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Issue 1374: July 11, 2018









New! Vaccine Safety References page on VEC's website lists journal articles available for use by expert witnesses in vaccine cases

The Vaccine Education Center at Children's Hospital of Philadelphia (VEC) recently added a new web section titled Vaccine Safety References. It is a listing of journal articles developed for those who may be asked to address these issues either with their patients or more formally, in court. The page is divided into the following topics:

  • Aluminum and vaccines
  • Autism and the MMR debate
  • Diabetes and vaccines
  • DNA and vaccines
  • Formaldehyde and vaccines
  • Multiple sclerosis and vaccines
  • Thimerosal (mercury) and vaccines
  • Too many vaccines, too soon
  • Vaccine ingredients

The introductory paragraphs are reprinted below.

This library provides key references regarding vaccine safety to clinicians and others, including those asked to provide expert testimony in legal proceedings involving the benefits and risks of vaccination, and to lawyers who are defending against such claims. It should also be of value to clinicians answering the questions of patients and parents concerning vaccine safety.

This collection of references should counteract the references of dubious scientific validity that allege safety issues regarding vaccination. We hope the library will serve to provide valuable information to those who confront these issues as well as maintain high levels of vaccine acceptance.

This new web page is the result of a collaboration between Paul Offit, MD, director, Vaccine Education Center; Stanley Plotkin, MD, emeritus professor of Pediatrics, University of Pennsylvania; Dorit Reiss, JD, professor, University of California Hastings College of Law, and Heather Bodenstab, PharmD, Children’s Hospital of Philadelphia.

Check out the Vaccine Safety References web section on the VEC website.

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IAC's Ask the Experts: Tetanus, Diphtheria, and Pertussis web page updated based on new ACIP recommendations 

IAC's Ask the Experts: Diphtheria, Tetanus, Pertussis web page containing questions and answers about DTaP, Tdap, Td, and DT vaccines; vaccine administration; vaccine scheduling; and other issues has been completely reviewed and updated by experts at CDC. The updates were based on the ACIP recommendations published on April 27, 2018: Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States.

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.
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CDC updates appendices in its online "Pink Book" 

On July 1, CDC announced updates to a number of the appendices in the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book").

To view the CDC web page listing the updated appendices, go to the book's Errata, Updates & Clarifications web page. Updates were made to the following:

Appendix A

  • Recommended Immunization Schedules for Persons Aged 0 Through 18 Years
  • Recommended Adult Immunization Schedule
  • Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines
  • Summary of Recommendations for Child/Teen Immunization
  • Summary of Recommendations for Adult Immunization
  • Recommended intervals between administration of immune globulin preparations and measles- or varicella-containing vaccine
  • Healthcare Personnel Vaccination Recommendations
  • Vaccination of Persons with Primary and Secondary Immune Deficiencies
  • Guide to Contraindications and Precautions to Commonly Used Vaccines
  • Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults

Appendix B

  • U.S. Vaccines
  • Vaccine Excipient and Media Summary, by Vaccine
  • Latex in Vaccine Packaging

Appendix C

  • It’s Federal Law
  • Instructions for Use of VISs
  • VIS Questions and Answers
  • CDC’s Vaccine Information Statement Web page

Appendix E

  • Reported Cases and Deaths from Vaccine Preventable Diseases, United States, 1950–2016
  • Impact of Vaccines in the 20th and 21st Centuries
  • Vaccine Coverage Levels, United States, 1962–2016

Appendix F

  • Contact Information: Selected Vaccine Manufacturers & Distributors
  • Immunization Grantees

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

To order a copy of "The Pink Book," go to the Public Health Foundation.

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IAC Spotlight: IAC's newly updated Adult Vaccination web page features useful materials from IAC and partner organizations to help increase adult vaccination rates

IAC's newly updated Adult Vaccination web page on is a collection of resources from IAC and other organizations related to adult vaccination. Available resources include summaries of recommendations, screening checklists, vaccine administration aids, and strategies and tips for improving adult vaccination rates. Besides IAC, materials are featured from CDC, the American College of Physicians, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the National Adult and Influenza Immunization Summit, the National Vaccine Program Office, and the National Foundation for Infectious Diseases.

