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Issue 1436: July 17, 2019










CDC shares information about anticipated delayed delivery of Sanofi flu vaccine and AstraZeneca’s limited supply of FluMist

In its July 5 AIM Weekly Partner Update, the Association of Immunization Managers shared information from CDC regarding influenza vaccine availability, which is reprinted below.

Flu Vaccine Timing

CDC announced expectations (see chart below) for flu vaccine timing for the upcoming 2019–2020 flu season in a message sent to all awardees on Friday, June 28. More detailed information about the timing of flu vaccine availability will be released later this summer as part of the Awardee Flu Vaccine Ordering Guidance document. Sanofi announced in a customer service letter that delivery of Sanofi influenza vaccines is anticipated to be 3–4 weeks behind previously announced shipping commitments. Sanofi Pasteur fully expects to manufacture and deliver every dose reserved by customers, beginning with partial shipments to all customers in late August or September, with all shipments completed by the end of November. AstraZeneca previously announced a reduction of supply of LAIV for the 2019–2020 influenza season.

Chart provided by CDC in all-awardee message dated June 28, 2019.

Related Link

AAP News: Delivery of Sanofi Flu Vaccines to Be Delayed (7/5/19)

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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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NOTE: IAC Express summary article on the June ACIP meeting inadvertently omitted a change in the routine MenB vaccination guidance

The July 3, 2019 edition (Issue #1433) of IAC Express contained a summary of votes taken at the most recent ACIP meeting. A key point was inadvertently omitted from the article regarding a change in the meningococcal B vaccine (MenB) recommendations. Specifically, when published, the updated ACIP recommendations will include an important change in wording as detailed below.

Previous “Category B” language for MenB primary vaccination in adolescents will be modified to state “ACIP recommends a MenB primary series for individuals aged 16–23 years based on shared clinical decision making.” This distinction clarifies the importance of the provider discussing information about MenB vaccination with all appropriately aged patients and sharing the decision about whether to administer the vaccine with the patient.

In addition, ACIP approved the removal of the current appendices that provide guidance on chemoprophylaxis of close contacts and management of outbreaks from the updated recommendations.

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AAP News publishes letter to the editor from three medical experts posing the question: "When a parent requests a vaccine exemption, what will you do?”

AAP News published Letter to the Editor: "When a parent requests a vaccine exemption, what will you do?" on July 10. The letter’s authors are three widely-respected pediatricians: Drs. Edgar Marcuse, Douglas Opel, and Douglas Diekema. The first two paragraphs of their letter are reprinted below.

In response to resurgence of measles, several state legislatures are considering or have enacted legislation to restrict or eliminate parents’ ability to get a personal, philosophical or religious exemption to the state’s school or child care immunization requirements.

What will you do when you encounter a parent whose child has no medical contraindication or even precaution to receiving measles, mumps, rubella (MMR) vaccine but adamantly refuses the vaccine for the child? Perhaps the parent is fearful of potential adverse consequences, such as autism.

Their letter explores the issues and facts surrounding this question and offers suggestions to doctors faced with parents' hesitancy or fears, state legislation, and the responsibility to maintain their own medical integrity.

Read the entire letter. 

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Mark your calendar! Dr. Sharon G. Humiston, IAC’s associate director for research, will present a webinar on adolescent immunization and the 16-year platform on August 14 at 1:00 p.m. (ET)

Prepping for the back-to-school rush? Join Sharon G. Humiston, MD, MPH, FAAP, IAC's associate director for research, for a one-hour webinar titled "Adolescent Immunization Update and the 16-Year-Old Platform" on August 14, at 1:00 p.m. (ET). During her presentation, Dr. Humiston will review the “need-to-know” facts of adolescent immunization.

Stay tuned for registration information and more details in an upcoming issue of IAC Express.

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IAC Spotlight! IAC's "Talking about Vaccines: Adjuvants and Ingredients” web page features resources to help providers answer parents’ questions

IAC's Talking about Vaccines: Adjuvants and Ingredients web page on was recently updated. This page contains many resources from IAC, CDC, and others to help healthcare professionals explain to parents and patients what they should know about the safety of vaccine adjuvants and ingredients and the important role that adjuvants play in increasing the body's immune response to vaccines.

