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Issue 1331: October 18, 2017

Ask the Experts
Ask the Experts—Question of the Week: I have a pregnant patient who is 26 weeks along and received a Tdap vaccine 2½  . . . read more









CDC reports on vaccination coverage of kindergarten students during 2016–17 in MMWR

CDC published Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten—United States, 2016–17 School Year in the October 13 issue of MMWR (pages 1073–80). A summary made available to the press is reprinted below.

For the 2016–17 school year, vaccination coverage among kindergartners remained high and exemptions remained low. Based on the data:
  • Median vaccination coverage was 94.0 percent for two doses of measles, mumps, and rubella vaccine; 94.5 percent for the state-required number of doses of diphtheria, tetanus, and acellular pertussis vaccine; and 93.8 percent for two doses of varicella vaccine
  • Median exemption level was 2.0 percent
  • Median proportion of kindergartners under a grace period or provisional enrollment was 2.0 percent, the same as in 2015–16

School assessment allows immunization programs to focus on schools with lower vaccination coverage and higher exemption levels, and encourages follow up with undervaccinated students to ensure kindergartners are protected from vaccine-preventable diseases.

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San Diego County hepatitis A death toll rises to 18; public health emergency status extended through October 24

The County of San Diego Board of Supervisors has extended the local health emergency to October 24 as the number of hepatitis A cases continues to rise in San Diego County, with 490 cases, 342 hospitalizations, and 18 confirmed fatalities. The large majority of those infected are people who are homeless, who use illicit drugs, or who provide services to those who are homeless. The outreach includes intensive vaccination and other prevention measures, including sanitation and education.

The Health and Human Services Agency and the local health care community have given 68,500 vaccinations since the outbreak began, including nearly 54,000 to the at-risk populations. More than 36,000 vaccinations have been given by local health care systems, community clinics and pharmacies in the county. About 21,600 of them have been given through mass vaccination events, mobile vans and foot teams that continue to hit the streets to target the homeless population. An additional 10,800 shots have been given to local food handlers and at-risk professionals.

San Diego County News Center: Hep A Emergency Declaration Extended Again

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October is Liver Cancer Awareness Month

October is Liver Cancer Awareness Month. Hepatitis B is the leading cause of liver cancer, which is the second-leading cause of all cancer deaths worldwide. Liver cancer is one of the only cancers increasing in incidence while the rates of most other types of cancer are declining or stabilizing.

To learn more about liver cancer, check out the links below.

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IAC Spotlight! Four healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

There are now 640 organizations enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.

Since September 13, when IAC Express last reported on the Influenza Vaccination Honor Roll, four additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

Newly added healthcare organizations, hospitals, government agencies, and medical practices

  • Cascade Behavioral Health, Tukwila, WA
  • Jones County Rest Home, Ellisville, MS
  • St. Rose Hospital, Hayward, CA
  • UAB Medicine, Birmingham, AL

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New for 16-year-olds! "You’re 16 . . . We recommend these vaccines for you!" from IAC and the Society for Adolescent Health and Medicine  

In recognition of the need to improve adolescent immunization rates, ACIP highlighted vaccines recommended at age 16 (MenACWY dose #2, MenB, HPV if not up-to-date, and influenza) when it published the 2017 Recommended Immunization Schedule for Children and Adolescents 18 Years or Younger. By adding a gray background to the “16 years” column on the schedule, ACIP emphasized the importance of this vaccination age platform, on par with the previously established vaccination platforms at 4–6 years and 11–12 years.

To assist providers in communicating the important vaccines recommended at the 16-year-old immunization visit, IAC and the Society for Adolescent Health and Medicine (SAHM) have partnered to develop a new 1-page handout that can be given to your teen patients or their parents. You're 16 ... We recommend these vaccines for you! utilizes a colorful, easy-to-understand format to describe the vaccines recommended at this age, as well as the impacts of the diseases the vaccines protect against and the recommended number and timing of doses.

Although multiple resources are available for adolescent vaccines, this is the first patient educational tool designed specifically to help inform patients and their parents about the important 16-year-old visit. Be sure to download and print this free handout to share with your teen patients and remind them, as stated on the handout, “Don’t miss out on everything life has in store for you. Get protected!”

Related Links

Immunization Platform for 16-Year-Olds

Clinical Tools

Additional Immunization Resources for Adolescents and Their Parents

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 makes small changes to the recently updated "Administering Vaccines: Dose, Route, Site, and Needle Size"

IAC recently revised its 1-page guide for healthcare professionals titled "Administering Vaccines: Dose, Route, Site, and Needle Size." After posting it online, additional changes were made to correct an error of omission and a need to clarify ages for the inactivated influenza vaccine. Thank you to our careful readers for notifying us.

Access the revised Administering Vaccines: Dose, Route, Site, and Needle Size.

