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Issue 1304: May 3, 2017

Ask the Experts
Ask the Experts—Question of the Week: We have a 45-year-old patient taking Mesalamine for ulcerative colitis. . . . read more










Free app of The Vaccine Handbook newly available from the Immunization Action Coalition

A new app of The Vaccine Handbook is now available from the Immunization Action Coalition. The free app, which is available for Apple iPhones and iPads only, contains the complete 2017 (6th) edition of The Vaccine Handbook (“The Purple Book”), by Dr. Gary Marshall, professor of pediatrics and chief of the Division of Pediatric Infectious Diseases at the University of Louisville. The app is fully searchable, with functionality that includes bookmarking, highlighting, user annotation, and links to important vaccination resources.
"The Purple Book" is a comprehensive source of vaccine information, drawing together vaccine science, guidance, and practice into a user-friendly resource for the private office, public health clinic, academic medical center, classroom, and hospital. The first section provides background on vaccine immunology, development, infrastructure, policy, standards, implementation, special circumstances, and—perhaps most importantly—addressing concerns. The second section contains details about every vaccine currently licensed in the U.S., including the burden and epidemiology of the respective disease, history of the immunization program, vaccine constituents, efficacy, safety, and recommendations.

The free app may be found by searching the iTunes App Store for “The Vaccine Handbook App” or clicking on the following link:

Print copies of the book ($34.95 each; bulk discounts are available from the publisher) can be ordered from the Immunization Action Coalition website at

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Children’s chewable acetaminophen 80 mg dose being discontinued; 160 mg will be the only children’s chewable dosage available in the future

Many manufacturers and retailers of pediatric acetaminophen solid dose medicines in the United States are transitioning to a single strength of 160 mg chewables. This change is intended to help minimize the potential for medication errors due to confusion between multiple strengths, and was part of a 2011 FDA Advisory Committee recommendation. Some important points from Johnson & Johnson Consumer Inc., the makers of Children’s Tylenol, are reprinted below:

  • Currently the marketplace includes pediatric acetaminophen chewable products available in both 80 mg and 160 mg strengths. These are commonly referred to as “Children’s” and “Jr” respectively.
  • Many manufacturers and retailers will be transitioning to one 160 mg strength to be named “Children’s." This dosage strength aligns with the most common single ingredient pediatric liquid acetaminophen medicine concentration (160 mg/5mL).
  • During this time of transition, there will still be some solid dose chewable products labeled as “Children’s” available in the marketplace and in medicine cabinets at the 80 mg strength as well as product labeled as “Junior” at the 160 mg strength.
  • The pediatric acetaminophen products currently on the market can continue to be used as labeled.
  • The in-store transition to the single strength 160 mg acetaminophen chewable products will begin in early 2017 and is anticipated to continue throughout 2017. However, the transition within any caregivers’ medicine cabinet may take considerably longer.

Please always verify the acetaminophen product strength (160 mg or 80 mg) a parent or caregiver is using before providing dosing directions. 

Access the complete Johnson & Johnson letter to healthcare professionals.

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U.S.-licensed yellow fever vaccine supply expected to be depleted by mid-2017 in the U.S.

CDC published an article titled Addressing a Yellow Fever Vaccine Shortage—United States, 2016–2017 in an MMWR Early Release on April 28. A related email announcement from CDC is reprinted below.

The Centers for Disease Control and Prevention outlines a plan to ensure a continuous yellow fever vaccine supply in the United States following the anticipated depletion of the U.S.-licensed YF-VAX yellow fever vaccine in mid-2017, according to a Morbidity and Mortality Weekly Report published April 28, 2017.

In 2016, a manufacturing issue at Sanofi Pasteur limited the production of YF-VAX, and no yellow fever vaccine is expected to be available by mid-2017. YF-VAX is the only yellow fever vaccine licensed for use in the United States and is distributed to approximately 4,000 clinic sites.

