IZ Express

Issue 1729: December 6, 2023

Top Stories
Immunize.org Website and Clinical Resources
Vaccine Information Statements
Featured Resources
Notable Publications

Top Stories

It’s National Influenza Vaccination Week. Lagging vaccination rate means millions more are unprotected so far this season. Encourage vaccination using CDC’s digital media toolkit.

National Influenza Vaccination Week (NIVW), observed December 4–8 this year, was established by CDC in 2005 to highlight the importance of continuing influenza vaccination activities through the holiday season and beyond. NIVW is a critical time to post and share reminder messages and vaccinate all those who are not yet protected. As influenza vaccination rates to date have fallen behind last season, millions more unvaccinated people risk preventable illness and hospitalization. Get the word out using CDC's 2023 NIVW Digital Media Toolkit, which includes the following assets.

  1. Template Matte Release: use CDC’s article to encourage flu vaccination on your website, blog, or other channels
  2. Sample Newsletter Blurb: include CDC’s sample text copy in your email newsletter or other communications
  3. Patient Reminder Messages: remind patients by sharing key messages through your patient portal or other reminders
  4. Social Media Messagesuse CDC’s suggested Twitter, Facebook, and Instagram graphics and copy to spread the word; schedule content to remind your networks about the importance of flu vaccination throughout the week

In addition to CDC resources, Pennsylvania’s Montgomery County Immunization Coalition (MCIC) posted a social media toolkit with resources available in several languages. Links to each translated image are below.

English 1 English 2 Chinese
Hindi Korean Spanish

Use #FightFlu to join the conversation all week and tag @CDCFlu on X (Twitter).
“Age-Adjusted Percentage of Adults Aged ≥18 Years Who Received an Influenza Vaccination during the Past 12 Months, by Sex and Race and Ethnicity—National Health Interview Survey, United States, 2022” published in MMWR

CDC published Age-Adjusted Percentage of Adults Aged ≥18 Years Who Received an Influenza Vaccination during the Past 12 Months, by Sex and Race and Ethnicity—National Health Interview Survey, United States, 2022 on December 1 in MMWR. The summary appears below.

In 2022, among persons aged ≥18 years, women were more likely than were men (49.2% versus 41.1%) to have received an influenza vaccination during the past 12 months. Women were more likely than were men to have received an influenza vaccination among Asian (61.0% versus 50.7%), Black (40.6% versus 30.1%), Hispanic (43.5% versus 35.9%), and White (51.5% versus 43.4%) adults. Among men, Black adults were the least likely to have received an influenza vaccination during the past 12 months compared with Asian, Hispanic, and White adults. Among women, Black and Hispanic adults were less likely to have received an influenza vaccination during the past 12 months than were Asian and White adults.

Access the MMWR article in HTML or PDF.

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Influenza-like-illness activity is high in states across the country and rising nationwide. NIVW is the time to reach the unvaccinated.

CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable picture of laboratory-confirmed influenza and influenza-like-illness activity state by state.

Influenza Surveillance
For week 47, ending November 25, CDC’s Weekly U.S. Influenza Surveillance Report, FluView shows that seasonal influenza activity continues to increase in most parts of the country, notably in southern, mountain, and west coast regions of the United States. Nationwide, 3.9% 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]). The national baseline is 2.5%. Five pediatric deaths were reported this week, bringing the total to 8 influenza-associated pediatric deaths thus far during the 2023–24 season. Given the influenza vaccination rates to date, millions more people remain unprotected, compared to last season, as the 2023–2024 annual influenza epidemic begins.

Visit the CDC Respiratory Virus Hospitalization Surveillance Network (RESP-NET) for weekly reports of hospitalizations across the United States due to three vaccine-preventable seasonal respiratory viruses: COVID-19, influenza, and RSV. Activity levels of each of these diseases are rising but are currently lower than during week 47 of 2022, when respiratory virus activity peaked remarkably early.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard shows that as of November 11, an estimated 29 million doses of flu vaccine were administered in pharmacies and more than 17 million doses in medical offices. Vaccine uptake appears to be lagging behind this time in 2022. Of particular note, influenza vaccination among pregnant people has declined sharply since 2019. Only 29% of pregnant people were vaccinated against influenza by October 2023, compared to 45.5% in October 2019, despite the growing body of evidence of safety and benefit for both mother and infant. It is critical to protect people now, as influenza activity is becoming widespread.

