Issue 1379: August 8, 2018










CDC releases clinical guidance for providers during the Shingrix shortage

In light of the current shortage of recombinant zoster vaccine (Shingrix; GSK), CDC has added the following Q&A to its "Frequently Asked Questions About Shingrix" web page:

Q: What is the clinical guidance during the Shingrix delay?

A: Shingrix is the preferred shingles vaccine. You and patients should make every effort to ensure that two doses are administered within the recommended interval. If more than 6 months have elapsed since the first dose, administer the second dose when possible. Do not restart the vaccine series, and do not substitute Zostavax (zoster vaccine live) for the second dose of Shingrix. If you are out of Shingrix and a patient needs a second dose, the Vaccine Finder may be helpful for patients to locate other providers that have Shingrix.

CDC still recommends Zostavax for healthy adults 60 years and older to prevent shingles. This shingles vaccine may be used in certain cases, such as when a person prefers Zostavax or requests immediate vaccination and Shingrix is unavailable. Patients who have received Zostavax are recommended to subsequently receive Shingrix. Age and time since receipt of Zostavax may be considered to determine when to vaccinate with Shingrix (minimum interval of 8 weeks).

Access all the Q&As on CDC's Frequently Asked Questions About Shingrix web page.

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National Immunization Awareness Month is here; upcoming week will focus on protecting babies and young children

Every year in August, National Immunization Awareness Month (NIAM) provides an opportunity to raise awareness of the importance of immunization and the need for improving national vaccination coverage levels. NIAM is co-sponsored by the National Public Health Information Coalition (NPHIC) and CDC. The upcoming week, August 12–18, focuses on vaccinations for babies and young children. The theme for the week is "A healthy start begins with on-time vaccinations."

The 2018 edition of the communications toolkit, put out by NPHIC in collaboration with CDC, contains key messages, vaccine information, sample news releases and articles, sample social media messages, links to web resources from CDC and other organizations, and logos, web banners, posters, and graphics to use with social media. The website also includes a place for you to share your NIAM activities and view what others are doing for NIAM, using the hashtag #NIAM18.

The first week of NIAM focused on vaccinations for pregnant women. The remaining weeks will focus on the following: 

  • August 19–25—Preteens & teens: Ensure a healthy future with vaccines
  • August 26–31—Adults: Vaccines are not just for kids​

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Available online: six-part series of online training sessions on implementing standing orders protocols for adult immunization in your healthcare setting

Standing orders protocols (SOPs) are known to improve immunization coverage rates, but are underutilized by providers serving adult patients. The content for a six-part webinar series will help healthcare settings implement SOPs for adult immunizations. 

The Executive Summary, provided by IAC executive director Dr. Deborah Wexler, gives a concise overview of the entire series presented by Drs. William Atkinson and Litjen Tan.  Attending this series does not earn Continuing Education (CE) credit. The series is developed and provided by IAC, IDCareLive, and Pfizer.

Registration is free, but is required in order to view any session. The link will bring up a short registration form to create a free IDCareLive account, if you don’t already have one.  After signing up, you will be transferred directly to the intended page. 

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IAC's Video of the Week presents personal stories, news, animations, and other video clips every Monday

IAC's Video of the Week has been an engaging and informative feature on the home page of since 2009, with a new video appearing every Monday. The videos present personal stories, news, animations, and other types of immunization-related video clips. In addition to appearing on the home page, it also appears every week in IAC Express in the right-hand column. Readers can explore the Video of the Week archive dating back to 2009 to see all previous videos. 

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

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

  • Andalusia Health, Andalusia, AL (98%)
  • Bronson Battle Creek Hospital, Battle Creek, MI (90%)
  • Crozer Chester Medical Center, Upland, PA (95%)
  • Hurley Medical Center, Flint, MI (90%)
  • Lehigh Valley Health Network Muhlenberg, Bethlehem, PA (92%)
  • Phoenixville Hospital, Phoenixville, PA (93%)
  • Pottstown Hospital, Pottstown, PA (93%)
  • St. Joseph Health System–Tawas, Tawas City, MI (91%)
  • Steward Easton Hospital, Easton, PA (92%)
  • UP Health System–Portage, Hancock, MI (90%)

The following six institutions are being recognized for a second year:

  • Andalusia Health, Andalusia, AL (98%)
  • Delaware County Memorial Hospital, Drexel Hill, PA (94%)
  • Hurley Medical Center, Flint, MI (91%)
  • Jefferson Hospital, Jefferson Hills, PA (92%)
  • Oneida Healthcare, Oneida, NY (93%)
  • St. Joseph Health System–Tawas, Tawas City, MI (96%)

In addition, the following two institutions are being recognized for a third year:

  • Oneida Healthcare, Oneida, NY (94%)
  • St. Joseph Health System–Tawas, Tawas City, MI (93%)

Finally, the following two institutions are being recognized for a fourth year:

  • MidMichigan Health Gratiot, Alma, MI (94%)
  • Oneida Healthcare, Oneida, NY (92%)

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

The Honor Roll now includes 412 birthing institutions from 40 states, Puerto Rico, Guam, and an overseas U.S. military base. Ninety-one institutions have qualified for two years, 47 institutions have qualified three times, 19 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.

