Issue 1,656: October 5, 2022
Top Stories Pages and Handouts
Vaccine Information Statements
Featured Resources
Notable Publications
Upcoming Events
Top Stories

View your state’s stats. CDC’s interactive web tool updated with 2021 Behavioral Risk Factor Surveillance System (BRFSS) data on adult vaccination rates.

Behavioral Risk Factor Surveillance System (BRFSS) data for 2021 are now available through CDC’s easy-to-use web-based tool. Topics include self-reported use of preventive services, including adult vaccination. Updated annually, the prevalence and trends tool offers fast access to a large portion of the 2021 data set and can be a helpful resource to reporters, vaccine advocates, students, public-health officials, and decision-makers. The tool is updated every year.

BRFSS prevalence and trends data are available for all states and territories. An example map showing adults aged 65+ vaccinated against influenza within the past year appears below.

Related Links

“Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022” published in MMWR Recommendations and Reports

CDC published Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022 in the September 30 issue of MMWR Recommendations and Reports. A portion of the summary appears below.

Cholera is rare in the United States, but cases occur among travelers to countries where cholera is endemic or epidemic and associated with unsafe water and inadequate sanitation. Travelers might be at increased risk for poor outcomes from cholera if they cannot readily access medical services or if they have a medical condition that would be worsened by dehydration, such as cardiovascular or kidney disease. This report describes previously published ACIP recommendations about use of CVD 103-HgR for adults aged 18–64 years and introduces a new recommendation for use in children and adolescents aged 2–17 years. ACIP recommends CVD 103-HgR, the only cholera vaccine licensed for use in the United States, for prevention of cholera among travelers aged 2–64 years to an area with active cholera transmission. Health care providers can use these guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.

Access the MMWR article in HTML or  PDF.

Related Links

"Incidence of Monkeypox among Unvaccinated Persons Compared with Persons Receiving ≥1 Jynneos Vaccine Dose—32 U.S. Jurisdictions, July 31–September 3, 2022" published in MMWR Early Release

CDC published Incidence of Monkeypox among Unvaccinated Persons Compared with Persons Receiving ≥1 Jynneos Vaccine Dose—32 U.S. Jurisdictions, July 31–September 3, 2022 in the September 30 issue of MMWR Early Release. The summary appears below.

Across 32 U.S. jurisdictions, among males aged 18–49 years eligible for JYNNEOS vaccination, monkeypox incidence was 14 times as high among unvaccinated males compared with those who had received a first vaccine dose ≥14 days earlier. . . .

These early findings suggest that a single JYNNEOS dose provides some protection against monkeypox infection. The degree and durability of such protection is unknown, and it is recommended that persons who are eligible for monkeypox vaccination receive the complete 2-dose series.

Access the  MMWR article in HTML.

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Keep up with influenza this season: use CDC’s FluView surveillance reports and Influenza Vaccination Dashboard, updated weekly

Influenza season has begun. CDC expects influenza activity, which is currently low, to increase in the coming weeks or months. CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state-by-state.

Influenza Surveillance
For week 38, ending September 24, CDC's Weekly U.S. Influenza Surveillance Report, FluView summary reports that, nationwide, 2.2% of patient visits reported through the Outpatient Influenza-Like Surveillance Network (ILINet) were due to respiratory illness that included fever plus a cough or sore throat (i.e., influenza-like illness [ILI]). Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard data show that 71.4 million doses of influenza vaccine have been distributed in the United States through September 17, 2022. Vaccine manufacturers project that they will supply the United States with 173.5 million to 183.5 million doses for the 2022–23 season.

CDC recommends everyone age 6 months and older get annual influenza vaccination. Influenza and other vaccines (e.g., 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. To be listed as a provider by VaccineFinder, see the information at this website.

If you don’t provide influenza vaccine at your site, please strongly recommend vaccination and refer people to sites that do vaccinate. The American College of Physicians offers free Adult Vaccination Prescription Pads listing ACIP-recommended vaccines for adults to enable easy referral to vaccinating sites.

“” offers VaccineFinder, a service of Boston Children’s Hospital, to help people find influenza, COVID-19, and other vaccines for any age group. 

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World Meningitis Day celebrated October 5. Are you advocating for adolescents to get MenB and second-dose MenACWY vaccine?

World Meningitis Day is observed on October 5. World Meningitis Day is organized by the Confederation of Meningitis Organisations (CoMO), an international organization that works to reduce the incidence and impact of meningitis.

To encourage sharing information about the signs and symptoms of meningitis, CoMo created infographics in 20 languages, all free to download and share. 

Visit partner websites:

Related Links

Invite your colleagues to subscribe to IZ Express so they don’t miss the latest immunization news!

