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Issue Number 420            October 27, 2003


  1. CDC notifies readers about guidelines for maintaining and managing the vaccine cold chain
  2. CDC Health Update: CDC identifies clusters of influenza A infections; timely influenza vaccination urged
  3. New: CDC posts information about ACIP decision to recommend influenza vaccination for children age 6 to 23 months
  4. New: IAC adds substantial information on vaccine-preventable diseases to its public website
  5. CDC Health Advisory: Unvaccinated Pennsylvania resident reported to have contracted respiratory diphtheria in Haiti
  6. October issue of CDC's "Immunization Works!" newsletter is available online
  7. Order now: Adult Immunization Record Card available by the carton at half-price--while supplies last
  8. New: Audio-format VISs explain the inactivated influenza VIS to English- and Spanish-speaking patients
  9. New: IAC posts three resources to help you translate immunization records from foreign countries


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October 27, 2003

The Centers for Disease Control and Prevention (CDC) published "Notice to Readers: Guidelines for Maintaining and Managing the Vaccine Cold Chain" in the October 24 issue of "Morbidity and Mortality Weekly Report" (MMWR). The notice is reprinted below in its entirety, excluding two tables and references.


In February 2002, the Advisory Committee on Immunization Practices (ACIP) and American Academy of Family Physicians (AAFP) released their revised General Recommendations on Immunization, which included recommendations on the storage and handling of immunobiologics. Because of increased concern over the potential for errors with the vaccine cold chain (i.e., maintaining proper vaccine temperatures during storage and handling to preserve potency), this notice advises vaccine providers of the importance of proper cold chain management practices. This report describes proper storage units and storage temperatures, outlines appropriate temperature-monitoring practices, and recommends steps for evaluating a temperature-monitoring program. The success of efforts against vaccine-preventable diseases is attributable in part to proper storage and handling of vaccines. Exposure of vaccines to temperatures outside the recommended ranges can affect potency adversely, thereby reducing protection from vaccine-preventable diseases. Good practices to maintain proper vaccine storage and handling can ensure that the full benefit of immunization is realized.

Recommended Storage Temperatures

The majority of commonly recommended vaccines require storage temperatures of 35-46 degrees Fahrenheit (2-8 degrees Celsius) and must not be exposed to freezing temperatures. Introduction of varicella vaccine in 1995 and of live attenuated influenza vaccine (LAIV) more recently increased the complexity of vaccine storage. Both varicella vaccine and LAIV must be stored in a continuously frozen state at or below 5 degrees Fahrenheit (-15 degrees Celsius) with no freeze-thaw cycles. In recent years, instances of improper vaccine storage have been reported. An estimated 17%-37% of providers expose vaccines to improper storage temperatures, and refrigerator temperatures are more commonly kept too cold than too warm.

Freezing temperatures can irreversibly reduce the potency of vaccines required to be stored at 35-46 degrees Fahrenheit (2-8 degrees Celsius). Certain freeze-sensitive vaccines contain an aluminum adjuvant that precipitates when exposed to freezing temperatures. This results in loss of the adjuvant effect and vaccine potency. Physical changes are not always apparent after exposure to freezing temperatures and visible signs of freezing are not necessary to result in a decrease in vaccine potency.

Although the potency of the majority of vaccines can be affected adversely by storage temperatures that are too warm, these effects are usually more gradual, predictable, and smaller in magnitude than losses from temperatures that are too cold. In contrast, varicella vaccine and LAIV are required to be stored in continuously frozen states and lose potency when stored above the recommended temperature range.

Vaccine Storage Requirements

Vaccine storage units must be selected carefully and used properly. A combination refrigerator/freezer unit sold for home use is acceptable for vaccine storage if the refrigerator and freezer compartments each have a separate door. However, vaccines should not be stored near the cold air outlet from the freezer to the refrigerator. Many combination units cool the refrigerator compartment by using air from the freezer compartment. In these units, the freezer thermostat controls freezer temperature while the refrigerator thermostat controls the volume of freezer temperature air entering the refrigerator. This can result in different temperature zones within the refrigerator.

