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Issue 1,698: June 21, 2023
Top Stories Pages and Handouts
Featured Resources
Notable Publications
Upcoming Events

Top Stories

Register for July 13 webinar! presents “Hepatitis B-Gone! Implementing universal adult screening and vaccination. Your practical questions answered.”

Anyone can be infected by hepatitis B virus. Everyone can benefit from knowing their status and being protected. For more than 30 years, hepatitis B vaccination has been recommended for all U.S. infants. In 2022, CDC recommended catch-up hepatitis B vaccination of all adults through age 59 years and older adults with risk factors or who want to be vaccinated. In 2023, CDC recommended one-time hepatitis B infection screening of all adults. Integrating these two important recommendations into clinical practice poses unique challenges for healthcare providers.

This live, 1-hour webinar conversation, Hepatitis B-Gone! Implementing Universal Adult Screening and Vaccination. Your Practical Questions Answered, is hosted by on July 13 at 3:00 p.m. (ET). Panelists will discuss the recommendations and the practical clinical questions you have about how to make the policies work for everyone. Widespread implementation of adult screening and catch-up vaccination brings within reach the goal of eliminating hepatitis B in the United States, along with hepatitis B-related liver damage and cancer.

The panelists will be:

  • Carolyn Wester, MD, MPH, Director of CDC’s Division of Viral Hepatitis
  • Kelly Moore, MD, MPH, CEO of
  • L.J Tan, PhD, MS, Chief Policy and Partnership Officer of

Dr. Wester and Dr. Moore are co-authors of the ACIP hepatitis B vaccination policy statement and longstanding champions of hepatitis B elimination.

Register now to watch this important session and get your practical questions answered.

This webinar was developed by and was supported by Grant No. NH23IP922654 from CDC and an independent educational grant from VBI Vaccines. Its contents are solely the responsibility of and do not necessarily represent the official views of either CDC or VBI.

“Interim Recommendation for Use of Bivalent mRNA COVID-19 Vaccines for Persons Aged ≥6 Months—United States, April 2023” published in MMWR

CDC published Interim Recommendation for Use of Bivalent mRNA COVID-19 Vaccines for Persons Aged ≥6 Months—United States, April 2023 on June 16 in MMWR. These recommendations are already in effect and have been reflected in CDC’s interim clinical considerations for the use of COVID-19 vaccines since late April. A portion of the summary appears below.

During August–October 2022, CDC recommended a bivalent COVID-19 mRNA vaccine dose for all persons aged ≥5 years who had received a monovalent primary vaccination series. . . .

During December 2022–April 2023, CDC made recommendations for a single bivalent vaccine dose for most persons aged ≥6 years, bivalent vaccines for children aged 6 months–5 years, and optional additional bivalent booster doses for moderately or severely immunocompromised persons aged ≥6 months and adults aged ≥65 years. . . .

Transition to a single bivalent COVID-19 vaccine dose for most persons, with additional doses for persons at increased risk for severe disease, facilitates implementation of simpler, more flexible recommendations. All persons aged ≥6 months should receive ≥1 bivalent vaccine dose.

Access the MMWR article in HTML or PDF.

Related Link updates its “Vaccines: Mpox” web page updated its Vaccines: Mpox main page that provides links to key resource pages from CDC, FDA,, and other professional organizations. Revisions include:

  • Title change from “Monkeypox” to “Mpox”
  • Most references to ACAM2000 [Smallpox (Vaccinia) Vaccine, Live] were removed. A link to CDC’s ACAM2000 vaccine information is available for reference. Although ACAM2000 may be used, in the current mpox outbreak Jynneos (Bavarian Nordic) has been the only vaccine in use.
  • Links to multiple mpox vaccine materials were updated to reflect the most current versions

Bookmark’s new Vaccines: Mpox main page for key links to important resources. The page will be updated as new guidelines and resources become available.

Related Links

Combination vaccines and catch-up schedules: Check out the latest Ask the Experts short video on Facebook, LinkedIn, Twitter, YouTube, and Instagram’s social media program highlights our educational resources for today’s vaccinators. Our latest short video, Can combination vaccines be used with children who have fallen behind with their vaccinations? If so, what schedule should we follow? is available now on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts questions. Our social media channels feature our most popular printable resources and Ask the Experts questions and answers, as well as announcements important to frontline vaccinators.

