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Issue 1248: June 1, 2016

Ask the Experts
Ask the Experts—Question of the Week: A child was inadvertently administered the first dose of rotavirus vaccine at five…read more







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

The May 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 feature the importance of using standing orders for improving immunization coverage, the 2016 U.S. recommended immunization schedules, how to order laminated pocket guides, and many 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.

Click on the images below to download the May 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 Contents, Ask the Experts section, magazine viewer, and back issues.

Vaccinate Adults: View the Table of Contents, Ask 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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MMWR reports on response to cases of serogroup B meningococcal disease at a university

CDC published a case study of the response to a case of serogroup B meningococcal disease titled Notes from the Field: Outbreak of Serogroup B Meningococcal Disease at a University—California, 2016 in the May 27 issue of MMWR (pages 520–521). A selection is printed below.

On January 31, 2016, the Santa Clara County Public Health Department (SCCPHD) was notified of a suspected case of meningococcal disease in a university undergraduate student. By February 2, two additional suspected cases had been reported in undergraduate students living on the same campus. The index patient (patient A) required intensive care, whereas patients B and C had milder illness; there were no deaths. All three patients were part of overlapping social networks and had attended the same events during the week before the onset of patient A’s symptoms, but whether they had direct contact with one another could not be verified. Serogroup B Neisseria meningitidis was identified in cerebrospinal fluid and blood from patient A and in blood from patient B. Serogroup B has been responsible for all U.S. college outbreaks of meningococcal disease since 2011. Laboratory results for patient C were inconclusive.

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MMWR reports on chemoprophylaxis to a case of meningococcal disease at an elementary school

CDC reports on the response to a case of serogroup B meningococcal disease in Notes from the Field: Expanded Chemoprophylaxis Offered in Response to a Case of Meningococcal Meningitis in an Elementary School—Indiana, 2015 in the May 27 issue of MMWR (page 522). A selection is printed below.

On December 11, 2015, the Fort Wayne-Allen County (Indiana) Department of Health was notified by a local hospital laboratory of a suspected case of meningococcal meningitis based on Gram stain results of cerebrospinal fluid. The county health department interviewed close family members and friends of the patient to establish an infectious period, timeline of events, and possible exposures. Close medical and household contacts were offered chemoprophylaxis. This case was associated with an elementary school. The patient had intermittent, close, potentially face-to-face contact with many students, and was reported to have had a persistent, productive cough throughout the exposure period. In light of these unusual circumstances, and the fact that elementary school–aged children are not routinely vaccinated against meningococcal disease, local and state health officials, with CDC support, decided to offer chemoprophylaxis to the patient’s contacts. A total of 581 child and adult contacts were identified.

On December 21, 2015, the patient was confirmed to have
Neisseria meningitidis serogroup B infection by testing performed at CDC. The patient fully recovered, and no additional cases were identified.

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CDC Division of Viral Hepatitis releases its five-year strategic plan

On May 23, the Division of Viral Hepatitis (DVH) released its five-year strategic plan covering 2016–2020. The DVH strategic plan is organized around four strategic imperatives:

  • Assure vulnerable populations are vaccinated to prevent viral hepatitis
  • Assure early detection and response to stop transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV)
  • Assure persons living with HBV and HCV are identified and linked to recommended care and treatment services
  • Act globally to prevent, detect, and control viral hepatitis

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Register now for an IAC “Take a Stand™" workshop on the use of standing orders in Boston, New York, Philadelphia, or Baltimore in June; related workshop to be offered at the Iowa Immunization Coalition Conference on June 15

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 recent sampling of comments received from attendees:

"Take a Stand Workshop was excellent. It provided my organization with the resources and tools needed for a successful implementation." T.B., registered nurse, SD

"Phenomenal! Helped us learn what next steps to take for our organization and how to obtain buy-in from front line staff!" A.P., BSN, RN, CCP, clinical services coordinator, Sanford Health, SD

"It is interesting to know preventative care of adults is just as important as that of children, so 'take a stand' to get adults immunized. Standing orders are a smart/easy way to capture non-immunized adults. The workshop is very informative and engaging." L.S., clinical manager, GA

"All the speakers are extremely knowledgeable and engaging. It is among the top 3 BEST conference/workshops I've ever attended." S.B., immunization program coordinator, FL

Don’t miss your chance to join these satisfied attendees. The next workshops are scheduled in the following four cities:

In addition, a Take a Stand™ mini-workshop has been added to the Iowa Immunization Coalition Conference on June 15. For more information, go to Mini-Session Take A Stand™ Davenport, Iowa. Note: attendees of the mini-workshop will need to register for the conference itself. The non-member registration fee is $100.

