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Issue 1473: January 15, 2020










CDC issues an MMWR Early Release titled “Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade—Louisiana, 2019”

On January 10, CDC released an MMWR Early Release titled Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade—Louisiana, 2019. The beginning of the first paragraph is reprinted below.

Multiple genetically distinct influenza B/Victoria lineage viruses have cocirculated in the United States recently, circulating sporadically during the 2018–19 season and more frequently early during the 2019–20 season. The beginning of the 2019–20 influenza season in Louisiana was unusually early and intense, with infections primarily caused by influenza B/Victoria lineage viruses. One large pediatric health care facility in New Orleans (facility A) reported 1,268 laboratory-confirmed influenza B virus infections, including 23 hospitalizations from July 31 to November 21, 2019, a time when influenza activity is typically low. During this period, Louisiana also reported one pediatric death associated with influenza B virus infection.... 

Access the complete MMWR Early Release article:

Related Link

  • MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements

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CDC issues Health Alert Network (HAN) advisory due to elevated influenza activity
On January 10, the CDC Health Alert Network (HAN) released Elevated Influenza Activity: Influenza B/Victoria and A(H1N1)pdm09 Viruses are the Predominant Viruses. The "Summary" section and portions of the "Recommendations" section are reprinted below.


This health advisory notifies clinicians that influenza activity remains high in the United States. Ongoing elevated activity is due to influenza B/Victoria viruses, increasing circulation of influenza A(H1N1)pdm09 viruses, and low levels of influenza B/Yamagata and influenza A(H3N2) viruses. CDC’s influenza forecasts suggest that national influenza activity will remain elevated for several more weeks. Because influenza activity is elevated and both influenza A and B virus infections can cause severe disease and death, this health advisory also serves as a reminder that early treatment with antiviral medications improves outcomes in patients with influenza. Early treatment with antiviral medications is recommended for hospitalized patients and high-risk outpatients, including children younger than two years. Clinicians should continue efforts to vaccinate patients for as long as influenza viruses are circulating, and promptly start antiviral treatment of severely ill and high-risk patients with suspected influenza without waiting for laboratory confirmation.

The Health Alert Advisory provides detailed recommendations for clinicians under the following headings: 

  • All People Six Months and Older Who Have Not Yet Received an Influenza Vaccine This Season Should Be Vaccinated against Influenza
  • All Hospitalized, Severely Ill, and High-Risk Patients with Suspected or Confirmed Influenza, Regardless of Influenza Vaccination Status, Should Be Treated with Antivirals as Soon as Possible after Onset of Illness
  • Antiviral Treatment in Non-High-Risk Patients with Uncomplicated Influenza 
  • Choice of Antiviral Medication
  • Timing of Treatment and Implications for Patient Evaluation, Treatment, and Testing

Access the complete HAN for more background information and detailed guidance for healthcare providers: Elevated Influenza Activity: Influenza B/Victoria and A(H1N1)pdm09 Viruses Are the Predominant Viruses.

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CDC releases updated VISs for rabies, adenovirus, and anthrax

On January 8, CDC released final versions of the Vaccine Information Statements (VISs) for rabies, adenovirus, and anthrax vaccines. 

Access these VISs on their respective IAC web pages by clicking on the links below.

For both interim and final VISs, CDC encourages providers to begin using them immediately, but stocks of the previous editions may be used until exhausted.

CDC states that it is acceptable to use out-of-date VIS translations since there have not been significant content changes compared with the previous VIS. In addition, the corresponding up-to-date English-language VIS must also be provided when providing an out-of-date translation.

The translations for some VISs on our website are from previously published English-language versions that have since been updated. Unfortunately, IAC is not always able to obtain translations as updates are issued. Please ensure that your patients receive information consistent with the current English-language version of the VISs.

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Dr. Deborah Wexler’s VEC Technically Speaking column about ACIP’s updated pneumococcal vaccine recommendations for adults age 65 years and older is 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.

December's column is titled ACIP Updates Its Pneumococcal Vaccine Recommendations for Adults Age 65 Years and Older. The introductory paragraphs are reprinted below.

On November 22, CDC published Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine among Adults Aged >65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) in Morbidity and Mortality Weekly Report (MMWR 68[46]:1069).