Refrigerators without freezers and stand-alone freezers usually perform better at maintaining the precise temperatures required for vaccine storage, and such single-purpose units sold for home use are less expensive alternatives to medical specialty equipment. Any refrigerator or freezer used for vaccine storage must maintain the required temperature range year-round, be large enough to hold the year's largest inventory, and be dedicated to storage of biologics (i.e., food or beverages should not be stored in vaccine storage units). In addition, vaccines should be stored centrally in the refrigerator or freezer, not in the door or on the bottom of the storage unit, and sufficiently away from walls to allow air to circulate.

Temperature Monitoring

Proper temperature monitoring is key to proper cold chain management. Thermometers should be placed in a central location in the storage unit, adjacent to the vaccine. Temperatures should be read and documented twice each day, once when the office or clinic opens and once at the end of the day. Temperature logs should be kept on file for 3 or more years, unless state statutes or rules require a longer period. Immediate action must be taken to correct storage temperatures that are outside the recommended ranges. Mishandled vaccines should not be administered.

One person should be assigned primary responsibility for maintaining temperature logs, along with one backup person. Temperature logs should be reviewed by the backup person at least weekly. All staff members working with vaccines should be familiar with proper temperature monitoring.

Different types of thermometers can be used, including standard fluid-filled, min-max, and continuous chart recorder thermometers. Standard fluid-filled thermometers are the simplest and least expensive products, but some models might perform poorly. Product temperature thermometers (i.e., those encased in biosafe liquids) might reflect vaccine temperature more accurately. Min-max thermometers monitor the temperature range. Continuous chart recorder thermometers monitor temperature range and duration and can be recalibrated at specified intervals. All thermometers used for monitoring vaccine storage temperatures should be calibrated and certified by an appropriate agency (e.g., National Institute of Standards and Technology). In addition, temperature indicators (e.g., Freeze Watch [3M, St. Paul, Minnesota] or ColdMark [Cold Ice, Inc., Oakland, California]) can be considered as a backup monitoring system; however, such indicators should not be used as a substitute for twice daily temperature readings and documentation.

All medical care providers who administer vaccines should evaluate their cold chain maintenance and management to ensure that 1) designated personnel and backup personnel have written duties and are trained in vaccine storage and handling; 2) accurate thermometers are placed properly in all vaccine storage units and any limitations of the storage system are fully known; 3) vaccines are placed properly within the refrigerator or freezer in which proper temperatures are maintained; 4) temperature logs are reviewed for completeness and any deviations from recommended temperature ranges; 5) any out-of-range temperatures prompt immediate action to fix the problem, with results of these actions documented; 6) any vaccines exposed to out-of-range temperatures are marked "do not use" and isolated physically; 7) when a problem is discovered, the exposed vaccine is maintained at proper temperatures while state or local health departments, or the vaccine manufacturers, are contacted for guidance; and 8) written emergency retrieval and storage procedures are in place in case of equipment failures or power outages. Around-the-clock monitoring systems might be considered to alert staff to after-hours emergencies, particularly if large vaccine inventories are maintained.

Additional information on vaccine storage and handling is available from the Immunization Action Coalition at Links to state and local health departments are available at Especially detailed guidelines from the Commonwealth of Australia on vaccine storage and handling, vaccine storage units, temperature monitoring, and stability of vaccines at different temperatures are available at


To obtain the complete text of the article online, go to:

To obtain a camera-ready (PDF format) copy of this issue of MMWR, go to:

To obtain a free electronic subscription to "Morbidity and Mortality Weekly Report" (MMWR), visit CDC's MMWR website at: Select "Free Subscription" from the menu at the left of the screen. Once you have submitted the required information, weekly issues of the MMWR and all new ACIP statements (published as MMWR's "Recommendations and Reports") will arrive automatically by email.

