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Issue 1445: September 11, 2019










Mayor and health officials declare end of measles outbreak in New York City

In a September 3 announcement, Mayor de Blasio and Health Commissioner Dr. Oxiris Barbot declared that the New York City measles outbreak, first announced on April 9, has ended and that the April 9 emergency order for parts of Brooklyn was rescinded. The emergency order had required all people living in particular ZIP codes to be vaccinated against measles if they were not already immune to it, or they would otherwise be fined. A statement by Health Commissioner Dr. Barbot that appears in the announcement is reprinted below.

“Measles is one of the most contagious diseases on the face of the earth....There may no longer be local transmission of measles in New York City, but the threat remains given other outbreaks in the U.S. and around the world. Our best defense against renewed transmission is having a well-immunized city. Vaccination coverage has increased significantly since the emergency order, which has been supported by community-led efforts. We are grateful to the New Yorkers who shared the truth about vaccines and protected the health of their friends and neighbors through this outbreak.”

The Health Department will continue to strictly enforce  the state law ending non-medical exemptions for required vaccinations for children in public and private schools and day care centers.

Read the complete announcement: Mayor de Blasio, Health Officials Declare End of Measles Outbreak in New York City.

Related Link

Washington Post: New York City Declares End to Largest Measles Outbreak in Nearly 30 Years (9/3/19)

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Total number of U.S. measles cases for 2019 climbs to 1,241 with 7 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. From January 1 through September 5, a total of 1,241 measles cases in 31 states were reported to CDC. The total reflects an increase of 7 cases reported this week. This is the greatest total 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 Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Ohio, 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 three or more cases) are currently ongoing in 2019 in the following jurisdictions:

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FDA issues statement reiterating the importance and safety of MMR vaccine 

On September 6, the Food and Drug Administration released a statement reiterating the importance, effectiveness, and safety of the MMR vaccine. The statement, titled FDA In Brief: FDA reiterates the importance of vaccines such as the Measles, Mumps, and Rubella (MMR) vaccine, is directed especially to parents and caregivers. The statement's opening paragraph is reprinted below.

"As the new school year is getting underway across the nation, the FDA would like to remind parents and caregivers about the importance of making sure children are up to date on their vaccines. We cannot state strongly enough that overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions, to both prevent individual illness and protect public health,” said Peter Marks, M.D., Ph.D., director of FDA’s Center for Biologics Evaluation and Research. “It is deeply concerning to see vaccine-preventable infectious diseases such as measles or mumps reemerging in the U.S. and impacting the health of individuals and entire communities. We understand that parents may have questions about vaccines and we want to urge them to discuss questions regarding vaccinations with their child’s health care provider. As a public health agency, we want to reiterate our confidence in the safety and efficacy of the MMR vaccine. The FDA always strives to use the best available scientific evidence to promote and protect the well-being of individuals and the public health, and the evidence fully supports the safety and effectiveness of this vaccine.”

Read the entire statement: FDA in Brief: FDA Reiterates the Importance of Vaccines Such As the Measles, Mumps, and Rubella (MMR) Vaccine (9/6/19)

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WHO reports that United Kingdom, Albania, the Czech Republic, and Greece have lost measles elimination status for the first time since verification process began in 2012 

On August 29, the World Health Organization (WHO) issued a press release regarding a report from the European Regional Verification Commission for Measles and Rubella Elimination (RVC). The RVC reported that for the first time since 2012, when the verification process began, that United Kingdom, Albania, the Czech Republic, and Greece lost their measles elimination status. In addition, RVC reported that the number of cases reported in just the first half of 2019 (90,000 cases) exceeded the number of measles cases in all of 2018 (84,462 cases). 

The following statement by Dr. Zsuzsanna Jakab, WHO regional director for Europe, is excerpted from the press release:

"Great efforts to control this highly contagious disease have brought us a long way towards regional elimination. However, ongoing measles outbreaks demonstrate that more is needed. Through activation of the emergency response, WHO has increased its focus on measles elimination and upgraded its action. This is the time and opportunity to address any underlying health system, social determinants and societal challenges that may have allowed this deadly virus to persist in this Region.” 