This document updates ACIP's 2014 statement which recommended routine use of pneumococcal conjugate vaccine (PCV13) in series with pneumococcal polysaccharide vaccine (PPSV23) for all adults in this age range. Since that time, the incidence of PCV13-type disease has been reduced to historically low levels among adults age >65 through indirect effects from pediatric PCV13 use. Because of this changing epidemiology, ACIP has updated its recommendations on PCV13 vaccine scheduling in older adults and incorporated the concept of shared clinical decision-making, as summarized below.

Access the complete column on the Technically Speaking web section of

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

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

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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 vaccine.

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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IAC's elegantly designed "Vaccines Save Lives" black enamel pins are a great way to show you value immunization!

IAC’s elegantly designed “Vaccines Save Lives” pin on hard black enamel with gold lettering and edges makes the statement that you 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 ongoing, so make sure you have IAC's "FLU VACCINE" buttons for staff and stickers for patients 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 updates "Current Dates of Vaccine Information Statements" and "You Must Provide Patients with Vaccine Information Statements (VISs)—It’s Federal Law!"

IAC recently revised Current Dates of Vaccine Information Statements as well as You Must Provide Patients with Vaccine Information Statements (VISs)—It’s Federal Law! to reflect the 1/8/20 date of the recently updated rabies, adenovirus, and anthrax VISs.

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WHO reports on 2019 influenza season in the southern hemisphere in this week's Weekly Epidemiological Record

The World Health Organization (WHO) published a report titled Review of the 2019 Influenza Season in the Southern Hemisphere in the January 10 issue of the Weekly Epidemiological Record. The first two paragraphs of the summary section are reprinted below.

The 2019 season was characterized by influenza A viruses, the dominant subtype differing by country. Influenza A(H1N1)pdm09 viruses predominated or co-circulated with influenza A(H3N2) viruses in most countries of temperate South America, while influenza A(H3N2) viruses predominated in South Africa and New Zealand. Influenza B viruses co-circulated in Australia and New Zealand and were detected at a lower level in the other countries of the temperate southern hemisphere. In Chile, influenza B viruses accounted for the majority of influenza detections during the second wave of influenza activity.

The timing of the onset and peak of the 2019 influenza season varied by country. The 2019 season started earlier than the average seasonal onset week in Australia (after elevated inter-seasonal activity), Chile and South Africa. An earlier peak was observed in most countries, except for Paraguay and Uruguay. The duration of the season was notably longer in Chile, where influenza viruses continued to circulate through late October 2019....

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WHO publishes article titled “Deaths from Democratic Republic of the Congo Measles Outbreak Top 6000”

On January 7, WHO Africa published an article titled Deaths from Democratic Republic of the Congo Measles Outbreak Top 6000. The first two paragraphs are reprinted below.

With the death toll from the world’s worst measles epidemic in the Democratic Republic of the Congo (DRC) surpassing 6000, the World Health Organization (WHO) is calling for more funding to stop the outbreak.

Under the leadership of the DRC Ministry of Health, WHO, Gavi, the Vaccine Alliance, and other partner aid agencies vaccinated more than 18 million children under five across the country in 2019. However, in some areas, routine vaccination coverage remains low and 25% of the reported measles cases are in children over the age of five.

Access the entire article: Deaths from Democratic Republic of the Congo Measles Outbreak Top 6000.

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CDC reports influenza activity remains high; please continue vaccinating through the winter months to prevent flu from spreading further

Seasonal influenza activity in the United States remains high according to CDC's Weekly U.S. Influenza Surveillance Report, FluView. Forty-nine states and Puerto Rico reported regional or widespread activity, while the District of Columbia and Hawaii reported local activity for the week ending January 4.  

Five influenza-associated pediatric deaths were reported to CDC during the week ending December 28 and one pediatric death was reported during the week ending January 4. A total of 32 influenza-associated pediatric deaths have been reported for the 2019–20 season. CDC estimates that so far this season there have been at least 9.7 million flu illnesses, 87,000 hospitalizations and 4,800 deaths from flu.

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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Visit IAC's updated website,, to enhance your efforts at increasing rates of the MenACWY booster and other adolescent vaccines

Last fall, IAC implemented a major upgrade to its collaborative website promoting the importance of receiving a booster dose of meningococcal ACWY (MenACWY) vaccine.