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October 27, 2003

On October 20, the Centers for Disease Control and Prevention (CDC) issued the following official CDC Health Update. CDC notes that a Health Update "provides updated information regarding an incident or situation; [it is] unlikely to require immediate action." It is reprinted below in its entirety.


This is an official CDC Health Update

Distributed via Health Alert Network
October 20, 2003 20:07 EDT (8:07 PM EDT)


This Health Alert Network notice describes recent reports of influenza A activity in Texas and other parts of the United States, presents results of preliminary laboratory analysis of influenza A(H3N2) isolates conducted at the Centers for Disease Control and Prevention, and outlines current recommendations for influenza vaccination.

During the first week of October, Texas health authorities reported cases and school outbreaks of laboratory-confirmed influenza A infections in the Houston metropolitan area. Testing in Texas identified influenza A(H3N2) virus, and isolates were sent to the Centers for Disease Control and Prevention (CDC) for further characterization. At CDC, preliminary analysis has shown that 8 of 13 A(H3N2) isolates from Texas are antigenically similar to the A(H3N2) A/Panama/2007/99 vaccine strain, while five isolates are antigenic drift [described in Note below] variants. Influenza subsequently has been reported from several counties in Texas.

During August and September, CDC had received influenza A(H3N2) isolates from sporadic cases in Alaska, Connecticut, Wisconsin, Hawaii, New Hampshire, New York, Texas, and the District of Columbia and influenza A isolates from sporadic cases in Louisiana, Texas, and Washington. While influenza activity in the United States usually starts in November or December and reaches peak levels from late December through April, the timing of influenza activity is highly variable from year to year and influenza outbreaks have been reported in October in some previous years. Influenza cases and isolated outbreaks can occur at any time of the year.

Similar to the Texas isolates, approximately 33% of influenza A(H3N2) viruses isolated worldwide between February and September have drifted antigenically from the current A(H3N2) A/Panama/2007/99 vaccine strain in laboratory tests. By contrast, influenza A(H1N1) and influenza B viruses generally have remained similar to their vaccine strain counterparts. Influenza vaccine is expected to provide good protection against influenza A(H1N1), B viruses, and A(H3N2) viruses that are similar to the vaccine strains. While vaccine protection against the A(H3N2) drift variants may be lower, the vaccine is expected to provide some degree of effectiveness although the level of protection cannot be predicted.

Supplies of influenza vaccine are adequate in the United States this year. The adequate supply, coupled with appearance of community influenza activity in Texas in early October, serves as a reminder of the need for timely vaccination against influenza, particularly among persons 6 months of age or older and who are at increased risk for complications of influenza. Such "high-risk" groups include:

  • Persons 65 years of age and older
  • Women who will be in the second or third trimester of pregnancy during influenza season
  • Persons with one of several chronic, long-term health problems (e.g., heart or lung disease, kidney problems, asthma, and HIV/AIDS or any other illness or condition that suppresses the immune system)

Influenza vaccination is also recommended for other target groups, including

  • Persons aged 50 to 64 years because of the increased prevalence of high-risk conditions in this age group
  • Health-care workers and others in close contact with high-risk individuals because of the possibility that this group might transmit influenza to persons in high-risk groups

For the 2003-04 influenza season, influenza vaccination also is encouraged, when feasible, for children 6 to 23 months of age and their household contacts and out-of-home caregivers because young children are at increased risk of influenza-related hospitalization. For 2004-05, influenza vaccination will be recommended for these groups for the first time.

[Note:] Antigenic drift is the gradual accumulation of changes in the hemagglutinin (HA) protein of influenza viruses that may affect the binding of antibodies to this virus protein. Since antibodies to the HA are important for protection from influenza, antigenic drift may result in an increase in susceptibility of the population to infection by these antigenically drifted viruses, in spite of previous infection or vaccination.

