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Issue 1412: February 20, 2019









ACIP publishes recommendations for the use of hepatitis A vaccine for people experiencing homelessness

CDC published Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness in the February 15 issue of MMWR (pages 153–156). A summary made available to the press is reprinted below.

In October 2018, the Advisory Committee on Immunization Practices (ACIP) unanimously approved updating the recommendations for HepA vaccine to include all people ages 1 year and older experiencing homelessness. The new recommendation is based on evidence showing the substantial public health and cost benefit of routine HepA vaccination for people who are homeless. Additionally, recent outbreaks of hepatitis A virus transmission have demonstrated the vulnerability of this population to this infection. Between 2016 and 2018, more than 7,000 cases of hepatitis A infection were reported in 12 states. The majority of these infections were among people reporting homelessness and/or injection or non-injection drug use. HepA vaccination for people who are homeless will protect these vulnerable individuals and reduce the risk of person-to-person outbreaks among this population.

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CDC provides update on influenza activity in the United States through February 2; influenza remains widespread so keep vaccinating your patients

CDC published Update: Influenza Activity—United States, September 30, 2018–February 2, 2019 in the February 15 issue of MMWR (pages 125–134). A summary made available to the press is reprinted below.

Since December 2018, influenza activity increased overall and remained elevated through early February. Nationwide, influenza A(H1N1)pdm09 viruses have predominated, but in the southeastern United States influenza A(H3N2) viruses have predominated. As of February 2, 2019, this has been a low-severity influenza season, with a lower percentage of outpatient visits for influenza-like illness (ILI), lower rates of hospitalization, and fewer deaths attributed to pneumonia and influenza compared with recent seasons. Nevertheless, this season has resulted in many illnesses, hospitalizations and deaths, which are being reported in-season for the first time. The majority of the influenza viruses characterized antigenically and genetically are similar to the cell-grown reference viruses representing the 2018–19 Northern Hemisphere influenza vaccine viruses.

CDC stated in its Weekly U.S. Influenza Surveillance Report, FluView, that during the week ending February 9, influenza activity continued to increase in the U.S., with 6 additional pediatric deaths from influenza reported, for a total of 34. Last season, there was a record-setting number of pediatric deaths in the U.S. (185), 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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CDC publishes interim estimates of the 2018–19 influenza vaccine effectiveness

CDC published Interim Estimates of 2018–19 Seasonal Influenza Vaccine Effectiveness—United States, February 2019 in the February 15 issue of MMWR (pages 135–139). A summary made available to the press is reprinted below.

CDC recommends yearly influenza vaccination for children at least 6 months old and adults. Early estimates indicate that influenza vaccines have reduced the risk of medically attended influenza-related illness by almost half (47%) in vaccinated people so far this season. Vaccination reduced the rate of illness caused by the predominant influenza H1N1 virus by about 46 percent among patients of all ages, and by about 62 percent among children 6 months through 17 years of age. Vaccination provided similar protection to that seen in previous H1N1 seasons in children and in adults younger than age 50. For these estimates, 3,254 children and adults with acute respiratory illness were enrolled from November 23, 2018 to February 2, 2019 at five study sites with outpatient medical facilities in the United States.

Related Link

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

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The 25th anniversary of National Infant Immunization Week is in April 

This year marks the 25th anniversary of National Infant Immunization Week (NIIW). From April 27–May 4, NIIW will highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs in promoting healthy communities through the United States.

In preparation for this important annual observance, on February 13, CDC launched its NIIW 2019 website with new information and helpful resources to:

  • support your NIIW activities
  • promote the importance of on-time vaccination in your practice and community
  • recognize those who are doing an exemplary job or going above and beyond to promote childhood immunizations in their communities

Check out CDC's National Infant Immunization Week web section by clicking on the 25th anniversary graphic below.

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IAC Spotlight! Invite your colleagues to sign up for IAC Express with the new easy-to-access link on the top of every web page

As a reader of IAC Express, you know how this weekly newsletter keeps you informed about new and updated vaccine recommendations, new vaccine licensures, new and updated Vaccine Information Statements and translations, CDC-reviewed immunization education materials from IAC, the latest resources from CDC and other organizations, and more.

To make it easier for people to sign up for this free newsletter, we have added a sign-up link at the top of every page on, as illustrated below.

Please urge your colleagues to sign up for IAC Express by clicking on this new gold bar at the top of any page!

Or simply visit

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CDC publishes study about university-based outbreaks of meningococcal disease caused by serogroup B

CDC researchers published University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018 in the March issue of Emerging Infectious Diseases (Soeters HM, et al.). The abstract is reprinted below.

We reviewed university-based outbreaks of meningococcal disease caused by serogroup B and vaccination responses in the United States in the years following serogroup B meningococcal (MenB) vaccine availability. Ten university-based outbreaks occurred in 7 states during 2013–2018, causing a total of 39 cases and 2 deaths. Outbreaks occurred at universities with 3,600–35,000 undergraduates. Outbreak case counts ranged from 2 to 9 cases; outbreak duration ranged from 0 to 376 days. All 10 universities implemented MenB vaccination: 3 primarily used MenB-FHbp [Trumenba] and 7 used MenB-4C [Bexsero]. Estimated first-dose vaccination coverage ranged from 14% to 98%. In 5 outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation. Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.

