Issue 1495: May 13, 2020







CDC publishes “Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, 2020" in MMWR Early Release   

CDC published Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration—United States, 2020 in the May 8 early release issue of MMWR. The report describes drastic reductions in vaccine ordering from the Vaccines For Children (VFC) program and also in vaccine administration to children and teens in recent weeks. On Monday, May 11, IAC issued a special edition of IAC Express to share this information. 

Various shelter-in-place and stay-at-home orders have helped slow the spread of the virus that causes COVID-19. However, recent findings show these restrictions have resulted in a troubling decrease in the number of children getting their recommended vaccinations. On March 24, CDC posted guidance stressing the importance of routine well-child visits and immunizations during the COVID-19 pandemic. But recent data show a notable decrease in the ordering and administering of childhood vaccines.  

A decline in measles-containing vaccine administration began the week after the declaration of the national emergency on March 13. Similar decreases were also noted for multiple vaccines that are essential to keep other serious diseases from reappearing during this public health emergency. The data indicate that many children are now vulnerable to several serious, vaccine-preventable diseases. The shortfalls are especially significant for children 2 through 18 years of age.

Going forward, healthcare organizations will need to promote childhood and adolescent vaccinations, including reaching out to parents of patients who are overdue for their recommended vaccinations. 

Parental fears about potentially exposing children to COVID-19 may contribute to the recent decline in vaccine delivery. Medical practices need to implement safety protocols to protect families and reassure parents that safety protocols are in place. Clinicians and health departments need to continue coordinated efforts to achieve the rapid vaccination catch-up necessary to avoid outbreaks of deadly diseases. 

Vaccinating children and teens is of the utmost importance. Parents need to schedule and attend well-child checkups, seek vaccination on schedule, and communicate with their healthcare provider to make sure children are up to date on all their vaccinations.  

The COVID-19 pandemic is a reminder of the importance of vaccination and prevention of disease. Postponing vaccinations puts millions of children at risk for preventable infection. 

Access the MMWR article in HTML format or in PDF format.

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CDC shares social media content for communicating with parents to encourage child and teen vaccination during pandemic

CDC has made available sample social media messages highlighting CDC’s parent-friendly immunization schedules for children 0–6 years old in English and Spanish. We encourage you to forward them to parents in your network.
Clinicians, remember to use CDC’s catch-up immunization schedule.

Sample social media messages for parents:

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Ask the Experts: COVID-19 and Routine Vaccination web page addresses the administration of routine vaccinations during the pandemic

IAC recently created its Ask the Experts: COVID-19 and Routine Vaccination web page to answer questions about the administration of routine immunizations for children and adults during the pandemic. This section of Ask the Experts will grow with more Q&As as additional information becomes available.

IAC’s Ask the Experts gateway page is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. IAC wishes to recognize its team of experts: Kelly L. Moore, MD, MPH (lead); Carolyn Bridges, MD, FACP; William Atkinson, MD, MPH; and Deborah Wexler, MD.

Some of the most frequently visited sections of Ask the Experts Q&As include the following:

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IAC Commentary: Society wants a COVID-19 vaccine—it’s not just a matter of when, but also how much and for whom (part 2) 

by John D. Grabenstein, RPh, PhD, IAC Express associate editor

Last week in IAC Express issue #1495, we considered when a SARS-CoV-2 (COVID-19) vaccine might be available for broader use. We cautioned that the point in time people eagerly anticipate is not a “finish line” when some big box arrives with enough vaccine for everybody served at your site. 

On the contrary, that will be the day when there is just-enough evidence to broaden the vaccine’s use. On that day, production capacity might be several tens of millions of doses per month, certainly not enough for everyone to get in line all at once. Colleagues who were vaccinating in 2004 or 2009 can tell you how priority groups for the limited supply of influenza vaccine were managed. 

When SARS-CoV-2 vaccine supply begins opening up, we will know some of the characteristics of the new vaccine, but not everything. The adverse-event profile for relatively common side effects should be fairly well established, but expect to be asked to support additional safety surveillance efforts. 

Meanwhile, what can you do to get your site ready for the unknown day when an unknown quantity of vaccine arrives, earmarked for as-yet-unspecified cohorts of people? Vaccinators know that training and logistics are pivotal to the success of vaccination programs, even if they aren’t glamorous. Get ready to train additional staff. Even if they know how to give injections, extra training may be needed on precautions to avoid shoulder injury. Think about patient flow, screening, and documentation. If any of your systems might need upgrading, get started on it. Enroll in your state immunization information system. 

