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Issue 1298: April 12, 2017

Ask the Experts
Ask the Experts—Question of the Week: A 5-year-old is in the office for vaccines and is due for MMR, polio, varicella . . . read more









New! April 2017 issue of Vaccinate Adults now available online

The April 2017 issue of Vaccinate Adults is now online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed.

This issue highlights IAC’s updated "Summary of Recommendations for Adult Immunization" and the 2017 U.S. immunization schedule for adults. You’ll also read about the new edition of The Vaccine Handbook: A Practical Guide for Clinicians (aka “The Purple Book”) and its newly updated app for iOS (Apple) devices available free from IAC via the iTunes store.

The April issue also features the always popular “Ask the Experts” column, with Q&As by experts from CDC’s National Center for Immunization and Respiratory Diseases.

Click on the image below to download the entire April issue of Vaccinate Adults (18-page, 10 MB PDF).

Access the Table of Contents to download individual sections or pages.

Download the April 2017 issue of Vaccinate Adults

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If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit our Subscribe to IAC page to sign up.

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Reminder: April 2017 issue of Needle Tips is available online

The April 2017 issue of Needle Tips is now online.

Click on the image below to download the entire April issue of Needle Tips (30-page, 12.87 MB PDF).

Access the Table of Contents (HTML) to download individual sections or pages.

Download the April 2017 issue of Needle Tips

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If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit our Subscribe to IAC page to sign up.

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Reminder: National Infant Immunization Week to be held April 22–29; Blog-a-thon to start April 24

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. NIIW will be held this year on April 22–29.

A NIIW Blog-a-thon will kick off on Monday, April 24. If you have your own blog or write for your organization's blog and feel passionate about the important role vaccines play in protecting children, CDC encourages you to show your support during NIIW by writing a blog post about vaccines. All participating blogs are encouraged to include the NIIW Blog-A-Thon web badge on their post. Visit the NIIW Blog-a-thon web page for more information on how to participate.

Visit CDC's updated NIIW website to find promotional and educational materials to help you plan your NIIW activities, and tailor them to the needs of your community.

CDC would like to hear from organizations planning a 2017 NIIW activity. Please complete the NIIW Activity Form so others can learn what you're doing to educate and inspire parents and providers to protect infants and toddlers from vaccine-preventable diseases. If you're looking for ideas, you can access events scheduled for 2017, and NIIW events held in past years from CDC's NIIW Activities around the U.S. web page.

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Adolescent Immunization Initiative releases white paper providing rationale for an immunization platform at 16 years of age

A significant but easy-to-overlook change was made when the Advisory Committee on Immunization Practices (ACIP) released the 2017 Recommended Immunization Schedule for Children and Adolescents Aged 18 Years and Younger. A distinct column was added for age 16 years (separate from ages 17 and 18 years) with a shaded column heading, similar to the emphasis placed on the “4–6 years” and “11–12 years” age ranges.
The reasoning behind adding this new column is provided in Rationale for an Immunization Platform at 16 Years of Age. This newly released white paper is the product of the Adolescent Immunization Initiative (AII), a multi-disciplinary group of experts in adolescent health and immunization who convened last summer for a meeting sponsored by Sanofi Pasteur. The publication emphasizes that establishing an immunization platform at 16 years of age has the potential to improve the adolescent health landscape by creating the expectation that adolescents are routinely immunized at this age, consistent with the recommendations.
This is especially important because adolescent immunization rates fall well short of recommended coverage levels, particularly for the recommended second dose of meningococcal conjugate (Men-ACWY, MCV4) vaccine. The addition of a 16-year-old immunization visit provides a distinctive, visible reminder to healthcare professionals that patients in this age group are due for several important vaccinations, including: 

  • MenACWY dose #2–Recommended at age 16
  • MenB dose #1–Recommended (category B) at age 16
  • Influenza vaccine–Recommended seasonally
  • Other vaccines–The 16-year-old platform provides a “catch-up” opportunity for patients who have fallen behind on other recommended vaccines, such as Tdap, HPV, MMR, varicella, HepA, and HepB 

However, as stated in the white paper, “The format change in the schedule will not achieve its intended effect unless steps are taken to convert that visit into an actual immunization platform with its own emphasis—akin to the 11- to 12-year-old immunization /preventive services visit.”
As noted by L.J Tan, MS, PhD, IAC’s chief strategy officer, “We are indoctrinated with the idea of well-care visits for children, but the concept of prevention recedes as they grow older. During adolescence, the frequency of well visits decreases, overall opportunities to see a physician decline, and the preventive mindset is lost. HCPs must engage adolescents to recognize the importance of prevention and of owning their own health.” 

