Issue 1,660: November 2, 2022
Top Stories Pages and Handouts
Vaccine Information Statements
Featured Resources
Notable Publications
Global News
Upcoming Events
Top Stories

Perfect storm brewing? Influenza activity surging early while influenza vaccination lags behind 2021. Urge patients to vaccinate without delay. 

CDC issued a media release on Friday, October 28, urging healthcare providers to step up the pace of influenza vaccination and urging the public not to delay vaccination. CDC’s surveillance systems indicate that vaccination rates appear to be lagging about 15% behind the same time last year, while influenza activity and hospitalizations appear to be increasing earlier than typical. While reasons for lagging vaccination rates vary, supplies are plentiful and swift action by vaccine providers now can protect more people from illnesses, hospitalizations, and deaths due to the early arrival of influenza this season.

Key points from the CDC release appear below:

  • The percentage of respiratory specimens testing positive for flu at clinical laboratories continues to rise nationally, increasing from 3.9% to 6.2%. This proportion ranges from about 1.2% in the northeastern part of the country to 18.1% in the southeast of the country.
  • H3N2 is the predominant virus so far. Previous seasons with mostly H3N2 viruses have been of higher severity, particularly for older adults and young children.
  • Preliminary estimates from October 1 through October 22 are that at least 880,000 people have been sickened with flu, 420,000 people have visited a healthcare provider for flu illness, 6,900 people have been hospitalized for flu, and 360 people have died due to flu illness or flu-related complications
  • As of October 22, 2022, 136.9 million doses of flu vaccine had been distributed in the United States
  • As of October 8, nearly 23 million flu vaccines had been given to adults in pharmacies and physician offices. This compares with about 27 million doses given as of October 9 last year.

Influenza Surveillance
For week 42, ending October 22, CDC's Weekly U.S. Influenza Surveillance Report, FluView reports that, nationwide, 3.3% 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. The first influenza-associated pediatric death of the 2022–23 season was reported this week.

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

Back to top

"Influenza Incidence and Vaccine Effectiveness during the Southern Hemisphere Influenza Season—Chile, 2022" published in MMWR

CDC published Influenza Incidence and Vaccine Effectiveness during the Southern Hemisphere Influenza Season—Chile, 2022 in the October 28 issue of MMWR. The media summary appears below.

In 2022, influenza A(H3N2) viruses circulated in Chile (Southern Hemisphere) months earlier than during influenza seasons that occurred before the COVID-19 pandemic. Influenza vaccination in Chile reduced the risk for A(H3N2) virus hospitalization by 49%. Similar to some countries in the Southern Hemisphere, countries in the Northern Hemisphere (including the United States) might face changes in the timing and intensity of flu activity during the 2022–23 season. Getting vaccinated is the best protection against flu and its potentially serious complications.

Access the MMWR article in HTML or PDF.

Related Link updates "Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools" with bivalent mRNA booster doses for age 5 through 11 years and monovalent Novavax vaccine for select adults needing first booster revised its four-page job aid, Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools, on October 31, to help you keep up with changes to COVID-19 vaccine guidance and resources. The checklist now includes content to reflect the October 12 expansion of the bivalent mRNA booster recommendations down to age 5 years and the recommendation for Novavax monovalent vaccine as a first booster dose for adults who have completed a primary series but cannot or will not receive an mRNA bivalent vaccine booster dose. 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.

Related Links

Clarification: CDC allows current monovalent Novavax COVID-19 Vaccine as a booster dose option for adults who will not receive bivalent mRNA vaccine only if they have had no previous booster doses has received several questions requesting clarification about the authorized use of monovalent Novavax COVID-19 Vaccine as a booster dose. On October 19, FDA authorized the use of Novavax COVID-19 Vaccine “to provide a first booster dose to individuals 18 years of age and older for whom an FDA-authorized mRNA bivalent COVID-19 booster vaccine is not accessible or clinically appropriate, and to individuals 18 years of age and older who elect to receive the Novavax COVID-19 Vaccine, Adjuvanted because they would otherwise not receive a booster dose of a COVID-19 vaccine.”
CDC followed FDA and recommended the use of monovalent Novavax COVID-19 Vaccine as a booster dose for people who had completed only a COVID-19 vaccination primary series and could not or would not receive a bivalent mRNA booster dose. This vaccine is not currently authorized for use in adults who have already received a previous COVID-19 vaccine booster dose, even if they would otherwise not receive an additional booster dose of a COVID-19 vaccine.