Read the complete article: University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018.

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IAC enrolls 13 new birthing institutions into its Hepatitis B Birth Dose Honor Roll; 19 previously honored institutions qualify for additional years' honors

The Immunization Action Coalition (IAC) is pleased to announce that 13 new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 440 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Grand View Health, Sellersville, PA (95%)
  • Henry Ford Wyandotte Hospital, Wyandotte, MI (90%)
  • Jackson North Medical Center, North Miami Beach, FL (97%)
  • Jackson South Medical Center, Miami, FL (100%)
  • Munson Healthcare Cadillac Hospital, Cadillac, MI (90%)
  • Munson Healthcare Manistee Hospital, Manistee, MI (92%)
  • Santa Rosa Medical Center, Milton, FL (93%)
  • Sentara Norfolk General Hospital, Norfolk, VA (93%)
  • Sharon Regional Medical Center, Sharon, PA (90%)
  • St. Luke's Meridian Medical Center, Meridian, ID (95%)
  • St. Vincent Women's Hospital, Indianapolis, IN (96%)
  • Spectrum Health Big Rapids, Big Rapids, MI (90%)
  • Spectrum Health United Hospital, Greenville, MI (91%)

The following 14 institutions are being recognized for a second year:

  • Big Bend Regional Medical Center, Alpine, TX (98%)
  • CarolinaEast Medical Center, New Bern, NC (94%)
  • Grand View Health, Sellersville, PA (95%)
  • Hill Regional Hospital, Hillsboro, TX (98%)
  • Huran Medical Center, Bad Axe, MI (91%)
  • Munson Healthcare Cadillac Hospital, Cadillac, MI (90%)
  • Munson Healthcare Manistee Hospital, Manistee, MI (94%)
  • Pottstown Hospital, Pottstown, PA (97%)
  • Sentara Norfolk General Hospital, Norfolk, VA (93%)
  • St. Clair Hospital, Pittsburgh, PA (98%)
  • St. Vincent Women's Hospital, Indianapolis, IN (91%)
  • Spectrum Health Big Rapids, Big Rapids, MI (90%)
  • Spectrum Health United Hospital, Greenville, MI (93%)
  • UPMC Pinnacle Hanover, Hanover, PA (94%)

In addition, the following 7 institutions are being recognized for a third year:

  • Delaware County Memorial Hospital, Drexel Hill, PA (95%)
  • Huran Medical Center, Bad Axe, MI (91%)
  • Jefferson Hospital, Jefferson Hills, PA (91%)
  • Mercy Health St. Mary's, Grand Rapids, MI (91%)
  • Munson Healthcare Manistee Hospital, Manistee, MI (92%)
  • Spectrum Health Big Rapids, Big Rapids, MI (90%)
  • Spectrum Health United Hospital, Greenville, MI (95%)

Finally, the following 3 institutions are being recognized for a fourth year:

  • Cogdell Memorial Hospital, Snyder, TX (98%)
  • Shannon Medical Center, San Angelo, TX (95%)
  • Spectrum Health United Hospital, Greenville, MI (92%)

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

The Honor Roll now includes 440 birthing institutions from 42 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred fifteen institutions have qualified for two years, 50 institutions have qualified three times, 28 institutions have qualified four times, 11 institutions have qualified five times, three institutions have qualified six times, and one institution has qualified eight 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 two podcasts: one about HPV vaccination and a second about a new conspiracy theory  

Voices for Vaccines (VFV) has posted two new entries in its Vax Talk podcast series. The titles and descriptions are as follows:

HPV Vaccines and How We Decide
Some people seem to view the HPV vaccine as something to fear instead of a cancer-preventing tool. When the science is clear that this vaccine is safe and needed, why do some refuse it? For answers, VFV talks to Dr. Noel Brewer, a health behavior expert and chair of the National HPV Vaccination Roundtable.

Vaccine Court, Autism, and a New Conspiracy Theory
It’s been more than a decade since a U.S. court, in an omnibus proceeding, found that vaccines do not cause autism, but that finding has sparked a new conspiracy theory, thanks in part to Robert F. Kennedy, Jr. VFV invited vaccine law expert Dorit Reiss to its show to discuss how this new conspiracy theory does not hold up to scrutiny.

If you or your organization would like information about how to become a sponsor of a VFV "Vax Talk" podcast, please contact VFV's executive director Karen Ernst, at  

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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HHS proposes new rules to improve the interoperability of health information

On February 11, the Department of Health and Human Services (HHS) proposed new rules to improve the exchange of health information. The first paragraph of a related press release is reprinted below.

