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Issue 1307: May 24, 2017

Ask the Experts
Ask the Experts—Question of the Week: I have a 3-month-old patient whose family will be doing mission work in . . . read more







CDC publishes ACIP's updated recommendations on use of Trumenba meningococcal serogroup B vaccine

CDC published Updated Recommendations for Use of MenB-FHbp Serogroup B Meningococcal Vaccine—Advisory Committee on Immunization Practices, 2016 in the May 19 issue of MMWR. The first paragraph is reprinted below.

Two serogroup B meningococcal (MenB) vaccines are currently licensed for use in persons aged 10–25 years in the United States. The two vaccines are MenB-FHbp (Trumenba, Pfizer, Inc.) and MenB-4C (Bexsero, GlaxoSmithKline Biologicals, Inc.). In February 2015, the Advisory Committee on Immunization Practices (ACIP) recommended use of MenB vaccines among certain groups of persons aged ≥10 years who are at increased risk for serogroup B meningococcal disease (Category A), and in June 2015, ACIP recommended that adolescents and young adults aged 16–23 years may be vaccinated with MenB vaccines to provide short-term protection against most strains of serogroup B meningococcal disease (Category B). Consistent with the original Food and Drug Administration (FDA) licensure for the two available MenB vaccines, ACIP recommended either a 3-dose series of MenB-FHbp or a 2-dose series of MenB-4C. Either MenB vaccine can be used when indicated; ACIP does not state a product preference. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses in a series. In April 2016, changes to the dosage and administration of MenB-FHbp were approved by FDA to allow for both a 2-dose series (administered at 0 and 6 months) and a 3-dose series (administered at 0, 1–2, and 6 months). In addition, the package insert now states that the choice of dosing schedule depends on the patient’s risk for exposure and susceptibility to serogroup B meningococcal disease. These recommendations are regarding use of the 2- and 3-dose schedules of MenB-FHbp vaccine (Trumenba) and replace previous ACIP recommendations for use of MenB-FHbp vaccine published in 2015. Recommendations regarding use of MenB-4C (Bexsero) are unchanged.

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Reported measles cases now number 69 in Minnesota outbreak

The measles outbreak in Minnesota covered in the last 3 issues of IAC Express is ongoing.

  • 69 total cases have been confirmed; 59 in Hennepin County, 4 in Ramsey County, 4 in Crow Wing County, and 2 in Le Sueur County
  • 65 have been confirmed to be unvaccinated; 1 had received 1 dose of MMR and 3 had received 2 doses of MMR
  • 66 cases have occurred in children ages 0 through 17 years; there have been 3 cases in adults 
  • 59 of the cases are in Somali-Minnesotan individuals

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 figure stripped of his license to practice medicine by Britain's General Medical Council as a result of ethical and financial misconduct.

The following is a sample of the coverage of this outbreak and its causes in the last week:

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Voices for Vaccines releases fifth podcast—Measles in Minnesota

Voices for Vaccines (VFV) has posted the fifth entry in its Vax Talk podcast series: Measles in Minnesota. The worst measles outbreak in Minnesota in 25 years, sparked by anti-vaccine misinformation, has VFV asking how officials handle outbreaks. In this podcast, pediatrician Dr. Nathan Boonstra and VFV executive director Karen Ernst interview Joe Kurland, an infection preventionist at Children’s Minnesota, where a significant number of cases in this outbreak have been treated, and state representative Mike Freiberg, who has worked for years in the Minnesota legislature to promote evidence-based public health measures.

Karen Ernst has written an accompanying column, also titled Measles in Minnesota.

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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CDC updates 3 items in "The Pink Book" appendices

On May 11, CDC updated the following 3 items in the online appendices of Epidemiology and Prevention of Vaccine-Preventable Diseases, also known as "The Pink Book."

