has been refreshed! Take a tour.
Issue 1342: December 20, 2017

Ask the Experts
Ask the Experts—Question of the Week: If a woman's rubella test result shows she is "not immune" during a prenatal visit . . . read more








Happy holidays from all of us at IAC! We'll be back on January 3.

All of us at the Immunization Action Coalition (IAC) wish you, our readers, a safe, happy, and relaxing holiday season. Because of the holiday schedule, we will not publish another issue of IAC Express until January 3. The IAC office will be closed on December 25 and 26, as well as January 1.

Happy holidays!

Back to top

Please donate to the Immunization Action Coalition!

The Immunization Action Coalition (IAC) is proud to be a trusted resource for the nation’s immunization healthcare professionals.

Our talented staff of 21 is the largest of any nonprofit immunization organization in the United States and is dedicated exclusively to providing healthcare professionals, the public, and policymakers, as well as the media, up-to-date immunization information and materials.

IAC Express subscribers are invaluable allies in educating the public about the importance of vaccination.

As 2017 draws to a close, we are asking our subscribers to make a tax-deductible donation to support IAC’s important work.

Please donate at

Every week throughout the year, IAC Express provides you with the critical immunization information you need in your work. Thus far in 2017, we have produced 60 issues with 850 articles that advance your immunization practice. Continuously since November 1997, we have published a total of 1,342 issues of IAC Express.

We've brought you news of updated ACIP recommendations, newly released VISs, helpful patient handouts, new staff education materials, and much more.

Throughout the year, our “Ask the Experts” feature brings answers to your questions from experts at CDC.

Our greatest satisfaction comes from believing that IAC Express plays an important role in your ability to prevent disease and save lives.

If you feel the same way, please make a donation at

More than 90 cents of every dollar IAC receives goes to our immunization projects.

We wish you happiness in this holiday season, and we look forward to continuing our work together in the new year.

Happy Holidays!

Deborah L. Wexler, MD, executive director, and the entire staff of the Immunization Action Coalition

Back to top

CDC and global health partners estimate that more people worldwide die from seasonal influenza-related respiratory illnesses each year than previously thought

On December 13, The Lancet published a study by CDC and global partners that estimated more people worldwide die from seasonal influenza-related respiratory illnesses each year than previously thought. The first paragraphs from a related press release from CDC are reprinted below.

According to new estimates published today, between 291,000 and 646,000 people worldwide die from seasonal influenza-related respiratory illnesses each year, higher than a previous estimate of 250,000 to 500,000 and based on a robust, multinational survey.

The new estimate, from a collaborative study by CDC and global health partners, appears today in 
The Lancet. The estimate excludes deaths during pandemics.

“These findings remind us of the seriousness of flu and that flu prevention should really be a global priority,” says Joe Bresee, MD, associate director for global health in CDC’s Influenza Division and a study co-author.

Access the full CDC press release: Seasonal flu death estimate increases worldwide.

Access the abstract from The LancetEstimates of global seasonal influenza-associated respiratory mortality: a modelling study. You must be a Lancet subscriber to access the entire article free of charge. Your nearest medical library may have it available for you.

Back to top

CDC requests nominations for its Childhood Immunization Champion Awards; submissions due by February 2

The CDC Childhood Immunization Champion Award is an annual award that recognizes individuals who make a significant contribution toward improving public health through their work in childhood immunization.
Each year, up to one CDC Immunization Champion from each of the 50 U.S. states, eight U.S. territories and freely associated states, and the District of Columbia will be honored. Champions can include coalition members, parent advocates, healthcare professionals (e.g., physicians, nurses, physicians’ assistants, nurse practitioners, and medical assistants), and other immunization leaders who meet the award criteria. Self-nominations are welcome, or you may submit an application for a deserving individual.

State immunization program managers, state and federal government employees of health agencies, individuals who have been affiliated with and/or employed by pharmaceutical companies, and those who have already received the award are not eligible to apply (for details, see page 3 of the nomination packet).

Awardees will be announced during National Infant Immunization Week (NIIW), which runs April 21–28 in 2018. Champions will receive a certificate of recognition, will be featured on CDC’s web site, and may be recognized by their immunization program during NIIW.

Nominations should be submitted to the immunization program manager in the state or territory where the nominee resides by February 2. Please contact your state immunization program to confirm your state’s deadline. 

Related Links

Back to top

Dr. Litjen Tan pens guest post about the benefits of influenza vaccination on "Shot of Prevention" blog

Litjen (LJ) Tan, MS, PhD, IAC's chief strategy officer and co-chair and co-founder of the National Adult and Influenza Immunization Summit, has written a guest post on Every Child By Two's "Shot of Prevention" blog. Titled Flu Vaccine Benefits Go Beyond Effectiveness of One Strain, this column explores the recent speculation about the effectiveness influenza vaccination. Healthcare professionals will find much valuable information here to share with patients who are skeptical of the value of getting vaccinated against flu.

