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Issue 1238: March 30, 2016

Ask the Experts
Ask the Experts—Question of the Week: I have a patient who is a medical student about to start clinical rotations…read more







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

The March 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 pneumococcal vaccination for adults starting at age 65, 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 March 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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Now available! IAC's sturdy laminated versions of the 2016 U.S. child/teen immunization schedule and the 2016 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2016 U.S. child/teen immunization schedule and the 2016 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11". 

Laminated Child and Teen Laminated Schedule

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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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 Spotlight! Photos of vaccine-preventable diseases illustrate the importance of vaccination

When it comes to educating the public and healthcare professionals about the serious health effects of vaccine-preventable diseases, nothing else packs the punch of a visual image. The IAC Image Library on provides access to hundreds of disease and vaccination-related images.

IAC has brought together images of people suffering from vaccine-preventable diseases; pictures of healthcare professionals vaccinating children, teens, and adults; and photos taken during various global immunization campaigns, as well as pathology specimens and micrographs of viruses and bacteria. Almost all of the images are free to download and can be used in lectures, articles, and presentations. As a courtesy, please credit the source of the image. Images accompanied by the copyright symbol are posted with the permission of the copyright holders and may not be reproduced without the express permission of the copyright holder (contact information is provided).

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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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Check out the third phase of CDC's Know Hepatitis B campaign, designed to promote hepatitis B testing among Asian Americans 

CDC has launched the third phase of its Know Hepatitis B campaign designed to promote hepatitis B testing among Asian Americans. While Asian Americans make up about 5 percent of the total U.S. population, they account for half of the 2.2 million Americans living with chronic hepatitis B. In fact, one in 12 Asian Americans has hepatitis B.  

Check out the following new campaign resources, most available in multiple languages:

  • 30- and 60-second video PSAs. One video features a conversation between a daughter and her parents, with the daughter explaining why Asian Americans should be tested for hepatitis B. The other PSA is an animated video with several key facts about hepatitis B.  
  • new poster promoting hepatitis B testing for Asian Americans that emphasizes the fact that hepatitis B often has no symptoms
  • A two-page infographic that visually presents key information about hepatitis B
  • A customizable vaccine card that has information about the hepatitis B vaccination to help people keep track of their vaccine series
  • Interactive games that engage potential clients in testing their hepatitis B knowledge
  • Customizable flyer templates developed to allow tailored information about local screening events

Visit CDC's Know Hepatitis B campaign web section.
If you have any questions about the campaign, please email Sherry Chen.

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ACOG publishes committee opinion on integrating immunization services into practice

The American College of Obstetricians and Gynecologists (ACOG) has just published a committee opinion titled Integrating Immunizations Into Practice. The abstract is reprinted below.

Immunization against vaccine-preventable diseases is an essential component of women’s primary and preventive health care. Despite the importance of vaccination and clear guidance from public health agencies, rates of vaccination lag behind national goals. Obstetrician–gynecologists can play a major role in reducing morbidity and mortality from a range of vaccine-preventable diseases, including pertussis, influenza, human papillomavirus, and hepatitis. Given demonstrated vaccine efficacy and safety, and the large potential for prevention of many infectious diseases that affect adults, pregnant women, and newborns, obstetrician–gynecologists should include immunizations as an integral part of their practice. To do so, they must embrace their role as important sources of information and advice on immunization for adults, adolescents, and pregnant women, and advance their patients’ well-being with continued efforts to augment immunization services in their offices. Increasing awareness combined with the many suggestions in this document will work to enhance immunization uptake.

The full article includes useful "Recommendations" and "Tips for Office Immunization Program Success" sections.

Access the complete committee opinion (PDF format): Integrating Immunizations Into Practice

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WHO publishes updated position paper on polio vaccines

The March 25 issue of the WHO periodical Weekly Epidemiological Record includes the latest WHO position paper on polio vaccines.

WHO position papers are available in chronological order on the IAC website.
A collection of WHO position papers on vaccines is also available in alphabetical order on the WHO website.

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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 (March 13–19), influenza activity decreased slightly, but remained elevated in the United States. 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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Reminder: National Immunization Conference abstract submission deadline is April 13

The 47th National Immunization Conference (NIC) is scheduled for September 13–15 at the Hilton Hotel in Atlanta, Georgia. The theme of the conference is Immunization: It Takes a Community. Those wishing to submit an abstract should be aware that the deadline for abstract submission is April 13.

This three-day conference will include three plenary sessions, 12 breakout sessions, workshops, two immunization Q&A sessions, posters, exhibits, and the Hilleman Lecture. The meeting will highlight the following major topics:

  • Adult Immunization
  • Immunization Information Systems
  • Programmatic Issues
  • Health and Risk Communications
  • Epidemiology and Surveillance
  • Childhood and Adolescent Immunization 

There is no charge to attend the conference, but space is limited. The organizers recommend registering well in advance of the registration deadline of August 22, 2016, to guarantee availability.

Access the conference web page, which includes information about conference and hotel registration, abstract submission, and more.

For questions related to the 47th NIC, email

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Question of the Week

I have a patient who is a medical student about to start clinical rotations. She has written documentation of two doses of varicella vaccine (the first at age 12 years and the second at age 26 years). Her varicella IgG is negative. Is she a non-responder? Should I give her a booster dose? 

Titers are not necessary or recommended if there are documented doses of varicella vaccine. Commercial serologic tests may not be sensitive enough to detect vaccine-induced antibody. In this situation, a negative titer should be disregarded. The student should be considered immune because of her documented vaccination history. See ACIP's Immunization of Health-Care Personnel, pages 23–24, for more information on this issue.

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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