Issue 1,711: August 30, 2023
Top Stories Pages and Handouts
Featured Resources
Notable Publications
Upcoming Events
Top Stories

“Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023” published in MMWR

CDC published Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023 in the August 25 issue of MMWR. A portion of the summary appears below.

In July 2023, the Food and Drug Administration approved nirsevimab, a long-acting monoclonal antibody, for prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in infants. . . .

On August 3, 2023, the Advisory Committee on Immunization Practices recommended nirsevimab for infants aged <8 months born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk of severe RSV disease entering their second RSV season. . . .

Nirsevimab can prevent severe RSV disease among infants and children aged <20 months at increased risk for severe RSV disease.

This long-acting monoclonal antibody is included in the federal Vaccines for Children (VFC) program to ensure access to all infants, regardless of insurance status. Healthcare providers who care for infants and toddlers should read the full recommendation for details about this important form of RSV prevention in infants. Access the MMWR article in HTML or PDF.

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“Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season” published in MMWR

CDC published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season in the August 25 issue of MMWR: Recommendations and Reports. The primary change in this year’s recommendations is the statement that people with egg allergy of any severity may receive any influenza vaccine with standard precautions. Portions of the summary appear below.

This report updates the 2022–23 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2022;71[No. RR-1]:1–28). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. All seasonal influenza vaccines expected to be available in the United States for the 2023–24 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. Inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. . . .

Any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used. . . . Egg allergy alone necessitates no additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg. . . . All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.

Access the MMWR article in HTML or PDF.

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“Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey–Teen, United States, 2022” published in MMWR

CDC published Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey–Teen, United States, 2022 in the August 25 issue of MMWR. A portion of the summary appears below.

Analyses of recent trends in routine vaccination coverage show declines in coverage by age 13 and 14 years among adolescents born in 2008. Among adolescents aged 13–17 years, routine vaccination coverage in 2022 was similar to coverage in 2021. Coverage with ≥1 HPV vaccine dose declined among adolescents insured by Medicaid.

Access the MMWR article in HTML or PDF.

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FDA licenses first vaccine for pregnant individuals to prevent RSV in their infants

On August 21, FDA announced the licensing of Abrysvo [respiratory syncytial virus (RSV) vaccine, Pfizer] for use in pregnant individuals to prevent lower respiratory tract disease (LRTD) and severe LRTD caused by RSV in infants from birth through 6 months of age. ACIP will meet at a future date to discuss recommendations for the use of RSV vaccine during pregnancy, including how maternal vaccination would affect clinical decisions concerning the use of nirsevimab during infancy. A portion of the news release appears below.

Abrysvo is approved for use at 32 through 36 weeks gestational age of pregnancy. Abrysvo is administered as a single dose injection into the muscle. The FDA approved Abrysvo in May for the prevention of LRTD caused by RSV in individuals 60 years of age and older.

Related Link updates its “Ask the Experts” web page on travel vaccines against cholera and tick-borne encephalitis's popular Ask the Experts: Travel Vaccines web page was updated with a thorough review. Information was added about the temporary unavailability of FDA-licensed cholera vaccine in the United States. Basic questions and answers were added about the newly recommended vaccine against tick-borne encephalitis (TBE, Ticovac, Pfizer).’s Ask the Experts main page leads you to 30 web pages on various 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.

Related Links

“Four Doses of Polio Vaccine before Age 4. Booster Needed?” Watch the 1-minute answer, part of the Ask the Experts Video Series on Facebook, LinkedIn, Twitter, YouTube, and Instagram.'s social media channels make it easy for you to learn a little more every day. This week, our featured episode from the Ask the Experts Video Series is Four Doses of Polio Vaccine before Age 4. Booster Needed? This is available on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts questions.

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

Spotlight: resources on state requirements, exemptions, and the consequences of being unvaccinated

In this week’s Spotlight, we summarize resources at that can aid your vaccine advocacy efforts.

State Requirements by Vaccine main page contains links to vaccine-specific requirements state by state for daycare, K-12, and post-secondary education settings. State-specific information about exemption policies appears as well. All of’s resources related to state requirements were updated with current information collected from state immunization program managers in March 2023. In addition, new state maps visually represent vaccine-specific requirements and state policies related to exemptions. These maps are ideal for use in presentations by policymakers, healthcare professionals, and advocates.

