has been refreshed! Take a tour.
Issue 1356: March 21, 2018









CDC warns about fatal yellow fever outbreak in Brazil in MMWR article and media advisory 

On March 16, CDC published Fatal Yellow Fever in Travelers to Brazil, 2018 in an Early Release MMWR. The first and last paragraphs are reprinted below.

Yellow fever virus is a mosquito-borne flavivirus that causes yellow fever, an acute infectious disease that occurs in South America and sub-Saharan Africa. Most patients with yellow fever are asymptomatic, but among the 15% who develop severe illness, the case fatality rate is 20%–60%. Effective live-attenuated virus vaccines are available that protect against yellow fever. An outbreak of yellow fever began in Brazil in December 2016; since July 2017, cases in both humans and nonhuman primates have been reported from the states of São Paulo, Minas Gerais, and Rio de Janeiro, including cases occurring near large urban centers in these states. On January 16, 2018, the World Health Organization updated yellow fever vaccination recommendations for Brazil to include all persons traveling to or living in Espírito Santo, São Paulo, and Rio de Janeiro states, and certain cities in Bahia state, in addition to areas where vaccination had been recommended before the recent outbreak. Since January 2018, 10 travel-related cases of yellow fever, including four deaths, have been reported in international travelers returning from Brazil. None of the 10 travelers had received yellow fever vaccination....

Yellow fever is a potentially fatal illness that is preventable by vaccination. Yellow fever vaccination is recommended for all eligible persons aged ≥9 months, traveling to many areas in Brazil, including the states of São Paulo and Rio de Janeiro (especially Ilha Grande). Unvaccinated travelers should avoid traveling to areas where vaccination is recommended ( Travelers planning to visit areas in Brazil or elsewhere where yellow fever transmission is occurring should receive yellow fever vaccine at least 10 days before travel and follow recommendations for avoiding mosquito bites ( The Food and Drug Administration–approved yellow fever vaccine, YF-VAX, is currently unavailable in the United States because of manufacturing difficulties. An alternative yellow fever vaccine, Stamaril, is available through a limited number of U.S. yellow fever vaccination clinics. U.S. travelers should therefore plan ahead to obtain Stamaril because it might take more time to access one of these clinics. Clinicians assessing returned travelers should be aware of yellow fever signs and symptoms and maintain vigilance regarding the possibility of yellow fever exposure in travelers returning from Brazil or other areas with ongoing transmission of yellow fever.

Access the complete article: Fatal Yellow Fever in Travelers to Brazil, 2018.

On the same day, CDC released a statement for the media titled CDC Warns Of Deadly Outbreak of Yellow Fever in Brazil. The first three paragraphs are reprinted below.

In response to a large, ongoing outbreak of yellow fever in multiple states of Brazil, including near large urban areas and popular tourist destinations, CDC is recommending travelers to the country protect themselves from yellow fever by getting the yellow fever vaccine at least 10 days before travel, and taking steps to prevent mosquito bites during their travel.

CDC recommends that people who are unable to get yellow fever vaccine or aren’t recommended to get it should avoid traveling to areas of Brazil where yellow fever vaccination is recommended. Travelers going to areas with ongoing outbreaks may consider getting a booster dose of yellow fever vaccine if it has been 10 or more years since they were vaccinated.

Yellow fever vaccine is available at a limited number of clinics in the United States, so travelers should plan ahead to get the vaccine. For more on yellow fever vaccination clinics:

Access the complete media advisory. 

Related Links

Back to top

Officials notify the public about possible measles exposure to travelers using Detroit, Newark, and Memphis airports

Public health officials are warning travelers that two cases of measles were confirmed in three U.S. airports in March.

The first person with measles returned from travelling abroad on March 6 at Detroit Metropolitan Airport. The individual was contagious then and was subsequently hospitalized. 

Read the Michigan Department of Health & Human Services press release: Measles case identified in Michigan; health officials urge protection through vaccination.

The second infected person arrived at Newark Liberty International Airport on March 12 before departing for Memphis International Airport.

