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Issue 1,513: August 26, 2020
Top Stories

IAC Handouts

Featured Resources

Journal Articles and Newsletters

Education and Training

On the Lighter Side


Top Stories

CDC releases ACIP recommendations on use of influenza vaccines for 2020–21 influenza season

CDC has released Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2020–21 Influenza Season in the August 21 MMWR Recommendations and Reports. Excerpts from the Summary section appear below.

Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. Most influenza vaccines available for the 2020–21 season will be quadrivalent, with the exception of MF59-adjuvanted IIV, which is expected to be available in both quadrivalent and trivalent formulations.

… Primary updates to this report include the following two items. First, the composition of 2020–21 U.S. influenza vaccines includes updates to the influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B/Victoria lineage components. Second, recent licensures of two new influenza vaccines, Fluzone High-Dose Quadrivalent and Fluad Quadrivalent, are discussed. Both new vaccines are licensed for persons aged ≥65 years. Additional changes include updated discussion of contraindications and precautions to influenza vaccination and the accompanying Table, updated discussion concerning use of LAIV4 in the setting of influenza antiviral medication use, and updated recommendations concerning vaccination of persons with egg allergy who receive either cell culture–based IIV4 (ccIIV4) or RIV4.

… Influenza vaccination of persons aged ≥6 months to reduce prevalence of illness caused by influenza will reduce symptoms that might be confused with those of COVID-19. Prevention of and reduction in the severity of influenza illness and reduction of outpatient illnesses, hospitalizations, and intensive care unit admissions through influenza vaccination also could alleviate stress on the U.S. health care system. Guidance for vaccine planning during the pandemic is available at

… A brief summary of the recommendations and a link to the most recent Background Document containing additional information are available at … Updates and other information are available from CDC’s influenza website ( 

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

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Massachusetts mandates flu vaccine for all children and adults attending childcare, pre-school, K-12, colleges, and universities. Seven more colleges and universities require flu vaccine for students and staff.

On August 19, the Massachusetts Department of Public Health (MDPH) announced that the influenza vaccine is now required for all Massachusetts students age 6 months and older who are enrolled in childcare, pre-school, K-12, and higher education. A paragraph from the press release appears below. 

Students will be expected to have received a flu vaccine by December 31, 2020 for the 2020–2021 influenza season, unless either a medical or religious exemption is provided. Also exempted are K-12 students who are homeschooled and higher education students who are completely off-campus and engaged in remote learning only. This new flu immunization requirement to enter school in January is in addition to existing vaccine requirements for all those attending child care, preschool, K-12, and colleges and universities in Massachusetts. Elementary and secondary students in districts and schools that are using a remote education model are not exempt.
Access the full press release.

Besides all Massachusetts colleges and universities, at least seven other colleges and universities have mandated influenza vaccination for the 2020–21 academic year: Butler UniversityDuke University, Purdue University, ten campuses in the University of California system, University of Miami, four campuses in the University of Tennessee system, and Wabash College

If you know of additional colleges or universities that require influenza vaccination, please send the name of the institution, as well as a link to the relevant policy (if available) to

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HHS amends emergency rules, authorizing pharmacists to vaccinate children under specific conditions
On August 19, the U.S. Department of Health and Human Services (HHS) issued its Third Amendment to Declaration under the Public Readiness and Emergency Preparedness Act [PREP] for Medical Countermeasures against COVID 19 to expand access to childhood vaccines.

The amended declaration authorizes pharmacists who meet certain criteria to order and administer ACIP-recommended vaccines to individuals ages 3 through 18 years, subject to several requirements. Pharmacists must have at least 20 hours of specified training, comply with local recordkeeping requirements, inform the patient’s primary-care provider, report to immunization information systems, report adverse events, and comply with other requirements. Pharmacists are to inform caregivers accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider, referring patients as appropriate.

An excerpt from the press release is reprinted below.

...The amendment authorizes State-licensed pharmacists (and pharmacy interns acting under their supervision to administer vaccines, if the pharmacy intern is licensed or registered by his or her State board of pharmacy) to order and administer vaccines to individuals ages three through 18 years, subject to several requirements...

