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Issue 1315: July 12, 2017

Ask the Experts
Ask the Experts—Question of the Week: Is it acceptable to administer vaccines in the nurses’ station . . . read more







Secretary Price appoints Dr. Brenda Fitzgerald as new CDC director

On July 7, U.S. Health and Human Services (HHS) Secretary Tom Price, MD, named Brenda Fitzgerald, MD, as director of the Centers for Disease Control and Prevention. The first four paragraphs of the HHS press release are reprinted below.

Today, Health and Human Services Secretary Tom Price, M.D., named Brenda Fitzgerald, M.D., as the 17th Director of the Centers for Disease Control and Prevention (CDC) and Administrator of the Agency for Toxic Substances and Disease Registry (ATSDR).

“Today, I am extremely proud and excited to announce Dr. Brenda Fitzgerald as the new Director of the CDC,” said Secretary Price. “Having known Dr. Fitzgerald for many years, I know that she has a deep appreciation and understanding of medicine, public health, policy and leadership—all qualities that will prove vital as she leads the CDC in its work to protect America’s health 24/7. We look forward to working with Dr. Fitzgerald to achieve President Trump's goal of strengthening public health surveillance and ensuring global health security at home and abroad. Congratulations to Dr. Fitzgerald and her family.”

Dr. Fitzgerald has been the commissioner of the Georgia Department of Public Health (DPH) and state health officer for the past six years. She replaces Dr. Anne Schuchat, who has been the acting CDC director and acting ATSDR administrator since January 20. Dr. Schuchat is returning to her role as CDC’s principal deputy director.

“Additionally, I’d like to extend my deep appreciation and thanks to Dr. Anne Schuchat for her exemplary service as acting director of the CDC,” said Secretary Price. “We thank Dr. Schuchat and her team for their dedication in our public health efforts to keep Americans safe and for their work to ensure a seamless transition. We look forward to continuing to work with Dr. Schuchat in her role as principal deputy director of CDC.”

Read the complete statement from HHS: Secretary Price Appoints Brenda Fitzgerald, M.D., as CDC Director and ATSDR Administrator

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CDC and FDA announce new Vaccine Adverse Event Reporting website and reporting form

On June 30, CDC and the Food and Drug Administration (FDA) announced a new Vaccine Adverse Event Reporting (VAERS) website and reporting form that allows people to:

  • Easily submit a VAERS report electronically
  • Access VAERS data
  • Learn more about how CDC and FDA monitor the safety of vaccines

There are now two ways to report an adverse event following vaccination to VAERS:

  1. Use the online reporting tool.
  2. Complete a paper VAERS form (PDF format) and upload it to the new VAERS website.

By the end of 2017, CDC and FDA will phase out the VAERS paper form and fully transition to the new VAERS 2.0 electronic submission process. Accommodations will be made for persons unable to submit reports electronically. Additional assistance is available via email at or by phone at (800) 822-7967.

Access the new VAERS website.

Adverse events should be reported to VAERS regardless of whether a healthcare professional thinks its related to the vaccine or not, as long as it follows administering a dose of vaccine.

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CDC publishes an MMWR Early Release and a CDC Health Advisory about patients receiving eculizumab being at high risk for meningococcal disease despite vaccination

On July 7, CDC published a report titled High Risk for Invasive Meningococcal Disease Among Patients Receiving Eculizumab (Soliris) Despite Receipt of Meningococcal Vaccine as an MMWR Early Release. On the same day, the CDC Health Alert Network released a "CDC Health Advisory" on the same topic, titled Patients Receiving Eculizumab (Soliris®) at High Risk for Invasive Meningococcal Disease Despite Vaccination. The first three sections of the health advisory are reprinted below.


Eculizumab (Soliris®) recipients have a 1,000 to 2,000-fold greater risk of invasive meningococcal disease compared to the general U.S. population. The Food and Drug Administration (FDA)-approved prescribing information for eculizumab includes a black box warning for increased risk of meningococcal disease, and the Advisory Committee on Immunization Practices (ACIP) recommends meningococcal vaccination for all patients receiving eculizumab. Recent data show that some patients receiving eculizumab who were vaccinated with the recommended meningococcal vaccines still developed meningococcal disease, most often from nongroupable
Neisseria meningitidis, which rarely causes invasive disease in healthy individuals.