Read the State of New Jersey Department of Health press release: Public Health Alert: Potential Measles Exposure at Newark Liberty International Airport.

People who were at any of these airports on these days are at risk of contracting measles if they have not been vaccinated or had measles.

Related Links

Back to top

CDC reports on a false-negative hepatitis B surface antigen test report in a hemodialysis patient

CDC published Notes from the Field: False-Negative Hepatitis B Surface Antigen Test Results in a Hemodialysis Patient—Nebraska, 2017 in the March 16 issue of MMWR (pages 311–12). Sections of this report are reprinted below.

In March 2017, the Nebraska Department of Health and Human Services (NDHHS) was contacted by a hemodialysis clinic regarding a patient who had tested negative for hepatitis B virus (HBV) surface antigen (HBsAg) after vaccination in 2010 and who later tested positive for HBsAg. A public health investigation subsequently determined that the false-negative results were caused by a surface antigen mutation. Notably, several commercial HBsAg testing kits cannot detect this mutant virus, making it a challenging pathogen for public health surveillance and intervention efforts....

The epidemiologic investigation identified 45 recent dialysis contacts and 10 close family contacts who were at risk for infection. None of the contacts had prior evidence of HBV infection, all were screened by tests capable of detecting this mutant virus (using a suitable HBsAg assay or by HBV DNA), and all test results were negative, indicating no evidence of HBV transmission, despite the potential exposures to the HBV-infected patient. Family members without evidence of prior HBV vaccination were also advised to complete the HBV vaccination series.

A subsequent survey of laboratories that reported HBsAg results to NDHHS in the previous year identified nine of 23 laboratories using tests that are not known to detect common HBsAg mutations. This included both local hospitals and large national reference laboratories....

Related Links

Back to top

CDC reports on assessing rabies risk after a mass bat exposure at a national park

CDC published Notes from the Field: Assessing Rabies Risk After a Mass Bat Exposure at a Research Facility in a National Park—Wyoming, 2017 in the March 16 issue of MMWR (pages 313–4). Sections of the article are reprinted below.

On August 2, 2017, the Wyoming Department of Health (WDH) was notified by local public health nursing of a group of 20 persons who had slept in a national park research facility and reported contact with bats and bat excrement....

Review of facility records identified 172 persons from 11 research groups who had slept at the research facility, with 73% of persons sleeping in one of two buildings possibly infested with bats ... Persons resided in 29 states, the District of Columbia, one U.S. territory, and four non-U.S. residents were from four countries....

A risk assessment tool adapted from a previous mass bat exposure investigation was used to determine each person’s risk for rabies virus exposure....

By February 8, 2018, risk assessments had been completed for 165 (95.9%) of 172 potentially exposed U.S. residents, with the remaining persons considered lost to follow-up. ... Although all persons were encouraged to consult with a health care provider if they had concerns about exposure, persons classified as having a high exposure risk were counseled regarding potential rabies virus exposure and strongly encouraged to receive PEP....

Related Links

Back to top

American Pharmacists Association awards Dr. William Atkinson its 2018 Outstanding Career Achievement Award 

Every year, the American Pharmacists Association (APhA) selects recipients of its Immunization Champions Awards, recognizing individuals and organizations who have made extraordinary contributions toward improved vaccination rates within their communities. This year's winner of APhA's Outstanding Career Achievement Award is William L. Atkinson, MD, MPH, retired CDC medical officer and current associate director for immunization education for the Immunization Action Coalition (IAC).

Dr. Atkinson retired from CDC after 25 years of service. At the time of his retirement, he was medical epidemiologist and training team lead, Immunization Services Division, National Center for Immunization and Respiratory Diseases, a position he held for 17 years. During his tenure at CDC, he produced, wrote, and/or appeared in more than 100 broadcasts and webcasts that were viewed by more than 300,000 healthcare providers. He also gave more than 600 invited lectures and taught more than 100 two-day training courses across the United States, addressing more than 150,000 attendees. He took the lead in writing CDC's Epidemiology and Prevention of Vaccine-Preventable Diseases (aka the Pink Book), and is the author or coauthor of many more publications and book chapters.