...HHS is expanding access to childhood vaccines to avoid preventable diseases in children, additional strains on the healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with an additional resurgence of COVID-19.

Access the entire press release.

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NIS-Teen: “National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years—United States, 2019” published in MMWR

CDC published National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years—United States, 2019 in the August 21 issue of MMWR. Three vaccines are recommended by the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents aged 11–12 years to protect against pertussis; meningococcal disease caused by types A, C, W, and Y; and human papillomavirus (HPV)-associated cancers.

CDC analyzed data from the 2019 National Immunization Survey-Teen (NIS-Teen) to estimate vaccination coverage among adolescents aged 13–17 years in the United States.

  • HPV: Coverage with ≥1 dose of HPV vaccine increased from 68.1% in 2018 to 71.5% in 2019. The percentage of adolescents up to date with the HPV vaccination series (HPV UTD) increased from 51.1% in 2018 to 54.2% in 2019. HPV vaccination coverage measures improved among both females and males.
  • MenACWY and MenB: Adolescent coverage with ≥1 dose of MenACWY increased from 86.6% in 2018 to 88.9% in 2019. Among 17-year-olds, 53.7% received the booster dose of MenACWY in 2019, not statistically different from 50.8% in 2018. Receipt of ≥1 dose of MenB increased from 17.2% in 2018 to 21.8% in 2019.
  • Pertussis: Coverage with ≥1 dose of Tdap remained stable and high (90.2%).
  • Social Trends: Among adolescents living at or above the poverty level, those living outside a metropolitan statistical area had lower coverage with ≥1 dose of MenACWY and with ≥1 HPV vaccine dose, and a lower percentage were HPV UTD, compared with those living in MSA principal cities.

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

Related Links

  • CDC's TeenVaxView gateway page
  • MMWR gateway page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements

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“Choosing Proper Needle Length for Vaccination of Children and Adults: What Should You Consider?” column by Dr. Deborah Wexler—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).

July's column is titled “Choosing Proper Needle Length for Vaccination of Children and Adults: What Should You Consider?” and is available on

Access the complete article here.

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IAC Spotlight! Newly updated “Guide to” is at the bottom of each IAC web page to help you find useful content quickly. Scroll on down.

IAC's newly updated "Guide to" appears at the bottom of each web page. The alphabetized topics link you directly to IAC's gateway pages.

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Advisory Commission for Childhood Vaccines (ACCV) seeks nominations to fill vacant positions 

The Advisory Commission for Childhood Vaccines (ACCV) is accepting nominations to fill vacant positions to serve on the ACCV. The three position categories of ACCV membership are listed below.

  • Health professionals with expertise in healthcare of children, epidemiology and prevention of childhood diseases, and adverse reactions associated with vaccines.
  • Members from the general public, including parents or guardians of children who have suffered a vaccine-related injury or death with a finding by the U.S. Court of Federal Claims or a civil court that a VICP-covered vaccine caused, or was presumed to have caused, the represented child’s injury or death. Based on an ACCV recommendation, the Secretary will consider a health professional with expertise in obstetrics as a member of the general public.
  • Attorneys, one of whom specializes in representing people who have suffered a vaccine-related injury or death, and one of whom must be an attorney whose specialty includes representation of vaccine manufacturers.

The nominees cannot be employees of the United States Government.