Aimed at healthcare professionals, the site was revised to incorporate newly updated materials and to highlight the importance of all recommended vaccines for 16-year-olds. A simplified navigation structure makes locating information a breeze.
The colorful website is divided into five easy-to-access sections: 

  • Vaccinate Teens – The tools included on this web page offer helpful information on teen vaccination schedules and tips for improving adolescent immunization rates.
  • Give 2 Doses – Fewer than half of teens have received the recommended second dose of MenACWY vaccine. This web page offers tools to help providers improve second dose coverage.
  • 16-Year-Old Visit – These resources help both providers and their patients remember the important vaccines recommended for 16-year-olds.
  • Tools for Providers – These tools from CDC, IAC, and other organizations explain meningococcal ACWY vaccine recommendations and assist in improving adolescent coverage for all recommended vaccines.
  • Resources – This section contains a wealth of information to assist provider efforts to improve adolescent immunization rates. The materials are subdivided into subsections for print materials, links to organizations involved in adolescent immunization, personal stories about the importance of vaccination, and additional resources of interest. 

Additional time savings are provided by the site’s single location where all website materials are listed according to whether they are primarily of interest to providers or to patients/parents. Other sections relate to general adolescent immunization, as well as meningococcal disease and vaccine information.
Visit and enjoy browsing (and hopefully deploying) its terrific resources, brought to you by our collaboration with Sanofi Pasteur.
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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Two new studies published in Pediatrics confirm safety of 9-valent human papillomavirus vaccine

In the December issue of Pediatrics (the official journal of the American Academy of Pediatrics), two new studies on HPV vaccine safety were published with important implications for healthcare providers.

In the first study, Safety of the 9-Valent Human Papillomavirus Vaccine (Tom T. Shimabukuro, et al.), researchers found that "No new or unexpected safety concerns or reporting patterns of 9vHPV with clinically important AEs [adverse events] were detected." 

In the second study, Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine (James G. Donahue, et al.), the authors concluded that "After 2 years of near real-time surveillance of 9vHPV and several prespecified adverse events, no new safety concerns were identified."

Also in the December issue of Pediatrics, Dr. H. Cody Meissner from Tufts University School of Medicine released a commentary titled From Peyton Rous to the HPV Vaccine: A Journey of Discovery and Progress. Dr. Meissner notes that "The HPV vaccine adds to the legacy of immunization as one of the most effective public health interventions for disease prevention and improvement of the health of humankind. Deferral of HPV vaccination because of questions regarding safety can no longer be defended as a reasonable option." 

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Science Magazine publishes article titled “This Italian Scientist Has Become a Celebrity by Fighting Vaccine Skeptics”

Science Magazine published This Italian Scientist Has Become a Celebrity by Fighting Vaccine Skeptics, telling the story of Roberto Burioni, a virologist at Vita-Salute San Raffaele University in Milan, Italy, whose TV appearance to face-off against two vaccine opponents catapulted him to fame. The first three paragraphs of the article are reprinted below.

In May 2016, Roberto Burioni, a virologist at Vita-Salute San Raffaele University in Milan, Italy, was asked to appear on a popular TV talk show to face off against two opponents of vaccines—a former DJ, Red Ronnie, and an actress and TV personality, Eleonora Brigliadori. The host gave most of the air time to the Italian celebrities. Then, with just a few minutes left, he turned to Burioni.

Burioni realized he didn't have time to make the usual arguments about statistics and scientific uncertainty, so he kept his message simple: "The Earth is round, gasoline is flammable, and vaccines are safe and effective," he said. "All the rest are dangerous lies."

"It went off like a bomb," Burioni recalls. Emails from viewers poured into the show, with some questioning how the publicly funded TV network hosting it could allow such ill-informed personalities to speak about medicine. Burioni took up the theme on his Facebook page, asking how one branch of government could broadcast lies about vaccines while its health agency promoted immunization. More than 5 million people responded to his comments. Radio journalist Alessandro Milan called Burioni's rebuttal to Red Ronnie "the 13 most beautiful words heard on TV in the last year."

Read the article in its entirety: This Italian Scientist Has Become a Celebrity by Fighting Vaccine Skeptics.

