Issue 1,601: November 24, 2021
Top Stories Pages and Handouts 
Featured Resources
Notable Publications
Upcoming Events  
Top Stories

IAC summarizes November 19 ACIP meeting expanding recommendations for COVID-19 vaccine boosters to include all adults age 18 years and older

The Advisory Committee on Immunization Practices (ACIP) met on November 19, 2021, to consider FDA’s authorization to expand and simplify eligibility for COVID-19 vaccine booster doses to all adults age 18 years and older who have completed a primary series. Adults who received Janssen (Johnson & Johnson) COVID-19 Vaccine are already eligible for a booster dose with any authorized COVID-19 vaccine at least 2 months after their first dose. ACIP unanimously voted to recommend a booster dose for all recipients of an mRNA vaccine primary series (Pfizer-BioNTech or Moderna). ACIP made a stronger recommendation for certain groups, stating that all eligible individuals age 50 years or older and all residents of long-term care facilities should receive a booster, while those 18 through 49 may receive a booster. Presentation slides are available online, and highlights of the meeting are provided below.
Any COVID-19 vaccine may be used as a booster dose for any person age 18 or older who is due for one. The timing of the booster dose depends on the primary series. Boosters for recipients of an mRNA vaccine primary series (Pfizer-BioNTech or Moderna) should be given at least 6 months after completion of the series, whereas the booster dose following Janssen (Johnson & Johnson) COVID-19 Vaccine should be given at least 2 months after the primary dose.
Updated booster dose guidance is included in the latest versions of the FDA COVID-19 Vaccine Fact Sheets (see Related Links below), and detailed clinical guidance is now available in CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States.
In making this decision, ACIP applied its Evidence to Recommendation framework, which demonstrated that the known and potential benefits of the booster dose for all adults far outweighed the risks. ACIP members also noted that the complexity of the previous recommendations (limited to certain age groups and others with specific medical or occupational risks) caused considerable confusion among both patients and healthcare personnel. Results of a Kaiser Family Foundation poll presented at the meeting indicated 4 in 10 fully vaccinated adults were unsure whether they were eligible for a booster dose.   
Additional discussion topic: CDC Emergency Use Instructions (EUI) for Pfizer-BioNTech COVID-19 Vaccine in recipients of non-FDA authorized/approved COVID-19 vaccines
Although not part of the ACIP vote, ACIP briefly reviewed CDC’s November 17 release of EUI (for Healthcare Providers and Recipients and Caregivers) providing guidance for the use of a single dose of Pfizer-BioNTech COVID-19 Vaccine as a booster dose in adults age 18 years or older who completed primary vaccination with a non-FDA authorized or approved COVID-19 vaccine (see separate article). This guidance addresses individuals vaccinated outside the United States with a COVID-19 vaccine listed for emergency use by the World Health Organization or those vaccinated as part of clinical trials for vaccines that have not received FDA authorization. Additional guidance is located in CDC’s interim clinical considerations under “People Who Received COVID-19 Vaccine outside the United States" and “People Who Received COVID-19 Vaccine as Part of a Clinical Trial.”
Future ACIP Meetings
The next scheduled ACIP meeting will be held February 23–24, 2022. Information about past and future ACIP meetings may be found on the ACIP website.
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Influenza is returning! CDC urges vaccination now, investigates large outbreak on University of Michigan campus.

On November 15, CDC announced that Weekly U.S. Influenza Surveillance Report, FluView, shows increasing flu activity, consistent with typical influenza seasonal activity. Most cases have been found in young adults and children, who are the main drivers of the community spread of flu virus. Anyone who has not received flu vaccine this season should get vaccinated now.
The University of Michigan reported a large and sudden increase in cases of flu among students on the Ann Arbor campus. CDC is working with the Michigan Department of Health and Human Services (MDHHS), Washtenaw County Health Department, and the University of Michigan to investigate the outbreak. This increase in flu activity as the holiday season is about to begin underscores the importance of flu vaccination, yet vaccination rates to date are considerably lower than last season. 

CDC's new Weekly Flu Vaccination Dashboard shares preliminary vaccination data. Through November 6, flu vaccination among all children is 6 percentage points lower than this time last year (34.3% compared to 40.3%) and flu vaccination among pregnant people is 17 percentage points lower this season as of October 2021 compared with last season (40.8% compared to 58.2%).
Flu vaccination is the best way to prevent the spread of flu and widespread flu illnesses. CDC recommends everyone age 6 months and older get an annual flu vaccine. Influenza and COVID-19 vaccines may be given at the same visit, if needed. COVID-19 vaccination alone provides no protection from influenza or any other respiratory virus. 

