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Issue 1314: July 6, 2017

Ask the Experts
Ask the Experts—Question of the Week: How effective are three doses of MMR vaccine compared to two doses . . . read more







Register now! Dr. William L. Atkinson, IAC's associate director for immunization education, will present a webinar on adolescent immunization and the 16-year-old platform on July 10

William L. Atkinson, MD, MPH, IAC's associate director for immunization education, will present a one-hour webinar titled "Adolescent Immunization Update and the 16-Year-Old Platform" on July 10 at 1:00 p.m. (ET). During his presentation, Dr. Atkinson will review the recommendations for adolescent vaccines, including those recommended at 11–12 years of age and those at age 16.

Register today for the webinar.

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National Center for Health Statistics releases data brief titled "Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015"

The National Center for Health Statistics recently released the data brief from its 2015 National Health Interview Survey. Key findings from the survey data include:

  • Among adults aged 65 and over, more than two-thirds had an influenza vaccine in the past 12 months (69.0%)
  • More than one in two adults aged 65 and over had a tetanus vaccine in the past 10 years (56.9%)
  • More than 6 of 10 adults aged 65 and over had ever had a pneumococcal vaccine (63.6%), while a little more than one-third had ever had a shingles vaccine (34.2%)
  • Among adults aged 65 and over, vaccination coverage was highest for non-Hispanic white adults compared with non-Hispanic black and Hispanic adults
  • Vaccination coverage was lowest among poor adults aged 65 and over
  • Older adults have greater susceptibility to and complications from disease and so, they stand to benefit greatly from vaccinations as a preventive health measure. This report describes the receipt of an influenza vaccination in the past 12 months, at least one dose of pneumococcal vaccine, a one-time dose of shingles vaccine, and a tetanus booster in the last 10 years among community-dwelling adults aged 65 and over. Data are presented by sex, age group, race and ethnicity, and poverty status.

Access the full NCHS Data Brief. (PDF)

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John Oliver, Last Week Tonight host on HBO, promotes vaccination in 27-minute monologue that has gone viral and has run in major media sources

On June 25, HBO's Last Week’s Tonight host John Oliver presented a 27-minute video monologue on vaccination. Since this monologue aired on June 25, it already has had over 5.5 million viewers, and several major media sources have reported on it as well.

In a monologue interwoven with humor, Oliver provides a comprehensive, in-depth, and research-based examination of the vital importance of vaccination as well as an examination and debunking of the fears and myths related to it. The video monologue includes clips of vaccine experts explaining the individual and global benefits of vaccination and the consequences of succumbing to the fears of vaccination. Oliver ends on a personal note by stating that despite his previous fears, he and his wife made the decision to fully vaccinate their 19-month-old prematurely born son, and he urges his audience—many of them young adults—to do the same. (Warning: this video contains some language and content that could offend, as John Oliver’s shows often do.)
Watch the HBO video monologue on YouTube.

Here are a selection of major media sources reporting on John Oliver's presentation:

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August is National Immunization Awareness Month; 2017 communications toolkit now available

Every year in August, National Immunization Awareness Month (NIAM) provides an opportunity to raise awareness of the importance of immunization and the need for improving national vaccination coverage levels. NIAM is sponsored by the National Public Health Information Coalition (NPHIC). The 2017 edition of the communications toolkit, put out by NPHIC in collaboration with CDC, contains key messages, vaccine information, sample news releases and articles, sample social media messages, links to web resources from CDC and other organizations, and logos, web banners, posters, and graphics to use with social media. It also includes a media outreach toolkit and a place for you to share your NIAM activities and view what others are doing for NIAM, using the hashtag #NIAM17.

The observance features a different group each week of August: 

  • July 31–August 6—Babies and Young Children: A healthy start begins with on-time vaccinations
  • August 7–13—Pregnant Women: Protect yourself and pass protection on to your baby
  • August 14–20—Adults: Vaccines are not just for kids
  • August 21–27—Preteens/teens: Ensure a healthy future with vaccines

CDC has provided the following suggestions to help providers promote vaccination during each week of NIAM.

  1. Update your materials with the latest information and key messages that are provided in the toolkit.
  2. Place matte articles (i.e., formatted, ready-to-print articles that are free to use in any publication) in newsletters, on your website, or in local news outlets. The articles provided in the toolkit assist in educating and motivating consumers to talk to their healthcare professional and get vaccinated, and also encourage healthcare professionals to strongly recommend the vaccines patients need. You can tailor the articles to your particular audience(s) to maximize their impact.
  3. Place NIAM logos and banners on your website and/or social media platforms to highlight your participation in NIAM.
  4. Create buzz for NIAM by using the social media messages in the toolkit. The messages are crafted in a way that enables you to use them as they are—or tailor them as you see fit for your audience(s).

