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Issue 1242: April 20, 2016

Ask the Experts
Ask the Experts—Question of the Week: I have a female patient who has a non-immune rubella titer two months after…read more






It's National Infant Immunization Week and CDC names Childhood Immunization Champion Award winners

National Infant Immunization Week (NIIW) is being celebrated this year from April 16–23. In accordance with annual tradition, CDC has released the names of the 2016 Childhood Immunization Champion Award recipients during this week. The CDC Childhood Immunization Champion Award is an annual award given jointly by the CDC Foundation and CDC to recognize individuals who make a significant contribution towards improving public health through their work in childhood immunization. Each year, one CDC Immunization Champion from each of the 50 states, 8 U.S. territories and freely associated states, and the District of Columbia may be honored. The award recipients for 2016 can be viewed at

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American Society of Clinical Oncology urges more aggressive use of HPV vaccination to prevent cancer

On April 11, the American Society of Clinical Oncology (ASCO) published a policy statement that urged increased use of HPV vaccination to prevent cancer. Selected text from a related press release is reprinted below.

Use of human papillomavirus (HPV) vaccines should be rapidly expanded to protect thousands of young people in the United States—and millions worldwide—from life-threatening cancers, the American Society of Clinical Oncology (ASCO) said today in a policy statement. Published in the Journal of Clinical Oncology, the statement outlines current barriers to HPV vaccination and recommendations to promote the uptake of these vaccines, which have the potential to save millions of lives.

“With safe and effective vaccines readily available, no young person today should have to face the devastating diagnosis of a preventable cancer like cervical cancer. But unless we rapidly increase vaccination rates for boys and girls, many of them will,” said ASCO President Julie M. Vose, MD, MBA, FASCO. “As oncologists, we see the terrible effects of these cancers first hand, and we have to contribute to improving today’s alarmingly low vaccination rates.”   

The 2011 National Immunization Survey found that only about 36% of girls and 14% of boys have received the full schedule of HPV vaccines needed to provide protection. Also, in a study published today in the 
Journal of Global Oncology, researchers analyzed data from the North American Association of Central Cancer Registries and found that a 40-year decline in cervical cancer rates in the U.S. has slowed. The study notes that some states with the highest incidence of cervical cancer have low rates of HPV vaccine uptake.

ASCO supports the recommendation to markedly increase the proportion of young boys and girls receiving the HPV vaccine in the United States and worldwide because research has shown that it is most effective in preventing cancer.

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New! Simplified flowchart for MCV4 immunization in adolescents now available

Following ACIP recommendations for the appropriate use and scheduling of meningococcal ACWY vaccine (MCV4) can be complex and confusing for healthcare providers. To help alleviate this confusion, the Give2MCV4 initiative (a collaboration of IAC and Sanofi Pasteur) has just published a new easy-to-follow flowchart that provides guidance on routine MCV4 immunization in adolescents 11–18 years of age. The flowchart also includes supplementary information on vaccine contraindications and precautions, as well as a summary of persons for whom MCV4 vaccine is recommended due to their increased risk for meningococcal disease.
This new flowchart is just one of many helpful resources available on the Give2MCV4 website. Be sure to review the project’s wide range of materials that are available to assist providers in their efforts to prevent meningococcal disease among their adolescent patients.

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NFID publishes call to action to improve adolescent vaccination rates

In March, the National Foundation for Infectious Diseases (NFID) published Call to Action: Addressing New and Ongoing Adolescent Vaccination Challenges. The recommendations in this call to action are based on the discussions at a February 2016 virtual roundtable convened by NFID which included representatives from professional medical and nursing associations, patient health organizations, and government agencies to discuss the long-term health impacts of under-immunized adolescents and the important role healthcare professionals play in increasing vaccination rates. 

The first two paragraphs are reprinted below.

Prior to 2006, the only vaccine recommended routinely for US adolescents was a tetanus and diphtheria (Td) booster. In the decade since, vaccines have been added to the US immunization schedule to protect adolescents against meningococcal disease, human papillomavirus (HPV)-associated cancers, influenza (flu), and pertussis (whooping cough).

But according to the National Immunization Survey-Teen (NIS-Teen), uptake of these vaccines is uneven, with some adolescent vaccination rates below Healthy People 2020 goals. Compared to the high coverage achieved for Tdap (tetanus, diphtheria, and pertussis) and the first dose of MenACWY (meningococcal serogroup A, C, W, Y), vaccination coverage is much lower for the HPV vaccine series recommended at age 11–12 years, the MenACWY booster recommended at age 16 years, and the annual influenza vaccine recommended for all individuals age 6 months and older. The result is millions of adolescents vulnerable to serious health risks from flu and meningitis, as well as serious long-term risks of HPV infection including oropharyngeal, cervical, and other anogenital cancers.

