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Issue 1337: November 22, 2017

Ask the Experts
Ask the Experts—Question of the Week: Our practice has an 11-year-old patient who is having a splenectomy. The doctor requested . . .read more







IAC releases newly updated 142-page book, Vaccinating Adults: A Step-by-Step Guide—available for purchase or free download

The Immunization Action Coalition (IAC) is delighted to announce the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).

This completely updated guide on adult immunization (originally published in 2004) provides easy-to-use, practical information covering important “how-to” activities to help providers enhance their existing adult immunization services or introduce them into any clinical setting, including:

  • setting up for vaccination services,
  • storing and handling vaccines,
  • deciding which people should receive which vaccines,
  • administering vaccines,
  • documenting vaccinations (including legal issues), and
  • understanding financial considerations and billing information. 

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

Two options are available to obtain a copy of the updated Guide:

  • Purchase a copy
    A limited number of printed editions of this 142-page book are available for purchase at The Guide’s lie-flat binding and 10 tabbed sections make it easy to locate the information being sought. Purchased copies are delivered in a box that includes Immunization Techniques: Best Practices with Infants, Children, and Adults, a 25-minute training DVD developed by the California Department of Public Health. Also included are several selected IAC print materials, such as the "Skills Checklist for Vaccine Administration," an assessment tool to assist in evaluating the skill level of staff who administer vaccines.
  • Download for free and print it yourself
    The entire Guide is available to download/print free of charge at The downloaded version is suitable for double-sided printing. Options are available online to download the entire book or selected chapters.

The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.

The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!

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Reminder! Final issues of Needle Tips and Vaccinate Adults are available online

The final issues of Needle Tips and Vaccinate Adults are available online.

Needle Tips

After publishing 61 issues since 1994, IAC has placed the final edition (November 2017) of Needle Tips online.

The lead story, "Thoughts on the Final Issue of Needle Tips" by Dr. Deborah Wexler, reviews the 23-year history of Needle Tips—how it began, how it grew over the years, and what’s next.

The final issue also features the highly popular "Ask the Experts" column, focused on influenza, with questions answered by experts from CDC’s National Center for Immunization and Respiratory Diseases.

You'll also find a new patient handout for 16-year-olds—"You're 16 . . . We recommend these vaccines for you!" from IAC and the Society for Adolescent Health and Medicine.

Click on the image below to download the entire November issue of Needle Tips (19-page, 8.58 MB PDF).

Download the November issue of Vaccinate Adults

Access the Needle Tips Table of Contents (HTML) to download individual sections or pages.

Vaccinate Adults

After publishing 52 issues since 1997, IAC has placed the final edition (November 2017) of Vaccinate Adults online.

The lead story, "20 Years Later—the Final Issue of Vaccinate Adults" by Dr. Deborah Wexler, reviews the 20-year history of Vaccinate Adults—how it began, how it grew over the years, and what’s next.

The final issue also features the highly popular "Ask the Experts" column, focused on influenza, with questions answered by experts from CDC’s National Center for Immunization and Respiratory Diseases.

You'll also find one-page CDC-reviewed patient handouts for adults and pregnant women, newly translated in seven languages.

Click on the image below to download the entire November issue of Vaccinate Adults (15-page, 7.8 MB PDF).

For the future, to be informed when new or revised IAC pieces, ACIP recommendations, VISs and translations, educational opportunities, and other resources are available, subscribe to our free weekly newsletter, IAC Express.

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Hepatitis A outbreak exceeds 500 cases in southeast Michigan and results in 20 deaths; outbreak includes 1,200 cases in five states

The hepatitis A outbreak in southeast Michigan, which has been growing rapidly, now exceeds 500 outbreak-related cases and has resulted in 20 deaths. Public health officials have responded with efforts that include increased awareness and outreach with vaccinations for high-risk populations. The outbreak now includes 1,200 cases in at least five states, including California, Utah, Arizona, and Colorado. Although most cases are people who are homeless or substance abusers, a quarter of the people infected with hepatitis A in southeast Michigan are not people who are homeless or who use illicit drugs.

San Diego County health officials report that 100,000 vaccinations have been provided there to quell the outbreak. Now a vaccine shortage in San Diego has limited efforts to provide the second dose of vaccine for many at risk for the disease. The demand for the vaccine is exceptionally high in the U.S. and worldwide; Merck and GlaxoSmithKline, the two companies licensed to sell the vaccine in the U.S., report that they are struggling to meet this unprecedented demand.

