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Issue 1241: April 13, 2016

Ask the Experts
Ask the Experts—Question of the Week: Zoster vaccine was inadvertently given to a patient taking Humira…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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Reminder: National Infant Immunization Week begins this Saturday, April 16

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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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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IAC enrolls eight new birthing institutions 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 eight new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Cookeville Regional Medical Center, Cookeville, TN (96%)
  • Medical Arts Hospital, Lamesa, TX (95%)
  • Memorial Healthcare, Owosso, MI (91%)
  • MidMichigan Health Gratiot, Alma, WI (91%)
  • North Ottawa Community Health System, Grand Haven, MI (91%)
  • Scenic Mountain Medical Center, Big Spring, TX (100%)
  • St. John Macomb, Warren, MI (91%)
  • Yoakum County Hospital, Denver City, TX (92%)

The following five institutions are being recognized for a second year:

  • Mercy Health Saint Mary's, Grand Rapids, MI (90%)
  • MidMichigan Health Gratiot, Alma, WI (93%)
  • Sturgis Hospital, Sturgis, MI (95%)
  • Three Rivers Health, Three Rivers, MI (91%)
  • University Medical Center of Southern Nevada, Las Vegas, NV (99%)

Note: MidMichigan Health Gratiot applied for two periods at once.

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

  • Lincoln Medical and Mental Health Center, Bronx, NY (99%)
  • Sinai-Grace Hospital, Detroit Medical Center, Detroit, MI (92%)
  • Sturgis Hospital, Sturgis, MI (94%)

Note: Sturgis Hospital applied for two periods at once.

Finally, the following institution has qualified four times:

  • Spectrum Health Ludington Hospital, Ludington, MI (93%)

The Honor Roll now includes 235 birthing institutions from 34 states and Puerto Rico. Sixty-nine institutions have qualified for two years, twelve institutions have qualified three times, and one institution has qualified for four time periods!

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’s “Take a Stand™” workshops are highly successful across the nation: Register NOW for a session in Atlanta in April or Boston, New York, Philadelphia, or Baltimore in June 

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; Phoenix and Tucson, AZ; and Orlando and Fort Lauderdale, FL. 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 five 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.
sample agenda and online registration information 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! IAC offers vaccination recommendation summaries for healthcare professionals

IAC's "Vaccine Recommendations" page of its Handouts web section offers a variety of vaccination summary resources for healthcare professionals, including recommendations by age (children, teens, and adults), some by vaccine (DTaP/Tdap/Td, meningococcal ACWY and B, pneumococcal, and zoster), and some by occupation/risk factors. Educational materials found here include IAC's popular Summary of Recommendations for Adult Immunization as well as Summary of Recommendations for Child/Teen Immunization.

Check out the Vaccine Recommendations web page to access all these practice aids.

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New! IAC develops hepatitis B surface antigen (HBsAg) checklist for nurses working with women in labor and delivery 

IAC has just posted a new resource for healthcare professionals working with women in labor and delivery units. Labor & Delivery HBsAg Admission Checklist for Birthing Mother is a tool to help determine if a woman was properly screened for HBsAg during her pregnancy, and if she has any additional risk factors for hepatitis B virus (HBV) infection for which a STAT HBsAg test would be recommended upon hospital admission.

This piece was developed as part of IAC’s cooperative agreement with CDC in a collaborative project with the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). The checklist was tested in six birthing hospitals in six different states by nurses who were admitting patients to labor and delivery units. Follow-up found that the checklist helped ensure that all women were screened for HBsAg as recommended by ACIP. Identifying delivering women who are HBsAg positive is critical in ensuring that their infants are provided with timely prophylaxis to prevent perinatal HBV infection.

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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 staff resource "Current Dates of Vaccine Information Statements"

IAC recently revised Current Dates of Vaccine Information Statements to reflect the 3/31/2016 date of the recently updated HPV 9 and Meningococcal ACWY VISs.