IAC congratulates Dr. Atkinson on APhA's recognition for his work throughout his public health career.

Related Links

Back to top

IAC Spotlight! IAC's “Documenting Vaccinations” web page in the Clinic Tools web section contains a wide variety of valuable tools and partner resources for your practice

Recently updated, IAC's Clinic Tools: Documenting Vaccinations web page on is a collection of resources from IAC and other organizations related to documenting vaccinations. This web page can be found by selecting the "Clinic Tools" tab (third from the left) in the light gray banner across the top of every web page and then selecting "Documenting Vaccinations" in the drop-down menu.

In the left-hand column of the page, you will find IAC's educational materials related to vaccine documentation. From here, you can access IAC's "Vaccine Administration Record for Children and Teens" and "Vaccine Administration Record for Adults," as well as links to other related resources available on The right-hand column of the page includes resources from CDC and other organizations, such as immunization site maps and the American Academy of Pediatrics's resource titled "Documenting Parental Refusal to Have Their Children Vaccinated."

Visit Clinic Tools: Documenting Vaccinations on

Related Links

Back to top

IAC enrolls six new birthing institutions into its Hepatitis B Birth Dose Honor Roll; eleven previously honored institutions qualify for additional years' honors

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

  • 48th Medical Group, U.S. military base in Lakenheath, Brandon, United Kingdom (90%)
  • Baylor Scott & White Medical Center–Brenham, Brenham, TX (91%)
  • Beaumont Hospital–Trenton, Trenton, MI (90%)
  • Cape Coral Hospital, Cape Coral, FL (97%)
  • Highland Community Hospital, Picayune, MS (91%)
  • Willow Creek Women's Hospital, Johnson, AR (100%)

The following institutions are being recognized for a second year:

  • Baylor Scott & White Medical Center–Brenham, Brenham, TX (100%)
  • Cogdell Memorial Hospital, Snyder, TX (100%)

The following four institutions are being recognized for a third year:

  • Cogdell Memorial Hospital, Snyder, TX (98%)
  • Griffin Hospital, Derby, CT (93%)
  • INTEGRIS Grove Hospital, Grove, OK (97%)
  • Lyndon B. Johnson General Hospital, Houston, TX (99%)
  • Memorial Hermann Southeast Hospital, Houston, TX (97%)

In addition, the following four institutions are being recognized for a fourth year:

  • Lyndon B. Johnson General Hospital, Houston, TX (99%)
  • Memorial Hermann Southeast Hospital, Houston, TX (95%)
  • Riverside Regional Medical Center, Newport News, VA (92%)
  • Sturgis Hospital, Sturgis, MI (97%)

The following four institutions are being recognized for a fifth year:

  • Beaumont Hospital–Wayne, Wayne, MI (92%)
  • Hospital Bella Vista, Mayaguez, PR (96%)
  • Spectrum Health Ludington Hospital, Ludington, MI (94%)
  • Sturgis Hospital, Sturgis, MI (92%)

And finally, one institution is being recognized for a sixth year:

  • Spectrum Health Ludington Hospital, Ludington, MI (91%)

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

The Honor Roll now includes 380 birthing institutions from 40 states, Puerto Rico, Guam, and U.S. military bases abroad. Eight-three institutions have qualified for two years, 44 institutions have qualified three times, 15 institutions have qualified four times, six institutions have qualified five times, one institution has qualified six times, and one 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.

Related Links

Back to top

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!

Related Links

Back to top


IAC updates "Zoster Vaccine: CDC Answers Your Questions"

IAC recently updated Zoster Vaccine: CDC Answers Your Questions to insert information about the new shingles vaccine, Shingrix (GSK). This resource is intended for healthcare professionals, and includes useful Q&As about zoster vaccination answered by CDC experts.

Related Links

Back to top


IAC posts 15 new Rotavirus VIS translations

IAC recently posted the following translations of the Rotavirus VIS (updated English-language version released 2/23/18). These translations were made possible through a cooperative agreement between IAC and CDC.

