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Issue 1351: February 21, 2018










CDC publishes interim estimates of current seasonal influenza vaccine effectiveness

CDC published Interim Estimates of 2017–18 Seasonal Influenza Vaccine Effectiveness—United States, February 2018 in the February 16 issue of MMWR (pages 180–5). The first paragraph is reprinted below. 

In the United States, annual vaccination against seasonal influenza is recommended for all persons aged ≥6 months. During each influenza season since 2004–05, CDC has estimated the effectiveness of seasonal influenza vaccine to prevent laboratory-confirmed influenza associated with medically attended acute respiratory illness (ARI). This report uses data from 4,562 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness Network (U.S. Flu VE Network) during November 2, 2017–February 3, 2018. During this period, overall adjusted vaccine effectiveness (VE) against influenza A and influenza B virus infection associated with medically attended ARI was 36% (95% confidence interval [CI] = 27%–44%). Most (69%) influenza infections were caused by A(H3N2) viruses. VE was estimated to be 25% (CI = 13% to 36%) against illness caused by influenza A(H3N2) virus, 67% (CI = 54%–76%) against A(H1N1)pdm09 viruses, and 42% (CI = 25%–56%) against influenza B viruses. These early VE estimates underscore the need for ongoing influenza prevention and treatment measures. CDC continues to recommend influenza vaccination because the vaccine can still prevent some infections with currently circulating influenza viruses, which are expected to continue circulating for several weeks. Even with current vaccine effectiveness estimates, vaccination will still prevent influenza illness, including thousands of hospitalizations and deaths. Persons aged ≥6 months who have not yet been vaccinated this season should be vaccinated.

Dr. Anne Schuchat, CDC acting director, and Alex M. Azar II, the new secretary of Health and Human Services, led a news briefing on February 15 about the effectiveness of this season's influenza vaccine. Read a summary of this briefing in the New York TimesThe Flu Vaccine Is Working Better Than Expected, C.D.C. Finds.

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CDC reports that 84 U.S. children have died from influenza this season

CDC has reported in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending February 10, influenza activity remained elevated in the United States. The total number of pediatric deaths has climbed to 84 since October 1, 2017. The proportion of outpatient visits for influenza-like illness (ILI) was 7.5%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above region-specific baseline levels. New York City, the District of Columbia, Puerto Rico and 43 states experienced high ILI activity; two states experienced moderate ILI activity; three states experienced low ILI activity; and two states experienced minimal ILI activity.

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.

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CDC reports on influenza activity in the United States from October 1, 2017 through February 3, 2018

CDC published Update: Influenza Activity—United States, October  1, 2017–February 3, 2018  in the February 16 issue of MMWR (pages 169–79). A summary made available to the press from CDC is reprinted below.

Influenza activity in the United States began to increase in early November 2017 and rose sharply from December through February 3, 2018. Influenza A viruses were most commonly identified, with influenza A(H3N2) viruses predominating, but influenza A(H1N1)pdm09 and influenza B viruses also were detected. With several more weeks of elevated influenza activity expected, an increasing proportion of influenza A(H1N1)pmd09 and influenza B viruses, and the potential to prevent significant illness through influenza vaccination, CDC continues to recommend influenza vaccination at this time. During more severe influenza seasons, influenza antiviral medications can be of greater use as an adjunct to vaccination in the treatment of influenza. While most people with influenza will experience uncomplicated illness and recover without needing medical care, some people are at high risk of developing serious flu complications. Early treatment with neuraminidase inhibitor antiviral medications is recommended for patients with severe, complicated, or progressive influenza illness and people who are at high risk for influenza complications, including adults aged ≥65 years, who develop influenza symptoms. Everyday preventive measures such as cough and respiratory etiquette, staying home from work or school when sick, and frequent hand hygiene, also can help slow the spread of influenza.

