IZ Express

Issue 1734: January 10, 2024

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

Supply issues eased: CDC resumes routine recommendations for nirsevimab to protect infants and high-risk toddlers from severe RSV

On January 5, CDC issued a Clinician Outreach and Communication Activity (COCA) emergency alert: Updated Guidance for Healthcare Providers on Increased Supply of Nirsevimab to Protect Young Children from Severe Respiratory Syncytial Virus (RSV) during the 2023–2024 Respiratory Virus Season. CDC now recommends resuming adherence to the published ACIP recommendations for use of nirsevimab and provides considerations for individual facilities with limited supplies. Immunize.org is updating its standing orders template to reflect this change. A portion of the guidance appears below.

On October 23, 2023, the Centers for Disease Control and Prevention (CDC) issued Health Alert Network (HAN) Health Advisory 499 to provide guidance for prioritization of nirsevimab given limited supply. Nirsevimab (Beyfortus, Sanofi and AstraZeneca) is a long-acting monoclonal antibody immunization recommended for preventing RSV-associated lower respiratory tract disease in young children. Given the recent increase in nirsevimab supply and the manufacturers’ plan to release an additional 230,000 doses in January, CDC advises healthcare providers to return to recommendations put forward by CDC and the Advisory Committee on Immunization Practices (ACIP) on use of nirsevimab in young children. Infants and children recommended to receive nirsevimab should be immunized as quickly as possible. Healthcare providers should not reserve nirsevimab doses for infants born later in the season when RSV circulation and risk for exposure to RSV may be lower. RSV activity remains elevated nationwide and is continuing to increase in many parts of the country, though decreased activity has been observed in the Southeast. 

Recommendations for Healthcare Providers

  • In the setting of increasing supply, healthcare providers should administer a single dose of nirsevimab to all infants aged less than 8 months, as well as children aged 8 through 19 months at increased risk.
    • Healthcare providers should continue to work with their state immunization program and the manufacturer to order available nirsevimab doses. CDC is working closely with jurisdictional partners to ensure adequate supply through the Vaccines for Children Program. 
    • Neither RSV vaccine (Pfizer Abrysvo, GSK Arexvy) is approved for use in infants or young children. Healthcare providers should take care to use the correct product for the correct population.
    • Although supply of nirsevimab is expected to increase, available supply may continue to vary locally and by healthcare facility. For healthcare providers who continue to have limited supply, nirsevimab should be prioritized to protect infants at the highest risk for severe RSV disease using the following principles: first by high-risk conditions and then by age, prioritizing the youngest infants first.   
  • Pregnant people 32 through 36 weeks gestation should receive RSV vaccination through January.
    • Pfizer Abrysvo is the only RSV vaccine recommended for use in pregnant people. GSK Arexvy is not recommended for use in pregnant people.
  • Administration of both nirsevimab and RSV vaccination for pregnant people is not needed to protect most infants. 

Related Links

Immunize.org launches its “Clinical Resources: Improving the Vaccination Experience” web page

With support from CDC, Immunize.org launched its Clinical Resources: Improving the Vaccination Experience web page, a home for all of its resources to help you create a positive vaccination experience and ease anxiety in children and adults. Immunize.org print and video resources offer effective and practical steps that vaccination providers, recipients, caregivers, and companions can take to reduce vaccination-related pain and anxiety. Links to additional resources from trusted partner organizations are also provided.

The web page features all of our printable clinical resources on addressing vaccination anxiety, two in-depth webinars, and six brief videos that run 4 minutes or less. The short videos are ideal for sharing with patient families on your website or social media. As with all Immunize.org resources, these videos and associated clinical resources are free to download, link, copy, and share.

The video topics include:

Related Links
CMS offers additional Medicare payments for certain in-home vaccinations

Starting January 1, 2024, the Centers for Medicare and Medicaid Services (CMS) will provide an additional payment amount for administering influenza, hepatitis B, and pneumococcal vaccinations in the patient's home for certain Medicare patients. 

For 2024, the additional payment amount for in-home Part B preventive vaccine administration is approximately $38. Medicare will pay this amount in addition to the standard administration amount (approximately $30 per influenza, hepatitis B, or pneumococcal dose) for a total payment of approximately $68 per vaccination administered in a patient's home in 2024. 

For additional details, including billing codes and conditions visit this CMS web page.
FDA, CDC, and vaccine experts refute Florida Surgeon General’s claims on mRNA COVID-19 vaccination

FDA, CDC, and the Vaccine Education Center at the Children's Hospital of Philadelphia (CHOP) issued a series of responses refuting the Florida Surgeon General's false claims and call for discontinuing mRNA vaccination. A portion of FDA and CDC's joint letter issued on December 14 appears below. 

