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Issue 1402: December 19, 2018







Happy holidays from all of us at IAC! We'll be back on January 2.

All of us at the Immunization Action Coalition (IAC) wish you, our readers, a safe, happy, and relaxing holiday season. Because of the holiday schedule, we will not publish another issue of IAC Express until January 2. The IAC office will be closed on December 24, 25, and 31 as well as January 1.

Happy holidays!

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IAC updates its popular Ask the Experts section on hepatitis A

IAC recently reviewed and updated its Ask the Experts: Hepatitis A web page with questions answered by CDC experts.

Ask the Experts: Hepatitis A: Revisions include new guidance for post-exposure prophylaxis of hepatitis A exposure and pre-exposure prophylaxis for international travel (including vaccination of infants as young as 6 months of age). Disease burden information was updated and the entire set was reorganized to make location of specific topics simpler and more consistent with other ATE sets.

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. Objio, 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.

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 publishes “Influenza Activity—United States, September 30–December 1, 2018” in this week’s MMWR

CDC published Influenza Activity—United States, September 30–December 1, 2018 in the December 14 issue of MMWR (pages 1369–1371). A summary is reprinted below.

Influenza activity in the United States was low during October 2018, and, although it increased slowly during November, activity remains low across most of the country. During the week ending December 1, 2018, the percentage of outpatient visits for influenza-like illness (ILI) was equal to the national baseline and was at or slightly above the region-specific baseline in four of the 10 U.S. Department of Health and Human Services regions (Regions 4 and 7–9). The majority of jurisdictions experienced minimal or low ILI activity since September 30; however, two experienced moderate ILI activity, and two experienced high ILI activity during the week ending December 1. The percentage of deaths attributed to pneumonia and influenza remains below the epidemic threshold, and the rate of influenza-associated hospitalizations remains low. Five laboratory-confirmed, influenza-associated pediatric deaths occurring since September 30 have been reported to CDC. During the week ending December 1, the majority of jurisdictions (40 states, the District of Columbia, Puerto Rico, and U.S. Virgin Islands) reported sporadic or local geographic spread of influenza activity, nine states reported regional activity, and one state reported widespread activity.

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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 by diagnosed diabetes status and age group

CDC published a "Quick Stats" report, Percentage of Adults Aged ≥18 Years Who Had an Influenza Vaccination in the Past 12 Months, by Diagnosed Diabetes Status and Age Group—National Health Interview Survey, 2017 in the December 14 issue of MMWR (page 1374). The text accompanying the "Quick Stats" table is reprinted below.

In 2017, among adults aged ≥18 years, those with a diagnosis of diabetes were more likely to have had an influenza vaccination in the past 12 months than those with a diagnosis of prediabetes (62.5% versus 56.1%); those with no diagnosed diabetes were the least likely to have had an influenza vaccination (40.1%). Among adults aged ≥65 years, influenza vaccination was higher for those with a diagnosis of diabetes (74.5%) or prediabetes (73.0%) than for those with no diagnosed diabetes (65.1%). For adults aged 18–64 years, influenza vaccination rates also were highest for those with diagnosed diabetes (54.3%), followed by those with diagnosed prediabetes (48.7%), and were lowest for those with no diagnosed diabetes (35.0%). Regardless of diabetes status, influenza vaccination rates were higher among those aged ≥65 years than among those aged 18–64 years.

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IAC Spotlight! Looking for easy-to-read Q&A handouts on diseases and vaccines? IAC has a collection of 20 of them in both English and Spanish

IAC’s easy-to-read, Q&A handouts for parents and patients are available in English and Spanish. This collection of 20 ready-to-print materials promote vaccination against chickenpox, hepatitis A, hepatitis B, Hib, HPV, influenza, measles-mumps-rubella, meningococcal disease, pneumococcal disease, polio, rotavirus, shingles, and whooping cough-tetanus-diphtheria. They feature simple, friendly illustrations. Specifically developed to be short and non-medical, the handouts emphasize the dangers of the vaccine-preventable diseases listed above and the importance of vaccination.

Download these print materials and make copies for parents and adult patients. 

Handouts for parents of children:

Handouts for teen and adult patients:

All these handouts—in English and Spanish—can be accessed from IAC's Q&As: Diseases and Vaccines, Easy-to-Read Handouts web page. Scroll down to see all the selections.