Getting ready will require extra effort on your part. But better to prepare now than to wait until SARS-CoV-2 vaccine is about to arrive. Planning ahead is what vaccines are all about. 

Vaccinators have long been unsung heroes. Get ready to be a hero people sing about. 

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New! IAC launches its MenB Vaccination Honor Roll recognizing colleges and universities that require or recommend the vaccine to protect students
On May 8, 2020, the Immunization Action Coalition (IAC) launched the MenB Vaccination Honor Roll! This is an initiative that recognizes colleges and universities that have established policies requiring or recommending meningococcal serogroup B (MenB) vaccination to protect their students and to prevent outbreaks. The MenB Vaccination Honor Roll recognizes exemplary institutions that have taken the lead in establishing such policies.
To date, IAC has identified 38 colleges and universities that require MenB vaccination for their students and 214 that recommend it.


To qualify for the MenB Vaccination Honor Roll, an institution must have a policy requiring or recommending MenB vaccination for students.
In the right-hand column of the MenB Vaccination Honor Roll web page, you’ll find resources such as news stories about meningitis B outbreaks, personal stories from families affected by meningitis B, journal articles, and links to organizations that work to prevent meningitis. 
Please help us to grow the honor roll by notifying us if you know of a college or university that requires or recommends MenB vaccination for its students. Colleges and universities may apply for the honor roll or you can alert us at
Colleges and universities added to the MenB Vaccination Honor Roll will be announced in IAC’s weekly immunization e-newsletter, IAC Express, emailed to more than 50,000 subscribers every Wednesday.  
Please click here if you would like to subscribe to IAC Express.

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CDC updates its "General Best Practice Guidelines for Immunization"

CDC has recently updated its General Best Practice Guidelines for Immunization with several changes. The General Best Practice Guidelines’ List of Errata/Updates web page provides a list of all errata and updates that have been made and the dates the changes were made. The list is updated whenever it is determined changes are necessary.

The page numbers correspond to the version in PDF format.

  • Page 13: Accelerated Twinrix dosing has been added to the list of vaccines for which providers cannot use the grace period.
  • Page 13: When three doses of hepatitis B vaccine have been administered, if the second dose was administered at least 4 weeks after the first dose, and the third dose (invalid) was administered less than 8 weeks after the second dose, the repeat third dose (let’s call it a fourth dose) can be administered 8 weeks after the second dose, and this fourth dose will be considered valid (as long as it is administered after 24 weeks of age) even if the fourth dose was not administered a full 8 weeks after the third dose. In other words, we allow the minimum interval forecast rule to be violated in this circumstance.
  • Page 55 (Table 4-1): Yeast is acknowledged to be a component of MenACWY (Menveo only).

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CDC publishes “Large Measles Outbreak in Orthodox Jewish Communities—Jerusalem District, Israel, 2018–2019” in MMWR

CDC published Large Measles Outbreak in Orthodox Jewish Communities—Jerusalem District, Israel, 2018–2019 in the May 8 issue of MMWR. The first paragraph is reprinted below.

During March 2018–May 2019, an outbreak of 4,115 measles cases occurred in Israel, following international importations, mainly from Ukraine. Approximately one half of the cases (2,202) occurred in residents of Jerusalem District, primarily in unvaccinated children in orthodox Jewish communities. The district’s population (1.25 million, approximately 14% of the national population) is 70% Jewish, approximately one third of whom are orthodox Jews. Children in those orthodox communities have lower rates of routine vaccination coverage; for measles vaccine, first dose coverage is 78.4%, compared with 90.1% among children in all other communities. Measles outbreak control in communities with long-standing inadequate vaccination coverage is challenging. Urgent response measures led to containment of this outbreak; however, sustaining vaccination coverage will require targeted interventions and resources.

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

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Dr. Deborah Wexler's VEC Technically Speaking column titled “Our Society Deserves Vaccination: Two New Educational Pieces from IAC Explain the Science Supporting Vaccines and the Value of the Vaccine Injury Compensation Program" 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.

April's column discusses two new IAC pieces: 

Access the complete article here.