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IAC Spotlight! Reminder: Explore the new "Favorites" tab at the top of every page on

IAC has just made a change to the top of every page of its website to make it easier for users to find the most popular sections on the site. A new dropdown tab, "Favorites," was inserted at the left on the dark gray banner that runs atop every page. When users hover over this new tab with their mouse or click on it, the "Favorites" page content will appear.

Here are just a few examples of the 18 web sections offered as choices on the Favorites tab:

We hope this new tab helps you navigate this IAC website more efficiently!

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CDC's "Update: Influenza Activity in the United States During the 2016-17 Season and Composition of the 2017–18 Influenza Vaccine"

CDC has published Update: Influenza Activity in the United States During the 2016–17 Season and Composition of the 2017–18 Influenza Vaccine in the June 30 issue of MMWR (pages 668–676).

A summary provided by CDC is reprinted below.

During October 2–May 20, 2017, influenza activity remained low through November 2016, increased during December, and peaked in February. During October 2, 2016–May 20, 2017, influenza A(H3N2) viruses were identified most frequently, but influenza A(H1N1)pdm09 and influenza B viruses were also reported. Data collected from November 28, 2016 to April 14, 2017, indicate that influenza vaccination this season reduced the overall risk for influenza-associated medical visits by 42% (95% CI = 35%–48%). The composition of the 2017–18 influenza vaccine has been updated to better match circulating influenza viruses.

Annual influenza vaccination is recommended for all persons aged ≥6 months and remains the most effective way to prevent influenza illness. Antiviral medications are an important adjunct to vaccination in the treatment and prevention of influenza. Early treatment with neuraminidase inhibitor antiviral medications is recommended for patients with severe, complicated, or progressive influenza illness and those at higher risk for influenza complications, including adults aged ≥65 years.

Access the full report from CDC. (PDF)

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

The recently released 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

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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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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New report by the Proceedings of the National Academy of Sciences analyzes the connection between nonmedical vaccine exemptions and pertussis outbreaks in the U.S.

The Proceedings of the National Academy of Sciences of the United States recently released a report titled Geospatial Analysis of Nonmedical Vaccine Exemptions and Pertussis Outbreaks in the United States. The abstract is reprinted below.

Because of increased numbers of recorded pertussis cases in the United States, this study sought to understand the role of nonmedical vaccine exemptions and waning immunity may have had on the resurgence of pertussis in the United States at the community level. We used geospatial scan statistics, SaTScan, version 9.4, to analyze nonmedical vaccine exemptions of children entering kindergarten in 2011 and 2012 and reported pertussis cases in 2012 for children in age groups 5 years and younger and 10 to 14 years. Eight statistically significant clusters of nonmedical vaccine exemptions in kindergarteners and 11 statistically significant clusters of pertussis cases in children and adolescents were identified and geospatially linked. Forty-five percent of the counties in the study had high rates of nonmedical vaccine exemptions. The proportion of kindergarteners with nonmedical vaccine exemptions was 2.8 times larger in the identified exemption clusters. In addition, 31 counties had geographic clusters of high rates of pertussis in children ages 10 to 14 years old, consistent with waning immunity. Our findings are consistent with the view that geographic clusters of nonmedical vaccine exemptions and waning immunity may have been factors contributing to community-level pertussis outbreaks.

Access the abstract and full article in PDF format: Geospatial analysis of nonmedical vaccine exemptions and pertussis outbreaks in the United States.

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Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through October 11; register now 

CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that started June 14 and will run through October 11. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.

The webinar series will provide an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers. 

Registration and more information is available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at

You can also order this resource from the Public Health Foundation for $40 plus shipping and handling. This print version does not include the 2017 supplement.

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Question of the Week

How effective are three doses of MMR vaccine compared to two doses for the prevention of mumps during an outbreak?  

There are no published estimates of the effectiveness of a third dose of mumps-containing vaccine in the setting of a mumps outbreak. However, CDC recommends that a third dose of MMR may be offered in certain outbreak settings (e.g., when a large proportion of cases are in 2-dose MMR recipients). Information about mumps and mumps outbreaks is available on the CDC website at
The Advisory Committee on Immunization Practices (ACIP) has established a Mumps Work Group to examine the epidemiology of mumps in more detail and to further assess the utility of a third dose of MMR vaccine in these outbreak situations.

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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