Issue 1264: September 7, 2016

Ask the Experts
Ask the Experts—Question of the Week: Why should we not give PCV13 vaccine to someone who has had a serious reaction…read more






CDC awards IAC new five-year cooperative agreement

The Immunization Action Coalition (IAC) and CDC's National Center for Immunization and Respiratory Diseases (NCIRD) have entered into a new five-year cooperative agreement. A selection from IAC's press release announcing this grant from CDC is reprinted below.

The Immunization Action Coalition (IAC) and the National Center for Immunization and Respiratory Diseases (NCIRD) of the Centers for Disease Control and Prevention (CDC) are entering into a cooperative agreement providing $1.5 million to IAC over a five-year term. This latest award continues the close working relationship between CDC and IAC which began in 1995 and is an expression of confidence in IAC’s renowned leadership team of Deborah L. Wexler, MD (Executive Director), L.J Tan, MS, PhD (Chief Strategy Officer), and William L. Atkinson, MD, MPH (Associate Director for Immunization Education) as well as in IAC’s unparalleled staff of immunization experts.

The grant is part of NCIRD’s efforts aimed at supporting external sources of scientific, accurate, and credible immunization information that healthcare providers can use to communicate with parents and the public about the value, effectiveness, and safety of vaccines.

Specifically, the activities undertaken in this project will increase coverage of recommended vaccines by providing the nation’s healthcare professionals with effective immunization educational materials, expert answers to technical vaccination questions, timely and continual email information including information about urgent events, and easy access to a wide range of translations of Vaccine Information Statements (VISs), the federally required information sheets explaining the risks and benefits of a vaccine.

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AAP issues recommendations for using MenB vaccines

The American Academy of Pediatrics (AAP) recently published Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older. The abstract is reprinted below.

This policy statement provides recommendations for the prevention of serogroup B meningococcal disease through the use of 2 newly licensed serogroup B meningococcal vaccines: MenB-FHbp (Trumenba; Wyeth Pharmaceuticals, a subsidiary of Pfizer, Philadelphia, PA) and MenB-4C (Bexsero; Novartis Vaccines, Siena, Italy). Both vaccines are approved for use in persons 10 through 25 years of age. MenB-FHbp is licensed as a 2- or 3-dose series, and MenB-4C is licensed as a 2-dose series for all groups. Either vaccine is recommended for routine use in persons 10 years and older who are at increased risk of serogroup B meningococcal disease (category A recommendation). Persons at increased risk of meningococcal serogroup B disease include the following: (1) persons with persistent complement component diseases, including inherited or chronic deficiencies in C3, C5–C9, properdin, factor D, or factor H or persons receiving eculizumab (Soliris; Alexion Pharmaceuticals, Cheshire, CT), a monoclonal antibody that acts as a terminal complement inhibitor by binding C5 and inhibiting cleavage of C5 to C5A; (2) persons with anatomic or functional asplenia, including sickle cell disease; and (3) healthy persons at increased risk because of a serogroup B meningococcal disease outbreak. Both serogroup B meningococcal vaccines have been shown to be safe and immunogenic and are licensed by the U.S. Food and Drug Administration for individuals between the ages of 10 and 25 years. On the basis of epidemiologic and antibody persistence data, the American Academy of Pediatrics agrees with the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that either vaccine may be administered to healthy adolescents and young adults 16 through 23 years of age (preferred ages are 16 through 18 years) to provide short-term protection against most strains of serogroup B meningococcal disease (category B recommendation).

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CDC reports about two-dose varicella vaccination program in MMWR

CDC published Epidemiology of Varicella During the 2-Dose Varicella Vaccination Program—United States, 2005–2014 in the September 2 issue of MMWR (pages 902–905). A media summary of the MMWR article is reprinted below.

