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Issue 1,658: October 19, 2022
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Top Stories

CDC expands COVID-19 vaccine bivalent booster dose recommendation to include children age 5 through 11 years

On October 12, CDC announced the expansion of its recommendations for the bivalent (“updated”) COVID-19 booster to include children age 5–11, as well as those age 12 years and older. This announcement follows the FDA's authorization of the bivalent Moderna COVID-19 Vaccine for children and adolescents age 6–17 and the bivalent Pfizer-BioNTech COVID-19 Vaccine for children age 5–11. Use of the bivalent Pfizer-BioNTech COVID-19 Vaccine was previously authorized for those age 12 years and older. A portion of the news release appears below. 

Updated COVID-19 vaccines add Omicron BA.4 and BA.5 spike protein components to the current vaccine composition, helping to restore protection that has waned since previous vaccination and targeting recent Omicron variants that are more transmissible and immune-evading.

The recommended schedule for use of these bivalent boosters in children age 5 through 17 is the same as the schedule for adults. The CDC web page, Use of COVID-19 Vaccines in the United States Interim Clinical Considerations, states that people age 5 years and older should receive one bivalent mRNA booster after completion of a monovalent primary series or previously received monovalent booster dose(s); these recommendations replace all prior booster recommendations for this age group. Monovalent COVID-19 vaccines should be used only for the primary series; they are no longer authorized for use as booster doses in anyone age 5 years or older.

Healthcare professionals who administer these vaccines for children should review CDC’s interim clinical considerations for dose and other information.

Related Links

Today! Virtual: Watch October 19–20 ACIP meeting. Topics include pneumococcal, COVID-19, polio, RSV, meningococcal, influenza, and dengue vaccines.

CDC will convene its Advisory Committee on Immunization Practices (ACIP) on October 19 from 8:30 a.m.–5:30 p.m. (ET) and on October 20 from 8:30 a.m.–4:00 p.m. (ET). The agenda includes pneumococcal, chikungunya, COVID-19, polio, respiratory syncytial virus (RSV), meningococcal, influenza, dengue, and monkeypox vaccines, as well as the combined immunization schedule.

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

Related Links updates “Vaccines: COVID-19” main page and "Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools" with content on bivalent boosters for adults age 18 and older revised its four-page job aid, Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools, on October 5, and its Vaccines: COVID-19 main page on October 8 to help you keep up with changes to COVID-19 vaccine guidance and resources. Both now include content on the bivalent boosters for adults age 18 and older. These resources do not yet reflect the October 12 expansion of the bivalent booster recommendations down to age 5 years. updates Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools at least monthly, prominently indicating when it was last updated at the top of the page.

All COVID-19 vaccination providers are encouraged to review this checklist each time it is revised to be sure practices stay up to date.'s Vaccines: COVID-19 main page connects you with a comprehensive list of resources from CDC and FDA including fact sheets, clinical considerations, vaccine administration tools, and storage and handling guidance. 

Bookmark this page for quick access to links to key COVID-19 vaccine resource pages. We will continue to update this page as new guidelines for COVID-19 vaccines and new CDC materials are released.

Related Links

Back to top posts updated "Ask the Experts: Vaccine Safety" web page's popular Ask the Experts web page content is regularly reviewed. Ask the Experts: Vaccine Safety was recently updated as needed. Now is a good time to refresh your vaccine safety understanding with a quick review of this short section on the general topic of vaccine safety. You can find safety questions about specific vaccines in their vaccine-specific section.’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 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.

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Get your influenza vaccination now: early increases in influenza activity across the United States

Now is the time for you and your patients to be vaccinated against influenza. CDC’s surveillance systems are reporting that seasonal influenza activity across the United States is low but increasing. The southeast and south-central areas of the country, in particular, are reporting increasing proportions of laboratory specimens testing positive for influenza. CDC expects influenza activity to continue to increase in the coming weeks. CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state-by-state.

