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Issue 1405: January 9, 2019







CDC reports that influenza is increasing across the U.S. and 13 children have died this season; please keep vaccinating your patients

CDC stated in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending December 29, influenza activity was increasing in the U.S. Two influenza-associated pediatric deaths were reported to CDC during week 52, for a total of 13 influenza-associated pediatric deaths reported for the 2018–2019 season. At this time, hospitalization rates in children younger than 5 years old (14.5 per 100,000) are the highest among all age groups. 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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IAC Spotlight! Find a comprehensive range of valuable influenza educational materials you need on IAC's "Influenza Handouts" web page

On IAC's Influenza web page in the "Handouts" web section of, you will find what you need among the range of educational materials related to influenza. These materials provide resources for healthcare professionals and for patients to protect children and adults.

Below are just a few of the educational materials on IAC's Influenza Handouts web page:

In addition, you will find links to Unprotected People Reports for Influenza as well as Vaccine Information Statements for Influenza (both LAIV and IIV).

Hovering over each item produces a thumbnail preview. Many of the handouts are available in Spanish as well.

Check out the Influenza Handouts web page today to access the valuable resources it offers!

Related Link

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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Pediatrics publishes study by CDC authors finding that college students are more likely than their nonstudent peers to contract meningococcal disease

The journal Pediatrics published a study by CDC authors finding that college students are more likely than their nonstudent peers to contract meningococcal disease. The study, titled Meningococcal Disease Among College-Aged Young Adults: 2014–2016, by S.A. Mbaeyi, et al., appeared in the January issue. The abstract is reprinted below.

Background: Freshman college students living in residence halls have previously been identified as being at an increased risk for meningococcal disease. In this evaluation, we assess the incidence and characteristics of meningococcal disease in college-aged young adults in the United States.

Methods: The incidence and relative risk (RR) of meningococcal disease among college students compared with noncollege students aged 18 to 24 years during 2014–2016 were calculated by using data from the National Notifiable Diseases Surveillance System and enhanced meningococcal disease surveillance. Differences in demographic characteristics and clinical features of meningococcal disease cases were assessed. Available meningococcal isolates were characterized by using slide agglutination, polymerase chain reaction, and whole genome sequencing.

Results: From 2014 to 2016, 166 cases of meningococcal disease occurred in persons aged 18 to 24 years, with an average annual incidence of 0.17 cases per 100000 population. Six serogroup B outbreaks were identified on college campuses, accounting for 31.7% of serogroup B cases in college students during this period. The RR of serogroup B meningococcal (MenB) disease in college students versus noncollege students was 3.54 (95% confidence interval: 2.21–5.41), and the RR of serogroups C, W, and Y combined was 0.56 (95% confidence interval: 0.27–1.14). The most common serogroup B clonal complexes identified were CC32/ET-5 and CC41/44 lineage 3.

Conclusions: Although the incidence is low, among 18- to 24-year-olds, college students are at an increased risk for sporadic and outbreak-associated MenB disease. Providers, college students, and parents should be aware of the availability of MenB vaccines.

Access the full text: Meningococcal Disease Among College-Aged Young Adults: 2014–2016.

Access the video abstract, presented by CDC medical epidemiologist and lead study author, Sarah Mbaeyi, MD, as well as the entire study in HTML format.

Related Link

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CDC launches new pneumococcal vaccination app for vaccine providers

CDC recently launched a free app to help vaccination providers quickly and easily determine which pneumococcal vaccines a patient needs and when. 

This PneumoRecs VaxAdvisor mobile app:

  • Incorporates recommendations for all ages so physicians, family physicians, pediatricians, and pharmacists alike will find the tool beneficial
  • Will especially help pediatric providers interpret schedules for catch-up vaccination
  • Will help all providers with vaccination based on medical indications

Users simply enter a patient’s age, note if the patient has specific underlying medical conditions, and answer questions about the patient’s pneumococcal vaccination history. Then the app provides patient-specific guidance consistent with the U.S. Advisory Committee on Immunization Practices recommended immunization schedule.
Get the free PneumoRecs VaxAdvisor mobile app now:

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Vaxopedia website provides immunization information to help educate parents about vaccines

Vaxopedia, a website created by pediatrician Vincent Iannelli, MD, provides a wealth of immunization information with the goal of helping to get parents educated about vaccines.

Among the wide range of informative and engaging web pages on Vaxopedia is an A–Z Index web page linking to 470 alphabetized topics related to immunization.

Vaxopedia also has a blog. Some of the recent topics include:

Visit the Vaxopedia website to review the rich content it offers.

It is easy to subscribe to the blog by going to any page on the website and entering your email address in the right-hand column. You will receive an email message whenever a new blog post is released.