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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Voices for Vaccines releases new Vax Talk podcast featuring IAC’s own Dr. L.J Tan on "What You Need to Know About Flu”

Voices for Vaccines (VFV) has posted a new Vax Talk podcast for December discussing what you need to know about the flu.

In Episode 24, The One About Influenza, L.J Tan, MS, PhD, IAC chief strategy officer, shares his knowledge on influenza past and future, how to improve flu vaccine uptake, and who needs a flu vaccine. 

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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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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Influenza is spreading and serious; please keep vaccinating your patients

Influenza season is now under way. CDC stated in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending December 8, the geographic spread of influenza in three states was reported as widespread; 10 states reported regional activity; 21 states reported local activity; the District of Columbia, Puerto Rico, the U.S. Virgin Islands and 16 states reported sporadic activity; and Guam did not report.

One influenza-associated pediatric death was reported to CDC during week 49. This death was associated with an influenza B virus and occurred during week 48 (the week ending December 1, 2018). A total of six influenza-associated pediatric deaths have been reported for the 2018–2019 season. Last season, there was a record-setting number of pediatric deaths in the U.S. (172), so be sure to protect all your patients for whom vaccination is recommended.

Influenza vaccination is recommended for everyone six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

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

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NACCHO releases new podcast featuring Dr. Melinda Wharton on the history of National Influenza Vaccination Week and how important vaccinations are at all stages of life

On December 6, the National Association of County and City Health Officials (NACCHO) released a new podcast in its Podcast from Washington series.

In this podcast, Melinda Wharton, MD, director, Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, spoke with Ian Goldstein about the history of National Influenza Vaccination Week and how important vaccinations are at all stages of life. They also discussed how local health departments can encourage their communities to get vaccinated.

Comprised of nearly 3,000 local health departments across the United States, NACCHO is focused on being a leader, partner, catalyst, and voice for change for local health departments around the nation.

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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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Nationwide Danish study finds the flu shot is tied to heart failure survival

Circulation published Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study by Daniel Modin, et al. in its December issue. The abstract is reprinted below.

Background: Influenza infection is a serious event for patients with heart failure (HF). Little knowledge exists about the association between influenza vaccination and outcome in patients with HF. This study sought to determine whether influenza vaccination is associated with improved long-term survival in patients with newly diagnosed HF.

Methods: We performed a nationwide cohort study including all patients who were >18 years of age and diagnosed with HF in Denmark in the period of January 1, 2003, to June 1, 2015 (n=134048). We collected linked data using nationwide registries. Vaccination status, number, and frequency during follow-up were treated as time-varying covariates in time-dependent Cox regression.

Results: Follow-up was 99.8% with a median follow-up time of 3.7 years (interquartile range, 1.7–6.8 years). The vaccination coverage of the study cohort ranged from 16% to 54% during the study period. In unadjusted analysis, receiving ≥1 vaccinations during follow-up was associated with a higher risk of death. After adjustment for inclusion date, comorbidities, medications, household income, and education level, receiving ≥1 vaccinations was associated with an 18% reduced risk of death (all-cause: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001; cardiovascular causes: hazard ratio, 0.82; 95% CI, 0.81-0.84; P<0.001). Annual vaccination, vaccination early in the year (September to October), and greater cumulative number of vaccinations were associated with larger reductions in the risk of death compared with intermittent vaccination.

Conclusions: In patients with HF, influenza vaccination was associated with a reduced risk of both all-cause and cardiovascular death after extensive adjustment for confounders. Frequent vaccination and vaccination earlier in the year were associated with larger reductions in the risk of death compared with intermittent and late vaccination.

Access the full text: Influenza Vaccine in Heart Failure: Cumulative Number of Vaccinations, Frequency, Timing, and Survival: A Danish Nationwide Cohort Study (PDF)

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NFID inviting abstracts by January 10 for presentations at 2019 Annual Conference on Vaccinology Research, April 3–5 in Baltimore

The National Foundation for Infectious Diseases (NFID) is inviting abstracts for its 2019 Annual Conference on Vaccinology Research (ACVR), which will be held April 3–5 in Baltimore, Maryland. The deadline for submitting an abstract is January 10, 2019. Access additional information on the 2019 Annual Conference on Vaccinology Research (ACVR) Call for Abstracts web page.

Access the ACVR abstract submission site.

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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.

If you have trouble receiving or displaying IAC Express messages, visit our online help section.

IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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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.

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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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