We would like to make clear that based on a thorough assessment of the entire manufacturing process, FDA is confident in the quality, safety, and effectiveness of the COVID-19 vaccines. The agency’s benefit risk assessment and ongoing safety surveillance demonstrate that the benefits of their use outweigh their risks. Additionally, with over a billion doses of the mRNA vaccines administered, no safety concerns related to residual DNA have been identified.

CHOP posted new resources on their web page addressing Questions and Answers about COVID-19 Vaccines, including a video featuring Paul Offit, MD, explaining why it’s virtually impossible for DNA fragments in COVID-19 mRNA vaccines to cause harm, such as cancers or autoimmune diseases. According to Dr. Offit, "You have a better chance of becoming Spider-Man" than being harmed by DNA from COVID vaccines.

Related Links

Spotlight: Use Immunize.org’s Vaccines & VISs tab to access the Vaccines A-Z menu to reach vaccine-specific summary pages for 34 vaccine-preventable diseases

In this week's Spotlight, Immunize.org highlights its Vaccines A-Z menu, accessible by clicking on the Vaccines & VISs menu tab at the top of the new Immunize.org home page. The Vaccines A-Z menu is the first major element you see after clicking on the Vaccines & VISs menu, displaying the direct links to 34 vaccine-specific pages.

Each vaccine-specific page includes content such as:  

  • Clinical resources for providers and vaccine recipients from Immunize.org
  • Sample questions from Ask the Experts Q&As (with easy access to all Q&As on the topic)
  • ACIP recommendations
  • VISs
  • FDA package inserts
  • State policies, including school entry requirements, if applicable
  • Links to partner resources, such as CDC’s vaccine-specific web pages
  • Unprotected people stories
  • Links to photos and videos

Use the Vaccines & VISs tab to access Immunize.org's Vaccines A-Z menu with links to our resource pages for each of 34 vaccine-preventable diseases.

Influenza-like illness is high in most states. Encourage influenza, COVID-19, and RSV vaccination now. 

CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable picture of laboratory-confirmed influenza and influenza-like-illness (ILI) activity state by state. ILI activity is caused by a variety of respiratory illnesses, including three vaccine-preventable infections: influenza, COVID-19, and RSV.

Influenza Surveillance
For week 52, ending December 30, CDC’s Weekly U.S. Influenza Surveillance Report, FluView shows that six jurisdictions experienced moderate ILI activity and 39 jurisdictions experienced high or very high activity. Nationwide, 6.9% 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., ILI). The national baseline is 2.5%. Seven pediatric influenza-associated deaths were reported this week, bringing the total to 27 pediatric deaths thus far during the 2023–24 season. Given the relatively low influenza, COVID-19, and RSV vaccination rates to date, millions more people remain unprotected, compared to last season.

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. 

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard shows that as of December 23, an estimated 155 million doses of flu vaccine were distributed in the United States. Of note, influenza vaccination coverage for all children is 5.0 percentage points lower this season compared with the same time last season (43.9% compared with 48.9%). Coverage this season so far is 9.8 percentage points lower compared with pre-pandemic coverage at the same time in December 2019 (53.7%). It is critical to protect people now, as influenza activity is 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.

Related Links

“Which Adults Need Hepatitis B Vaccine?”: watch the 1-minute answer, part of the Ask the Experts Video Series on YouTube

This week, our featured episode from the Ask the Experts Video Series is Which Adults Need Hepatitis B Vaccine? The video briefly describes ACIP's April 2022 recommendations for the use of hepatitis B vaccine in adults. It 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 Immunize.org’s social media accounts and encourage colleagues and others interested in vaccination to do likewise:

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

Immunize.org updates its "Vaccine Storage Emergency Response Worksheet" for addressing power failures and temperature excursions

Immunize.org updated its resource titled Vaccine Storage Emergency Response Worksheet. The worksheet helps healthcare professionals deal with the aftermath of power failures and temperature excursions. One vaccine was added—Ixchiq (chikungunya vaccine)—and several manufacturer names and telephone numbers were updated. A QR code linking to the online version of the document was added.

Related Links

Immunize.org updates "Vaccinations for Infants and Children, Age 0–10 Years" to incorporate RSV preventive antibody

Immunize.org recently updated its popular parental handout Vaccinations for Infants and Children, Age 0–10 Years. Changes were made to incorporate RSV preventive antibody (nirsevimab).


Related Link

  • Immunize.org: Clinical Resources A-Z main page, where you can filter by topic, vaccine, language, or other criteria 

Immunize.org updates LAIV considerations on its popular child and teen screening checklist for contraindications to vaccines

Immunize.org’s popular Screening Checklist for Contraindications to Vaccines for Children and Teens was revised to clarify the live attenuated influenza vaccine (LAIV) contraindications and precautions and to add a link to Immunize.org’s Clinical Resources: Addressing Vaccination Anxiety.


