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Issue 1323: August 30, 2017

Ask the Experts
Ask the Experts—Question of the Week: I have a healthy 11-month-old patient whose family is traveling to Zimbabwe . . . read more








CDC publishes ACIP 2017–18 influenza vaccination recommendations

CDC published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2017–18 Influenza Season" in the August 25 MMWR Recommendations and Reports. The first three paragraphs of the Summary section are reprinted below.

This report updates the 2016–17 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines (MMWR Recomm Rep 2016;65[No. RR-5]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used.

For the 2017–18 season, quadrivalent and trivalent influenza vaccines will be available. Inactivated influenza vaccines (IIVs) will be available in trivalent (IIV3) and quadrivalent (IIV4) formulations. Recombinant influenza vaccine (RIV) will be available in trivalent (RIV3) and quadrivalent (RIV4) formulations. Live attenuated influenza vaccine (LAIV4) is not recommended for use during the 2017–18 season due to concerns about its effectiveness against (H1N1)pdm09 viruses during the 2013–14 and 2015–16 seasons. Recommendations for different vaccine types and specific populations are discussed. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended product is available.

Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 20, 2016; February 22, 2017; and June 21, 2017. New and updated information in this report includes the following:

  • Vaccine viruses included in the 2017–18 U.S. trivalent influenza vaccines will be an A/Michigan/45/2015 (H1N1)pdm09–like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain these three viruses and an additional influenza B vaccine virus, a B/Phuket/3073/2013–like virus (Yamagata lineage).
  • Information on recent licensures and labelling changes is discussed, including licensure of Afluria Quadrivalent (IIV4; Seqirus, Parkville, Victoria, Australia); Flublok Quadrivalent (RIV4; Protein Sciences, Meriden, Connecticut); and expansion of the age indication for FluLaval Quadrivalent (IIV4; ID Biomedical Corporation of Quebec, Quebec City, Quebec, Canada), previously licensed for ≥3 years, to ≥6 months.
  • Pregnant women may receive any licensed, recommended, age-appropriate influenza vaccine.
  • Afluria (IIV3; Seqirus, Parkville, Victoria, Australia) may be used for persons aged ≥5 years, consistent with Food and Drug Administration–approved labeling.
  • FluMist Quadrivalent (LAIV4; MedImmune, Gaithersburg, Maryland) should not be used during the 2017–18 season due to concerns about effectiveness against influenza A(H1N1)pdm09 viruses in the United States during the 2013–14 and 2015–16 influenza seasons.

Read the full report here.

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CDC issues report on the national, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years in the U.S. in 2016

CDC published National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years—United States, 2016 on August 25 in MMWR. The first two paragraphs are printed below.

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents routinely receive tetanus, diphtheria, and acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MenACWY), and human papillomavirus (HPV) vaccine at age 11–12 years. ACIP also recommends catch-up vaccination with hepatitis B vaccine, measles, mumps, and rubella (MMR) vaccine, and varicella vaccine for adolescents who are not up to date with childhood vaccinations. ACIP recommends a booster dose of MenACWY at age 16 years. In December 2016, ACIP updated HPV vaccine recommendations to include a 2-dose schedule for immunocompetent adolescents initiating the vaccination series before their 15th birthday. To estimate adolescent vaccination coverage in the United States, CDC analyzed data from the 2016 National Immunization Survey–Teen (NIS-Teen) for 20,475 adolescents aged 13–17 years. During 2015–2016, coverage increased for ≥1 dose of Tdap (from 86.4% to 88.0%) and for each HPV vaccine dose (from 56.1% to 60.4% for ≥1 dose). Among adolescents aged 17 years, coverage with ≥2 doses of MenACWY increased from 33.3% to 39.1%. In 2016, 43.4% of adolescents (49.5% of females; 37.5% of males) were up to date with the HPV vaccination series, applying the updated HPV vaccine recommendations retrospectively. Coverage with ≥1 HPV vaccine dose varied by metropolitan statistical area (MSA) status and was lowest (50.4%) among adolescents living in non-MSA areas and highest (65.9%) among those living in MSA central cities. Adolescent vaccination coverage continues to improve overall; however, substantial opportunities exist to further increase HPV-associated cancer prevention.

NIS-Teen is conducted among parents and guardians of eligible adolescents identified using a random-digit–dialed sample of landline and cellular telephone numbers. Parents and guardians are interviewed for information on the sociodemographic characteristics of the adolescent and household, and contact information for the child’s vaccination providers. If more than one age-eligible adolescent lives in the household, one adolescent is randomly selected for participation. With parental/guardian consent, health care providers identified during the interview are mailed a questionnaire requesting the vaccination history from the adolescent’s medical record.

Access the full report.

