Issue 1240: April 6, 2016

Ask the Experts
Ask the Experts—Question of the Week: We have a two-month-old male with his second episode of meningococcemia…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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CDC estimates one in 68 school-age children have autism; no change from previous estimate

CDC published Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012 in an April 1 issue of MMWR Surveillance Summaries (pages 1–28). The first paragraph of a related press release is reprinted below.

An estimated 1 in 68 (14.6 per 1,000) school-aged children have been identified with autism spectrum disorder (ASD), according to a CDC report published today in the Morbidity and Mortality Weekly Report (MMWR) Surveillance Summary. This report shows essentially no change in ASD prevalence, the proportion of school aged-children with ASD, from the previous report released in 2014. However, it is too soon to know whether ASD prevalence in the United States might be starting to stabilize. CDC will continue tracking ASD prevalence to better understand changes over time.

Access the complete press release: CDC estimates 1 in 68 school-aged children have autism; no change from previous estimate

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CDC publishes 2016 binational immunization schedule for children who received some vaccines in Mexico 

CDC has posted the 2016 Binational Immunization Resource Tool for Children from Birth Through 18 Years on its website. This schedule provides a side-by-side presentation of recommended vaccines in Mexico and the United States, and helps healthcare professionals identify vaccines needed by children in the U.S. who received some vaccines in Mexico.

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NAIIS announces 2016 Immunization Excellence Award winners

The National Adult and Influenza Immunization Summit (NAIIS) recently announced the recipients of its 2016 Immunization Excellence Awards
These prestigious awards, which recognize individuals and organizations that made extraordinary contributions toward improving vaccination rates within their communities during 2015, highlight excellence in five categories.

Here are the 2016 winners:

  • In the category Laura Scott Outstanding Influenza Season Activities Award (in memoriam of Laura Scott, who cofounded Families Fighting Flu and served as its executive director for 10 years), the winner is the Central Texas Flu Immunization Campaign (Austin, TX) 
  • In the category Adult Immunization Champion, there was an organization winner, Bon Secours Health System (Marriottsville, MD), and an individual winner, Susan Lett, MD (Jamaica Plains, MA). Honorable award recipients are AMGA Foundation (Alexandria, VA) and Giant Eagle Pharmacy (Pittsburgh, PA).
  • In the category Corporate Campaign, the winner is Seqirus (King of Prussia, PA)
  • In the category "Immunization Neighborhood" Champion, the winner is Telligen and Flu Fighters (Oak Brook, IL)
  • In the category Adult Immunization Publication, the winner is the University of Texas Southwestern/ Parkland Health and Hospital System/Dallas County Department of Health

The award winners will be recognized during the 2016 NAIIS Awards Luncheon being held in Atlanta on May 11.
Congratulations to the award recipients and nominees, all of whom are winners for working toward improving health in their communities.

Access the press release: National Awards Program Recognizes Outstanding Efforts in Immunizations 

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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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IAC Spotlight! Vaccine package inserts and FDA web pages on have been updated 

Immunization providers around the country have given IAC feedback that the Package Inserts web page in its online Directory of Immunization Resources is one of the most valuable resources for busy clinics that administer vaccines. IAC recently updated this entire section, and linked the package inserts information to the manufacturer websites whenever possible in an effort to get the most current web-based information. The FDA Product Approval page was also updated. The links on this page provide all of the U.S. Federal Drug Administration (FDA) information about the licensure of and indications for a vaccine. The package insert links on this page also go to manufacturer websites.  

Check it out, and see how easy it is to access the current information for any vaccine!

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Three 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 March 16, when IAC Express last reported on the Influenza Vaccination Honor Roll, three additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

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

  • Kaiser Permanente, Baldwin Park, CA
  • Pratt Regional Medical Center, Pratt, KS
  • Northern Maine Medical Center, Fort Kent, ME

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Join CDC in a social media Thunderclap to promote childhood immunization on April 18

National Infant Immunization Week (NIIW), held this year on April 16–23, is a great opportunity to raise awareness of the importance of childhood immunization. CDC is encouraging partners to join them in voicing support for childhood immunization by using the hashtag #NIIW during this observance week. Specifically, on April 18 at 12:00 p.m. (ET), the #NIIW message will be released, all at once, creating a THUNDERCLAP announcement that is heard far and wide. 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 social media accounts. The collective action creates a wave of support—or “thunderclap”—across social media. 
How to show your support

  1. Go to
  2. Choose a social media channel (Twitter, Facebook*, or Tumblr) through which to share your support. Detailed instructions are included on the Thunderclap page. *Organizational Facebook pages can’t directly participate in a Thunderclap campaign; however, Facebook administrators can post a message with a link to the Thunderclap page and encourage fans to support the campaign.
  3. After you sign up, you can authorize Thunderclap to tell your friends and followers that you’re supporting #NIIW.
  4. Encourage others to sign up too.
  5. Watch on April 18 as we proclaim in unison our support for infant and child immunization using #NIIW. 

