxford University Press; 2016.”

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IAC updates "Vaccinations for Pregnant Women," a handout developed in collaboration with ACOG 

IAC just updated Vaccinations for Pregnant Women to include information about meningococcal serogroup B vaccination. This piece was developed in collaboration with the American College of Obstetricians and Gynecologists (ACOG), and is part of a suite of handouts for adult patients that focuses on routine vaccination and vaccination of risk groups.

IAC also updated the following eight handouts from the suite recently, as reported in the March 9 issue of IAC Express: 

Visit IAC's Adult Vaccination web page to access all handouts in this series for adult patients, as well as resources for healthcare professionals providing vaccination services to adults.

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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IAC updates its "Guide to Contraindications and Precautions to Commonly Used Vaccines" and "Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults"

IAC has updated its Guide to Contraindications and Precautions to Commonly Used Vaccines which covers vaccines for all age groups, and Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults with two new citations and information about the contraindications and precautions to meningococcal serogroup B vaccination.

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IAC updates "Human Papillomavirus: A Parent’s Guide to Preteen and Teen HPV Vaccination"

IAC recently updated Human Papillomavirus: A Parent’s Guide to Preteen and Teen HPV Vaccination with new statistics and other small edits. IAC originally adapted this handout from a piece developed by the Michigan Department of Community Services in order to make it more generally available. This guide is an excellent two-page resource that answers common questions parents have about the safety, effectiveness, and necessity of HPV vaccination for their preteen or teen.

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Influenza is spreading and serious; please keep vaccinating your patients

According to the most recent week's FluView report from CDC, influenza activity remains elevated in the United States. A total of 18 influenza-associated pediatric deaths have been reported during the 2015–2016 season. Flu activity most often peaks in February and can last into May. 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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February issue of CDC's Immunization Works newsletter now available

CDC recently released the February 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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Study shows that state laws mandating influenza immunization for healthcare personnel increase vaccination rates

In February, the Journal of the National Medical Association published an article titled Association of State Laws and Healthcare Workers’ Influenza Vaccination Rates. The abstract is reprinted below.

State laws are being used to increase healthcare worker (HCW) influenza vaccine uptake. Approximately 40% of states have enacted such laws but their effectiveness has been infrequently studied. Data sources for this study were the 2000–2011 U.S. National Health Interview Survey Adult Sample File and a summary of U.S. state HCW influenza vaccination laws. Hierarchical linear modeling was used for two time periods: 1) 2000–2005 (before enactment of many state laws) and 2) 2006–2011 (a time of increased enactment of state HCW influenza vaccination legislation). During 2000–2005, two states had HCW influenza vaccination laws and HCW influenza vaccination rates averaged 22.5%. In 2006–2011, 19 states had such laws and vaccination rates averaged 50.9% (p < 0.001). The likelihood of HCW vaccination increased with the scope and breadth, measured by a law score. Although laws varied widely in scope and applicability, states with HCW influenza vaccination laws reported higher HCW vaccination rates.

Access the complete article: Association of State Laws and Healthcare Workers’ Influenza Vaccination Rates

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March 23 VICNetwork webinar to focus on norovirus, including issues and challenges related to norovirus vaccine development
The VICNetwork has scheduled a webinar on March 23 titled Stop Norovirus: Protect Yourself and Others. This webinar will feature a review of the virus and its burden on the community, how it is transmitted, key prevention tips, and communication materials developed for various audiences to help prevent and control norovirus outbreaks. The speaker will also help participants understand the issues and challenges related to norovirus vaccine development.

The one-hour webinar begins at 2:00 p.m. (ET).

The Virtual Immunization Communication (VIC) Network is a project of the National Public Health Information Coalition and the California Immunization Coalition. 

Registrations are being accepted.

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Question of the Week

We have a 61-year-old patient who is taking 500 mg of valacyclovir (Valtrex) daily. Can she receive zoster vaccine? 

Acyclovir, famciclovir, and valacyclovir are antiviral drugs that are active against herpesviruses. These drugs' agents might interfere with replication of live zoster vaccine. All three drugs have relatively short serum half-lives and are quickly eliminated from the body. Persons taking acyclovir, famciclovir, or valacyclovir should discontinue the drug at least 24 hours before administration of zoster vaccine, if possible. The drug should not be taken again for at least 14 days after vaccination, by which time the immunologic effect of the vaccine should be established.

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 healthcare 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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