Issue 1305: May 10, 2017
Ask the Experts—Question of the Week: I had an 18-year-old in the clinic today for varicella vaccination. . . . read more
OFFICIAL RELEASES AND ANNOUNCEMENTS
EDUCATION AND TRAINING
MMWR reports on vaccination coverage among U.S. adults in 2015
CDC published Surveillance
of Vaccination Coverage Among Adult Populations—United States, 2015 in a May 5 issue of MMWR Surveillance Summaries. The abstract is reprinted below.
Overall, the prevalence of illness attributable to vaccine-preventable diseases is greater among adults than among children. Adults are recommended to receive vaccinations based on their age, underlying medical conditions, lifestyle, prior vaccinations, and other considerations. Updated vaccination recommendations from CDC are published annually in the U.S. Adult Immunization Schedule. Despite longstanding recommendations for use of many vaccines, vaccination coverage among U.S. adults is low.
August 2014–June 2015 (for influenza vaccination) and January–December 2015 (for
pneumococcal, tetanus and diphtheria [Td] and tetanus and diphtheria with
acellular pertussis [Tdap], hepatitis A, hepatitis B, herpes zoster, and human
papillomavirus [HPV] vaccination).
Description of System
The National Health Interview Survey (NHIS) is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The survey objective is to monitor the health of the U.S. population and provide estimates of health indicators, health care use and access, and health-related behaviors.
Compared with data from the 2014 NHIS, increases in vaccination coverage
occurred for influenza vaccine among adults aged ≥19 years (a 1.6 percentage
point increase compared with the 2013–14 season to 44.8%), pneumococcal vaccine
among adults aged 19–64 years at increased risk for pneumococcal disease (a 2.8
percentage point increase to 23.0%), Tdap vaccine among adults aged ≥19 years
and adults aged 19–64 years (a 3.1 percentage point and 3.3 percentage point
increase to 23.1% and to 24.7%, respectively), herpes zoster vaccine among
adults aged ≥60 years and adults aged ≥65 years (a 2.7 percentage point and 3.2
percentage point increase to 30.6% and to 34.2%, respectively), and hepatitis B
vaccine among health care personnel (HCP) aged ≥19 years (a 4.1 percentage point
increase to 64.7%). Herpes zoster vaccination coverage in 2015 met the Healthy
People 2020 target of 30%. Aside from these modest improvements, vaccination
coverage among adults in 2015 was similar to estimates from 2014. Racial/ethnic
differences in coverage persisted for all seven vaccines, with higher coverage
generally for whites compared with most other groups. Adults without health
insurance reported receipt of influenza vaccine (all age groups), pneumococcal
vaccine (adults aged 19–64 years at increased risk), Td vaccine (adults aged ≥19
years, 19–64 years, and 50–64 years), Tdap vaccine (adults aged ≥19 years and
19–64 years), hepatitis A vaccine (adults aged ≥19 years overall and among
travelers), hepatitis B vaccine (adults aged ≥19 years, 19–49 years, and among
travelers), herpes zoster vaccine (adults aged ≥60 years), and HPV vaccine
(males and females aged 19–26 years) less often than those with health
insurance. Adults who reported having a usual place for health care generally
reported receipt of recommended vaccinations more often than those who did not
have such a place, regardless of whether they had health insurance. Vaccination
coverage was higher among adults reporting one or more physician contacts in the
past year compared with those who had not visited a physician in the past year,
regardless of whether they had health insurance. Even among adults who had
health insurance and ≥10 physician contacts within the past year, depending on
the vaccine, 18.2%–85.6% reported not having received vaccinations that were
recommended either for all persons or for those with specific indications.
Overall, vaccination coverage among U.S.-born adults was higher than that among
foreign-born adults, with few exceptions (influenza vaccination [adults aged
19–49 years and 50–64 years], hepatitis A vaccination [adults aged ≥19 years],
and hepatitis B vaccination [adults aged ≥19 years with diabetes or chronic
Coverage for all vaccines for adults remained low but modest gains occurred in
vaccination coverage for influenza (adults aged ≥19 years), pneumococcal (adults
aged 19–64 years with increased risk), Tdap (adults aged ≥19 years and adults
aged 19–64 years), herpes zoster (adults aged ≥60 years and ≥65 years), and
hepatitis B (HCP aged ≥19 years); coverage for other vaccines and groups with
vaccination indications did not improve. The 30% Healthy People 2020 target for
herpes zoster vaccination was met. Racial/ethnic disparities persisted for
routinely recommended adult vaccines. Missed opportunities to vaccinate
remained. Although having health insurance coverage and a usual place for health
care were associated with higher vaccination coverage, these factors alone were
not associated with optimal adult vaccination coverage. HPV vaccination coverage
for males and females has increased since CDC recommended vaccination to prevent
cancers caused by HPV, but many adolescents and young adults remained
Public Health Actions
Assessing factors associated with low coverage rates and disparities in
vaccination is important for implementing strategies to improve vaccination
coverage. Evidence-based practices that have been demonstrated to improve
vaccination coverage should be used. These practices include assessment of
patients’ vaccination indications by health care providers and routine
recommendation and offer of needed vaccines to adults, implementation of
reminder-recall systems, use of standing-order programs for vaccination, and
assessment of practice-level vaccination rates with feedback to staff members.
