Issue 1467: December 11, 2019









Measles outbreak in Samoa has killed dozens of children; anti-vaccine misinformation has contributed to the low vaccination rate 

A measles outbreak with over 4,300 cases in the Pacific island of Samoa has killed at least 63 people, most of them infants and children under age 4. Samoa's government declared a state of emergency on November 15, and mass vaccination campaigns have been held since then. Schools are closed indefinitely, children are barred from public gatherings, and red flags have been hung outside homes that contain people unvaccinated against measles. On December 5 and 6, the entire government was shut down to allow all non-essential civil servants to assist in the vaccination campaign. 

From a December 2 Washington Post article:

Samoan officials say they believe the outbreak was initially spread by a traveler from New Zealand, the AP reported. Once in the country, the virus found a population with an uncommonly low vaccination rate.

Before the epidemic, Samoa’s vaccination rate stood at only 31 percent, according to the World Health Organization, and vaccination coverage has declined in Samoa since 2013, according to WHO and UNICEF data. Fears about the safety of the vaccine accelerated in 2018, after two babies in Samoa died when their vaccinations were mixed incorrectly
[the vaccine was mixed with a muscle relaxant instead of the sterile water diluent], the BBC reported....

Now, the country is scrambling to vaccinate as much of its population of 196,000 as swiftly as possible.

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Louisiana AAP releases results of survey about state residents’ attitudes on vaccines

The Louisiana Chapter of the American Academy of Pediatrics (LAAAP) has released the results of a survey they commissioned to evaluate the attitudes of state residents about vaccines. Two paragraphs from their December 5 press release are reprinted below.

The results of the poll indicate strong support for vaccines across all age ranges and geographic regions of the state. When asked if vaccines are important to protect infants and children from serious and life-threatening diseases, 95 percent of respondents strongly agreed or agreed.

Additionally, 92 percent of respondents agree with the statement that it was important to have all children vaccinated in order to protect other children around them who cannot be vaccinated because of a medical condition....

Review the highlights of the Louisiana poll at

The full poll results are available online.

Access the complete press release: Louisiana Chapter of American Academy of Pediatrics Polls State Residents’ Attitudes on Vaccines.

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Dr. Deborah Wexler’s VEC Technically Speaking column about ACIP’s updated Tdap/Td recommendations now available on

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

Her November column is titled ACIP Votes to Approve That Tdap and Td Vaccines May Now Be Used Interchangeably. The complete column is reprinted below.

At CDC's Advisory Committee of Immunization Practices (ACIP) meeting held in October, the committee voted unanimously to approve that Td and Tdap vaccines may be used interchangeably in almost all situations where currently only Td vaccine is recommended. Specifically, Tdap may now be used instead of Td in any of the following situations:
  • 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 voted to approve Tdap for use in the Vaccines For Children (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: Recommendations of ACIP 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 MMWR to clarify that children who receive a dose of Tdap at >10 years of age do not need to repeat the Tdap dose at age 11–12 years.

Note: All recommendations approved by ACIP are provisional until they are approved by the CDC director and published in MMWR.

Presentation slides from the October ACIP meeting.

You can find current and past issues of Technically Speaking in the following ways:

  • From the Technically Speaking display box in the middle of the home page
  • From the bottom of every web page in the "Guide to" box
  • From the Technically Speaking main page on 

To subscribe to VEC's Vaccine Update e-newsletter, go to the sign-up form.

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IAC Spotlight! Easily find what you're looking for on by using the blue-gray navigation tabs that run across the top of every web page

Each page on the Immunization Action Coalition (IAC) website includes the following six clickable tabs to make it easy to navigate.

  • Favorites: Includes the most frequently requested pages, such as ACIP Recommendations, "Ask the Experts," Package Inserts, and 15 more
  • Handouts & Staff Materials: Includes IAC's print resources for healthcare professionals and their patients, sortable in multiple ways
  • Clinic Tools: Includes resources from IAC, CDC, and other organizations related to administering vaccines, adult vaccination, documenting vaccinations, scheduling vaccines, screening for contraindications, vaccine storage and handling, and vaccine recommendations
  • Vaccine Information Statements: Includes all English VISs and translations in up to 50 languages, as well as information about using VISs
  • Diseases & Vaccines: Includes the latest recommendations, information, and up-to-date resources from IAC, CDC, and other organizations for 22 vaccine-preventable diseases
  • Talking about Vaccines: Includes the following sections: Adjuvants and Ingredients, Alternative Medicine, Autism, Countering Dr. Sears, Importance of Vaccines, MMR Vaccine, Religious Concerns, Responding to Parents, Thimerosal, Too Many Vaccines?, and Vaccine Safety   

Explore these sections by clicking on the blue-gray navigation tabs at the top of any web page of

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Reminder: "Current Issues in Influenza," the webinar by IAC’s chief strategy officer, Dr. L.J Tan, now archived on IAC website; slide set available upon request 

On October 29, Litjen (L.J) Tan, MS, PhD, IAC's chief strategy officer, presented a 1-hour webinar titled Current Issues in Influenza.

