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Issue 1,597: October 27, 2021
Top Stories

Vaccine Information Statements
Featured Resources
Notable Publications
Upcoming Events  
Top Stories

November 2–3: Watch the virtual ACIP meeting on COVID-19 vaccine recommendation for children age 5–11 years

CDC will convene its Advisory Committee on Immunization Practices (ACIP) on November 2 from 10:00 a.m.–5:00 p.m. (ET) and November 3 from 10:00 a.m.–5:00 p.m. (ET) for an emergency meeting. The committee will discuss COVID-19 vaccine recommendations for children age 5–11 years, among other topics.

No registration is required to watch webcasts of live ACIP meetings or listen via telephone. Opportunities for public comment are described at the website.

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IAC summarizes ACIP meeting on COVID-19 booster doses, October 21
The Advisory Committee on Immunization Practices (ACIP) met on October 20 and 21, 2021. The October 21 session was devoted to COVID-19 vaccine issues, including votes on recommendations for booster doses of Moderna and Janssen (Johnson & Johnson) vaccines. CDC also provided updates on COVID-19 vaccine safety and effectiveness. Presentation slides are available online, and highlights of the meeting are provided below. 
Booster Doses – On October 20, FDA authorized use of booster doses for designated recipients of Moderna and Janssen (Johnson & Johnson) COVID-19 Vaccines. A booster dose for designated recipients of Pfizer-BioNTech COVID-19 Vaccine was authorized on September 22, 2021, and recommended by CDC on September 24. ACIP reviewed these FDA authorizations and used its Evidence to Recommendation (EtR) framework to evaluate them based on criteria of implementation, values, acceptability, resource use, and equity. The Committee unanimously approved use of booster doses for each vaccine, as follows:
Moderna – A single COVID-19 vaccine booster dose is recommended 6 months or more after completion of the mRNA primary series, in the same risk groups* for whom CDC recommended a booster dose of Pfizer-BioNTech, under the FDA’s Emergency Use Authorization. With this vote, designated recipients of either mRNA COVID-19 vaccine are recommended for a booster 6 months after completion of the primary series.
* Risk groups:
  • individuals age 65 years and older should receive a booster;
  • individuals age 18–64 years at high risk of severe COVID-19 should receive a booster; and
  • individuals age 18–64 years who live or work in high-risk settings may receive a booster.
When using Moderna’s vaccine as a booster dose, administer a half-dose (0.25 mL, or 50 mcg), rather than the full 0.5 mL (100 mcg) primary-series dose. The lower dose was highly effective in boosting the immune response of previously vaccinated immunocompetent recipients. Primary and booster doses of different volumes may be drawn from the same vial, which have the same NDC code. Regardless of the volume used, a single Moderna vaccine vial stopper may be punctured no more than 20 times before it must be discarded. Adverse events after the booster are mostly mild or moderate and short-lived and similar to or less frequent than those seen after dose 2 of the primary series.
Patients with moderate to severe immunocompromise who are already recommended to receive an additional mRNA vaccine dose at least 28 days after dose 2 should still receive a third 0.5-mL dose of the product used for the primary series: there is no recommendation at this time for these patients to receive a fourth (booster) dose.
Janssen (Johnson & Johnson)  A single COVID-19 vaccine booster dose is recommended for persons 18 years of age and older, at least 2 months after receipt of the initial Janssen dose, under the FDA’s Emergency Use Authorization.
Due to its consistently lower level of protection against severe COVID-19 disease when compared to mRNA vaccines and evidence that a single booster dose raised the level of protection to be comparable to the mRNA vaccines, all recipients of a Janssen vaccine should receive a booster dose. When using the Janssen COVID-19 Vaccine as a booster dose, use the same dose volume (0.5 mL) as the primary dose.  
Heterologous (“mix and match”) boosting – Although not specifically addressed in the votes, ACIP recommendations support the FDA’s authorization of any COVID-19 vaccine as a booster dose for immunocompetent recipients, regardless of the brand used for the primary series. Evidence from a study by the National Institutes of Health showed that a booster dose of a COVID-19 vaccine different from the primary series yielded the same or better immune response as a booster dose of the same product. The Committee noted that providers should continue to use the same vaccine product for both doses of an mRNA vaccine primary vaccine series.
The timing of the booster dose is based on the recipient’s primary series product, regardless of the product used for the booster dose. In other words, eligible patients who received an mRNA primary series should receive their booster at least 6 months after dose 2. Patients who received a Janssen vaccine should receive a booster dose at least 2 months later.
Additional Clinical Considerations – Consult CDC’s interim clinical considerations for complete guidance on use of COVID-19 vaccines. Highlights of the ACIP discussion of these issues include:
  • “Fully vaccinated” – People who completed a primary vaccine series (i.e., 2-dose mRNA vaccine series or a single dose of the Janssen vaccine) are considered for public health and administrative purposes to be fully vaccinated once 2 weeks have passed since completion of the series.
  • Coadministration – Any COVID-19 vaccine may be given with other vaccines, without regard to timing. If multiple vaccines are given at a single visit, injections should be administered at different injection sites.