Visit Weekly U.S. Influenza Surveillance Report, FluView, and Weekly Flu Vaccination Dashboard regularly to stay informed about influenza in your community this season.

If you don’t provide influenza vaccine at your site, please strongly recommend vaccination and refer people to sites that do vaccinate. Boston Children’s Hospital, in partnership with CDC, has developed VaccineFinder, a user-friendly website to help people of all ages find influenza, COVID-19, and other vaccines. Participating providers can now update their vaccine inventory estimates on VaccineFinder. For questions or more information, contact

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Help us improve your website experience. Please take 5 minutes to complete our website user-feedback survey.

Launched in 1994, one of the earliest websites devoted to immunization, is the premier non-profit web-based resource for practical, user-friendly immunization information available today, serving about 35,000 visitors per day. The website houses IAC's collection of more than 250 healthcare professional immunization education materials and patient handouts. These materials are available free of charge, and users are encouraged to download them, make copies, and distribute them. This website also makes available all Vaccine Information Statements (VISs) published in the United States, with translations available in more than 47 languages. Users download more than 8 million print-ready documents from the website each year. 

Your feedback will help us improve your experience on the website. Please take 5 minutes to complete this website user experience survey to help us shape the next generation of our website.  

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IAC posts new translations in Burmese, Russian, Somali, and Vietnamese of Vaccine Information Statements (VISs) released by CDC on October 15, 2021

On October 15th, CDC released updated final versions of the Hepatitis A, Hepatitis B, Multi-vaccine Pediatric, and Rotavirus VISs. These have been translated into four additional languages: Burmese, Russian, Somali, and Vietnamese. All translations are available in PDF.

VIS translations in Burmese:

VIS translations in Russian:

VIS translations in Somali:

VIS translations in 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.

Related Links

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CDC issues emergency use instructions and guidance for the use of Pfizer-BioNTech COVID-19 Vaccine among recipients of COVID-19 vaccines not authorized in the United States

On November 17, CDC issued COVID-19 Vaccine Emergency Use Instructions (EUI) Resources and updated its Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States to allow for the use of Pfizer-BioNTech COVID-19 vaccine as an additional primary dose (for the immunocompromised) or as a booster dose to people who were vaccinated outside of the United States with certain COVID-19 vaccines that are not authorized or approved by the FDA, or who received certain non-FDA authorized or approved COVID-19 vaccines through participation in clinical trials. 

CDC summarized the November 17 changes in its Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States

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November 22 designated Public Health Thank You Day. IAC adds our thanks as the nation recognizes our dedicated public health workforce!

Public health professionals have been leaders in the COVID-19 response from day one, making sure their communities have access to accurate information, critical public health interventions, and resources. This Thanksgiving season the nation recognizes the contributions, sacrifices, and hard work of public health professionals.

November 22 was declared Public Health Thank You Day. At a special ceremony, speakers from the White House COVID-19 Response Team, HHS Secretary Xavier Becerra, and CDC Director Rochelle Walensky shared their thoughts on the public health community and thanked them for their efforts to protect those in need during the pandemic. State and local health officials also joined in to laud the advancements made to strengthen the U.S. public health infrastructure. 

Watch the White House Virtual Event: Public Health Community Appreciation Town Hall virtual event recording.

The Association of Immunization Managers (AIM) has also put together a brief Public Health Thank You Day video celebrating and thanking immunization program managers and staff for their dedication throughout the pandemic. Please share this video with your public health friends and colleagues.

Today, IAC adds our heartfelt thanks to each public healthcare professional working tirelessly to make our nation safe this holiday season and always. It is a privilege for us to support your work.

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IAC Spotlight! Review of resources at focused on vaccine products

In this week's IAC Spotlight, we summarize resources at that focus on specific vaccine products. 

Our Vaccines main page links to information about 23 vaccines and the diseases they prevent. For each vaccine, access the latest recommendations, information, and up-to-date resources from IAC and CDC.

Our Package Inserts and FDA Product Approvals main page is a handy resource for clinics that administer vaccines. The main page provides up-to-date product information links for all vaccines licensed for use in the U.S., as well as links to FDA vaccine approval web pages. 

