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Issue 1398: December 5, 2018








It's National Influenza Vaccination Week; make sure all your patients are protected against flu! 

National Influenza Vaccination Week (NIVW), an awareness week focused on highlighting the importance of influenza vaccination, is this week, December 2–8. Influenza season is spreading and serious, so this is a great time to vaccinate your patients who have not yet been protected against flu and to remind your patients who have not been vaccinated to be sure they get protected. 

CDC has stated in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending November 24, the geographic spread of influenza in five states was reported as regional; 16 states reported local activity; and the District of Columbia, Puerto Rico, the U.S. Virgin Islands and 28 states reported sporadic activity.

Two influenza-associated pediatric deaths were reported this week, for a total of five that have been reported for the 2018–2019 season. 

Click on the graphic below to access many related resources from CDC, including web tools, a NIVW toolkit, videos, communication hints, matte articles to submit to newspapers, animated graphics, and more.

Influenza vaccination is recommended for everyone six months of age and older. As a reminder, vaccination efforts should continue through the holiday season and beyond. Peak influenza activity does not generally occur until February. Providers are encouraged to continue vaccinating patients throughout the influenza season, including into the spring months (e.g., through May), as long as they have unvaccinated patients in their office.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:

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IAC Spotlight! Explore IAC’s "Ask the Experts" web section for answers to more than 1,000 Q&As about vaccines and their administration

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 Mark S. Freedman, DVM, MPH, DACVPM; Andrew T. Kroger, MD, MPH; Tina S. Obijo, MSN, MHA, RN; 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.

The "Ask the Experts" index page can be found at Here you will find more than 1,000 Q&As on all vaccines routinely recommended in the United States, as well as information on such topics as administering vaccines, billing and reimbursement, documenting vaccination, precautions and contraindications, scheduling vaccines, storage and handling, travel vaccines, vaccine recommendations, and vaccine safety. 

Here are links to some of our most popular pages within the "Ask the Experts" web section:

Explore all IAC's "Ask the Experts" Q&As by clicking on the graphic below.

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 far right column.

If this issue of IAC Express was forwarded to you by someone else, consider getting your own free subscription to IAC Express so you don't miss anything, including these special "Ask the Experts" editions. Sign up at

If you have a question about vaccination that is not covered in this web section, feel free to write

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New Jersey and New York experiencing ongoing outbreaks of measles

Since October, New Jersey and New York have been experiencing ongoing measles outbreaks. According to the State of New Jersey Department of Health, 18 cases have been confirmed in Ocean and Passaic counties. In Brooklyn, 34 confirmed cases in the Orthodox Jewish community have been reported by the New York City Department of Health. The child who initially contracted measles was unvaccinated and had traveled to Israel, where there has been a large measles outbreak. In New York's Rockland County, there are currently 87 confirmed cases of measles.

On August 20, the World Health Organization reported that over 41,000 children and adults in the European region had been infected in the first six months of 2018. This number is far higher than the 12-month total for measles in the region for all the years between 2010 and 2017.

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CDC and WHO report on worldwide progress toward regional measles elimination in this week’s MMWR and Weekly Epidemiological Record, respectively; continuing education credit available for reading MMWR article

CDC published Progress Toward Regional Measles Elimination—Worldwide, 2000–2017 in the November 30 issue of MMWR (pages 1323–1329). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards regional measles elimination—worldwide, 2000–2017 (pages 649–659). A media summary of the MMWR article is reprinted below.

During 2000–2017, increased vaccination coverage with measles-containing vaccine administered through routine immunization programs, supplementary immunization activities, and other global measles elimination efforts contributed to an 83 percent drop in reported measles incidence and an 80 percent reduction in estimated measles mortality. The increasing number of countries verified as having achieved measles elimination indicates progress toward interruption of measles virus transmission globally. Continuing to increase coverage with first dose of measles-containing vaccine (MCV1) and second dose of measles-containing vaccine (MCV2) is critical to both the achievement and sustainability of global and regional measles goals. During 2000–2017, MCV1 coverage increased globally from 72 percent to 85 percent due to routine immunization programs, supplemental immunization activities (SIAs), and other global measles-elimination efforts. Measles vaccination prevented an estimated 21.1 million deaths during this period, with the majority of deaths averted in the WHO African region and among Gavi, the Vaccine Alliance-eligible countries. Estimated MCV2 coverage increased globally from 15 percent in 2000 to 67 percent in 2017, largely due to an increase in the number of countries providing MCV2 nationally from 98 (51%) in 2000 to 167 (86%) in 2017. Despite progress made, global milestones have not been achieved: MCV1 coverage has stagnated for nearly a decade; global MCV2 coverage is only at 67 percent despite steady increases in coverage; and several regions are experiencing a measles resurgence.