Because yellow fever is a potentially serious disease, CDC and Sanofi Pasteur collaborated on a plan to distribute limited quantities of Stamaril yellow fever vaccine to prevent people from becoming infected by the virus until production of YF-VAX resumes at a new facility in 2018. Stamaril is manufactured by Sanofi Pasteur in France and distributed in more than 70 countries. In October 2016, the U.S. Food and Drug Administration authorized an Expanded Access Investigational New Drug protocol that allows for the distribution of Stamaril to designated U.S. clinic sites until YF-VAX production resumes.

To ensure broad accessibility to limited quantities of the Stamaril vaccine, Sanofi Pasteur and CDC targeted clinic sites that administered a high volume of yellow fever vaccine to international travelers in 2016 or can provide coverage to an area of geographic need.  Based on these criteria, Sanofi Pasteur identified approximately 250 U.S. clinics to distribute Stamaril. This is a significant decrease from the approximately 4,000 clinic sites that distribute YF-VAX.

When YF-VAX is no longer available, CDC will publish a list of clinic sites offering Stamaril at

Healthcare providers and travelers can find more information about staying healthy while traveling at

For yellow fever vaccine shortage and drug information, visit Sanofi Pasteur at

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May is Hepatitis Awareness Month; promote hepatitis awareness and the sixth annual Hepatitis Testing Day

It's time to celebrate Hepatitis Awareness Month and the sixth annual national Hepatitis Testing Day on May 19! CDC has shared the following to help your efforts during May and beyond. 

  1. The Hepatitis Awareness Month and Testing Day Resource Center has free tools to help support your awareness activities and testing events. Resources include buttons, badges, and a quiz widget for your website or email signatures; Live-Read Radio Scripts templates to pitch your events to local radio stations; and sample proclamations for Hepatitis Awareness Month and/or national Hepatitis Testing Day.
  2. Join the Be #HepAware Thunderclap on May 19 at 12:00 p.m. (ET). Supporters can sign up in advance using their Twitter, Facebook, or Tumblr accounts for a one-time post that will automatically be sent on May 19. Visit to sign up and help spread the word to your members and followers. Contact or visit the Resource Center for more details.
  3. If your organization provides ongoing hepatitis testing and vaccination services, please visit and fill out an online form to make sure your services are registered within their database. This site is a tool for people to enter their zip code and find ongoing services in their area.
  4. Share our feature on the ABCs of Viral Hepatitis and encourage people to take the Hepatitis Risk Assessment to get personalized hepatitis vaccination and testing recommendations. The Risk Assessment can be shared by posting badges on your website or promoting the link on social media.
  5. The Know More Hepatitis campaign, which encourages people born from 1945–1965 to get tested for hepatitis C, and the multilingual Know Hepatitis B campaign, promoting hepatitis B testing among Asian Americans, have free resources available for use. Campaign resources include video PSAs and posters, radio PSAs, infographics, fact sheets, customizable event flyers, and other materials.
  6. Visit the Division of Viral Hepatitis’s website for information and resources on all types of hepatitis, including fact sheets, posters, provider resources, and much more.  
  7. Follow @cdchep on Twitter for information about hepatitis resources, tools, publications, campaign updates, and events. Use the hashtags #HepAware, #hepatitis, #HepTestingDay, and #HepatitisElimination to join the conversation and share information on viral hepatitis.
  8. Sign up for monthly emails from the Division of Viral Hepatitis about new publications, recommendations, new materials, or significant events.

Feel free to email CDC's Division of Viral Hepatitis with questions or suggestions about Hepatitis Awareness Month and Hepatitis Testing Day.

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Hep B United and StoryCenter to host May 9 video chat on the Hepatitis B Foundation's storytelling project: HBF releases additional videos in honor of Hepatitis Awareness Month

Please join Hep B United and StoryCenter on May 9 at 3:00 p.m. (ET) for a "Hep B Hangout," a video chat webinar about the Hepatitis B Foundation’s storytelling campaign, #justB: Real People Sharing their Stories of Hepatitis B. 