The U.S. Department of Health and Human Services (HHS) today proposed new rules to support seamless and secure access, exchange, and use of electronic health information. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would increase choice and competition while fostering innovation that promotes patient access to and control over their health information. The proposed ONC rule would require that patient electronic access to this electronic health information (EHI) be made available at no cost.

Read the complete press release: HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information.

Access a fact sheet on the proposal: CMS Advances Interoperability & Patient Access to Health Data through New Proposals.

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Measles killed 72 children and adults in WHO's European Region in 2018 

On February 7, the World Health Organization (WHO) published a press release titled Measles in Europe: Record Number of Both Sick and Immunized. The first two paragraphs are reprinted below.

More children in the WHO European Region are being vaccinated against measles than ever before; but progress has been uneven between and within countries, leaving increasing clusters of susceptible individuals unprotected, and resulting in a record number of people affected by the virus in 2018. In light of measles data for the year 2018 released today, WHO urges European countries to target their interventions to those places and groups where immunization gaps persist.

Measles killed 72 children and adults in the European Region in 2018. According to monthly country reports for January to December 2018 (received as of 01 February 2019), 82,596 people in 47 of 53 countries contracted measles. In countries reporting hospitalization data, nearly 2/3 (61%) of measles cases were hospitalized. The total number of people infected with the virus in 2018 was the highest this decade: 3 times the total reported in 2017 and 15 times the record low number of people affected in 2016.

Read the complete release: Measles in Europe: Record Number of Both Sick and Immunized.

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WHO reports on meetings of two influenza working groups this week's Weekly Epidemiological Record

The February 15 issue of the World Health Organization's (WHO) Weekly Epidemiological Record included the following two articles about influenza working groups:

  1. 7th Meeting of the WHO Expert Working Group of the Global Influenza Surveillance and Response System for Surveillance of Antiviral Susceptibility
  2. Executive summary of the 10th meeting of the WHO Working Group for the Molecular Detection and Subtyping of Influenza Viruses and the use of next-generation sequencing in the Global Influenza Surveillance and Response System

Access the February 15 issue of WHO's Weekly Epidemiological Record to read either or both of these articles.

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

In 2018, IAC and Seqirus launched its 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. 

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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February’s Parents PACK newsletter from the Vaccine Education Center includes article on the importance of understanding the latest scientific information in its historical context

Parents PACK (Possessing, Accessing, and Communicating Knowledge about vaccines) from the Vaccine Education Center at Children's Hospital of Philadelphia offers an electronic newsletter for parents. The February issue includes a feature article titled Chapters vs. Books: How Scientific Studies Tell a Story, which encourages people to look at new information in the context of the existing body of literature. Healthcare providers should check out the issue and encourage parents to subscribe to the free Parents PACK newsletter.

To find more information about their resources and subscribe to their newsletter, visit the Parents PACK web page.

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CDC publishes study of the 2017–18 influenza season severity in Minnesota and Utah

CDC published Notes from the Field: Assessment of State-Level Influenza Season Severity—Minnesota and Utah, 2017–18 Influenza Season in the February 15 issue of MMWR (pages 165–166). Selections from the article are reprinted below.

The U.S. 2017–18 influenza season was a high-severity season, with the highest number of outpatient visits for influenza-like illness (ILI) since the 2009–10 pandemic and the highest rate of influenza-associated hospitalizations since surveillance expanded to include adult hospitalizations during the 2005–06 season. The severe season was characterized by reports of strained emergency departments and hospitals and spot shortages of influenza antiviral medications. Influenza activity can vary widely across geographic regions, and local severity assessments might better guide public health actions and health care needs and support the development of tailored communication messages to prevent influenza morbidity and mortality. CDC assesses influenza season severity at the national level, but the applicability of this approach at state or local levels has not been tested.

In February 2018, field investigations were conducted in Minnesota and Utah to identify potential indicators of state-level influenza activity and pilot a state-level approach to assessing influenza season severity in real time....

The national severity assessment framework was successfully adapted for use in Minnesota and Utah. Utah is piloting the report of the weekly severity assessments for the 2018–19 season. Additional states might find this method useful for improving local public health messaging, preparedness, and response during an influenza season and in the event of a pandemic. CDC continues to develop resources to support local assessments of influenza season severity; interested jurisdictions are encouraged to contact CDC’s Influenza Division for assistance.

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Tune in to CDC's ACIP meeting February 27–28 (Wednesday and Thursday) via live webcast

Tune in to the Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta on February 27 and 28 (Wednesday and Thursday) via live webcast.

These instructions also include information about how to listen to the meeting via phone only.

Related Links

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American Immunization Registry Association 2019 meeting to be held August 13–15 in Indianapolis

The American Immunization Registry Association (AIRA) annual meeting will be held August 13–15 in Indianapolis, IN.

Access information about the AIRA national meeting.

In 2019, AIRA will be celebrating its 20th anniversary of supporting and promoting the use of immunization information to ensure healthy communities through the development and implementation of immunization information systems. Learn more about AIRA at

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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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Copyright (C) 2019 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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