A webinar titled Hepatitis A 2017 Outbreak Response—Lessons from Big Cities, hosted and recorded by the National Association of County and City Health Officials (NACCHO) on November 3, is now available online. In the webinar, county health officials from California and Michigan describe the outbreak, lessons learned, and ways other health departments can prepare against hepatitis A outbreaks.

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Michigan couple become public advocates for vaccines after their baby dies from whooping cough

After experiencing the tragic death of their three-month-old baby from whooping cough, a Michigan couple, Veronica and Sean McNally, became strong advocates for raising awareness in parents about vaccination. Their daughter, Francesca, died from whooping cough that she contracted from Veronica, who had not been vaccinated against the disease before she gave birth to Francesca. Although she was offered the Tdap vaccine on the day Francesca was born, Veronica reported she was not told what the vaccine was for, and she did not consent to the shot. After their daughter died, Sean and Veronica were determined to change hospital policy in Michigan protect other children and families from diseases preventable through vaccination. They established the Franny Strong Foundation to promote awareness of pertussis and its prevention among families and healthcare professionals. Then, with support from the Michigan Department of Health and Human Services and the Franny Strong Foundation, they established the website to provide families with information and tools about immunization.

CDC recommends that pregnant women receive the Tdap vaccination between the 27th and 36th week of pregnancy.

View a video interview of Veronica and Sean telling their story.

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IAC Spotlight! IAC’s "Additional Immunization Resources" web section on contains many valuable resources and tools for healthcare professionals

The Additional Immunization Resources web section on IAC's website offers healthcare professionals access to a wide variety of valuable resources and tools to support and enhance their practice. These resources include apps, email news services, vaccine manufacturers' information, package inserts, PowerPoint slide sets, a listing of IAC immunization partners, as well as CDC resources. Visit the pages below to find tools that can support and enhance your practice!

Visit the "Additional Immunization Resources" main page at to access the links for all these resources:

Email if you would like to suggest additional information to be added.

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Several hundred students get meningococcal B vaccine at University of Massachusetts Amherst after two students confirmed to have serogroup B infection

After two unrelated University of Massachusetts Amherst students were confirmed to have meningitis serogroup B infections about three weeks apart, the university initiated a large-scale immunization effort by vaccinating 100 students at University Health Services. The university has been working with federal and state public health officials and aimed to have another 500 students vaccinated soon after the second case was confirmed.

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CDC and WHO publish “Global Routine Vaccination Coverage, 2016” in this week’s MMWR and Weekly Epidemiological Record, respectively

CDC published Global Routine Vaccination Coverage, 2016 in the November 17 issue of MMWR (pages 1252–1255). On the same day, WHO's Weekly Epidemiological Record published the same article (pages 701–707). A media summary of the MMWR article is reprinted below.

In recent years, vaccination coverage rates have remained the same. This suggests the need to improve access to and completion of vaccinations for hard-to-reach populations in order to reduce global morbidity and mortality from vaccine-preventable diseases. Substantial progress in global routine vaccination coverage has been made in the past 40 years since the establishment of the World Health Organization (WHO) Expanded Program on Immunization (EPI). In 2016, the global vaccination coverage rate with vaccines to prevent tuberculosis, diphtheria, tetanus, pertussis, polio, and measles was ≥85 percent. However, 33 percent of countries still are not meeting the target requirements needed to reach and sustain high vaccination coverage. Targeted strategies are needed to improve access to vaccination and to increase the number of children who are fully protected from vaccine-preventable diseases.

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CDC and WHO publish “Rubella and Congenital Rubella Syndrome Control and Elimination—Global Progress, 2000–2016,” in this week’s MMWR and Weekly Epidemiological Record, respectively

CDC published Rubella and Congenital Rubella Syndrome Control and Elimination—Global Progress, 2000–2016 in the November 17 issue of MMWR (pages 1256–1260). On the same day, WHO's Weekly Epidemiological Record published the same article (pages 708–716). A media summary of the MMWR article is reprinted below.

