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Issue 1316: July 19, 2017

Ask the Experts
Ask the Experts—Question of the Week: What is the dosing for tetanus immune globulin for an adult with suspected . . . read more








CDC reports on Minnesota measles outbreak in MMWR

CDC published Measles Outbreak—Minnesota April–May 2017 in the July 14 issue of MMWR (pages 712–7). A summary made available to the press is reprinted below.

Since April 2017, a measles outbreak in Minnesota has been demonstrating the importance of maintaining high vaccination rates to protect communities from measles. Measles quickly spread in an under-vaccinated population, resulting in a large-scale and intensive public health response to prevent further illnesses and possible deaths. The outbreak also highlighted the importance of building trust with communities and identifying effective, culturally appropriate ways to address questions, concerns, and misinformation about the MMR vaccine.

After a hopeful pause in reported new cases in this Minnesota outbreak, a new case was reported on July 13, for a total of 79.

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Measles outbreaks in Europe have caused 35 deaths in the past year  

In the past 12 months, 35 children have died from a measles outbreak in Europe, according to the World Health Organization (WHO). Thirty-one of those deaths occurred in Romania. In Italy, where there have been more than 3,300 cases in the past year, the Prime Minister blamed the “spread of anti-scientific theories” as a reason for a decrease in vaccinations.

In a July 11 press release, WHO’s Regional Director for Europe, Dr. Zsuzsanna Jakab, stated:

Every death or disability caused by this vaccine-preventable disease is an unacceptable tragedy. We are very concerned that although a safe, effective, and affordable vaccine is available, measles remains a leading cause of death among children worldwide, and unfortunately Europe is not spared. Working closely with health authorities in all European affected countries is our priority to control the outbreaks and maintain high vaccination coverage for all sections of the population.
News reports on the deadly measles outbreak in Europe:

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CDC publishes Vaccine Information Statement for cholera

On July 6, CDC released a new Cholera Vaccine Information Statement (VIS). The U.S. Food and Drug Administration (FDA) approved Vaxchora (PaxVax) for the prevention of cholera on June 10, 2016. The vaccine was approved for use in adults 18 through 64 years old traveling to cholera-affected areas. It is the only FDA-approved vaccine to prevent cholera. 

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IAC Spotlight! July 10 webinar of Dr. William L. Atkinson presenting “Adolescent Immunization Update and the 16-Year-Old Platform” can be viewed on IAC website; slide set and presenter's notes also available

On July 10, Dr. William L. Atkinson, MD, MPH, IAC’s associate director for immunization education, presented a webinar titled “Adolescent Immunization Update and the 16-Year-Old Platform.” The webinar provided a review of immunization platforms —healthcare visits where specific vaccines are indicated—specifically the 16-year-old immunization platform added to the Child and Adolescent Immunization Schedule in 2017. It also included a discussion of current immunization rates among adolescents and recommendations for Tdap, HPV, and meningococcal vaccines (both meningococcal conjugate and meningococcal serogroup B), with emphasis on the second dose of meningococcal conjugate vaccine recommended at the 16-year-old visit. Strategies to improve immunization rates among adolescents were also summarized.

This presentation is now available on the home page of IAC’s main website at To view it, scroll down to the middle of the page to Dr. Atkinson’s photo and click on the link.

In addition, the slide presentation and presenter's notes are available on IAC’s PowerPoint Slide Set web page. At this link, you can request the full PowerPoint slide set and presenter's notes to create your own adolescent immunization presentation.

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Cholera cases in Yemen now exceed 300,000, with 7,000 new cases daily

The number of those stricken with cholera in Yemen now exceeds 300,000, with about 7,000 new cases every day, according to the International Committee of the Red Cross (ICRC). In fewer than 3 weeks, the number of cases has increased by 100,000.
After two years of civil war, Yemen’s sewage system has stopped functioning, its clean water system has been crippled, and the country is on the brink of famine. The rise of malnutrition has made the population especially vulnerable to cholera.
A selection of the news reports about the Yemen cholera outbreak follows:

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Reminder: August is National Immunization Awareness Month; 2017 communications toolkit 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. The website also includes 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.

  • Update your materials with the latest information and key messages that are provided in the toolkit
  • 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.
  • Place NIAM logos and banners on your website and/or social media platforms to highlight your participation in NIAM
  • 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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CDC reports on pneumococcal vaccination of Medicare beneficiaries following 2014 ACIP recommendation

CDC published Pneumococcal Vaccination Among Medicare Beneficiaries Occurring After the Advisory Committee on Immunization Practices Recommendation for Routine Use Of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults Aged ≥65 Years in the July 14 issue of MMWR (pages 728–33). A summary made available to the press is reprinted below.

CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare & Medicaid Services (CMS) to help measure PCV13 and PPSV23 vaccination uptake among adults aged ≥65 years before and after implementation of revised recommendations in September 2014. By September 18, 2016, 43.2 percent of Medicare Parts A and B beneficiaries aged ≥65 years had claims for at least one dose of PPSV23 (regardless of PCV13 status), 31.5 percent had claims for at least one dose of PCV13 (regardless of PPSV23 status), and 18.3 percent had claims for at least one dose each of PCV13 and PPSV23.
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Unity Consortium survey finds major areas for improvement in preventive health communications to teens

The Unity Consortium recently released the results of a fall 2016 survey about teen health communication. Selections from a related press release are reprinted below.

A vast majority of parents and teens believe it is important for all teens to be vaccinated. However, in reality teen vaccination rates are far lower than where they should be. For instance, less than 50% of male teens and 65% of female teens have received the first dose of the HPV vaccine series. Why the reason for this gap? Unity evaluated this closely in a recently published Call to Action, Adolescent Immunization: Understanding Challenges and Framing Solutions for Healthcare Providers, and the survey results reinforced that both parents’ and teens’ attitudes towards preventive health keep them from prioritizing important preventive health strategies like vaccination.

  • Approximately 1 in 4 parents and teens (23% each) believe that vaccines are more important for babies and not as important for teens
  • More than one-third of teens (34%) don't know how being vaccinated helps them
  • Four in 10 parents (41%) believe their teen should only see a doctor when he/she feels sick, reducing opportunities to discuss preventive health measures, such as vaccines
  • While most teens (92%) trust their doctor when seeking information about their health, nearly half of all teens (47%) agree they do not like talking to doctors or other healthcare providers....

Access the complete press release: Vaccines Not Just for Babies: New Survey Reveals Teen Health May Be Impacted by Misperceptions.

The mission of the Unity Consortium is improving adolescent health through a focus on prevention and immunization. 

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Voices for Vaccines releases new podcast about a pro-vaccine advocate touring the country to counter misinformation

Voices for Vaccines (VFV) has posted the seventh entry in its Vax Talk podcast series. The newest podcast features Craig Egan, who took a hiatus from his job and set up a Go Fund Me page to finance a multi-state tour to follow the anti-vaccine crew on the Vaxxed bus. VFV invited him to discuss what is happening behind the scenes on this tour, what happened when he set up a protest outside the bus, and how everyone can do their part to advocate for immunization. 

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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Weekly Epidemiological Report publishes summary of Global Advisory Committee on Vaccine Safety meeting

WHO published Meeting of the Global Advisory Committee on Vaccine Safety, 7–8 June 2017 in the July 14 issue of the Weekly Epidemiological Record. The first paragraph is reprinted below.

The Global Advisory Committee on Vaccine Safety (GACVS), an independent expert clinical and scientific advisory body, provides WHO with scientifically rigorous advice on vaccine safety issues of potential global importance. GACVS held its 36th meeting in Geneva, Switzerland, on 7–8 June 2017. The Committee examined 3 vaccine specific safety issues: pharmacovigilance planning for the pilot implementation programme for the antimalaria vaccine, RTS,S/AS01 (RTS,S) in 3 countries; updates on the safety profiles of Bacillus Calmette-Guérin (BCG) vaccine and human papilloma virus (HPV) vaccine; and the generic issue of development of standards and a template for the review of the safety profile of vaccines during GACVS meetings.

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CDC offers new multimedia products to share with parents

CDC offers a selection of multimedia products to help promote immunization with parents, including easy-to-read immunization schedules, an immunization tracker, videos, listicles, infographics, fact sheets, PSAs, sample Facebook posts and Twitter messages, graphics (including animated graphics), print ads, and posters.


CDC suggests you share these materials with audiences in the following ways:
  • Linking to them from your website
  • Sharing them via your social media channels
  • Copying and distributing flyers and fact sheets
  • Printing and hanging posters
  • Using print ads for media buys with local magazines and newspapers

Visit CDC's Multimedia Products for Parents web page to explore these resources.

