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Issue 1293: March 8, 2017

Ask the Experts
Ask the Experts—Question of the Week: Are there recommendations for administering Tdap when Td is not available? . . . read more








ECBT has shared a special report on the state of our nation’s “ImmUnion” with members of Congress

Every Child By Two (ECBT) recently shared a special report titled State of the ImmUnion: A Report on Vaccine-Preventable Diseases in the U.S. with members of Congress to highlight the power of vaccines and suggest areas of action to fortify the health of our nation. While the medical community has the ability to protect Americans of all ages from deadly infectious diseases, public health workers continue to battle disease outbreaks across the nation that threaten the health and well-being of our citizens. Many Americans continue to lack access to life-saving vaccines that can protect themselves, their families, and their communities from preventable diseases, while others fail to realize that vaccines are available to protect them from many life-threatening diseases.
This report highlights the successes of vaccines, the economic and societal savings incurred as a result of vaccines, challenges facing the public health system, and key areas to focus on to achieve optimal protection for all Americans. The report includes details on the following:

  • Immense success of vaccines in preventing illness and saving lives
  • Economic and societal savings as a result of high vaccination rates
  • Challenges facing the public health system that threaten our country’s progress in combating vaccine-preventable diseases among all age groups
  • Key areas of focus for legislators to help ensure optimal protection against these devastating diseases
  • Links to educational and vaccine policy resources from partner organizations 

ECBT is hopeful that this report will not only help congressional leaders learn more about the vaccination rates in their home states, but will also help public health advocates prioritize the benefits of immunizations in the years ahead as we face emerging health and budget threats. Please help to disseminate the messages in the report over the coming months as state and federal legislators continue to address vaccine budget and policy issues.  

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IAC Spotlight! IAC enrolls eight new birthing institutions into its Hepatitis B Birth Dose Honor Roll; six previously honored institutions qualify for additional years' honors

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.

  • Baylor, Scott & White Medical Center–College Station, College Station, TX (91%)
  • Capital Health Medical Center–Hopewell Campus, Hopewell, NJ (92%)
  • CHI St. Joseph Health, Bryan, TX (91%)
  • Coleman County Medical Center, Coleman, TX (100%)
  • Lake Granbury Medical Center, Granbury, TX (99%)
  • Lakeland Medical Center, St. Joseph, MI (91%)
  • Starr County Memorial Hospital, Rio Grande City, TX (98%)
  • Unity Health–White County Medical Center, Searcy, AR (99%)

In addition, the following institution is being recognized for a second year:

  • Hamilton Medical Center, Dalton, GA (99%)

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

  • Bluffton Regional Medical Center, Bluffton, IN (91%)
  • Holy Family Hospital, Methuen, MA (95%)
  • Mercy Hospital NWA, Rogers, AR (91%)
  • University Medical Center of Southern Nevada, Las Vegas, NV (99%)

Finally, the following institution is being recognized for a fourth year:

  • Union Hospital, Terre Haute, IN (94%)

The Honor Roll now includes 324 birthing institutions from 38 states, Puerto Rico, and Guam. One hundred four institutions have qualified for two years, 39 institutions have qualified three times, 9 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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Vaccine Safety Net project highlighted on WHO's website

The World Health Organization (WHO) recently published an article about the Vaccine Safety Net (VSN) project on the main page of its website titled Check the source: WHO-validated websites provide trustworthy information on vaccine safety. The Immunization Action Coalition is proud to be a member of the Vaccine Safety Net project, participating in the project through its two websites, and, for more than 10 years.

The mission of the Vaccine Safety Net is to help internet users find reliable vaccine safety information tailored to their needs.

The following U.S.-based organizations are part of the VSN project:

The first paragraphs of the WHO article are reprinted below.

When people need advice about topics like health, careers, or relationships, the first place they often look is the internet. The same is true when parents and caregivers are seeking credible information about whether vaccines are safe for their children.

However, finding that information often isn't easy. In recent years a number of websites providing unbalanced, misleading, and alarming vaccine safety information have been established, prompting a wave of undue fears.

"Every day, misinformation about vaccines continues to proliferate on the internet," says Isabelle Sahinovic, Vaccine Safety Net coordinator at WHO. "This is dangerous. We need to make sure that all parents, caregivers, and healthcare professionals can easily access accurate and trustworthy information about vaccines."

WHO’s Vaccine Safety Net, a global network of vaccine safety websites, aims to do just this. Today, the network has 47 member websites in 12 languages. It is estimated that more than 173 million users every month access VSN websites that contain, among other information, credible vaccine safety information.

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WHO publishes report on measles and rubella surveillance

WHO published a report titled Roadmap to elimination—standard measles and rubella surveillance in the March 3 issue of its Weekly Epidemiological Record. The first paragraph is reprinted below.

The Global Vaccine Action Plan (GVAP) for 2012–2020, endorsed by the 194 WHO Member States at the 65th World Health Assembly in May 2012, calls for the elimination of measles and rubella in at least 5 of the 6 WHO Regions by 2020. While elimination of measles, rubella and congenital rubella syndrome (CRS) has been verified in the Region of the Americas, and endemic measles virus transmission eliminated in several countries of other WHO Regions, the recent Measles and Rubella Global Strategic Plan 2012–2020, Midterm Review reported that progress for elimination was not “on track” and concluded that it was critical to “re-orient the [measles and rubella elimination] program to increase emphasis on surveillance so that programmatic and strategic decisions can be guided by disease data."