Access Flu Vaccine Benefits Go Beyond Effectiveness of One Strain.

Back to top

Dr. Paul Offit's column in The Daily Beast explores why the unhealthiest state in America has the best vaccination rates

On December 15, the The Daily Beast published an article by Dr. Paul Offit titled The Unhealthiest State in America Has the Best Vaccination Rate. The article describes the 1979 court case that led to Mississippi abolishing religious exemptions for vaccination and its current status as the nation's leader in childhood vaccination rates. The last two paragraphs are reprinted below.

In 1979, the state of Mississippi argued that children whose parents hold ill-founded and potentially dangerous beliefs—whether cloaked in the robes of religion or not—shouldn’t be afforded less protection under the law. In essence, they argued that although parents can determine how a child lives, they can’t determine whether the child has the right to a life unhindered by preventable diseases.

Today, 47 states have religious exemptions to vaccination. Using religion as an excuse to perform a profoundly unreligious act, parents in these states have the right to allow their children to catch and transmit potentially fatal infections. Our country would do well to follow the state that stood up for its children in 1979.

Dr. Paul A. Offit, MD, is director of the Vaccine Education Center at Children's Hospital of Philadelphia.

Related Links

Back to top 

IAC Spotlight! IAC's new 142-page book, Vaccinating Adults: A Step-by-Step Guide, describes how to implement adult vaccination services in your healthcare setting and provides a review for staff who already vaccinate adults; IAC Guide available for free download or purchase

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

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!

Related Links

Back to top


WHO publishes review of global influenza activity in this week's Weekly Epidemiological Record

The World Health Organization (WHO) published Review of global influenza activity, October 2016–October 2017 in the December 15 issue of its Weekly Epidemiological Record. The report summarizes the 2016–2017 influenza season in the temperate regions of the northern hemisphere, the 2017 influenza season in the temperate regions of the southern hemisphere, and influenza activity in tropical and subtropical regions.

Related Link

Back to top

CDC reports on introduction of IPV in China and elimination of vaccine-associated paralytic polio

CDC published Introduction of Inactivated Poliovirus Vaccine and Elimination of Vaccine-Associated Paralytic Poliomyelitis—Beijing, China, 2014–2016 in the December 15 issue of MMWR (pages 1357–61). The first paragraph is reprinted below.

When included in a sequential polio vaccination schedule, inactivated polio vaccine (IPV) reduces the risk for vaccine-associated paralytic poliomyelitis (VAPP), a rare adverse event associated with receipt of oral poliovirus vaccine (OPV). During January 2014, the World Health Organization (WHO) recommended introduction of at least 1 IPV dose into routine immunization schedules in OPV-using countries. The Polio Eradication and Endgame Strategic Plan 2013–2018 recommended completion of IPV introduction in 2015 and globally synchronized withdrawal of OPV type 2 in 2016. Introduction of 1 dose of IPV into Beijing’s Expanded Program on Immunization (EPI) on December 5, 2014 represented China’s first province-wide IPV introduction. Coverage with the first dose of polio vaccine was maintained from 96.2% to 96.9%, similar to coverage with the first dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP) (96.5%–97.2%); the polio vaccine dropout rate (the percentage of children who received the first dose of polio vaccine but failed to complete the series) was 1.0% in 2015 and 0.4% in 2016. The use of 3 doses of private-sector IPV per child decreased from 18.1% in 2014, to 17.4% in 2015, and to 14.8% in 2016. No cases of VAPP were identified during 2014–2016. Successful introduction of IPV into the public sector EPI program was attributed to comprehensive planning, preparation, implementation, robust surveillance for adverse events after immunization (AEFI), and monitoring of vaccination coverage. This evaluation provided information that helped contribute to the expansion of IPV use in China and in other OPV-using countries.

Related Links

Back to top

Report of outbreak of Neisseria meningitidis serogroup C published in MMWR

CDC published Large Outbreak of Neisseria meningitidis Serogroup C—Nigeria, December 2016–June 2017 in the December 15 issue of MMWR (pages 1352–6). A summary made available to the press is reprinted below.

From December 2016–June 2017, Nigeria experienced the largest global outbreak of meningitis caused by a new strain of the bacteria N. meningitidis serogroup C (NmC); 14,542 suspected cases and 1,166 deaths were reported. Nigeria, a country in the sub-Saharan “meningitis belt,” previously experienced large outbreaks caused by meningococcal A serogroup, which declined dramatically following the introduction in 2013 of meningococcal A vaccines. National and regional evaluations of the outbreak response outlined recommendations for improving meningitis outbreak prevention, timely detection, and response. Implementing these recommendations and expanding the availability of multivalent vaccines effective against non-A serogroups will reduce future meningitis outbreaks.