Our Standing Orders Templates for Administering Vaccines main page contains 36 templates and related resources for vaccines recommended for children, teens, and adults. The page links to CDC’s standing orders templates for administering COVID-19 vaccines.

Our Vaccine Manufacturers main page provides links to the websites of the vaccine manufacturers in the United States, as well as contact information such as telephone numbers and email addresses. In addition, the vaccine products for each of the companies are listed.

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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 updates “Administering Vaccines: Dose, Route, Site, and Needle Size” print-ready handouts

IAC recently updated its one-page handout Administering Vaccines: Dose, Route, Site, and Needle Size to expand the age parameters for COVID-19 vaccine to include individuals age 5 and older, to update details for the Moderna COVID-19 Vaccine and Flucelvax, and to add an option to use the anterolateral thigh for intramuscular injections in adults. 

IAC also updated its Administering Vaccines to Adults: Dose, Route, Site, and Needle Size to include the COVID-19 vaccine in the vaccine table, and the option of using the anterolateral thigh for intramuscular injections to the injection site table. 

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Featured Resources

Resolve to Save Lives creates “Voices of Long COVID” campaign to increase COVID-19 vaccine uptake

On November 16, Resolve to Save Lives (RTSL), an initiative of the global public health organization Vital Strategies, launched its Voices of Long COVID campaign to increase public awareness of long COVID and COVID-19 vaccine confidence and uptake among unvaccinated communities. The campaign features testimonials from individuals 18–29 years old who are experiencing persistent health problems from COVID-19. 

The campaign offers royalty-free media assets that you can customize and promote, including ads for television and radio, as well as social media and digital banners and graphics. Visit Help Promote the Voices of Long COVID web page to view available materials.  

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Going fast! IAC offers FREE “I Got My COVID-19 Vaccine” buttons and stickers 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. Stickers and buttons in both Spanish and English remain available. Share them with patients, colleagues, and friends to show confidence in COVID-19 vaccination.   

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

Related Links

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More COVID-19 vaccine doses in your family? Encourage your 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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IAC’s shop offers great gift ideas for your colleagues and coworkers this holiday season!
On the Shop IAC web page, you will find many resources such as 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 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.

Order Immunization Record Cards

IAC’s elegantly designed “Vaccines Save Lives” pins are meaningful gifts for people who care about vaccination. 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!


Visit Shop IAC to view IAC's products available this holiday season!

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Notable Publications
"Mycobacterium porcinum Skin and Soft Tissue Infections after Vaccinations—Indiana, Kentucky, and Ohio, September 2018–February 2019" published in MMWR

CDC published Mycobacterium porcinum Skin and Soft Tissue Infections after Vaccinations—Indiana, Kentucky, and Ohio, September 2018–February 2019 on October 22 in MMWR. A portion of the summary appears below.

A multistate investigation identified 101 patients with vaccination-associated adverse events, including 30 with confirmed nontuberculous mycobacteria infection (vaccines received included influenza; hepatitis A; pneumococcal; or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines). Improper vaccine storage, handling, and administration by inadequately trained personnel contributed to injection-site infections and other adverse events....

These events centered around workplace vaccinations provided by "Company A.” From observations during site visits and interviews, investigators identified poor hand hygiene and improper storage and administration practices. During vaccination events, hand sanitizer was not used, nor were hands routinely washed. Vaccines were stored without temperature monitoring in the office or during off-site vaccination events. Vaccines were drawn from multidose vials into syringes at Company A facilities; predrawn syringes were stored for hours to weeks before being administered. Multidose vials were stored with food in a compact, dormitory-style refrigerator inappropriate for vaccine storage. Education concerning proper vaccine storage and handling is essential for all people who handle or administer vaccines.

Access the MMWR article in HTML or PDF.

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"Incidence of SARS-CoV-2 Infection, Emergency Department Visits, and Hospitalizations because of COVID-19 among Persons Aged ≥12 Years, by COVID-19 Vaccination Status—Oregon and Washington, July 4–September 25, 2021" published in MMWR

CDC published Incidence of SARS-CoV-2 Infection, Emergency Department Visits, and Hospitalizations because of COVID-19 among Persons Aged ≥12 Years, by COVID-19 Vaccination Status—Oregon and Washington, July 4–September 25, 2021 on November 19 in MMWR. A summary appears below.