Nominations should be sent to Annie Herzog at

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IAC enrolls four new birthing institutions into its Hepatitis B Birth Dose Honor Roll; seven 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 516 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • NYC Health + Hospitals/Elmhurst, Elmhurst, NY (99%)
  • Southwestern Medical Center, Lawton, OK (98%)
  • St. John’s Episcopal Hospital, Far Rockaway, NY (93%)
  • White Oak Medical Center, Silver Spring, MD (93%)

Two institutions are being recognized for a second year:

  • Covenant Children’s Hospital, Lubbock, TX (97%)
  • Sharon Regional Medical Center, Sharon, PA (96%)

Three institutions are being recognized for a third year:

  • Abington Hospital – Jefferson Health, Abington, PA (93%)
  • Phoenixville Hospital, Phoenixville, PA (96%)
  • Pottstown Hospital, Pottstown, PA (91%)

One institution is being recognized for a fourth year: 

  • NYC Health + Hospitals/Queens, Jamaica, NY (99%)

Finally, one institution is being recognized for a fifth year:

  • Lowell General Hospital, Lowell, MA (99%)

The Honor Roll now includes 516 birthing institutions from 44 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred seventeen institutions have qualified for two years, 75 institutions have qualified three times, 37 institutions have qualified four times, 24 institutions have qualified five times, 17 institutions have qualified six times, seven institutions have qualified seven times, two institutions have qualified eight times and one institution has qualified nine 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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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. Check the resources below for the latest information. Stay in touch with your local and state health departments. 

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IAC Handouts

IAC updates “Influenza Vaccine Products for the 2020–2021 Influenza Season” handout for healthcare staff

IAC recently revised its 1-page Influenza Vaccine Products for the 2020–2021 Influenza Season sheet for healthcare professionals.

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IAC posts seven updated translations for “When Do Children and Teens Need Vaccinations?” 

IAC now offers seven updated translations to match the English version of its 1-page patient handout When Do Children and Teens Need Vaccinations? 

When Do Children and Teens Need Vaccinations? has been translated into Arabic, Chinese Simplified, French, Korean, Russian, Spanish, and Vietnamese

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“Screening Checklists for Contraindications to Vaccines” for children/teens and for adults now updated in seven languages

IAC now offers seven updated translations to match the English version of its 2-page parent and provider handout Screening Checklist for Contraindications to Vaccines for Children and Teens. 

IAC also updated seven translations to match the English version of its 2-page parent and provider handout Screening Checklist for Contraindications to Vaccines for Adults


Screening Checklist for Contraindications to Vaccines for Children and Teens has been translated into Arabic, Chinese Simplified, French, Korean, Russian, Spanish, and Vietnamese.

Screening Checklist for Contraindications to Vaccines for Adults has been translated into Arabic, Chinese Traditional, French, Korean, Russian, Spanish, and Vietnamese.

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“Screening Checklist for Contraindications to HPV, MenACWY, MenB, and Tdap Vaccines for Teens” now updated in Spanish

IAC posted a revised Spanish translation of its 2-page screening questionnaire for teens, titled Screening Checklist for Contraindications to HPV, MenACWY, MenB, and Tdap Vaccines for Teens.


View the handout in Spanish.

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Featured Resources

It’s time to start vaccinating against flu. IAC is shipping tens of thousands of our bright red "FLU VACCINE" buttons and stickers! Order yours now!

IAC “FLU VACCINE” buttons and stickers are flying out of our office by the thousands! A half-million stickers already sold this year! 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, these stickers adhere well to clothing and have an easy-peel-off backing.
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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In our “Video of the Week,” a neonatologist explains how he recommends vaccines to parents of premature babies

In this #HowIRecommend video from CDC, neonatologist Dr. Shetal Shah explains how he recommends vaccines to parents of babies in the NICU. He also asks nurses, who build strong relationships with the families, to stress the importance of vaccination in their conversations with parents.

Visit the VOTW archive.

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New vaccine-related resources from AAP, WHO, ACOG, CPHCE, and NY State Department of Health to enhance your practice