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Dr. Paul Offit discusses the new zoster vaccine Shingrix in Medscape commentary

Paul Offit, MD, director, Vaccine Education Center at Children’s Hospital of Philadelphia, has recorded a 4-minute expert commentary for Medscape titled "Shingrix: Is the Hype Justified?" He discusses the efficacy of Shingrix vaccine and provides a brief overview of the recommendations.

Access Shingrix: Is the Hype Justified? on Medscape (free, but log-in is required).

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The National Immunization Conference (NIC) will be held May 15–17 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 

The NIC mission is to offer information that will help participants provide comprehensive immunization services for all age groups. The conference also offers participants an opportunity to learn innovative strategies for developing programs and policies, and advancing science to promote immunization among all ages today for a healthy tomorrow.

Registration for this conference will close on April 20. Visit the National Immunization Conference web page for information about conference and hotel registration, fees, and more.

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Two foundations collaboratively launch the Meningitis B Action Project to increase awareness of MenB vaccination

The Kimberly Coffey Foundation and The Emily Stillman Foundation were both founded by mothers who lost a daughter to meningococcal B (MenB). Now these two foundations have launched a joint initiative called the Meningitis B Action Project. Part of a press release about the project is reprinted below:

The Project aims to provide parents and young adults with the information to proactively talk to their healthcare provider about Meningitis B and the vaccine available to help prevent it, and to encourage the medical and education community to inform patients and students about the availability of the Meningitis B vaccine....

The Project is a joint initiative by Patti Wukovits and Alicia Stillman, who each lost their daughters to Meningitis B. High school senior Kimberly Coffey, 17, died one week before her graduation. College sophomore Emily Stillman, 19, died just 36 hours after her first symptoms. While both had received the MenACWY vaccine, the MenB vaccine was not yet available to help protect them. In 2014, Patti, a registered nurse, and Alicia, an accountant, each established their own foundations named after their daughters, The Kimberly Coffey Foundation and The Emily Stillman Foundation. Today, both mothers are joining forces to make sure other parents don’t needlessly suffer the same fate....

Access the Meningitis B Action Project website for more information and resources such as an Action Kit and brochure.

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NASHP and AcademyHealth invite state Medicaid, public health, and immunization officials to join an initiative to boost immunization rates among Medicaid enrollees

AcademyHealth and the National Academy for State Health Policy (NASHP), with support from the Colorado Children’s Immunization Coalition, invite state health officials interested in improving their immunization rates to participate in a Community of Practice. This group is open to state Medicaid agencies interested in collaborating with their public health and immunization information system partners to improve Medicaid policies and immunization outreach to increase immunization rates among low-income children and pregnant women. 

For more information about this initiative, visit the website.

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IAC Spotlight! IAC enrolls one new birthing institution into its Hepatitis B Birth Dose Honor Roll; 16 previously honored institutions qualify for additional years' honors

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

  • War Memorial Hospital, Sault Ste. Marie, MI (96%)

The following eight institutions are being recognized for a second year:

  • Baylor, Scott & White Medical Center–Waxahachie, Waxahachie, TX (93%)
  • Christus Mother Frances Hospital Sulphur Springs, Sulphur Springs, TX (95%)
  • Clay County Medical Center, Clay Center, KS (98%)
  • Covenant Health Plainview, Plainview, TX (99%)
  • Lehigh Valley Hospital–Schuylkill S. Jackson Street, Pottsville, PA (98%)
  • Ochiltree General Hospital, Perryton, TX (99%)
  • Odessa Regional Medical Center, Odessa, TX (98%)
  • Texas Health Rockwall, Rockwall, TX (98%)

In addition, the following five institutions are being recognized for a third year:

  • Baylor, Scott & White Medical Center–Waxahachie, Waxahachie, TX (98%)
  • Memorial Healthcare, Owosso, MI (94%)
  • MetroHealth Medical Center, Cleveland, OH (94%)
  • St. Anthony Regional Hospital, Carroll, IA (97%)
  • Shannon Medical Center, San Angelo, TX (98%)

The following three institutions are being recognized for a fourth year:

  • Palo Pinto General Hospital, Mineral Wells, TX (92%)
  • Riverside Shore Memorial Hospital, Onancock, VA (96%)
  • St. Anthony Regional Hospital, Carroll, IA (98%)

Finally, the following institution is being recognized for a fifth year:

  • Hillsdale Hospital, Hillsdale, MI (94%)

Note: Two of these institutions qualified for multiple 12-month periods at one time.