For additional information about influenza, please see the CDC website at


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October 27, 2003

On October 16, the National Immunization Program, Centers for Disease Control and Prevention (CDC) posted on its website the following information about the decision of the Advisory Committee on Immunization Practices (ACIP) to recommend influenza vaccination for children age 6 to 23 months, starting with the 2004-05 influenza season. The information is reprinted below in its entirety.


October 15, 2003

The Advisory Committee on Immunization Practices (ACIP) today (October 15, 2003) voted to recommend that children 6 to 23 months of age be vaccinated annually against influenza. The ACIP recommended this change be implemented in the fall of 2004. The ACIP had previously encouraged physicians to vaccinate 6 to 23 month old children when feasible; that is, when they had resources and capacity to educate parents about influenza, to administer the needed doses, and to monitor vaccine adverse events.

The current inactivated influenza vaccine is not approved by FDA for use among children less than six months of age.

Two doses of inactivated influenza vaccine administered more than one month apart are recommended for previously unvaccinated children less than nine years of age. If possible, the second dose should be administered before December. All subsequent annual influenza vaccinations require only one dose of vaccine.

Annual vaccination with the current vaccine is recommended because immunity declines during the year after vaccination and because the vaccine composition usually changes each year. Vaccine prepared for a previous influenza season should not be administered to provide protection for the current season.

The recommendations of the ACIP are forwarded to the Director of the CDC and the Secretary of Health and Human Services (HHS) for review. If the ACIP recommendations are accepted by the Director of CDC and the Secretary of HHS, they are published in the Morbidity and Mortality Weekly Report and become recommendations of CDC.

The ACIP consists of 15 experts in fields associated with immunization who have been selected for the Secretary of HHS to provide guidance to the Secretary, the Assistant Secretary for Health, and the CDC on the most effective means to prevent vaccine-preventable diseases. The Committee reviews and reports on immunization practices and recommends improvements in the national immunization efforts.


To access the information from the CDC website, go to:

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October 27, 2003

The Immunization Action Coalition (IAC) has recently added new resources to its website for the public, Each disease page on the public website now includes two Q & A sections, one about the disease and another about the vaccine that prevents it. Experts at the Centers for Disease Control and Prevention reviewed the questions and answers included on the website.

The disease Q & A section explores such questions as what causes a disease, how it is spread, what its symptoms are, how common the disease is in the United States and world, and how the disease can be treated. The vaccine Q & A section discusses the type of vaccine used to prevent the disease, the year it was licensed, its efficacy and safety, who should receive it, and its possible side effects.

IAC also added new photographs to the website's photo section, bringing the total available to 200. Each month IAC's web statistics show these photographs to be among the most viewed items on our websites--a picture truly is worth a thousand words!

The addition of the Vaccine Education Center's video, "Vaccines: Separating Fact from Fear," brings the number of video clips available to 25.

Developed in 2002, the public website presents straightforward information about vaccine-preventable diseases and their vaccines to patients, parents, providers, and the media. Please visit the website often, use its resources, and share them with others.

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October 27, 2003

On October 24, the Centers for Disease Control and Prevention (CDC) issued the following official CDC Health Advisory. CDC notes that a Health Advisory "provides important information for a specific incident or situation; [it] may not require immediate action." It is reprinted below in its entirety.


This is an official CDC Health Advisory

Distributed via Health Alert Network
October 24, 2003 14:20 EDT (2:20 PM EDT)


On 10/18/03, the Pennsylvania Department of Health and CDC were notified of a case of respiratory diphtheria in a 63-year-old male. This Pennsylvania resident had reportedly never been vaccinated against diphtheria. From October 3-10, this man and seven other men from New York, Pennsylvania, and West Virginia had worked in a rural village in Haiti. On return to Pennsylvania, the man was admitted to a hospital because of his severe sore throat and respiratory distress. Respiratory diphtheria was suspected when, during a tracheostomy procedure, a pseudomembrane was seen throughout his upper airways consistent with respiratory diphtheria. Several days later, a sample of the pseudomembrane was PCR [polymerase chain reaction] positive for Corynebacterium diphtheriae tox genes. Based on his history of travel to Haiti where diphtheria is endemic, his clinical symptoms, and the positive PCR results, this patient has a confirmed case of respiratory diphtheria.