New vaccine-related resources and toolkits are available:
  • Preparing for Flu Season gateway page from American Academy of Pediatrics (AAP), provides information to help practices maximize influenza vaccination rates while keeping patients, families, and practice teams safe during the pandemic. The gateway page also includes links to a recording of Preparing Your Practice for the 2020­­–21 Influenza Season: A Virtual Townhall webinar.
  • A Guide to Adolescent Immunizations: Flipchart for Pediatric Offices and Parents, by the AAP Childhood Immunization Support Program, a cooperative agreement with the CDC, is designed for use by pediatricians and other primary care providers during clinical encounters with patients and families. The flipchart focuses on the 10 recommended vaccines routinely provided to children from birth through age 6 years and contains family-friendly infographics and detailed speaking points for providers to aid them in conducting efficient, productive conversations about childhood vaccination. You may request print copies of this flipchart to use with patients or obtain a digital copy of this flipchart here
  • Best Practice Guidance: How to Respond to Vocal Vaccine Deniers in Public from WHO provides basic principles on how to respond to vocal vaccine deniers. The suggestions are based on psychological research on persuasion, research in public health, communication studies, and WHO risk-communication guidelines. 
  • Pregnancy and Immunization: A Guide to Creating Patient Materials from American College of Obstetricians and Gynecologists (ACOG) addresses common concerns of pregnant women. The guide highlights evidence-based considerations to support effective patient education messaging and materials to help pregnant women make informed decisions about receiving vaccines.
  • Vaccine Communication Toolkit compiled by the Center for Public Health Continuing Education (CPHCE) and the New York State Department of Health is designed to help providers enhance their practice systems, with resources for communicating with parents.

Please share these resources to promote vaccination! 

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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)

Download IAC's free book on all aspects of adult immunization, to help train your team and refresh your leaders: Vaccinating Adults: A Step-by-Step Guide (Guide).

This up-to-date, thorough "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.

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 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 vaccination rates. Be sure to get a copy today!

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Journal Articles and Newsletters

JAMA and JN Learning discuss measles vaccine refusal and consequent measles outbreaks in the U.S.

In its August 14 issue, JAMA published Vaccine Refusal and Measles Outbreaks in the US. This review found that unvaccinated individuals constitute the majority of cases in measles outbreaks in the U.S. Most U.S. outbreaks stem from importation of measles by travelers who acquired measles in countries where measles remains endemic. Outbreaks are then sustained in communities where a high proportion of unvaccinated individuals reside. 

JN Learning released a related podcast, titled The Consequences of Not Vaccinating for Measles, in which the study’s senior author, Saad Omer, PhD, from the Yale Institute for Global Health, discusses the challenges in achieving adequate measles vaccination.

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Education and Training

AIRA 2020 National Meeting Presentations offers eight-part webinar series; second half of the series begins on September 1
The American Immunization Registry Association (AIRA) will host the last four of the Select AIRA 2020 National Meeting Presentations webinar series on Tuesdays from 3:00–4:00 p.m. (ET) from September 1–22. This eight-part series showcases key issues affecting immunization information systems (IISs) during the pandemic. The September webinars are scheduled as follows: 

Information on the four webinars can be found here. Space is limited, so register today!

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CDC’s recorded webinar on meningococcal vaccines, as well as eight other segments in the "Pink Book" weekly series, available now

CDC continues its 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). The series discusses vaccination principles, general best practices, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each broadcast includes updated information from recent Advisory Committee on Immunization Practices (ACIP) meetings and votes.

Because of limited CDC staff availability during the ongoing COVID-19 response, the series is prerecorded. 

There is no registration process to view the sessions. The link to each course can be accessed at midday on the indicated date or thereafter.

These weekly 1-hour web-on-demand videos will run through October 14.  

The first eight webinars are available online now. The next three webinars are scheduled as follows:

  • August 26: Measles, Mumps, Rubella
  • September 2: Polio and Hib
  • September 9: Varicella and Zoster

Questions about the material presented can be submitted to Continuing education will be available for each event.

Information and program details are available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at You also can order this resource from the Public Health Foundation for $45 plus shipping and handling.

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On the Lighter Side

2004 PSA from CDC and the Ad Council shows you don’t need to go to extremes to prevent the flu

In this 2004 PSA titled Spaceman, an astronaut does his laundry fully suited-up to avoid catching the flu while out in public. Produced by CDC and the Ad Council, this 30-second spot is part of a PSA collection curated by vaccine expert William L. Atkinson, MD, MPH. 

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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