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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 2018, 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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Hepatitis B Foundation releases six new #justB stories to empower people affected by hepatitis B, raise awareness, and end stigma

The Hepatitis B Foundation continues its storytelling campaign: #justB: Real People Sharing Their Stories of Hepatitis B by recently releasing six new stories. These new stories focus on immigration, family, discrimination, and supporting loved ones who have hepatitis B. 

The following description of the #justB storytelling campaign is reprinted from the Hepatitis B Foundation's #justB main page:

The #justB storytelling campaign aims to raise the profile of hepatitis B as an urgent public health priority and helps put a human face on this serious disease by sharing stories of real people living with or affected by hepatitis B. The goals of the campaign are to increase awareness and advocacy; decrease stigma and discrimination; and promote testing, vaccination, linkage to care, and treatment to help save lives. 

A free, 58-page discussion guide to accompany the videos has also just been released and is available for free downloading through an email address you provide.

Related Links

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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!

Related Links

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Obstetrics & Gynecology journal publishes “Obstetrician-Gynecologists’ Strategies to Address Vaccine Refusal among Pregnant Women”

The Obstetrics & Gynecology journal published Obstetrician-Gynecologists’ Strategies to Address Vaccine Refusal Among Pregnant Women, by S.T. O'Leary, et al., in its January issue. The abstract is reprinted below.

OBJECTIVE: To describe 1) obstetrician-gynecologists' (ob-gyns’) perceptions of the frequency of vaccine refusal among pregnant patients and perceived reasons for refusal and 2) ob-gyns’ strategies used when encountering vaccine refusal and perceived effectiveness of those strategies.

METHODS: We conducted an email and mail survey among a nationally representative network of ob-gyns from March 2016 to June 2016.

RESULTS: The response rate was 69% (331/477). Health care providers perceived that pregnant women more commonly refused influenza vaccine than tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine: 62% of respondents reported 10% or greater of pregnant women they care for in a typical month refused influenza vaccine compared with 32% reporting this for Tdap vaccine. The most commonly reported reasons for vaccine refusal were patients' belief that influenza vaccine makes them sick (48%), belief they are unlikely to get a vaccine-preventable disease (38%), general worries about vaccines (32%), desire to maintain a natural pregnancy (31%), and concern that their child could develop autism as a result of maternal vaccination (25%). The most commonly reported strategies ob-gyns used to address refusal were stating that it is safe to receive vaccines in pregnancy (96%), explaining that not getting the vaccine puts the fetus or newborn at risk (90%), or that not getting the vaccine puts the pregnant woman's health at risk (84%). The strategy perceived as most effective was stating that not getting vaccinated puts the fetus or newborn at risk.

CONCLUSION: Ob-gyns perceive vaccine refusal among pregnant women as common and refusal of influenza vaccine as more common than refusal of Tdap vaccine. Emphasizing the risk of disease to the fetus or newborn may be an effective strategy to increase vaccine uptake.

Read the entire article: Obstetrician-Gynecologists’ Strategies to Address Vaccine Refusal Among Pregnant Women (HTML format). A version in PDF format is downloadable through a link in the right column of the article's main page.

Related Link

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CDC publishes report on death of Virginia resident from rabies contracted in India

CDC published Human Rabies—Virginia, 2017 in the January 4 issue of MMWR (pages 1410–1414). A summary made available to the press is reprinted below. 

While human rabies deaths are rare in the United States, they are still highly prevalent in many other countries. Travelers to other countries should consult the CDC Yellow Book and their medical provider prior to travels to countries where rabies is present, particularly if they are engaging in activities that will put them in close proximity to animals such as dogs, cats, and wildlife. A 65-year-old Virginia resident died from rabies after being bitten by a puppy while vacationing in India. Rabies is a highly lethal virus, but is preventable when medical care and vaccination are sought shortly after an exposure. Unfortunately, the victim did not seek medical care after the bite, and six weeks later developed the first signs of rabies after returning to her home in Virginia. Despite intensive medical care, the victim passed away. Rabies is primarily transmitted by bites from animals when virus in the saliva is introduced into a victim’s body. In very rare occasions, non-bite transmission may occur when saliva infects fresh open wounds or mucous membranes (such as the eyes or mouth). A public health investigation identified 72 hospital staff with suspected exposures to infectious materials; all were advised to receive vaccination.

Related Link

  • MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements

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New Medscape CME/CE program titled "Preventing Meningococcal B Disease: Challenges and Opportunities" now online

On December 19, Medscape posted an online training program titled Preventing Meningococcal B Disease: Challenges and Opportunities. The presenters are Litjen Tan, PhD, MS, Immunization Action Coalition; Gary S. Marshall, MD, University of Louisville School of Medicine; and Utibe Effiong, MD, MPH, MidMichigan Health System. The presentation's downloadable slides as well as information on obtaining continuing education credit are available once you sign in to the presentation.

If you are not a registered user on Medscape, you can register for free and get unlimited access to all Medscape features, including continuing education activities.

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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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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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