Vaccine Safety Review – CDC experts reviewed current data from multiple COVID-19 vaccine safety surveillance systems. There have been no significant changes in the rare safety signals (i.e., myocarditis/pericarditis, thrombosis with thrombocytopenia syndrome [TTS], and Guillain Barré Syndrome [GBS]) previously characterized.  
Future ACIP Meetings
The next ACIP meeting is scheduled for November 2–3. Information about past and future ACIP meetings may be found on the ACIP website.
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IAC summarizes ACIP meeting on pneumococcal, zoster, and influenza vaccines, October 20
The Advisory Committee on Immunization Practices (ACIP) met on October 20 and 21, 2021. On October 20, the committee voted on updated recommendations for pneumococcal and zoster vaccines, and discussed influenza vaccines. The October 21 meeting, devoted to COVID-19 vaccine issues, is summarized separately. Presentation slides are available online; conclusions are highlighted below.   
Pneumococcal Vaccines for Adults – At its September 29 meeting, ACIP reviewed options for use of two pneumococcal conjugate vaccines licensed by FDA earlier in 2021; a 20-valent PCV (PCV20, Prevnar 20, Pfizer), and a 15-valent pneumococcal conjugate vaccine (PCV15, Vaxneuvance, Merck). ACIP weighed options for PCV20 alone and options for PCV15 administered as part of a 2-vaccine series with 23-valent pneumococcal polysaccharide vaccine (PPSV23, Pneumovax 23, Merck). On October 20, ACIP unanimously approved the following two recommendations:
  • Age-based: Adults age 65 years or older who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV20 or PCV15). If PCV15 is used, it should be followed by a dose of PPSV23.
  • Risk-based: Adults age 19 years or older with certain underlying medical conditions or other risk factors who have not previously received a pneumococcal conjugate vaccine or whose previous vaccination history is unknown should receive a pneumococcal conjugate vaccine (either PCV20 or PCV15). If PCV15 is used, this should be followed by a dose of PPSV23. 
No changes were made to the underlying medical conditions and other risk factors for which pneumococcal vaccination is recommended as early as age 19 years: alcoholism, chronic heart/liver/lung disease, cigarette smoking, diabetes mellitus, chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, human immunodeficiency virus, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, congenital or acquired asplenia, sickle cell disease or other hemoglobinopathies, CSF leak, or cochlear implant.
These recommendations, once published by CDC, will replace the current adult pneumococcal vaccination recommendations for PPSV23 and PCV13 (Prevnar 13, Pfizer). Additional implementation guidance, including the recommended interval between doses for the PCV15 followed by PPSV23 regimen, will be included when the clinical considerations are published.
Zoster Vaccine – Recombinant zoster vaccine (RZV, Shingrix, GSK) has been recommended for immunocompetent adults age 50 years and older since January 2018. Compared to this population, people younger than 50 who are immunodeficient or immunosuppressed due to disease or therapy are at equal or greater risk of developing herpes zoster and its complications. Following its Evidence to Recommendation framework, ACIP reviewed available data and unanimously approved the following recommendation:
  • Two doses of recombinant zoster vaccine are recommended for the prevention of herpes zoster and its complications in adults age 19 years or older who are or will be immunodeficient or immunosuppressed due to disease or therapy.
Shingrix has not been evaluated and is not indicated for the prevention of primary varicella infection (chickenpox). Additional guidance related to the management of immunocompromised adults born more recently than 1980 who lack a history of chickenpox or of varicella vaccination will be included in the clinical considerations section of the ACIP recommendation when it is published.
Influenza Vaccines – On October 14, FDA approved lowering the age indication for use of Flucelvax Quadrivalent, a cell culture-based inactivated influenza vaccine, to age 6 months and older at the same dose given to older children and adults (0.5 mL). With this addition, there are now five licensed inactivated influenza vaccines available for use in children beginning at age 6 months. Because the vaccine is already recommended for children age 2 years and older, no ACIP vote is required for immunization providers to begin using the vaccine for all patients, including those in the Vaccines for Children (VFC) program as FDA-approved down to age 6 months.
Coadministration of Influenza and COVID-19 Vaccines – The ACIP reviewed results of the first study demonstrating that short term safety and immune responses to vaccination with influenza and COVID-19 mRNA vaccines at different anatomic locations on the same visit were unaffected by coadministration compared to administering these vaccines at separate visits. This study of Fluzone High-Dose Quadrivalent influenza vaccine (Sanofi) coadministered with a booster dose of Moderna COVID-19 Vaccine supports existing recommendations allowing coadministration of COVID-19 and influenza vaccines.  
Future ACIP Meetings
The next ACIP meeting is scheduled for November 2–3. Information about past and future ACIP meetings may be found on the ACIP website.
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CDC posts web page “COVID-19 Vaccination for Children 5–11 Years Old” to help public health clinics, pharmacists, and community partners plan for COVID-19 vaccination of this age group in near future 