Encourage your co-workers to subscribe to IZ Express so they get all the news that matters to vaccinators in their own inbox each Wednesday. IZ Express, the free weekly e-newsletter produced by, succinctly summarizes each week’s important vaccine developments. IZ Express also features:

  • Newly posted Vaccine Information Statements and their translations
  • Educational materials from, CDC, AAP, and others
  • Notices about online and in-person educational opportunities, many offering free continuing education credit

We appreciate you as a subscriber! Thank you for helping us spread the latest immunization news.

Spotlight: “Ask the Experts” answers more than 1,200 questions on vaccines and vaccinations

In this week's Spotlight, we highlight the Ask the Experts main page at

Our Ask the Experts main page offers more than a thousand timely questions on vaccines and vaccine administration answered by our experts. Topics include specific diseases and their vaccines as well as vaccine delivery guidance (e.g., administration, billing, documenting).'s Ask the Experts main page leads you to 30 distinct web pages on a variety of topics with more than 1,200 common or challenging questions and answers (Q&As) about vaccines and their administration.'s team of experts includes Kelly L. Moore, MD, MPH (team lead), Carolyn B. Bridges, MD, FACP, and Iyabode Beysolow, MD, MPH.

New and updated Ask the Experts Q&As are published in special editions of IZ Express five times per year. If you have a question that you think may be of interest to our readers, please send it to us using our online form

Journalists interview experts

Journalists seek out 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 recent citation.

Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination. Pages and Handouts updates its patient handout, "You're 16...We Recommend These Vaccines for You!" and the Society for Adolescent Health and Medicine (SAHM) recently updated their patient handout, You're 16...We Recommend These Vaccines for You! The sheet now indicates that:

  • Human papillomavirus (HPV) vaccine may be started beginning at age 9 years
  • The first dose of MenB vaccine should be administered at age 16–18 years
  •  COVID-19 vaccine is recommended for adolescents as a primary series plus booster doses

Related Links

Recap: These updated educational materials and web pages for clinicians were released during August and September

In case you missed them during recent weeks, updates were made to these helpful materials:

Updated Influenza Materials and Web pages

Updated Printable Materials for Clinicians Updated Web Pages Updated Printable Materials for Patients Related Links
  • Handouts main page to see educational materials sorted by category
  • Ask the Experts main page to access more than 1,200 questions answered by experts
  • Clinic Tools main page and its nine subtopics
  • Educational Materials for Patients and Staff—an alphabetical list of more than 230 ready-to-print staff educational materials and patient handouts updates “Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing” updated its Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing document in three ways:

  • Adding the newest recommended hepatitis B vaccine option, PreHevbrio (VBI Vaccines)
  • Clarifying considerations for healthcare personnel with documentation of a complete series of HepB vaccination but no documentation of protective levels of anti-HBs antibody
  • Adding a link to the April 2022 CDC recommendation for routine HepB vaccination of all adults 19 through 59 years old

Related Links

Vaccine Information Statements

Recap: These new VISs and VIS translations were released during August and September

In August, CDC released an update to the Smallpox/Monkeypox Vaccine VIS.
Here are recent languages of VIS translations posted during August and September:

  • Haitian Creole – Multi pediatric vaccines and Smallpox/monkeypox vaccine
  • Portuguese – Multi pediatric vaccines and Smallpox/monkeypox vaccine
  • Turkish – Adenovirus, Anthrax, Japanese encephalitis, Multi pediatric vaccines, PCV, Yellow fever, and Zoster
Additionally, two handouts related to VISs were updated: Related Links
Featured Resources

Explore the website to increase coverage for the MenACWY booster and other adolescent vaccinations's website promotes the importance of adolescent vaccination, including the recommended MenACWY vaccine booster dose at age 16. Many teens are behind on vaccines because of the pandemic, so vaccination is more important than ever.

Materials on this colorful website for healthcare professionals incorporate the 2020 ACIP meningococcal vaccine recommendations and 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 through 18 Years of Age.


The website 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.

Related Links 

Notable Publications

“Association between Aluminum Exposure from Vaccines before Age 24 Months and Persistent Asthma at Age 24 to 59 Months” published in Academic Pediatrics

In its article-in-press version, Academic Pediatrics released Association between Aluminum Exposure from Vaccines before Age 24 Months and Persistent Asthma at Age 24 to 59 Months. A portion of the article, written by Vaccine Safety Datalink (VSD) investigators (including CDC), appears below.

In a large observational study, a positive association was found between vaccine-related aluminum exposure and persistent asthma. While recognizing the small effect sizes identified and the potential for unmeasured confounding, additional investigation of this hypothesis appears warranted.