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Voices for Vaccines releases new podcast: "Hashtag Vaccines–The Social Media Episode"

Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: Hashtag Vaccines–The Social Media Episode. In this podcast, Karen Ernst, Voices for Vaccines, and Dr. Nathan Boonstra, Blank Children's Hospital, talk to Dr. Jen Golbeck, director of the Social Intelligence Lab at the University of Maryland, College Park, about the negative aspects of social media (e.g., echo chambers, misinformation, and conspiracy theories) that pro-vaccine advocates have to fight daily.

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

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IAC updates "Don't Be Guilty of These Preventable Errors in Vaccine Storage and Handling!" and "Checklist for Safe Vaccine Storage and Handling"

IAC recently revised the following two resources for healthcare professionals to help with safe vaccine storage and handling.

  1. Don't Be Guilty of These Preventable Errors in Vaccine Storage and Handling! was revised to remove references to Menomune and to change the acronym for Zostavax to ZVL.
  2. Checklist for Safe Vaccine Storage and Handling was updated to ensure the text was in conformity with CDC's January 2018 Vaccine Storage & Handling Toolkit.

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IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC revises "Vaccines with Diluents: How to Use Them"

IAC recently revised Vaccines with Diluents: How to Use Them to remove references to Menomune and to change the acronym for Zostavax to ZVL.

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IAC updates its vaccine storage and handling "Emergency Response Worksheet" for addressing power failures and temperature excursions

IAC recently updated its vaccine storage and handling resource titled Emergency Response Worksheet. The worksheet help healthcare professionals properly deal with the aftermath of power failures and temperature excursions. Changes were made to update contact information for the vaccine manufacturers listed on the handout.

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IAC updates its vaccination record for medical charts, "Vaccine Administration Record for Adults"

IAC updated its Vaccine Administration Record for Adults to add Shingrix (RZV) to the zoster vaccine options and Heplisav-B to the hepatitis B vaccine options. Additionally, the example pages that demonstrate how to use the vaccine administration record were updated as well. This two-page vaccine administration record is designed for paper medical charts and includes columns for all required information. Providers can also print out and save the completed example pages to help staff correctly use this resource.

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

CDC published Progress Toward Poliomyelitis Eradication—Afghanistan, January 2017–May 2018 in the August 3 issue of MMWR (pages 833–837). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards poliomyelitis eradication in Afghanistan, January 2017–May 2018. A media summary of the MMWR article is reprinted below.

To achieve wild polio virus type 1 (WPV1) eradication, Afghanistan and global partners must continue to maintain and regain access for supplementary immunization activities (SIAs) in security-challenged areas, strengthen oversight of SIAs in accessible areas to reduce the number of missed children, and coordinate with authorities in Pakistan to track and vaccinate high-risk mobile populations in their shared transit corridors. In 2017, fourteen WPV1 cases were confirmed in Afghanistan, compared with 13 in 2016. From January–May 2018, eight WPV1 cases were reported, which was twice the number of cases reported from January–May 2017. The number of polio-affected districts in Afghanistan increased from six in 2016 to 14 in 2017 (including WPV1 cases and positive environmental samples). Polio cases in 2018 have been limited to two regions bordering Pakistan known as the Southern and Northern corridors. We are making continued progress in reaching children everywhere and finding the virus where it persists.

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CDC, U.S. Department of Agriculture, and 4-H develop free 60-page comic book-style story called “The Junior Disease Detectives: Operation Outbreak"    

CDC has collaborated with the U.S. Department of Agriculture and 4-H to develop a 60-page comic book-style story (graphic novel) called “The Junior Disease Detectives: Operation Outbreak.” A description of the book from CDC follows:

The novel follows a group of teenage 4-H members who participate in a state agricultural fair and later attend CDC’s Disease Detective Camp in Atlanta. When one of the boys becomes sick following the fair, the rest of the group uses their newly acquired disease detective knowledge to help a team of public and animal health experts solve the mystery of how their friend became sick. The graphic novel is intended to raise awareness among youth about the potential human health risks associated with variant influenza virus infections, and it is also intended to inspire youth interest in careers in public and animal health. The release of the graphic novel is intended to coincide with agriculture fair season, which is occurring right now in the U.S.

Download this graphic novel at no charge from the Apple iTunes bookstore or download and print "Junior Disease Detectives" as a PDF document.

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Still available! IAC's sturdy laminated version of the 2018 U.S. adult immunization schedule—order a supply for your healthcare setting today! Child/teen schedules sold out.

