Issue 1361: April 25, 2018








CDC publishes ACIP recommendations for use of hepatitis B vaccine with a novel adjuvant in MMWR 

CDC published Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant in the April 20 issue of MMWR (pages 455–8). Portions of the "Introduction" and "CDC Guidance for Use" sections are reprinted below.


Vaccination is the primary means for preventing hepatitis B virus (HBV) infection and its complications. Existing hepatitis B (HepB) vaccines use an aluminum adjuvant. On November 9, 2017, Heplisav-B (HepB-CpG), a single-antigen HepB vaccine with a novel immunostimulatory sequence adjuvant, was approved by the Food and Drug Administration for the prevention of HBV in persons aged ≥18 years. The vaccine is administered as 2 doses, 1 month apart. On February 21, 2018, the Advisory Committee on Immunization Practices (ACIP) recommended HepB-CpG for use in persons aged ≥18 years...

HepB-CpG is the fifth inactivated HepB vaccine currently recommended for use in the United States. This report contains ACIP guidance specific to HepB-CpG and augments the 2018 ACIP recommendations for the prevention of HBV infection. This report does not include new guidance for populations recommended to receive HepB vaccination or immunization management issues other than those that pertain specifically to HepB-CpG....

CDC Guidance for Use

Interchangeability and dosing schedule. Data are limited on the safety and immunogenicity effects when HepB-CpG is interchanged with HepB vaccines from other manufacturers. When feasible, the same manufacturer’s vaccines should be used to complete the series. However, vaccination should not be deferred when the manufacturer of the previously administered vaccine is unknown or when the vaccine from the same manufacturer is unavailable.

The 2-dose HepB vaccine series only applies when both doses in the series consist of HepB-CpG. Series consisting of a combination of 1 dose of HepB-CpG and a vaccine from a different manufacturer should consist of 3 total vaccine doses and should adhere to the 3-dose schedule minimum intervals of 4 weeks between dose 1 and 2, 8 weeks between dose 2 and 3, and 16 weeks between dose 1 and 3. Doses administered at less than the minimum interval should be repeated. However, a series containing 2 doses of HepB-CpG administered at least 4 weeks apart is valid, even if the patient received a single earlier dose from another manufacturer.

Special populations. There are no clinical studies of HepB-CpG in pregnant women. Available human data on HepB-CpG administered to pregnant women are insufficient to inform assessment of vaccine-associated risks in pregnancy. Until safety data are available for HepB-CpG, providers should continue to vaccinate pregnant women needing HepB vaccination with a vaccine from a different manufacturer.

Postvaccination serologic testing. To assess response to vaccination and the need for revaccination, postvaccination serologic testing 1–2 months after the final dose of vaccine is recommended for certain persons following vaccination (e.g., hemodialysis patients, HIV-infected and other immunocompromised persons, health care personnel, and sex partners of HBsAg-positive persons). Postvaccination serologic testing should be performed using a method that allows determination of the protective level of anti-HBs (≥10 mIU/mL). Persons with anti-HBs <10 mIU/mL following receipt of 2 doses of HepB-CpG should be revaccinated. Revaccination may consist of administration of a second complete HepB vaccine series followed by anti-HBs testing 1–2 months after the final dose. Alternatively, revaccination may consist of administration of an additional single HepB vaccine dose followed by anti-HBs testing 1–2 months later (and, if anti-HBs remains <10 mIU/mL, completion of the second HepB vaccine series followed again by anti-HBs testing 1–2 months after the final dose).

Administration of more than two complete HepB vaccine series is generally not recommended, except for hemodialysis patients. HepB-CpG may be used for revaccination following an initial HepB vaccine series that consisted of doses of HepB-CpG or doses from a different manufacturer. HepB-CpG may also be used to revaccinate new health care personnel (including the challenge dose) initially vaccinated with a vaccine from a different manufacturer in the distant past who have anti-HBs <10 mIU/mL upon hire or matriculation.

Access the complete recommendation: Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant.

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It's National Infant Immunization Week; CDC names Childhood Immunization Champion Award winners

National Infant Immunization Week (NIIW) is being celebrated this year from April 21–28. NIIW is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities.