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Pediatrics publishes article about understanding the Category B recommendation for serogroup B meningococcal vaccine 

The April issue of the journal Pediatrics features an article titled Understanding the Category B Recommendation for Serogroup B Meningococcal Vaccine. Several paragraphs are reprinted below.

Category B (formerly known as “permissive”) recommendations are a call for individual clinical decision-making. Specifically, they are used in the context of clinician–patient interaction to determine if vaccination may be appropriate for that patient. It is important to understand that a Category B recommendation is a “recommendation,” as opposed to a “non-recommendation,” silence on the topic, or something that can be ignored. The October 2015 ACIP recommendation that the MenB vaccine “may be given” to persons 16 to 23 years of age, with the preferred age being 16 to 18 years, is an example of a Category B recommendation. Why was the MenB vaccine assigned Category B rather than Category A for healthy adolescents? Simply speaking, there was not enough evidence to recommend that all 16- to 18-year-olds receive the vaccine, but there was enough evidence to recommend that adolescents and young adults be given the choice of vaccination, in the context of the provider–patient relationship and joint decision-making. Factors that favored Category B included the low burden of disease and the high cost per quality-adjusted life year saved of a universal program (which would have been implemented with a Category A recommendation), as well as a lack of information about duration of protection, effects on carriage, herd immunity, and strain coverage (serogroup B strains are antigenically diverse).

“Individual clinical decision-making” cannot occur if a patient does not know about the vaccine and the disease. The AAP acknowledges this caveat by encouraging pediatricians to discuss the availability of the MenB vaccine with families, in essence providing the first real guidance on implementing the Category B recommendation. In the absence of such a discussion, disparities could arise between the “information haves” (families who know about the disease and seek vaccination) and the “information have-nots” (those who do not know about the disease or the vaccine). Under Category B, patients should have a choice between being vaccinated or not being vaccinated, a choice that boils down to, at the individual level, the tradeoff between a sore arm and continued vulnerability to a rare but potentially devastating disease. It is noteworthy that, generally speaking, the patient’s choice is not whether to spend his or her money; the Patient Protection and Affordable Care Act directs insurance companies to pay first-dollar for both Category A and Category B recommendations, and both categories of recommendations are generally covered under the Vaccines for Children Program.

Providers need to decide how they will approach initiating the discussion about the MenB vaccine (and, indeed, vaccines yet to come that may carry a Category B recommendation). Should they recommend that every 16- to 18-year-old in the practice be vaccinated (a presumptive approach)? Should they present vaccination as an option (a participatory approach) and ask the patient and family to decide? One problem with the latter approach is that there is no way to predict, short of exposure during an outbreak, which healthy adolescents are at risk for invasive serogroup B disease (even college attendance is not a risk factor). Should the whole practice or health care system adopt a standard, consistent approach or leave the process up to each provider? Either way, we agree with the implication from the AAP’s statement: not discussing MenB disease and the vaccine that is currently available should not be an option.

Access the complete article: Understanding the Category B Recommendation for Serogroup B Meningococcal Vaccine (PDF format).

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Reminder: New edition of The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall available for purchase from IAC; free app for iPhones and iPads available from IAC

The 6th edition of The Vaccine Handbook: A Practical Guide for Clinicians ("The Purple Book") is considered a vital source of practical, up-to-date information for vaccine providers and educators. Now printed in color and updated with the latest vaccine information through early 2017, "The Purple Book" draws 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.

