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Issue 1,593: October 6, 2021
Top Stories Pages and Handouts   
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Notable Publications
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Top Stories

CDC issues urgent health advisory to increase COVID-19 vaccination for people before, after, or during pregnancy

On September 29, CDC issued an urgent health advisory to increase COVID-19 vaccination among people who are pregnant, recently were pregnant (including those who are lactating), are trying to become pregnant, or might become pregnant in the future. A portion of the media statement appears below. 

The CDC health advisory strongly recommends COVID-19 vaccination either before or during pregnancy because the benefits of vaccination for both pregnant persons and their fetus or infant outweigh known or potential risks. Additionally, the advisory calls on health departments and clinicians to educate pregnant people on the benefits of vaccination and the safety of recommended vaccines.
According to CDC data, only 31 percent of pregnant people have been vaccinated against COVID-19 and vaccination rates vary markedly by race and ethnicity. Vaccination coverage is highest among Asian people who are pregnant (45.7 percent), but lower among Hispanic or Latino pregnant people (25 percent), and lowest among Black pregnant people (15.6 percent).
Through September 27th, there were more than 125,000 confirmed cases of COVID-19 in pregnant people including more than 22,000 hospitalized and 161 deaths; of which, 22 deaths occurred in the month of August alone. Cases of COVID-19 in symptomatic, pregnant people have a two-fold risk of admission into intensive care and a 70 percent increased risk of death. Pregnant people with COVID-19 are at increased risk of adverse pregnancy outcomes that could include preterm birth, stillbirth, and admission into the ICU of a newborn also infected with COVID-19.

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IAC summarizes September 29 ACIP meeting on zoster, pneumococcal, and hepatitis B vaccination and other diseases