The Honor Roll now includes 374 birthing institutions from 39 states, Puerto Rico, and Guam. Eighty-seven institutions have qualified for two years, 42 institutions have qualified three times, 16 institutions have qualified four times, 6 institutions have qualified five times, and 1 institution has qualified seven 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'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

The Immunization Action Coalition (IAC) recently announced 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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IAC updates its staff education materials: "Current Dates of Vaccine Information Statements" and "You Must Give Your Patients Vaccine Information Statements (VISs)—It’s Federal Law!"

IAC recently revised Current Dates of Vaccine Information Statements as well as You must give your patients current Vaccine Information Statements—It's Federal Law! to reflect the 2/12/2018 date of the recently released MMR, MMRV, varicella, zoster (RZV), and zoster (RZL) VISs.

Note: "You Must Give Your Patients Vaccine Information Statements (VISs)—It’s Federal Law!" was formerly titled "It's Federal Law! You Must Give Your Patients Vaccine Information Statements (VISs)."

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IAC revises "Administering Vaccines to Adults: Dose, Route, Site, and Needle Size"

IAC recently revised Administering Vaccines to Adults: Dose, Route, Site, and Needle Size to incorporate the recently licensed recombinant zoster vaccine (RZV, Shingrix; GSK) that is to be administered intramuscularly, as well as the recently licensed hepatitis B vaccine for adults (Heplisav-B; Dynavax), also administered intramuscularly.

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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 updates "Standing Orders for Administering Influenza Vaccine to Children and Adolescents"

IAC recently revised Standing Orders for Administering Influenza Vaccine to Children and Adolescents to incorporate the new age indication for Fluarix (GSK) to allow for use in infants beginning at age 6 months.

To view all influenza vaccines licensed for 2017–18 for children and adults, see IAC's Influenza Vaccine Products for the 2017–2018 Influenza Season.

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IAC posts updated handout for the public titled "Shingles (Zoster): Questions and Answers"

IAC recently revised its handout for the public titled Shingles (Zoster): Questions and Answers. Changes were made to include information about the new recombinant zoster vaccine (RZV, Shingrix; GSK), and the related ACIP recommendations.

Access IAC's "Questions and Answers" handouts for patients for 18 vaccine-preventable diseases.

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HHS releases Partner Planning Guide for the National Viral Hepatitis Action Plan 2017–2020

The U.S. Department of Health and Human Services (HHS) has released a Partner Planning Guide as a companion to the 2017–2020 National Viral Hepatitis Action Plan. 

The Partner Planning Guide is a tool designed for use by individuals, groups, and organizations that are conducting strategic planning efforts for hepatitis B and/or hepatitis C, to help assess existing activities and plan new ones that align with the action plan. It can be used in conjunction with existing strategic plans to identify shared priorities and goals as well as opportunities for alignment and leveraging of capacities and resources to improve the programs that serve individuals and communities in need.

Access the Partner Planning Guide (PDF format; 18 pages).

The National Viral Hepatitis Action Plan is the nation’s battle plan for fighting viral hepatitis in the United States. The updated plan outlines four major goals, strategies to achieve those goals, and indicators to help track progress between now and 2020.

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WHO reports on progress toward implementing the hepatitis B birth dose worldwide 

On February 16, the World Health Organization (WHO) published Implementation of hepatitis B birth dose vaccination—worldwide, 2016 in its Weekly Epidemiological Record. Part of the introduction is reprinted below.