CDC recommends everyone age 6 months and older get annual influenza vaccination. Influenza and other vaccines (e.g., COVID-19 vaccine, RSV vaccine) may be given at the same visit, if needed. Infants 6 months of age and older may receive influenza and COVID-19 vaccines at the same visit when they receive the RSV preventive antibody, nirsevimab. Locate influenza and COVID-19 vaccines in your area by entering your zip code in the VaccineFinder on Vaccines.gov or Vacunas.gov. To be listed as a provider by VaccineFinder, see the information on this website.

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Be alert to potential for error: CDC receives reports of RSV vaccines for adults being mistakenly administered to infants

On November 30, CDC informed public health immunization programs that they have received reports of infants being mistakenly administered RSV vaccines intended for adults. Infants should only receive the RSV preventive antibody, nirsevimab (Beyfortus, Sanofi).

RSV vaccines (Arexvy by GSK and Abrysvo by Pfizer) are recommended only for adults and have not been evaluated for safety or effectiveness in infants or children. Practices that carry both RSV vaccine and RSV preventive antibody products should review their immunization administration safety procedures to ensure only the correct product is administered to recipients.

CDC encourages vaccinators to promptly report all vaccine administration errors like these to VAERS. In the event that a vaccine administration error involving RSV vaccine occurs and further clinical guidance is needed, contact your state or local immunization program or CDC experts who may be reached by email at NIPINFO@cdc.gov.

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“SARS-CoV-2 Epidemiology and COVID-19 mRNA Vaccine Effectiveness among Infants and Children Aged 6 Months–4 Years—New Vaccine Surveillance Network, United States, July 2022–September 2023” published in MMWR

CDC published SARS-CoV-2 Epidemiology and COVID-19 mRNA Vaccine Effectiveness among Infants and Children Aged 6 Months–4 Years—New Vaccine Surveillance Network, United States, July 2022–September 2023 on December 1 in MMWR. The national network assessed vaccination status and SARS-CoV-2 test results among vaccine-eligible children younger than age 5 years who were hospitalized or sought care in emergency departments (ED) for acute respiratory illness during July 2022–September 2023. Part of the abstract appears below.

Among 7,434 children included, 5% received a positive SARS-CoV-2 test result, and 95% received a negative test result; 86% were unvaccinated, 4% had received 1 dose of any vaccine product, and 10% had received ≥2 doses. When compared with receipt of no vaccines among children, receipt of ≥2 COVID-19 mRNA vaccine doses was 40% effective (95% CI = 8%–60%) in preventing ED visits and hospitalization. [The effectiveness of a single mRNA COVID-19 vaccine dose for preventing COVID-19–associated ED visits and hospitalization was not statistically significant.] These findings support existing recommendations for COVID-19 vaccination of young children to reduce COVID-19–associated ED visits and hospitalization.

Access the MMWR article in HTML or PDF.

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“The National Wastewater Surveillance System’s Centers of Excellence Contributions to Public Health Action during the Respiratory Virus Season—Four U.S. Jurisdictions, 2022–23” published in MMWR

CDC published The National Wastewater Surveillance System’s Centers of Excellence Contributions to Public Health Action during the Respiratory Virus Season—Four U.S. Jurisdictions, 2022–23 on December 1 in MMWR. The preliminary conclusions and actions section appears below.

NWSS Centers of Excellence have reported correlation between WWS data and clinical surveillance with WWS allowing localized, timely coverage, and in some situations, valuable lead time notification. In Wisconsin, WWS detected increases in influenza and RSV weeks before increases in related emergency department visits were observed. NWSS data, together with clinical surveillance data, have guided jurisdictional partner decisions regarding allocation of resources, deployment of vaccination clinics, updating clinical guidance, and sending respiratory disease notifications and alerts when trends exceed baseline thresholds. NWSS Centers of Excellence have developed public-facing and internal pathogen data dashboards that provide metrics for public health partners and the communities they serve. During the 2022–23 respiratory disease season, NWSS Centers of Excellence translated WWS data into real-time public health action for multiple respiratory pathogens, highlighting the contribution of WWS in monitoring disease circulation and helping guide public health response.

Access the MMWR article in HTML or PDF.