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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Teaching young people about vaccines: IAC compiles reliable resources for instructing elementary school-aged children on vaccines and how they work

Recognizing that many people are now at home teaching their children, IAC has compiled a list of resources to educate children and adolescents on vaccines and the immune system. For the next few weeks, IAC will share resources for various age cohorts: elementary, middle school, and high school. Please use these resources to teach your own children how vaccines work and help spread the word about these credible resources for students in many classroom settings. 

  • CHOP's The Vaccine Makers Project: Includes elementary lesson plans (revised 2018), videos, and 3-D animations. Aligned to the Next Generation Science Standards (NGSS) and Common Core State Standards (CCSS), this content describes how the immune system works and how vaccines work to prevent disease. Activities and resources introduce the scientific method and equip students to critically evaluate science-based topics central to our lives. 
  • CHOP’s Vaccine Resources for Kids and Teens gateway page (revised in 2017) includes: 
    • My Vaccine Activity Book (PDF, 5 MB): A 16-page booklet that presents the science of vaccines with fun images to color and activities to complete; available in English and Spanish
    • Vax Pack Hero: A program which features a web-based video game, physical trading cards, and an educational website
  • BrainPOP: Vaccines (free until June 15): This BrainPOP video (4:43 min) discusses vaccines and how they work. BrainPOP is offering free access to all products through June 15. Viewers will learn how vaccines interact with the body’s immune system. The interactive Vaccines web page includes quizzes, extra reading, worksheets, and games to inspire learning.

For shorter activities, here are several videos that share important lessons about vaccines, how they work, and important vaccine champions.

Look for resources for middle school and high school students in future issues of IAC Express.

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Not-to-miss immunization articles in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.

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Stay up to date on the latest coronavirus information 

CDC, NIH, WHO, and Johns Hopkins are closely monitoring the SARS-CoV-2 pandemic. Be sure to check the resources below for the latest information. Stay in touch with your local and state health departments. 

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“Shop IAC” on offers many resources for your practice. Order laminated 2020 U.S. immunization schedules for your exam rooms today!

On the Shop IAC web page you will find many resources such as laminated vaccination schedules, personal immunization record cards, pins for your lapel, and more! Your purchases will help IAC keep delivering free, educational materials to healthcare professionals and to the public. 

IAC's laminated versions of the 2020 U.S. child/adolescent immunization schedule and the 2020 U.S. adult immunization schedule are ideal for use in any busy healthcare setting where vaccinations are given.


The schedules' coating can be wiped down, and they’re durable enough to stand up to a year's worth of use. Visit the Shop IAC: Laminated Schedules web page for more information on the schedules.

IAC’s three personal immunization record cards—child & teen, adult, and lifetime—are printed on durable rip-, smudge-, and water-proof paper. Sized to fit in a wallet when folded, the cards are brightly colored to stand out. Give these nearly indestructible personal record cards to your patients. They're sold in boxes of 250.

You too can show your support for vaccination with IAC’s elegantly designed “Vaccines Save Lives” pin on your lapel. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125" x 0.75”. Order yours today to show how much you value immunizations!

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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) published its 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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“Association Between Rotavirus Vaccination and Type 1 Diabetes in Children” published in JAMA Pediatrics

In its March 9, 2020, issue, JAMA Pediatrics published Association Between Rotavirus Vaccination and Type 1 Diabetes in Children, by Jason M. Glanz, et al. The authors conclude:

Rotavirus vaccination is a highly effective vaccine routinely recommended for all infants by 8 months of age. In this large cohort study, we did not find evidence that rotavirus vaccination was associated with an increased or decreased incidence of type 1 diabetes in children. Although rotavirus vaccination may not prevent type 1 diabetes, these results should provide additional reassurance to the public that rotavirus vaccination can be safely administered to infants.

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Historical immunization spot featuring Batman and Robin urges healthcare providers to sign up for IAC Express newsletter and access IAC resources

Direct from the Bat Cave, this immunization spot features Batman and Robin action figures to promote IAC Express and IAC resources. Produced in 2001 by the Centers for Disease Control and Prevention, the spot is part of a PSA collection curated by vaccine expert William L. Atkinson, MD, MPH. Some things don’t change: IAC Express and IAC resources are all still free!

Previous videos mentioned in “On the Lighter Side” are available when viewing this Vimeo video.

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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.

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 Disclaimer
ISSN: 1526-1786

Our mailing address is
Immunization Action Coalition
2550 University Avenue West, Suite 415 North
Saint Paul, MN 55114

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 Disclaimer
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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