Infections due to hepatitis B virus (HBV) are a leading cause of death worldwide. WHO estimated that in 2015, 257 million people globally were living with chronic HBV infection and that 887,000 deaths occurred due to HBV, mostly from long-term complications such as cirrhosis and hepatocellular carcinoma. The prevalence of chronic HBV infection among the general population ranges from >5% in most countries in the Western Pacific and African Regions, to <2% in most countries in the European and American Regions. In the majority of settings, chronic infections are commonly acquired at birth through perinatal transmission and in early childhood, when the risk of developing chronic infection is highest.

HBV infection can be prevented by administration of the hepatitis B vaccine. WHO recommends at least 3 doses of hepatitis B vaccination for all children worldwide, with the first dose to be administered at birth....

This report provides an update on the global implementation of hepatitis B birth dose vaccination and describes challenges, lessons, and opportunities for improving hepatitis B birth dose implementation in the future. 

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WHO Special Intervention Teams have vaccinated almost 400,000 children at transit points

The World Health Organization (WHO) recently published information about vaccinating hard-to-reach children in Nigeria. Selections from the article are reprinted below.

Many children in north-east Nigeria have never received vaccinations or are behind schedule due to the highly mobile nature of the populations. To reach this high-risk population, WHO devised an innovative strategy: “Special Intervention Teams” which reach the children at strategic transit points across north-east Nigeria. The teams consist of a vaccinator, a profiler, a recorder, a member of the civilian Joint Task Force, and a community leader. They often venture into areas where people have little access to health services....

Presently, WHO has engaged 400 Special Intervention Teams in Borno state who operate quasi-fixed vaccination posts at transit points, motor parks, markets and along nomadic grazing routes, host communities, and internally displaced people (IDP) camps. Their job is to intercept, assess, profile, and vaccinate all children on transit with the appropriate vaccines including polio, measles, and yellow fever....

Out of the nearly 400,000 children tracked and profiled by the team, more than 375,000 were from populations trapped in inaccessible and partially accessible wards and settlements with no healthcare facilities...

The Special Intervention Teams are helping to fill the gap in healthcare due to the humanitarian crisis by providing children who are often extremely vulnerable protection from some of childhood’s most virulent diseases. 

Read the complete article: WHO Special Intervention Teams Vaccinate Nearly 400,000 children at transit points.

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APhA develops chart to clearly show the differences between the two zoster vaccines

The American Pharmacists Association (APhA) has developed a new 1-page chart to illustrate the differences between the two zoster vaccines (Shingrix [RZV]; GSK and Zostavax [ZVL]; Merck). The document provides information at a glance about storage (freezer vs. refrigerator), vaccine type, route of administration (IM vs. SC), dosing intervals, age indications, contraindications, adverse effects, and concomitant administration.

Access Key Points to Be Aware of Regarding Differences Between Zoster Vaccines.

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CDC develops new sample vaccine labels to incorporate the new ACIP zoster recommendations

Based on the updated shingles vaccine recommendations released January 26, 2018, CDC recently made the following changes in its Vaccine Labels Examples:

  • Created two new Shingrix vaccine labels (the standard label and the reconstituted vaccine label)
  • Changed the Zostavax vaccine labels from LZV (live zoster vaccine) to ZVL (Zoster Vaccine Live) for both the standard label and the reconstituted vaccine label

Immunization providers are encouraged to use these sample labels for all vaccines to avoid mix-ups. 

Access CDC's Vaccine Label Examples.

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Reminder: National Adult Immunization and Influenza Summit offers tools to assist satellite, temporary, and off-site influenza vaccination clinics 

The National Adult and Influenza Immunization Summit (NAIIS) has developed tools to assist satellite, temporary, and off-site vaccination clinics in implementing best practices. These clinics, functioning in non-traditional settings, face unique challenges. Information about these tools and their purpose can be found on the new Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics web section of the NAIIS website.