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Immunize.org updates two Questions and Answers handouts

Immunize.org recently updated two of its resources, Polio: Questions and Answers and Rotavirus: Questions and Answers. Changes are described below.

  • Polio: Questions and Answers: This was updated with the new recommendation for all U.S. adults who are known or suspected to be unvaccinated or incompletely vaccinated to complete a 3-dose primary series. Information was added relating to the 2022 paralytic polio case in New York. A QR code linking to the online version of the document was added.
  • Rotavirus: Questions and Answers: This was reviewed for accuracy; minor updates were made. A QR code linking to the online version of the document was added.

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“How to Administer Multiple Intramuscular Vaccines to Adults during One Visit”: watch the 3-minute video, part of the Improving the Vaccination Experience Video Series on YouTube

As more vaccines are available to prevent serious illness in adults, patients often need more than one vaccination at a time. This 3-minute video, How to Administer Multiple Intramuscular Vaccines to Adults during One Visit, demonstrates clinical resources for vaccination providers to support their practice and increase their confidence. This video is part of Immunize.org’s new Improving the Vaccination Experience Video Series. It is available on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts questions.

This video features the printable Immunize.org clinical resource of the same name, How to Administer Multiple Intramuscular Vaccines to Adults During One Visit

Immunize.org’s series of short videos introduces you to a variety of ways to improve the vaccination experience for infants, children, teens, and adults. Three are for a general audience, and three are intended for healthcare professionals. As with all Immunize.org resources, these videos are free to download, link, copy, and share. You can also find this video and all of our resources related to vaccination anxiety on our Improving the Vaccination Experience main page.

Like, follow, and share Immunize.org’s social media accounts and encourage colleagues and others interested in vaccination to do likewise: Related Links
Immunize.org’s Hepatitis B Birth Dose Honor Roll features three renewing honorees

Immunize.org is pleased to renew three institutions’ Hepatitis B Birth Dose Honor Roll status. Each of these birthing institutions, listed below with their reported hepatitis B birth dose coverage rates, has maintained a standard of excellence in protecting newborns from hepatitis B for at least three years.

  • Newman Regional Health, Emporia, KS (95%) (3 years)
  • Riverview Health, Noblesville, IN (91%) (3 years)
  • Children’s Hospital at Montefiore, Bronx, NY (93%) (7 years)

The Honor Roll is a key part of Immunize.org’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 receive an 8.5" x 11" color certificate suitable for printing and framing. And their acceptance is announced through Immunize.org’s social media channels and to IZ Express’s 55,000+ readers.

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

Related Immunize.org Resources
Vaccines in the news

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

Immunize.org Website and Clinical Resources

Recap: Immunize.org updated these clinical resources in October and November

IZ Express regularly summarizes Immunize.org’s new and updated educational materials and web pages. All Immunize.org materials are free to distribute. In recent weeks, Immunize.org updated or created new helpful materials:

Immunize.org Printable Materials for Clinicians

Immunize.org Printable Materials for Patients Immunize.org Web Pages Related Links
  • Immunize.org: Clinical Resources A-Z main page to see educational materials sorted by category
  • Immunize.org: Ask the Experts main page to access more than 1,200 questions answered by Immunize.org experts

Vaccine Information Statements

Recap: VISs and translations released in October and November

IZ Express regularly provides readers with information about new and updated VISs and their translations.

On October 19, CDC released a new VIS for COVID-19 Vaccine and an updated VIS for Respiratory Syncytial Virus (RSV) Vaccine for adults. 

As a result of these VIS releases, two handouts related to VISs were updated:

On September 25, CDC released the Immunization Information Statement (IIS) – Respiratory Syncytial Virus (RSV) Preventive Antibody.
Immunize.org provided 13 translations of the following:
COVID-19 Vaccine VIS RSV Vaccine VIS for Adults RSV Preventive Antibody IIS
Armenian Armenian Armenian
Chinese–Simplified  Chinese–Simplified  Chinese–Simplified 
Chinese-Traditional Chinese-Traditional Chinese-Traditional
German German German
Italian Italian Italian
Japanese Japanese Japanese
Korean Korean Korean
Pashto Pashto Pashto
Polish Polish Polish
Russian Russian Russian
Somali Somali Somali
Spanish PDF and RTF  Spanish PDF and RTF  Spanish PDF and RTF 
Vietnamese  Vietnamese  Vietnamese 
The following five VIS translations were generously donated by St. Peter’s Health Partners of Albany, NY:
Hepatitis B VIS (view in English) Multi-vaccine VIS (view in English) Pneumococcal Conjugate (PCV) Vaccine VIS (view in English)  Related Links
Featured Resources

Vaccine Track shows Medicare vaccination rates increasing, a potential effect of the Inflation Reduction Act that eliminated patient co-pays under Medicare Part D

Vaccine Track is a website that displays state and national trend data on use of vaccines recommended for U.S. adults. Vaccine Track is produced through a partnership between GSK and IQVIA, a data analytics company. The following is a summary of recent data trends.