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CDC publishes “Quick Stats” report in this week’s MMWR based on 2017 National Health Interview Survey of percentage of U.S. adults 18 and over who received flu vaccination

CDC published a "Quick Stats" report, Percentage of U.S. Adults Aged ≥18 Years Who Have Had a Flu Vaccination in the Past 12 Months, by Sex and Age Group—National Health Interview Survey, 2017 in the November 30 issue of MMWR (page 1330). The text accompanying the "Quick Stats" table is reprinted below.

Overall, 46.7% of women and 39.9% of men aged ≥18 years have had a flu vaccination in the past 12 months. For both sexes, as age increased, a higher percentage of adults had a flu vaccination. Among men, 27.8% of those aged 18–44 years, 40.8% of those aged 45–64 years, and 68.7% of those aged ≥65 years have had a flu vaccination. Among women, 37.2% of those aged 18–44 years, 46.4% of those aged 45–64 years, and 67.1% of those aged ≥65 years have had a flu vaccination. Women aged 18–44 years and 45–64 years were significantly more likely to have had a flu vaccination compared with men of the same age groups. 

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

There are now 805 organizations enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, long-term care facilities (LTCFs), medical practices, pharmacies, 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 November 7, when IAC Express last reported on the Influenza Vaccination Honor Roll, nine additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply by visiting the Application page.

Newly added healthcare organizations, hospitals, LTCFs, agencies, and medical practices:

  • CHAS Health, Spokane, WA
  • Englewood Health, Englewood, NJ
  • Hillsdale Hospital, Hillsdale, MI (hospital and LTCF)
  • Hunterdon Medical Center, Flemington, NJ
  • Inspira Health Network, Mullica Hill, NJ
  • Lewis County Public Health, Lowville, NY
  • North Central Health District, Macon, GA
  • Pediatrics Northwest, P.S., Tacoma, WA
  • Williams County and Cities Health District, Round Rock, TX

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U.S. Preventive Services Task Force issues draft research plan for hepatitis B virus screening in non-pregnant adolescents and adults; public comment requested

The U.S. Preventive Services Task Force (USPSTF) is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The panel's purpose is improving the health of all Americans by making evidence-based recommendations about clinical preventive services.

On November 29, the USPSTF posted a draft research plan titled Draft Research Plan for Hepatitis B Virus Infection: Screening in Nonpregnant Adolescents and Adults. The draft plan is available for review and public comment through January 2, 2019. 

The final research plan will be used to guide a systematic review of the evidence by researchers at an evidence-based practice center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic. Recommendations made by the USPSTF are independent of the U.S. government. 

Review Draft Research Plan for Hepatitis B Virus Infection: Screening in Nonpregnant Adolescents and Adults.

Submit comments by January 2 using the comment form.

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IAC posts seven revised translations of the Meningococcal ACWY VIS

IAC recently posted seven updated translations of the Meningococcal ACWY VIS, which was revised on 8/24/18.

IAC thanks the State of Hawaii, Department of Health, Disease Outbreak Control Division, Immunization Branch, for their generosity in providing the following translations:

IAC thanks the Massachusetts Department of Public Health Immunization Program for providing the Portuguese-language translation of the MenACWY VIS:

English-language version: MenACWY VIS

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IAC posts seven new and updated translations of the DTaP VIS

IAC recently posted seven new translations of the DTaP VIS, which was updated on 8/24/18. IAC thanks the State of Hawaii, Department of Health, Disease Outbreak Control Division, Immunization Branch for their generosity in providing the following new translations in Chuukese, Ilokano, Marshallese, Pohnpeian, Samoan, and Tongan.

IAC thanks the Massachusetts Department of Public Health Immunization Program for providing the updated Portuguese-language translation of the DTaP VIS:

English-language version: DTaP VIS

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IAC posts five updated and new translations of the Hepatitis B VIS

IAC recently posted updated translations of the hepatitis B VIS in four languages: Hindi, Punjabi, Thai, and Karen. IAC also posted a new translation of the hepatitis B VIS in Kiswahili (Swahili). IAC thanks the California Department of Public Health, Immunization Branch, for their generosity in providing the updated translations in Hindi, Punjabi, and Thai. IAC thanks St. Peter's Health Partners, Albany, New York, for their generosity in providing the updated translation in Karen and the new Kiswahili (Swahili) translation.

English-language version: HepB VIS

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Reminder: New 65+ Flu Defense website features information and resources for healthcare professionals serving adults age 65 and older

In October, IAC and Seqirus launched the new 65+ Flu Defense website at to help with vaccinating adults 65 years of age and older.

The website equips healthcare professionals with information, tools, and resources needed to proactively discuss flu vaccination with patients age 65 and older and to better communicate the impact of flu and its complications in older adults.

Annual influenza vaccination is the best way to prevent influenza, but vaccination coverage among older adults in the U.S. has stagnated, and in some years has declined significantly over the previous season’s rate. In the 2016–2017 season, only 65.3% of adults age 65 and older were vaccinated against influenza.

