Issue 1366: May 23, 2018







IAC's "Ask the Experts: Hepatitis B” web page content has been reviewed and updated by CDC experts

IAC's Ask the Experts: Hepatitis B web page containing questions and answers about hepatitis B vaccines, vaccine administration, and other related issues has been completely reviewed and updated by experts at CDC. New content includes information about the newly recommended hepatitis B vaccine for use in adults, Heplisav-B (Dynavax), scheduling information for hepatitis B vaccines, and minimum interval information.

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.

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 right-hand column.
Related Links

CDC publishes “QuickStats: Percentage of Adults Aged ≥60 Years Who Ever Had the Shingles Vaccine, by Sex—National Health Interview Survey, 2008–2016” in this week’s MMWR

CDC published QuickStats: Percentage of Adults Aged ≥60 Years Who Ever Had the Shingles Vaccine, by Sex—National Health Interview Survey, 2008–2016 in the May 18 issue of MMWR (page 565). The summary paragraph is reprinted below.

The percentage of adults aged ≥60 years who ever had the shingles vaccine increased from 6.7% in 2008 to 33.4% in 2016. The percentage of men who had the vaccine increased from 4.9% to 31.2%, and the percentage of women who had the vaccine increased from 8.2% to 35.2%. For each year during 2008–2016, women were more likely than men to have had the shingles vaccine.

CDC issues press release about new rapid rabies test that could save lives and lead to fewer unnecessary rabies shots

CDC issued a press release on May 16 announcing a new rapid rabies test that could revolutionize testing and treatment. The first two paragraphs are reprinted below.

A new rabies test developed at the CDC could mean people exposed to potentially rabid animals could forego the weeks-long regimen of shots to prevent the deadly disease.

The new test, designed for use in animals, can more easily and precisely diagnose rabies infection, according to a study published today in PLOS One. The new LN34 test is simpler and easier to use than current tests. During the pilot study, it produced no false negatives, fewer false positive, and fewer inconclusive results. It could allow doctors and patients to make better informed decisions about who needs treatment for rabies, which is nearly always fatal once symptoms start.

Read the full press release: New rapid rabies test could revolutionize testing and treatment

Related Links

IAC Spotlight! IAC’s "State Laws and Mandates" web page provides information on vaccination requirements in childcare facilities, schools, colleges, and long-term care facilities

IAC's State Laws and Mandates web section on provides up-to-date access to vaccination requirements in childcare facilities, schools, colleges, and long-term care facilities, along with information on states authorizing pharmacists to vaccinate. Pages within this web section are listed below:
  • Hepatitis A state mandates for daycare and K-12
  • Hepatitis B state mandates for daycare and K-12
  • Hepatitis B state mandates for colleges and universities
  • Hib requirements for childcare
  • HPV state mandates for secondary schools
  • Influenza state mandates for daycare
  • Meningococcal ACWY state mandates for colleges and universities
  • Meningococcal ACWY state mandates for elementary and secondary schools
  • MMR requirements for childcare
  • MMR requirements for kindergarten
  • MMR requirements for middle school
  • Pneumococcal (PCV) state mandates for daycare
  • Polio requirements for childcare
  • Polio requirements for kindergarten
  • Rotavirus state mandates for daycare
  • Tdap booster requirements for secondary schools
  • DTaP requirements for childcare
  • DTaP requirements for kindergarten
  • Varicella (chickenpox) state mandates for daycare, elementary, and secondary schools
  • Exemptions permitted for state immunization requirements
  • States authorizing pharmacists to vaccinate
Note: Some of the information in the bulleted list (e.g., Hib, MMR, polio, DTaP [not Tdap]) was compiled and is maintained by CDC.
In addition to the sections above, this web page includes links to policy statements from professional medical organizations on the importance of vaccination and the risks associated with personal belief exemptions.
If you have any additions or corrections for these pages, please email

CDC publishes report on community-based services for persons with chronic hepatitis B infection in this week’s MMWR

CDC published Community-Based Services to Improve Testing and Linkage to Care Among Non–U.S.-Born Persons with Chronic Hepatitis B Virus InfectionThree U.S. Programs, October 2014–September 2017 in the May 18 issue of MMWR (541–6). An excerpt from the opening paragraph is reprinted below.