The number of varicella cases has declined 85% since the two-dose vaccination program began in 2007. National varicella surveillance data from 2005–2006 (end of the one-dose program) through 2013–2014 documented the decline. Since the beginning of the one-dose program in 1996, the number of chickenpox cases has declined 97%. The largest declines in the number of cases are among age groups most likely to receive the second dose: children and adolescents aged 5–14 years. Almost 80% of states report case-based varicella data to CDC for use in national surveillance, but the completeness of reported data varies. Continued efforts to improve data reporting and completeness are necessary to more accurately describe varicella disease trends and epidemiology.

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CDC reports about meningococcal C outbreak primarily among men who have sex with men in Southern California

CDC published Outbreak of Serogroup C Meningococcal Disease Primarily Affecting Men Who Have Sex with Men—Southern California, 2016 in an MMWR Early Release published on September 2 (pages 1–3). A selection of the article is reprinted below.

During March 4–August 11, 2016, 25 outbreak-associated cases of meningococcal disease, including two deaths (8% case-fatality ratio), were reported in Southern California. Twenty-four of the cases were caused by serogroup C Neisseria meningitidis (NmC) and one by N. meningitidis with an undetermined serogroup. On June 24, 2016, in response to this increase in NmC cases, primarily among men who have sex with men (MSM) in Los Angeles County, the city of Long Beach, and Orange County, the California Department of Public Health (CDPH) issued a press release and health advisory, declaring an outbreak of NmC in Southern California.

Of the 25 cases in the current outbreak, 23 (92.0%) patients were male, 20 (87.0%) of whom self-identified as MSM. Among MSM, eight (40.0%) reported Hispanic ethnicity, consistent with the proportion of Hispanic persons among the overall population of the three jurisdictions combined, and the median age was 32 years (range: 17−74 years). The estimated NmC attack rate among MSM in the three affected jurisdictions was 6.4 cases per 100,000 MSM which is more than 50 times the incidence of meningococcal disease among males aged ≥18 years in the United States in 2015 (0.12 cases per 100,000 population).

Ten of the 25 cases occurred among residents from Los Angeles County, seven in residents from Long Beach, seven in residents from Orange County, and one in a resident of another state who traveled to Los Angeles in the week before illness onset. Two of the patients were known to have HIV infection. No direct epidemiologic linkages, geographic concentration, visits to common events or venues, or behaviors such as drug use or multiple sexual partners were consistently identified among the MSM patients.

On July 26, 2016, given the absence of identifiable risk groups among MSM, in contrast to the previous Los Angeles County cluster (2012−2014), local health departments in Los Angeles County, Long Beach, and Orange County, along with San Diego County, in consultation with CDPH, expanded their vaccination recommendations to include all MSM regardless of risk behaviors, residing in the respective jurisdictions. Outreach and vaccination activities are ongoing in collaboration with community-based organizations, pharmacies, and health care providers. The Advisory Committee on Immunization Practices recently discussed use of MenACWY vaccine among MSM and HIV-infected persons ( and in June 2016 recommended that all HIV-infected persons be routinely vaccinated with MenACWY (

Increased awareness of the signs and symptoms of meningococcal disease ( and prompt early case recognition among health care providers are critical. During investigations of meningococcal disease caused by any serogroup, health departments are encouraged to assess HIV status of all patients and sex of sex partners in cases occurring among males aged ≥16 years. If permitted by state law, state health departments are asked to complete a supplemental case report form (available at for all cases of meningococcal disease occurring among MSM, submit the forms to CDC via secure e-mail ( or via secure fax (404-315-4681), and submit any available isolates to CDC for whole genome sequencing. In addition, health departments should assess NmC patients for epidemiologic linkages to the Southern California region to identify additional cases possibly related to this ongoing outbreak.

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Join Voices for Vaccines for a September 19 conference call about vaccine refusal with Dr. Jennifer Reich

Join Voices for Vaccines (VFV) on September 19 at 12:00 p.m. (ET) for a conference call with Jennifer Reich, PhD. Dr. Reich, a professor of sociology at the University of Colorado-Denver, has been studying why parents refuse to vaccinate their children; she provides answers in her recently published book Calling the Shots: Why Parents Reject Vaccines.

