Issue 1451: October 9, 2019









CDC issues an MMWR Early Release about measles cases and outbreaks in the United States in 2019

On October 4, CDC released an MMWR Early Release titled National Update on Measles Cases and Outbreaks—United States, January 1–October 1, 2019. The beginning of the first paragraph is reprinted below.

During January 1–October 1, 2019, a total of 1,249 measles cases and 22 measles outbreaks were reported in the United States. This represents the most U.S. cases reported in a single year since 1992, and the second highest number of reported outbreaks annually since measles was declared eliminated in the United States in 2000. Measles is an acute febrile rash illness with an attack rate of approximately 90% in susceptible household contacts. Domestic outbreaks can occur when travelers contract measles outside the United States and subsequently transmit infection to unvaccinated persons they expose in the United States. Among the 1,249 measles cases reported in 2019, 1,163 (93%) were associated with the 22 outbreaks, 1,107 (89%) were in patients who were unvaccinated or had an unknown vaccination status, and 119 (10%) measles patients were hospitalized. Closely related outbreaks in New York City (NYC) and New York State (NYS; excluding NYC), with ongoing transmission for nearly 1 year in large and close-knit Orthodox Jewish communities, accounted for 934 (75%) cases during 2019 and threatened the elimination status of measles in the United States. Robust responses in NYC and NYS were effective in controlling transmission before the 1-year mark; however, continued vigilance for additional cases within these communities is essential to determine whether elimination has been sustained....

Access the complete report: National Update on Measles Cases and Outbreaks—United States, January 1–October 1, 2019.

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HHS announces that the United States has maintained its measles elimination status

On October 4, the U.S. Department of Health and Human Services (HHS) released a statement titled With End of New York Outbreak, United States Keeps Measles Elimination Status. Selections of this press release are reprinted below.

The United States has maintained its measles elimination status of nearly 20 years. The New York State Department of Health yesterday declared the end of the state’s nearly year-long outbreak that had put the U.S. at risk of losing its measles elimination status....

This year marks the greatest number of measles cases in the country since 1992. While cases have been reported in 31 states, 75% of measles cases were linked to outbreaks in New York City and New York state, most of which were among unvaccinated children in Orthodox Jewish communities. These outbreaks have been traced to unvaccinated travelers who brought measles back from other countries at the beginning of October 2018.

Since measles outbreaks continue to occur in countries around the world, there is always a risk of measles importations into the U.S. When measles is imported into a highly vaccinated community, outbreaks either do not happen or are usually small. However, if measles is introduced into an under-vaccinated community, it can spread quickly and it can be difficult to control. Measles elimination status is lost immediately if a chain of transmission in a given outbreak is sustained for more than 12 months....

A significant factor contributing to the outbreaks this year has been misinformation in some communities about the safety of the measles-mumps-rubella (MMR) vaccine. Some organizations are deliberately targeting these communities with inaccurate and misleading information about vaccines. CDC continues to encourage parents to speak to their family’s healthcare provider about the importance of vaccination. CDC also encourages local leaders to provide accurate, scientific-based information to counter misinformation....

Before the measles vaccine was introduced in the U.S., nearly all children got measles by the time they were 15 years of age. It is estimated three to four million people were infected, and among the 500,000 measles cases reported annually, 48,000 were hospitalized and 500 people died. 

Access the complete HHS statement: With End of New York Outbreak, United States Keeps Measles Elimination Status.

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IAC develops new 1-page handout for policymakers that summarizes medical organizations' support of strong school and childcare vaccination requirements and elimination of non-medical exemptions

IAC recently developed a new handout for policymakers and those who work with them titled Leading Medical Organizations Endorse Strong School and Childcare Vaccination Requirements and Elimination of Non-Medical Exemptions

This concise 1-page handout lists 10 major medical organizations, including nursing and public health, that have issued policy positions endorsing vaccination requirements and supporting elimination of non-medical exemptions (e.g., religious, philosophical). We hope you find it useful when working with state legislators and local officials on vaccine policy issues.

IAC acknowledges that there are likely more organizations that we missed so please contact us if you know of others at

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IAC's elegantly designed "Vaccines Save Lives” enamel pins are now available–they make great gifts!

IAC has just designed an elegant new “Vaccines Save Lives” pin on hard black enamel with gold lettering and edges. 