Sample Tweets to promote the Thunderclap event

  • Support childhood vaccines by using #NIIW in a Tweet or FB post. Join @cdcgov @ThunderclapIt
  • Vaccines protect children. Join the @cdcgov #NIIW Thunderclap & let the world know you support childhood vaccines

Sample Facebook post to promote the Thunderclap event

  • When you use #NIIW, you’re saying that you are part of the majority of people who choose the safe, proven disease protection that vaccines offer babies. Show your support by signing up on Thunderclap.

Thank you for taking part in the campaign and supporting #NIIW during this important time! If you have questions about Thunderclap, please email Brad Weisberg at CDC.

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Join Voices for Vaccines for an April 14 conference call about online vaccine advocacy

Join Voices for Vaccines (VFV) on April 14 at 12:00 p.m. (ET) for a conference call with VFV director Karen Ernst about how online advocacy can be positive and productive.

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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Voting is open! NAIIS 2016 adult vaccine video contest entries now posted

The National Adult and Influenza Immunization Summit (NAIIS) recently asked the public to make short, creative videos to help educate adults about the importance of adult vaccines. Video makers were asked to incorporate at least one of the following important adult vaccine 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 

The Adult Vaccine Video Contest Review Board received multiple fantastic entries! Now you can vote for your favorite by watching the videos on YouTube and “liking” your favorite. (Note: You must have a YouTube account and be signed in for your vote to count.)

For more information on how to vote, and links to the seven finalists, go to

The first and second-place videos will be announced during the NAIIS meeting being held in Atlanta on May 10–12. Voting closes at 5 p.m. (ET) on April 12, so be sure to vote for your favorite now!

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IAC makes an additional revision to "Vaccinations for Pregnant Women," a handout developed in collaboration with ACOG

IAC just made an additional revision to its patient handout titled Vaccinations for Pregnant Women, which was most recently updated on March 16, by editing the text in the meningococcal section. 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.

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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CDC releases final versions of HPV 9 and Meningococcal ACWY Vaccine Information Statements

On March 31, CDC released final versions of the HPV 9 and the Meningococcal ACWY Vaccine Information Statements (VISs). Neither differs significantly from the existing VIS, but both are now final, as opposed to interim, editions. CDC encourages providers to begin using these VISs immediately, but stocks of the previous editions may still be used until exhausted.

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Influenza is serious; vaccination is recommended for nearly everyone, so please keep vaccinating your patients

According to the most recent week's FluView report from CDC (March 20–26), 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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Analysis shows the global burden of influenza in pediatric respiratory hospitalizations

On March 24, PLOS Medicine published Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis. The first paragraph from a related CDC press release is reprinted below.

A study by CDC authors and global partners published today in the journal PLOS Medicine looked at influenza surveillance data from 350 sites in 60 countries and found that influenza was responsible for about 10% of respiratory hospitalizations in all children younger than 18 years worldwide, with a range by age group of 5% to 16%. The highest proportion of respiratory hospitalizations attributed to flu occurred among children 5 years to 17 years of age. The study is the first to look at global flu-associated hospitalizations in that age group. The study also broke down hospitalizations by region and found that the majority of flu-associated hospitalizations in young children occur in developing countries. Study authors suggest that increasing influenza vaccination coverage among young children and pregnant women worldwide could reduce this burden.

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CDC updates its "You Call the Shots" module on Tdap/Td; free CE credit available

CDC recently updated the Tdap/Td module 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, Vaccine Storage and Handling, Vaccines for Children). 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.

The Tdap/Td module was updated in March. Participants can access information about obtaining CE credit from the You Call the Shots main page.

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Presentation slides from February ACIP meeting are now available; next meeting scheduled for June 22–23

ACIP recently posted the presentation slides from the ACIP meeting held on February 24. 

ACIP will hold its next meeting on June 22–23 in Atlanta. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens is May 18; for U.S. citizens, it's June 6. Registration is not required to watch the live webcast of the meeting.

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Question of the Week

We have a two-month-old male with his second episode of meningococcemia (group B). He is still undergoing an evaluation for primary immunodeficiency, but we are planning to proceed with immunizations, including meningococcal ACWY-CRM vaccine, but wanted to provide meningococcal B as well. Given that in the U.S., meningococcal B vaccine is only approved in children age 10 years and older, can we use it in the infant age group? 

Use of either meningococcal serogroup B vaccine in persons younger than age 10 years is off-label in the U.S. There is currently no ACIP recommendation for use of this vaccine for this age group. However, Bexsero brand meningococcal B vaccine has been studied among infants and is approved for infants by the European Medicines Agency (the European version of the U.S. Food and Drug Administration). It is routinely recommended for infants in the United Kingdom (see for details). A clinician may choose to use a vaccine off-label if, in their opinion, the benefit of the vaccine exceeds the risk from the vaccine. Product information for Bexsero can be found on the European Medicines Agency website 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 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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