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Issue 1422: April 24, 2019







Total number of U.S. measles cases for 2019 climbs to 626 with 71 new cases reported since last week

CDC has posted its latest update on 2019 measles cases in the U.S. on its Measles Cases and Outbreaks web page. The web page shows a preliminary estimate of 626 cases across 22 states as of April 19. In 2018, the number of cases for the entire year was 372. The first two paragraphs from this website are reprinted below.

From January 1 to April 19, 2019, 626 individual cases of measles have been confirmed in 22 states. This is an increase of 71 cases from the previous week. This is the second-greatest number of cases reported in the U.S. since measles was eliminated in 2000, second only to the 667 cases reported during all of 2014. In the coming weeks, 2019 confirmed case numbers will likely surpass 2014 levels.

The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, Tennessee, and Washington.

Access additional information about U.S. measles cases in 2019 on CDC's Measles Cases and Outbreaks web page.

Click on the following links for information about specific outbreaks:

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Dr. Paul Offit discusses measles and MMR vaccination in CNN interview

On April 17, Paul Offit, MD, director, Vaccine Education Center at Children's Hospital of Philadelphia, provided a 14-minute interview with Christiane Amanpour of CNN about why the choice to not vaccinate has led to the dangerous resurgence of measles in the United States.

View the interview by clicking on the image above or here

Dr. Offit is also a professor of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia and the Maurice R. Hilleman Professor of Vaccinology at the Perelman School of Medicine at the University of Pennsylvania.

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Reminder! National Infant Immunization Week is April 27–May 4; many resources available to help you plan activities

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and to celebrate the achievements of immunization programs and their partners in promoting healthy communities. NIIW will be held this year on April 27–May 4. This year is the 25th anniversary of NIIW!

Visit CDC's updated NIIW website to find promotional and educational materials to help you plan your NIIW activities, including those in the 2019 Digital Media Toolkit, and tailor them to the needs of your community. If you're looking for planning ideas and tools, you can access guidance on CDC's Planning Your NIIW web page.

CDC would like to hear from organizations planning a 2019 NIIW activity. Please complete the NIIW Activity Form so others can learn what you're doing to educate and inspire parents and providers to protect infants and toddlers from vaccine-preventable diseases.

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CDC publishes report on the number of cases of high-grade cervical lesions diagnosed among women; reduction in cases demonstrates impact of the HPV vaccination program

CDC published Estimated Number of Cases of High-Grade Cervical Lesions Diagnosed Among Women—United States, 2008 and 2016 in the April 19 issue of MMWR. A summary made available to the press is reprinted below.

We report the first estimate of the number of high-grade cervical precancers (CIN2+ cases) in the United States using population-based data. In 2008, before vaccine impact, an estimated 216,000 women were diagnosed with CIN2+, and 10 years after vaccine introduction, an estimated 196,000. In 2008, 55% of cervical precancers were detected in women less than 30 years of age; in 2016, only 36% of cervical precancers were diagnosed in this age group. This decline reflects both the impact of the U.S. HPV vaccination program and changes in cervical cancer screening recommendations between 2008 and 2016. Some of the changes include initiating cervical cancer screening at an older age, incorporating HPV testing as part of screening, and having longer intervals between screenings. Overall, an estimated 76% of cervical precancers were attributable to HPV vaccine types.

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Influenza activity decreased again this week but remains elevated; CDC reports an estimate of up to 57,300 influenza-related deaths so far this season

According to CDC, influenza activity decreased again in the U.S. but remained elevated in the period ending April 13. The proportion of outpatient visits for influenza-like illness (ILI) decreased to 2.4%, but remained above the national baseline of 2.2%. Seven of 10 regions reported ILI at or above their region-specific baseline level. CDC estimates that flu has caused as many as 41.3 million flu illnesses, 610,000 hospitalizations, and 57,300 deaths so far this season. 

