has been refreshed! Take a tour.
Issue 1,662: November 9, 2022
Top Stories Pages and Handouts
Featured Resources
Notable Publications
Upcoming Events
Top Stories

CDC's Health Alert Network issues advisory to clinicians about increased respiratory virus activity. Vaccinate your patients now.

On Friday, November 4, the CDC issued a Health Alert Network (HAN) Health AdvisoryIncreased Respiratory Virus Activity, Especially among Children, Early in the 2022–2023 Fall and Winter. Cocirculation of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2, and others are stressing healthcare systems this fall. Influenza vaccination this season should offer protection against the predominant A(H3N2) viruses to date.
Key recommendations for healthcare professionals from the Health Advisory are listed below:

  • Recommend and offer vaccination against influenza and COVID-19 for all eligible people age 6 months or older
  • Use diagnostic testing to guide treatment and clinical management
  • Treat patients with suspected or confirmed influenza who meet clinical criteria with influenza antivirals
  • Treat outpatients and hospitalized patients with confirmed SARS-CoV-2 infection who are at increased risk for severe illness and meet age- and weight-eligibility requirements

Access the complete CDC HAN Health Advisory.

Related Links

Back to top
Influenza activity continues early surge. Vaccine widely available.

Now is the time for you, your patients, and your coworkers to be vaccinated against influenza. CDC’s surveillance systems are reporting that seasonal influenza activity across the United States continues to increase. The southeastern and south-central United States continue to report the highest levels of activity. CDC expects influenza activity to continue to increase further and spread across the United States in its seasonal epidemic pattern. CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state-by-state.

Influenza Surveillance
For week 43, ending October 29, CDC's Weekly U.S. Influenza Surveillance Report, FluView reports that, nationwide, 4.3% 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]). This exceeds the national baseline of 2.5%. Multiple respiratory viruses are co-circulating; the relative contribution of influenza virus infection to ILI varies by location. Sadly, two children died from influenza-associated causes so far during the 2022–23 season.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard data show that 137 million doses of influenza vaccine were distributed in the United States through November 4, 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. Supply is sufficient to manage a surge in demand due to early influenza activity.

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

“Routine Vaccination Coverage—Worldwide, 2021” published in MMWR

CDC published Routine Vaccination Coverage—Worldwide, 2021 in the November 4 issue of MMWR. Portions of the media summary appear below.

High routine childhood vaccination coverage achieved during 2015–2019 declined globally for most vaccines during 2019–2021 because of COVID-19 pandemic disruptions. . . .

In 2021, the estimated global coverage with 3 doses of diphtheria-tetanus-pertussis–containing vaccine as well as the first dose of measles-containing vaccine decreased to 81%, the lowest level since 2008. Globally, 25.0 million children were unvaccinated or incompletely vaccinated in 2021, 5.9 million more than in 2019. . . . 

Reversing declining vaccination trends and addressing immunity gaps, as well as extending previous gains in vaccination coverage beyond prepandemic levels, requires targeted and context-specific approaches that prioritize routine vaccination as an essential health service and improve access to vaccination across the life span.

Access the MMWR article in HTML or PDF.

Related Link

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

“Safety Monitoring of Bivalent COVID-19 mRNA Vaccine Booster Doses among Persons Aged >12 Years—United States, August 31, 2022–October 23, 2022” published in MMWR

CDC published Safety Monitoring of Bivalent COVID-19 mRNA Vaccine Booster Doses among Persons Aged >12 Years—United States, August 31, 2022–October 23, 2022 in the November 4 issue of MMWR. Portions of the media summary appear below.

CDC recommended bivalent COVID-19 booster vaccination for persons aged ≥12 years in August 2022; approximately 22.6 million bivalent booster doses were administered during August 31–October 23, 2022. . . . 

Early safety findings from v-safe and the Vaccine Adverse Event Reporting System for bivalent booster doses administered to persons aged ≥12 years during the first 7 weeks of vaccine availability are similar to those previously described for monovalent vaccine booster vaccines. . . . 

Adverse events reported after a bivalent booster dose appear consistent with those reported after a monovalent booster and are less common and less serious than health impacts associated with COVID-19 illness. 

Access the MMWR article in HTML or PDF.

Related Link

CDC revises several passages in its General Best Practice Guidelines for Immunization, an important resource for daily use

On October 28, CDC updated the list of errata/updates for its General Best Practice Guidelines for Immunization. Recent updates include:

Contraindications and Precautions
Page 59, Table 4-1: In the row for PCV13, “PCV15” and “PCV20” were added to the row margin-header. These three vaccines have the same contraindications and precautions.