  • Pages A-13–A-14 (Appendix A) “Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines”
  • Pages B-1–B-4 (Appendix B) “U.S. Vaccines”
  • Pages D-5–D-6 (Appendix D) “National Childhood Vaccine Injury Act: Vaccine Injury Table”

Access the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases online, which includes the 2017 Supplement, as well as the updates to the appendices.

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CDC's 2015 viral hepatitis surveillance report is now available

On May 11, CDC released 2015 viral hepatitis surveillance data for the United States, including information on the reported cases of hepatitis A, B, and C. One finding is that in over just 5 years, the number of new hepatitis C virus infections reported to CDC has nearly tripled, reaching a 15-year high.

From a CDC press release:

New hepatitis C virus infections are increasing most rapidly among young people, with the highest overall number of new infections among 20- to 29-year-olds. This is primarily a result of increasing injection drug use associated with America’s growing opioid epidemic.

However, the majority (three-quarters) of the 3.5 million Americans already living with hepatitis C are baby boomers born from 1945 to 1965. Baby boomers are six times more likely to be infected with hepatitis C than those in other age groups and are at much greater risk of death from the virus.

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Applications to host 2019 National Conference for Immunization Coalitions and Partnerships due July 31

The goal of the National Conference for Immunization Coalitions and Partnerships (NCICP) is to improve community health by enhancing the effectiveness of health coalitions by offering training in relevant coalition management and health promotion topics, as well as networking and professional development opportunities, including a bi-annual conference. The conference has traditionally occurred just before Memorial Day weekend in even years; however, when CDC announced that the National Immunization Conference would be held in even years, the NCICP steering committee and coalition directors decided to change its conference to the odd years. In 2017, NCICP will be hosted by Immunize Nevada as part of the Nevada Health Conference, November 13–14, 2017, at Green Valley Ranch, Las Vegas. More information about this 2017 conference will be shared when registration opens.

Please consider hosting the 2019 National Conference for Immunization Coalitions and Partnerships! The conference is usually hosted by a state immunization coalition, with help from a national volunteer planning committee. If your coalition/organization is interested in possibly hosting the 2019 NCICP conference, please email Lisa Robertson (director@VACCINATEINDIANA.ORG) at the Indiana Immunization Coalition, by July 31, 2017, for more information and the application form.

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IAC clarifies Question of the Week about Td/Tdap vaccine series published in previous issue of IAC Express

The Question of the Week (QOTW) featured in the May 17 issue of IAC Express may have generated some confusion because of missing information in the question. The QOTW is reprinted below with an additional sentence added in bold text.

A 16-year-old refugee’s record indicates 2 doses of Td separated by 1 month and 1 dose of Tdap given 4 months after the second Td. The first dose of Td was given at 16 years of age. Is he up to date?  

The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td 6 months after the invalid Tdap dose. If Td is not available, Tdap can be used for this dose.

The minimum interval between the second and third doses of tetanus-containing vaccine is 4 weeks when the first dose in the series is given before the first birthday when a 4-dose series is recommended. In this case, the first dose of Td received was at age 16 years. At this age, a 3-dose series is recommended and the interval between the second and third doses is 6 months, as stated in the answer.

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Free app of The Vaccine Handbook 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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Still 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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CDC reports on hepatitis B screening of pregnant women and care of infants born to HBsAg-positive mothers in Guam

CDC published Hepatitis B Surface Antigen Screening Among Pregnant Women and Care of Infants of Hepatitis B Surface Antigen-Positive Mothers—Guam, 2014 in the May 19 issue of MMWR. A summary made available to the press is reprinted below.

HBV infection is widespread in the U.S. territory of Guam. CDC researchers analyzed data from medical records of pregnant women who delivered live born infants at the largest delivery hospital in Guam in 2014 to assess the prevalence of HBV screening and infection among pregnant women. Among 899 women with available data, 18 (2%) tested positive for hepatitis B surface antigen (HBsAg), an indicator of HBV infection. The 2% HBsAg positivity prevalence from this analysis is more than twice the maternal prevalence estimate for the continental United States (0.9%). Because most of the HBsAg-positive women were born before hepatitis B vaccines was introduced into Guam’s infant vaccination schedule, the risk of perinatal HBV transmission is expected to decrease in future years. However, the findings from this study underscore how vital prenatal HBsAg screening is to ensure positive cases are identified. When given within 12 hours of birth, post-exposure prophylaxis is 85% to 95% effective in preventing HBV transmission.