The sixth edition of this valuable guide (592 pages) is available on IAC's website at The price of the handbook is $34.95 per copy, plus shipping charges. Order copies for your staff or for distribution at an upcoming conference.

Discount pricing is available for more than 10 copies. 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!

The Vaccine Handbook App for Apple iPhones and iPads is available free from IAC. Sorry, the app is not available for android devices. Book purchase is not necessary but registration to obtain the app is required.

The app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to valuable content from nonprofit and governmental sources.

Click on the image below to visit the The Vaccine Handbook App page in the iTunes store.

Download new app!

About the Author
Gary S. 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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New! Easy-to-customize postcards to help you recall 16-year-olds for their MCV4 booster dose  

A new, vibrant, eye-catching postcard is now available to help healthcare professionals (HCPs) remind parents that it is time for their adolescent to receive the recommended second (booster) dose of meningococcal conjugate vaccine.
The need for this tool is apparent; the 2015 National Immunization Survey–Teen indicated that only one-third of eligible adolescents received the recommended second dose of meningococcal conjugate vaccine (MenACWY, MCV4) to help protect against meningococcal meningitis. Among other possible reasons, this low rate may be the result of parents forgetting their teen’s appointment or simply not knowing that a dose is due.
This reminder postcard declares “Your teen needs a boost!” on the front side and concludes with "And we’re here to give it.” on the back side.

Easy-to-follow instructions allow providers to use an online printing service to customize the card with their own contact information and return address. This simplifies the reminder process for providers while concurrently giving the card a personalized message and professional look.
Although downloading the layout of the postcard is complimentary for providers, there will be printing costs associated with using the online service described in the instructions. But this small cost could reap large benefits in improving your immunization rates and providing your patients with the best preventive health care. And while they’re in the office, take advantage of the opportunity to provide other immunizations and preventive services recommended for adolescents. In this way, the reminder card can serve as the perfect tool to help promote the 16-year-old immunization platform highlighted in a separate article in this issue of IAC Express.
The reminder postcard is a new addition to the wide array of resources available on the MCV4: You’re Not Done If You Give Just One website. This project was launched by IAC, in collaboration with Sanofi Pasteur, in recognition of the low immunization rates for the second dose of meningococcal vaccine.

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Now available! IAC's sturdy laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 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 Spotlight! Two healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

Over 600 organizations are now 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 March 29, when IAC Express last reported on the Influenza Vaccination Honor Roll, two additional healthcare organizations have been enrolled, for a total of 623.

IAC urges qualifying healthcare organizations to apply.

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

  • Marcus Daly Memorial Hospital, Hamilton, MT
  • Porter Adventist Hospital, Denver, CO

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Michigan launches I Vaccinate campaign

On March 20, the Michigan Department of Health and Human Services (MDHHS) partnered with the Franny Strong Foundation to launch the I Vaccinate public health education campaign to help parents protect their children from vaccine-preventable diseases. Designed with input from Michigan mothers, I Vaccinate provides the facts parents need to make informed decisions about vaccinations. Support is provided by MDHHS and the Franny Strong Foundation.

Although this campaign is Michigan-specific, the website includes much user-friendly, science-based information for all parents. You can encourage parents to visit this new resource at

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CDC and WHO report on surveillance systems to track progress toward polio eradication in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Surveillance Systems to Track Progress Toward Polio Eradication—Worldwide, 2015–2016 in the April 7 issue of MMWR. On the same day, WHO's Weekly Epidemiological Record published a similar article titled Surveillance systems to track progress towards polio eradication worldwide. A media summary of the MMWR article is reprinted below.
This report presents poliovirus surveillance data from 2015 and 2016, with particular focus on 20 countries in the African Region (AFR) and six in the Eastern Mediterranean Region (EMR) that reported wild poliovirus (WPV) or circulating vaccine-derived polioviruses (VDPVs) during 2011–2016, as well as the three countries most affected by the 2014–2015 Ebola virus disease outbreak (Guinea, Liberia, and Sierra Leone). During 2016, 12 of the 20 AFR countries and all six of the EMR countries met both surveillance quality indicators at the national level; however, provincial-level variation was seen. To complete and certify polio eradication, surveillance gaps must be identified and surveillance activities—including supervision, monitoring, specimen collection, and handling—must be further strengthened.