Pages 58–59, Table 4-1: For the rows for MenACWY and PCV13, 15, 20. . . "yeast” was removed as a call-out item. There is nothing special about yeast versus any other vaccine component, so there is no need to call it out. Yeast still is a component for these vaccines, so if someone had a severe allergic reaction (e.g., anaphylaxis) to yeast, this is a contraindication to MenACWY, PCV13, PCV15, and PCV20. Gluten sensitivity and history of yeast infection are neither contraindications nor precautions to MenACWY, PCV13, PCV15, and PCV20.

Preventing and Managing Adverse Reactions
Page 75: For management of anaphylaxis, providers should stock at least three doses of epinephrine on hand (in preparation for one patient).

Vaccine Administration
Page 93: Information about the route of administration for ACAM2000 and Jynneos was added.

Related Link

Spotlight: resources that focus on influenza vaccine

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

Vaccines: Influenza main page provides access to the latest influenza recommendations, information, and up-to-date resources from and CDC.

Handouts: Influenza Vaccine main page gives users free access to influenza vaccination-related handouts and fact sheets for healthcare professionals and the public. All items are free to print, copy, and distribute widely.

Ask the Experts: Influenza main page provides answers to timely questions about influenza vaccines and their administration.

Vaccine Information Statements (VIS) main page provides access to the Influenza, inactivated or recombinant VIS and Influenza, live intranasal VIS. Available in multiple languages, VISs explain both the benefits and risks of a vaccine to adult vaccine recipients and the parents or legal representatives of vaccinees.

Clinic Tools: Screening Checklists main page links users to screening checklists for influenza vaccine contraindications and precautions.

Handouts: Standing Orders main page provides access to the updated 2022–23 Standing Orders for Administering Influenza Vaccine to Children and Teens and Standing Orders for Administering Influenza Vaccine to Adults.

ACIP Recommendations: Influenza main page includes a comprehensive list of current and former ACIP recommendations for the prevention and control of seasonal influenza.

Package Inserts: Influenza main page provides access to influenza vaccination package inserts and Food and Drug Administration product approvals.

IZ Express keeps 55,000+ readers up to date on what’s new in vaccines each week; invite your colleagues to subscribe!

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, alerts 55,000+ readers to the week’s important vaccine developments. IZ Express also features:

  • Educational materials from, CDC, AAP, and others
  • Newly posted Vaccine Information Statements and their translations
  • 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.

Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination. Pages and Handouts updates “Immunizations for Babies” guide for parents revised its Immunizations for Babies 1-page guide for parents. Edits were made to incorporate recommendations for COVID-19 vaccination for infants beginning at age 6 months.

Related Links updates “Key Vaccination Resources for Healthcare Professionals” training guide organized by experience level recently updated its Key Vaccination Resources for Healthcare Professionals 5-page training guide for providers. Revisions were made to update several URLs and refine content throughout the guide. 

Related Links adds QR codes, makes minor updates to three handouts for healthcare providers and parents recently updated three handouts for healthcare workers and parents with QR codes and minor revisions. The updated handouts include: 


Related Links

Featured Resources

Reminder: Check your document versions with’s "Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools" 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 reflects 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

Back to top can help you keep the line moving's website assists you in finding ideas for developing your own high-volume clinics. Mass vaccination efforts are useful for influenza and COVID-19 vaccination.

Many of the documents were written before the COVID-19 pandemic and may need modification to address specific COVID-19 issues.

More resources have been added, including:

In addition,'s on-demand full-length webinar (1 h. 46 min.) highlighting best practices and offering practical information, Mass Vaccination Clinics: Challenges and Best Practices, can be viewed on

The website includes a Related Resources web page linking to three articles by authors that appeared in Becker’s Hospital Review.

If you have a resource to suggest for the website, please send a message to

The webinar and the website are supported by a medical education grant from Seqirus.

Related Links

Order’s child, adult, and lifetime immunization record cards—wallet-sized, designed to last!'s personal immunization record cards, printed on rip-proof, smudge-proof, water-proof paper, are designed to last a lifetime. They fit in a wallet when folded. The record cards are for you to give to your patients as a permanent personal vaccination record and are sold in boxes of 250.