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Pediatrics publishes study that showed children were more likely to be immunized if their parents had received influenza vaccine

The May issue of the journal Pediatrics includes a study titled The Concordance of Parent and Child Immunization. The abstract is reprinted below.

A substantial body of work has related survey-based parental vaccine hesitancy to noncompliant childhood immunization. However little attention has been paid to the connection between parents’ own immunization behavior and the immunizations their children receive.

Using the Oregon ALERT Immunization Information System, we identified adult caregiver–child pairs for children between 9 months and 17 years of age. The likelihood of adult–child concordance of influenza immunization per influenza season from 2010–2011 through 2014–2015 was assessed. The utility of adult immunization as a predictor was also assessed for other, noninfluenza recommended immunizations for children and adolescents.

A total of 450,687 matched adult caregiver–child pairs were included in the study. The children of immunizing adults were 2.77 times more likely to also be immunized for seasonal influenza across all seasons (95% confidence interval, 2.74–2.79), with similar results applying within each season. Adult immunization status was also significantly associated with the likelihood of children and adolescents getting other noninfluenza immunizations, such as the human papillomavirus vaccine (HPV). When adults improved their own behavior from nonimmunizing to immunizing across influenza seasons, their children if not immunized in the previous season were 5.44 times (95% confidence interval, 5.35–5.53) more likely to become immunized for influenza.

Children’s likelihood of following immunization recommendations is associated with the immunization behavior of their parents. Encouraging parental immunization is a potential tool for increasing children’s immunization rates.

Access the complete article in PDF format: The Concordance of Parent and Child Immunization.

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NFID webinar on addressing challenges in adult vaccine financing scheduled for June 7

The National Foundation for Infectious Diseases (NFID) will be hosting a discussion about challenges around adult vaccine financing and strategies to address barriers on June 7. Presenters include Angela K. Shen, ScD, MPH, senior science policy advisor, National Vaccine Program Office at the U.S. Department of Health and Human Services and C. Michael Soppet, MD, primary care general internist at the Internal Medicine Associates of Dothan and a member of the American College of Physicians Immunization Technical Advisory Committee.
At the conclusion of this activity, participants will be able to:
  • Identify challenges facing providers of adult vaccinations
  • Discuss strategies to address financing barriers
  • Identify practical resources for healthcare professionals

Registration information

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"Principles of Vaccine Storage and Handling" webinar, along with other NFID offerings, now archived for viewing at your convenience

On May 3, Kelly Moore, MD, MPH, director, Tennessee Immunization Program and assistant professor, Preventive Medicine at the Vanderbilt University School of Medicine, presented a webinar for the National Foundation for Infectious Diseases (NFID) on the principles of vaccine storage and handling. You can now access this archived webinar to watch at your convenience.

Other archived webinars, including ones on such topics as travel and occupational vaccination, can be found in the NFID Webinar Library.

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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 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. Remaining presentations are:

  • 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

I have a 3-month-old patient whose family will be doing mission work in sub-Saharan Africa. They are leaving as soon as the child is 6 months old. We gave her the first dose of Menveo brand MenACWY vaccine today. I know the usual Menveo schedule for an infant is 2, 4, 6, and 12 months. If we maintain usual spacing, she will only get 1 more dose before she leaves. Can we compress the schedule so she can get 2 more doses prior to travel? 

The meningococcal ACIP recommendations don't clearly state a minimum interval for MenACWY in this situation. However, the minimum interval for a pediatric MenACWY schedule would presumably be 4 weeks like for other pediatric vaccines on a 2–4–6 schedule. You should try to give a third dose before travel begins.

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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