In January, the Hepatitis B Foundation launched #justB—a national, multi-lingual storytelling campaign aimed at raising the profile of hepatitis B as an urgent public health priority. The campaign features real stories of everyday people from across the country who have been affected by hepatitis B and want to share their stories to educate communities and inspire action. The goals for the campaign are to increase awareness, decrease stigmatization and discrimination, promote testing and linkages to care, and advocate for improved services for people living with hepatitis B. 

The Hepatitis B Foundation partnered with StoryCenter to produce 15 new short videos that were released on May 1, coinciding with Hepatitis Awareness Month and Asian Pacific American Heritage Month.

Access #justB: Real People Sharing their Stories of Hepatitis B.

Register for the May 9 webinar.

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FDA publishes article about PRISM, a computer-based vaccine safety monitoring system

The U.S. Food and Drug Administration (FDA) recently published an article titled PRISM Identifies Vaccine Safety Issues. The first paragraphs are reprinted below.

The word “prism” might make you think of a triangular piece of glass that separates white light into a rainbow of colors.

But at FDA, it means a powerful, computer-based system that separates critical bits of information from vast streams of healthcare data in order to investigate adverse events and determine if there is a connection to a specific vaccine. And while the FDA prism—called Post-licensure Rapid Immunization Safety Monitoring System (PRISM)—might not have such a colorful name, it’s a bright light in the agency’s continual efforts to identify adverse effects in a timely manner.

PRISM is a cooperative effort between FDA’s Center for Biologics Evaluation and Research and its partners in the health care and medical insurance communities. It analyzes health insurance claims data from four national healthcare plans: Aetna, HealthCore (Wellpoint), Humana, and OptumInsight (United Healthcare).

Since it was first inaugurated in 2010, PRISM has made valuable contributions to public safety.

For example, FDA was able to use the system to reassure the public that there was no link between an influenza vaccine and increased risk of febrile seizure in children (convulsion or seizure brought on by a fever). Another PRISM study comprising more than 1.4 million doses of Gardasil doses found no evidence of venous thromboembolism after vaccination among females 9 to 26 years old. FDA also used PRISM to identify a link between a rotavirus vaccine (RotaTeq) and an increased risk of intussusception in infants.

Access the complete article: PRISM Identifies Vaccine Safety Issues.

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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 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 April 12, when IAC Express last reported on the Influenza Vaccination Honor Roll, two additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

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

  • Ochner Health System, New Orleans, LA
  • William Beaumont Army Medical Center, El Paso, TX

There are now 625 institutions on the list.

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Voices for Vaccines releases fourth podcast—an interview with two mothers whose children suffered from vaccine-preventable diseases

Voices for Vaccines (VFV) has posted the fourth entry in its Vax Talk podcast series: National Infant Immunization Week! In honor of National Infant Immunization Week and World Immunization Week, this podcast stresses the importance of the vaccines babies receive in the first two years of life. The speakers answer questions about what diseases those vaccines protect against and talk to two mothers whose babies caught vaccine-preventable diseases before they were old enough to be vaccinated against them.

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 values vaccines to become a member. Please spread the word to your friends and colleagues to join VFV!
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IAC posts 17 translations of the Td VIS released by CDC on April 11

IAC recently posted the following translations of the updated TD VIS that CDC released on April 11:

The Spanish-language rich text format (otherwise known as RTF) file for the updated TD VIS is available by going to This format can be used with electronic medical records system such as GE Centricity or Epic. English VISs in RTF can be downloaded from CDC's website (click on any VIS to access all available formats).

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WHO issues updated position paper on measles vaccines

WHO published Measles vaccines: WHO position paper—April 2017 in the April 28 issue of its Weekly Epidemiological Record. This is the most recent addition to a WHO-issued series of regularly updated position papers on vaccines that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programs.