Related Links

Immunize.org launches its “Vaccines: Chikungunya” main page to include package insert and FDA vaccine approval information 

Immunize.org launched its Vaccines: Chikungunya main page. This new page was added to include package insert and vaccine approval info and partner resources. As future resources become available for this vaccine, including forthcoming ACIP recommendations, they will be added here. 

Bookmark Immunize.org's Vaccines: Chikungunya main page to connect with a comprehensive list of resources from CDC, FDA, and Immunize.org.

Immunize.org updates its "Sample Vaccine Policy Statement," a template for medical practices to adapt and explain their pro-vaccine policy statement

Immunize.org revised its Sample Vaccine Policy Statement, which is based on one generously shared by All Star Pediatrics of Exton, Pennsylvania. This document now reflects updates made by the originators of this sample policy. Additionally, it lists specific vaccines and the preventive antibody routinely recommended for all children.

Related Link

  • Immunize.org: Clinical Resources A-Z main page, where you can filter by topic, vaccine, language, or other criteria 

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

IZ Express regularly provides readers with information about Immunize.org’s new and updated educational materials for healthcare professionals and handouts for patients. All Immunize.org materials are free to distribute.
In case you missed them during recent weeks, updates were made to these helpful materials:

Immunize.org Updated Materials for Clinicians

Immunize.org Updated Influenza-Specific Materials for Clinicians 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: These new VISs and translations were released in November and December

IZ Express regularly provides readers with information about Vaccine Information Statements (VISs) and translations of VISs. 

On December 7, 2023, CDC released a new VIS for Tick-borne Encephalitis (TBE) Vaccine.

As a result, two handouts related to VISs were updated:

On October 19, CDC released a new VIS for COVID-19 Vaccine and an updated VIS for Respiratory Syncytial Virus (RSV) Vaccine for adults. On September 25, CDC released the Immunization Information Statement (IIS) – Respiratory Syncytial Virus (RSV) Preventive Antibody.
Immunize.org provided 25 translations of the following:
COVID-19 Vaccine VIS RSV Vaccine VIS for Adults RSV Preventive Antibody IIS
Arabic Arabic Arabic
Armenian Armenian Armenian
Burmese Burmese Burmese
Chinese–Simplified  Chinese–Simplified  Chinese–Simplified 
Chinese-Traditional Chinese-Traditional Chinese-Traditional
Farsi Farsi Farsi
French French French
German German German
Hindi Hindi Hindi
Italian Italian Italian
Japanese Japanese Japanese
Khmer Khmer Khmer
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 
Swahili Swahili Swahili
Tagalog Tagalog Tagalog
Ukrainian Ukrainian Ukrainian
Urdu Urdu Urdu
Vietnamese  Vietnamese  Vietnamese 
Yiddish Yiddish Yiddish

Related Links
Featured Resources

Sign up for the 3Cs program from Unity Consortium to address vaccine hesitancy

Unity Consortium offers its 3Cs educational program to help healthcare providers deliver Confident, Concise, and Consistent recommendations (the 3Cs) for all ACIP-recommended vaccines for adolescents and young adults.

This free self-guided resource features video vignettes of healthcare providers responding to common questions and concerns.

  • Videos: the videos, available with Spanish captions, demonstrate how providers can use simple motivational interviewing and shared clinical decision-making strategies to address concerns and help adolescents and parents be confident in accepting vaccine recommendations
  • Resource guide: a Q&A-style resource guide, available in both English and Spanish, includes sample recommendations by age
  • CE: the 3Cs program is appropriate for individual and team training; continuing education credit is available through the Indiana University School of Medicine

The Pursuit of the 3Cs: Confident, Concise, and Consistent Provider Recommendations for Adolescent Vaccines video series was funded by Unity’s member organizations and St. Jude Children’s Research Hospital's HPV Cancer Prevention Program.

Visit Unity’s 3Cs web page for more information and to register for the free, online program.

NFID posts podcast featuring CDC Director Mandy K. Cohen on building trust through transparency 

Infectious IDeas, a podcast series from NFID, brings leading experts together for thought-provoking conversations. The latest entry in the series, Building Trust through Transparency, features Mandy K. Cohen, MD, MPH. A description from the web page appears below.

In this episode, hosts Marla Dalton, PE, CAE, and William Schaffner, MD, talk with Mandy K. Cohen, MD, MPH, director of the CDC about her perspectives on rebuilding trust in public health agencies. She shares what first influenced her to study medicine, what she is most proud of to date at CDC, and what most keeps her awake at night.