In accordance with annual tradition, CDC has released the names of the 2018 Childhood Immunization Champion Award recipients during this week. 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, one CDC Immunization Champion from each of the 50 states, 8 U.S. territories and freely associated states, and the District of Columbia may be honored.

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Now available! IAC's sturdy laminated versions of the 2018 U.S. child/teen immunization schedule and the 2018 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2018 U.S. child/teen immunization schedule and the 2018 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11".

Adult Laminated Immunization Schedules

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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National Vaccine Advisory Committee is seeking members; nominations due May 4

The U.S. Department of Health and Human Services is seeking nominees to serve on the National Vaccine Advisory Committee (NVAC). Staffed by the National Vaccine Program Office (NVPO), the advisory committee recommends ways to achieve optimal prevention of human infectious diseases through vaccine development, and provides direction to prevent adverse reactions to vaccines. NVAC members serve a pivotal role by providing peer review, consultation, advice, and recommendations to the Assistant Secretary for Health, who serves as the director of the National Vaccine Program.

NVAC functions include encouraging an adequate supply of safe and effective vaccines, recommending research priorities, advising the director on implementation of the Public Health Service Act, and identifying partners to carry out immunization goals. NVPO is responsible for coordinating and ensuring collaboration among the many federal agencies involved in vaccine and immunization activities.

Nominations will be considered for two voting member positions opening in 2018 and may also be considered for future committee vacancies. Applications must be submitted by 5:00 p.m. (ET) on May 4, 2018.

For information on the committee and how to apply, please visit the Federal Register Notice and NVAC Membership web pages.

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IAC Spotlight! IAC’s recently updated Vaccine Timeline web page features historic dates and events related to vaccines and immunization

IAC maintains a vaccine timeline on its website for healthcare professionals at This is a wonderful resource to use when updating immunization presentations, documents, and websites.

Not too many years ago, we celebrated the 200th anniversary of Edward Jenner's first smallpox vaccination in 1796. The development of vaccines continued at a fairly slow rate until the last several decades when new scientific discoveries and technologies led to rapid advances in virology, molecular biology, and vaccinology.

The timeline displays many of the vaccine- and immunization-related events that have occurred since Jenner's critical discovery. This list is by no means exhaustive.

Visit IAC's Vaccine Timeline web page.

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Four healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

There are now 668 organizations enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.

Since March 28, when IAC Express last reported on the Influenza Vaccination Honor Roll, four additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

Newly added healthcare organizations, hospitals, government agencies, and medical practices

  • St. John's Pleasant Valley Hospital, Camarillo, CA
  • St. John's Regional Medical Center, Oxnard, CA
  • Sarasota Memorial Health Care System, Sarasota FL
  • Open Door Family Medical Centers, Ossining, NY

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CDC's 2016 viral hepatitis surveillance report is now available

On April 16, CDC released Surveillance for Viral Hepatitis—U.S., 2016 (PDF), including information on the reported cases of hepatitis A, B, and C. Portions of the report are reprinted below.

Hepatitis A
Between 2012 and 2016, the number of hepatitis A virus (HAV) infections reported to CDC fluctuated because large outbreaks occurred. After a long downward trend, the first increase between 2012 and 2013 (1,562 and 1,781 reported cases, respectively), was due to a large multi-state outbreak associated with pomegranate arils imported from Turkey. Between 2015 and 2016, the reported cases again increased by 44.4% from 1,390 in 2015 to 2,007 cases in 2016. The 2016 increase was due to two HAV outbreaks, each of which was linked to imported foods.

Hepatitis B
After a marked decline in acute hepatitis B virus (HBV) infections reported to CDC since the 1990s—with the widespread introduction of hepatitis B vaccination—there has been no consistent trend in acute HBV cases since 2012; that is, reported cases have been fluctuating around 3,000 cases each year. In 2016, there were 3,218 cases reported to CDC. After adjusting for under-ascertainment and under-reporting, the estimated number of new HBV infections in 2016 was 20,900 (95% CI, 11,900–51,200).