The accelerated introduction of rubella-containing vaccine (RCV) into national immunization schedules is a significant step toward rubella elimination. For regions to achieve rubella elimination, as has been achieved in the Americas, a strong commitment is required in all countries to introduce rubella-containing vaccine and increase the quality of rubella routine and campaign immunization activities. Countries and international partners should take advantage of opportunities provided by existing measles-elimination activities. Rubella is the leading vaccine-preventable cause of birth defects in the world. Rubella during pregnancy can cause miscarriage, fetal death, stillbirth, and congenital malformations known as congenital rubella syndrome (CRS). During 20002016, 53 countries introduced RCV into their national immunization schedules. By the end of 2016, 152 (78 percent) of 194 countries were using rubella vaccine. Reported rubella cases declined 97 percent, from 670,894 cases in 102 countries in 2000 to 22,361 cases in 165 countries in 2016. The WHO Americas region achieved rubella and CRS elimination in 2015, and 33 of 53 countries in the European region have eliminated endemic rubella and CRS. The Western Pacific Region also has a rubella elimination goal (no countries verified).

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2017 edition of The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," available for purchase

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! Visit the "Shop IAC: The Vaccine Handbook" web page.

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. Visit the Vaccine Handout App page in the iTunes Store.

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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Influenza is serious; many resources are available to help healthcare professionals vaccinate 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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Recent study reports steady decline in meningococcal disease among adolescents in U.S. during past two decades 

A recently published study reported that there has been a steady decline in meningococcal disease among adolescents in the U.S. during the past two decades. The study, Current Epidemiology and Trends in Meningococcal Disease—United States, 1996–2015, by J.R. MacNeil, et al., appeared in the November 8, 2017 issue of Clinical Infectious Diseases. The abstract is reprinted below.

In 2005, meningococcal conjugate vaccine (MenACWY) was recommended for routine use among adolescents aged 11–18 years. This report describes the epidemiologic features of meningococcal disease and trends in meningococcal disease incidence following MenACWY introduction in the United States.

Incidence rates and case-fatality ratios by age group and serogroup during 2006-2015 were calculated using data from the National Notifiable Diseases Surveillance System (NNDSS); changes in incidence during this time were evaluated. Additionally, 20-year trends (1996-2015) in age- and race-standardized incidence were examined using data from Active Bacterial Core surveillance (ABCs).

During the years 2006–2015, 7,924 cases of meningococcal disease were reported to NNDSS, resulting in an average annual incidence of 0.26 cases per 100,000 population; 14.9% of cases were fatal. Among cases with serogroup information, 2,290 (35.8%) were serogroup B, 1,827 (28.5%) were serogroup Y, 1,457 (22.8%) were serogroup C, 436 (6.8%) were serogroup W, and 392 (6.1%) were other serogroups. The incidence of serogroups A, C, W, and Y combined declined 76% among persons aged 11–20 years from 2006–2010 to 2011–2015 (p<.0001). From 1996–2015, the incidence of meningococcal disease declined among all age groups and predominant serogroups.

Declines in meningococcal disease incidence in the United States have been observed among all age groups and predominant serogroups (B, C, and Y). Reductions in the incidence of meningococcal disease due to serogroups A, C, W, and Y among adolescents suggest an impact of the MenACWY vaccine program in this age group.

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New from Medscape and MMWR: Free online continuing education on ACIP recommendations for the use of seasonal influenza vaccines

CDC's MMWR and Medscape are offering a new online continuing medical education activity on the updated recommendations from ACIP regarding the use of seasonal influenza vaccines. These recommendations, titled Prevention and Control of Season Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization PracticesUnited States, 2017–18 Influenza Season, appeared in the August 25, 2017 issue of MMWR.

This activity is intended for infectious disease practitioners, internists, pediatricians, family medicine practitioners, pulmonologists, public health officials, nurses, pharmacists, and other clinicians who treat and manage patients in whom vaccination is recommended against seasonal influenza.

Upon completion of this activity, participants will be able to do the following:
  • Describe available influenza vaccines for the 2017–18 season, based on updated ACIP recommendations
  • Describe new and updated information and recommendations regarding influenza vaccination during the 2017–18 season, based on updated ACIP guidance
  • Describe contraindications and precautions regarding influenza vaccination during the 2017–18 season, based on updated ACIP recommendations
To access this FREE MMWR/Medscape CME activity visit:

If you do not have a Medscape account, you can register for free and login without a password and get unlimited access to all continuing education activities and other Medscape features.

Register and log in to the training.

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Question of the Week

Our practice has an 11-year-old patient who is having a splenectomy. The doctor requested meningococcal serogroup B vaccine (MenB) before the surgery and wants to know if the patient will need booster doses or a repeat MenB series at some point in the future (as in the meningococcal ACWY vaccine recommendations). 

The current recommendations for MenB vaccine are to receive one series in a lifetime for high-risk people, such as your patient. There is no recommendation at present for booster doses. The recommendations for those at high-risk for meningococcal serogroup B disease are available 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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