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Reminder: CDC offers new online educational program on vaccine administration 

In June, CDC released a new free, interactive, online educational program ("e-Learn") that serves as a useful introductory course or a great refresher on vaccine administration. Proper vaccine administration is critical for ensuring that vaccines are both safe and effective, but unfortunately, administration errors happen too frequently. Some of the most common vaccination administration errors include:

  • Not following the recommended immunization schedule
  • Administering improperly stored or expired vaccine and/or diluent
  • Administering the wrong vaccine—confusing look-alike or sound-alike vaccines such as DTaP/Tdap or administering products outside age indications

The self-paced e-Learn provides comprehensive training—using videos, job aids, and other resources to accommodate a variety of learning styles—and offers a certificate of completion and/or continuing education for those that complete the training.

The new course is available at

For more information, please contact

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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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June issue of CDC's Immunization Works newsletter now available

CDC recently released the June issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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CDC publishes information about patients receiving eculizumab being at high risk for meningococcal disease despite vaccination; previously published as an MMWR Early Release 

CDC published High Risk for Invasive Meningococcal Disease Among Patients Receiving Eculizumab (Soliris) Despite Receipt of Meningococcal Vaccine in the July 14 issue of MMWR (pages 734–7). This information was previously published as an MMWR Early Release and a CDC Health Advisory on July 7, and covered in the July 12 issue of IAC Express.

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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

ACOG to present "Best Practices to Improve Maternal Immunization" webinar on August 7
The American College of Obstetricians and Gynecologists (ACOG) will be hosting a webinar titled "Best Practices to Improve Maternal Immunization" on August 7, at 12:00 p.m. (ET). This session is free and open to all; ACOG membership is not required. CME credit is available.

Upon completion of the webinar, participants will be able to
  • Emphasize the importance of maternal immunizations
  • Update on current recommendations for maternal immunization and the future of maternal immunization 
  • Discuss practical tips to incorporate immunizations into your practice
  • Identify and locate resources for providers and patients regarding immunizations
Registration information

Following the live presentation, the webinar will be archived on ACOG’s archived webinar web page, for convenient viewing. The recording will not provide CME credit. 

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Four upcoming opportunities to participate in GSA's "Immunization Champions, Advocates & Mentors Program" (ICAMP) training

Immunization providers are invited to participate in one of four half-day "Immunization Champions, Advocates & Mentors Program" (ICAMP) trainings, sponsored by the Gerontological Society of America (GSA). ICAMP is a multidisciplinary program designed to equip healthcare professionals to champion adult immunization practices that improve public health and the quality of care for the people they serve.

Upcoming training sessions will be held in Miami (September 14), San Antonio (September 28), Chicago (October 10), and New York City (November 2). A $175 registration fee includes program materials, live program and action planning, snack, and ongoing dialogue with 2016 and 2017 immunization champions. Attendees are required to participate in a pre-program webinar and respond to three surveys over 12 months on adult immunization rate changes. Program objectives:

  • Learn the skills needed to champion practice change
  • Create an action plan to mobilize your organization to improve adult immunization rates
  • Collaborate with multidisciplinary health care professionals
  • Establish your measurement parameters

Registration information

ICAMP is developed by the Gerontological Society of America and supported in part by Pfizer and Merck.

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Area Health Education Center Network offers archived webinars on HPV vaccination, including one on HPV hesitancy and myths; free CE/CEU credit available

The Scenic Rivers Area Health Education Center Network has a number of webinars about HPV archived on its website, including a June offering titled "Addressing HPV Vaccine Hesitancy and Myths." Free continuing education credit (CE/CME) is available for completing archived events. 

Access the archived webinar page on the Scenic Rivers Area Health Education Center Network website.

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Question of the Week

What is the dosing for tetanus immune globulin for an adult with suspected tetanus?   

ACIP recommends a single dose of tetanus immune globulin (TIG) for treatment of persons with tetanus. Although the optimal therapeutic dose has not been established, experts recommend 500 international units (IU), which appears to be as effective as higher doses ranging from 3,000 to 6,000 IU and causes less discomfort. Available preparations must be administered intramuscularly; TIG preparations available in the United States are not licensed or formulated for intrathecal or intravenous use. Infiltration of part of the dose locally around the wound is usually recommended if feasible, although the efficacy of this approach has not been proven. If TIG is not available, intravenous immune globulin (IGIV) can be used at a dose of 200 to 400 milligrams per kilogram (mg/kg). However, the Food and Drug Administration has not approved IGIV for this use. In addition, anti- tetanus antibody content varies from lot to lot. See for more information on this issue.

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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