The Advisory Committee on Immunization Practices (ACIP) met on September 29, 2021, to review information on vaccines to prevent tick-borne encephalitis (TBE), zoster, pneumococcal disease, hepatitis B, and orthopoxvirus diseases. With the exception of TBE, the Committee reviewed each vaccine using its Evidence to Recommendations (EtR) framework to prepare for potential votes during future meetings. No votes were held at this meeting. Presentation slides are available online, and highlights of the meeting are provided below.
Tick-borne encephalitis (TBE) vaccine – Information was presented on the safety and immunogenicity of TBE vaccine (Ticovac, Pfizer) licensed by FDA on August 13, 2021, as a 3-dose primary series (with a booster, if needed, after 3 years) administered intramuscularly to individuals age 1 year or older. TBE does not occur naturally in the Americas; however, this vaccine and similar vaccines have been in use in endemic countries for decades with high levels of effectiveness against TBE reported. ACIP is considering recommendations for U.S. adults and children at risk of exposure to infected ticks while traveling in endemic regions of Europe and Asia and workers at risk of exposure to TBE virus in a laboratory setting. Because the disease is rare, the vaccine has been approved based on its immunogenicity, with protective antibody levels detected in at least 94% of vaccine recipients after 3 years. Available data identified no major safety issues and few systemic or severe local reactions reported. A vote is proposed for the February 2022 ACIP meeting.
Zoster vaccine – ACIP discussed policy options and evidence to support the use of recombinant shingles vaccine (Shingrix, GSK) as a 2-dose series in immunocompromised people age 19 years and older. Because Shingrix is already recommended for immunocompetent adults age 50 years and older and licensed for all adults age 50 and older, there was little specific discussion of this age group. The benefit of vaccination varies widely due to the different degrees of risk of shingles and its complications among people with different types of immunocompromising conditions. However, adults age 19 through 49 with common autoimmune conditions, such as psoriasis, remain at 2- to 4-fold higher risk than the healthy people age 50 or older currently recommended for vaccination. Due to this variability, the work group endorsed support for a simple, broad ACIP recommendation. A vote is anticipated at a future ACIP meeting.
Pneumococcal vaccine – ACIP reviewed policy options for the use of two new pneumococcal conjugate vaccines licensed by FDA during summer 2021: a 15-valent pneumococcal conjugate vaccine (PCV15, Merck) and a 20-valent PCV (PCV20, Pfizer). They compared each vaccine separately against current pneumococcal vaccine recommendations. They did not compare the two new vaccines against each other. The work group had settled on a list of possible policies. For PCV20, they evaluated the evidence to support recommending PCV20 for all adults beginning at either age 50 years or age 65 years, and they also evaluated PCV20 for younger adults beginning at age 19 years who have chronic medical conditions or immunocompromise. For PCV15, the work group considered it only if used in combination with the current 23-valent pneumococcal polysaccharide vaccine (PPSV23), beginning at 65 and older for all or beginning at age 19 years for people with chronic medical conditions or immunocompromise. Economically, the PCV20 recommendations were more favorable than the PCV15+PPSV23 options; however, it is possible for the ACIP to recommend both. Discussion focused on the complexity of the pneumococcal vaccination schedule and hopes for a simpler set of recommendations. A vote is anticipated at the upcoming October 20–21 meeting.
Hepatitis B vaccine (HepB) – ACIP reviewed evidence to support a potential recommendation for HepB vaccination of all unvaccinated adults, replacing the current recommendations that limit HepB vaccination to those who report risk factors or who request it. Such an expansion would address persistent rates of acute hepatitis B infection among adults, especially those age 30 to 50 years without reported risk factors. There are federal public health goals to reduce acute hepatitis B infections by 90% by 2030, but adult vaccination rates remain low. In addition to the policy discussion, a large, observational safety study was presented comparing the risk of an acute myocardial infarction after vaccination with either 3-dose hepatitis B vaccine (Engerix-B, GSK) or 2-dose hepatitis B vaccine (Heplisav-B, Dynavax) showing no evidence of any difference in risk of acute myocardial infarction by type of hepatitis B vaccine given. After receiving the work group’s conclusion to recommend the expansion, the committee discussed the relative value of a universal vaccination policy compared to the current risk-based recommendations. A vote is anticipated for the upcoming October 20–21 ACIP meeting.
Orthopoxvirus vaccines – The committee ended its day with a discussion of proposed recommendations for the use of a non-replicating vaccine (Jynneos, Bavarian Nordic) against orthopoxviruses (a family of viruses that includes monkeypox, vaccinia, and smallpox). Jynneos is approved as a 2-dose series (0, 4 weeks) administered subcutaneously and available only through the federal Strategic National Stockpile (SNS) to designated recipients. The vaccine is being considered by ACIP only for research and clinical laboratory personnel performing diagnostic testing for orthopoxviruses and for designated response teams at risk of occupational exposure. Booster doses are being considered every 2 years for individuals at ongoing risk of exposure to high virulence orthopoxviruses (i.e., monkeypox, smallpox) and every 10 years for individuals at ongoing risk of exposure to lower virulence orthopoxviruses (e.g., cowpox, vaccinia). Jynneos is being considered as an alternative to the current live vaccinia vaccine, ACAM2000 (Emergent BioSolutions), which is based on the traditional smallpox vaccine and administered by scarification of the skin. As a non-replicating vaccine, Jynneos has a lower risk of serious adverse events and fewer contraindications than ACAM2000. A vote is proposed for the October 20–21 meeting.

Future ACIP Meetings
The next regularly scheduled ACIP meeting will be held on October 20–21. However, in the interim, ACIP may call additional meetings to address updated recommendations for use of any FDA-authorized COVID-19 vaccine(s). Information about past and future ACIP meetings may be found on the ACIP website.

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New VIS translations to download now: IAC posts Arabic, Burmese, French, and Somali translations of August 6 Vaccine Information Statements for multiple vaccines
IAC has posted new translations of Vaccine Information Statements (VISs) issued by CDC on August 6. The new languages available are Arabic, Burmese, French, and Somali. All translations are available in PDF and print-ready format.

VIS translations in Arabic: VIS translations in Burmese:·      VIS translations in French: VIS translations in Somali: These join the other languages previously announced in IACX: Chinese (Simplified and Traditional), Dari, Pashto, Russian, Spanish, Turkish, and Vietnamese.

Translations of previous VIS versions may be used until new translations become available. CDC states that the corresponding up-to-date English-language VIS must also be supplied when providing an out-of-date translation.

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"Safety Monitoring of an Additional Dose of COVID-19 Vaccine—United States, August 12–September 19, 2021" published in MMWR Early Release

CDC published Safety Monitoring of an Additional Dose of COVID-19 Vaccine—United States, August 12–September 19, 2021 on September 28 as an MMWR Early Release. A portion of the summary appears below.

Among 306 Pfizer-BioNTech clinical trial participants, adverse reactions after dose 3 were similar to those after dose 2....

During August 12–September 19, 2021, among 12,591 v-safe registrants who completed a health check-in survey after all 3 doses of an mRNA COVID-19 vaccine, 79.4% and 74.1% reported local or systemic reactions, respectively, after the third dose; 77.6% and 76.5% reported local or systemic reactions after the second dose, respectively....