Read WHO's entire press release: European Region Loses Ground in Effort To Eliminate Measles (8/29/19)

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WHO director-general issues press release regarding Facebook’s commitment to combat vaccine misinformation
The director-general of the World Health Organization (WHO), Dr. Tedros Adhanom Ghebreyesus, issued a statement on September 4 about vaccine misinformation and welcomed Facebook's commitment to ensure that users will be directed to accurate, reliable vaccine information on Instagram, Facebook Search, Groups, Pages, and other forums where people search for information and advice. WHO has been working with Facebook for several months to accomplish this goal.

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IAC Spotlight! IAC’s ACIP web section on provides links to both current and past ACIP recommendations

The ACIP web section on provides links to all current ACIP vaccine recommendations as well as to almost all of the past guidance documents dating back to 1991. You can access the ACIP recommendations in two ways: sorted alphabetically by diseases and vaccines or chronologically by date of publication.

View the ACIP recommendations in the Vaccine Index, where they are sorted alphabetically by diseases and vaccines.

View the ACIP recommendations chronologically if you are interested in seeing recommendations by date, divided into two web pages:

Visit the ACIP web section on, where you will access the information and resources you need related to ACIP recommendations.

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Reminder: IAC’s August webinar "Adolescent Immunization Update and the 16-Year-Old Platform" presented by Dr. Sharon G. Humiston is archived on IAC website; slide set and presenter's notes also available for your use

On August 14, Sharon G. Humiston, MD, MPH, FAAP, IAC's associate director for research, presented a 1-hour webinar titled Adolescent Immunization Update and the 16-Year-Old Platform.

During her presentation, Dr. Humiston reviewed the “need-to-know” facts of adolescent immunization, including the recommendations for adolescent vaccination at 11–12 years of age and those at age 16. 

To watch this webinar, click here or go to the home page of IAC’s main website and click on Dr. Humiston’s photo in the middle of the page. 

From IAC's PowerPoint Slide Set web page, you can:

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Reminder: “Dear Colleague” call-to-action letter from AAFP, AAP, ACHA, ACOG, APhA, SAHM, and IAC stresses importance of implementing immunization visit at 16 years of age

On August 1, IAC and six professional societies published a "Dear Colleague" letter titled 16-Year-Old Patients: Make Sure They Receive Their Annual Well Visit and Vaccinations. Selections from this call-to-action letter are reprinted below.

Dear Colleague:

The American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College Health Association (ACHA), American College of Obstetricians and Gynecologists (ACOG), American Pharmacists Association (APhA), Society for Adolescent Health and Medicine (SAHM), and Immunization Action Coalition (IAC) urge you and your fellow healthcare professionals to make sure that your patients who are 16 years of age receive the vaccines that are recommended for them in accordance with the Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2019, approved by AAFP, AAP, ACOG, and CDC....

Immunization coverage rates for several adolescent vaccines are poor

According to data from CDC, coverage rates for several recommended adolescent vaccinations are quite low. For example:

  • The coverage rate for the second (booster) dose of quadrivalent meningococcal conjugate vaccine (MenACWY), which is recommended at age 16, was only 44% by the 18th birthday.
  • Human papillomavirus (HPV) vaccine coverage for ≥1 dose among all adolescents was only 66% (69% for females; 63% for males); and only 49% of all adolescents were fully vaccinated with a complete series (53% for females; 44% for males).
  • Less than half (47%) of adolescents age 13–17 years had received influenza vaccine....

Vaccination at age 16 years has been highlighted on the U.S. Immunization Schedule

Beginning in 2017, the official U.S. immunization schedule implemented a significant format change by creating a stand-alone column for age 16 years. Like the 4–6 years and 11–12 years columns, it is highlighted by a gray-shaded heading. The “16 year” age column was also separated out from the previous “16–18 year” age range to highlight the need for the recommended MenACWY 2nd dose at age 16 years.

