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Issue 1434: July 10, 2019









Total number of U.S. measles cases for 2019 climbs to 1,109 with 14 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 1,109 cases across 28 states as of July 3. This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated from the U.S. in 2000.

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

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

Measles outbreaks (defined as 3 or more cases) are currently ongoing in 2019 in the following jurisdictions:

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CDC publishes “Health-Related Workplace Absenteeism Among Full-Time Workers—United States, 2017–18 Influenza Season” in this week’s MMWR

CDC published Health-Related Workplace Absenteeism Among Full-Time Workers—United States, 2017–18 Influenza Season in the July 5 issue of MMWR (pages 577–582). The first paragraph is reprinted below.

During an influenza pandemic and during seasonal epidemics, more persons have symptomatic illness without seeking medical care than seek treatment at doctor’s offices, clinics, and hospitals. Consequently, surveillance based on mortality, health care encounters, and laboratory data does not reflect the full extent of influenza morbidity. CDC uses a mathematical model to estimate the total number of influenza illnesses in the United States. In addition, syndromic methods for monitoring illness outside health care settings, such as tracking absenteeism trends in schools and workplaces, are important adjuncts to conventional disease reporting. Every month, CDC’s National Institute for Occupational Safety and Health (NIOSH) monitors the prevalence of health-related workplace absenteeism among full-time workers in the United States using data from the Current Population Survey (CPS). This report describes the results of workplace absenteeism surveillance analyses conducted during the high-severity 2017–18 influenza season (October 2017–September 2018). Absenteeism increased sharply in November, peaked in January and, at its peak, was significantly higher than the average during the previous five seasons. Persons especially affected included male workers, workers aged 45–64 years, workers living in U.S. Department of Health and Human Services (HHS) Region 6 and Region 9, and those working in management, business, and financial; installation, maintenance, and repair; and production and related occupations. Public health authorities and employers might consider results from relevant absenteeism surveillance analyses when developing prevention messages and in pandemic preparedness planning. The most effective ways to prevent influenza transmission in the workplace include vaccination and nonpharmaceutical interventions, such as staying home when sick, covering coughs and sneezes, washing hands frequently, and routinely cleaning frequently touched surfaces.

Access the complete report: Health-Related Workplace Absenteeism Among Full-Time Workers—United States, 2017–18 Influenza Season (HTML version)

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

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New! “FLU VACCINE” buttons and stickers now available for purchase from IAC

Start your preparations for the 2019–20 influenza season by ordering IAC's new “FLU VACCINE” buttons and stickers from SHOP IAC. These new resources are modeled after “I Voted” stickers, which are given to voters in many states as they leave the polls on Election Day. The flu vaccine buttons and stickers are bright red to help broadcast your important vaccination message. And the cost is low!


Demonstrate your clinic-wide support for protecting everyone from influenza by purchasing buttons for all staff to wear. Measuring 1.25" across, the button is understated in size but carries a bold message! Brightly colored red, round button with white text and a metal pin that clasps on the back.

Pin on your lab coat, uniform, other clothing, tote bags, or backpacks to show support for influenza vaccination. Wear it when flu vaccine is available in your clinic to remind patients and the public to protect themselves from influenza.
Buttons are delivered in bags of 10 buttons per bag. Click here for pricing and ordering.

These brightly colored red, round stickers, measure 1.5" across. Printed on Avery labels, they adhere well to clothing and have an easy-peel-off back.
Wearing these brightly colored stickers, your patients will be letting their communities know that influenza vaccination is important.

Suitable for clinic staff, too! Urge all staff (including receptionists!) to wear them at work during flu vaccination season. This sends a powerful reminder to patients to get vaccinated.
Stickers are delivered to you cut individually (not on rolls)—available in bundles of 100. Click here for pricing and ordering information.

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Clarification: IAC adds more information to last week’s article about change in storage temperature requirements for Vaxchora (Emergent Biosolutions) oral cholera vaccine; the product currently available still requires frozen storage 

In the July 3 issue of IAC Express, IAC reported that the U.S. Food and Drug Administration (FDA) had approved a change in storage temperature requirements for Vaxchora (Emergent BioSolutions), an oral cholera vaccine. IAC is issuing a clarification to this article to make it clear that the Vaxchora product currently available still requires frozen storage.

The refrigerator-stored product is not expected to be available until early quarter 4.