CDC has reported 5 additional influenza-associated pediatric deaths this season, for a total of 91. Last season, there was a record-setting 185 pediatric deaths in the U.S.  

CDC stated in its Weekly U.S. Influenza Surveillance Report, FluView, that during the week ending April 13, the geographic spread of influenza in 11 states was reported as widespread; Puerto Rico and 20 states reported regional activity; the District of Columbia and 17 states reported local activity; the U.S. Virgin Islands and two states reported sporadic activity; Guam did not report.

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! The "Favorites" tab at the top of every page on brings you to 18 of the most popular web sections on IAC's website

Using IAC's "Favorites" drop-down tab at the top of every web page, you will find 18 of the most highly visited web sections on IAC's content-rich website. Access the Favorites web page instantly by clicking on the "Favorites" drop-down tab at the left-most end of the 6 blue tabs that run across the top of every page of When users hover over this tab with their mouse or click on it, the Favorites web page content will appear.

The following web sections are offered as choices on the Favorites web page

Just click on the "Favorites" tab to visit the Favorites web page to find the most utilized content on

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IAC enrolls 6 new birthing institutions into its Hepatitis B Birth Dose Honor Roll; 11 previously honored institutions qualify for additional years' honors

The Immunization Action Coalition (IAC) is pleased to announce that 6 new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 451 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Homestead Hospital, Homestead, FL (97%)
  • Grant Memorial Hospital, Petersburg, WV (96%)
  • Manatee Memorial Hospital, Bradenton, FL (97%)
  • U.S. Naval Hospital Jacksonville, Jacksonville, FL (93%)
  • UPMC Altoona Hospital, Altoona, PA (94%)
  • Wellspan Gettysburg Hospital, Gettysburg, PA (90%)

The following 4 institutions are being recognized for a second year:

  • 48th Medical Group (U.S. military base), Lakenheath, England (92%)
  • Conemaugh Nason Medical Center Roaring Spring, PA (92%)
  • Methodist Dallas Medical Center, Dallas, TX (98%)
  • Wellspan Good Samaritan Hospital, Lebanon, PA (91%)

In addition, the following 2 institutions are being recognized for a third year:

  • Christus Mother Frances Hospital Sulphur Springs, Sulphur Springs, TX (95%)
  • Paoli Hospital, Paoli, PA (99%)

The following 3 institutions are being recognized for a fourth year:

  • INTEGRIS Grove Hospital, Grove, OK (95%)
  • Women & Infants Hospital of Rhode Island, Providence, RI (94%)
  • Yoakum County Hospital, Denver City, TX (92%)

The following 2 institutions are being recognized for a fifth year:

  • Oswego Hospital, Oswego, NY (97%)
  • Women & Infants Hospital of Rhode Island, Providence, RI (93%)

The following 2 institutions are being recognized for a sixth year:

  • Hospital Bella Vista, Mayaguez, PR (96%)
  • Women & Infants Hospital of Rhode Island, Providence, RI (96%)

Last, but certainly not least, the following institution is being recognized for a seventh year:

  • Women & Infants Hospital of Rhode Island, Providence, RI (96%)

Note: One of these institutions qualified for four 12-month periods at one time.

The Honor Roll now includes 451 birthing institutions from 43 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred fifteen institutions have qualified for two years, 53 institutions have qualified three times, 28 institutions have qualified four times, 14 institutions have qualified five times, 4 institutions have qualified six times, 1 institution has qualified seven times, and 1 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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Available now! IAC’s sturdy laminated versions of the 2019 U.S. child/adolescent immunization schedule and the 2019 U.S. adult immunization schedule—order them for your exam rooms today! Bulk purchase prices available.

IAC's laminated versions of the 2019 U.S. child/adolescent immunization schedule and the 2019 U.S. adult immunization schedule are available now. These schedules are covered with a tough coating you can wipe down; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. The child/adolescent schedule is eight pages (i.e., four double-sided pages) and the adult schedule is six pages (i.e., three double-sided pages). Both schedules are folded to measure 8.5" x 11". 