IAC's laminated versions of 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. The schedule is eight pages (i.e., four double-sided pages) and is folded to measure 8.5" x 11". 

The child/teen immunization schedules are sold out. If you wish to order a quantity of 500 or more, you can email to request a quote.              

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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July issue of CDC's Immunization Works newsletter now available

CDC recently released the July 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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Report highlights gaps in adult vaccination that could be improved by implementing Standards for Adult Immunization Practice

On July 23, the American Journal of Preventive Medicine published Clinicians’ and Pharmacists’ Reported Implementation of Vaccination Practices for Adults (CS Lutz et al.). Sections of the abstract are reprinted below.

Despite the proven effectiveness of immunization in preventing morbidity and mortality, adult vaccines remain underutilized. The objective of this study was to describe clinicians’ and pharmacists’ self-reported implementation of the Standards for Adult Immunization Practice (“the Standards”; i.e., routine assessment, recommendation, and administration/referral for needed vaccines, and documentation of administered vaccines, including in immunization information systems).

Implementation of the Standards varied substantially by vaccine and provider type. For example, >80.0% of providers, including obstetrician/gynecologists and subspecialists, assessed for and recommended influenza vaccine. However, 24.3% of obstetrician/gynecologists and 48.9% of subspecialists did not stock influenza vaccine for administration. Although zoster vaccine was recommended by >89.0% of primary care providers, <58.0% stocked the vaccine; by contrast, 91.6% of pharmacists stocked zoster vaccine. Vaccine needs assessments, recommendations, and stocking/referrals also varied by provider type for pneumococcal; tetanus, diphtheria, acellular pertussis; tetanus diphtheria; human papillomavirus; and hepatitis B vaccines.

This report highlights gaps in access to vaccines recommended for adults across the spectrum of provider specialties. Greater implementation of the Standards by all providers could improve adult vaccination rates in the U.S. by reducing missed opportunities to recommend vaccinations and either vaccinate or refer patients to vaccine providers.

Access the complete article: Clinicians’ and Pharmacists’ Reported Implementation of Vaccination Practices for Adults.

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New CDC study conducted over multiple influenza seasons found that getting a flu shot lessened the risk of severe influenza among adults

On August 1, the journal Vaccine published Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012–2015 online (Thompson MG, et al.). The study was a collaborative project with CDC, conducted through the Southern Hemisphere Influenza and Vaccine Effectiveness Research and Surveillance project. A section of a summary about the study from CDC is reprinted below.

 A new CDC-supported study published in Vaccine conducted over multiple flu seasons shows that getting a flu shot lessened the risk of severe influenza (flu) among adults, including reducing the risk of hospitalization and admission to the intensive care unit (ICU), and also lessened the severity of illness. CDC recommends an annual flu vaccine for everyone 6 months and older. Annual flu vaccination varies in how well it works, but it is the best available way to prevent flu and its potentially serious consequences.

The study was conducted over four flu seasons from 2012 to 2015 and found that flu vaccination prevented severe disease:

  • Flu vaccination among adults reduced the risk of being admitted to the hospital with flu and placed in a general ward bed by 32 percent
  • Flu vaccination was even more effective in preventing the most severe forms of flu and reduced the risk of being admitted to an ICU with flu by 82 percent

Risk among vaccinated vs. unvaccinated

Because flu vaccine varies in how well it works and people who are vaccinated may still get sick, the study also looked at whether flu vaccination reduced the severity of illness among hospitalized people who were vaccinated compared to those who were unvaccinated and found that:

  • Among adults who were admitted to the hospital with flu, vaccinated adults were 59 percent less likely to have very severe illness resulting in ICU admission than those who had not been vaccinated
  • Among adults in the ICU with flu, vaccinated patients on average spent 4 fewer days in the hospital than those who were not vaccinated previously

Access the abstract:  Influenza vaccine effectiveness in preventing influenza-associated intensive care admissions and attenuating severe disease among adults in New Zealand 2012–2015.

Access the complete CDC summary: Study Shows Flu Vaccine Reduces Risk of Severe Illness.

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Weekly CDC webinar series on "The Pink Book" chapter topics continues August 15 with "Varicella/Zoster"; 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 August 15 webinar will cover "Varicella/Zoster" 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. 


2018 World Influenza Conference to take place in Beijing on September 7–10

The 2018 World Influenza Conference will take place in Beijing on September 7–10. The meeting is sponsored collaboratively by the Asia-Pacific Alliance for the Control of Influenza (APACI), the Chinese Center for Disease Control and Prevention, the National Adult and Influenza Immunization Summit (NAIIS), and other global partners.

More information is available on the APACI website. The registration fee will be waived for NAIIS partners. To obtain a passcode for registration, email As the number of seats available for international attendees will be limited to around 350, and the process for obtaining a visa for China can be complicated and protracted, anyone interested in attending should start making arrangements now.

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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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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.

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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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