Access the complete Call to Action: Addressing New and Ongoing Adolescent Vaccination Challenges

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New HPV brief released by CHOP's Policy Lab and Vaccine Education Center

Dr. Kristen Feemster and colleagues at the Children's Hospital of Philadelphia released a new Evidence to Action brief titled Increasing HPV Vaccination Rates Among Adolescents: Challenges and Opportunities. This brief addresses barriers to human papillomavirus (HPV) vaccination and provides recommendations about how to increase HPV vaccination rates.
To accompany the brief's release, Dr. Feemster has written a blog about her experience treating adolescents with HPV and the importance of increasing rates of HPV vaccination. Making HPV vaccination a priority for adolescent health care can prevent potentially life-threatening cancers for young men and women throughout their lives, and for generations to come. 
Dr. Feemster is the Director of Research for the Vaccine Education Center, a faculty member of CHOP’s Policy Lab, and an assistant professor of Pediatrics in the Division of Infectious Diseases at CHOP and the Perelman School of Medicine, University of Pennsylvania. She is also the medical director for the Philadelphia Department of Health’s Immunization Program.

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IAC posts corrected Spanish translation of the PCV13 VIS 

IAC recently posted a Spanish translation of the newly released PCV13 VIS. An astute reader noticed that in Section 2, the Spanish translation contained an error in the dosing schedule. Please use this corrected version

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Institute of Medicine publishes the first phase of a report on eliminating hepatitis B and C in the United States

On April 11, the Institute of Medicine (IOM) published Eliminating the Public Health Problem of Hepatitis B and C in the U.S. This report explores the barriers that must be overcome to eliminate hepatitis B and C in the United States, and reaffirms that hepatitis B and C elimination can be achieved with sufficient resources, commitment, and strategies. The introduction is reprinted below.

Viral hepatitis is the seventh leading cause of death in the world, killing more people than road traffic injuries, HIV and AIDS, or diabetes. Every year chronic viral hepatitis, of which hepatitis B and C are the most common forms, kills a million people, roughly 20,000 of them in the United States. These deaths could be prevented. Hepatitis B vaccine conveys 95 percent immunity, and new therapies for hepatitis C cure the vast majority of patients. A recent report from the National Academies of Sciences, Engineering, and Medicine concluded that both hepatitis B and C could be rare diseases in the United States, but there are substantial obstacles to meeting this goal. The Centers for Disease Control and Prevention Division of Viral Hepatitis and Department of Health and Human Services Office of Minority Health commissioned the Academies to work in two parts. The first report discusses the feasibility of eliminating hepatitis B and C from the United States. A second report from the same committee will recommend specific actions to hasten the end of these diseases. This report will be released in 2017.

Go to Eliminating the Public Health Problem of Hepatitis B and C in the U.S. to access different ways to order, download, and read the report.

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

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; Orlando and Fort Lauderdale, FL; and Atlanta, GA. 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 four 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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NFID launches new shingles awareness campaign targeted to people age 60 and older

The National Foundation for Infectious Diseases (NFID) recently launched a new shingles awareness campaign targeted to people age 60 and older. Materials include an online quiz/video to help individuals determine if the zoster vaccine is recommended for them, and a factsheet with shingles myths vs. facts.

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

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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CDC updates its "You Call the Shots" module on rotavirus vaccine; free CE credit available

CDC recently updated the Rotavirus Vaccine module of its web-based training course You Call the Shots. The nurse education training program has 15 modules on a variety of immunization topics (e.g., DTaP/Tdap, Hepatitis B, Influenza, General Recommendations on Immunization, 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 Rotavirus Vaccine module was updated in April. Participants can access information about obtaining CE credit from the You Call the Shots main page.

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Question of the Week

I have a female patient who has a non-immune rubella titer two months after her second MMR vaccination. Should she be revaccinated? If so, should the titer again be checked to determine seroconversion?   

ACIP recommends that vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine (maximum of three doses). Repeat serologic testing for evidence of rubella immunity is not recommended. See, pages 18–20, for more information on this issue.
MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant. Because of the theoretical risk to the fetus when the mother receives a live virus vaccine, women should be counseled to avoid becoming pregnant for 28 days after receipt of MMR vaccine.

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
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    Kayla Ohlde

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