For vaccination coverage to be improved among those who reported lower coverage
rates of recommended adult vaccines, efforts also are needed to identify adults
who do not have a regular provider or insurance and who report fewer health care
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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
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 www.immunize.org/vaccine-handbook.
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Forty-eight cases of measles reported in Minnesota children
The measles outbreak in Minnesota originally covered in the April 26 issue of IAC Express is ongoing.
- 48 total cases have been confirmed; 45 in Hennepin County, 2 in Ramsey County, and 1 in Crow Wing County
- 45 have been confirmed to be unvaccinated; 1 had received 1 dose of MMR and 2 had received 2 doses of MMR
- 46 cases have occurred in children ages 0 through 10 years; there have been 2 cases in adults
- 41 of the cases are Somali Minnesotan
The local Somali community has been targeted for years with misinformation about a connection between vaccination and autism, including visits from anti-vaccine activists, including Andrew Wakefield, the controversial physician whose license to practice medicine was revoked by Britain's General Medical Council as a result of ethical and financial misconduct. On May 5, The Washington Post published an insightful article about this background to the outbreak.
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The PolicyLab and the Vaccine Education Center release an Evidence to Action brief about addressing vaccine hesitancy
The PolicyLab and the Vaccine Education Center (VEC) at Children's Hospital of
Philadelphia recently released an Evidence to Action brief titled “Addressing
Vaccine Hesitancy to Protect Children and Communities Against Preventable
Diseases.” The brief included a review of vaccine hesitancy, identification of
three areas of concern, and a series of recommendations to address the concerns.
The areas of concern include:
- Diminished prioritization—delayed immunizations resulting from lack of
experience with diseases being prevented and convenience factors and
barriers related to access or philosophical beliefs or concerns
- Lack of confidence in vaccine safety and efficacy—resistance to
immunizations based on misinformation that is perpetrated in the media and
online. Difficulty reversing misconceptions also contributes to this area of
- Inadequate state policies—nonmedical exemptions and pockets of
noncompliance lead to regions or areas of increased susceptibility and
decreased herd immunity
Recommendations focused on three areas of action related to healthcare provider recommendations, vaccine mandates, and education.
View or download the complete brief: Addressing Vaccine Hesitancy to Protect Children and Communities Against Preventable Diseases (PDF format; 20 pages).
More information, including a summary of the recommendations, a related webinar, and a social media toolkit, is available in the March issue of VEC's newsletter, Vaccine Update for Healthcare Professionals.
is an independent research center at Children’s Hospital of Philadelphia.
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The National Adult and Influenza Immunization Summit’s new coding and billing
resource is now available online
The National Adult and Influenza Immunization Summit recently posted a coding and billing resource on its website. A summary from the web section is reprinted below.
A common problem that has been expressed by providers of adult vaccinations
has been the intricacies and complexities associated with coding and billing for
those services. Much discussion at meetings of the National Adult and Influenza
Immunization Summit (“Summit”) has focused on opportunities to provide
information to providers to reduce the errors and confusion associated with
coding and billing for adult vaccines. The Summit’s Access and Provider
Workgroup has developed this website in response to this identified need.
At this one web location, you will find the top questions identified with coding and/or billing for adult vaccinations, scenarios that detail how to go about coding and billing for adult vaccines, and collected resources
from the Summit’s medical association, public health, and vaccine manufacturing
Access Coding and Billing for Adult Vaccinations.
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Please complete CDC’s post-NIIW survey and share your feedback on this year’s
planning and promotional materials
CDC’s Childhood Immunization Communication Team thanks everyone for another
successful National Infant Immunization Week (NIIW)! Your ongoing efforts and
support of childhood immunization help us achieve overall high coverage for most
vaccines routinely recommended for young children in the United States.
While NIIW is still fresh in your mind, CDC has two requests.