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

“Increase in Meningococcal Disease among Persons with HIV—United States, 2022” published in MMWR

CDC published Increase in Meningococcal Disease among Persons with HIV—United States, 2022 on June 16 in MMWR. Main points of the article appear below.

  • Meningococcal conjugate (MenACWY) vaccines offer the best protection from the devastating effects of serogroup A, C, W, and Y meningococcal disease
  • Meningococcal disease kills up to 1 in 10 people who get it
  • 2022 U.S. data show an increase in meningococcal cases among people with HIV compared to the prior 5 years
  • In 2022, nearly 10% of meningococcal cases occurred in people with HIV, a marked increase over the prior 5 years
  • Meningococcal disease remains uncommon, but these data highlight the importance of MenACWY vaccination, including boosters, for people with HIV. Healthcare professionals should make sure all people with HIV are up to date with MenACWY vaccination, maintain a high suspicion for meningococcal disease when someone with HIV has symptoms compatible with meningococcal disease, and ensure that patients with meningococcal disease and unknown HIV status are screened for HIV

Access the MMWR article in HTML or PDF.

Related Link

“Tetanus in an Unvaccinated Man from Mexico—Oregon, 2022” published in MMWR

CDC published Tetanus in an Unvaccinated Man from Mexico—Oregon, 2022 on June 16 in MMWR. Main points from the article appear below.

  • Migrant populations in the United States typically have lower vaccination coverage than non-migrant populations and often work in professions for which the risk for injuries resulting in tetanus is greater (e.g., construction and agriculture)
  • In June 2022, a non–English-speaking, migrant construction worker was evaluated at an Oregon emergency department (ED). He had difficulty opening his mouth and reported pain in his back, arms, and neck. After a third ED visit due to worsening symptoms, his family reported he had recently stepped on a nail at work; he had no reported history of tetanus immunization.
  • Immunization history was not collected during the patients’ first two ED visits. This case highlights the need for clinicians to determine immunization histories in migrant populations early on. To address issues of health literacy and overcome language barriers, clinicians should consider use of both written and oral formats, photonovelas (picture stories), “teach-back” methods, and translators.

Access the MMWR article in HTML or PDF.

Related Link

Spotlight:'s resources focused on enhancing clinic and practice operations

The topic index on the Clinic Tools main page is a one-stop source of practical information for vaccine providers. You will find “how-to” information about vaccinating in any setting.

Clinic Tools: Storage and Handling main page offers printable temperature logs to monitor freezers and refrigerators. This site also includes a troubleshooting record to document the occurrence and resolution of questionable or unacceptable vaccine storage events.

Clinic Tools: Documenting Vaccination main page offers forms to document vaccination or declination of vaccination, as well as various forms and checklists useful to healthcare personnel.

Key Vaccination Resources for Healthcare Professionals is a 5-page annotated list of resources for people who vaccinate or oversee vaccination clinics. The document lists foundational content with which every vaccinator should be familiar, supplemental content useful after completing foundational training, and additional tools to help providers grow in vaccination expertise.

Vaccinating Adults: A Step-by-Step Guide, a free downloadable book, is a “how to” guide that provides easy-to-use, practical information covering essential adult vaccination activities.

Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination. Pages and Handouts enhances readability of several translations of four popular handouts recently posted four reference handouts in several languages with changes to the translations designed to improve patient readability. Changes were enhancements related to a quality improvement evaluation and do not imply errors in the previous translations. If you use these translations in your practice, please download the newest versions for an improved patient experience:

After the Shots . . . What to Do If Your Child Has Discomfort translations:

Vaccinations for Infants and Children, Age 0–10 Years translations:

Vaccinations for Preteens and Teens translations:

Vaccinations for Adults translations:

Related Links updates "Vaccines with Diluents: How to Use Them" revised its 1-page guide Vaccines with Diluents: How to Use Them to update entries for COVID-19, rotavirus, and cholera vaccines.

Related Links updates "Steps to Implementing Standing Orders for Immunization in Your Practice Setting" recently updated its 4-page guide Steps to Implementing Standing Orders for Immunization in Your Practice Setting to simplify and clarify the steps. A QR code linking to the online version of the document was also added.