The call is free and open to the public, but you must register here.

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

Bulk quantities of two recently updated laminated pocket guides for use by healthcare professionals are 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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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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Still 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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Watch grand rounds about HPV-related oropharyngeal cancer presented by Children’s Mercy Hospital; CE credit available
The Academic Pediatric Association sponsored a notable head and neck surgeon, Dr. Terance Tsue, to present grand rounds about HPV-related oropharyngeal cancer at Children's Mercy Hospital, Kansas City, MO, on August 18. The presentation is available on Children's Mercy Hospital's website. Registration is free, but required. To receive Continuing Education (CE) credit, complete the pre-test, watch the video presentation, then complete the post-test and evaluation.

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Nurses can now watch the film "Someone You Love: The HPV Epidemic" and get free continuing education credit

"Someone You Love: The HPV Epidemic" is a feature-length documentary that presents the struggles and triumphs of five women whose lives were changed forever by this deadly virus. Directed by Frederic Lumiere and narrated by Vanessa Williams, the film interweaves personal stories with facts about this common and potentially deadly virus. The goal of this project is to raise awareness about HPV and cervical cancer.

The film has been available through the Indiana University School of Medicine, in partnership with the Indiana Immunization Coalition and Lumiere Media, as a free online CME activity worth 1.5 AMA PRA Category 1 Credits for physicians and for 1.5 credit hours (0.15 CEU) for pharmacists and pharmacy techs. Continuing nursing education activity is also now available through the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation, for 1.91 Contact Hours.

Physicians, pharmacists, and nurses can all access more information on the Indiana University Division of Continuing Medical Education website.

NOTE: Groups wishing to inquire about sponsoring a screening of this film should contact Lumiere Media at

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Weekly CDC webinar series on "The Pink Book" chapter topics continues through September 21; register now

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 started 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 for each session after it is archived. CE credit may be available for up to a year after the date it was live.

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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Attending the National Immunization Conference? Presentation on vaccine hesitancy/confidence to be offered the evening of September 14

During the 47th National Immunization Conference in Atlanta, PRI Healthcare and Sanofi Pasteur will present an educational dinner program titled "Vaccine Confidence: Practical Tips For Talking To Parents" on September 14 from 6:00–8:30 p.m. The session will feature Gary S. Marshall, MD, and Carole H. Moloney, RN, MSN, CPNP. Attendees will learn about specific communication techniques for addressing the wide range of individual attitudes and beliefs about immunization held by vaccine-hesitant parents—and will see those techniques demonstrated by the expert speakers.

More information about the program and registration (required) is available here.

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Reminder: Registration open for Idaho Immunization Summit, November 2–4; meeting will include CDC's "Pink Book" course

The 2016 Idaho Immunization Summit will be held November 2–4 in Boise. The program will include CDC's live two-day "Epidemiology and Prevention of Vaccine-Preventable Diseases" course (a.k.a. the "Pink Book" course) on November 2 and 3. This course provides a comprehensive review of immunizations and the diseases they prevent. Continuing education credits are available.

A half-day Immunization Summit will take place on November 4, with reporter Tara Haelle as the keynote speaker. The theme for this Immunization Summit is vaccine hesitancy and how to approach immunization concerns with confidence. The conference is sponsored by the Idaho Immunization Program and the Idaho Immunization Program. More information is available on the conference website.

Registration is available online now.

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Question of the Week

Why should we not give PCV13 vaccine to someone who has had a serious reaction to a diphtheria-containing vaccine in the past?

PCV13 vaccine is conjugated to a type of diphtheria-toxoid. So if someone has a past history of anaphylaxis following diphtheria-containing vaccine, it might be due to the diphtheria toxoid, and the cause of the anaphylactic allergy should be identified before the administration of PCV13 vaccine. This could be difficult since no single-antigen diphtheria toxoid is available in the U.S. Fortunately, true anaphylactic allergy to diphtheria-containing vaccine is rare.

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 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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