The following tools are available on this NAIIS web section for downloading and printing: 

In particular, NAIIS is urging partners holding these clinics to take the pledge. The pledge is for organizations that conduct satellite, temporary, or off-site vaccination clinics to sign annually, affirming that they will adhere to best practices, including using the "Checklist of Best Practices for Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations." Organizations that sign the pledge will be recognized on the NAIIS website for their commitment to provide safe and effective vaccine clinics. Companies seeking to hire an organization to conduct a vaccination clinic can check to see if that organization has signed the pledge and is recognized on the NAIIS website.
If your organization has signed the pledge, please send an email to with the subject “Vaccine Clinic Pledge Form.” In the message area, include your organization's name and an email address for an organization contact. Please be sure to attach a copy of your signed pledge so that we can properly recognize you!

Read more about the launch of these new tools and their purpose in the NAIIS web section titled Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics.

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CDC posts updated infographic, “The Journey of Your Child’s Vaccine,” to help parents understand the process of developing and monitoring new vaccines

CDC has updated an infographic to help parents understand the process of developing and monitoring new vaccines. Click on the image below to access "The Journey of Your Child’s Vaccine." Feel free to share this resource in your social media channels, or simply print it out for the office.

Explore more resources for parents from CDC by visiting their Infant and Childhood Immunization Resources web section.

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Hepatitis B Foundation releases new video titled "Jin'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 February video, Jin's Story, about a young woman of Chinese ancestry who was adopted into an American family who discovered she was chronically infected with the hepatitis B virus after testing in the U.S. Despite her mother's strong advocacy for her, Jin faced (and still faces) stigmatization.

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New CDC study shows that two-thirds of the 675 children and teenagers who died of flu between 2010 and 2016 had not received the influenza vaccine

On February 12, the journal Pediatrics published a new CDC study titled Influenza-Associated Pediatric Deaths in the United States, 2010–2016 (Mei Shang et al.). The researchers analyzed deaths in children younger than 18 years of age with laboratory-confirmed influenza virus infection reported to CDC during the 2010–2011 to 2015–2016 influenza seasons—675 reported deaths. A selection of the "Results" section is reprinted below.

Only 31% (n = 149 of 477) of children aged ≥6 months had received any influenza vaccination. Overall, 65% (n = 410 of 628) of children died within 7 days after symptom onset. Half of the children (n = 327 of 654) had no preexisting medical conditions.

Access the complete abstract: Influenza-Associated Pediatric Deaths in the United States, 2010–2016.

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Harvard research estimates how vaccination could help decrease premature deaths and poverty in developing countries 

A study published in the journal Health Affairs by researchers from the Harvard T.H. Chan School of Public Health found that vaccination not only lowers the number of premature deaths in developing countries, but also can decrease poverty caused by medical expenses. The poorest countries have the most to gain from vaccination programs, in both health and economic terms. Two paragraphs from a related Boston Globe article are reprinted below.

Using a mathematical model, the researchers found if investments were sufficient to administer 10 vaccines in 41 low- and middle-income countries, it could prevent up to 36 million deaths over 15 years.

Researchers also found it could prevent 24 million cases of medical impoverishment over the same period. Medical impoverishment is caused by out-of-pocket medical expenses by those who do not have access to affordable health care or insurance.

Access The Equity Impact Vaccines May Have On Averting Deaths And Medical Impoverishment In Developing Countries in Health Affairs.

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Tune in to CDC's ACIP meeting February 21–22 (Wednesday and Thursday) via live webcast

Tune in to the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta on February 21 and 22 (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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Florida Immunization Summit to be held May 10–11 in Daytona Beach

The 2018 Florida Immunization Summit is scheduled for May 10–11 in Daytona Beach. This statewide conference will be hosted by the Suwannee River AHEC and the Florida Department of Health in Volusia County.

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.

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IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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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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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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