Issue 1353: March 7, 2018









CDC reports 17 additional pediatric deaths from influenza in the U.S. between October 1 and February 24, bringing total to 114; influenza still widespread

CDC has reported in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending February 24, influenza activity decreased in the United States, although it was still widespread. The total number of pediatric deaths has climbed to 114 since October 1, 2017. The proportion of outpatient visits for influenza-like illness (ILI) was 5.0%, 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, and 32 states experienced high ILI activity; Puerto Rico and nine states experienced moderate ILI activity; six states experienced low ILI activity; and three 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.

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

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ECBT's Amy Pisani writes editorial supporting the importance of immunization in The Hill

On February 22, Amy Pisani, executive director, Every Child By Two (ECBT), had an editorial titled Undercutting the immunization program puts both lives and dollars at risk published in The Hill. Four paragraphs are reprinted below.

...For every $1 we spend on childhood vaccines, we save $10.10, which is nearly double the savings of preventing fraud. The vaccines given to children born over the past two decades will result in a savings of $360 billion in direct and nearly $1.65 trillion in societal costs.

The benefits don’t end with children. The U.S. still spends nearly $26.5 billion annually treating adults over the age of 50 for just four diseases that could be prevented by vaccines: influenza, pertussis, pneumococcal disease, and shingles.

The majority of these avoidable costs are borne by federal health insurance programs. Yet for the second year in a row, the President has proposed gutting the Centers for Disease Control and Prevention’s (CDC’s) Immunization Program.

This is not just a discussion of dollars saved. It’s also a matter of lives saved. Over the past 23 years, the Vaccines for Children program has prevented 381 million illnesses, 855,000 early deaths and 25 million hospitalizations, but we have much more work to do....

Access the complete editorial: Undercutting the immunization program puts both lives and dollars at risk

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Reported cases of hepatitis B infection in adults increasing due to opioid use

On February 21, the U.S. Department of Health and Human Services published an article online titled The Rise in Acute Hepatitis B Infection in the U.S. Authored by Rhea Racho, Hepatitis B Foundation, and Kate Moraras, Hepatitis B Foundation and Hep B United, the article links the opioid epidemic in the U.S. to the risk of contracting infectious diseases such as hepatitis B (HBV), hepatitis C (HCV), and/or HIV through injection drug use. The first three paragraphs are reprinted below.

In light of the ongoing opioid epidemic in the U.S., it is becoming increasingly important to raise awareness about the risk of contracting infectious diseases such as hepatitis B (HBV), hepatitis C (HCV), and/or HIV through injection drug use.

To help address the link between the opioid crisis and the spread of infectious diseases, state and local health departments, health care providers, and community organizations are working to coordinate treatment and services for substance use disorders with HCV and HIV prevention and care. However, even among public health workers and advocates, there remains a lack of awareness and action around the rise in acute hepatitis B infection.

Hepatitis B education and outreach often focuses on its most common global mode of transmission—from an infected mother to her baby during childbirth—but among the other modes of hepatitis B transmission, injection drug use is a growing concern. In 2015, the acute hepatitis B infection rate in the U.S. increased by 20.7%, rising for the first time since 2006. The sharpest increases in new hepatitis B cases are occurring largely in states that have been impacted the most by the opioid epidemic.

Access the complete article: The Rise in Acute Hepatitis B Infection in the U.S.

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New York State Department of Health warns that tourist may have spread measles in NYC

On February 23, the New York State Department of Health (NYSDH) announced that a tourist from Australia with confirmed measles visited multiple places in Manhattan and Brooklyn from February 16–21. The complete press release from NYSDH includes more detailed information about the locations where exposure to the virus may have taken place. People who visited any of these places during this time period and who lack immunity to measles or are not sure if they have been vaccinated, should contact their healthcare provider if they develop measles symptoms. Symptoms include a fever, rash, cough, conjunctivitis, or runny nose. Symptoms usually appear in 10–12 days after exposure. 

Read the complete announcement: New York State Department of Health Warns of Potential Measles Exposures in NYC, Orange & Putnam Counties.

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Trust for America's Health publishes report on federal public health funding trends, including state-level data

On March 1, Trust for America’s Health (TFAH) published a new analysis, A Funding Crisis for Public Health and Safety: State-by-State and Federal Public Health Funding Facts and Recommendations, that found spending on public health is insufficient. Sections of a related press released are reprinted below.