The pin is a stick-through-post variety with the back end covered by a round rubber cap that holds pin securely. A gold metal spring-lock clasp is also provided. The pin makes a refined statement, measuring 1.125" x 0.75". 

Wear these pins on clothing, uniforms, lab coats, tote bags, and backpacks to show that you value vaccines!

Click here for "Vaccines Save Lives" pin pricing and ordering information.

Visit Shop IAC for additional items, including enamel "FLU VACCINE" buttons and stickers, patient record cards, and a vaccine administration training video.

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It's time to order IAC’s new "FLU VACCINE" buttons and stickers! 

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


The button measures 1.25" across and carries a bold message! Pin on lab coats, uniforms, other clothing, tote bags, or backpacks to show support for flu vaccine.
Buttons are delivered in bags of 10 buttons per bag.

Click here for pricing and ordering information for "FLU VACCINE" buttons.

Measuring 1.5" across and printed on Avery labels, theses stickers adhere well to clothing and have an easy-peel-off back.
Stickers are delivered to you cut individually (not on rolls)—available in bundles of 100. 

Click here for pricing and ordering information for “FLU VACCINE” stickers.

Visit Shop IAC for additional items, including "Vaccines Save Lives" enamel pins, patient record cards, and a vaccine administration training video.

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The 49th National Immunization Conference will be held in Atlanta on May 19–21; abstracts solicited

The 49th National Immunization Conference (NIC) will be held May 19–21 at the Westin Peachtree Plaza Hotel in Atlanta, GA. NIC brings together more than 1,500 local, state, federal, and private-sector immunization stakeholders and partners to explore science, policy, education, and planning issues related to immunization and vaccine-preventable diseases.

Registration for the conference is now open

CDC will be accepting abstract submissions from October 1–December 16. Visit NIC Abstract Information for details on the conference themes and for instructions on submitting an abstract.

Visit the National Immunization Conference web page for more information about conference and hotel registration, fees, and more.

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Save the Date! IAC's Dr. Litjen Tan to present webinar about current issues in influenza on October 29

On October 29, Litjen (L.J) Tan, MS, PhD, chief strategy officer, IAC, will present a webinar titled "Current Issues in Influenza." Please save the date for this engaging and information session; registration information will be available soon.

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! 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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Seven new measles cases reported to CDC in week ending October 3; total cases for 2019 increase to 1,250 across 31 states

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 1,250 cases across 31 states as of October 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 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 can cause serious complications. As of October 3, 119 of the people who got measles this year were hospitalized, and 61 reported having complications, including pneumonia and encephalitis.

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Voices for Vaccines' new podcast episode features Dr. Richard Pan, pediatrician and California legislator who worked to eliminate non-medical vaccine exemptions in the state

Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: California’s Vaccine Legislator. In this episode, VFV interviews Richard Pan, pediatrician and California state senator. Dr. Pan has been a champion for community immunity his entire career, from his beginnings as a resident in Pittsburgh to his work in the California legislation to eliminate non-medical vaccine exemptions. 

Access more information about Dr. Pan.

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 and SAHM update "You’re 16…We Recommend These Vaccines For You!"

IAC and the Society for Adolescent Health and Medicine (SAHM) recently updated You’re 16…We Recommend These Vaccines For You! The information was reviewed, the text in the box at the bottom was modified slightly, and the date at the bottom was changed to be current.

You're 16 ...We Recommend These Vaccines For You! utilizes a colorful, easy-to-understand format to describe the vaccines recommended at this age, as well as the impacts of the diseases the vaccines protect against and the recommended number and timing of doses. 

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IAC posts updated Spanish-language translation of "Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination"

IAC recently posted an updated Spanish-language translation of its Screening Checklist for Contraindications to Inactivated Injectable Influenza VaccinationChanges were made on page 2 to reference the new season (2019–2020), and to update links to references. The updated English version was announced in the September 18 issue of IAC Express.

Access Cuestionario de contraindicaciones para la vacuna inyectable contra la gripe.

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CDC and WHO report on progress toward rubella and congenital rubella syndrome control in this week's MMWR and Weekly Epidemiological Record, respectively

CDC published a report titled Progress Toward Rubella and Congenital Rubella Syndrome Control and Elimination—Worldwide, 2000–2018 in the October 4 issue of MMWR. On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards Control and Elimination of Rubella and Congenital Rubella Syndrome—Worldwide, 2000–2018. Selections from the first paragraph are reprinted below.

