Issue 1324: September 6, 2017

Ask the Experts
Ask the Experts—Question of the Week: A 5-year-old patient received Pentacel (DTaP-IPV/Hib) for the 5th dose of DTaP . . . read more








AAP issues policy stating that newborns should routinely receive hepatitis B vaccine within 24 hours of birth

The American Academy of Pediatrics (AAP) issued a new policy statement titled Elimination of Perinatal Hepatitis B: Providing the First Vaccine Dose Within 24 Hours of Birth in the August issue of the journal Pediatrics. Two sections are reprinted below.

After the introduction of the hepatitis B vaccine in the United States in 1982, a greater than 90% reduction in new infections was achieved. However, approximately 1,000 new cases of perinatal hepatitis B infection are still identified annually in the United States. Prevention of perinatal hepatitis B relies on the proper and timely identification of infants born to mothers who are hepatitis B surface antigen positive and to mothers with unknown status to ensure administration of appropriate postexposure immunoprophylaxis with hepatitis B vaccine and immune globulin. To reduce the incidence of perinatal hepatitis B transmission further, the American Academy of Pediatrics endorses the recommendation of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that all newborn infants with a birth weight of greater than or equal to 2,000 g receive hepatitis B vaccine by 24 hours of age.

The American Academy of Pediatrics Committee on Infectious Diseases and the Committee on Fetus and Newborn support removal of permissive language for delaying the birth dose of hepatitis B vaccine, endorse the recommendation of the ACIP for giving the birth dose within the first 24 hours of life in all medically stable infants weighing greater than or equal to 2000 g, and provide guidance for implementation.

Access the complete policy statement: 

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IAC Spotlight! IAC enrolls seven new birthing institutions into its Hepatitis B Birth Dose Honor Roll; one previously honored institution qualifies for additional year

The Immunization Action Coalition (IAC) is pleased to announce that seven new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Franciscan Health–Indianapolis, Indianapolis, IN (100%)
  • McLaren Greater Lansing, Lansing, MI (90%)
  • McLaren Northern Michigan, Petoskey, MI (90%)
  • Parkwest Medical Center, Knoxville, TN (92%)
  • Pratt Regional Medical Center, Pratt, KS (92%)
  • Texoma Medical Center, Denison, TX (99%)
  • Woodlawn Hospital, Rochester, IN (98%)

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

  • Hillsdale Hospital, Hillsdale, MI (95%)

The Honor Roll now includes 356 birthing institutions from 39 states, Puerto Rico, and Guam. Seventy-six institutions have qualified for two years, 39 institutions have qualified three times, 11 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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IAC revises "Screening Checklist for Contraindications to Vaccines for Children and Teens" and "Screening Checklist for Contraindications to Vaccines for Adults"

IAC recently revised the following two screening checklists:

The changes to the screening checklist for contraindications to vaccines for children and teens were: 1) to incorporate a history of thrombocytopenia or thrombocytopenia purpura as an additional precaution to MMR/MMRV vaccines and 2) to modify the T-lymphocyte criteria for HIV-infected children and receipt of varicella vaccine from counts to percentage at the 6th birthday (The checklist previously read "at the 8th birthday.")

A change to the screening checklist for contraindications to vaccines for adults was made to incorporate a history of thrombocytopenia or thrombocytopenia purpura as an additional precaution to administering MMR/MMRV vaccines.

Related Links

  • IAC's Screening Checklists web section 
  • IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely

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IAC revises "Standing Orders for Administering Meningococcal ACWY Vaccine to Adults"

IAC recently revised the following standing orders template: Standing Orders for Administering Meningococcal ACWY Vaccine to Adults.

Changes were made to incorporate a new section on how to administer MenACWY as well as new procedures for submitting reports to the Vaccine Adverse Event Reporting System.

Related Link

  • IAC's Standing Orders web section contains standing orders templates for administering all routinely recommended vaccines and for the medical management of vaccine reactions

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Resources for the 2017–18 flu season featured on, including poster of all influenza vaccine packages, California's Vaccines for Children (VFC) program website, features many resources for the 2017–18 flu season, including colorful posters in English and Spanish to view and download. These posters promote and provide information for parents and caregivers, pregnant women, adults over 65, and healthcare workers about flu vaccine for all ages. One of the featured posters is the 2017–18 Influenza Vaccine Identification Guide, a 2-page guide displaying all flu vaccine packages available for this season for various age groups. 

Visit the Flu & Respiratory Disease Prevention Promotional Materials web section to view and download these posters and many other helpful influenza resources.