First, please take a few minutes to complete
CDC’s Post-NIIW Survey and share your feedback on this year’s planning and
promotional materials available from the CDC. Your responses will help guide CDC
as they begin planning activities for another successful NIIW in 2018. This
survey is brief and should take less than 5 minutes to complete. Your responses
will be kept private to the extent allowed by law, and we will only report
answers that have been pooled together across all respondents. Your input is
Secondly, please let CDC know what you did in your community during NIIW by filling out the NIIW Activity Form. If you tried earlier and ran into technical difficulties, please try again as the problem has been fixed.
CDC would appreciate your input by May 15th.
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AAP invites all immunizers to join its Community of Immunizers Listserv
The American Academy of Pediatrics (AAP) would like to invite all immunizers to join its Community of Immunizers Listserv. The Community of Immunizers Listserv is currently comprised of more than 125 immunizers, including physicians, physician assistants, nurse practitioners, nurses, medical assistants, and other office staff. It allows users to communicate with fellow immunizers, ask questions, and share ideas, resources, and successes! Email email@example.com and include IZCOMMUNITY and your role as an immunization advocate to request to be added to the Community of Immunizers Listserv.
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IAC Spotlight! IAC enrolls three new birthing institutions into its Hepatitis B Birth Dose Honor Roll; four previously honored institutions qualify for additional years' honors
The Immunization Action Coalition (IAC) is pleased to announce that three 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.
- Covenant Health Levelland, Levelland, TX (97%)
- MidMichigan Medical Center–Alpena, Alpena, MI (91%)
- Valley Children's Hospital, Madera, CA (95%)
In addition, the following institution is being recognized for a second year:
- MidMichigan Medical Center–Alpena, Alpena, MI (90%)
Finally, the following three institutions are being recognized for a third year:
- Georgetown Community Hospital, Georgetown, KY (96%)
- Harrison Memorial Hospital, Cynthiana, KY (97%)
- ProMedica Monroe Regional Hospital, Monroe, MI (90%)
Note: MidMichigan Medical Center–Alpena qualified for two periods at one
The Honor Roll now includes 336 birthing institutions from 38 states, Puerto Rico, and Guam. Sixty-eight institutions have qualified for two years, 40 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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CDC publishes information about yellow fever vaccine shortage; previously published as an MMWR Early Report
CDC published Addressing
a Yellow Fever Vaccine Shortage—United States, 2016–2017 in the May 5 issue of MMWR. This information was previously published as an MMWR Early Release and covered in IAC Express #1305.
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OFFICIAL RELEASES AND ANNOUNCEMENTS
World Hand Hygiene Day celebrated May 5; CDC and WHO have many new resources on their websites
May 5 was World Hand Hygiene Day. CDC has this to say about hand hygiene:
Practicing hand hygiene is a simple yet effective way to prevent infections. Cleaning your hands can prevent the spread of germs, including those that are resistant to antibiotics and are becoming difficult, if not impossible, to treat. On average, healthcare providers clean their hands less than half of the times they should. On any given day, about one in 25 hospital patients has at least one healthcare-associated infection.
The related Clean Hands Count campaign aims to:
- Improve healthcare provider adherence to CDC hand hygiene recommendations
- Address the myths and misperceptions about hand hygiene
- Empower patients to play a role in their care by asking or reminding healthcare providers to clean their hands
The Clean Hands Count Campaign on CDC's website offers online educational courses and a promotional video for healthcare providers, as well as other resources such as posters, fact sheets, and digital tools. The World Health Organization (WHO) also has much information related to cleaning hands appropriately on its SAVE LIVES: Clean Your Hands web section.
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Measles & Rubella Initiative announces the launch of its newly redesigned website
The Measles & Rubella Initiative partners are pleased to announce the launch of their newly redesigned website. New features include:
- New and improved interactive map
- Compatibility with mobile devices
- Regularly updated links to recent peer reviewed publications
- Up-to-date information on where the Initiative is operating around the world
Check out the redesigned website at http://measlesrubellainitiative.org.
The Measles & Rubella Initiative is led by the American Red Cross, the United Nations Foundation, the U.S. Centers for Disease Control and Prevention, UNICEF, and the World Health Organization.
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CDC and WHO report on the progress toward measles elimination in Africa in this week's MMWR and Weekly Epidemiological Report, respectively
CDC published Progress
Toward Measles Elimination—African Region, 2013–2016 in the May 5 issue of MMWR. On the same day, the World Health Organization (WHO) published
Progress towards measles elimination—African Region, 2013–2016 in its Weekly Epidemiological Record. A summary of the MMWR article provided to the press is reprinted below.
