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Issue 1289: February 8, 2017

Ask the Experts
Ask the Experts—Question of the Week: I have a patient who is 62 years old and is immigrating to the U.S. . . . read more








2017 U.S. recommended immunization schedule for 0 through 18 years and "catch up" now available

On February 7, CDC published Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger—United States, 2017 as an MMWR Early Release.
Each year, the Advisory Committee on Immunization Practices (ACIP) updates the immunization schedules to reflect current recommendations for licensed vaccines. In October 2016, ACIP approved the recommended immunization schedules for 2017. The "Changes in the 2017 Child and Adolescent Immunization Schedule" section of the article is reprinted below.

Changes in the 2017 immunization schedules for children and adolescents aged 18 years or younger include new or revised ACIP recommendations for influenza; human papillomavirus; hepatitis B; Haemophilus influenzae type b; pneumococcal; meningococcal; and diphtheria and tetanus toxoids and acellular pertussis vaccines.

Figure 1. Changes to the 2017 figure from the 2016 schedule are as follows:
  • The 16-year age column has been separated from the 17–18-year age column to highlight the need for a meningococcal conjugate vaccine booster dose at age 16 years.
  • Live attenuated influenza vaccine (LAIV) has been removed from the influenza row.
  • A blue bar was added for human papillomavirus vaccine (HPV) for children aged 9–10 years, indicating that persons in this age group may be vaccinated (even in the absence of a high-risk condition).

Figure 3. A new figure, “Figure 3. Vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications,” has been added. The purpose of this figure is to do the following:

  • Demonstrate most children with medical conditions can (and should) be vaccinated according to the routine child/adolescent immunization schedule.
  • Indicate when a medical condition is a precaution or contraindication to vaccination.
  • Indicate when additional doses of vaccines may be necessary because of a child’s or adolescent’s medical condition. Providers should consult the relevant footnotes for additional information.

Footnotes. Changes to the footnotes for the figures are as follows:

  • The Hepatitis B vaccine (HepB) footnote was revised to reflect that the birth dose of HepB should be administered within 24 hours of birth.
  • The diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) footnote was revised to more clearly present recommendations following an inadvertently early administered fourth dose of DTaP
  • Within the Haemophilus influenzae type b vaccine (Hib) footnote, Comvax was removed from the routine vaccination portion of footnote. This vaccine has been removed from the market, and all available doses have expired. Additionally, Hiberix has been added to the list of vaccines that may be used for the primary vaccination series.
  • Within the pneumococcal vaccine footnote, references to 7-valent pneumococcal conjugate vaccine (PCV7) have been removed. All healthy children who might have received PCV7 as part of a primary series have now aged out of the recommendation for pneumococcal vaccine.
  • The influenza vaccine footnote has been updated to indicate that LAIV should not be used during the 2016–2017 influenza season.
  • The meningococcal vaccines footnote has been updated to include recommendations for meningococcal vaccination of children with human immunodeficiency virus (HIV) infection and to reflect recommendations for the use of a 2-dose Trumenba (meningococcal B vaccine) schedule.
  • The tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) footnote for vaccination of pregnant adolescents between gestational weeks 27–36 has been updated to reflect a preference for vaccination earlier during this period. Currently available data suggest that vaccinating earlier in the 27 through 36–week period will maximize passive antibody transfer to the infant.
  • The footnote for HPV vaccine has been updated to include the new 2-dose schedule for persons initiating the HPV vaccination series before age 15 years. In addition, bivalent HPV vaccine has been removed from the schedule. This vaccine has been removed from the U.S. market, and all available vaccine doses have expired.

The recommended birth through 18 years and catch-up immunization schedules have been approved by the ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

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2017 U.S. recommended immunization schedule for adults now available

On February 7, CDC published Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2017.

Each year, the Advisory Committee on Immunization Practices (ACIP) updates the immunization schedules to reflect current recommendations for licensed vaccines. In October 2016, ACIP approved the recommended immunization schedules for 2017. Changes in the 2017 adult immunization schedule from the previous year’s schedule include new or revised ACIP recommendations for influenza, human papillomavirus, hepatitis B, and meningococcal ACWY and B vaccines. You can read about what changed in the adult schedule and footnotes in the article referenced above.

The recommended adult immunization schedule has been approved by the ACIP, the American Academy of Family Physicians, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.

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February is International Prenatal Infection Prevention Month! Make sure your pregnant patients receive influenza and Tdap vaccines

February is International Prenatal Infection Prevention Month. ACIP recommends both influenza and Tdap vaccines for pregnant women, but uptake continues to be far from ideal.

According to CDC, during the 2015–16 flu season, only about half of pregnant women received influenza vaccine. A study published in MMWR on January 17 looked at 113,730 women in Minnesota who had delivered a live birth during March 2013–December 2014, and for whom immunization records were available. Of these women, 46% had received influenza vaccine during their pregnancy. 

The same study of Minnesota women referenced above also looked at Tdap vaccination and found that only 58% of pregnant women had received a dose of Tdap during their pregnancy.

The following resources for healthcare professionals and their patients can help improve influenza and Tdap vaccination rates in pregnant women:

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Eight healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

There are now 614 organizations 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 January 4, when IAC Express last reported on the Influenza Vaccination Honor Roll, eight additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

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

  • Ascension Borgess, Kalamazoo, MI
  • Gibson Area Hospital and Health Services, Gibson City, IL
  • New Vista Nursing and Rehabilitation, Sunland, CA
  • New Vista Post Acute Care, Los Angeles, CA
  • Parkview Medical Center, Pueblo, CO
  • Pediatric and Young Adult Clinic, Oskaloosa, IA
  • Schoolcraft Memorial Hospital, Manistique, MI
  • Tazewell County Health Department, Tremont, IL

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IAC enrolls two new birthing institutions into its Hepatitis B Birth Dose Honor Roll; seven previously honored institutions qualify for additional years' honors

The Immunization Action Coalition (IAC) is pleased to announce that two 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.