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The Lancet publishes article titled “The Public Health Crisis of Underimmunisation: A Global Plan of Action” 

On November 6, The Lancet published The Public Health Crisis of Underimmunisation: A Global Plan of Action. The summary is reprinted below.

Vaccination is one of public health's greatest achievements, responsible for saving billions of lives. Yet, 20% of children worldwide are not fully protected, leading to 1.5 million child deaths annually from vaccine-preventable diseases. Millions more people have severe disabling illnesses, cancers, and disabilities stemming from underimmunisation. Reasons for falling vaccination rates globally include low public trust in vaccines, constraints on affordability or access, and insufficient governmental vaccine investments. Consequently, an emerging crisis in vaccine hesitancy ranges from hyperlocal to national and worldwide. Outbreaks often originate in small, insular communities with low immunisation rates. Local outbreaks can spread rapidly, however, transcending borders. Following an assessment of underlying determinants of low vaccination rates, we offer an action based on scientific evidence, ethics, and human rights that spans multiple governments, organisations, disciplines, and sectors. 

Read the article in its entirety: The Public Health Crisis of Underimmunisation: A Global Plan of Action.

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WHO joins partners in a year-long celebration of the work of nurses and midwives

The World Health Assembly has designated 2020 as the International Year of the Nurse and the Midwife. As part of the campaign, WHO has joined with the International Confederation of Midwives (ICM), International Council of Nurses (ICN), Nursing Now, and the United Nations Population Fund (UNFPA) to celebrate the work of nurses and midwives. The first paragraph of the campaign web page is reprinted below.

Nurses and midwives play a vital role in providing health services. These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs. They are often, the first and only point of care in their communities. The world needs 9 million more nurses and midwives if it is to achieve universal health coverage by 2030.

Utilize the campaign toolkit and participate in the social media campaign by using the hashtags #SupportNursesAndMidwives, #Nurses2020, and #midwives2020.

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Free, live webcast on strengthening vaccine confidence in pediatric practice to be held January 16 with CE credit from University at Albany School of Public Health
As part of their Public Health Live! series, the University at Albany School of Public Health is offering a webinar titled Strengthening Vaccine Confidence in Pediatric Practice on January 16 at 9:00 a.m. (ET). This webinar, led by Jesse Hackell, MD, FAAP, will review the key concepts of vaccine hesitancy and vaccine safety and efficacy, identify ways that providers can address parental concerns and hesitancies, and indicate the key components of a strong presumptive recommendation. The webinar will be available online for two weeks after the live presentation.

Registration (required) is open now.

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Registration is open for the Epidemiology & Prevention of Vaccine-Preventable Diseases ("The Pink Book") course in Indiana, April 14–15

CDC faculty from its National Center for Immunization and Respiratory Diseases will present a comprehensive review of immunization principles and recommendations. This two-day continuing education course, Epidemiology and Prevention of Vaccine Preventable Diseases ("The Pink Book"), will be hosted by the Indiana Immunization Coalition on April 14–15 in Plainfield, IN.

Registration information

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Reminder: 49th National Immunization Conference will be held in Atlanta on May 19–21

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

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

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California Immunization Coalition Summit scheduled for June 9–10 in Sacramento; abstract submissions due by February 3

Registration is open for the 2020 California Immunization Coalition (CIC) Summit titled "A Healthier Future Is in Sight CIC Summit 2020," scheduled for June 9–10 in Sacramento, California.

Visit the 2020 CIC Summit web page for information about conference and hotel registration, fees, and more. 

Abstracts, which are due by February 3, are encouraged from those from all disciplines who are coalition members, immunization program staff, community-based organizations, healthcare providers, government and non-government agencies, health communications specialists, and others interested in immunization issues. Information about abstract submission is available on the CIC Summit web page. Access the abstract submission form.

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AIRA 2020 National Meeting scheduled on August 11–13 in Portland; abstract submissions due by March 1

The American Immunization Registry Association (AIRA) is inviting abstracts for its 2020 National Meeting, which will be held on August 11–13 in Portland, Oregon. The AIRA National Meeting provides an annual opportunity to bring peers and partners together to educate on the latest immunization information system (IIS) best practices and bring IIS discussion to a national stage.

Visit the meeting web page for information about conference and hotel registration, presentations, and more. The deadline for submitting an abstract is March 1.

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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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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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