Among an estimated 850,000 to 2.2 million persons with chronic hepatitis B virus (HBV) infection in the United States, 70% are non-U.S.-born (1,2). All patients require linkage to care, and approximately 20%–40% require antiviral treatment (3). Without treatment, one in four persons chronically infected with HBV will die prematurely from liver failure, liver cirrhosis, or hepatocellular carcinoma (4). To mitigate morbidity and mortality, CDC funded a cooperative agreement to develop hepatitis B testing and linkage-to-care programs serving non-U.S.-born persons during October 2014–September 2017. This report describes each program’s operational services and partnerships with primary care centers, community-based organizations, and public health departments to recruit non-U.S.-born persons for HBV testing using the hepatitis B surface antigen (HBsAg) and link those whose test results were positive to HBV-directed care (medical visit attendance with monitoring of HBV DNA and liver enzyme tests). Among 10,152 program participants, 757 (7.5%) were HBsAg-positive, indicative of chronic HBV infection; among these, 643 (85%) attended ≥1 medical visit, 587 (78%) received HBV-directed care, and 137 (18%) were prescribed antiviral treatment. Among 273 household contacts of HBsAg-positive persons, 39 (14%) had positive test results for HBsAg. Prevalence of current HBV infection was high in this non-U.S.-born population and among household and sexual contacts of HBV-infected persons. HBV testing and linkage to care can be achieved through partnerships with community organizations, health centers, and public health departments.

Access the complete article: Community-Based Services to Improve Testing and Linkage to Care Among Non–U.S.-Born Persons with Chronic Hepatitis B Virus Infection—Three U.S. Programs, October 2014–September 2017

An additional hospital has joined IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

There are now 669 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 April 25, when IAC Express last reported on the Influenza Vaccination Honor Roll, one additional healthcare organization has been enrolled.

IAC urges qualifying healthcare organizations to apply.

Newly added healthcare organizations, hospitals, government agencies, and medical practices
  • Swedish, Edmonds Campus, Edmonds, WA
Related Links

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.

Back to top

NIH recognized May 18 as HIV Vaccine Awareness Day

The National Institutes of Health (NIH) issued a statement recognizing May 18 as HIV Vaccine Awareness Day. A podcast is available featuring an interview with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. A portion of the statement is reprinted below. 
...These advances and ongoing investigations provide cautious optimism that the development of an HIV vaccine is making headway. With each new finding, and with gratitude to those who volunteer for HIV vaccine clinical trials, we move further along the pathway toward a vaccine. On this HIV Vaccine Awareness Day, we are encouraged by the progress that has been made, and pledge to continue our pursuit of the goal of developing a safe and effective HIV vaccine that could help end the HIV pandemic. 
Related Links


Ebola vaccine arrives in Democratic Congo of the Republic; campaign to begin within days

The World Health Organization (WHO) published a report, Ebola Virus Disease: Democratic Republic of Congo (DRC), on May 14. The first 4,000 units of Ebola virus vaccine have arrived in DRC and efforts are underway to administer immunizations to the population. Portions of the report are reprinted below.
On 8 May 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease (EVD) in Bikoro Health Zone, Equateur Province. This is the ninth outbreak of Ebola virus disease over the last four decades in the country, with the most recent one occurring in May 2017. 
Since the last situation report, an additional Health Zone in Equateur Province reported EVD cases—Wangata Health Zone in the city of Mbandaka—with a total of three affected Health Zones as of 14 May 2018. Waganta Health Zone reported two probable cases on 11 May 2018 with both cases testing positive by Rapid Diagnostic Testing (RDT)—both their samples are awaiting PCR confirmation from INRB in Kinshasa. As of 13 May, there is a cumulative total of 41 cases, including 20 deaths (case fatality rate = 48.8%) and three healthcare workers from Bikoro (n=2) and Iboko (n=1). Of the 41 cases reported, two cases are confirmed, 17 are suspected and 22 are probable.  A total of 432 contacts are being monitored in the health zones of Bikoro (n=274), Iboko (n=115) and Mbandaka (n=43) as of 14 May 2018.
Compassionate use immunization is planned for contacts of those positive for EVD and first line workers in affected areas, and preparations for the Bikoro and Wangata Belt Vaccination Campaign began on 14 May 2018, supported by Médicines sans Frontièrs-Switzerland and WHO.