IAC also posted the Spanish version of the Rotavirus VIS in rich text format (RTF). RTF files are intended for use in electronic systems, such as electronic medical records, immunization information systems, or other electronic databases. CDC supplies RTF files of the English-language VISs, and IAC develops Spanish RTF files of VISs for each routinely recommended vaccine.

Related Links

Back to top

Vietnamese-language Influenza VIS corrected to include missing phrase

The Vietnamese-language Inactivated Influenza Vaccine (IIV) VIS was recently corrected to include the following phrase that had inadvertently been left off: “Most people who get a flu shot do not have any problems with it.” 

Related Links

Back to top


CDC and WHO report on vaccine-derived polio outbreaks in the Democratic Republic of the Congo in this week's MMWR and Weekly Epidemiological Record, respectively

CDC published Vaccine-Derived Poliovirus Outbreaks and Events—Three Provinces, Democratic Republic of the Congo, 2017 in the March 16 issue of MMWR (pages 300–5).  On the same day, WHO's Weekly Epidemiological Record published a similar article titled Vaccine-derived polioviruses outbreaks and events in 3 provinces of Democratic Republic of the Congo, 2017. A media summary of the MMWR article is reprinted below.

The last confirmed wild poliovirus case in the DRC [Democratic Republic of the Congo] occurred in December 2011; however, the country continues to report cases of vaccine-derived polioviruses (VDPVs). VDPVs can emerge from oral poliovirus vaccine (OPV) and spread within populations with low immunity to the virus. In 2017 (as of 8 March 2018), 25 cases of VDPV were reported in three provinces. In response to these cases, supplementary immunization activities were conducted June–December 2017. Because of limitations in surveillance and poor immunization activities, VDPV circulation will likely continue in 2018, requiring additional immunization programs. DRC health officials and Global Polio Eradication Initiative (GPEI) partners are increasing human and financial resources to improve all aspects of the response.

Related Links

Back to top


Flu vaccination still recommended as long as influenza viruses are circulating

CDC has reported in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending March 10, influenza activity decreased in the United States, although it was still widespread, with 9 additional pediatric deaths. The total number of pediatric deaths since October 1, 2017 is 123. The proportion of outpatient visits for influenza-like illness (ILI) was 3.3%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above region-specific baseline levels. The geographic spread of influenza in Puerto Rico and 26 states was reported as widespread.

Influenza vaccination is recommended for everyone six months of age and older as long as influenza viruses are still circulating. 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

Hepatitis B Foundation releases new video titled "M.D.'s Story: Just Be Vocal" in its storytelling project #justB

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

Watch the March video, M.D.'s Story: Just Be Vocal, about a young woman of Vietnamese ancestry who spent years hiding her chronic hepatitis B infection status from others and how she learned to speak out and stop keeping secrets.

Related Links

Back to top


Reminder: Vaccine Education Center’s “Current Issues in Vaccines” webinar with Dr. Paul Offit to be held March 28
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, beginning at 12:00 p.m. (ET) on March 28, as part of its Current Issues in Vaccines series. The webinar will feature Paul Offit, MD, director of VEC, discussing:
  • Novel hepatitis B vaccine: ACIP recommendations
  • Influenza: Updates on vaccine efficacy and disease burden
  • HPV: Updates on vaccine safety and long-term efficacy
  • PCV13: Evidence for herd immunity
  • Meningococcal disease: Revised data on risk for college students
Free continuing education credits (CME, CEU, and CPE) are available; instructions for obtaining credits are provided at the end of the recording.

Registration (required) is open now.

Related Link
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.

If you have trouble receiving or displaying IAC Express messages, visit our online help section.

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.

IAC Express Disclaimer
ISSN: 1526-1786
Our mailing address is
Immunization Action Coalition
2550 University Avenue West, Suite 415 North
Saint Paul, MN 55114

Copyright (C) 2018 Immunization Action Coalition
All rights reserved.

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 .