Adult Laminated Immunization Schedules

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading. They come complete with essential tables and notes, and they replicate the newly designed CDC schedule format.

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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WHO reports that measles cases increased 300% in the first three months of 2019 compared to the first three months of 2018

On April 15, the World Health Organization (WHO) reported that measles cases worldwide had increased 300% in the first months of 2019 compared to the first three months of 2018. The beginning section of this report is reprinted below.

Measles cases have continued to climb into 2019. Preliminary global data shows that reported cases rose by 300 percent in the first three months of 2019, compared to the same period in 2018. This follows consecutive increases over the past two years.

While this data is provisional and not yet complete, it indicates a clear trend. Many countries are in the midst of sizeable measles outbreaks, with all regions of the world experiencing sustained rises in cases. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand, and Ukraine, causing many deaths—mostly among young children.

Over recent months, spikes in case numbers have also occurred in countries with high overall vaccination coverage, including the United States of America as well as Israel, Thailand, and Tunisia, as the disease has spread fast among clusters of unvaccinated people.

Measles is one of the world’s most contagious diseases, with the potential to be extremely severe. In 2017, the most recent year for which estimates are available, it caused close to 110 000 deaths. Even in high-income countries, complications result in hospitalization in up to a quarter of cases, and can lead to lifelong disability, from brain damage and blindness to hearing loss.

The disease is almost entirely preventable through two doses of a safe and effective vaccine. For several years, however, global coverage with the first dose of measles vaccine has stalled at 85 percent. This is still short of the 95 percent needed to prevent outbreaks, and leaves many people, in many communities, at risk. Second dose coverage, while increasing, stands at 67 percent.

Read the complete WHO report: New Measles Surveillance Data for 2019.

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World Immunization Week is the last week of April; read about heroic efforts around the world to protect people from vaccine-preventable diseases

World Vaccination Week (WIW) is traditionally celebrated the last week of April. WHO provided the following description of WIW 2019:

World Immunization Week aims to promote the use of vaccines to protect people of all ages against disease. Immunization saves millions of lives every year and is widely recognized as one of the world’s most successful and cost-effective health interventions. Yet, there are still nearly 20 million unvaccinated and under-vaccinated children in the world today.

The theme of this year’s campaign is Protected Together: Vaccines Work!, and the campaign will celebrate Vaccine Heroes from around the world—from parents and community members to health workers and innovators—who help ensure we are all protected, at all ages, through the power of vaccines.

Click on any of the images below to access information about vaccine heroes and campaign materials on the WIW website.

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Vaccine Education Center updates its “Vaccines and Autism: What You Should Know” Q&A sheet

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia has updated its Q&A sheet titled "Vaccines and Autism: What You Should Know." The most significant changes relate to the addition of references for newer studies and updated statistics, particularly related to the incidence of autism. 

This piece is part of VEC's Vaccine- and Vaccine Safety-Related Q&A Sheets series, and is available in English and Spanish online. Any of these Q&A sheets can also be ordered in print for a nominal cost.

Access all of the Vaccine Education Center's vaccine- and vaccine safety-related Q&A sheets.

Access all of the Vaccine Education Center's booklets for parents and patients.

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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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"There’s an App for That: Increasing HPV Vaccination Rates" webinar scheduled for May 21
A webinar titled There’s an App for That: Increasing HPV Vaccination Rates is scheduled for May 21 at 3:00 p.m. (ET). Participants will learn the benefits of using the "HPV Same Way Same Day" app as a clinical training tool to increase HPV vaccination rates from presenter Sharon Humiston, MD, MPH, FAAP, professor of Pediatrics, Children’s Mercy Hospital, Kansas City, MO. This webinar is offered through the National AHEC Organization HPV Immunization Project.

Registration information

Access more information on the American Academy of Pediatrics' free Same Way Same Day app.
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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