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Issue 1456: October 30, 2019









IAC provides a summary article about votes taken at October 23–24 ACIP meeting  
The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on October 23–24, 2019

During the meeting, several topics were discussed for informational purposes only. Specifically, the Committee received updates on current influenza surveillance and possible future changes to the high-dose influenza vaccine formulation, a review of Ebola vaccine, an overview of vaccine safety and monitoring systems and methods, an update on a new orthopoxvirus vaccine, and a detailed discussion of dengue vaccine and its potential impact in Puerto Rico, where 65% of children have been infected with dengue virus by 9 years of age. The group also received an update on rabies vaccine and reports on the recent measles outbreaks in New York State and New York City

In addition, ACIP took votes related to use of adult tetanus-diphtheria-pertussis (Tdap) vaccine and release of the 2020 recommended immunization schedules for children/adolescents and adults. Information on these votes is highlighted below.

Tdap Vaccine Approved as Substitute for Td Vaccine
ACIP voted unanimously to allow either Td or Tdap vaccine in almost all situations where currently only Td vaccine is recommended. Specifically, either Tdap or Td vaccine is now recommended for:

  • Decennial (every 10 years) Td booster;
  • Tetanus prophylaxis for wound management;
  • Catch-up immunization schedule for persons age 7 and older, including pregnant women. 

The Committee reached this decision after noting that there were no substantive safety concerns or increased adverse events when Tdap is given in place of Td. Several members also noted that this change supports commonly accepted clinical practice. ACIP also unanimously approved this Tdap substitution within the VFC program,
Finally, ACIP also took this opportunity to clarify its recommendations on the use of Tdap vaccine in children who are 10 years of age. The current ACIP guidance, Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines, recommends that children 7–10 years of age who receive Tdap inadvertently or for catch-up immunization should be given an adolescent Tdap dose at age 11–12 years. However, both Tdap vaccines currently in use in the United States are licensed beginning at 10 years of age. Therefore, the Committee will issue a Policy Note in the MMWR to clarify that children who receive a dose of Tdap at ≥ 10 years of age do not have to have the Tdap dose repeated at age 11–12 years.

Recommended Immunization Schedules for Children/Adolescents and Adults for 2020

Each February, CDC publishes updated child/adolescent and adult immunization schedules. Of note, these updated schedules do not provide new guidance; rather, they are intended to provide a comprehensive visual representation of current recommendations.
During the October meeting, the Committee reviewed the proposed wording and formatting of the 2020 schedules. ACIP voted unanimously to approve the 2020 schedules, though the wording may still be modified slightly prior to final publication. Detailed information about changes from the 2019 schedules will be provided when the final 2020 schedules are published in February.
All recommendations approved by ACIP are provisional until they are approved by the CDC director and published in MMWR. Presentation slides from the October meeting should be posted on the ACIP website in the next 4–6 weeks.

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CDC and WHO report on routine global vaccination coverage in this week's MMWR and Weekly Epidemiological Record, respectively 

CDC published Global Routine Vaccination Coverage, 2018 in the October 25 issue of MMWR (pages 937–942). On the same day, WHO's Weekly Epidemiological Record published a similar article also titled Global Routine Vaccination Coverage, 2018

Access the MMWR article in HTML format.

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Flu season is here, so be ready with IAC’s new "FLU VACCINE" buttons for staff and stickers for patients!

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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IAC's elegantly designed "Vaccines Save Lives” enamel pins are selling well—and 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 the 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" pins pricing and ordering information.

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

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IAC Spotlight! The "Favorites" web page, easy to click on from the top of every web page on, brings you to 18 of the most popular web sections on IAC's website

When you visit IAC's Favorites web page, you will find links to 18 of the most highly visited  web sections on IAC's content-rich website. The page is easy to find from anywhere on—it’s the first of the 6 blue tabs that run across the top of every web page. When you hover over this blue tab with your mouse or click on it, the Favorites web page content will appear.

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

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

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

The Immunization Action Coalition (IAC) is pleased to announce that eight new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 490 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Allen County Regional Hospital, Iola, KS (94%)
  • Ascension Sacred Heart Hospital Pensacola, Pensacola, FL (92%)
  • Dukes Memorial Hospital, Peru, IN (95%)
  • Gulf Coast Regional Medical Center, Panama City, FL (92%)
  • JFK Medical Center, Atlantis, FL (95%)
  • Newport Hospital, Newport, RI (91%)
  • St. Vincent Anderson Regional Hospital, Anderson, IN (96%)
  • Yale New Haven Hospital–St. Raphael's Campus, New Haven, CT (90%)

The following institution is being recognized for a second year:

  • Newport Hospital, Newport, RI (93%)

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

  • Harrison County Hospital, Corydon, IN (93%)
  • MHP Medical Center/Major Hospital, Shelbyville, IN (99%)
  • Newport Hospital, Newport, RI (92%)
  • Phoebe Putney Memorial Hospital, Albany, GA (98%)
  • Woodlawn Hospital, Rochester, IN (97%)