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Deadly hepatitis A outbreak has killed 14 in San Diego County since early 2017

The County of San Diego Health and Human Services Agency's Public Health Services Division has been seeking the source of a hepatitis A outbreak that has claimed 14 lives since early 2017. To date, 352 cases have been reported that are related to the local outbreak. To reduce the spread of this outbreak, the county staff and their healthcare partners have been vaccinating people in target locations. Most, but not all, stricken by the disease have been people who are homeless or who use illicit drugs. 

Access information and resources regarding hepatitis A and additional news about the outbreak on the Health and Human Services web page of the San Diego County website.

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American Academy of Family Physicians releases new immunization advocacy online tool showing vaccine legislation and vaccine coverage by state

The American Academy of Family Physicians (AAFP) has released a new online mapping tool that provides state-by-state information on vaccination rates and other types of data that can support immunization advocacy efforts. For example, the tool shows which states permit certain types of vaccination exemptions. This State Immunization Information System (IIS) Legislation tool can assist with efforts to reach out to legislators regarding state immunization efforts. An article on the AAFP website, which describes the tool, states one of its major objectives:

By using the state-by-state information the tool offers through both maps and information tables, immunization advocates can show state legislators where immunization data are falling through the cracks and appeal to them to tighten up reporting requirements. Getting as complete a picture of overall vaccine coverage as possible allows health policy makers to more reliably target efforts to enhance public health through immunization outreach programs.

Read the full article on the AAFP website: AAFP Mapping Tool Aims to Enhance Immunization Advocacy (8/23/17).

Visit the AAFP mapping tool.

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Reminder: Today, Wednesday, August 30, VICNetwork webinar at 2 p.m. (ET) about new Advisory Committee on Immunization Practices recommendations on influenza vaccination for 2017–18

VICNetwork is presenting a one-hour webinar today, Wednesday, August 30, beginning at 2:00 p.m. (ET) titled "Communication Strategies and Recommendations for the Upcoming 2017–18 Flu Season." This webinar will feature important updates from ACIP on this year's flu vaccine, communication plans by CDC, and resources that will help with national, state, and local influenza vaccination efforts.

Register for the webinar.

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IAC Spotlight! IAC's Video of the Week presents personal stories, news, animations, and other video clips of interest to our readers every Monday

IAC's Video of the Week has been an engaging and informative feature on since 2009. The videos present personal stories, news, animations, and other types of immunization-related video clips that are of interest to our readers. Video of the Week appears on the home page of and changes every Monday. It also appears every week in the IAC Express in the right-hand column. In addition, our readers can search by year and month for previous videos of the week in the Video of the Week Archive web page of

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Voices for Vaccines releases a total of four podcasts in August during National Immunization Awareness Month 

Voices for Vaccines released four podcasts during National Immunization Awareness Month in August. Each of the podcasts listed below, which are part of their Vax Talk series, addresses a topic related to one of the four weekly topics that were the focus of National Immunization Awareness Month: babies and young children, pregnant women, adults, and preteens and teens. 

  • Episode 8.1, on how to be an advocate for immunization, with Karen Ernst, Voices for Vaccines, and Dr. Nathan Boonstraw, Blank Children's Hospital, in "NIAM 17, Baby!"
  • Episode 8.2, on "Pregnancy and Vaccines" with Dr. Flor Munoz, Texas Children's Hospital
  • Episode 8.3, on how "Vaccines Aren't Just for Kids!" featuring Dr. William Schaffner, Vanderbilt University
  • Episode 8.4, on "Teens and Vaccines," featuring an interview with Patti Wukovitz, the mother of Kimberley Coffey, who died from meningitis

Listeners can access these podcasts on the Voices for Vaccines podcast web page, which also provides information on how to subscribe to the entire series.

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IAC corrects small error in the Question of the Week in the August 16 issue of IAC Express

An error occurred in the answer of the Question of the Week published in the August 16 issue of IAC Express. Here is the corrected Q&A:

If a patient received Trumenba meningococcal B vaccine (Pfizer) 2 months ago and Bexsero meningococcal B vaccine (GSK) yesterday, should they complete the series with Trumenba or with Bexsero, since the two brands are not interchangeable? What would be the intervals from the Bexsero dose to the subsequent dose(s)?

The patient can complete the series with either vaccine. If Bexsero is chosen, the second and final dose should be administered at least 1 month after yesterday’s dose. If Trumenba is chosen and the patient is healthy (i.e., does not have a high-risk condition for meningococcal B disease such as asplenia), the second and final dose of Trumenba should be administered at least 4 months after yesterday’s Bexsero dose. If the person is at increased risk for meningococcal B disease and Trumenba is being used, a second Trumenba dose should be administered 1 month after yesterday’s Bexsero dose and a third dose should be administered 4 months after the second Trumenba dose.