A new CDC analysis among members of a large health system ages 12 years and older found unvaccinated people were at least three times more likely to be infected by COVID-19 than were fully vaccinated people. Among those with COVID-19, unvaccinated patients were twice as likely to need emergency care and to be hospitalized and seven times more likely to die compared with fully vaccinated patients....Rates of infections, ED care, hospital admissions, and deaths were highest for unvaccinated people compared to vaccinated people across all age groups, races, and ethnicities, even during a period of Delta variant circulation. COVID-19 vaccines remain an effective method to protect against infection and severe COVID-19 illness.

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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"State Laws Permitting Adolescent Consent to Human Papillomavirus Vaccination and Rates of Immunization" published in JAMA Pediatrics

In the November 15 issue, JAMA Pediatrics published State Laws Permitting Adolescent Consent to Human Papillomavirus Vaccination and Rates of Immunization. The discussion section appears below. 
Laws that permit adolescents to consent to HPV vaccination are either in a scope of laws allowing adolescents to make independent decisions on sexual health, or less commonly, in a more general scope of preventive health inclusive of vaccines. Our analysis showed a significant positive association between adolescents being permitted to consent to HPV vaccination by state laws in their location of residence and increased rates of initiation of the vaccine series. This suggests that policies that permit adolescents to consent to HPV vaccination could be an important strategy toward improving vaccine initiation among young adolescents, when the vaccine is likely to be most effective....However, it is notable that states permitting adolescent consent to HPV vaccinations are highly diverse with respect to geography, population, and demographic variables. 

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Upcoming Events
Register now! IAC webinar December 9 at 1:00 p.m. (ET): “Fight the Flu and COVID-19 Too: Influenza Vaccination in December and beyond and Practical Approaches to Coadministration of Vaccines in Adults”

In recognition of National Influenza Vaccination Week (NIVW), (IAC) will hold an interactive webinar addressing flu vaccination in December and beyond on Thursday, December 9, from 1:00 to 2:00 p.m. (ET). Speakers include JoEllen Wolicki, BSN, RN, from CDC’s National Center for Immunization and Respiratory Diseases and Dr. Jason Goldman, ACIP liaison representative of the American College of Physicians.

The objectives of the webinar are to:

  • Discuss CDC’s new influenza surveillance tool, the Weekly National Influenza (Flu) Vaccination Dashboard and review this season’s vaccination coverage to date
  • Describe the science of the safety and effectiveness of co-administering vaccines, featuring basic immunology you should understand to answer recipients’ questions confidently
  • Detail practical techniques for administering multiple shots to an adult, including how to deliver two vaccines in one deltoid, which vaccines should be given in separate limbs if possible, and use of the anterolateral thigh as an injection site

Registration is open now! More details available shortly. 

This webinar is hosted by IAC with support from Sanofi Pasteur. 

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Virtual: National Academies of Science, Engineering, and Medicine offers webinar “Communication Strategies for Building Confidence in COVID-19 Vaccines: Addressing Variants and Childhood Vaccinations” on November 30

The National Academies of Science, Engineering, and Medicine (NASEM) will host a webinar titled Communication Strategies for Building Confidence in COVID-19 Vaccines from 2:00–3:00 p.m. (ET) on November 30. The emergence of the Delta variant provides new urgency for reaching people who are not yet vaccinated. Learn strategies from the social and behavioral sciences to communicate with parents who are considering vaccination for their children and individuals who are vaccine-hesitant. 

Registration information.

Related Link

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Virtual: Project VCTR offers webinar "How to Combat and Respond to Anti-vaccine Attacks on Social Media" on November 30

Project VCTR and the Partnering for Vaccine Equity program are offering a webinar titled How to Combat and Respond to Anti-vaccine Attacks on Social Media from 2:00–3:00 p.m. (ET) on November 30. Special guest presenter Dr. Todd Wolynn, founder of Shots Heard Round the World, will provide guidance on how vaccine advocates can prepare for, defend against, and move forward after an anti-vaccination attack on social media. Participants will also hear how Project VCTR, a public media monitoring program, can be a helpful resource for staying informed on the latest online COVID-19 conversations and being prepared for potential negative online conversations.

Register for this free event, available to non-VCTR members.

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For more upcoming events, visit our Calendar of Events.
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.

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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.

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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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