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AAP creates new educational piece for primary care nursing personnel about HPV vaccination

The American Academy of Pediatrics (AAP) has developed an educational piece about HPV vaccination targeted toward primary care nursing personnel. This colorful 2-page resource, Changing the Future: Preventing HPV Cancers, addresses such questions as:
  • What is the most important thing I can say to be sure our patients get vaccinated?
  • How can our office increase the number of patients who are vaccinated?
  • What should I do if a parent declines HPV vaccine?
Access this great new resource: Changing the Future: Preventing HPV Cancers.

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Hepatitis B Foundation releases new 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 Maureen's Story about a couple who adopted a baby from China who was infected with the hepatitis B virus. Maureen discusses what happened when she disclosed her daughter's hepatitis B-infected status and what one should think about before disclosing.

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Immunize Canada launches its new, more mobile-friendly website!

Immunize Canada has recently re-launched its website in a more mobile-friendly format, and invites everyone to check out the following new features:

  • Fully responsive for hand-held devices
  • Clean new design
  • Updated content
  • Easy navigation
  • Fully bilingual (English/French)
  • More resources to promote immunization

Access the Immunize Canada website at

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CDC publishes data brief on the prevalence of HPV infection in U.S. adults

On April 6, CDC published a National Health and Nutrition Examination Survey data brief titled Prevalence of Human Papillomavirus in U.S. Adults Aged 18–69 Years, 2011–2014. The listed key findings from this survey are:

  • During 2011–2014, prevalence of any oral human papillomavirus (HPV) for adults aged 18–69 was 7.3%; high-risk HPV was 4.0%
  • Overall, prevalence of any and high-risk oral HPV was lowest among non-Hispanic Asian adults; any oral HPV was highest among non-Hispanic black adults
  • Prevalence of any and high-risk oral HPV was higher in men than women except for high-risk HPV among Asian adults
  • During 2013–2014, prevalence of any and high-risk genital HPV for adults aged 18–59 was 45.2% and 25.1% in men and 39.9% and 20.4% in women, respectively
  • Prevalence of any and high-risk genital HPV was lower among non-Hispanic Asian and higher among non-Hispanic black than both non-Hispanic white and Hispanic men and women

Access Prevalence of HPV in Adults Aged 18–69: United States, 2011–2014 (web section).

Access Prevalence of Human Papillomavirus in U.S. Adults Aged 18-69 Years, 2011–2014 (PDF format).

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March issue of CDC's Immunization Works newsletter now available

CDC recently released the March 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 study published in Pediatrics confirms that influenza vaccination saves children's lives

On April 3, the journal Pediatrics published a CDC study titled Influenza Vaccine Effectiveness Against Pediatric Deaths: 2010–2014. The first paragraph of a related CDC press release is reprinted below.

A new CDC study published today in Pediatrics is the first of its kind to show that flu vaccination significantly reduced a child’s risk of dying from influenza. The study, which looked at data from four flu seasons between 2010 and 2014, found that flu vaccination reduced the risk of flu-associated death by half (51 percent) among children with underlying high-risk medical conditions and by nearly two-thirds (65 percent) among healthy children. The study findings underscore the importance of the recommendation by CDC and the American Academy of Pediatrics that all children 6 months and older get an annual flu vaccine.

Access the complete article: Influenza Vaccine Effectiveness Against Pediatric Deaths: 2010–2014.

Read the complete press release: CDC Study Finds Flu Vaccine Saves Children’s Lives.

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New CDC study published in Pediatrics finds that Tdap administered during pregnancy is effective in protecting infants against pertussis 

The April issue of Pediatrics includes an article about a CDC study titled Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis. The abstract is reprinted below.

Vaccination against pertussis during pregnancy is recommended to protect newborns, yet there is limited information about the effectiveness of maternal tetanus toxoid, reduced diphtheria toxoid, acellular pertussis (Tdap) vaccine before the first infant dose of diphtheria, tetanus and acellular pertussis (DTaP) vaccine and during the first year of life in infants who have received DTaP.