State Exemptions web page offers information on state requirements by vaccine-preventable disease. It includes policy statements from medical organizations endorsing strong school and childcare vaccination requirements and the elimination of non-medical exemptions.

Exemptions Permitted for State Childcare and School (Kg–Gr 12) Immunization Requirements web page shows which states accept medical, religious, and personal vaccination exemptions and offers a map of exemptions permitted for school and child care.

State Health Departments: Immunization Requirements main page offers links to each state’s immunization program and to additional pages provided by each state related to its vaccination requirements.

Talking about Vaccines main page provides medical professionals with background information and practical resources divided into different topics that will help them discuss vaccination with concerned parents or patients.

Unprotected People Stories main page features 109 real-life accounts of people who suffered or died from vaccine-preventable diseases: compelling personal testimonies, remembrances, case reports, and newspaper articles.

Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination. Pages and Handouts posts complete suite of materials on vaccination anxiety, designed for healthcare personnel and the public

Anxiety about injections is common at all ages and contributes to vaccine hesitancy in those affected. Among some adolescents and adults, anxiety can trigger dizziness or fainting, risking fall-related injuries. Both the vaccinator and the vaccine recipient can take simple and effective steps to improve the recipient’s vaccination experience.

Thanks to support from CDC as part of its work to increase vaccine confidence, now offers clinical tools for healthcare professionals and corresponding patient handouts on vaccination-related fainting and anxiety:

These 1-page resources highlight major points and include key references. The resources for healthcare personnel are ideal for teaching huddles and in-service trainings. They may also serve as the basis for quality-improvement efforts.


These resources are ideal to use in concert with’s screening checklists for contraindications to vaccination, recently revised to include questions about vaccination anxiety and fainting.

Related Links updates “Questions and Answers” handouts on measles, mumps, and rubella recently updated three of its Questions and Answers: Diseases and Vaccines handouts to provide updated information on recent measles and mumps outbreaks and current rubella morbidity. In addition to updated epidemiology, the primary update was the addition of Priorix (GSK) as a second MMR vaccine brand that may be used interchangeably with M-M-R II (Merck). Additional edits added a QR code and updated hyperlinks.

Updated handouts include:

Related Links

Featured Resources

“Shop” offers resources for your practice. Don’t miss getting laminated 2023 U.S. adult immunization schedules for your exam rooms.

On the Shop web page, you will find many resources such as laminated vaccination schedules, personal immunization record cards, pins for your lapel, and more! Your purchases help keep delivering free educational materials to healthcare professionals and to the public.’s three personal immunization record cards—child & teen, adult, and lifetime—are printed on durable rip-, smudge-, and water-proof paper. Sized to fit in a wallet when folded, the cards are brightly colored to stand out. Give these nearly indestructible personal record cards to your patients. They're sold in boxes of 250.

You too can show your support for vaccination with’s elegantly designed “Vaccines Save Lives” pin on your lapel. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125” x 0.75”. Order yours today to show how much you value vaccination!'s laminated versions of the 2023 U.S. adult immunization schedule are still available. Once sold out, we will not print more until 2024.

The schedules' coating can be wiped down, and they’re durable enough to stand up to a year's worth of use. Visit the Shop Laminated Immunization Schedules web page for more information on the schedules.

Related Links

Notable Publications

"Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020–2021" published in Emerging Infectious Diseases

In the September 2023 issue, Emerging Infectious Diseases published Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020–2021. The abstract appears below.

Streptococcus pneumoniae can co-infect persons who have viral respiratory tract infections. However, research on S. pneumoniae infections that are temporally associated with SARS-CoV-2 infections is limited. We described the epidemiology and clinical course of patients who had invasive pneumococcal disease (IPD) and temporally associated SARS-CoV-2 infections in Alaska, USA, during January 1, 2020–December 23, 2021. Of 271 patients who had laboratory-confirmed IPD, 55 (20%) had a positive SARS-CoV-2 test result. We observed no major differences in age, race, sex, or underlying medical conditions among IPD patients with and without SARS-CoV-2. However, a larger proportion of IPD patients with SARS-CoV-2 died (16%, n = 9) than for those with IPD alone (4%, n = 9) (p<0.01). IPD patients with SARS-CoV-2 were also more likely to be experiencing homelessness (adjusted OR 3.5; 95% CI 1.7–7.5). Our study highlights the risk for dual infection and ongoing benefits of pneumococcal and COVID-19 vaccination, especially among vulnerable populations.