Along with MenACWY at age 16, influenza vaccine (seasonally) is recommended. In addition, vaccination with meningococcal serogroup B vaccine (MenB) is recommended for individual clinical decision making. Focusing on a 16-year-old visit also allows catch-up on vaccine doses for adolescents who may have fallen behind on vaccines such as HPV, Tdap, and others....

Access the complete "Dear Colleague" letter: 16-Year-Old Patients: Make Sure They Receive Their Annual Well Visit and Vaccinations.
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Reminder: The new edition of The Vaccine Handbook: A Practical Guide for Clinicians app is now available free of charge from the Pediatric Infectious Diseases Society

The Pediatric Infectious Diseases Society (PIDS) is pleased to make available a new edition of The Vaccine Handbook app. This mobile app for iOS devices contains the 2019 (8th) edition of The Vaccine Handbook: A Practical Guide for Clinicians (also known as The Purple Book), by Dr. Gary S. Marshall, professor of pediatrics at the University of Louisville School of Medicine. This authoritative, practical tool is available free of charge from the Apple iTunes App Store (purchase of the print edition is not required). 

Please help PIDS spread the word to members of your organization, partner organizations, vaccine providers, trainees, and others.

The Vaccine Handbook is a readable, comprehensive source of up-to-date information for vaccine providers and educators. It draws together the latest vaccine science and guidance into a concise, user-friendly, practical resource for the private office, public health clinic, academic medical center, and hospital. The app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to useful content on the Internet. It includes:

  • Scientific foundations of vaccinology
  • Information on every vaccine licensed in the United States
  • The rationale behind authoritative vaccine recommendations
  • Contingencies encountered in everyday practice
  • An entire chapter on addressing vaccine concerns
  • Background on vaccine infrastructure and policy-making
  • Standards and regulations
  • Office logistics, billing procedures, and much more

The app may be found by searching the App Store for “The Vaccine Handbook App” or clicking on the following link:

Paper copies of The Vaccine Handbook are available through the publisher, Professional Communications, Inc. (West Islip, NY) at

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Honolulu National Conference for Immunization Coalitions early bird registration extended to September 15; conference dates are November 13–15

Register now to get your early bird discount to the exciting 14th National Conference for Immunization Coalitions and Partnerships (NCICP) in Honolulu from November 13–15. Conference attendees will 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 September 15 to receive the early bird rate.

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Eight translations of the two new influenza VISs (injectable and intranasal), including Spanish-language RTF files, are now available from IAC

On August 15, CDC released two new influenza vaccine VISs, one for injectable influenza vaccine (inactivated and recombinant) and the other for intranasal influenza vaccine.

IAC recently posted new Arabic, Burmese, Chinese, French, Russian, Somali, Spanish, and Vietnamese translations of the new injectable (inactivated and recombinant ) influenza VIS as well as the intranasal influenza VIS.  

Influenza, inactivated or recombinant VIS translations:

Influenza, live intranasal VIS translations:

Spanish-language RTF files:

IAC also posted the Spanish-language versions of the two new influenza VISs in rich text format (RTF). RTF files are intended for use in electronic systems, such as electronic medical records, immunization information systems, or other electronic databases. CDC supplies RTF files of the English-language VISs, and IAC provides Spanish RTF files of VISs for each routinely recommended vaccine. 

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AAP publishes its influenza recommendations for 2019–2020 season

The American Academy of Pediatrics (AAP) has published Recommendations for Prevention and Control of Influenza in Children, 2019–20 in the September issue of Pediatrics. The Abstract is reprinted below.