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CDC publishes information about global polio surveillance systems

CDC published Surveillance Systems to Track Progress Toward Polio Eradication—Worldwide, 2014–2015 in the April 8 issue of MMWR (pages 346–351). A media summary of the MMWR article is reprinted below.
The removal of Nigeria from WHO’s list of polio-endemic countries in 2015 is an important milestone towards polio eradication. However, continued efforts to strengthen detection of suspected polio cases is critical to ensure timely polio-free certification of the WHO African Region. Despite the success in Nigeria, half of the WHO African Region countries examined in the report did not meet one or both national indicators used to monitor how well countries can detect and diagnose polio cases, including countries heavily affected by the recent Ebola virus disease outbreak. Of particular importance is the need to improve transport of specimens collected from suspected polio cases to WHO-accredited laboratories for testing. Sensitive and timely detection of suspected polio cases everywhere is key to eradicating polio.

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CDC publishes easy-to-read 2016 immunization schedule for preteens and teens 

CDC has posted its easy-to-read 2016 Recommended Immunizations for Children 7–18 Years Old schedule for parents. The Spanish-language version is scheduled to be released later in the month. 

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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 27–April 2), 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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Influenza  vaccination during pregnancy may reduce the risk of stillbirth

On March 30, the journal Clinical Infectious Diseases published Seasonal Trivalent Influenza Vaccination During Pregnancy and the Incidence of Stillbirth: Population-Based Retrospective Cohort Study online. The abstract is reprinted below.

Although antenatal influenza vaccination is an important public health intervention for preventing serious infection in pregnant women and newborns, reported vaccine coverage is often <50%. Concern for the safety to the fetus is a commonly cited reason for vaccine hesitancy and refusal. The incidence of stillbirth following pandemic vaccination has been previously studied; however, no population-based study has evaluated the incidence of stillbirth following seasonal trivalent influenza vaccination.

We used probabilistic linking of perinatal and maternal vaccination records to establish a cohort of 58,008 births occurring between April 2012 and December 2013. Stillbirth was defined as birth ≥20 weeks’ gestation with an Apgar score of zero at 1 and 5 minutes following delivery. Cox regression models adjusted for maternal smoking, Indigenous status, and propensity for vaccination were used to calculate adjusted hazard ratios (aHRs) in vaccinated and unvaccinated mothers.

A total of 5,076 (8.8%) pregnant women received trivalent influenza vaccine and 377 stillbirths occurred. There were 5.0 and 3.0 stillbirths per 100,000 pregnancy-days among unvaccinated and vaccinated women, respectively. After adjustment, stillbirth was 51% less likely among vaccinated vs unvaccinated mothers (aHR, 0.49; 95% confidence interval [CI], .29–.84). The largest relative reduction in stillbirths was observed for births occurring just after influenza season (aHR, 0.33; 95% CI, .12–.88).

Mothers who received seasonal TIV during pregnancy were significantly less likely to experience stillbirth compared with unvaccinated mothers. These results support the safety of seasonal influenza immunization during pregnancy and suggest a protective effect.

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Continuing education credit is available for watching Vaccine Education Center's archived webinar featuring Dr. Paul Offit
The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, presents a Current Issues in Vaccines series that features Paul Offit, MD, director of VEC. The March 23 webinar is now available to watch; free continuing education credits (CME, CEU, and CPE) are available for completing the course. This session included the following topics:
  • HPV vaccine: Is it time for a two-dose schedule?
  • Meningococcal serogroup B vaccines: The latest evidence
  • Influenza vaccines and egg allergy: An update
Visit VEC's Vaccine Webinar Archive web page to access the March 23 webinar, as well as other offerings.

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CDC's March 16 "Current Issues in Immunization NetConference" on the 2016 immunization schedules now archived; continuing education credit available

CDC has posted its March 16 "Current Issues in Immunization Netconference" on its website. This webinar featured CDC experts discussing the 2016 child/adolescent and adult immunization schedules.

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Question of the Week

Zoster vaccine was inadvertently given to a patient taking Humira (adalimumab) 40 mg per week for rheumatoid arthritis. Because of the high dose, should the patient be started on antivirals as prophylaxis or should the patient just be monitored?   

Although herpes zoster vaccine is contraindicated for patients taking biologic agents including tumor necrosis factor (TNF) antagonists (adalimumab is a TNF antagonist), vaccinating patients that are immunocompromised is unlikely to result in serious adverse events.
It is prudent to monitor your patient with a low threshold for any signs of adverse events (such as rash or fever), within one month after vaccination, but prophylactic antivirals are not indicated. Acyclovir, valacyclovir, and famciclovir are active against the vaccine virus and can be used in the unlikely situation in which illness develops.

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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