Notable Publications

"Nirsevimab for Prevention of Hospitalizations Due to RSV in Infants" published in New England Journal of Medicine

In the December 28 issue, New England Journal of Medicine published Nirsevimab for Prevention of Hospitalizations Due to RSV in Infants. The conclusions section appears below.

Nirsevimab protected infants against hospitalization for RSV-associated lower respiratory tract infection and against very severe RSV-associated lower respiratory tract infection in conditions that approximated real-world settings.

In brief, the study demonstrated that nirsevimab was 83.2% effective at preventing hospitalization for RSV-associated lower respiratory tract infection. It was 75.7% effective at preventing very severe RSV-associated lower respiratory tract infection.

Click image for video abstract, available with a free nejm.org account.

“Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines among Nursing Home Residents—National Healthcare Safety Network, United States, December 2023” published in MMWR

CDC published Coverage with Influenza, Respiratory Syncytial Virus, and Updated COVID-19 Vaccines among Nursing Home Residents—National Healthcare Safety Network, United States, December 2023 on December 22 in MMWR. A portion of the summary appears below. 

Nursing home residents are vulnerable to infection with and complications from SARS-CoV-2, influenza, and respiratory syncytial virus (RSV). Vaccination reduces severe illness and death from these vaccine-preventable respiratory diseases. . . .

As of December 10, 2023, 33% of nursing home residents were up to date with COVID-19 vaccination. Among residents at 20% and 19% of facilities that elected to report influenza and RSV vaccination coverage, respectively, 72% had received influenza vaccination, and 10% had received RSV vaccination. . . .

There is an urgent need to protect nursing home residents against severe outcomes of respiratory illnesses by increasing vaccination against COVID-19 and influenza and discussing RSV vaccination with eligible residents.

Access the MMWR article in HTML or PDF.

Related Link

  • CDC: MMWR main page providing access to the MMWR family of publications

“Influenza, Updated COVID-19, and Respiratory Syncytial Virus Vaccination Coverage among Adults—United States, Fall 2023” published in MMWR

CDC published Influenza, Updated COVID-19, and Respiratory Syncytial Virus Vaccination Coverage among Adults—United States, Fall 2023 on December 22 in MMWR. A portion of the summary appears below. 

The Advisory Committee on Immunization Practices recommends that all adults receive influenza and COVID-19 vaccines, and those aged ≥60 years may receive respiratory syncytial virus (RSV) vaccine during the 2023–24 respiratory virus season. . . .

By December 9, 2023, an estimated 42.2% and 18.3% of adults aged ≥18 years had received influenza and updated 2023–2024 COVID-19 vaccine, respectively; 17.0% of adults aged ≥60 years had received RSV vaccine. Many adults who had not received the vaccines reported being open to vaccination. . . .

Strong provider recommendations for and offers of vaccination could increase influenza, COVID-19, and RSV vaccination coverage. Immunization programs and vaccination partners might benefit from using these within-season data to understand vaccination patterns in their jurisdictions to strengthen vaccination activities.

Access the MMWR article in HTML or PDF.

Related Link

  • CDC: MMWR main page providing access to the MMWR family of publications

Upcoming Events

Virtual: NFID hosts webinar titled “Strategies for Improving HPV Vaccination Rates” on January 18 at 1:00 p.m. (ET); CME credit available

NFID.org will host a webinar titled Strategies for Improving HPV Vaccination Rates, 1:00–2:00 p.m. (ET) on January 18. NFID Medical Director Robert (Bob) H. Hopkins, Jr., MD,  will moderate the webinar with presentations by Cassandra (Sandy) Pingali, MS, MPH, CDC epidemiologist, and Sherri Zorn, MD, pediatric physician-quality improvement coach, Washington State HPV Free Task Force. Kimberly Williams, chief diversity equity and inclusion officer at Cervivor, will also share her personal story as a cervical cancer survivor. CME credit is available.

There is no fee to participate in this activity, but preregistration is required.

Register for the webinar.

NFID hosts monthly webinars to increase awareness of the importance of infectious disease prevention and treatment. CME, CNE, and CPE credit are available for select recordings. View all archived NFID webinars.

Virtual: The International Society for Influenza and other Respiratory Diseases hosts webinar titled "RSV Vaccination in the Elderly Population" on January 24 at 8:30 a.m. (ET)

The International Society for Influenza and other Respiratory Diseases will host a webinar titled RSV Vaccination in the Elderly Population, 8:30–10:00 a.m. (ET) on January 24. Barney Graham, MD, Morehouse School of Medicine, will speak on "Proof-of-Concept for Structure-Based Vaccine Design," and Edward E. Walsh, MD, University of Rochester Medical Center, will speak on "Clinical Development of the RSV Vaccines for the Elderly and Their Likely Impact upon Rollout."

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 Immunize.org 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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