... Although rubella virus infection usually causes a mild febrile rash illness in children and adults, infection during pregnancy, especially during the first trimester, can result in miscarriage, fetal death, stillbirth, or a constellation of birth defects known as congenital rubella syndrome (CRS). A single dose of rubella-containing vaccine (RCV) can provide lifelong protection. In 2011, the World Health Organization (WHO) updated guidance on the use of RCV and recommended capitalizing on the accelerated measles elimination activities as an opportunity to introduce RCV. The Global Vaccine Action Plan 2011–2020 (GVAP) includes a target to achieve elimination of rubella in at least five of the six WHO regions by 2020....Among WHO Member States, the number with RCV in their immunization schedules has increased from 99 (52% of 191) in 2000 to 168 (87% of 194) in 2018; 69% of the world’s infants were vaccinated against rubella in 2018. Rubella elimination has been verified in 81 (42%) countries. To make further progress to control and eliminate rubella, and to reduce the equity gap, introduction of RCV in all countries is important. Likewise, countries that have introduced RCV can achieve and maintain elimination with high vaccination coverage and surveillance for rubella and CRS. The two WHO regions that have not established an elimination goal (African [AFR] and Eastern Mediterranean [EMR]) should consider establishing a goal.

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Watch and share Families Fighting Flu's powerful video about the seriousness of influenza

Families Fighting Flu (FFF) has developed a video that features not only facts about the seriousness of influenza—such as the fact that flu kills more people than car crashes and drug overdoses—but also powerful personal stories. We Share Our Stories To Convince You To Vaccinate features moving music and text slides with families' stories of losing loved ones to flu. FFF's rationale for this video is reprinted below.

What's keeping you from getting vaccinated? Perhaps you don't think diseases like flu are dangerous. After watching our loved ones suffer and die from flu, we hope we can convince you otherwise. We encourage flu vaccination because it reduces the risk of flu-related hospitalization and death. And getting a flu vaccine protects yourself as well as everyone you come in contact with. To hear our stories and get the facts about flu and flu prevention, visit

Watch the video by clicking on the graphic below and share with your patients and colleagues.

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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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Check out these recent archived webinars and training modules; many offer free continuing education credit! 

IAC informs readers about upcoming educational opportunities in each weekly IAC Express newsletter. What you may not know is that most of these webinars and training modules are archived online, so you can watch them at your convenience any time after the live session. Here are some outstanding recent learning opportunities that are now archived for your convenience: 

In addition, check out the offerings from the following organizations for more choices.



Vaccine Education Center, Children's Hospital of Philadelphia (VEC)

  • Current Issues in Vaccines is a webinar series offered four times per year for healthcare providers. Each event is co-sponsored by the VEC and the Pennsylvania Chapter, American Academy of Pediatrics and features Paul Offit, MD, director of VEC. The archived versions are available to watch for continuing education credit.

National Foundation for Infectious Diseases (NFID)

  • The NFID Webinar Library offers a variety of online continuing education activities led by key opinion leaders enabling participants to earn credits and gain practical knowledge, tools, and skills. Continuing education credit is available for archived webinars up to one year after the live date.

National AHEC Organization

  • The National AHEC Organization HPV Vaccination Project has sponsored a number of educational webinars about HPV vaccination. These webinars are available on demand from the organization's website. Continuing education is only available when participating in the live session.

National Association of County and City Health Officials (NACCHO)

  • NACCHO is offering a 5-part webinar series to help local health departments build capacity to engage in public health communication. These webinars are open to all health professionals. Access Principles to Address Vaccine Resistance and Hesitancy to find upcoming and archived webinars on this topic. Continuing education credit is not available.

If you know of other free continuing education opportunities for immunization providers, please let IAC know by emailing

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Reminder: National Conference for Immunization Coalitions and Partnerships will take place November 13–15 in Honolulu

The 14th National Conference for Immunization Coalitions and Partnerships (NCICP) will take place in beautiful 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.

Click on the graphic below for more information about the conference, including registration.

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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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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 DisclaimerISSN 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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