In Fiscal Year (FY) 2017, the U.S. Centers for Disease Control and Prevention’s (CDC) budget was $7.1504 billion ($21.95 per person). Adjusting for inflation, CDC’s core budget—not including the Prevention and Public Health Fund—has been essentially flat for the last decade.

Because much of CDC’s budget is distributed to states and localities, the impact of budget cuts is experienced directly at the state and local level. Of the roughly 75 percent of CDC funds that go to states and local communities, support ranges from a low of $5.74 per person in Missouri to a high of $114.38 per person in Alaska.

In addition, 12 percent of CDC’s budget consists of the Prevention and Public Health Fund, with about $625 million a year of that directed to state and local efforts. From FY 2013 through FY 2027, the Prevention Fund will receive nearly $12 billion less than the law intended....

Spending for public health by states has been declining. Based on a TFAH analysis (adjusted for inflation), 31 states made cuts to their public health budgets from FY 2015–2016 to FY 2016–2017....

Access the complete report: A Funding Crisis for Public Health and Safety: State-by-State and Federal Public Health Funding Facts and Recommendations (PDF format; 28 pages).

Access the TFAH March 1 press release: New Report: Funding for Public Health Has Declined Significantly since the Great Recession.

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IAC Spotlight! Check out the "Ask the Experts" online archive for answers to immunization questions

IAC’s "Ask the Experts" web section is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. William Atkinson, MD, MPH, IAC's associate director for immunization education, manages this web section, with answers provided by Andrew T. Kroger, MD, MPH; Candice L. Robinson, MD, MPH; Raymond A. Strikas, MD, MPH, FACP, FIDSA; and JoEllen Wolicki, BSN, RN, all from the National Center for Immunization and Respiratory Diseases, CDC.

The "Ask the Experts" index page can be found at Here you will find more than 1,000 Q&As on all vaccines routinely recommended in the United States, as well as information on such topics as administering vaccines, billing and reimbursement, documenting vaccination, precautions and contraindications, scheduling vaccines, storage and handling, travel vaccines, vaccine recommendations, and vaccine safety. 

Explore IAC's "Ask the Experts" Q&As by clicking on the graphic below.

IAC Express publishes five special editions each year of "Ask the Experts" Q&As answered by CDC experts. You can access the four most recent IAC Express "Ask the Experts" sets of Q&As from the main web page of "Ask the Experts," in the far right column.

If this issue of IAC Express was forwarded to you by someone else, consider getting your own free subscription to IAC Express so you don't miss anything, including these special "Ask the Experts" editions. Sign up at

If you have a question about vaccination that is not covered in this web section, feel free to write

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Voices for Vaccines releases a new podcast episode, "Parenthetical Science," about how parents can get tangled up in unnecessary vaccination drama

Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: Parenthetical Science. In this episode, Karen Ernst, Voices for Vaccines, and Dr. Nathan Boonstra, Blank Children's Hospital, talk to Dr. Chad Hayes and Natalie Newell from the Parenthetical Science Podcast for a rousing discussion about how parenting is harder than it needs to be and how people can fall into the never-ending "woo rabbit hole," as relates to vaccination.

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who values vaccines to become a member. Please spread the word to your friends and colleagues to join VFV!
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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

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.

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 Vaccine Information Statements (VISs)—It’s Federal Law! to reflect the 2/23/2018 date of the recently updated rotavirus VIS.

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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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National Institute of Allergy and Infectious Diseases announces new priority: developing a universal influenza vaccine

On February 28, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, revealed a new strategic plan for addressing the research areas essential to developing a universal influenza vaccine. According to NIAID, an effective universal flu vaccine must meet the following four criteria:

  • Be at least 75% effective
  • Protect against group I and II influenza A viruses
  • Have durable protection that lasts at least one year
  • Be suitable for all age groups

The strategic plan was accepted for publication in The Journal of Infectious Diseases on February 28. 