"COVID-19 Booster Vaccination during Pregnancy Enhances Maternal Binding and Neutralizing Antibody Responses and Transplacental Antibody Transfer to the Newborn" published in Vaccine

In the August 14 issue, Vaccine published COVID-19 Booster Vaccination during Pregnancy Enhances Maternal Binding and Neutralizing Antibody Responses and Transplacental Antibody Transfer to the Newborn. Select highlights from the article appear below.

  • mRNA vaccines during pregnancy elicited robust binding and nAb [neutralizing antibody] responses.
  • Booster vaccination during pregnancy elicited significantly higher Ab [antibody] levels at delivery and in cord blood than 2-dose primary series, including against Delta and Omicron BA.1 variants.
  • COVID-19 vaccines, including booster doses, should continue to be strongly recommended during pregnancy.

"Differences in SARS-CoV-2 Specific Humoral and Cellular Immune Responses after Contralateral and Ipsilateral COVID-19 Vaccination" published in Lancet

In the August 11 issue, Lancet published Differences in SARS-CoV-2 Specific Humoral and Cellular Immune Responses after Contralateral and Ipsilateral COVID-19 Vaccination. The interpretation section appears below.

Both ipsilateral [same arm] and contralateral [opposite arm] vaccination induce a strong immune response, but secondary boosting is more pronounced when choosing vaccine administration-routes that allows for drainage by the same lymph nodes used for priming [i.e., same arm for both doses]. Higher neutralizing antibody activity and higher levels of spike-specific CD8 T-cells may have implications for protection from infection and severe disease and support general preference for ipsilateral vaccination.

“Immunization Update: 2024 Vaccine Schedules for Infants, Children, and Adolescents” published in Clinical Advisor

In its August 24, 2023, issue, Clinical Advisor published Immunization Update: 2024 Vaccine Schedules for Infants, Children, and Adolescents. This review was written by’s Mary Beth Koslap-Petraco, DNP, FAANP. The Conclusions section appears below.

The number one public health achievement has been the development of vaccines and widespread vaccination programs. Although the pandemic and vaccine hesitancy have eroded immunization rates, rates of vaccinations are beginning to increase globally. Vaccine hesitancy is alive and well, but several resources are available that provide guidance on working with those who question the need and safety of vaccines.

What are clinicians going to do to help increase the rate of vaccinations? Establish trust with parents. Use paradigms that do not belittle or harass parents, and keep the conversation going even if patients refuse or delay vaccines. Back to school is the perfect time to get all of those children to catch up on much-needed vaccines. If this opportunity is lost, the next pandemic could be caused by a vaccine-preventable disease.

Upcoming Events

Virtual: Today! CDC hosts webinar titled "New RSV Vaccines for Adults: General Information and Clinical Guidance" on August 30 at 12:00 p.m. (ET); CE credit offered.

The Immunization Services Division (ISD) in the National Center for Immunization and Respiratory Diseases (NCIRD) will host a webinar in their Current Issues in Immunization Webinars (CIIW) series titled New RSV Vaccines for Adults: General Information and Clinical Guidance, 12:00–1:00 p.m. (ET) on August 30. During the webinar, Michael Melgar, MD, NCIRD, and Amadea Britton, MD, MPH, NCIRD, will give updates on RSV vaccination recommendations for adults.

Registration is not needed, but participation is limited. CME, CNE, and CPE credit are available.

A recording will be available following the webinar. View archived CIIW videos.

Join the event directly.

Virtual: Watch September 12 ACIP meeting to discuss updated COVID-19 vaccines for fall 2023

CDC will convene its Advisory Committee on Immunization Practices (ACIP), September 12, 10:00 a.m.–4:00 p.m. (ET). The agenda will focus on recommendations for COVID-19 vaccines that target the XBB variants of SARS-CoV-2.

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

Related Links

Virtual: CHOP hosts Current Issues in Vaccines webinar titled “RSV Vaccines Across the Lifespan” on September 13; CE credit offered

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP) will present a 1-hour webinar titled RSV Vaccines Across the Lifespan beginning at 12:00 p.m. (ET) on September 13. 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.

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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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