In a retrospective cohort study of infants born at Kaiser Permanente Northern California from 2010 to 2015, we estimated the effectiveness of maternal pertussis vaccination for protecting newborns against pertussis in the first 2 months of life and in the first year of life accounting for each infant DTaP dose.

Among 148,981 newborns, the vaccine effectiveness of maternal Tdap was 91.4% (95% confidence interval [CI], 19.5 to 99.1) during the first 2 months of life and 69.0% (95% CI, 43.6 to 82.9) during the entire first year of life. The vaccine effectiveness was 87.9% (95% CI, 41.4 to 97.5) before infants had any DTaP vaccine doses, 81.4% (95% CI, 42.5 to 94.0) between doses 1 and 2, 6.4% (95% CI, −165.1 to 66.9) between doses 2 and 3, and 65.9% (95% CI, 4.5 to 87.8) after infants had 3 DTaP doses.

Maternal Tdap vaccination was highly protective against infant pertussis, especially in the first 2 months of life. Even after infant DTaP dosing, there was evidence of additional protection from maternal Tdap vaccination for the first year of life. This study strongly supports the United States’ current recommendation to administer Tdap during each pregnancy.

Access the complete article: Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis.

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Dr. Kelly Moore to present NFID webinar reviewing principles on vaccine storage and handling on May 3 
Kelly Moore, MD, MPH, director, Tennessee Immunization Program and assistant professor, Preventive Medicine at the Vanderbilt University School of Medicine, will present a webinar titled "Principles of Vaccine Storage and Handling" on May at 12:00 p.m. (ET). Vaccines are fragile and require strict temperature-controlled storage conditions if they are to work optimally to prevent disease. Join this webinar for an overview of fundamental principles of vaccine storage and handling in any clinical setting. Dr. Moore will also highlight available guidance and training resources and how to best approach decisions about storage and temperature monitoring equipment.

At the conclusion, participants will be able to: 
  • Describe proper vaccine storage conditions and why they are important
  • Discuss key considerations in selecting vaccine storage and temperature monitoring equipment
  • Explain the types of plans and training necessary for optimal routine and emergency vaccine management

This webinar is sponsored by the National Foundation for Infectious Diseases (NFID).

Registration information

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Reminder: CDC's NetConference series about adult immunization runs every Wednesday, April 12–May 31

CDC is sponsoring a six-part NetConference series on vaccinating adults that will address key issues related to protecting adults from vaccine-preventable diseases. A collaborative effort between CDC and Maryland’s adult immunization coalition and state immunization program, the "Vaccinating Adults" series will feature six presentations by experts in promoting, administering, and securing reimbursement for adult immunizations.

  • Wednesday, April 12—Burden of Vaccine-Preventable Diseases in Adults: Medical, Social, and Economic Costs
  • Wednesday, April 19—Provider Reimbursement for Adult Immunizations
  • Wednesday, April 26—Immunizing Adults: Immunization Schedule, Coverage, and Challenges
  • Wednesday, May 17—Immunizing Older Adults and the Chronically Ill
  • Wednesday, May 24—Immunizing Pregnant Women, Health Care Personnel, and in the Workplace
  • Wednesday, May 31—Clinic Logistics: Vaccine Administration, Storage, and Handling

Each session will start at 12:00 p.m. (ET).

Continuing education will be available for each event. The series will be archived later on CDC's website.

Advanced registration is required to participate.

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Question of the Week

A 5-year-old is in the office for vaccines and is due for MMR, polio, varicella, and DTaP. Is there a specific order I should be giving these vaccines?   

The Advisory Committee on Immunization Practices (ACIP) does not address this issue. There is no recommended order in which the vaccines should be given. A best practice strategy to decrease injection or procedural pain is to administer the vaccine that causes the most pain (stinging, for example) last. For more information on vaccine administration, please see the "Vaccine Administration" chapter of Epidemiology and Prevention of Vaccine-Preventable Diseases at

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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