Until then, healthcare providers should continue to store Vaxchora frozen as they have been doing and should refer to the storage instructions that accompany their existing product.
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CDC publishes new web page on MMR vaccination recommendations for international travelers and for people living in or traveling domestically to areas with ongoing measles outbreaks in the U.S.

CDC has created a new web page under its Measles (Rubeola) web section titled Plan for Travel. You will find it a helpful resource for understanding current MMR vaccination recommendations for international travelers and persons living in or traveling domestically to areas with ongoing measles outbreaks and community-wide transmission.

Its new sections include: 

  • Which Travelers Are at Risk?
  • Before International Travel: Make Sure You’re Protected Against Measles
  • What Countries Are Having Measles Outbreaks?
  • How Do Measles Outbreaks Start in the U.S.?
  • Travel Notices: Global Measles Outbreak Notice
  • After International Travel: Watch for Measles
  • What Can Clinicians Do?

Visit CDC's new Measles: Plan for Travel web page today.

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June's Technically Speaking column by IAC's executive director titled “Looking for New Tools and Resources to Help Increase Your Clinic's HPV Vaccination Rates? Here Are Some Great Ones!” now available on IAC's website

Technically Speaking is a monthly column written by IAC Executive Director Dr. Deborah Wexler for Vaccine Update for Healthcare Providers, a monthly e-newsletter from the Vaccine Education Center at the Children's Hospital of Philadelphia (CHOP). The column covers practical topics in immunization, such as vaccine administration, immunization scheduling, vaccine storage and handling, and vaccine recommendations.

June's column, titled "Looking for New Tools and Resources to Help Increase Your Clinic's HPV Vaccination Rates? Here Are Some Great Ones!" is now available on IAC's Technically Speaking web section and is reprinted below.

Looking for New Tools and Resources to Help Increase Your Clinic's HPV Vaccination Rates? Here Are Some Great Ones!
Published June 2019

The most recently published data from the 2017 National Immunization Survey – Teen showed that, although HPV vaccination coverage has increased annually since 2013, initiation of HPV vaccination remains lower than MenACWY. From 2016 to 2017, 85% of surveyed adolescents age 13–17 had received at least 1 dose of MenACWY vaccine, but only 66% had received at least 1 dose of HPV vaccine. And only 49% had completed an HPV vaccine series. For comparison, 89% of these adolescents had received Tdap.

One of the barriers to HPV vaccination is that some parents question the need to vaccinate their preteen against a sexually transmitted virus. Unfortunately, providers have too often responded to this parental concern by not giving a strong recommendation for HPV vaccination, or by introducing the vaccine to parents in an entirely different way than Tdap or MenACWY. Yet all three of these vaccines are recommended at the same age.

Multiple studies show that patients who receive a strong vaccine recommendation from their provider are four to five times more likely to receive the HPV vaccine. Clearly, YOU are the key to HPV-related cancer prevention!

CDC and AAP have developed several new resources to help providers feel confident communicating with parents about HPV vaccination of their preteen.

  • CDC's HPV Information for Clinicians: web section offers factsheets and guidance for clinicians, recommendations and schedules, and research-based answers for parents' questions about HPV vaccination.
  • CDC's #HowIRecommend HPV Vaccination Video Series features clinicians explaining how they are achieving high HPV vaccination rates and effectively addressing HPV vaccination questions in their practices. These short, informative videos cover a range of topics related to HPV vaccination, including:
    • Making effective recommendations to increase vaccination rates
    • Helping parents understand why HPV vaccine is important for their preteen
    • Addressing parents' questions about HPV vaccine safety
    • Involving everyone in your practice in HPV vaccination efforts
  • The American Academy of Pediatrics offers a free app, HPV Vaccine: Same Way Same Day. This interactive role-play simulation app is designed to enhance providers' discussions about HPV with parents.

Additional HPV Resources

You can access the current and past issues of Technically Speaking in the following ways: from a box in the middle of the home page, from the "Guide to" at the bottom of every web page, or by going directly to the home page.

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IAC Spotlight! Just in case you missed them—these IAC materials and web pages were updated during May and June

In almost every issue of IAC Express, we provide readers with information about new and updated educational materials for healthcare professionals and handouts for patients that have been posted during the past week on IAC’s website for healthcare professionals, All these materials are CDC-reviewed and available free for you to download, print, copy, and distribute in your healthcare settings. We also announce major updates to the content on various web sections and pages on
Below you’ll find a listing of the new and updated items and web pages we’ve announced in IAC Express during the months of May and June, in case you’ve missed any of them.