The resources include those of the following organizations:

  • IAC
  • CDC
  • U.S. Food and Drug Administration
  • Vaccine Education Center (VEC), Children's Hospital of Philadelphia 
  • American Academy of Pediatrics
  • Vaxopedia
  • World Health Organization

To easily locate this web page from anywhere on, go to the light blue band of tabs across the top, choose the "Talking About Vaccines" tab (far right), and then select "Adjuvants" from the drop-down menu.

The direct link is

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CDC calls on medical professionals to recognize symptoms and report suspected cases of acute flaccid myelitis (AFM)

In its July 9 press release, CDC urged doctors to rapidly recognize and report cases of acute flaccid myelitis (AFM) to their health department. Late summer/early fall has been the peak season for AFM, which primarily affects previously healthy children. Respiratory symptoms or fever consistent with a viral infection are followed in less than a week by limb weakness. This may progress rapidly to respiratory failure. CDC’s press release emphasizes that early recognition and reporting are critical for providing patients with appropriate care and rehabilitation as well as for better understanding of AFM.

In the July 12 issue of MMWR, CDC published Vital Signs: Surveillance for Acute Flaccid Myelitis—United States, 2018 in the July 12 issue of MMWR (pages 608–613). The authors note:

Identification of risk factors leading to outbreaks of AFM remains a public health priority. Prompt recognition of signs and symptoms, early specimen collection, and complete and rapid reporting will expedite public health investigations and research studies to elucidate the recent epidemiology of AFM and subsequently inform treatment and prevention recommendations.

CDC has also released the audio recording and transcript of its July 9 telebriefing: TRANSCRIPT of July 9, 2019, CDC Vital Signs: Nationwide Outbreak of Acute Flaccid Myelitis—United States, 2018. In this briefing, Dr. Anne Schuchat, CDC’s Principal Deputy Director, and Dr. Tom Clark, a pediatrician and lead investigator for CDC’s AFM team, discuss what CDC has learned about AFM and the continued work to better understand this syndrome. 

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Total number of U.S. measles cases for 2019 climbs to 1,123 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 1,123 cases across 28 states as of July 11. 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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Voices for Vaccines releases new podcast episode titled "Rotary's Polio Mission"

Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: Rotary's Polio Mission. Carol Pandak, director of PolioPlus at Rotary International, will discuss Rotary's mission to end polio. In addition, Karen Ernst, executive director, VFV, and Nathan Boonstraw, MD, Blank Children's Hospital, will discuss methods anti-vaccine advocates use to advance their cause, including opposing California's bill limiting medical exemptions.

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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IAC updates its two pieces on the medical management of vaccine reactions in community settings—one pertaining to children and teens, and the other to adults

IAC recently updated its two pieces on the medical management of vaccine reactions in community settings, one for youth and one for adults. The materials include information on signs and symptoms, management by severity, and suggested medications and supplies to have on hand. These standing orders templates may be modified for use in healthcare settings. Access them below.

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WHO reports on June 2019 meeting of the Global Advisory Committee on Vaccine Safety in this week's Weekly Epidemiological Record

The World Health Organization (WHO) published a report titled Global Advisory Committee on Vaccine Safety, 5–6 June 2019 in the July 12 issue of the Weekly Epidemiological Record. The opening paragraph is reprinted below.

The Global Advisory Committee on Vaccine Safety (GACVS), an independent expert clinical and scientific advisory body, provides WHO with scientifically rigorous advice on vaccine safety issues of potential global importance. GACVS held its 40th meeting in Geneva, Switzerland, on 5–6 June 2019. The Committee examined the clinical development of Ebola virus vaccines and conducted an inventory of available data on their safety. It also reviewed 3 generic issues: updating a global strategy on vaccine safety, use of a network of distributed data to monitor the safety of vaccines and case studies of communication about the safety of human papillomavirus (HPV) vaccines.

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New “Why Take the Chance” video from the Meningitis B Action Project highlights need for MenB vaccine to protect teens and college students

The Meningitis B Action Project (MBAP) has posted a new video titled Why Take the Chance, aimed at young people of pre-college or college age and their parents. The MBAP website has additional brochures, posters, videos, and infographics designed especially for young people, parents, and healthcare professionals on their Educational Resources web page.

