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Issue 1,680: March 1, 2023
Top Stories Pages and Handouts
Vaccine Information Statements
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Global News
Upcoming Events
Top Stories summarizes ACIP’s February 22–24 meeting recommending mpox vaccine for adults during outbreaks and discussing RSV, pneumococcal disease, meningococcal disease, future COVID-19 vaccine plans, and more

The Advisory Committee on Immunization Practices (ACIP) met on February 22–24, 2023. The 3-day meeting included a single vote to recommend use of mpox vaccine in adults age 18 years and older during outbreaks. The Committee also received informational updates on influenza and vaccines under consideration by FDA for pneumococcal, meningococcal, chikungunya, dengue, and respiratory syncytial virus (RSV) in adults, as well as updates on nirsevimab (a long-acting monoclonal antibody) being evaluated by FDA to prevent RSV in infants. The third day was devoted to reviewing COVID-19 vaccine safety and discussing future plans for vaccine use. Presentation slides are available online. Highlights of the meeting are provided below.
Mpox vaccine
Since May 2022, more than 30,000 cases of mpox were reported in the United States, largely among gay, bisexual, and other men who have sex with men. Cases continue to occur at a low rate. In August 2022, FDA issued an emergency use authorization (EUA) for the licensed Jynneos vaccine (Bavarian Nordic) when used for pre- or post-exposure prophylaxis in children and for intradermal administration in adults. CDC maintains Interim Clinical Considerations for Use of JYNNEOS and ACAM2000 Vaccines during the 2022 U.S. Mpox Outbreak to guide use of these two vaccines, although ACAM2000 is not being used in the current outbreak. Almost 1.2 million doses of Jynneos have been administered since the outbreak began.
Before this February meeting, ACIP had not issued a recommendation for use of Jynneos during outbreaks. The Committee reviewed data on Jynneos vaccine effectiveness (66%–83% after 2 doses, regardless of route of administration) and safety. No new safety concerns have been identified; to date, safety surveillance systems have not detected any increased risk of myocarditis or pericarditis following receipt of Jynneos. ACIP voted unanimously to recommend the 2-dose Jynneos series for people age 18 years and older at risk of mpox during an mpox outbreak. As a part of this new recommendation, subcutaneous administration will be recommended unless supply constraints necessitate intradermal administration. ACIP will consider use of the vaccine in people younger than age 18 years during its June 2023 meeting. Plans for a longer-term vaccination strategy for 2-dose Jynneos will be considered at the October 2023 meeting. ACIP and CDC emphasized that the current U.S. mpox vaccination strategy remains active; populations at high risk should continue to be vaccinated.
Influenza vaccine
Influenza activity in the United States peaked early this season, in late November/early December 2022. Influenza A(H3N2) has been the predominant subtype to date. The preliminary estimate for 2022–23 overall vaccine effectiveness is 49% against laboratory-confirmed influenza illness. This season’s vaccine provides substantial protection against hospitalization and among important high-risk groups, such as persons age 65 years and older and those who are immunocompromised.
Pneumococcal vaccine (PCV20)
Pneumococcal conjugate vaccines (PCVs) currently recommended in the United States include PCV13 and PCV15 for children and PCV15 and PCV20 for adults. In addition, PPSV23 (pneumococcal polysaccharide vaccine) is recommended for certain children based on their risk and for adults with certain high-risk conditions, including those who previously received PCV13 and PCV15. Use of PCV20 in children is under FDA review and could be licensed as soon as April 2023. ACIP reviewed potential PCV20 dosing schedules for children younger than age 2 years, as well as considerations for using PCV20 instead of PPSV23 in older children who have underlying medical conditions. ACIP will vote on updated recommendations after anticipated FDA licensure of the PCV20 vaccine for pediatric use.
Meningococcal vaccine
ACIP members heard an overview of the epidemiology of meningococcal disease in the United States, and updates on pentavalent (MenABCWY) vaccines from Pfizer and GSK that are being evaluated by FDA. ACIP’s meningococcal vaccine workgroup will continue to review available information on these vaccines. Current MenACWY and MenB vaccines are offered at differing ages and with different dosing schedules. The committee may consider adjusting the schedules when incorporating pentavalent meningococcal vaccines into the adolescent schedule. ACIP will continue this discussion at the June meeting, with a potential vote in October 2023.
RSV prophylaxis (pediatric/maternal)
Respiratory syncytial virus (RSV) infection is associated with millions of outpatient visits, up to 80,000 hospitalizations, and up to 300 deaths in U.S. children less than 5 years of age each year. RSV is the most common cause of hospitalization in U.S. infants, most of whom were healthy before infection. RSV transmission typically increases during winter months, though transmission outside the usual season occurred during the COVID-19 pandemic. No RSV vaccine is currently licensed. The long-acting monoclonal antibody nirsevimab (Sanofi), intended for intramuscular injection of infants or newborns once in a season, was found effective in RSV prevention. Nirsevimab is the first passive immunization product to be considered for inclusion by ACIP in the CDC immunization schedule as a vaccine-like seasonal immunization. ACIP heard discussion of cost effectiveness. Members stressed the value of including it in the Vaccines for Children (VFC) program to ensure access for all infants. ACIP also received a presentation on use of a maternal RSV vaccine (Pfizer) being evaluated by FDA for use at 24 to 36 weeks gestation for prevention of RSV infection in pregnant persons to protect them and their newborn children. More information about this product will be presented at later ACIP meetings.