Diphtheria is caused by toxigenic strains of the bacterium Corynebacterium diphtheriae. The mainstay of therapy is administration of diphtheria antitoxin (DAT). DAT should be given when diphtheria is suspected without waiting for laboratory confirmation. In the U.S., DAT is only available from the CDC [(770) 488-7100]. Suspected diphtheria case-patients should also receive antibiotics to eradicate carriage of C. diphtheriae. When respiratory diphtheria is suspected in a patient, Td vaccination is recommended for the patient's close contacts (i.e., those who may have been exposed to respiratory secretions or who are close household contacts) if Td has not been administered within the last 5 years. These contacts should have nasal and pharyngeal specimens obtained for culture and should also be given antibiotic prophylaxis. Contact investigations identified the diphtheria case-patient's seven travel companions, several health-care providers, and his wife as close contacts, and they received these interventions; other passengers on the commercial airliner that the case-patient took while in the infectious period were not considered to be close contacts.

Diphtheria is uncommon in the United States. From 1980 to 2002, only 54 cases of probable or confirmed respiratory diphtheria were reported to the CDC's National Notifiable Diseases Surveillance System. Diphtheria is endemic in Algeria, Egypt, sub-Saharan Africa; Brazil, Dominican Republic, Ecuador, and Haiti; Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Iran, Iraq, Laos, Mongolia, Myanmar, Nepal, Pakistan, Philippines, Syria, Thailand, Turkey, Vietnam, and Yemen; and Albania and all countries of the former Soviet Union. Travelers who travel to these areas may be at substantial risk for exposure to toxigenic strains of C. diphtheriae, especially with prolonged travel, extensive contact with children, or exposure to poor hygiene.

Primary diphtheria immunization with diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) is recommended for all persons aged 6 weeks to 6 years of age. The five DTaP doses are administered at ages 2, 4, and 6 months, at 15-18 months and at 4-6 years. Adolescents and adults should receive the adult formulation of tetanus and diphtheria toxoids (Td) every 10 years.

Health care providers should ensure that travelers to all countries with endemic diphtheria are up-to-date with diphtheria and other vaccinations according to the ACIP guidelines. For additional information on diphtheria, please see the CDC website at: For additional health information for international travel, please see the CDC website at


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October 27, 2003

The October issue of "Immunization Works!" a monthly email newsletter published by the Centers for Disease Control and Prevention (CDC), is available on the website of the Immunization Action Coalition (IAC). The newsletter offers members of the immunization community information about current topics. Some of the information in the October issue has already appeared in previous issues of "IAC EXPRESS." Following is the text of seven articles we have not covered.


ACIP Meeting: The Advisory Committee on Immunization Practices (ACIP) met last week in Atlanta. During the meeting ACIP unanimously approved moving from the current "encouragement" of influenza vaccination to a full recommendation for children aged 6-23 months. If accepted by the CDC and the Department of Health and Human Services, implementation will occur with the 2004-2005 influenza season. Children will need two doses of the vaccine, a month apart, in the first year that they receive immunization. Subsequent vaccinations only require one dose. The ACIP's influenza recommendations also include annual vaccination of household and out-of-house caregivers of persons who are at high risk of complications from influenza. ["IAC EXPRESS" editor's note: For more information on this topic, see the previous "IAC EXPRESS" article.]

The ACIP also approved the Recommended Childhood and Adolescent Schedule and catch-up schedule for 2004 with minor changes from 2003. The Live Attenuated Influenza Vaccine was added. The inactivated influenza vaccine for infants will also be added. The committee agreed to clarify that the third dose of Hepatitis B (at six months of age) is acceptable at 24 weeks of age.