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February issue of CDC's Immunization Works newsletter now available

CDC recently released the February issue of its monthly newsletter Immunization Works. The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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CDC and WHO report on progress toward polio eradication in Nigeria in this week's MMWR and Weekly Epidemiological Record, respectively

CDC published Progress Toward Poliomyelitis Eradication—Nigeria, January–December 2017 in the March 2 issue of MMWR (pages 253–6). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards poliomyelitis eradication: Nigeria, January–December 2017. A media summary of the MMWR article is reprinted below.

In August and September 2016, after more than two years without any reported cases of wild poliovirus (WPV), Nigeria detected four WPV cases associated with insurgency-held areas in Borno state. Since September 2016 there have been no new reported cases of WPV in Nigeria. However, polio eradication efforts, including surveillance and vaccination, have not reached many northern communities affected by the insurgency. The Nigerian government and its partners continue efforts to reach children living in inaccessible regions, but an estimated 30 percent of settlements in Borno State, with an estimated 160,000 to 210,000 children under the age of five, remain beyond reach. Commitment to strengthening vaccination coverage and surveillance in insurgent-controlled regions is needed to ensure polio eradication in Nigeria and protect every last child.

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CDC reports on rabies vaccine hesitancy and deaths in pregnant and breastfeeding women in Vietnam

CDC published Rabies Vaccine Hesitancy and Deaths Among Pregnant and Breastfeeding Women—Vietnam, 2015–2016 in the March 2 issue of MMWR (pages 250–2). The first paragraph is reprinted below.

Human rabies deaths are preventable through prompt administration of postexposure prophylaxis (PEP) with rabies immune globulin and rabies vaccine after exposure to a rabid animal; there are no known contraindications to receiving PEP. Despite widespread availability of PEP in Vietnam, in 2015 the Ministry of Health (MoH) received reports of pregnant and breastfeeding women with clinically diagnosed rabies. MoH investigated factors associated with these rabies cases. MoH found that, during 2015–2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeeding mothers and four in pregnant women, all of whom had been bitten by dogs. All six patients died. Three of the four pregnant women had cesarean deliveries. One of the three newborns died from complications believed to be unrelated to rabies; the fourth pregnant woman contracted rabies too early in pregnancy for the fetus to be viable. Two of the patients sought care from a medical provider or traditional healer; however, none sought PEP after being bitten. In each case, families reported the patient’s fear of risk to the fetus or breastfed child as the primary barrier to receiving PEP. These findings highlight the need for public health messaging about the safety and effectiveness of PEP in preventing rabies among all persons with exposures, including pregnant and breastfeeding women.

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CDC updates "You Call the Shots" modules on vaccine storage and handling and the VFC program; free CE credit available

CDC recently updated the Vaccine Storage and Handling and the Vaccines For Children (VFC) modules of its web-based training course "You Call the Shots." The nurse education training program has 16 modules on a variety of immunization topics (e.g., DTaP, Hepatitis A, Influenza, Vaccine Storage and Handling, Vaccines for Children). Continuing education credit is available for viewing a module and completing an evaluation. The training course is supported by CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

Participants can access information about obtaining CE credit from the You Call the Shots main page.

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CDC’s Public Health Grand Rounds to present “Global Introduction of New Vaccines: Delivering More to More” on March 20

CDC's Public Health Grand Rounds will present Global Introduction of New Vaccines: Delivering More to More on March 20 at 1:00 p.m. (ET). Those interested in viewing this one-hour session should go to the live external webcast link during the scheduled time.

Sessions are archived 3–4 days after each presentation, so you can view any of these presentations on the archive page at your convenience.

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NFID webinar about improving HPV immunization rates scheduled for March 21 

The National Foundation for Infectious Diseases (NFID) will present a webinar titled "HPV Vaccination: Recommendations and Strategies for Improving Coverage" on March 21 at 12:00 p.m. (ET). NFID medical director, William Schaffner, MD, and subject matter experts Joseph A. Bocchini, Jr., MD, Louisiana State University Health Sciences Center, and Shannon Stokley, DrPH, Immunization Services Division of the National Center for Immunization and Respiratory Diseases, CDC, will provide an update on current HPV vaccine recommendations, vaccine safety and effectiveness, and strategies for improving immunization rates.

The 48th National Immunization Conference (NIC)—Immunization: Prevention, Protection, and Progress—will be held May 15–17 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 provides 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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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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