RSV vaccines (older adults)
RSV is a frequent, often unrecognized, cause of severe respiratory illness in adults. It is associated with more than 1 million medical encounters and 6,000–10,000 deaths per year among U.S. adults age 65 years and older. Two RSV vaccines for adults (GSK and Pfizer) are being evaluated by FDA. ACIP began a discussion of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) information for each vaccine, assuming vaccination beginning at age 60 or 65 years. Members discussed vaccine safety and the limited information available on the duration of vaccine effectiveness, which may extend to two seasons. Additional information on duration of protection will become available later in 2023.
Other vaccines: polio, chikungunya, dengue
ACIP reviewed surveillance data and discussed clarifying and updating recommendations for the use of inactivated polio vaccine as a primary series or booster dose for U.S. adults. A vote is anticipated in June 2023. The committee discussed the burden of chikungunya disease and potential benefit of a future vaccine. The committee also reviewed the epidemiology of dengue disease and heard preliminary information on a new dengue vaccine from Takeda that has been submitted for FDA licensure. 
COVID-19 vaccines
The third day of the ACIP meeting included CDC presentations on COVID-19 vaccine effectiveness and safety, a risk-benefit assessment of updated (bivalent) mRNA COVID-19 vaccination, and preliminary discussions about future updates to COVID-19 vaccine recommendations.
Data continue to show that COVID-19 vaccines are highly effective at preventing serious disease outcomes in all age groups. Data through December 2022 indicate that the hospitalization rate of unvaccinated adults was 16 times higher than the hospitalization rate of adults who received a recommended bivalent mRNA booster. The rate among vaccinated adults who lacked a bivalent booster was 2.6 times higher than those who had received one.
COVID-19 vaccines continue to undergo the most extensive vaccine safety monitoring in U.S. history. Information is continually evaluated through multiple surveillance systems, including the Vaccine Adverse Event Reporting System (VAERS), v-safe, and the Vaccine Safety Datalink (VSD) system. In November 2022, a possible safety signal for ischemic stroke in adults age 65 years and older after the Pfizer-BioNTech bivalent COVID-19 vaccination was detected in VSD. No similar signal was seen in any other vaccine safety surveillance system in the United States or internationally, and no signal was seen after the Moderna bivalent COVID-19 vaccination. Additional analysis indicates the signal was stronger following simultaneous administration of the Pfizer-BioNTech bivalent booster and influenza vaccine. Presenters emphasized that the small signal has diminished since it was first detected and could be the result of patient conditions or simply a chance finding. Current information cannot prove a causal link, and researchers will continue to investigate. Ischemic stroke is also a frequent complication of COVID-19 disease. CDC recommends that vaccination continue without modification. Additional safety data presented at the meeting showed no increased risk of myocarditis in adolescent males following receipt of a bivalent booster dose.
The ACIP meeting concluded with a robust discussion of considerations for simplifying COVID-19 vaccination recommendations later this year. Committee members discussed whether to end the recommendation for a 2-dose primary series in immunocompetent older children and adults, and whether to adopt a 1-dose schedule after early childhood, now that data show the immune systems of almost all U.S. residents have been primed through vaccination, infection, or both. They also discussed the potential use of bivalent vaccines for both the primary series and booster doses, if approved by FDA. Eliminating monovalent vaccines would reduce the recommended formulations from 11 different mRNA COVID-19 products to five, eliminating look-alike vials and decreasing vaccine administration errors. Novavax monovalent COVID-19 vaccine also remains available as an option.
ACIP and CDC continue to emphasize the importance of following all current COVID-19 vaccine recommendations. Up-to-date vaccine coverage remains relatively low in all age groups, but extremely low in young children and adolescents. Fewer than half of adults age 65 years and older have received an updated COVID-19 booster.
Varicella vaccine: 25th anniversary
The committee heard a review of the 25th anniversary of routine varicella vaccination in the United States. The CDC presenter summarized the tremendous success of the U.S. varicella vaccination program, including prevention of up to 91 million cases of chickenpox, 238,000 hospitalizations for chickenpox, and up to 2,446 deaths. These benefits have saved society more than $23 billion.
The next scheduled ACIP meeting will be held on June 21–22, 2023, although additional emergency meetings may be announced before that time. Information about past and future ACIP meetings may be found on the ACIP website.  
Related Links