This statement updates the recommendations of the American Academy of Pediatrics for the routine use of influenza vaccines and antiviral medications in the prevention and treatment of influenza in children during the 2019–2020 season. The American Academy of Pediatrics continues to recommend routine influenza immunization of all children without medical contraindications, starting at 6 months of age. Any licensed, recommended, age-appropriate vaccine available can be administered, without preference of one product or formulation over another. Antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication continues to be recommended for children with suspected or confirmed influenza, particularly those who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza.

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IAC’s new FLU VACCINE buttons and stickers flew out the door! But don't worry. We ordered more. Stock up for flu season!

Everyone wants to display flu shot support—don’t be left out! Jump-start your preparations for the 2019–20 influenza season by ordering IAC's new “FLU VACCINE” buttons and stickers from SHOP IAC. These popular 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 bag, or backpack 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 information.

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 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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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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CDC publishes “Impact of Public Health Interventions on Drinking Water–Associated Outbreaks of Hepatitis A—United States, 1971–2017” in this week’s MMWR

CDC published Impact of Public Health Interventions on Drinking Water–Associated Outbreaks of Hepatitis A—United States, 1971–2017 in the September 6 issue of MMWR (pages 766–770). A summary made available to the press is reprinted below.

Drinking-water-related hepatitis A outbreaks have become exceedingly rare in the U.S. due to routine hepatitis A vaccination and drinking-water regulations for public groundwater systems. However, people who use untreated groundwater from private wells remain at risk for hepatitis A infection from contaminated water. Since 2009, there have not been any reported drinking water-associated hepatitis A outbreaks from public or private water systems in the United States. Currently, there are no regulations at the federal level for individual water systems. CDC recommends that private well owners test their water annually to make sure it's free of contaminants and safe to drink. Public health officials can raise awareness of risks associated with untreated ground water among users of private wells, and of private well testing and treatment options.

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Pediatrics publishes study finding that preterm infants are less likely than full-term infants to be fully vaccinated

The journal Pediatrics has published Early Childhood Vaccination Status of Preterm Infants, by A.M. Hofstetter, et al., in its September 2019 issue. The study found that preterm infants are less likely than full-term infants to be fully vaccinated. The Conclusions section of the abstract is reprinted below.

CONCLUSIONS: Over half of preterm infants were undervaccinated at 19 months; one-third failed to catch up by 36 months. Strategies to improve vaccination of these high-risk infants are needed. 

Access the abstract in print or as a video. 

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CDC’s Public Health Grand Rounds to present “Maternal Immunization: Current Status and Future Directions” on September 18

CDC's Public Health Grand Rounds will present Maternal Immunization: Current Status and Future Directions on September 18 at 1:00 p.m. (ET). Those interested in viewing this one-hour session should go to the live external webcast link during the scheduled time.

Sessions are archived 3–4 days after each presentation, so you can view any of these presentations on the archive page at your convenience.

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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:
  • September 18: Pneumococcal Vaccines
  • September 25: Influenza
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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Save the date! CDC’s webinar “Influenza Recommendations for Children,” to be held Thursday, September 26 

Save the date for CDC's upcoming Clinical Outreach and Communication Activity (COCA) call/webinar titled “Influenza Recommendations for Children,” scheduled for Thursday, September 26, at 2:00 p.m. (ET).

More information and a registration link will follow soon.

Related Link

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State of Michigan’s 2019 fall regional immunization conferences to take place in eight cities on different dates

Registration is now open for the state of Michigan's 2019 fall immunization conferences to be held in Marquette (October 8), Gaylord (October 10), Grand Rapids (October 29), Kalamazoo (October 30), Flint (November 1), Lansing (November 5), Rochester (November 7), and Dearborn (November 8).

These 1-day conferences will provide participants with a variety of practice-management tools, techniques, and information that will help assure that all of their patients are fully immunized. The conferences are appropriate for physicians, nurses, nurse practitioners, medical assistants, public health staff, pharmacists, physicians, physician assistants, and medical and nursing students.

Access additional information and the registration links.

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.

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IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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