Countries in the World Health Organization African Region show progress and
setbacks toward a regional goal of measles elimination by 2020. The number of
new cases annually in the region has decreased by 63% from 2013 to 2016.
However, not enough children are receiving the recommended two doses of vaccine
to provide full protection against measles. The majority of children in the
region not being fully protected against measles reside in four countries:
Nigeria, Ethiopia, the Democratic Republic of the Congo, and Angola; these
countries also account for the majority of the region’s measles cases each year.
Only half of all African Region countries have introduced a second vaccine dose
against measles. For the region to eliminate measles by 2020, efforts are needed
for countries to achieve ≥95% two-dose coverage.
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Dr. Paul Offit's column in The Daily Beast discusses the importance of influenza and Tdap vaccination during pregnancy
As reported in the February 1 issue of IAC Express, Dr. Paul A. Offit, MD, director of the Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, is now contributing weekly columns to The Daily Beast. Columns will be about popular issues related to science, not limited to vaccines. This week's column about the importance of influenza and Tdap vaccination during pregnancy is titled This
Could Save Your Baby’s Life.
You can follow Dr. Offit’s columns by visiting the relevant archive page on The Daily Beast.
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ECBT's "Shot of Prevention" blog provides a community forum for discussing immunization; May 4 post features "The Purple Book" app
"Shot of Prevention" is a community blog where individuals, parents, medical professionals, and others can discuss questions and current events regarding immunizations. Blog posts are written, and discussion is moderated, by Every Child By Two (ECBT).
The May 4 "Shot of Prevention" postincludes information about the newly updated The Vaccine Handbook App, including input from the author, Dr. Gary Marshall, and a review by MaryBeth Koslap-Petraco, pediatric nurse practitioner and adjunct clinical assistant professor at Stony Brook University School of Nursing.
For more information on this free app for iPhones and iPads, see the second article in this issue of IAC Express.
Clinicians should feel free to refer vaccine-hesitant parents and patients to "Shot of Prevention" at www.shotofprevention.com. Feel free to visit and recommend the other ECBT websites as well: www.ecbt.org and www.vaccinateyourfamily.org.
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"Seattle Mama Doc" explores vaccine hesitancy in recent blog post
"Seattle Mama Doc," a blog by Dr. Wendy Sue Swanson, MD, MBE, FAAP, published
on the Seattle Children’s Hospital's website, recently published a post titled Vaccination Hesitancy: 4 Myths Explained. The first three paragraphs are reprinted below.
Vaccination hesitancy or concern about getting your child their shots isn’t
new. But it has recently been gaining attention in the media. In
February, Robert Kennedy Jr. offered a $100,000 reward for anyone who could
turn up a study showing that it is safe to administer vaccines to children and
pregnant women. Let me start by saying that there are countlessstudies and
data in support of vaccination safety. So the offer and claim should be
given/received over and over and over again.
I mean, COME ON.
However, with politicians using their platform to blast these fallacies and
doubts about vaccination, I worry there is a new sense of unease growing among
parents. This unease is causing pediatricians to worry about what’s to come in
the coming years for families and their safety.
Access the complete post: Vaccination Hesitancy: 4 Myths Explained
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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 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 firstname.lastname@example.org.
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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EDUCATION AND TRAINING
Reminder: CDC's NetConference series about adult immunization runs every
Wednesday, April 12–May 31
CDC is sponsoring a 6-part NetConference series on vaccinating adults
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,
- 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
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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ASK THE EXPERTS
Question of the Week
I had an 18-year-old in the clinic today for varicella vaccination. He reports having antiphospholipid syndrome being treated with rituximab (a drug that affects the function of B lymphocytes). The next dose of rituximab will be in 2 weeks. He has also had 12 immune globulin (IG) injections in the last year. Should he get the varicella vaccine at all with this condition, and if so, what time frame do we need to be concerned with in relation to the rituximab treatment and/or IG?
The Infectious Diseases Society of America guidelines indicate that persons
receiving rituximab should be considered to have high-level immunosuppression.
Both inactivated and live vaccines should be withheld at least 6 months
following treatment with anti-B cell medications such as rituximab. As for the
IG, the interval to live vaccination depends on the dose. Please refer to the
table on pages 37–39 of the "General Best Practices Guidelines for Immunization"
at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf for guidance. This interval could be as long as 11 months, depending on the dose he receives.
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 www.immunize.org/subscribe.
If you have a question for the CDC immunization experts, you can email them directly at email@example.com. There is no charge for this service.
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