Related Links’s Hepatitis B Birth Dose Honor Roll recognizes 572 institutions, including three new honorees is pleased to welcome three new institutions into its Hepatitis B Birth Dose Honor Roll, for a total of 572 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.

  • Columbus Regional Healthcare System, Whiteville, NC (99%)
  • Republic County Hospital, Belleville, KS (93%)
  • Vail Health Hospital, Vail, CO (90%)
The Honor Roll now includes 572 birthing institutions from 44 states, the District of Columbia, Puerto Rico, Guam, Saipan, and a U.S. military base in England.

The Honor Roll is a key part of’s 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 for hepatitis B vaccine at birth and meeting additional criteria. To learn whether your organization qualifies and to access the application form, please see Hepatitis B Birth Dose Honor Roll online.

Honorees are awarded an 8.5" x 11" color certificate suitable for printing and framing and their acceptance is announced to IZ Express’s 54,000+ readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and celebrates their exceptional efforts to protect infants from perinatal hepatitis B transmission.

Related Resources
Spotlight: Expedite vaccination with's screening checklists

In this week's Spotlight, we summarize resources at that focus on screening checklists to help expedite vaccination.'s Screening Checklist main page links to forms for patients to fill out, simplifying assessment of vaccination needs and contraindications. The back of each screening checklist provides detailed guidance to help healthcare personnel interpret patient answers to know if a vaccine is contraindicated or can be given with confidence. Several checklists are available in multiple languages.

Screening checklists are especially useful in settings where standing orders or batched orders are used, as well as in settings where the patient’s full medical record is not readily available. offers nine screening checklists, including:

Related Links

Vaccines in the news

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

Recap: These updated educational materials for clinicians were released during September and October

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

Updated 2022–23 Season 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

Vaccine Information Statements

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

Updated Turkish VIS translations (Adenovirus, Anthrax, Japanese encephalitis, pediatric multi-vaccine, PCV, Yellow fever, and Zoster) posted in September.

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

“Influenza during the 2010–2020 Decade in the United States: Seasonal Outbreaks and Vaccine Interventions” published in Clinical Infectious Diseases

In the October 11 issue, Clinical Infectious Diseases published Influenza during the 2010–2020 Decade in the United States: Seasonal Outbreaks and Vaccine Interventions. The abstract appears below.

The 10 years between the last influenza pandemic and start of the severe acute respiratory syndrome coronavirus 2 pandemic have been marked by great advances in our ability to follow influenza occurrence and determine vaccine effectiveness (VE), largely based on widespread use of the polymerase chain reaction assay. We examine the results, focusing mainly on data from the United States and inactivated vaccines. Surveillance has expanded, resulting in increased ability to characterize circulating viruses and their impact. The surveillance has often confirmed previous observations on timing of outbreaks and age groups affected, which can now be examined in greater detail. Selection of strains for vaccines is now based on enhanced viral characterization using immunologic, virologic, and computational techniques not previously available. Vaccine coverage has been largely stable, but VE has remained modest and, in some years, very low. We discuss ways to improve VE based on existing technology while we work toward supraseasonal vaccines.

“Receipt of First and Second Doses of Jynneos Vaccine for Prevention of Monkeypox—United States, May 22–October 10, 2022” published in MMWR

CDC published Receipt of First and Second Doses of Jynneos Vaccine for Prevention of Monkeypox—United States, May 22–October 10, 2022 on October 28 issue of MMWR. A portion of the summary appears below. 

In the United States, JYNNEOS vaccine is recommended for persons exposed to or at high risk for exposure to Monkeypox virus. . . .