Influenza Surveillance
For week 40, ending October 8, CDC's Weekly U.S. Influenza Surveillance Report, FluView reports that, nationwide, 2.6% of patient visits reported through the Outpatient Influenza-Like Illness 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; the relative contribution of influenza virus infection to ILI varies by location.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard data show that 105.8 million doses of influenza vaccine were distributed in the United States through October 14, 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. “” offers VaccineFinder, a service of Boston Children’s Hospital, to help people find influenza and COVID-19 vaccines for any age group. To be listed as a provider by VaccineFinder, see the information at this website.

Coadministration of influenza and COVID-19 bivalent booster vaccinations when both are due is safe, recommended, and efficient. COVID-19 vaccination alone provides no protection from influenza or any other respiratory virus. To gain confidence in your approach to administering multiple intramuscular vaccinations to an adult, download’s printable document How to Administer Multiple Intramuscular Vaccines to Adults during One Visit.

Related Links's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination now features 1,293 organizations, including one new facility's Influenza Vaccination Honor Roll recognizes facilities that take a stand for patient safety by implementing policies for mandatory healthcare personnel influenza vaccination. There are now 1,293 organizations enrolled. Since September 14, 2022, one additional healthcare organization is recognized.

  • Edgerton Hospital and Health Services, Edgerton, WI

  • Eligible organizations: Hospitals, long-term care facilities, medical practices, pharmacies, professional organizations, health departments, and other government entities
  • Requirements:
    • Your policy must require influenza vaccination for all staff
    • The application must describe measures to prevent transmission of influenza from unvaccinated personnel to patients (e.g., masking for the entire work shift)
Related Links

Spotlight:'s “Clinic Tools: Administering Vaccines” main page provides practical tools based on authoritative sources's Clinic Tools: Administering Vaccines main page is a collection of resources from, CDC, and other organizations. To find it, select the "Clinic Tools" tab in the middle of the blue banner atop every web page and then select "Administering Vaccines."

In the left-hand column of the page, you will find's educational materials such as:

  • Administering Vaccines: Dose, Route, Site, and Needle Size
  • Don’t Be Guilty of These Preventable Errors in Vaccine Administration
  • Skills Checklist for Vaccine Administration, and related resources
The right-hand column of the page features resources from CDC, including:
  • Links to vaccine administration guidelines
  • “General Best Practice Guidelines for Immunization”
  • The Epidemiology and Prevention of Vaccine-Preventable Diseases ("The Pink Book")

Visit the Clinic Tools: Administering Vaccines main page on

Related Links

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 one of our recent citations.

Vaccines in the news

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

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Featured Resources

Montgomery County (Pennsylvania) Immunization Coalition shares its Say Boo to the Flu and COVID Too! social media toolkit

The Montgomery County Immunization Coalition (MCIC) created Say Boo to the Flu and COVID Too! social media campaign with images and sample text to make it easy for you to get the word out to your community about the importance of getting vaccinated before Halloween. 

Feel free to use the toolkit with social media images and sample text.

Vaccinate Your Family launches its “Not ‘Just’ the Flu” campaign to raise awareness about the seriousness of influenza 

Vaccinate Your Family launched its Not “Just” the Flu campaign to raise awareness about the seriousness of influenza and the importance of flu vaccination.

This campaign features key messages, social media graphics, and pre-drafted posts with a special focus on pregnant people, parents of young kids, people living with chronic conditions, and people age 65 and older. “Not ‘Just’ the Flu” materials include:

The campaign will run for as long as influenza season lasts. 

If you’re interested in co-branding, please reach out to's elegant "Vaccines Save Lives" black enamel pins make thoughtful tokens of thanks for hard-working colleagues’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".

The pin is a stick-through-post variety with the back end covered by a round rubber cap that holds the pin securely. A gold metal spring-lock clasp is also provided.

Wear these pins on clothing, uniforms, and white coats to show that you value vaccines.


Click here for "Vaccines Save Lives" pin pricing and ordering information.

Upcoming Events

On-demand: CDC’s “The Pink Book” chapter webinars on vaccine-preventable diseases and best practices roll out weekly. Influenza chapter 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 influenza was released on October 18. Sixteen 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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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

This page was updated on .