Order Immunization Record Cards

Make bulk purchases and receive quantity discounts. For quotes on larger quantities or customizing, or to request sample cards, call 651-647-9009 or email

Notable Publications

"Perspectives on Maternal Vaccination from Obstetrical Clinicians: A Qualitative Multi-site Study" published in Maternal Child Health Journal

In the October 31 issue, Maternal Child Health Journal published Perspectives on Maternal Vaccination from Obstetrical Clinicians: A Qualitative Multi-site Study featuring's Director for Research, Sharon G. Humiston, MD, MPH, FAAP. The results and conclusions sections appear below.

We conducted 20 interviews between 4/2020 and 9/2020: 13 providers (physician or nurse midwife) (5 NY, 8 CA); 7 office nurses (6 NY, 1 CA). In almost all offices, patient refusal of influenza vaccine was considered the major vaccination barrier; Tdap was often deferred by patients until post-delivery. Nurse-only visits for either vaccine were rare. Vaccination outside the office was uncommon; few offices systematically documented vaccines given elsewhere in a retrievable manner. Participants emphasized patient education as key to prenatal care, but the number of topics left little time for immunizations. Few interviewees could identify an office "immunization champion," knew their office vaccination rates, or had participated in vaccination quality improvement. Several interviewees indicated that they or another provider were good at persuading hesitant patients, but their method had not been shared with other clinicians. . . .

Multiple practical barriers and maternal vaccine hesitancy limit maternal vaccination. Quality improvement strategies are needed.

“Wastewater Testing and Detection of Poliovirus Type 2 Genetically Linked to Virus Isolated from a Paralytic Polio Case—New York, March 9–October 11, 2022” published in MMWR

CDC published Wastewater Testing and Detection of Poliovirus Type 2 Genetically Linked to Virus Isolated from a Paralytic Polio Case—New York, March 9–October 11, 2022 on October 28 in MMWR Early Release. A portion of the summary appears below. 

In July 2022, a case of paralytic poliomyelitis was confirmed in an unvaccinated adult Rockland County, New York resident; environmental sampling found evidence of poliovirus transmission. . . .

Wastewater testing has identified circulating polioviruses genetically related to virus isolated from the Rockland County patient in at least five New York counties. . . .

Public health efforts to prevent polio should focus on improving coverage with inactivated polio vaccine. Although most persons in the United States are sufficiently immunized, unvaccinated or undervaccinated persons living or working in Kings, Orange, Queens, Rockland, or Sullivan counties, New York should complete the polio vaccination series to prevent additional paralytic cases and curtail transmission.

Access the MMWR article in HTML or PDF.

Related Link

Journal of Infectious Diseases: The Varicella Vaccination Program in the United States: 25 Years of Saving Lives and Preventing Illness supplement publishes 14 articles on saving lives and preventing illness

In an October 21 supplement, the Journal of Infectious Diseases published 14 articles on the theme of saving lives and preventing varicella illness. An excerpt from the introductory article by Mona Marin and colleagues appears below (emphasis added). 

In this supplement of the Journal of Infectious Diseases, we present the United States experience with the varicella vaccination program, summarizing the successes and challenges in implementing and monitoring the program over 25 years, including establishing varicella surveillance, monitoring varicella and HZ epidemiology, monitoring vaccine coverage, safety and effectiveness, clinical and laboratory issues, and economic impact. . . . Since 1995, the United States varicella vaccination program has led to prevention of more than 91 million varicella cases, 238 000 hospitalizations, and almost 2000 deaths, with an impressive return on investment with net societal savings of more than $23 billion. It is a public health achievement made possible by the efforts of thousands of nurses, physicians, pharmacists, and public health staff who implemented this immunization program. We dedicate this supplement to them and to the memory of Dr Takahashi who bravely pioneered the development of varicella-zoster virus vaccines.

Related Link
Upcoming Events

Tomorrow! Virtual: Immunize Colorado hosts webinar “Seasonal Influenza: Vaccination, Prevention, and Control in the COVID-19 Era” on November 10.

Immunize Colorado will host a webinar titled Seasonal Influenza: Vaccination, Prevention, and Control in the COVID-19 Era at 1:00 p.m. (ET) on November 10. 

Register for the webinar

This event will be archived on Immunize Colorado's Education Series Past Events web page.

Virtual: CHOP’s Current Issues in Vaccines for Providers webinar on December 7 features Dr. Paul Offit discussing polio; CE available

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP) will present a 1-hour webinar titled Is Polio Coming Back? beginning at 12:00 p.m. (ET) on December 7. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of the VEC.

Free continuing-education credits (CME, CEU, and CPE) will be available for both the live and archived events.

Register for the webinar.

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.

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

This page was updated on .