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Back to top website is now available in Arabic, Hindi, and Urdu, as well as Spanish

The College of Physicians of Philadelphia recently announced that its award-winning website is now available in Arabic, Hindi, and Urdu. This project makes available to hundreds of millions more global visitors reliable, accurate information about immunization’s history and its continuing contributions to human health. The website was already available in Spanish, as well as English. 

To choose a language other than English, use the drop-down menu on the top-right side of the home page.

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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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Pediatrics publishes review of 29 studies showing that serious vaccine reactions rarely recurred 

The August issue of Pediatrics includes an article titled Risk of Recurrence of Adverse Events Following Immunization: A Systematic Review by J.C. Safack et al. Selections from the abstract are reprinted below.

Reimmunizing patients who had an adverse event following immunization (AEFI) is sometimes a challenge because there are limited data on the risk and severity of AEFI recurrence.

To summarize the literature on the risk of AEFI recurrence.

Twenty-nine articles were included. Among patients with a history of hypotonic hyporesponsive episode (n = 398), anaphylaxis (n = 133), or seizures (n = 60) who were reimmunized, events recurred in 0% to 0.8%. Allergic-like events recurred in 30 of 594 reimmunized patients. Fever recurred in 0% to 84% of 836 reimmunized patients, depending on the vaccine and dose number. Among children with extensive limb swelling after the fourth dose of diphtheria-tetanus-acellular pertussis vaccine, recurrence was higher when the fifth dose was given with the full-antigen formulation (78%) compared with the reduced-antigen formulation (53%, P = .02).

Despite vaccines being administered to millions of people annually, there are few studies in which researchers evaluated AEFI recurrence. Published studies suggest that reimmunization is usually safe. However in these studies, severe cases were often not reimmunized.

Access the complete article: 

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CDC reports on a fatal case of yellow fever in a U.S. traveler returning from Peru

CDC published Notes from the Field: Fatal Yellow Fever in a Traveler Returning from Peru—New York, 2016 in the September 1 issue of MMWR, pages 914–15. The first paragraph is reprinted below.

In October 2016, a male New York resident aged 74 years developed fever, myalgia, nausea, and vomiting while traveling in Peru, 3 days after visiting the northern Amazon area. During the next 2 days, he experienced fever, abdominal pain, and watery diarrhea and was admitted to a hospital in Peru, where Entamoeba histolytica was detected in his stool. He was treated with intravenous fluids and antibiotics and released 1 day after admission. His condition worsened, however, and he returned to New York and immediately sought care at a hospital emergency department, where he was found to be afebrile, slightly confused, and jaundiced. Laboratory tests revealed leukopenia, thrombocytopenia, acute renal failure, liver dysfunction, and a metabolic acidosis. He was transferred from the emergency department to a tertiary care center, where he was admitted and received intravenous fluids, antibiotics, and hemodialysis. During the next 2 days, he developed melena and disseminated intravascular coagulation. He experienced multiple episodes of ventricular fibrillation and died 3 days after admission. Autopsy revealed gastrointestinal hemorrhage and subtotal hepatocellular necrosis. Testing for selected viral, bacterial, and parasitic agents was negative, except for antibody to Salmonella H type A/B. He had not received yellow fever vaccine before traveling. Serum specimens and tissues were sent to Wadsworth Center, the New York State Public Health Laboratory, and CDC to test for yellow fever virus and other pathogens.

Read the full article, Notes from the Field: Fatal Yellow Fever in a Traveler Returning from Peru—New York, 2016

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CDC Current Issues in Immunization NetConference, "Influenza Update 2017–2018," scheduled for September 13
CDC will present a one-hour Current Issues in Immunization NetConference on September 13 at 12:00 p.m. (ET). The topic is "Influenza Update 2017–2018." The NetConference will be moderated by Andrew Kroger, MD, MPH, medical officer, National Center for Immunization and Respiratory Diseases, CDC.

This is a limited registration event. Registration is required.

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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

A 5-year-old patient received Pentacel (DTaP-IPV/Hib) for the 5th dose of DTaP instead of Quadracel (DTaP-IPV). Can I count the Pentacel as a valid dose or will we need to revaccinate this patient?   

While administration of Pentacel to a 5-year-old would be considered off-label and a vaccine administration error, the doses of DTaP and IPV can be counted as valid and do not need to be repeated. Hib vaccine is not routinely administered after a child has reached the age of 5 years so it is also a vaccine administration error. You should explain this error to the parents and assure them that the extra Hib dose will cause no harm. 

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.

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Editorial Information

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