Hepatitis C
Reported cases of acute hepatitis C virus (HCV) infection increased about 3.5-fold from 2010 through 2016 (from 850 to 2,967 reported cases), rising annually throughout this period. Examining annual trends beginning in 2012, reported cases of acute HCV infection increased 20.2% from 2012 to 2013 (n=1,778 and 2,138 cases, respectively), increased 2.6% to 2,194 cases in 2014, increased 11.0% to 2,436 cases in 2015, and increased 21.8% to 2,967 cases in 2016. The increase in acute HCV case reports reflects new infections associated with rising rates of injection-drug use, and, to a lesser extent, improved case detection. New hepatitis C virus infections are increasing most rapidly among young people, with the highest overall number of new infections among 20- to 29-year-olds. This is primarily a result of increasing injection drug use associated with America’s growing opioid epidemic.

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May is Hepatitis Awareness Month; promote hepatitis awareness and join the May 19 Hepatitis Day Thunderclap!

It's time to celebrate Hepatitis Awareness Month and the seventh annual national Hepatitis Testing Day on May 19! CDC has shared the following to help your efforts during May and beyond.

The Hepatitis Awareness Month and Testing Day Resource Center has free tools to help support your awareness activities and testing events. Resources include buttons, badges, and a quiz widget for your website or email signatures; Live-Read Radio Scripts templates to pitch your events to local radio stations; and sample proclamations for Hepatitis Awareness Month and/or national Hepatitis Testing Day.

Join the Be #HepAware Thunderclap on May 19 at 12:00 p.m. (ET). Supporters can sign up in advance using their Twitter, Facebook, or Tumblr accounts for a one-time post that will automatically be sent on May 19. Visit to sign up and help spread the word to your members and followers.

If your organization provides ongoing hepatitis testing and vaccination services, please visit and fill out an online form to make sure your services are registered within their database. This site is a tool for people to enter their zip code and find ongoing services in their area.

Share the feature on the ABCs of Viral Hepatitis and encourage people to take the Hepatitis Risk Assessment to get personalized hepatitis vaccination and testing recommendations. The Risk Assessment can be shared by posting badges on your website or promoting the link on social media.

The Know More Hepatitis campaign, which encourages people born from 1945–1965 to get tested for hepatitis C, and the multilingual Know Hepatitis B campaign, promoting hepatitis B testing among Asian Americans, have free resources available for use. Campaign resources include video PSAs and posters, radio PSAs, infographics, fact sheets, customizable event flyers, and other materials.

Visit the Division of Viral Hepatitis’s website for information and resources on all types of hepatitis, including fact sheets, posters, provider resources, and much more.

Follow @cdchep on Twitter for information about hepatitis resources, tools, publications, campaign updates, and events. Use the hashtags #HepAware, #hepatitis, and #HepTestingDay, to join the conversation and share information on viral hepatitis.

Sign up for monthly emails from the Division of Viral Hepatitis about new publications, recommendations, new materials, or significant events.

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WHO publishes new position paper on rabies vaccines in this week's Weekly Epidemiological Record

The World Health Organization (WHO) published Rabies vaccines: WHO position paper—April 2018 in the April 20 issue of the Weekly Epidemiological Record (pages 201–20). Portions of the article are reprinted below.

WHO Position
Rabies is an infectious zoonotic viral disease that is almost always fatal following the onset of clinical symptoms. It remains an important cause of mortality in many endemic countries in particular in marginalized populations. While rabies control depends heavily on prevention of rabies in dogs, vaccination of humans is an effective preventive intervention after an exposure to RABV or before exposure to RABV. Rabies vaccines are highly effective, safe and well tolerated.

WHO recommends 2 main immunization strategies for the prevention of human rabies:

  • PEP which includes extensive and thorough wound washing at the RABV-exposure site, together with RIG administration if indicated, and the administration of a course of several doses of rabies vaccine;
  • PrEP which is the administration of several doses of rabies vaccine before exposure to RABV.

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New resources available from CDC's #PreteenVax program

CDC and its partners have developed new resources to assist healthcare providers in promoting preteen vaccinations, including new fact sheets, flip charts, and action guides, as well as webinars and continuing education modules. The new materials available are described below.