Visit IAC's Adult Vaccination web page at

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Dr. Paul Offit authors new book: Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Information

Paul Offit, MD, director, Vaccine Education Center at Children's Hospital of Philadelphia, as well as the Maurice R. Hilleman Professor of Vaccinology and professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania, has written a new book titled Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Information. A selection from a description of the book from Dr. Offit's website is reprinted below.

Science doesn’t speak for itself. Neck-deep in work that can be messy and confounding, and naive in the ways of public communication, scientists are often unable to package their insights into the neat narratives that the public requires. Enter the celebrities, the advocates, the lobbyists, and the funders behind them, who take advantage of scientists’ reluctance to provide easy answers, flooding the media with misleading or incorrect claims about health risks. Amid this onslaught of spurious information, Americans are more confused than ever about what’s good for them and what isn’t.

Bad Advice, Paul A. Offit shares hard-earned wisdom on the do’s and don’ts of battling misinformation....

The book can be purchased through Dr. Offit's website (click on the images at the bottom of the page), from the publisher Columbia University Press, or your favorite bookstore or seller.

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Association of Immunization Managers announces award winners from its spring meeting

The Association of Immunization Managers (AIM) honored a number of individuals and organizations with awards at its June meeting in San Diego. The following list of winners is reprinted from the AIM Weekly Update newsletter.
  • The Impact Award recognizes an AIM member who dedicates a significant amount of time, expertise, and experience toward achieving the organizational goals of AIM. Winner: Michele Roberts (WA)
  • The Rising Star Award recognizes a new program manager who demonstrates effective leadership and potential for growth within AIM. Winner: Shannon Bennett (NV)
  • The Partnership Award recognizes partners who have implemented a program, project, or service that delivers a valuable benefit, service, or resource that positively impacts all AIM members. Winner: Amy Pisani (Vaccinate Your Family: the Next Generation of Every Child By Two)
  • The Bull’s-Eye Award for Innovation and Excellence in Immunization is presented to immunization programs in recognition of outstanding immunization initiatives. Congratulations to the following programs:
    • New Jersey Department of Health, Vaccine Preventable Disease Program (HPV Vaccination Coverage Assessment Tool)
    • Washington State Department of Health, Office of Immunization and Child Profile (Immunization practices and policies at four-year colleges and universities in Washington state)
    • North Dakota Department of Health, Immunization Program (School Immunization Quality Improvement in North Dakota)
  • The Leading Through Adversity Award recognizes program managers who have risen to the challenge of managing the immunization program through difficult circumstances. AIM presented this award to the program managers who were significantly impacted by the 2017 hurricane season: Omar Salgado (Houston), Nancy Ejuma (TX), Dr. Angel Rivera (Puerto Rico), Leone Jackson (US Virgin Islands), and Bob Griffin (FL).
  • The Natalie J. Smith Award is presented to an immunization program manager exhibiting the high ideals, innovation, and commitment to excellence that characterized the career of Dr. Natalie J. Smith, former California program manager, immunization leader and contributor to AIM. Winner: Annette Aguon (Guam)
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Nominations open for the 2018 HPV Vaccine Is Cancer Prevention Champion Award 

The HPV Vaccine Is Cancer Prevention Champion Award is given annually by CDC, the American Cancer Society (ACS), and the Association of American Cancer Institutes (AACI). This award recognizes clinicians, clinics, practices, groups, and health systems that are going above and beyond to foster HPV vaccination among adolescents in their communities. This year, up to one Champion from each of the 50 U.S. states, 8 U.S. Territories and Freely Associated States, and the District of Columbia will be recognized.

State and territorial immunization program managers will coordinate the nomination and review process, and then send their nomination to CDC for final review. The 2018 award recipients will be announced in the fall of 2018. Champions will be featured on CDC’s website and in the #PreteenVaxNews e-newsletter. Champions will also receive a congratulatory letter from AACI, ACS, and CDC, an HPV Vaccine Is Cancer Prevention Champion plaque, and a digital web badge for their websites.