On October 19, CDC posted COVID-19 Vaccination for Children 5–11 Years Old, a web page with up-to-date information and resources for jurisdictions, pediatric healthcare providers, pharmacists, and community partners to aid in planning for COVID-19 vaccination among children age 5–11 years. A link to information for parents and care givers is also provided.

The Food and Drug Administration (FDA) has not yet authorized a COVID-19 vaccine for children age 5 to 11 years, and CDC’s Advisory Committee on Immunization Practices (ACIP) has not yet made a recommendation on vaccinating this age group. CDC will update this web page when new information is available.  

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Hosting happy holidays: CDC guidance emphasizes vaccination for safe gatherings

On October 15, CDC posted Safer Ways to Celebrate Holidays, a web page dedicated to minimizing COVID-19 risk and keeping friends and families safe during the holiday season. Generally, the CDC stresses that the best way to maximize protection from COVID-19 and prevent spreading it to others is to get vaccinated as soon as possible.

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Voices for Vaccines releases podcast with IAC’s L.J Tan, MS, PhD, on the upcoming influenza season co-occurring with the pandemic
Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: Now That We Found COVID What Is Flu Gonna Do? featuring IAC's L.J Tan, MS, PhD. A description from the VFV web page appears below.

Science types hate predicting the future–and L.J Tan from is no exception. So we invited him on to the podcast to discuss what we do know about the upcoming influenza season co-occurring with our long-enduring pandemic. And, of course, we talk about the vaccines for both.

Voices for Vaccines is a national organization of parents and others dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who values vaccines to become a member, use VFV tools in their own community, and get involved with VFV. Please follow Voices for Vaccines on Facebook and spread the word to your friends and colleagues to join!

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IAC Spotlight: Review of resources at focused on communications

In this week's IAC Spotlight, we summarize resources at that focus on communication between healthcare personnel, patients, and caregivers.

IAC's Talking about Vaccines web section provides medical professionals with 11 topical web pages to help them discuss immunization with concerned parents or patients. Examples include Adjuvants, Alternative Medicine, Autism, Religious Concerns, and Thimerosal. 

Unprotected People Stories features 109 real-life accounts of people who suffered or died from vaccine-preventable diseases.

Handouts for Patients and Staff leads to hundreds of patient handouts and fact sheets for healthcare professionals. All items are free to download, print, copy, and distribute widely.

Ask the Experts offers over a thousand timely questions on vaccines and vaccine administration answered by IAC experts. Topics include specific diseases and their vaccines as well as vaccine delivery guidance (e.g., administration, billing, documenting).

Vaccine Basics: Common Questions about Vaccines offers patients and caregivers timely, accurate, and factual information about vaccines and the diseases they prevent. 

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National Academy of Medicine elects 100 new members, including IAC's John Grabenstein, RPh, PhD 
The National Academy of Medicine (NAM) elected 100 new members in October, individuals who have demonstrated outstanding professional achievement and commitment to service. Election into NAM is one of the highest honors in the fields of health and medicine.

IAC is proud to announce its director of scientific communication and managing editor of IAC Express, John D. Grabenstein, RPh, PhD, is among the newly elected members of NAM. John is also the president of Vaccine Dynamics and a retired U.S. Army colonel.

John was cited ”for establishing vaccination services by pharmacists across the U.S. by developing nationally adopted policy frameworks and curricula that trained more than 360,000 pharmacists as vaccinators, enabling rapid, widespread delivery of COVID-19 and other vaccines; for advancing international vaccination and medical countermeasure programs; and for contributions to pharmacy national leadership development.”

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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.