Preorder today! Laminated versions of CDC’s 2023 immunization schedules will ship in early March.

Preorder’s laminated versions of the new schedules:

They will ship in early March.
While the schedules are available online from CDC at no cost,’s laminated schedules are ideal for use in any busy healthcare setting. Their tough coating can be wiped down, and they’re durable enough to stand up to a year of use.
  • Length: Each schedule with appendices is 12 pages
  • Size: Standard 8.5” X 11” booklet format
  • Full Color: With color coding for easy reading, our laminated schedules replicate the original CDC formatting, including the essential tables and notes
  • Bonus: The adult schedule includes’s popular 1-page handout summarizing the dose, route, and needle length recommendations for all vaccines and recipients


Pricing for Each Schedule
1 copy: $10.00
2–4 copies: $9.50 each
5–19 copies: $8.50 each
20–99 copies: $7.50 each
100–499 copies: $6.00 each
500–999 copies: $5.00 each
1,000–1,999 copies: $4.00 each
2,000+ copies: $3.25 each

Visit Shop Laminated Schedules to view images of each page and order today!

For additional information, call 651-647-9009 or email

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"Interim Estimates of 2022–23 Seasonal Influenza Vaccine Effectiveness—Wisconsin, October 2022–February 2023" published in MMWR

CDC published Interim Estimates of 2022–23 Seasonal Influenza Vaccine Effectiveness—Wisconsin, October 2022–February 2023 in the February 24 issue of MMWR. A portion of the summary appears below.

Data from two concurrent studies in Wisconsin found that effectiveness of the 2022–23 influenza vaccine was 54% for preventing medically attended influenza A infection among persons aged <65 years and 71% for preventing symptomatic influenza A illness among children and adolescents aged <18 years.

Access the MMWR article in HTML or PDF.

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Influenza activity is low, but vaccines work, so with weeks of winter still ahead, keep vaccinating

Keep encouraging influenza vaccination for those not yet protected. This is especially important for young children who still need a second dose in their first vaccination season and those who need vaccination during pregnancy.

CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state by state. For week 7, ending February 14, FluView reports that 2.6% of outpatient visits nationwide were due to respiratory illness that included fever plus a cough or sore throat (i.e., influenza-like illness [ILI]). The national baseline is 2.5%. Multiple respiratory viruses are co-circulating; the relative contribution of influenza virus infection to ILI varies by location. So far this season, 115 children died from influenza-associated causes.

Influenza Vaccination Effectiveness Estimates
CDC posted a web spotlight on influenza vaccine effectiveness (VE) this season. Estimates show that influenza vaccine provided substantial protection this season. From September 13, 2022, to January 25, 2023, vaccinated children were 68% less likely to be hospitalized due to influenza illness or related complications, and 42% less likely to visit an emergency department. Overall, vaccination reduced the risk of hospitalization or emergency department visits for influenza by 49% in all ages.

Influenza Vaccination Dashboard
CDC’s Weekly Flu Vaccination Dashboard shows that coverage this season for children age 6 months to 4 years is 8.6 percentage points higher compared with children age 5 to 12 years (62.4% compared with 53.8%) and 18.1 percentage points higher compared with children age 13 to 17 years (62.4% compared with 44.4%).

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.

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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 may interest our readers, please send it to us using our online form. Those who follow on social media can also enjoy and share video versions of some of our most popular Ask the Experts questions.

Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination. Pages and Handouts updates and streamlines its “Vaccines: COVID-19” main page updated and simplified its Vaccines: COVID-19 main page. The web page now directs visitors seeking quick links to all print-ready federal fact sheets and COVID-19 vaccination resources to’s Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools, which is updated at least monthly. The web page continues to link to other important government and partner websites.

Bookmark's Vaccines: COVID-19 main page to connect with a comprehensive list of resources from CDC and FDA including fact sheets, clinical considerations, vaccine administration tools, and storage and handling guidance. 