During his presentation, Dr. Tan discussed the 2018–2019 influenza season, some of its unique aspects, and the topic of vaccine effectiveness. He reviewed the importance of vaccination in preventing negative outcomes, highlighted new ACIP language regarding influenza vaccination, and discussed messaging for the 2019–2020 season.

This webinar is also available for viewing by clicking on Dr. Tan’s photo in the middle of the home page

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

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Healthcare providers: You can help the Meningitis B Action Project by completing a brief survey about MenB vaccine use in practice
The Meningitis B Action Project is conducting a brief survey of healthcare providers to assess how the meningitis B (MenB) vaccine is being discussed and used in clinical practice. This survey is for providers who are, and who are not, routinely recommending the MenB vaccine. All questions are multiple choice and answers are anonymous. Your answers will help policymakers, researchers, and advocates better understand the practical applications of current meningitis B vaccination recommendations. The survey is available here.

The Meningitis B Action Project is an independent educational initiative started by two mothers who each lost a daughter to meningitis B. For more information, visit the Meningitis B Action Project website.

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

The Immunization Action Coalition (IAC) is pleased to announce that four new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 495 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • King's Daughters Health, Madison, IN (97%)
  • Mitchell County Hospital Health Systems, Beloit, KS (92%)
  • Schneck Medical Center, Seymour, IN (96%)
  • Sentara Williamsburg Regional Medical Center, Williamsburg, VA (90%)

The following six institutions are being recognized for a second year:

  • Community Hospital South, Indianapolis, IN (100%)
  • Franciscan Health Michigan City, Michigan City, IN (95%)
  • Good Samaritan Hospital, Vincennes, IN (96%)
  • Indiana University Health North Hospital, Carmel, IN (90%)
  • Lawrence General Hospital, Lawrence, MA (98%)
  • St. Vincent Dunn Hospital, Bedford, IN (98%)
  • The Women's Hospital, Newburgh, IN (95%)

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

  • Abraham Lincoln Memorial Hospital, Lincoln, IL (94%)
  • Franciscan Health Michigan City, Michigan City, IN (97%)

Finally, the following institution is being recognized for a fourth year:

  • Griffin Hospital, Derby, CT (95%)

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

The Honor Roll now includes 495 birthing institutions from 44 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred twelve institutions have qualified for two years, 60 institutions have qualified three times, 28 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 52,000 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.

Related IAC Resources

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IAC's elegantly designed "Vaccines Save Lives" black enamel pins make great gifts for the holidays!

IAC’s new elegantly designed “Vaccines Save Lives” pin on hard black enamel with gold lettering and edges makes a meaningful gift for people who care about immunization.

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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Flu season is here, so make sure you have IAC's new "FLU VACCINE" buttons for staff and patient stickers on hand!

IAC's “FLU VACCINE” buttons and stickers are ready to ship! Their bright red color helps broadcast your important message about the need for flu vaccination. And the cost is nominal.


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 offers updated translations of its 12 easy-to-read handouts about vaccines for parents 

In October, IAC reviewed—and updated as needed—12 popular 1-page handouts for parents posted on its Easy-to-Read Q&As web page. Specifically developed to be short and simple, the handouts emphasize the dangers of vaccine-preventable diseases and the importance of vaccination. The following reviewed/updated translations are now available:

"Chickenpox is a serious disease...make sure your child is protected!"
"Hepatitis A is a serious disease...make sure your child is protected!"
"Hepatitis B is a serious disease...make sure your child is protected!"

"Hib is a serious disease...make sure your child is protected!"

"HPV is a serious disease...make sure your child is protected!"

"Influenza is a serious disease...make sure your child is protected!"

"Measles, mumps, and rubella are serious diseases...make sure your child is protected!"

"Meningococcal disease is serious...make sure your child is protected!"

"Pneumococcal disease is serious...make sure your child is protected!"

"Polio is a serious disease...make sure your child is protected!"

"Rotavirus is a serious disease...make sure your child is protected!"

"Whooping cough, tetanus, and diphtheria are serious diseases...make sure your child is protected!"

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IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC posts updated Spanish translation of "Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination" 

IAC recently posted an updated Spanish translation of its "Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination." This version now matches the English-language version which was revised in September.

The Spanish translation now corresponds to the English-language version, which was updated in September.

Related Links

IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC updates its PowerPoint slide set "To Err Is Human: Not to Err Is Better! Vaccination Errors and How to Prevent Them"; use it "as is" or modify it to fit your needs

IAC recently posted a revised edition of its PowerPoint slide presentation for healthcare professionals titled To Err Is Human: Not to Err Is Better! Vaccination Errors and How to Prevent Them. This slide set provides information about preventing vaccination errors in the areas of storage and handling, administration, scheduling, and documentation. Slides have been updated to reflect current recommendations from CDC's Advisory Committee on Immunization Practices, as well as providing additional real-life examples.