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

  • Denver Health Medical Center, Denver, CO (93%)
  • Newport Hospital, Newport, RI (94%)

The following institution is being recognized for a fifth year:

  • Newport Hospital, Newport, RI (95%)

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

The Honor Roll now includes 490 birthing institutions from 44 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred seven institutions have qualified for two years, 59 institutions have qualified three times, 29 institutions have qualified four times, 21 institutions have qualified five times, seven institutions have qualified six times, four institutions have qualified seven times, and one institution has qualified eight times.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give Birth to the End of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90 percent or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 51,000 readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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IAC updates "Personal Belief Exemptions for Vaccination Put People at Risk. Examine the Evidence for Yourself" by adding more journal article links

IAC recently updated Personal Belief Exemptions for Vaccination Put People at Risk. Examine the Evidence for Yourself to incorporate additional journal articles, now totaling 31. All these articles illustrate the disease consequences that can arise from children obtaining vaccination exemptions for personal belief reasons. Several recent outbreaks of measles, pertussis, and varicella have been traced to pockets of unvaccinated children in states that allow personal belief exemptions. Share this 6-page print resource with vaccine-hesitant parents and legislators so they can examine the evidence and understand the impact of vaccine refusal.

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IAC revises "Influenza: Questions and Answers," a handout for patients, parents, and providers

IAC recently revised its handout titled Influenza: Questions and Answers—Information about the Disease and Vaccines. Edits were made throughout the piece, including updated influenza-related morbidity and mortality data and a new antiviral medication (baloxavir).

Although this piece is intended for the public, healthcare professionals may find it helpful as well.

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IAC updates "Standing Orders for Administering Human Papillomavirus Vaccine to Adults" to match the latest ACIP recommendations

IAC recently revised Standing Orders for Administering Human Papillomavirus Vaccine to Adults. Edits were made to incorporate the expanded ACIP HPV vaccine recommendations to include all males through age 26, and to vaccinate adults ages 27 through 45 years, based on shared clinical decision making.

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Influenza season has begun; be sure all your patients are getting vaccinated!

Influenza season is now beginning, and CDC expects flu activity to remain low but increase in the coming weeks. Visit the CDC’s Weekly U.S. Influenza Surveillance Report, FluView, for details.

Influenza vaccination is recommended for everyone six months of age and older, so please continue to vaccinate all your patients in this age range. If you don't provide influenza vaccination in your clinic, please refer your patients 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'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 at Children's Hospital of Philadelphia publishes October issue of its newsletter Vaccine Update 

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia publishes a monthly immunization-focused newsletter titled Vaccine Update. The October issue includes the following articles:

VEC also added information and examples of placebo-controlled vaccine trials to the Making Vaccines: Process of Vaccine Development page in the “Making Vaccines” section of its website.

Additional resources for organizations, healthcare professionals, and parents are available in the full newsletter.

Access the sign-up form to subscribe to Vaccine Update.

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American Journal of Nursing publishes article titled "Countering Vaccine Misinformation"

The October issue of the American Journal of Nursing included a "Special Feature" titled Countering Vaccine Misinformation by L. Danielson, et al. The article lays out the evidence behind the safety and effectiveness of vaccines, and discusses the role of nurses in countering misinformation. The abstract is reprinted below.

ABSTRACT: Evidence consistently shows that vaccines are safe, effective, and cost-efficient. Yet preventable outbreaks of infectious diseases are occurring in the United States, leading to a strong public response and intense scrutiny of the antivaccine movement and its persistent spread of misinformation. Social media has been a major platform for such misinformation, and recent examinations have found that nurses are not exempt from engaging in antivaccine discourse.

By practicing evidence-based care, addressing health literacy, and becoming involved in public health policy, nurses can be excellent advocates for immunization and may help prevent additional outbreaks of preventable diseases.

Access the complete article: Countering Vaccine Misinformation.

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CDC reports on case of treatment of a vaccinia virus infection from an occupational needlestick

CDC published Novel Treatment of a Vaccinia Virus Infection from an Occupational Needlestick—San Diego, California, 2019 in the October 25 issue of MMWR (pages 943–946). 

Access the MMWR article in HTML format.

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Vaccine Education Center plans Current Issues in Vaccines webinar on December 11

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, beginning at 12:00 p.m. (ET) on December 11. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit's topics for this webinar will be:

  • Tdap vaccine: Updates on safety
  • Influenza vaccine: Latest surveillance and effectiveness data
  • Dengue vaccine: Where things stand

Free continuing education credits (CME, CEU, and CPE) will be available for both the live and archived events. 

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Reminder: 49th National Immunization Conference will be held in Atlanta on May 19–21; abstracts accepted through December 16

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 through 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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Final 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 on 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. 

Visit the conference website for more information on the conference and 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.

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.

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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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