With regard to smallpox vaccination in the event of an outbreak, the ACIP expressed that in an affected area of outbreak, immunosuppressed persons and children under one year of age would still be advised against smallpox vaccination. However, the Committee agreed that ring vaccination of all contacts and secondary contacts of cases should take place as previously recommended.


Pneumococcal Conjugate Vaccine Supply Normalized: All providers are reminded that a return to the routine vaccine schedule for pneumococcal conjugate vaccine was recommended by the ACIP in May. The recommendation was made after the pneumococcal conjugate (Prevnar) vaccine supply was normalized earlier this year. All children without medical contraindication should receive the full pneumococcal conjugate dosing schedule according to the ACIP and the AAP Red Book Committee recommendations. For more information, view the May 16, 2003 MMWR at


Private Provider Awards Announced: CDC has awarded new cooperative agreements to private provider organizations to promote immunization outreach. More than $685,000 will be spread among six organizations: Ambulatory Pediatric Association, Society of Adolescent Medicine, American Academy of Family Physicians, American College of Physicians, American Pharmacists Association, and Society of Teachers of Family Medicine.

The funding will support a range of new and continuing projects that target multiple private provider audiences. New projects include the development of a camera-ready immunization schedule for easy duplication in member newsletters, training and long-term assistance for physicians to implement the Adult and Adolescent Clinical Assessment Software Application (ACASA) into their practices, and the development and dissemination of pharmacy toolkits on collaborative best practices. Continuing projects include adding components to TIDE, an on-line vaccine educational curriculum for child and adolescent providers; and enhancing SHOTS, a PDA program containing vaccine information for all immunization providers.

Funding for these projects is expected to be available for three years, concluding in September 2006. Information about future CDC funding opportunities can be found at or in the Federal Register.


International Immunization Opportunities: The Global Immunization Division at the National Immunization Program at CDC is currently accepting applications for the January and May 2004 Stop Transmission of Polio (STOP) teams. CDC is recruiting candidates to work in field surveillance assignments, as well as data management assignments. In order to qualify for consideration, candidates must either have obtained a graduate degree or licensure in health and have three years of relevant work experience (for example, MD, PA, RN, DVM, MPH) OR have five years of relevant work experience. Particularly desirable is field surveillance and/or immunization program experience, especially in developing countries, in addition to a demonstrated ability to work in French, Portuguese, or Arabic. For more information and application procedures, please visit

Also, CDC periodically recruits Medical Officers and Epidemiologists to work on measles, polio and other activities in Atlanta-based positions as well as long-term assignments (2 yrs. minimum) in various overseas locations. We are especially interested in mid-career professionals with at least five years of international public health management, disease surveillance and/or immunization program experience, and excellent interpersonal skills. Please contact Liz Bell at or Carla Lee at for further information.



CDC Makes Conference Support Grants Available: The CDC has limited resources available to support public health conferences. To support this process, CDC has implemented a new Conference Support Grant Program. There are several cycles available for submitting Letters of Intent (LOIs) and applications. Upcoming deadlines are January 6, 2004, for LOIs and March 8, 2004, for applications for conferences August 1, 2004, through July 31, 2005. LOIs will be accepted April 1, 2004, and Applications June 1, 2004 for conferences November 1, 2004, through September 30, 2005. For more information visit



The 38th National Immunization Conference is soliciting abstracts for its upcoming meeting in Nashville, Tennessee, May 11-14, 2004. The conference will bring together a wide variety of local, state, federal, and private-sector immunization partners to explore science, policy, education, and planning issues related to immunization in general and vaccine-preventable disease. The deadline for abstract submission is January 16, 2004. For more information visit


The Sixth National Conference on Immunization Coalitions: Chart Your Coalition's Course for Norfolk, is soliciting abstracts for its upcoming meeting in Norfolk, Virginia, September 20-22, 2004. The conference provides training on how to create, lead and sustain effective local or state coalitions and partnerships that address childhood, adolescent, and adult immunization. More specifically, the conference will address coalitions as agents of social change, the elements of a successful coalition, and social and ethnic diversity in coalitions. The deadline for abstract submission is December 15, 2003. For more information visit


To access the entire October issue from the IAC website, go to:

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October 27, 2003

Our printer's error creates a wonderful opportunity for you to stock up on one or more cartons of the Immunization Action Coalition (IAC) Adult Immunization Record Card--and pay only half the price you'd expect! We are offering a 3750-card carton to "IAC EXPRESS" readers for the marked-down price of $131.25, plus shipping. Your typical cost would be $262.50 per carton.