Related Links

Featured Resources

CHOP's Vaccine Education Center releases documentary featuring former FDA official Marion Gruber, PhD, MS, addressing pandemics, outbreaks, and preparing for the next health emergency

Children’s Hospital of Philadelphia’s (CHOP) Vaccine Education Center (VEC) presents Marion Gruber: Preparedness Is Prevention, a 30-minute documentary featuring Marian Gruber, PhD, MS. Dr. Gruber was director of the Office of Vaccines Research at FDA and is now vice president of public health and regulatory science at the International AIDS Vaccine Initiative (IAVI). In this short film, Dr. Gruber and several of her colleagues describe their efforts to ensure that life-saving vaccines were available during recent public health emergencies and why preparing now for the next infectious disease threat is crucial.

Related Links

New YouTube episode in the Beyond the Noise series, featuring Vincent Racaniello, PhD, and Paul Offit, MD, discussing important vaccine topics

The YouTube series Beyond the Noise features vaccination conversations between creator Vincent Racaniello, PhD, professor of immunology at Columbia University, and Paul Offit, MD. The most recent episode, The Next Wave of Severe COVID-19, shares insights into a recent meeting of experts at the White House.

Watch Beyond the Noise on YouTube.

Related Links

Voices for Vaccines releases podcast with Jonathan Howard, MD, about his provocatively titled book, We Want Them Infected

Voices for Vaccines (VFV) posted a new entry in its Vax Talk podcast series titled Dr. Howard Fights the Forces That Want to Infect You featuring Jonathan Howard, MD. A description from the VFV web page appears below.

At the pandemic’s beginning, small bands of scientists and doctors devised a plan: what if we got young people sick on purpose? What could possibly go wrong?

Dr. Jonathan Howard’s new book, We Want Them Infected, traces this ill-begotten quest and the inevitable pseudoscience that followed.

Related Links

Notable Publications
“Comparison of COVID-19 Mortality Rates among Adults Aged ≥65 Years Who Were Unvaccinated and Those Who Received a Bivalent Booster Dose within the Preceding 6 Months—20 U.S. Jurisdictions, September 18, 2022–April 1, 2023” published in MMWR

CDC published Comparison of COVID-19 Mortality Rates among Adults Aged ≥65 Years Who Were Unvaccinated and Those Who Received a Bivalent Booster Dose within the Preceding 6 Months—20 U.S. Jurisdictions, September 18, 2022–April 1, 2023 on June 16 in MMWR. Main points from the article appear below.

  • Rates of death were similar among people who received a bivalent COVID-19 vaccine 2 weeks to 2 months earlier compared to people who received a bivalent vaccine 3–6 months earlier, demonstrating sustained protection against death provided by bivalent COVID-19 vaccines. While protection against death remained strong, it declined somewhat from the Omicron BA.5 period (September 18–November 5, 2022) to the Omicron XBB.1.5 period (January 22–April 1, 2023). These findings are relevant to future decisions on COVID-19 vaccine composition.
  • For the best protection against COVID-19–associated deaths, everyone age 6 months and older should stay up to date with COVID-19 vaccines, including getting at least 1 bivalent dose. Additional bivalent vaccine doses are optional for adults ages 65 years and older and people with weakened immune systems.

Access the MMWR article in HTML or PDF.

Related Link

Upcoming Events
Today! Virtual: Watch June 21–23 ACIP meeting. Topics include RSV, polio, influenza, pneumococcal, dengue, chikungunya, mpox, meningococcal, and COVID-19 vaccines.

CDC will convene an extended, 3-day meeting of the Advisory Committee on Immunization Practices (ACIP), June 21–23, starting at 8:00 a.m. (ET). ACIP will discuss vaccination recommendations for respiratory syncytial virus (RSV), polio, influenza, pneumococcal, dengue, chikungunya, mpox, meningococcal, and COVID-19 vaccines.

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

View the agenda.

Related Links

  • ACIP main page for access to webcast, agendas
  • ACIP: Meeting Information for presentation slides, content from previous meetings, and information about future meetings

Virtual: NFID hosts webinar titled “Addressing Adult Vaccine Hesitancy in the U.S.” on June 29

The National Foundation of Infectious Diseases (NFID) will host a webinar titled Addressing Adult Vaccine Hesitancy in the U.S. on June 29, 12:00–1:00 p.m. (ET). The webinar will feature interactive case studies to address current vaccine recommendations and gaps in coverage. Presenters will share strategies for effective communication on vaccine recommendations for influenza, pneumococcal disease, hepatitis B, Tdap, and COVID-19 for U.S. adults.

There is no fee to participate in this activity, but pre-registration is required.

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.

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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
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    Kayla Ohlde

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