Click on the graphic below to find out more about nominating an HPV Champion.

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Help raise awareness on World Hepatitis Day, July 28

July 28 is World Hepatitis Day. On this day, people around the world are called on to take action, raise awareness, and join in the quest to find the "missing millions"—the estimated 300 million people who are unknowingly living with viral hepatitis. Without finding the undiagnosed and linking them to care, millions will continue to suffer, and lives will be lost.

For more information and campaign materials, such as the customizable posters below, visit the World Hepatitis Day website.

Organizations can show their support for the Find the Missing Millions campaign by adding their name and logo here.

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Medical Board of California orders 35 months’ probation for pediatrician Dr. Bob Sears, known for advocating "alternative" vaccination schedules

Bob Sears, MD, a California pediatrician known for advocating "alternative" vaccination schedules and discouraging parents from vaccinating, has been placed on probation by the Medical Board of California until he fulfills the requirements of a probationary period of 35 months. The first three paragraphs of an article in the LA Times are reprinted below.

In a decision that could signal how California’s fierce vaccine debates will play out in the coming years, the Medical Board of California has ordered 35 months’ probation for Dr. Bob Sears, an Orange County pediatrician well-known for being sympathetic to parents opposed to vaccines.

In 2016, the board threatened to revoke Sears’ medical license for wrongly writing a doctor’s note for a 2-year-old boy that exempted him from all childhood vaccinations. This week, the medical board settled on a lesser punishment.

Sears can keep practicing medicine but will be required to take 40 hours of medical education courses a year, as well as an ethics class, and also be monitored by a fellow doctor. He also must notify all hospital and medical facilities where he practices of the order and is not allowed to supervise physician assistants or nurse practitioners.

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IAC updates its slide set "Common Immunization Myths and Misconceptions"; use it “as is” or modify it to fit your needs

IAC recently updated its slide set titled Common Immunization Myths and Misconceptions. This 56-slide resource includes not only rebuttals to misconceptions held by parents and patients, but also addresses misconceptions of some healthcare professionals, such as "Providers need to check vital signs before vaccinating." The updates in the slide set are mainly to titles of, and links to, the references.

To request this PowerPoint slide set, go to IAC's PowerPoint Slide Sets web page and scroll down to the alphabetical list of titles. Just below the presentation's tile and description, click on "Request the PowerPoint slide set" and IAC will email the PowerPoint presentation to you. Once you have received the presentation, you can edit and use it as you see fit.

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IAC revises Spanish translation of "Protect yourself from shingles ... get vaccinated!"

In April, IAC revised its easy-to-read handout for adults titled Protect yourself from shingles . . . Get vaccinated! to change the age at which all adults need zoster vaccine from 60 to 50 and to include the 2-dose recombinant zoster vaccine, Shingrix. The Spanish-language version has now been updated to match the revised English-language version.

Access the revised Spanish translation: Protéjase de la culebrilla... ¡Vacúnese!

Access all 20 of IAC's easy-to-read handouts for patients and parents.

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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CDC and WHO report on measles-rubella supplementary immunization activities in India in this week's MMWR and Weekly Epidemiological Record, respectively​

CDC published Measles-Rubella Supplementary Immunization Activity Readiness Assessment—India, 2017–2018 in the July 6 issue of MMWR (pages 742–6). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Assessment of readiness for measles–rubella supplementary immunization activity, India, 2018. A media summary of the MMWR article is reprinted below.

India adopted the goal of measles elimination and rubella and congenital rubella syndrome (CRS) control by 2020. Achieving this goal requires SIAs [supplementary immunization activities] using measles-rubella (MR) vaccine. Nationwide MR SIAs for children ages 9 months–14 years began in 2017 and are to be completed by first quarter of 2019. SIAs require substantial preparation. To ensure high-quality SIAs, researchers performed an SIA readiness assessment. This report describes the process and experience of implementing SIA readiness assessments in three Indian states (Andhra Pradesh, Kerala, and Telangana).​

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Global Polio Eradication Initiative publishes news story about reaching refugees and internally displaced people in Chad with vaccination services 

The Global Polio Eradication Initiative recently published an online article titled These Places Prove Our Biggest Challenge, describing with words and photos the challenges of providing immunizations to refugees and internally displaced people in Chad. Three paragraphs of the story are reprinted below.