We can offer the card at this price because our printer mistakenly printed cards with the "old" design, which included space for a patient's social security number. Cards with the "new" design, which are not available at half price, have space for a patient number instead.

The Adult Immunization Record Card is extremely popular. Since introducing it in May 2002, IAC has shipped more than a million cards to health care providers across the United States. Health professionals find the card invaluable for educating patients that immunization is a lifelong process and for giving patients the means to keep a lifetime record of their immunization status.

Printed on smudge-proof, rip-proof, waterproof paper, the card comes pre-folded to fit in a wallet. Its bright, canary-yellow color makes it easy to spot among credit cards and other items.

To view a copy of the "new" design online, go to: Remember, the half-price card is identical to the online card with one exception: The half-price card has "Social Security Number" instead of "Patient Number."

You can place an order for a 3,750-card carton (or more) of the half-price card in two ways: (1) fax your order to us at (651) 647-9131 or (2) send an email to the following address: Include your complete shipping information (your name, shipping address, and daytime phone number). Please include your fax number in your fax or email to us, and we will fax you a confirmation of your order and an expected shipping date. We accept payment by check, purchase order, or credit card; we will ship in 2-3 weeks. You pay shipping charges.

Orders will be filled only for multiples of 3,750 (e.g., 7,500, 11,250, 15,000, etc.) and will be shipped IN THE ORDER WE RECEIVE THEM until supplies are depleted. Don't delay!

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October 27, 2003

The 2003-04 Inactivated Influenza Vaccine Information Statement (VIS) in audio format is now available in English and Spanish on the Immunization Action Coalition (IAC) website. IAC gratefully acknowledges Healthy Roads Media, National Library of Medicine Multilingual Health Education Resource Project, for the audio-format VISs. To find out more about the project and access additional resources, go to:

To access the audio-format inactivated influenza VIS in English or Spanish from the IAC VIS web page, go to: Click on option #4, "VISs listed by disease," click on "inactivated influenza vaccine," and click on "English (audio VIS)" or "Spanish (audio VIS)."

For information about the use of VISs, and for VISs in a total of 30 languages, visit IAC's VIS web page at

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October 27, 2003

When a patient arrives at your practice or clinic site with immunization records written in a language you don't know, how can you interpret the records well enough to verify the patient's immunization history? It's a complex task, but three resources recently posted on the Immunization Action Coalition (IAC) website can help make it somewhat easier. IAC is grateful to the Minnesota Department of Health for permission to adapt and post these resources.

Following are the resources' titles, descriptions, and URLs:

(1) "Quick Chart of Vaccine-Preventable Disease Terms in Multiple Languages" lists 20 immunization-related terms in English and gives translations for them in Somali and several Eastern European and Western European languages.

To access a camera-ready (PDF) copy, go to:

(2) "Translation of Vaccine-Related Terms Into English" lists more than 180 immunization-related terms in several Western European and Eastern European languages, as well as a few in African, Caribbean, and Pacific Islander languages. In addition, more than 20 such terms are given in the Cyrillic alphabet.

To access a camera-ready (PDF) copy, go to:

(3) "Vaccines and Biologics Used in U.S. and Foreign Markets" lists more than 300 vaccine products or trade names that are or have been used in the U.S. and international markets. The list includes products manufactured in more than 25 countries worldwide.

To access a camera-ready (PDF) copy, go to:

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.

IZ Express Disclaimer
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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