Educational Materials for Healthcare Professionals

Handouts for Your Patients

Updated Web Sections and Pages

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CDC and WHO publish “Genetic Characterization of Measles and Rubella Viruses Detected Through Global Measles and Rubella Elimination Surveillance, 2016–2018” in this week's MMWR and Weekly Epidemiological Record, respectively

CDC published Genetic Characterization of Measles and Rubella Viruses Detected Through Global Measles and Rubella Elimination Surveillance, 2016–2018 in the July 5 issue of MMWR (pages 587–591). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Genetic Characterization of Measles and Rubella Viruses Detected Through Global Measles and Rubella Elimination Surveillance, 2016–2018. The Summary box content from the MMWR article is reprinted below. 

What is already known about this topic?
Monitoring progress toward measles and rubella elimination requires high-quality case-based surveillance, including genetic characterization of measles viruses and rubella viruses.

What is added by this report?
During 2016–2018, the number of reported measles virus genotypes declined from six to four; two (B3 and D8) accounted for 95% of reported sequences. Of 13 rubella virus genotypes, reported genotypes declined from five to two.

What are the implications for public health practice?
Diversity of measles and rubella viruses has decreased globally, consistent with progress toward elimination. Continued collection of specimens from all confirmed cases for genotyping and submission of wild-type virus sequences to global databases will strengthen case-based surveillance.

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New study identifies causes of severe pneumonia in children from Africa and Asia

On June 27, The Lancet published Causes of Severe Pneumonia Requiring Hospital Admission in Children without HIV Infection from Africa and Asia: The PERCH Multi-Country Case-Control Study and a related commentary titled What the PERCH Study Means for Future Pneumonia Strategies. The Background and Interpretation paragraphs from the Summary section of The Lancet article are reprinted below.

Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings.

In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes.

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Still available! IAC’s sturdy laminated 2019 U.S. child/adolescent immunization schedules—order some for your exam rooms today! Bulk purchase prices available.

IAC's laminated 2019 U.S. child/adolescent immunization schedule is still available. The adult schedules have sold out. 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 is folded to measure 8.5" x 11". 

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 the schedule, view an image, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide is available for free download either by chapter or in its entirety (142 pages)

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 "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting. Topics include:

  • 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 Guide is available to download/print either by chapter or in its entirety free of charge at The downloaded version is suitable for double-sided printing. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.

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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June issue of CDC's Immunization Works newsletter now available

CDC recently released the June 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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The Lancet publishes study showing remarkable effectiveness of HPV vaccine

On June 26, The Lancet published Population-Level Impact and Herd Effects Following the Introduction of Human Papillomavirus Vaccination Programmes: Updated Systematic Review and Meta-Analysis. The Interpretation paragraph from the Summary section of The Lancet article is reprinted below.

This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects.

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Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through September 25; register now

Register for CDC's 15-part, live CE-accredited series of 1-hour webinars designed to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). Topics include specific vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.  
All sessions begin at 12:00 p.m. (ET). This series began on June 5 and will run through September 25, 2019. The next two webinars are scheduled as follows:
  • July 17: Vaccine Storage and Handling and Administration and Vaccine Administration
  • July 24: DTaP/Tdap
Recordings of sessions will be available online within 2 weeks after each webinar.

Information on registration and program details are available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at You can also order this resource from the Public Health Foundation for $40 plus shipping and handling.

Reminder: 2019 National Conference for Immunization Coalitions and Partnerships scheduled for November 13–15 in Honolulu; register by August 31 to receive early bird rate

The 14th National Conference for Immunization Coalitions and Partnerships (NCICP) will take place in Honolulu from November 13–15. This is a great opportunity for coalition members and others to learn from expert speakers and network with members of immunization coalitions from around the nation.

Keynote speakers will include Nancy Messonnier, MD, director, National Center for Immunization and Respiratory Diseases, CDC, and Erica DeWald, directory of advocacy, Vaccinate Your Family. The conference will also include 40 breakout sessions, as well as research and coalition posters.

Please register for the conference by August 31 to receive the early bird rate.

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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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ISSN: 1526-1786
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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.

IZ Express Disclaimer
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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