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WHO receives news about attack on medical facilities in eastern Syrian Arab Republic that destroyed vaccines and related supplies 

The World Health Organization (WHO) has received news of an attack on medical facilities in eastern Syrian Arab Republic that could have a negative impact on protecting children from measles and polio. A section of a related press release is reprinted below.

WHO has received reports of an attack on medical facilities in eastern Syrian Arab Republic that has destroyed the only vaccines cold room in al-Mayadeen district, Deir Ezzor Governorate.

More than 100,000 doses of measles vaccines and 35,000 doses of polio vaccines were stored in these facilities, alongside equipment, syringes, and stocks for all vaccine-preventable childhood diseases.

If confirmed, this would set back the efforts of WHO and health partners to protect the children of Deir Ezzor from preventable childhood diseases, including polio. WHO and local partners have intensified efforts to respond to an outbreak of polio that has affected 48 children in the Syrian Arab Republic since March this year.   

Access the complete news release: Attack on vaccines sets back immunization efforts in eastern Syrian Arab Republic.

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Second largest oral cholera vaccination campaign starts in Bangladesh

The World Health Organization and UNICEF have announced that the world’s second largest oral cholera vaccination campaign started October 10 at Rohingya camps in Bangladesh. A section of a related press release is reprinted below.

A massive cholera immunization campaign started today near Cox’s Bazar, Bangladesh, to protect newly arrived Rohingya and host communities from the life-threatening diarrheal disease. 900,000 doses of the vaccine have been mobilized and are being delivered by more than 200 mobile vaccination teams, making it the second largest oral cholera vaccination campaign ever.

The campaign, which is led by the Ministry of Health and supported by the World Health Organization (WHO) and UNICEF, is being held in Ukhiya and Teknaf, where more than half a million people have arrived from across the border since August, joining vast numbers already residing in a series of settlements and camps.

The first round of the campaign will cover 650,000 people aged one year and older. The second round will commence on 31 October and will target 250,000 children between one and five years with an additional dose of the vaccine for added protection.

The largest oral cholera vaccination campaign occurred in Haiti in 2016.

Access the complete news release: World’s second largest oral cholera vaccination campaign kicks off at Rohingya camps in Bangladesh.

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CDC provides resource on making a strong recommendation for influenza vaccination

CDC has posted a new resource for healthcare professionals titled Make a Strong Flu Vaccine Recommendation. CDC recommends using the following SHARE method to make a strong vaccine recommendation:
  • S-SHARE the reasons why the influenza vaccine is right for the patient given his or her age, health status, lifestyle, occupation, or other risk factors
  • H-HIGHLIGHT positive experiences with influenza vaccines (personal or in your practice) to reinforce the benefits and strengthen confidence in flu vaccination
  • A-ADDRESS patient questions and any concerns about the influenza vaccine in plain and understandable language
  • R-REMIND patients that influenza vaccines protect them and their loves ones from serious flu illness and flu-related complications
  • E-EXPLAIN the potential costs of getting the flu, including serious health effects, time lost, and financial costs

For more information, access the complete piece: Make a Strong Flu Vaccine Recommendation. Also available in web page format.

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Hepatitis B Foundation releases new video titled "Dai's Story" in its storytelling project #justB

The Hepatitis B Foundation continues its storytelling campaign: #justB: Real People Sharing their Stories of Hepatitis B. 

Watch the October video, Dai's Story, about a young woman of Vietnamese ancestry who, along with her mother, cared for her father for the three years he was dying of hepatitis B-related liver cancer. 

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Influenza is spreading and serious; please keep vaccinating your patients

Influenza vaccination is recommended for everyone six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:

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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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VICNetwork to present webinar about HPV immunization quality improvement tools on October 19
On October 19 at 1:00 p.m. (ET) the VICNetwork Adolescent Immunization Webinar Series will sponsor a session titled "What's your HPV IQ? A Conversation About Immunization Quality Improvement Tools." Sharon Humiston, MD, MPH, FAAP, will engage in a conversation with the creators of the newly launched HPV IQ website, which provides evidence-based tools for HPV vaccine quality improvement.

Registration information

The VICNetwork is a nationwide "virtual immunization community" of health educators, public health communicators and others who promote immunizations to exchange and share resources, materials, and the best practices.

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Tune in to the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta on October 25 and 26 (Wednesday and Thursday) via live webcast.

These instructions also include information about how to listen to the meeting via phone only.

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Question of the Week

I have a pregnant patient who is 26 weeks along and received a Tdap vaccine 2½ months ago because of healthcare employment. Normally we give our pregnant patients Tdap between 27–36 weeks as recommended. Should we give her another dose of Tdap when she reaches 27 weeks gestation?  

The Advisory Committee on Immunization Practices does not recommend Tdap more than once during a pregnancy. The Tdap she received earlier in pregnancy may not provide optimal protection from pertussis for the infant, but some protection is expected. More information can be found at

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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