Dar es Salam refugee camp, in Bagassola district, Chad, is home to thousands of refugees. 95% of the population is Nigerian, displaced by years of violent insurgency, drought and insecurity in the Lake Chad basin. Some have lived in the camp since 2014....

Polio immunization is a core health intervention offered by the health centre here, with monthly house to house vaccination protecting every child from the virus....

At a camp in Mélea, vaccinators perform routine immunization against measles and other diseases under a shelter made from branches. Cross-legged on the ground, they fill in paperwork, carefully administer injections, sooth babies, and dispose safely of needles. Other vaccinators give the oral polio vaccine to every child under the age of ten. These children are mostly from the islands, displaced by insurgency. Their vaccination history is patchy at best, and it is critical that they are protected....

Access the complete news story: These Places Prove Our Biggest Challenge

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Still 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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IAC's 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

In late 2017, the Immunization Action Coalition (IAC) 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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June issue of CDC's Immunization Works newsletter now available

CDC recently released the June 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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New study finds prenatal maternal Tdap effective in preventing pertussis in infants

The American Journal of Preventive Medicine published a study by Sylvia Becker-Dreps et al. titled Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S. The abstract is reprinted below.

It is recommended that all pregnant women in the U.S. receive tetanus, diphtheria, acellular pertussis (Tdap) immunization to prevent infant pertussis. This study’s objective was to examine the clinical effectiveness of prenatal Tdap, and whether effectiveness varies by gestational age at immunization.

A nationwide cohort study of pregnant women with deliveries in 2010–2014 and their infants was performed. Commercial insurance claims data were analyzed in 2016–2017 to identify Tdap receipt by the pregnant women, and hospitalizations and outpatient visits for pertussis in their infants until the infants reached 18 months of age. Pertussis occurrence was compared between infants of mothers who received prenatal Tdap (overall and stratified by gestational age at administration) and infants of unvaccinated mothers.

There were 675,167 mother–infant pairs in the cohort. Among infants whose mothers received prenatal Tdap, the rate of pertussis was 43% lower (hazard ratio=0.57, 95% CI=0.35, 0.92) than infants whose mothers did not receive prenatal or postpartum Tdap; this reduction was consistent across pertussis definitions (hazard ratio for inpatient-only pertussis=0.32, 95% CI=0.11, 0.91). Pertussis rates were also lower for infants whose mothers received Tdap during the third trimester. Infants whose mothers received Tdap at <27 weeks of gestation did not experience reductions in pertussis rates (hazard ratio for pertussis=1.10, 95% CI=0.54, 2.25).

Infants of mothers who received prenatal Tdap experienced half the rate of pertussis as compared with infants of unimmunized mothers. These results do not provide evidence to support changing the currently recommended timing of Tdap administration in pregnancy.

Access the complete article:  Effectiveness of Prenatal Tetanus, Diphtheria, Acellular Pertussis Vaccination in the Prevention of Infant Pertussis in the U.S.

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ACOG to present webinar about adult immunization for 0b-gyn providers on August 2

The American College of Obstetricians and Gynecologists (ACOG) will present a webinar, "An Overview of Adult Immunizations for Ob-Gyn Providers" featuring CDC's Amy Parker Fiebelkorn, MSN, MPH, on August 2 at 12:00 p.m. (ET). This 1 CME credit session will discuss vaccines recommended for routine use in adult ob-gyn patients, as well as review strategies and resources obstetricians and gynecologists can utilize as they incorporate immunizations into their practice. This webinar is free and open to all.

Registration information

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Weekly CDC webinar series on "The Pink Book" chapter topics continues July 18 with "Immunization Strategies"; register now for series running through September 26

CDC is 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 started June 6 and will run through September 26. The webinar series provides an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.
The July 18 webinar will cover "Immunization Strategies" and include a live Q&A session. 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.

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. 

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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ISSN: 1526-1786
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Copyright (C) 2018 Immunization Action Coalition
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About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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

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