The correction is in the third sentence of the answer. The interval for the second and final dose of Trumenba for healthy people is at least 4 months after the Bexsero dose, not 5 months as originally stated.

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Reminder! Nominations due by September 15 for the HPV Vaccine Is Cancer Prevention Champion award sponsored by CDC, the Association of American Cancer Institutes, and the American Cancer Society

The HPV Vaccine Is Cancer Prevention Champion Award is a new annual award given jointly by CDC, the Association of American Cancer Institutes (AACI), and the American Cancer Society (ACS). Nominations for this award are due by September 15. This award recognizes clinicians, clinics, practices, groups, and health systems that are working effectively to protect their adolescents against HPV cancers by achieving high HPV vaccination rates among 11- and 12-year-old patients. Each year, up to one champion from each of the ten U.S. Department of Health and Human Services regions will be selected and recognized.

The first award recipients will be announced in the fall of 2017 and will be featured on the CDC website. They receive an HPV Vaccine Is Cancer Prevention Champion plaque, and they may be recognized at local or national events led by cancer or pediatric organizations. Candidates must be a clinician, clinic, practice, group, or health system that treats adolescents as part of their overall population.

Access the complete award criteria.

Access additional information, instructions, and obtain the nomination packet.

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Weekly Epidemiological Record publishes position paper on cholera vaccines

WHO published Cholera Vaccines: WHO Position Paper—August 2017 in the August 25 issue of the Weekly Epidemiological Record (pages 477–500). An excerpt from the Introduction appears below:

This position paper replaces the 2010 WHO position paper on cholera vaccines. It incorporates recent developments in the field of cholera and provides revised guidance on the target populations for immunization.

Access the full WHO position paper here.

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AAFP News guest editorial by Dr. Margot Savoy highlights wealth of resources to help boost immunization rates

Margot Savoy, MD, MPH, medical director of the Christiana Care Health System Department of Family and Community Medicine and liaison to CDC's Advisory Committee on Immunization Practices, has written a guest editorial for the AAFP website titled Wealth of Resources Available to Help Boost Vaccination Rates. Dr. Savoy describes many resources for boosting vaccination rates, including those available through the AAFP, CDC, and IAC. She also highlights several online resources that support family doctors in having positive conversations around immunization with their patients.

Read Dr. Savoy's guest editorial in the AAFP News.

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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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Vaccine Education Center’s August newsletter for healthcare professionals now online

The Vaccine Education Center at the Children's Hospital of Philadelphia published its immunization-focused newsletter titled Vaccine Update for Healthcare Professionals. The August issue includes the following articles:

Additional resources, including free resources for providers, are available in the full newsletter.

Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.

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Registration now open for Vaccine Education Center's "Current Issues in Vaccines" webinar on September 13 with Dr. Paul Offit

The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, Current Issues in Vaccines—Fall 2017, beginning at 12:00 p.m. (ET) on September 13. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit's topics will be:  
  • Hepatitis A vaccines: Updated recommendations
  • Influenza vaccine: How did we do this year?
  • Varicella vaccine: Impact on the incidence of shingles
  • Mumps vaccine: Is it time for a third dose?
  • Meningococcal vaccine: A remarkable case

Registration (required) is open now. This webinar, viewed live or archived, is accredited for one CPE, one CME, and .1 CEU.

View additional continuing education information.

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IAC and the National Adult and Influenza Immunization Summit sponsor August 31 webinar: “Overcoming Challenges to Providing Adult Immunizations in Healthcare Systems”

IAC and the National Adult and Influenza Immunization Summit (NAIIS) are sponsoring a webinar titled "Overcoming Challenges to Providing Adult Immunizations in Healthcare Systems" on August 31 from 11 a.m.–12 p.m. (ET). The panel of healthcare experts will discuss evidence-based approaches for adult immunization initiatives to become a cost-effective preventive care strategy for hospitals and to improve outcomes for vulnerable populations.

Access the information and registration page for the webinar.

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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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Save the date: Texas Immunization Conference scheduled for November 28–30 in San Antonio

The Texas Immunization Conference will take place on November 28–30 in San Antonio. More information is available on the Texas Immunization Conference website.

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Question of the Week

I have a healthy 11-month-old patient whose family is traveling to Zimbabwe. Where they are traveling has a high rate of varicella. Should I give varicella vaccine to the infant before she travels to Africa?   

The Advisory Committee on Immunization does not recommend varicella vaccination before 12 months of age. It is likely safe to vaccinate the child, but maternal antibodies may limit the benefits of vaccination. If you choose to vaccinate, the child should receive two more doses of varicella vaccine, at 12 months of age or older, separated by at least three months.

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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