Related Links

CDC publishes “Cholera Epidemic—Lusaka, Zambia, 2017–2018” in this week’s MMWR

CDC published Cholera Epidemic—Lusaka, Zambia, 2017–2018 in the May 18 issue of MMWR (pages 556–9). The first paragraph is reprinted below.

On October 6, 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool specimens from two patients with acute watery diarrhea. The two patients had gone to a clinic in Lusaka, the capital city, on October 4. Cholera cases increased rapidly, from several hundred cases in early December 2017 to approximately 2,000 by early January 2018. In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples. In late December 2017, a number of water-related preventive actions were initiated, including increasing chlorine levels throughout the city’s water distribution system and placing emergency tanks of chlorinated water in the most affected neighborhoods; cholera cases declined sharply in January 2018. During January 10–February 14, 2018, approximately 2 million doses of oral cholera vaccine were administered to Lusaka residents aged ≥1 year. However, in mid-March, heavy flooding and widespread water shortages occurred, leading to a resurgence of cholera. As of May 12, 2018, the outbreak had affected seven of the 10 provinces in Zambia, with 5,905 suspected cases and a case fatality rate (CFR) of 1.9%. Among the suspected cases, 5,414 (91.7%), including 98 deaths (CFR = 1.8%), occurred in Lusaka residents.

Related Links


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

Hepatitis B Foundation releases seven new #justB stories to empower people affected by hepatitis B, raise awareness, and end stigma

The Hepatitis B Foundation continues its storytelling campaign: #justB: Real People Sharing their Stories of Hepatitis B. Portions of the May press release announcing seven new stories are reprinted below.

The Hepatitis B Foundation released seven new videos as part of its national #justB storytelling campaign, which was launched one year ago to highlight the personal stories of people from across the United States who have been affected by hepatitis B. The #justB campaign is designed to increase awareness of hepatitis B and its role in causing liver failure and liver cancer, decrease stigma and discrimination associated with the disease, promote testing and vaccination, and support the foundation’s advocacy efforts to increase federal funding for improved access to care and more research to find a cure.

Related Links


MMWR and Medscape offer free continuing education credit on the recommended immunization schedule for adults

MMWR and Medscape are collaborating to offer free continuing education credit for physicians, nurses, and pharmacists who complete an online course about the recommended immunization schedule for adults. The content is based on ACIP's adult vaccination recommendations, released in February.

Access the course: Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2018.

Medscape provides online continuing medical education for selected journal articles, allowing clinicians the opportunity to earn Medscape CME credit. In addition, Medscape is jointly accredited by the Accreditation Council for Continuing Medical Education, the Accreditation Council for Pharmacy Education, and the American Nurses Credentialing Center, to provide continuing education for the healthcare team. If you are not a registered user on Medscape, you can register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

Related Link

June 12 webinar to present strategies and interventions for increasing HPV vaccination rates
The National AHEC Organization, through a cooperative agreement with the CDC, will present a one-hour webinar on strategies to increase HPV vaccination rates at 2:00 p.m. (ET) on June 12. The webinar will feature Betty Lo, MD, professor of clinical medicine and pediatrics, and director of medicine/pediatrics residency program at Louisiana State University School of Medicine.
This presentation will provide up-to-date information on HPV infection/disease, the HPV vaccine, ACIP recommendations, and ways to successfully communicate with patients and their parents about HPV vaccination. Find out how to reduce missed opportunities by recommending HPV vaccine the same way and same day you recommend other routinely recommended adolescent vaccines. Learn best practices from other medical offices across the nation that are making HPV vaccination a priority.
Continuing education credits are pending.

Registration (required) is open now.

Related Link

Weekly CDC webinar series on "The Pink Book" chapter topics runs June 6 through September 26; register now

CDC is again presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that will start June 6 and run through September 26. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.

The webinar series will provide an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.

Registration and more information is available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at

You can also order this resource from the Public Health Foundation for $40 plus shipping and handling. This print version does not include the 2017 supplement.
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 .