Related Links updates "Talking about Vaccines" web pages on alternative medicine and importance of vaccines updated our Talking about Vaccines: Alternative Medicine and Talking about Vaccines: Importance of Vaccines web pages. These pages lead to many resources from, CDC, and others to help healthcare professionals communicate with parents and patients about important vaccine topics.

To easily locate this section of, go to the upper right corner of the page, and choose the "Talking about Vaccines" tab. You also can use the Guide to at the bottom of every web page.

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Recap: See updated clinician materials released in January and February

IZ Express regularly provides readers with information about’s new and updated educational materials for healthcare professionals and handouts for patients. All materials are free to distribute.

In case you missed them during recent weeks, updates were made to these helpful materials: Materials for Clinicians Web Pages 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 posts Rabies Vaccine Information Statements in Haitian Creole and Portuguese expanded its collection of Vaccination Information Statement (VIS) translations with new rabies VIS translations (English-language version):

All translations are available in print-ready PDF format. Check the version dates of your office copies of newly updated translations. Translations of previous VIS versions should be discarded now that translations of the current versions are available.

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Recap: Use new Vaccine Information Statement translations released in January and February

With support from CDC, is working with partners to increase the number of Vaccine Information Statement (VIS) translations available.

During January and February, VIS translations were posted in 14 languages: Armenian, Farsi, German, Hindi, Italian, Japanese, Khmer, Korean, Polish, Swahili, Tagalog, Ukrainian, Urdu, and Yiddish.

More than 200 VIS translations were added to these 22 VIS pages:

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Featured Resources

Updated 65+ Flu Defense website offers resources for healthcare professionals serving older adults   

Confident recommendations for influenza vaccine from healthcare providers are powerfully persuasive. To assist you in maximizing protection for your patients,, in collaboration with CSL Seqirus, updated the 65+ Flu Defense website.

Older adults are at increased risk of severe influenza and COVID-19 illness, including hospitalization and death, especially if they are not up to date on these vaccinations. An updated fact sheet on the website, The Importance of Preventing Influenza and COVID-19, offers responses to help guide discussions with patients on the importance of preventing influenza and COVID-19. 

This helpful site includes information, tools, and tips for communicating with adults age 65 and older about the scope and severity of influenza. Resources include:

Check out the updated 65+ Flu Defense website at to assist your ongoing efforts in protecting this vulnerable population.

Help reach more vaccinators through your social media networks. Follow us and share our new Ask the Experts videos and our clinical resources on Facebook, Twitter, and Instagram. launched a social media program to highlight our educational resources for a new audience of vaccinators. Our social media channels now feature our most popular printable resources and Ask the Experts questions, as well as announcements important to frontline vaccinators. Please view and share our newest feature, Ask the Experts videos.

Like, follow, and share’s social media accounts and encourage colleagues and others interested in vaccination to do likewise:

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Explore the www.Give2MenACWY​.org website to increase coverage with 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.

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Global News

WHO posts “African Leaders Call for Urgent Action to Revitalize Routine Immunization”

On February 19, WHO posted an article titled, African Leaders Call for Urgent Action to Revitalize Routine Immunization. A portion of the article appears below.

African heads of state today agreed on key measures to revamp routine immunization across the continent following massive disruptions by the COVID-19 pandemic that stymied childhood vaccination programmes and heightened outbreaks of vaccine-preventable diseases.

A total of 8.4 million children in the African region, compared with 18 million globally, were left out by immunization services in 2021, according to estimates by UNICEF and World Health Organization (WHO). Access to immunization services is even more difficult among poor or marginalized communities or those rendered vulnerable by conflicts or living in fragile settings.

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Upcoming Events

Virtual and In-Person: Clinical Care Options offers satellite symposium, “Giving Adolescents the Best Shot against Cancer: Overcoming Barriers to HPV Vaccine Uptake” on March 8; CE available

Clinical Care Options will present a live, 1-hour satellite symposium titled Giving Adolescents the Best Shot Against Cancer: Overcoming Barriers to HPV Vaccine Uptake beginning at 12:45 p.m. (CT) on March 8 in Chicago, Illinois. Part of the Society for Adolescent Health and Medicine 2023 Annual Meeting, the expert panel will discuss vaccine misinformation, vaccine hesitancy, shared decision-making, and more.

Free continuing-education credits (CME, CPE, CE) will be available for both the live and archived events. Bring your questions for the Q&A session with the expert panel at the end of the live session. 

Register for the in-person or virtual event.

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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

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