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CDC reports increase in human infection with avian influenza virus in China

CDC published Increase in Human Infections with Avian Influenza A(H7N9) Virus During the Fifth Epidemic—China, October 2016–February 2017 in an MMWR Early Release published on March 3. A summary from CDC is reprinted below.

Human infections with avian influenza A(H7N9) virus were first reported in China in March 2013. Annual epidemics of human infection with influenza A(H7N9) virus in China have been reported since that time. During the ongoing fifth epidemic, 460 human infections with A(H7N9) have been reported, a significant increase over the first four epidemics. During the first four epidemics, 88% of patients developed pneumonia, 68% were admitted to an intensive care unit, and 41% died.

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Three items in CDC's Pink Book's appendices have been updated in the online edition

CDC has announced that the following three appendices in the textbook Epidemiology and Prevention of Vaccine-Preventable Diseases, also known as "The Pink Book," have been updated in the online edition:

The 13th edition of the Pink Book is available for purchase from the PHF Learning Resource Center or can be viewed/downloaded online at no charge. The online edition includes not only the updates to these appendices, but also a 2017 supplement, released earlier this year.

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New comic book titled The Test is a readable way to learn about hepatitis B screening results

The Charles B. Wang Community Health Center, New York City, has developed a comic book titled The Test that explains the basics of hepatitis B screening results. Healthcare professionals may find this a helpful educational adjunct for patients who have been tested for hepatitis B virus infection, especially Asian Pacific Islander American patients, for whom this comic book is especially targeted.

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Influenza is spreading and serious; please keep vaccinating your patients

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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CDC reports on response to polio outbreak in Syria in 2013–2015

CDC published Response to a Large Polio Outbreak in a Setting of Conflict—Middle East, 2013?2015 in the March 3 issue of MMWR (pages 227–31). A summary made available to the press is reprinted below.

This report describes the response to a wild poliovirus outbreak, which occurred in Syria and Iraq during 2013?2014 following importation of a poliovirus strain circulating in Pakistan. The outbreak represented the first occurrence of polio cases in both countries in over a decade and resulted in 38 polio cases, including 36 in Syria and two in Iraq. The civil war in Syria led to significant disruption in the delivery of immunization services, leaving many children born during the crisis vulnerable to poliovirus infection. Nonetheless, development and implementation of an integrated response plan for strengthening acute flaccid paralysis surveillance and synchronized mass vaccination campaigns by eight national governments in the Middle East facilitated interruption of the outbreak within six months of its identification.

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New study found that older adults who received high-dose influenza were 36% less likely to die during a bad H3N2 flu season 

On March 2, The Journal of Infectious Diseases published Comparative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries in Preventing Postinfluenza Deaths During 2012–2013 and 2013–2014 online. The abstract is reprinted below.

Recipients of high-dose vs standard-dose influenza vaccines have fewer influenza illnesses. We evaluated the comparative effectiveness of high-dose vaccine in preventing postinfluenza deaths during 2012–2013 and 2013–2014, when influenza viruses and vaccines were similar.

We identified Medicare beneficiaries aged ≥65 years who received high-dose or standard-dose vaccines in community-located pharmacies offering both vaccines. The primary outcome was death in the 30 days following an inpatient or emergency department encounter listing an influenza International of Classification of Diseases, Ninth Revision, Clinical Modification code. Effectiveness was estimated by using multivariate Poisson regression models; effectiveness was allowed to vary by season.

We studied 1,039,645 recipients of high-dose and 1,683,264 recipients of standard-dose vaccines during 2012–2013, and 1,508,176 high-dose and 1,877,327 standard-dose recipients during 2013–2014. Vaccinees were well-balanced for medical conditions and indicators of frail health. Rates of postinfluenza death were 0.028 and 0.038/10,000 person-weeks in high-dose and standard-dose recipients, respectively. Comparative effectiveness was 24.0% (95% confidence interval [CI], .6%–42%); there was evidence of variation by season (P = .12). In 2012–2013, high-dose was 36.4% (95% CI, 9.0%–56%) more effective in reducing mortality; in 2013–2014, it was 2.5% (95% CI, –47% to 35%).

High-dose vaccine was significantly more effective in preventing postinfluenza deaths in 2012–2013, when A(H3N2) circulation was common, but not in 2013–2014.

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"Vaccine Confidence: The Key to Communicating with Parents and Patients" webinar to be offered four times in March
A new webinar titled "Vaccine Confidence: The Key to Communicating with Parents and Patients" will be presented four times in March. This program will explore the wide range of individual attitudes and beliefs about immunizations and offer guidance in responding to specific questions and concerns about vaccines.
Presenters Gary Marshall, MD, professor of pediatrics and chief of the Division of Pediatric Infectious Diseases, University of Louisville School of Medicine, and Carole Moloney, RN, MSN, CPNP, pediatric nurse practitioner and clinical instructor in pediatrics at Boston University School of Medicine, will identify and provide solutions for the key issues that arise in vaccine conversations with parents of pediatric and adolescent patients.
The webcast, sponsored by Sanofi Pasteur, will be offered within a 60-minute time frame, which includes the formal presentation plus a live question-and-answer session with the faculty. Sessions will be offered on the following dates and times:
  • March 7, 2:00 p.m. (ET)
  • March 9, 12:00 p.m. (ET)
  • March 14, 3:00 p.m. (ET)
  • March 16, 1:00 p.m. (ET)

Registration information


Question of the Week

Are there recommendations for administering Tdap when Td is not available?   

If Td is indicated but unavailable, Tdap should be administered in place of Td, and administration should include persons who previously received Tdap. 

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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