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Issue 1383: September 5, 2018









Twitter bots and Russian Internet trolls amplify mistrust and discord about immunization in the U.S.

The American Journal of Public Health (AJPH) published Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate, by D.A. Broniatowski, et al., on August 23. The abstract is reprinted below.

To understand how Twitter bots and trolls (“bots”) promote online health content.

We compared bots’ to average users’ rates of vaccine-relevant messages, which we collected online from July 2014 through September 2017. We estimated the likelihood that users were bots, comparing proportions of polarized and antivaccine tweets across user types. We conducted a content analysis of a Twitter hashtag associated with Russian troll activity.

Compared with average users, Russian trolls (χ2(1) = 102.0; P < .001), sophisticated bots (χ2(1) = 28.6; P < .001), and “content polluters” (χ2(1) = 7.0; P < .001) tweeted about vaccination at higher rates. Whereas content polluters posted more antivaccine content (χ2(1) = 11.18; P < .001), Russian trolls amplified both sides. Unidentifiable accounts were more polarized (χ2(1) = 12.1; P < .001) and antivaccine (χ2(1) = 35.9; P < .001). Analysis of the Russian troll hashtag showed that its messages were more political and divisive.

Whereas bots that spread malware and unsolicited content disseminated antivaccine messages, Russian trolls promoted discord. Accounts masquerading as legitimate users create false equivalency, eroding public consensus on vaccination.

Public Health Implications 
Directly confronting vaccine skeptics enables bots to legitimize the vaccine debate. More research is needed to determine how best to combat bot-driven content.

View the abstract on the AJPH website.

Read the entire study in PDF format. 

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IAC Spotlight! IAC’s Influenza Honor Roll now highlights long-term care/assisted living facility honorees

The best way to prevent transmission of influenza to patients and residents of facilities is to mandate vaccination of healthcare personnel (HCP). For many years, IAC has recognized stellar examples of facilities and organizations that have established influenza vaccination mandates for their HCP by including them on IAC’s Influenza Vaccination Honor Roll. To be included on the honor roll, a facility’s mandate must require influenza vaccination for employees and must include serious measures to prevent transmission of influenza from unvaccinated workers to patients/residents.
Long-term care/assisted living facilities (LTCFs) represent a particularly high-risk environment for transmission of influenza from unvaccinated HCP to patients/residents due to the close quarters of LTCFs and the immunocompromised state and medical complexity of residents, as well as their contact with multiple caregivers. In recognition of the importance of this healthcare setting for influenza transmission and the reported low rates of influenza vaccination coverage among HCP in LTCFs, IAC has established a new page to highlight LTCF honorees included on the Influenza Vaccination Honor Roll.
A wide variety of resources are available to assist LTCF administrators in establishing HCP vaccination mandates: 

LTCFs now have the opportunity to implement these important mandates and be nationally recognized for their efforts on IAC’s Influenza Vaccination Honor Roll as well as being singled out for special acknowledgement on the new Influenza Vaccination Honor Roll for Long-Term Care/Assisted Living Facilities. In addition to this recognition, participating LTCFs can have the satisfaction of knowing they are taking the number one action available in preventing influenza transmission among their medically fragile residents.

Related Links
Information from IAC

Information from AMDA—The Society for Post-Acute and Long-Term Care Medicine

Information from the National Adult and Influenza Immunization Summit

Information from CDC

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September is National Preparedness Month; CDC posts “Partner Toolkit” for messaging, pandemic planning, and other resources

Every September, CDC supports emergency preparedness efforts and encourages Americans to take action before, during, and after a public health emergency such as an infectious disease outbreak, national disaster, or chemical or radiological release. This year CDC is highlighting "Prepare Your Health."

Visit CDC's Preparedness Month 2018 web page to learn more about the themes of each of the four weeks for September 2018.

Learn about this year's Preparedness Month Partner Toolkit, which has links to a wide variety of information, social media suggestions, and other resources to promote public health preparedness in September and all year long.

Access the Preparedness Month Partner Toolkit in PDF format.

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Voices for Vaccines releases new podcast episode, "Superman, Cancer, and Vaccines," with Jason Mendelsohn, HPV cancer survivor; he tells his story and urges parents to vaccinate their sons and daughters

Voices for Vaccines (VFV) has released a new podcast in its Vax Talk series: Superman, Cancer, and Vaccines. In this podcast, Jason Mendelsohn, a Stage 4 HPV cancer survivor known as "Superman HPV," tells his story to Karen Ernst, Voices for Vaccines, and Dr. Nathan Boonstra, Blank Children's Hospital, and urges parents to vaccinate all their children.