#PreteenVaxScene Webinar Recording
The Massachusetts Oral HPV Prevention Taskforce recently participated in a #PreteenVaxScene webinar, An Interprofessional Approach to HPV and Oropharyngeal Cancer Prevention Education, to educate and empower dental professionals to help their patients make informed decisions about oral health and cancer prevention.

New CME: HPV Vaccination at 11 and 12 as a Standard of Care
In this CME, you’ll learn how clinicians can and have been successful making HPV vaccine recommendations for adolescents 11–12 years of age. Other topics addressed include how to effectively answer parents’ questions and communicate HPV vaccination information to parents and patients. This web-on-demand video was released on January 16, 2018 and continuing education is available until January 16, 2020.

AAP 5 Key Points Fact Sheets and Guide to Adolescent Immunizations Flip Chart
The American Academy of Pediatrics (AAP) has three new HPV Fact Sheets for dental and medical professionals, which can be found in the Printable Resources section of the HPV Champion Toolkit. These sheets can be shared electronically and/or posted to organization's websites for further distribution.

The AAP has also developed a flip chart for pediatric offices and parents. This resource is aimed at helping pediatric healthcare providers discuss adolescent immunizations with their patients and families. It provides information and answers to parents' questions on adolescent vaccines in easy-to-understand infographics on one side and talking points for healthcare providers on the other.

ACS Clinical and System Action Guides
The American Cancer Society (ACS) developed Clinician and System Action Guides, which are a suite of six booklets tailored to specific professional audiences. The guides communicate the collective guidance of the HPV Roundtable for healthcare providers, decision makers, and support staff to implement key interventions and strategies to raise HPV vaccination rates.

HPV Vaccine: Same Way, Same Day
HPV Vaccine: Same Way, Same Day is a brief, interactive role-play simulation designed to enhance healthcare providers’ ability to introduce the HPV vaccine and address parents’ concerns. It is ideal immunization education for clinicians involved in residency training, quality improvement collaboratives, office in-service training, etc. The simulation was developed by the Academic Pediatric Association, the AAP, and Kognito. The complimentary versions are available for download from the Google Play Store and Apple iTunes Store.

Facebook Group: HPV Cancer Free Family
The National HPV Vaccination Roundtable invites you to join the HPV Cancer Free Family on Facebook. This Facebook group is a place for families to find accurate information about HPV vaccination, HPV-related cancers and get answers from doctors, nurses, researchers, HPV cancer survivors and other advocates. A representative of the National HPV Vaccination Roundtable will be on-hand to answer questions and respond to comments at least once a day Monday–Friday.

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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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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 April 14, influenza activity continued to decrease in the United States, although widespread activity was still reported in five states. With five additional pediatric deaths reported, the total number of pediatric deaths since October 1, 2017 is now 156.

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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Study finds health education and persuasion campaigns less likely to lead to vaccination; indirect behavior modification more effective

A new report published in Psychological Science in the Public Interest, by N.T. Brewer, et al., found that using education campaigns and persuasion tactics is less effective in motivating individuals to get vaccinated than indirect behavioral nudges. The study found that people are less likely to respond to facts and education about the importance of vaccines and more likely to respond to actions that help them overcome inconveniences and barriers to vaccination. In order to improve vaccination rates, this study found evidence that healthcare providers should utilize indirect behavior modification tools, such as automatically scheduled vaccination appointments, phone and text reminders from doctors' offices and monetary incentives from employers.

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"Epidemics Going Viral: Innovation Vs. Nature” webinar on April 27 will feature Bill Gates

Join the Massachusetts Medical Society and the New England Journal of Medicine for a free live web event Epidemics Going Viral: Innovation Vs. Nature. This event, which is scheduled for Friday, April 27, 8:00 a.m. to 12:45 p.m. (ET), will examine the complexity of preparing for, and responding to, the next epidemic, which may have catastrophic implications for global health. The web event will feature many well-known speakers, including Anne Schuchat, MD, principal deputy director, CDC; Tom Frieden, MD, MPH, president and chief executive officer, Resolve to Save Lives; and Bill Gates, co-chair, Bill & Melinda Gates Foundation.

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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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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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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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