Seniors are at greater risk of severe complications from influenza, due both to their increased likelihood of having chronic conditions and to the decline of their immune systems as they age.

As a healthcare professional, your strong, confident recommendation for flu vaccine is a very powerful and persuasive tool in determining if your patients are vaccinated.

65+ Flu Defense is divided into several easy-to-use topic areas, including:  

Two new patient handouts are also available on the website:

Be sure to check out the information and printable materials for your patients available on the 65+ Flu Defense website at and boost your efforts aimed at protecting this vulnerable population.

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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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Pediatrics study examines impact on medical exemptions of California’s 2015 policy eliminating personal belief exemptions for vaccination

The journal Pediatrics published Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California, by S. Mohanty, et al., in its November issue. The abstract is reprinted below.

In 2015, California passed Senate Bill 227 (SB277), eliminating nonmedical vaccine exemptions for school entry. Our objective for this study was to describe the experiences of health officers and immunization staff addressing medical exemption requests under SB277.

We conducted semistructured telephone interviews between August 2017 and September 2017 with health officers and immunization staff from local health jurisdictions in California. Interviews were recorded, transcribed, and analyzed for key themes.

We conducted 34 interviews with 40 health officers and immunization staff representing 35 of the 61 local health jurisdictions in California. Four main themes emerged related to experiences with medical exemptions: (1) the role of stakeholders, (2) reviewing medical exemptions received by schools, (3) medical exemptions that were perceived as problematic, and (4) frustration and concern over medical exemptions. Generally, local health jurisdictions described a narrow role in providing support and technical assistance to schools. Only 5 jurisdictions actively tracked medical exemptions received by schools, with 1 jurisdiction facing a lawsuit as a result. Examples were provided of medical exemptions that listed family history of allergies and autoimmune diseases as contraindications for immunization and of physicians charging steep fees for medical exemptions. Participants also reported concerns about the increase in medical exemptions after the implementation of SB277.

Participants reported many challenges and concerns with medical exemptions under SB277. Without additional legal changes, including a standardized review of medical exemptions, some physicians may continue to write medical exemptions for vaccine-hesitant parents, potentially limiting the long-term impact of SB277.

View the abstract as well as the video abstract (4:52 minutes) on "AAP News & Journal Gateway" web page.

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American Journal of Public Health publishes "Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011–2017"

The American Journal of Public Health (AJPH) recently published Trends and Characteristics of Proposed and Enacted State Legislation on Childhood Vaccination Exemption, 2011–2017, by N.D. Goldstein, et al. The abstract is reprinted below. 

Objectives. To examine trends and characteristics of proposed and enacted state legislation that would directly affect states’ immunization exemption laws.

Methods. We performed content analysis of proposed bills in state legislatures from 2011 to 2017. We classified bills as provaccination or antivaccination.

Results. State legislators proposed 175 bills, with the volume increasing over time: 92 (53%) bills expanded access to exemptions, and 83 (47%) limited the ability to exempt. Of the 13 bills signed into law, 12 (92%) limited the ability to exempt. Bills that expanded access to exemptions were more likely to come from Republican legislators and Northeastern and Southern states.

Conclusions. Although most proposed legislation would have expanded access to exemptions, bills that limited exemptions were more likely to be enacted into law. Legal barriers to exempt one’s children from vaccination persist despite vaccine hesitancy, which is encouraging for public health.

Public Health Implications. Most vaccine exemption laws introduced in state legislatures would pose threats to the public’s health. There is a need for constituents to engage their elected legislators and advocate provaccination policies

If you are not a subscriber to the AJPH, you may be able to access the complete article at your nearest medical library.

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November issue of CDC's Immunization Works newsletter now available

CDC recently released the November 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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2019 California Immunization Coalition Summit scheduled for April 8–9 in Riverside; submissions for abstracts due by December 14

Registration is open for the 2019 California Immunization Coalition (CIC) Summit titled "Today's Vision, Tomorrow's Reality," scheduled for April 8–9, 2019, in Riverside, California.

The CIC Summit web page provides information and additional details, and it lists the following objectives for the event:

  • Provide support and technical assistance to enhance existing education, communication, and outreach efforts
  • Share successful strategies and best practices to strengthen local and statewide advocacy efforts
  • Review new recommendations, issues, and trends in immunizations and vaccine-preventable diseases
  • Disseminate innovative approaches to promote and deliver immunizations across the lifespan

Visit the CIC Summit web page for information about conference and hotel registration, fees, and more. 

Abstracts, which are due by December 14, are encouraged from those from all disciplines who are coalition members, immunization program staff, community-based organizations, health care providers, government and non-government agencies, health communications specialists, and others interested in immunization issues. Information about abstract submission is available on the CIC Summit web page. Access the abstract submission form.

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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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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.

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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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