By October 10, 2022, a total of 931,155 JYNNEOS vaccine doses were administered in the United States. Among persons who received ≥1 vaccine dose, 51.4% were non-Hispanic White, 12.6% were non-Hispanic Black or African American (Black), and 22.5% were Hispanic persons. The percentages of vaccine recipients who were Black (5.6%) and Hispanic (15.5%) during May 22–June 25 increased to 13.3% and 22.7%, respectively, during July 31–October 10. . . .

Tracking and addressing disparities in vaccination can reduce inequities and help ensure that disproportionately affected populations are protected.

Access the MMWR article in HTML or PDF.

Related Link

“Characteristics of Jynneos Vaccine Recipients before and during a Large Multiday LGBTQIA+ Festival—Louisiana, August 9–September 5, 2022” published in MMWR

CDC published Characteristics of Jynneos Vaccine Recipients before and during a Large Multiday LGBTQIA+ Festival—Louisiana, August 9–September 5, 2022 in the October 28 issue of MMWR. A portion of the article appears below.

During August 9–September 5, 2022, a total of 6,854 doses of JYNNEOS were administered in Louisiana (Table), with 53.0%, 34.8%, and 12.2% administered at clinics, non–Health Hub community vaccination events, and the Health Hub, respectively. Among persons who received vaccine outside the Health Hub, 90.1% were Louisiana residents; 54%, 24.0%, and 6.7% were non-Hispanic White (White), Black, and Hispanic or Latino (Hispanic) persons, respectively. Among Health Hub vaccine recipients, 45.5% were Louisiana residents, and 52.3%, 13.9%, and 10.3% were White, Black, and Hispanic persons, respectively. Residents of California, Florida, New York, and Texas accounted for 26.0% of Health Hub vaccine recipients.

Access the MMWR article in HTML or PDF.

Related Link

“A Health Equity Approach for Implementation of Jynneos Vaccination at Large, Community-Based LGBTQIA+ Events—Georgia, August 27–September 5, 2022” published in MMWR

CDC published A Health Equity Approach for Implementation of Jynneos Vaccination at Large, Community-Based LGBTQIA+ Events—Georgia, August 27–September 5, 2022 in the October 28 issue of MMWR. A portion of the article appears below.

During August 27–September 5, a total of 4,282 JYNNEOS vaccine doses (78% of the additional allocation) were administered. Two thirds (2,874) of doses were administered before the festival and one third (1,408) during the event. Overall, 2,886 (67%) doses were administered at 22 routine vaccination events at health department clinics, 702 (16%) doses at 20 mobile, community pop-up events, and 694 (16%) doses at one fixed location (a Georgia DPH-sponsored mass vaccination event). Among vaccine recipients, 93% were male, 55% were aged 30–49 years, 48% were Black, and 8% were Hispanic (Table). The proportion of Black persons receiving vaccine was higher during the festival (53%) than before the event (46%), but the proportion of Hispanic recipients was similar (7% versus 8%). Nearly one third (31%) of records were missing data on state of residence.

Access the MMWR article in HTML or PDF.

Related Link

Global News

Plan now for World Pneumonia Day and Family Health History Day, November 12 and 24

November 12 is World Pneumonia Day, established by the Stop Pneumonia Initiative in 2009 to advocate for global action to prevent, diagnose, and treat this deadly illness. Every child and adult deserves to access life-saving vaccinations, oxygen, and antibiotics to stop the world’s leading infectious killer and put an end to the devastating consequences caused by pneumonia.

Thanksgiving Day (November 24) is Family Health History Day. During the Thanksgiving holidays, use family gatherings to ask about the pneumococcal vaccination status of family members who need its protection. CDC has resources for taking family health histories and acting on that information.

Access the World Pneumonia Day website for more information and use the social media tags #StopPneumonia and #EveryBreathCounts.

Related Links

Upcoming Events

On-demand: CDC’s “The Pink Book” chapter webinar series on vaccine-preventable diseases and best practices is complete. Dengue chapter now available, with CE.

CDC completed the release of its multi-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").

Webinar #18, "Dengue," was released on November 1. Additional webinars were released weekly, beginning on July 5, 2022. Viewers can go back and view any chapters they missed.
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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