Average national vaccination claims (excluding influenza) for adults aged 19 and older showed improvements in the first half of 2023 compared to the same interval in 2022 and 2019. Claims increased by 12% compared to 2022 and by 9% from 2019 levels. The boost in rates can be largely attributed to an uptick in Medicare claims, as commercial claims remained stable.

As of January 1, 2023, Medicare Part D beneficiaries no longer have any out-of-pocket costs when given any CDC-recommended vaccinations. Medicare experienced a notable 14% increase in the first half (H1) of 2023 compared to the same period in 2019, while commercial vaccination claims increased 3%. Medicare claims increased 36% in H1 2023 while commercial claims increased 1%. Compared to H1 2019, Medicare Part D claims increased 36% in H1 2023, while Part B claims were down 40%.

In H1 2023, 11 states continued to experience adult vaccination claims rates below 2019 levels. The map below shows the vaccination percent change for all vaccines except influenza among adults based on Quarter 2 2023 claims data.

Vaccine Track data are refreshed quarterly, while CDC data are typically updated annually. Vaccine Track is the first tool to make comprehensive vaccination claims data across different payer types available publicly.

Related Links

Explore the www.Give2MenACWY.org website to increase coverage for the meningococcal ACWY booster and other adolescent vaccinations

Immunize.org's www.Give2MenACWY.org 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 vaccine outreach 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 update 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 Give2MenACWY.org and enjoy browsing (and deploying) its bountiful resources.

Related Links 

Notable Publications

"Communicating the Value of Influenza Vaccines to Patients: Translating Vaccine Effectiveness to Acceptance" published in Annals of Internal Medicine

In the November 28 issue, Annals of Internal Medicine published Communicating the Value of Influenza Vaccines to Patients: Translating Vaccine Effectiveness to Acceptance. This commentary highlights the SHARE method:

  • Share why an influenza vaccine is right for the patient
  • Highlight positive experiences with influenza vaccines
  • Address patient questions and any concerns
  • Remind patients that vaccines help protect them and their loved ones
  • Explain the potential costs of getting influenza

This tool was developed by the CDC to help healthcare professionals make a strong recommendation for vaccination. More information and a healthcare provider toolkit are available online.
The authors emphasize, “Conversations about influenza vaccination are likely to be most effective if health care professionals can individualize discussions of influenza risk and benefit.” Specifically:

  • For older persons or those with certain medical conditions: Emphasize that vaccination substantially reduces the risk for influenza-associated hospitalization or death
  • For young, healthy people: While at comparatively low risk for severe influenza, these people have greater exposure to influenza through school, work, or other activities. Emphasize that vaccination reduces (1) the risk for missing school or work, (2) the inconvenience and costs associated with medical visits, and (3) the risk of spreading infection to loved ones, such as older relatives or young children in the household.

"Vaccination, Immunity, and the Changing Impact of COVID-19 on Infant Health" published in Proceedings of the National Academy of Sciences

In the November 27 issue, Proceedings of the National Academy of Sciences published Vaccination, Immunity, and the Changing Impact of COVID-19 on Infant Health. The significance section appears below.

The effects of COVID-19 on infant health may be among the most enduring legacies of the pandemic. Using linked population-level data on siblings born between 2014 and 2023 in birthing facilities with confirmed universal testing, we establish that maternal COVID-19 infection during pregnancy causally, and substantially, increased the risk of preterm birth—an infant outcome with lifelong consequences for health and socioeconomic well-being. We show that this effect disappeared by 2022 and demonstrate that the disappearance of this effect happened almost a year earlier in places that were early adopters of COVID-19 vaccination. The availability of vaccines and the decision to use them may have reduced a serious health burden for the next generation of U.S. children.

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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 Immunize.org 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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