Voluntary reports to v-safe found no unexpected patterns of adverse reactions after an additional dose of COVID-19 vaccine. CDC will continue to monitor vaccine safety, including for additional COVID-19 doses.

Access the MMWR Early Release article in HTML or PDF.

Related Link

  • MMWR's main page provides access to MMWR Weekly and its companion publications

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IAC Spotlight: Check out the resources to help with your vaccine advocacy

In this week's IAC Spotlight, we summarize resources at that focus on aiding in your vaccine advocacy efforts.

Our State Laws and Mandates by Vaccine main page contains links to vaccine-specific requirements state-by-state for daycare, K-12, and post-secondary education settings. State-specific information about exemption policies is available as well.

Our State Exemptions main page offers information on state mandates by vaccine-preventable disease. It includes policy statements from medical organizations endorsing strong school and childcare vaccination requirements and the elimination of non-medical exemptions.

Our State Information: Exemptions Permitted for State Immunization Requirements web page shows which states allow medical, religious, and personal vaccination exemptions and offers a map of exemptions permitted for school and child care.

Our State Information: Direct Links to State Immunization Websites main page offers links to each state's vaccination policy web page.  

Our Talking about Vaccines main page provides medical professionals with background information and practical resources divided into different topics that will help them discuss immunization with concerned parents or patients. 

Our Unprotected People Stories main page features 109 real-life accounts of people who have suffered or died from vaccine-preventable diseases: compelling personal testimonies, remembrances, case reports, and newspaper articles.

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IAC’s Hepatitis B Birth Dose Honor Roll recognizes 540 institutions, including one new honoree. Five previously honored institutions qualify for additional years' honors.

The Immunization Action Coalition (IAC) is pleased to announce that one new institution has been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 540 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.
  • Brigham and Women’s Hospital, Boston, MA (92%)
One institution is being recognized for a second year:
  • Salina Regional Health Center, Salina, KS (91%)
Two institutions are being recognized for a third year:
  • Covenant Children’s Hospital, Lubbock, TX (93%)
  • Geary Community Hospital, Junction City, KS (94%)
One institution is being recognized for a fourth year:
  • Greene County General Hospital, Linton, IN (96%)
Finally, one institution is being recognized for a fifth year:
  • ChristianaCare Christiana Hospital, Newark, DE (93%)
The Honor Roll now includes 540 birthing institutions from 44 states, Puerto Rico, Guam, Saipan, and a U.S. military base in England. One hundred twenty-two institutions have qualified twice, 73 institutions have qualified three times, 42 institutions have qualified four times, 25 institutions have qualified five times, 23 institutions have qualified six times, eight 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% 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 before 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 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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Your colleagues don’t want to be the last to know. Urge them to subscribe to IAC Express for free.

IAC Express, the free week ly e-newsletter produced by the Immunization Action Coalition (IAC), succinctly summarizes each week’s important vaccine developments, including new and updated recommendations from CDC and the latest vaccine decisions by FDA. IAC Express also features newly posted Vaccine Information Statements and their translations, plus educational materials from IAC, CDC, AAP, and others. Subscribers learn about online and in-person educational opportunities, many offering free continuing education credit.

We appreciate you as a subscriber! Encourage your co-workers to subscribe to IAC Express themselves so they get everything that matters to vaccinators in their own inbox each Wednesday.

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Journalists interview IAC experts
Journalists seek out IAC experts to help explain vaccines to the public and policy makers. We help the media understand and communicate the complex work vaccinators do. Here is a selection of our recent citations. Related Link

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Vaccines in the news

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

Back to top Pages and Handouts 
IAC and AIM update print-ready training tool: "Communicating the Benefits of Influenza Vaccine during COVID-19" 

IAC and the Association of Immunization Managers (AIM) recently updated the print-ready training tool Communicating the Benefits of Influenza Vaccine during COVID-19 for discussing the flu vaccine with patients. The 2021–2022 influenza season modifications include:

  • Updated CDC estimates of the annual impact from influenza
  • Updated influenza vaccination rates
  • Acknowledgement of the risk of increased influenza activity in the 2021–22 season as masking and social distancing are relaxed
  • Calls for co-administration of influenza and COVID-19 vaccines for those who need both
  • Updated references

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Echo: These updated IAC educational materials for clinicians were released during August and September