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Vaccine Information Statements
CDC releases four updated Vaccine Information Statements (VISs) for immediate use; translations in progress

On October 15, CDC posted four updated Vaccine Information Statements (VISs). Access these VISs on their respective IAC web pages by clicking the links below. 

CDC encourages providers to begin using these VISs immediately; however, existing supplies of the previous editions may be used until they are depleted.

IAC will post translations of these new VISs on as they become available over the next several weeks. 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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Featured Resources

Scare off COVID-19 this Halloween! IAC offers FREE "I Got My COVID-19 Vaccine" buttons and stickers. Available in English and Spanish.

Anyone 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. 

Click the picture below to go directly to the order form.

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Got your COVID-19 booster recently? Encourage friends to follow your lead by adding IAC’s “I Got My COVID-19 Vaccine” Facebook profile photo frame.

Share your excitement about COVID-19 vaccination and inspire your friends! After you are vaccinated against COVID-19, add IAC's new "I Got My COVID-19 Vaccine" Facebook photo frame to liven up your profile picture!

You can obtain the frame in three ways:

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Notable Publications

“Effectiveness of Pfizer-BioNTech mRNA Vaccination against COVID-19 Hospitalization among Persons Aged 12–18 Years—United States, June–September 2021” published in MMWR 

CDC published Effectiveness of Pfizer-BioNTech mRNA Vaccination against COVID-19 Hospitalization among Persons Aged 12–18 Years—United States, June–September 2021 on October 22 in MMWR. A portion of the summary appears below.

Among hospitalized U.S. patients aged 12–18 years, vaccine effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization during June–September 2021, was 93% (95% confidence interval = 83%–97%)....

Findings reinforce the importance of vaccination to protect U.S. youths against severe COVID-19.

Access the MMWR article in HTML or PDF.

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“COVID-19 Vaccination and Non-COVID-19 Mortality Risk—Seven Integrated Health Care Organizations, United States, December 14, 2020–July 31, 2021” published in MMWR Early Release 

CDC published COVID-19 Vaccination and Non-COVID-19 Mortality Risk—Seven Integrated Health Care Organizations, United States, December 14, 2020–July 31, 2021 in the October 22 MMWR Early Release. A portion of the summary appears below.

Although deaths after COVID-19 vaccination have been reported to the Vaccine Adverse Events Reporting System, few studies have been conducted to evaluate mortality not associated with COVID-19 among vaccinated and unvaccinated groups....

During December 2020–July 2021, COVID-19 vaccine recipients had lower rates of non–COVID-19 mortality than did unvaccinated persons after adjusting for age, sex, race and ethnicity, and study site....

There is no increased risk for mortality among COVID-19 vaccine recipients. This finding reinforces the safety profile of currently approved COVID-19 vaccines in the United States. All persons aged > 12 years should receive a COVID-19 vaccine.

Access the MMWR Early Release article in HTML or PDF.

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“COVID-19 Vaccination during Pregnancy and First-Trimester Miscarriage” published in NEJM 

In the October 20 issue, NEJM published COVID-19 Vaccination during Pregnancy and First-Trimester Miscarriage. A portion of the article appears below.  

Pregnant women with coronavirus disease 2019 (Covid-19) are at increased risk for adverse outcomes, and Covid-19 vaccination is recommended during pregnancy....

...Our study found no evidence of an increased risk for early pregnancy loss after Covid-19 vaccination and adds to the findings from other reports supporting Covid-19 vaccination during pregnancy. 

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Upcoming Events
Tomorrow! Virtual: ACOG hosts webinar titled "COVID-19 Vaccination during Pregnancy: What You Need to Know" on October 28.

The American College of Obstetricians and Gynecologists (ACOG) will host a webinar titled COVID-19 Vaccination during Pregnancy: What You Need to Know on Thursday, October 28 from 1:00–2:00 p.m. (ET). During this webinar, participants will hear presentations from CDC, ACOG, and the Association of Immunization Managers (AIM).

Register for the free event.

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Virtual: CDC offers webinar titled “Influenza Update—2021–2022” on November 3; seats are limited, recording will be posted

CDC will host a webinar titled Influenza Update—2021–2022 on November 3 from 12:00–1:00 p.m. (ET). The event will be moderated by Andrew Kroger, MD, MPH, and the speaker will be Lisa Grohskopf, MD, MPH, both from the National Center for Immunization and Respiratory Diseases (NCIRD) at CDC. Registration will not be needed for the event; however, seating is limited. A recording will be posted after the event. 

View webinar information.
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

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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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