The MBAP founders, Patti Wukovits and Alicia Stillman, whose daughters, Kimberly and Emily, respectively, died from meningitis B during adolescence, are featured in the new video. Their daughters had received the MenACWY vaccine, but the MenB vaccine was not available in time to protect them.

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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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Vaccine Education Center resources about fetal cells include new video and accompanying article 

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP) has new resources related to the use of fetal cells to make vaccines. They include:

  • new 20-minute video interview with Dr. Stanley Plotkin about his use of fetal cells to make the rubella vaccine. The video, "Stanley Plotkin: Pioneering the Use of Fetal Cells to Make Rubella Vaccine," uses animations to describe how viruses reproduce in cells and how they are attenuated for use in live vaccines.
  • An accompanying article posted with the video describing how we can still be using fetal cells isolated in the 1960s to make vaccines today. That is, it describes how cells are grown and split in the lab.

The July 2019 Parents PACK newsletter answers some of the most common questions related to fetal cells in a parent-friendly manner:

  • Which vaccines are made using fetal cells?
  • Do vaccines contain parts of fetuses or fetal cells?
  • Why are fetal cells used to make some vaccines?
  • How can cells from the 1960s still be used today?
  • Do more abortions need to be done?
  • My religion is against abortions, so I don’t want to get these vaccines. Are alternatives available? 

Access the article in PDF format for printing and sharing.

Healthcare providers should check out these resources and encourage parents to subscribe to the free Parents PACK newsletter.

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Researchers find that providing parents with an educational handout before doctor’s visit increases flu vaccination rates 

The journal Pediatrics recently published a study titled Office-Based Educational Handout for Influenza Vaccination: A Randomized Controlled Trial, by V.P. Scott, et al. The study found that giving parents an educational handout about influenza in the waiting room before they saw the pediatrician made it more likely their child would get vaccinated against influenza by the end of the season. The abstract is reprinted below.

OBJECTIVES: To assess the impact of a parent educational intervention about influenza disease on child vaccine receipt.

METHODS: A convenience sample of parents of children ≥6 months old with a visit at 2 New York City pediatric clinics between August 2016 and March 2017 were randomly assigned (1:1:1) to receive either usual care, an educational handout about influenza disease that was based on local data, or an educational handout about influenza disease that was based on national data. Parents received the handout in the waiting room before their visit. Primary outcomes were child influenza vaccine receipt on the day of the clinic visit and by the end of the season. A multivariable logistic regression was used to assess associations between intervention and vaccination, with adjustment for variables that were significantly different between arms.

RESULTS: Parents who received an intervention (versus usual care) had greater odds of child influenza vaccine receipt by the end of the season (74.9% vs 65.4%; adjusted odds ratio 1.68; 95% confidence interval: 1.06–2.67) but not on the day of the clinic visit. Parents who received the national data handout (versus usual care) had greater odds of child influenza vaccine receipt on the day of the clinic visit (59.0% vs 52.6%; adjusted odds ratio 1.79; 95% confidence interval: 1.04–3.08) but not by the end of the season.

CONCLUSIONS: Providing an educational intervention in the waiting room before a pediatric provider visit may help increase child influenza vaccine receipt.

View the video abstract as well.

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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 24: DTaP/Tdap
  • July 31: Rotavirus and Hepatitis A

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.

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Reminder: 2019 Northwest Immunization Conference, sponsored by Immunize Oregon, will be held August 13–15 in Portland

The 2019 Northwest Immunization Conference (NWIC), hosted by Immunize Oregon, will be held on August 13–15 in Portland, Oregon. The presentations and workshops on Day 1 will focus on provider communication related to immunization as well as on clinical skill-building in management, vaccine administration, vaccine safety, and public health advocacy. The presenters include Ari Brown, MD, FAAP; Richard Pan, MD, MPH, California State Senator; Joel Amundson, MD, FAAP; JoEllen Wolicki, BSN, RN; and Andrew Kroger, MD, MPH.

On Days 2 and 3, experts from CDC will present the Epidemiology and Prevention of Vaccine-Preventable Diseases (the "Pink Book") course, with up-to-date information on immunizations and vaccine issues that affect health-care practices.

Find more information about the conference and registration on the conference website:

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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) 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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