Eculizumab is most commonly prescribed for treatment of 2 rare blood disorders: atypical hemolytic uremic syndrome (aHUS) and paroxysmal nocturnal hemoglobinuria (PNH). Through a request for data on meningococcal disease cases reported to state health departments, the U.S. Centers for Disease Control and Prevention (CDC) identified 16 cases of meningococcal disease in eculizumab recipients in the United States from 2008 through 2016; 11 (69%) of these were caused by nongroupable
N. meningitidis. Meningococcal conjugate (MenACWY) vaccine targets serogroups A, C, W, and Y, and provides no protection against nongroupable N. meningitidis. Serogroup B meningococcal (MenB) vaccines are licensed specifically for protection against serogroup B meningococcal disease. Researchers have not assessed the extent of any potential cross protection for nongroupable N. meningitidis strains.

Recommendations for Healthcare Providers

Healthcare Providers:

  • Could consider antimicrobial prophylaxis for the duration of eculizumab therapy to potentially reduce the risk of meningococcal disease
  • Should continue meningococcal vaccination of all patients who receive eculizumab
  • Should administer meningococcal vaccines at least 2 weeks prior to administering the first dose of eculizumab, unless the risks of delaying eculizumab therapy outweigh the risks of developing a meningococcal infection, according to the product label
  • Should maintain a high index of suspicion for meningococcal disease in patients taking eculizumab who present with any symptoms consistent with either meningitis or meningococcemia, even if the patient’s symptoms initially appear mild, and irrespective of the patient’s meningococcal vaccine or antimicrobial prophylaxis status

The complete CDC Health Advisory includes a section of additional information with many links and references, including the following:

Related Links

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Polio worker killed in Pakistan; over 100 such workers have been killed in the last 5 years

A polio worker in northwestern Pakistan, returning from his vaccination outreach work at the village hospital, was shot and killed by two men on June 30. According to news sources, since December 2012, more than 100 such health workers have been killed. No organization has claimed responsibility for this most recent attack. The World Health Organization’s (WHO) statement on the polio eradication initiative in Pakistan indicates that there has been a continuing ban on immunization by militants.

Soheil Ahmed, the health worker who was shot, was working for Pakistan’s Expanded Programme on Immunisation. 
News reports on the deaths of the polio health workers:

Related Links

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IAC Spotlight! Six previously honored institutions qualify for additional years on IAC's Hepatitis B Birth Dose Honor Roll

The Immunization Action Coalition (IAC) is pleased to announce that six institutions have qualified for its Hepatitis B Birth Dose Honor Roll for an addition period. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

The following four institutions are being recognized for a second year:

  • Adirondack Medical Center, Saranac Lake, NY (100%)
  • Columbus Community Hospital, Columbus, TX (99%)
  • Metropolitan Hospital Center, Women and Children's Services Health, New York, NY (100%)
  • Nemaha Valley Community Hospital, Seneca, KS (100%)

In addition, the following institution is being recognized for a third year:

  • 673rd Medical Group, JBER, AK (97%)

Finally, the following institution is being recognized for a fourth year:

  • Arkansas Valley Regional Medical Center, La Junta, CO (92%)

The Honor Roll now includes 344 birthing institutions from 39 states, Puerto Rico, and Guam. Seventy-five institutions have qualified for two years, 40 institutions have qualified three times, 10 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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WHO releases updated position paper on hepatitis B vaccination

WHO published Hepatitis B vaccines: WHO position paper—July 2017 in the July 7 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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Reminder: Coding and billing resources available online from the National Adult and Influenza Immunization Summit

In May, the National Adult and Influenza Immunization Summit posted Coding and Billing for Adult Vaccinations 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.

This resource includes the following sections:

Access Coding and Billing for Adult Vaccinations.

Related Link

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Hepatitis B Foundation releases new video in its storytelling project: #justB

In January, the Hepatitis B Foundation launched its 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 the July video, Bunmi's Story, about a woman of Nigerian ancestry whose father died of liver cancer. She recounts the taboos and stigmas associated with hepatitis B virus infection.

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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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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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Hawaii Immunization Coalition to sponsor September 19 webinar on using standing orders

The Hawaii Immunization Coalition is sponsoring a webinar on September 19 titled "Standing Orders for Vaccination." The featured speaker will be William Atkinson, MD, MPH, former CDC medical epidemiologist and now the associate director for immunization education at the Immunization Action Coalition.

Standing orders are written protocols approved by a physician or other authorized practitioner that allow qualified healthcare professionals, such as registered nurses or pharmacists, to assess the need for vaccination and to vaccinate patients meeting certain criteria. Standing orders have been proven effective in increasing vaccination rates among adults and children, when used alone or with additional interventions, and across a range of settings (clinics, hospitals, pharmacies, and long-term care facilities) and populations.

Access registration information.

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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

Is it acceptable to administer vaccines in the nurses’ station where vital signs and other patient care is performed?

Yes. Vaccines can be administered in a patient care area. The recommendation from CDC's safe injection practices experts is that storing and preparing vaccines should not be done in the same area where patient care is conducted. These activities should be done in a separate area.  

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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