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 "Current Dates of Vaccine Information Statements" and "You Must Give Your Patients Vaccine Information Statements (VISs)—It’s Federal Law!"

IAC recently updated Current Dates of Vaccine Information Statements as well as You Must Give Your Patients Vaccine Information Statements (VISs)—It’s Federal Law! to incorporate the 8/24/2018 date of both the recently updated DTaP VIS and the MenACWY VIS.

Related Links

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 updates “Influenza Vaccine Products for the 2018–2019 Influenza Season”

IAC recently updated its 1-page table for healthcare professionals titled Influenza Vaccine Products for the 2018–2019 Influenza Season. Changes were made to update the product billing code information for the Flucelvax multi-dose vial and to remove Fluzone, Intradermal, and Fluvirin influenza vaccines that will not be distributed for the 2018–19 season.

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IAC revises “Standing Orders for Administering Diphtheria, Tetanus, and Acellular Pertussis (DTaP) Vaccine to Children Younger Than Age 7 Years”

IAC recently revised Standing Orders for Administering Diphtheria, Tetanus, and Acellular Pertussis (DTaP) Vaccine to Children Younger Than Age 7 Years. The following were removed from the list of precautions: fever of 105 degrees or higher within 48 hours of a previous dose, collapse or shock-like state within 48 hours, seizure within 3 days, and persistent, inconsolable crying for more than 3 hours.

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IAC makes a small correction to its popular 4-page handout for patients: “Questions Frequently Asked about Hepatitis B”

IAC recently made a small correction to its popular 4-page handout for patients titled Questions Frequently Asked about Hepatitis B. Changes were made to clarify the common modes of transmission of hepatitis A.

Related Links

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AAP releases several videos, including one featuring pediatricians sharing why they vaccinate and another addressing the importance of the hepatitis B vaccine birth dose

The American Academy of Pediatrics (AAP) Immunization Campaign Materials web page provides tools for promoting the safety and effectiveness of vaccines. These tools include brief videos featuring individual pediatricians talking about vaccines and why they are important.

In one of the newly released videos, Pediatricians Share Why They Vaccinate, several pediatricians discuss their personal reasons for why they vaccinate their patients and their children.

In a video titled Dr. David Hill On the Life-Saving Hepatitis B Vaccine, Dr. Hill explains why it is vitally important to vaccinate newborns with hepatitis B vaccine within 24 hours of birth.

Access these videos, as well as several others, on AAP's Immunizations Campaign Materials web page.

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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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August issue of CDC's Immunization Works newsletter now available

CDC recently released the August 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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Weekly CDC webinar series on "The Pink Book" chapter topics continues September 12 with "HPV"; 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 September 12 webinar will cover "HPV" 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). Free continuing education is available for healthcare personnel including physicians, nurses, nurse practitioners, pharmacists, physician’s assistants, and others.

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.

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Opportunity to participate in Gerontological Society of America's "Immunization Champions, Advocates & Mentors Program" (ICAMP) training in Boston on November 13 

Immunization providers from a wide variety of backgrounds are invited to participate in a half-day "Immunization Champions, Advocates & Mentors Program" (ICAMP) training sponsored by the Gerontological Society of America (GSA) in Boston on November 13 from 12:30–4:30 p.m. (ET) at the Sheraton Boston Hotel. ICAMP is a multidisciplinary program designed to equip healthcare professionals to champion adult immunization practices that improve public health and the quality of care for the people they serve.

ICAMP is being offered as a pre-conference activity for GSA’s annual meeting, but participants do not need to attend the conference or be a member of GSA to attend ICAMP. The cost for ICAMP is $105 for GSA members and $130 for non-members. Scholarships are available by contacting

The half-day program's objectives follow:

  • Learn the skills needed to champion practice change
  • Create an action plan to mobilize your organization to improve adult immunization rates
  • Collaborate with multidisciplinary healthcare professionals
  • Establish your measurement parameters

ICAMP is developed by GSA and supported in part by Pfizer, Merck, and Sanofi Pasteur. 

Access specific instructions explaining how to register for the ICAMP training. 

Related Link

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European Scientific Working Group on Influenza Flu Summit to be held in Belgium on September 28; registration open and free of charge

The European Scientific Working group on Influenza (ESWI) is sponsoring a one-day summit titled Bringing Childhood Flu Vaccination to the Next Level in Leuven, Belgium, on September 28. 

Access information about the summit on the ESWI Summit website.

Participation is free of charge, but registration is necessary.

Register for the summit.

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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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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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