IAC Express regularly provides readers with information about IAC’s new and updated educational materials for healthcare professionals and handouts for patients. All IAC materials are free to distribute.
In case you missed them during recent weeks, updates were made to these helpful materials:

IAC’s Updated Materials for Clinicians IAC’s Updated Influenza Web Page and Materials for Clinicians Related Links

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Vaccine Information Statements
Echo: These new VISs and VIS translations were released during August and September

IAC Express regularly provides readers with information about Vaccine Information Statements (VISs) and translations of VISs.
In August, CDC released updated final versions of 14 VISs. During September, IAC posted translations in Arabic, Burmese, Chinese (Simplified and Traditional), Dari, French, Pashto, Russian, Somali, Spanish, Turkish, and Vietnamese. Here are links to the web page of each new VIS and the available translations: 

Plus, two IAC handouts related to VISs were updated: Dates of Current Vaccine Information Statements (VISs) and You Must Provide Patients with Vaccine Information Statements (VISs) – It's Federal Law!

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Featured Resources

CDC provides field guide with 12 evidence-based strategies to promote COVID-19 vaccination confidence and uptake 
CDC has produced the COVID-19 Vaccination Field Guide: 12 Strategies for Your Community to promote COVID-19 vaccination. This guide highlights several strategies derived from evidence-based practices that are being applied in communities to promote vaccine confidence and uptake. The guide is intended to support the work of health departments, community organizations, faith-based communities, and leaders from all sectors of public life.

The first section highlights some common barriers that communities experience in vaccine confidence and uptake. Because not all barriers are relevant in all communities, the second section of this guide offers tools you can use to identify and understand what barriers and facilitators may be factors in your community. You may need only one of these tools or several to increase your understanding of your community. The final section describes 12 strategies to increase vaccine confidence and uptake. The research that supports each strategy is provided along with case study examples.

While most of the guide focuses on increasing vaccine uptake, several strategies address increasing vaccine confidence. Each strategy highlights the approach, population(s) served, location, barriers addressed, basis in research, and an example of how the strategy is currently being applied to address COVID-19 vaccination.

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Public Health Communications Collaborative releases resources to help answer questions about COVID-19 vaccine booster doses and support vaccination outreach

Public Health Communications Collaborative offers resources to address questions about COVID-19 vaccine booster doses and support local vaccination outreach. The resources include: 

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Spread the word, not the virus! IAC offers FREE “I Got My COVID-19 Vaccine” buttons and stickers to those promoting vaccination in hesitant communities. Available in English and Spanish.

Any group or person promoting COVID-19 vaccination can order IAC’s FREE “I Got My COVID-19 Vaccine” buttons and stickers, provided with support from CDC. Available in English and Spanish, the buttons and stickers look great on lab coats, uniforms, jackets, lanyards, ID badges, or backpacks to show confidence in COVID-19 vaccination. Access this order form to request the FREE buttons and stickers for your outreach efforts while supplies last.


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Explore the updated website to increase coverage for the MenACWY booster and other adolescent vaccinations

IAC’s website promotes the importance of adolescent vaccination, including administering the recommended booster dose of MenACWY vaccine at age 16. Many teens are behind on vaccines because of the pandemic, so adolescent vaccination is more important than ever.

Original materials on this colorful website for healthcare professionals have been updated to incorporate the 2020 ACIP meningococcal vaccine recommendations and the most recent vaccine coverage statistics from CDC’s National Immunization Survey–Teen (NIS–Teen). One particularly popular resource on the site is the updated Algorithm for MenACWY Immunization in Adolescents 11–18 Years of Age.


The website’s navigation structure makes locating information a breeze; it is divided into five easy-to-access sections:

The site also categorizes materials according to whether they are primarily of interest to providers, to adolescents, or to parents.

Visit and enjoy browsing (and deploying) its bountiful resources.

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IAC's red "FLU VACCINE" buttons and stickers are a bright idea. Order today!

Remember to order your IAC “FLU VACCINE” buttons and stickers. They are ready to ship! Their bright red color highlights your important message about the need for influenza vaccination. And the cost is reasonable.



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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IAC's Calendar of Events provides information about federal, state, and national partners' vaccination conferences, as well as professional societies' annual meetings

IAC maintains a Calendar of Events on its website for healthcare professionals at This is an easy way to find out about upcoming regional, state, and national conferences, workshops, and electronic continuing educational opportunities. The calendar also includes special weeks of observances.

If you have a vaccination-related event that you would like your colleagues to know about via this Calendar of Events, email IAC.