NIH-funded study links COVID-19 vaccination and temporary increase in menstrual cycle length

On September 27, NIH announced results of an international study, linking a temporary increase of less than 1 day in menstrual cycle length with COVID-19 vaccination. The study was published in BMJ Medicine, and titled Association between Menstrual Cycle Length and COVID-19 Vaccination: Global, Retrospective Cohort Study of Prospectively Collected Data. The first paragraph of the press release appears below.

A large international study has confirmed the findings of a previous U.S. study that linked COVID-19 vaccination with an average increase in menstrual cycle length of less than one day. The increase was not associated with any change in the number of days of menses (days of bleeding). Funded by the National Institutes of Health, the new study included data from nearly 20,000 people from Canada, the United Kingdom, the United States, Europe and other parts of the world who received any of nine different vaccines. For most study participants, the increase resolved in the cycle following vaccination.

"Estimation of COVID-19 mRNA Vaccine Effectiveness against Medically Attended COVID-19 in Pregnancy during Periods of Delta and Omicron Variant Predominance in the United States" published in JAMA Network

JAMA Network published Estimation of COVID-19 mRNA Vaccine Effectiveness against Medically Attended COVID-19 in Pregnancy during Periods of Delta and Omicron Variant Predominance in the United States on September 26. The conclusions and relevance section appears below.

In this study, maternal mRNA COVID-19 vaccination, including booster dose, was associated with protection against medically attended COVID-19. VE [vaccine effectiveness] estimates were higher against COVID-19–associated hospitalization than ED/UC [emergency department or urgent care] visits and lower against the Omicron variant than the Delta variant. Protection waned over time, particularly during Omicron predominance.

“Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission—United States, 2016–2020” published in MMWR

CDC published Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission—United States, 2016–2020 in the September 30 issue of MMWR. A portion of the summary appears below.

Hepatitis A epidemiology in the United States has shifted as a result of recent and ongoing outbreaks associated with person-to-person transmission. During August 1, 2016–December 31, 2020, 33 states reported hepatitis A outbreaks involving approximately 37,500 cases. Among cases with available information, 56% of persons reported drug use, 14% reported homelessness, and 61% were hospitalized; 380 outbreak-associated deaths were reported. . . .

Increased hepatitis A vaccination coverage, through implementation of nontraditional vaccination strategies to reach disproportionately affected populations, along with improved universal and catch-up childhood vaccination, will be necessary to respond to the current hepatitis A outbreaks and prevent similar outbreaks in the future.

Access the  MMWR article in HTML or PDF.

Related Links

“Effectiveness of a Second COVID-19 Vaccine Booster Dose against Infection, Hospitalization, or Death among Nursing Home Residents—19 States, March 29–July 25, 2022” published in MMWR

CDC published Effectiveness of a Second COVID-19 Vaccine Booster Dose against Infection, Hospitalization, or Death among Nursing Home Residents—19 States, March 29–July 25, 2022 in the September 30 issue of MMWR. A portion of the summary appears below.

In a large cohort of nursing home residents, receipt of a second mRNA COVID-19 booster dose during circulation of SARS-CoV-2 Omicron subvariants was 74% effective at 60 days against severe COVID-19–related outcomes (including hospitalization or death) and 90% against death alone compared with receipt of a single booster dose. . . .

Efforts should be made to ensure that nursing home residents remain up to date with recommended booster doses of COVID-19 vaccines.

Access the  MMWR article in HTML or PDF.

Related Link

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

Upcoming Events

Virtual: National Foundation for Infectious Diseases hosts "Clinical Vaccinology Course" on November 16–18; CME/CNE available

The National Foundation of Infectious Diseases (NFID) Clinical Vaccinology Course will be held online November 16–18. This 3-day online course focuses on new developments and issues related to use of vaccines. Expert faculty provide the latest information on vaccines, including updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination.

Continuing medical education (CME) and continuing nursing education (CNE) credit will be offered.

Register for the online course ($750 fee).

On-demand: CDC’s “The Pink Book” chapter webinars on vaccine-preventable diseases and best practices roll out weekly. HPV webinar now available, with CE.

CDC continues its free 19-part pre-recorded webinar series to provide a chapter-by-chapter overview of the 14th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book").

The webinar on human papillomavirus (HPV) was released on October 4. Fourteen webinars are now available on demand. Additional webinars will be released weekly, concluding on November 1, 2022.
No registration is required to view the sessions. Information and program details are available on CDC's Pink Book Webinars series web page.

CME, CNE, CPE, and CEU credits are available for each event. Questions about the material can be submitted to

For more upcoming events, visit our Calendar of Events.

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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