You can download the 6-slide-per-page handout of 68 slides (PDF format) or request the slide set for your own use with audiences. To request the PowerPoint file from IAC, go to IAC's PowerPoint Slide Sets web page. Just below the presentation's title and description, click on "Request the PowerPoint slide set" and IAC will email the request form for the PowerPoint presentation. Once you have submitted your request, we will send you the presentation. You can edit and use it as you see fit.

IAC's PowerPoint Slide Sets web page on contains presentations on a variety of immunization topics. Use the slides "as is" or modify them to suit your organization's needs. Currently there are 13 slide sets available in a 6-slide-per-page handout format. The titles and links to the handout-formatted slides are listed below.

Visit the IAC's PowerPoint Slide Sets web page on to access and begin utilizing these valuable slide sets today!

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CDC and WHO report on progress toward measles elimination worldwide in this week's MMWR and Weekly Epidemiological Record, respectively 

CDC published Progress Toward Regional Measles Elimination—Worldwide, 2000–2018 in the December 6 issue of MMWR (pages 1105–1111). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress Towards Regional Measles Elimination—Worldwide, 2000–2018. A media summary of the MMWR article is reprinted below.

During 2000–2018, increased coverage with measles vaccines, supplemental immunization activities, and other elimination efforts contributed to a 66% decrease in reported measles incidence, a 73% reduction in estimated measles mortality, and a reduction in the number of circulating wild measles genotypes worldwide. Measles vaccination prevented an estimated 23.2 million deaths during this period. Despite this progress, global measles control milestones have not been achieved, reported measles incidence has increased in five of the six World Health Organization regions since 2016, and estimated global measles deaths have increased since 2017. Large measles outbreaks in countries with weak immunization systems accounted for most reported measles cases. Outbreaks should serve as opportunities to investigate underlying causes for under-vaccination and to design and implement specific routine immunization strengthening activities to prevent future outbreaks.

Access the MMWR article in HTML format.

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CDC publishes report about progress toward measles elimination in China 

CDC published Progress Toward Measles Elimination—China, January 2013–June 2019 in the December issue of MMWR (pages 1112–1116). A summary made available to the press is reprinted below.

China’s measles incidence per million population decreased from 20.4 in 2013 to 2.8 in 2018. Measles cases, incidence, and outbreaks were all at historic low levels in 2017 and 2018. Reported measles-related deaths decreased from 32 in 2015 to one in 2018, and to zero through June, 2019. Measles elimination in China can be achieved through strengthening the immunization program’s existing strategies: Ensuring sufficient vaccine supply, continuing to improve laboratory-supported surveillance and outbreak investigation and response, strengthening school entry vaccination checks, and vaccinating students without documentation of two doses of measles-rubella vaccine.

Access the MMWR article in HTML format.

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Influenza season is here; check out these resources and make sure all your patients are getting vaccinated!

According to CDC, seasonal influenza activity in the United States has been elevated for four weeks and continues to increase. CDC stated in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending November 30, the number of jurisdictions reporting regional or widespread activity increased to 24 this week from 15 last week.

One influenza-associated pediatric death was reported to CDC during the week ending November 30. A total of six influenza-associated pediatric deaths have been reported for the 2019–20 season. 

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 recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate influenza vaccination services near them.

Related Links:

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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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November issue of CDC's Immunization Works newsletter now available

CDC recently released the November issue of its monthly newsletter Immunization Works. The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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JAMA Pediatrics publishes article about adolescents consenting to their own vaccination 

On October 7, JAMA Pediatrics published a "Viewpoint" article online titled Adolescent Consent to Vaccination in the Age of Vaccine-Hesitant Parents (Y. Tony Yang, et al.). The introductory paragraph is reprinted below.

As children of vaccine-hesitant parents become adolescents, they develop their individual perspectives on vaccination. One of these adolescents, Ethan Lindenberger, researched vaccines, discussed them with trusted adults, and ultimately got vaccinated. His testimony to the Senate Committee on Health, Education, Labor and Pensions made national headlines. Many other adolescents are similarly seeking advice on how to get vaccinated. While vaccination against measles and other conditions occurs in early childhood, vaccine-hesitant parents have also refused human papillomavirus vaccination, routinely provided for adolescents beginning at age 11 or 12 years. And they have refused to let their children catch up on any missed early childhood vaccinations. Prior research has shown that adolescents feel generally marginalized in the decision-making process, yet they desire to participate in decisions. Their main obstacle to vaccination is that most states require an individual to be 18 years or older to consent to medical procedures. We argue for expansion of the rights of adolescents to make their own decisions to be vaccinated against serious and potentially life-threatening diseases without requiring parental consent and involvement.

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Reminder: Abstracts for the 49th National Immunization Conference accepted through December 16

CDC will be accepting abstract submissions through December 16 for the 49th National Immunization Conference (NIC) to be held May 19–21 in Atlanta. 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.

Visit the NIC Abstract Information web page 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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Presentation slides and videos from October ACIP meeting are now available

ACIP recently posted the presentation slides and videos from the ACIP meeting held October 23–24.

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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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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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