  • RC Hospital & Clinics, Olivia, MN (98%)
  • Wellspan Good Samaritan Hospital, Lebanon, PA (95%)

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

  • Memorial Healthcare, Grand Haven, MI (94%)
  • North Ottawa Community Health System, Owosso, MI (90%)
  • Shannon Medical Center, San Angelo, TX (96%)

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

  • Hospital Bella Vista, Mayaguez, PR (96%)
  • Lincoln Medical Center, Bronx, NY (98%)
  • Sturgis Hospital, Sturgis, MI (95%)

And finally, the following institution is being recognized for a fifth year:

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

The Honor Roll now includes 316 birthing institutions from 38 states, Puerto Rico, and Guam. One hundred three institutions have qualified for two years, 35 institutions have qualified three times, 8 institutions have qualified four times, and 3 institutions have qualified five times.

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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Reminder: Nominations are still open for the National Adult and Influenza Immunization Summit Excellence Awards

The National Adult and Influenza Immunization Summit (NAIIS) is soliciting nominations for the 2017 Immunization Excellence Awards. These prestigious awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2016. The awards focus on individuals and organizations that exemplify the meaning of the "immunization neighborhood" (collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases).

The national winner in each category will be invited to present their program at the 2017 NAIIS meeting, to be held May 9–11 in Atlanta, Georgia. The deadline for receipt of nominations is February 24.

Nominations are being accepted for the following six award categories:     

  • NEW: Non-Healthcare Employer Campaign
  • Laura Scott NAIIS Immunization Excellence Award for Outstanding Influenza Season Activities Campaign
  • “Immunization Neighborhood” Champion
  • Adult Immunization Champion
  • Corporate Campaign
  • Adult Immunization Publication Award

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IAC posts updated handout for the public titled "Human Papillomavirus (HPV): Questions and Answers"

IAC recently revised its handout for the public titled Human Papillomavirus (HPV): Questions and Answers. Changes were made to update the data on HPV and associated cancers, to add information about the new 2-dose schedule for people who begin their series before the age of 15, and to remove references to Cervarix which is no longer distributed in the U.S.

Access all IAC's Questions and Answers handouts for 18 vaccine-preventable diseases.

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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Hepatitis B Foundation releases next video in its storytelling project: #justB

In January, the Hepatitis B Foundation launched a new storytelling campaign: #justB: Real People Sharing their Stories of Hepatitis B. The volunteers sharing their stories do so to put a human face on this serious disease, decrease stigma and discrimination, and promote the importance of testing and treatment for hepatitis B. A new story will be featured each month throughout 2017. 

Watch—and share—the uplifting February story about a young man chronically infected with the hepatitis B virus who biked across the country to raise awareness: John's Story.

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Flu activity continues to increase; 40 states are reporting widespread activity

According to CDC, at the end of January, 40 states and Puerto Rico were reporting widespread influenza activity, Guam and nine states were reporting regional activity, and the District of Columbia and one state reported local activity. Seven influenza-associated pediatric deaths were reported during the last week of January. 

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.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:

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January issue of CDC's Immunization Works newsletter now available

CDC recently released the January issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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CDC reports on knowledge, attitudes, and practices regarding yellow fever vaccination among men during an outbreak in Angola

CDC published Notes from the Field: Knowledge, Attitudes, and Practices Regarding Yellow Fever Vaccination Among Men During an Outbreak—Luanda, Angola, 2016 in the February 3 issue of MMWR (pages 117–8). Sections of the first paragraph are reprinted below.

In January 2016, the Angola Ministry of Health reported an outbreak of yellow fever, a vaccine-preventable disease. . .By May 8, a total of 2,267 suspected cases were reported nationally, of which 696 (31%) were laboratory confirmed; 293 (13%) persons died . . . As part of the public health response that included strengthened surveillance, vector control, case management, and social mobilization, mass vaccination campaigns were implemented in Luanda during February 2–April 16. Despite >90% administrative vaccination coverage (the number of vaccine doses administered divided by the most recent census estimates for the target population), the province continued to report cases. Field teams reported low numbers of men being vaccinated, which was a concern because of a preliminary analysis that indicated approximately 70% of confirmed yellow fever cases occurred in males. A rapid assessment to identify and address potential barriers to vaccination among men was designed, using a knowledge, attitudes, and practices survey.

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Prevent Cancer Foundation to sponsor webinar about the link between viruses and cancer on February 22
The Prevent Cancer Foundation will sponsor a webinar on February 22 at 2:00 p.m. (ET), as part of its Think About the Link series. The presentation, "Addressing the Impact of Viruses and Related Cancers on Minority Populations,” will examine the impact of viruses and cancer on the African-American, Asian, and Hispanic communities in the U.S., with a focus on vaccination and treatment as proven cancer-prevention methods. 

Think About the Link is a multi-year prevention and education campaign from the Foundation advancing awareness of the connection between cancer and viruses. The campaign is focused on three viruses linked to cancer: human papillomavirus (HPV), hepatitis B virus, and hepatitis C virus.

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Question of the Week

I have a patient who is 62 years old and is immigrating to the U.S. She received a dose of zoster vaccine 2 months ago. The immigration requirements state she should receive 2 doses of varicella vaccine. Does she need additional varicella vaccine?   

To meet the immigration requirements, the dose of zoster vaccine counts as the first dose of the varicella vaccine series. You should give a dose of varicella vaccine now since it has been more than 4 weeks since the dose of zoster vaccine. The varicella vaccine dose may not be needed, but it will not be harmful and will allow your patient to meet the regulatory requirement. 

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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