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UNICEF warns that too many poor children still missing out on life-saving vaccinations 

On April 26, UNICEF issued a news release about the inequalities between poor and rich children worldwide in receiving vaccines. A section of it is reprinted below.

Even though billions of doses of vaccines for children across 100 countries around the world were supplied in 2016, millions of children—especially those in conflict zones—still miss out on life-saving inoculations, the United Nations Children’s Fund (UNICEF) has warned. ...  According to estimates, 19.4 million children around the world still miss out on full vaccinations every year.

Around two-thirds of all unvaccinated children live in conflict-affected countries. Weak health systems, poverty, and social inequities also mean that one in five children under the age of five is still not reached with life-saving vaccines....

In countries where 80 per cent of the world’s under-five child deaths occur, over half of the poorest children are not fully vaccinated. Globally, the poorest children are nearly twice as likely to die before the age of five as the richest....

Read the complete press release: Inequalities between rich and poor temper broad success of immunization—UNICEF.

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CDC offers helpful handouts for parents 

CDC offers clinicians a number of useful handouts for parents. These materials, most optimized for office printers, provide information to help parents better understand their children’s vaccines. Share with your patients’ parents and caregivers.

Visit CDC's Vaccine Resources to Share with Parents for these and other resources, including easy-to-read immunization schedules and a well child visit tracker.

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Vaccine Education Center releases new fact sheets for the public, one about hepatitis B and one about evaluating information

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia has released two new fact sheets for members of the public. The first is an addition to its Vaccine Q&A Sheet series: Hepatitis B: What you should know (Spanish-language version). This new Q&A sheet about hepatitis B addresses questions including:

  • What is hepatitis B?
  • How is hepatitis B spread?
  • What is my child’s risk of getting hepatitis B infection?
  • Is there a hepatitis B vaccine?
  • Is the hepatitis B vaccine safe?
  • Who should get the hepatitis B vaccine?
  • What if I get the hepatitis B vaccine, but am still not protected?
  • Why are newborns recommended to get a hepatitis B vaccine?
  • Do I need to get hepatitis B vaccine if it has been a long time since I was immunized?

You can access and download all 16 of the fact sheets about vaccines and vaccine safety in this series at VEC's Vaccine- and Vaccine Safety-Related Q&A Sheets web page. Each is available in Spanish and English. These Vaccine Q&A fact sheets can also be ordered for a small fee.

The second fact sheet is an addition to VEC's Special Topics series: Evaluating Information: What You Should Know. This new Special Topics sheet contains sections related to:

  • Evaluating media reports
  • Evaluating websites
  • Evaluating scientific studies, including discussions of:
    • What constitutes a good scientific study?
    • Studies and the scientists who conduct them
    • Studies and the media outlets that report them

You can access all 16 of these fact sheets about various topics at VEC's Special Topics Online Series Q&A Sheets web page.

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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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Science magazine publishes special issue about "The Vaccine Wars"

On April 28, Science magazine published a special issue about what they referred to as "The Vaccine Wars." The issue includes the following five articles:

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Vaccine Education Center's newsletter for healthcare professionals features an article about fetal cell use in vaccine development, research on HPV vaccination during pregnancy, and more

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia publishes a monthly immunization-focused newsletter titled Vaccine Update for Healthcare Professionals. The April issue includes the following articles:

Additional resources, including information about VEC's archived March webinar on HPV vaccine safety, are available in the full newsletter.

Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.

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

CDCis sponsoring a 6-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 6 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

We have a 45-year-old patient taking Mesalamine for ulcerative colitis. Should he receive PCV13 and/or PPSV23?  

Mesalamine (mesalazine) is a non-steroidal anti-inflammatory drug. It is not immunosuppressive, so its use would not be an indication for early pneumococcal vaccination with either of these vaccines (i.e., prior to the routine vaccination age of 65 years).

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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