Related Links

Back to top


NFID releases PSA to increase awareness of the importance of Tdap vaccination

The National Foundation for Infectious Diseases (NFID) has launched a new Tdap awareness campaign in collaboration with Sanofi Pasteur that includes a new 30-second public service announcement (PSA) video. Help spread the word about pertussis/whooping cough prevention by sharing this PSA using sample social media posts from NFID as follows:


  • Whooping cough (pertussis) is a serious infection that spreads easily from person to person. The infection can cause coughing spells that are so severe that it can be hard to breathe, eat, or sleep. Whooping cough may even lead to cracked ribs, pneumonia, or hospitalization. Make sure that you and your loved ones are protected and ask your healthcare provider about staying up-to-date with Tdap vaccines

Click on the graphic below to view the PSA.

NFID has also published a related guest post on its blog: Protecting Your Children’s Health Through the Holidays.

Related Links

Back to top

Hepatitis B Foundation releases new video titled "Carolyn'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 December video, Carolyn's Story, about a young woman in nursing school who found out that her beloved father was dying of hepatitis-B related liver disease, a diagnosis he and her mother had kept secret from their daughters for years. 

Related Links

Back to top

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:

Back to top


January 8 VICNetwork webinar to focus on HPV and oral cancer prevention
On January 8 at 12:00 p.m. (ET) the California Immunization Coalition's VICNetwork will sponsor a webinar titled "An Interprofessional Approach to HPV and Oropharyngeal Cancer Prevention Education." The objectives of the course are:
  • Describe action steps to build a partnership with dental providers on HPV education and the importance of HPV vaccination
  • Identify the relationship between oral HPV infections and head and neck cancers
  • Discuss ways that dental professionals can include HPV education in patient visits, including an overview of helpful resources
  • Determine the effectiveness of an HPV prevention campaign via interprofessional education and consider strategies for sustainability

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.

Back to top

National Influenza Vaccination Disparities Partnership to host January 10 webinar about addressing patients' misconceptions and hesitancy about flu vaccination 
On January 10 at 2:00 p.m. ET, the National Influenza Vaccination Disparities Partnership will host a webinar titled "Talking to Patients about Flu: Sharing Facts and Addressing Misconceptions and Hesitancy." The webinar will address current ACIP influenza vaccine recommendations and ways to address flu vaccine misconceptions and hesitancy. The webinar will include opportunities for questions and discussion.

Registration information

The National Influenza Vaccination Disparities Partnership is a national multi-sector campaign, spearheaded by local influential partners and supported by CDC, that commits to promote the importance of flu vaccination among underserved populations. 

Back to top 


Reminder: Abstract deadline for the 2018 National Immunization Conference is December 31

The deadline for submitting an abstract for CDC's 48th National Immunization Conference (NIC) is December 31.

The conference will be held May 15–17, 2018, at the Hilton Hotel in Atlanta. NIC brings together more than 1,500 local, state, federal, and private-sector immunization stakeholders and partners to explore science, policy, education, and planning issues related to immunization and vaccine-preventable diseases.

This three-day conference will include the following session tracks:

  • Adult Immunization
  • Immunization Information Systems
  • Programmatic Issues
  • Health and Risk Communications
  • Epidemiology and Surveillance
  • Childhood/Adolescent Immunization 

Access the guidelines and link for submitting an abstract for the 48th National Immunization Conference.

Related Link

Back to top


Question of the Week

If a woman's rubella test result shows she is "not immune" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?  

In 2013, ACIP changed its recommendation for this situation (see, pages 18–20). It is recommended that women of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity. MMR should not be administered to a pregnant woman.

This is IAC’s last Question of the Week

This is the final issue of Question of the Week (QOTW), a special feature of IAC Express since 2014, where CDC experts have provided answers to vaccine questions. We thank all of the CDC experts for making this weekly series possible.
“Ask the Experts” is not going away! IAC will continue to provide special editions of IAC Express containing exclusively “Ask the Experts” Q&As from CDC at least five times per year.
To access more than a thousand “Ask the Experts” questions that have been answered by CDC, visit IAC’s highly popular “Ask the Experts” web section at  You’ll be able to search IAC’s collection of questions by vaccine or topic to find the answers you’re looking for.

If you have a question for CDC immunization experts, you can email them directly at There is no charge for this service.

Back to top

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

This page was updated on .