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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Register for the 2016 Iowa Immunization Coalition Conference 

In partnership with Genesis Medical Center, the Iowa Immunization Coalition is hosting the Iowa Immunization Coalition Conference on June 15. Participants will engage in a learning opportunity that highlights the importance of autonomy in healthcare decision making, and be able to share best practices learned with colleagues. Target audience is physicians, nurse practitioners, physician assistants, nurses, certified medical assistants, pharmacists, and other interested healthcare professionals. Agenda and registration information are available below

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Free bulk quantities of pneumococcal and zoster vaccination laminated pocket guides available from IAC for distribution within your organization

IAC is pleased to announce the availability of bulk quantities of two newly updated laminated pocket guides for use by healthcare professionals, yours free for the ordering! The guides address issues related to the administration of (1) pneumococcal conjugate (PCV13) and polysaccharide (PPSV23) vaccines and (2) zoster vaccine. 
These concise pocket guides provide front-line healthcare personnel with quick reference information highlighting: 

  • Indications and contraindications for each vaccine
  • Targeted populations to be vaccinated
  • Details on how to administer the vaccines
  • Talking points for discussions with patients 

Each guide is laminated for durability, and the compact size (3¾" x 6¾") is designed to fit in a shirt or lab coat pocket.
The pocket guides are available at no cost to your organization. However, to assist us in controlling our mailing costs, we ask that you order in bulk (with a minimum order of 25) and that you manage the distribution of the guides (e.g., through internal networks, educational forums, member meetings, mass mailings) to your constituents.
To view the pocket guides and place your order, please visit or click on either image below. These cards are for healthcare professional use only, not for distribution to patients.

Laminated Child and Teen Laminated Schedule     

 Laminated Child and Teen Laminated Schedule
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IAC updates eight translations of its educational handout for parents: "Immunizations for Babies"

IAC recently revised the following eight translations of Immunizations for Babies: 

Minor updates have been made from the previous edition.

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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WHO reports on April 2016 meeting of the Strategic Advisory Group of Experts on Immunization

The May 27 edition of the WHO periodical Weekly Epidemiological Record reported on the April 2016 meeting of the Strategic Advisory Group of Experts on Immunization in an article titled Meeting of the Strategic Advisory Group of Experts on immunization, April 2016—conclusions and recommendations

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Download Dr. Gary Marshall's The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book") as a new app for iOS devices or purchase as a print book

The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book,” 2015) is a 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. This book is now available as a new app for iOS devices.

Information about the iOS app version of The Vaccine Handbook: A Practical Guide for Clinicians

The Vaccine Handbook App contains the 5th edition of the book, updated with the latest immunization schedules and recommendations. The app enhances the utility of an already valuable print resource by including functions like keyword search, internal links, bookmarking, quick access to schedules and tables, hyperlinks to external sources, and the ability for real-time updates. A resources section provides ready access to authoritative immunization-related websites.  Available through a collaboration between the publisher and Sanofi Pasteur, registration as well as reporting under Open Payments is required. (Offer void in Minnesota.) Click on the image below to visit the relevant App Store page to download this resource today.
Download new app!
Information about the print version of The Vaccine Handbook: A Practical Guide for Clinicians

The fifth edition of this valuable guide (560 pages) is 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! Click on the image below to visit the "Shop IAC: The Vaccine Handbook" web page.
Order your copy of The Vaccine Handbook today!
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.

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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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Register now for the 2016 CDC webinar series on "The Pink Book" chapter topics, starting June 1
CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of one-hour webinars that starts June 1. Recordings of sessions will be available online after each webinar. All sessions begin at 12:00 p.m. (ET). Information about receiving continuing education credit will be available soon.

Registration and more information is available on CDC's Pink Book Webinar Series web page.

Download Epidemiology and Prevention of Vaccine-Preventable Diseases

Order Epidemiology and Prevention of Vaccine-Preventable Diseases

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Question of the Week

A child was inadvertently administered the first dose of rotavirus vaccine at five months of age. Since the rotavirus vaccine series was started after age 15 weeks, should the series be continued?  

If a child inadvertently receives the first dose of rotavirus vaccine at 15 weeks or older, the remaining doses of the series can be given as long as they are administered by 8 months and 0 days of age. However, if the child is already 8 months and 1 day or older, ACIP does not recommend giving any further doses because 8 months and 0 days is the maximum age for administering any dose in the series. See page 17 of Prevention of Rotavirus Gastroenteritis Among Infants and Children Recommendations of the Advisory Committee on Immunization Practices (ACIP) for more information.

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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