You can locate IAC's "Calendar of Events" web page in the “Guide to” index at the bottom of every web page.

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Notable Publications
CHOP's Vaccine Education Center publishes September issue of Vaccine Update newsletter

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

Additional resources, including information booklets for patients, are available in the full newsletter.

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

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"Disparities in COVID-19 Vaccination Status, Intent, and Perceived Access for Noninstitutionalized Adults, by Disability Status—National Immunization Survey Adult COVID Module, United States, May 30–June 26, 2021" published in MMWR 

CDC published Disparities in COVID-19 Vaccination Status, Intent, and Perceived Access for Noninstitutionalized Adults, by Disability Status—National Immunization Survey Adult COVID Module, United States, May 30–June 26, 2021 in a September 30 MMWR. A summary appears below. 

An analysis of CDC survey data show adults with a disability were more likely to report difficulty getting a COVID-19 vaccine compared to adults without a disability. Despite disparities related to COVID-19 vaccine access, adults with a disability are less likely to report vaccine hesitancy compared to adults without a disability....Adults with a disability were more likely to report difficulty getting a COVID-19 vaccine due to challenges with getting an appointment online, not knowing where to get vaccinated, and getting to a vaccination site compared to adults without a disability. Efforts that make COVID-19 vaccination more accessible for adults with disabilities could help address inequities and increase vaccination demand and coverage.

Access the MMWR article in HTML or PDF.

Related Link

  • MMWR's main page provides access to MMWR Weekly and its companion publications

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“Protection of BNT162b2 Vaccine Booster against COVID-19 in Israel” published in NEJM

In the September 15 issue, NEJM published Protection of BNT162b2 Vaccine Booster against COVID-19 in Israel. The conclusions section appears below. 

In this study involving participants who were 60 years of age or older and had received two doses of the [Pfizer-BioNTech] BNT162b2 vaccine at least 5 months earlier, we found that the rates of confirmed Covid-19 and severe illness were substantially lower among those who received a booster (third) dose of the BNT162b2 vaccine.

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“Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel” published in NEJM

In the September 22 issue, NEJM published Effectiveness of mRNA Covid-19 Vaccine among U.S. Health Care Personnel. The conclusions section appears below. 

The [Pfizer-BioNTech] BNT162b2 and [Moderna] mRNA-1273 vaccines were highly effective under real-world conditions in preventing symptomatic Covid-19 in health care personnel, including those at risk for severe Covid-19 and those in racial and ethnic groups that have been disproportionately affected by the pandemic. 

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Upcoming Events
Virtual: Massachusetts Immunization Action Partnership hosts 26th annual "MIAP Pediatric Immunization Skills Building Conference" on October 28; CE available

Massachusetts Immunization Action Partnership (MIAP) will host 26th Annual MIAP Pediatric Immunization Skills Building Conference from 8:00 a.m.–3:45 p.m. (ET) on October 28. This full-day virtual pediatric conference will provide up-to-date information with an emphasis on current recommendations and general updates. Learning objectives include: 
  • Summarize the current Advisory Committee on Immunization Practices (ACIP) schedules and recommendations
  • Cite two current topics related to immunizations in Massachusetts and nationally
  • Describe current COVID-19 vaccine recommendations
  • Review strategies to identify and catch up children who have fallen behind on their vaccinations
CE is available upon completion of the event. There is a $75 fee to attend.

Register for the event.

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Virtual: University of Nevada, Las Vegas offers webinar titled COVID-19 Vaccines, Masks, and Mandates: Exploring the Legal Boundaries of Public Health Protections on November 4

The University of Nevada, Las Vegas (UNLV), William S. Boyd School of Law will host COVID-19 Vaccines, Masks, and Mandates: Exploring the Legal Boundaries of Public Health Protections from 3:00–4:00 p.m. (PT) on November 4. As virus variations, vaccine hesitancy, and political divergences over personal freedoms fuel a new surge of the COVID-19 pandemic, governments and businesses have adopted or renewed mandates for vaccination, masking, closures, and other measures to stem the rising tide of cases. In this presentation, James G. Hodge, Jr., JD, LLM, director of the Center for Public Health Law and Policy at the Sandra Day O’Connor College of Law, Arizona State University, will discuss legal supports, limits, and practicalities underlying mandates and other public health preventative measures in an evolving legal and political environment.

Register for the event.

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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. 1NH23IP922654 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:
Immunization Action Coalition
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About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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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