Immunization Works October 2018

November 1, 2018: Content on this page kept for historical reasons.

October Immunization Works Newsletter

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ACIP Meeting: The Advisory Committee on Immunization Practices (ACIP) met October 24–25, 2018. They voted to routinely recommend hepatitis A vaccination for individuals who are homeless and approved the 2019 child/adolescent and adult immunization schedules. CDC also presented an overview of background data, so ACIP can discuss policy options for expanding the age recommendations for HPV vaccine, in anticipation of a vote at a future ACIP meeting. CDC and ACIP are conducting a rapid and thorough review all of the latest available data to inform recommendations for HPV vaccination following the recent U.S. Food and Drug Administration (FDA) approval of an expanded age of licensure for human papillomavirus (HPV) 9-valent vaccine (Gardasil 9).

Please visit the ACIP meeting web page for agendas, presentation slides, meeting minutes, and archived video broadcasts.


Mumps Outbreak in a Marshallese Community in the Denver Metropolitan Area, 2016–2017: In January 2017, the Colorado Department of Public Health and Environment (CDPHE) identified four epidemiologically linked cases of mumps among persons from a Marshallese community who were members of the same church in the Denver metropolitan area. During 2016–2017, sizable outbreaks of mumps reported in Arkansas, Hawaii, and Washington also affected the Marshallese population. CDPHE, the Tri-County Health Department (TCHD), and Denver Public Health collaborated to conduct an outbreak investigation during January–March 2017 using active and passive surveillance that identified 17 confirmed and 30 probable cases. Public health actions included conducting measles-mumps-rubella (MMR) vaccination clinics at local Marshallese churches; these resulted in the vaccination of 126 persons with more than 1 dose of MMR vaccine. Implementation of active surveillance and support from local Marshallese church leaders in promoting vaccination programs likely contributed to interruption of the outbreak. Please read the October 19 MMWR for the full report.

Vaccination Coverage for Selected Vaccines and Exemption Rates among Children in Kindergarten in the U.S. during the 2017–18 School Year: State and local school vaccination requirements exist to ensure that students are protected from vaccine-preventable diseases. The October 12 MMWR summarizes vaccination coverage and exemption estimates collected by state and local immunization programs for children in kindergarten (kindergartners) in 49 states and the District of Columbia and kindergartners provisionally enrolled (attending school without complete vaccination or exemption while completing a catch-up vaccination schedule) or in a grace period (a set interval during which a student may be enrolled and attend school without proof of complete vaccination or exemption) for 28 states. Median vaccination coverage was 95.1% for the state-required number of doses of diphtheria and tetanus toxoids, and acellular pertussis vaccine (DTaP); 94.3% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 93.8% for 2 doses of varicella vaccine. The median percentage of kindergartners with an exemption from at least one vaccine was 2.2%, and the median percentage provisionally enrolled or attending school during a grace period was 1.8%. Vaccination coverage among kindergartners remained high; however, schools can improve coverage by following up with students who are provisionally enrolled, in a grace period, or lacking complete documentation of required vaccinations.

Vaccination Coverage among Children Aged 19–35 Months in the U.S. during 2017: The ACIP recommends routine vaccination by age 24 months against 14 potentially serious illnesses. CDC used data from the 2017 National Immunization Survey-Child (NIS-Child) to assess vaccination coverage at national, state, territorial, and selected local levels among children aged 19–35 months in the U.S. Coverage remained high and stable overall, exceeding 90% for 3 or more doses of poliovirus vaccine, 1 or more doses of measles, mumps, and rubella vaccine (MMR), 3 or more doses of hepatitis B vaccine (HepB), and 1 or more doses of varicella vaccine. Although the proportion of children who received no vaccine doses by age 24 months was low, this proportion increased gradually from 0.9% for children born in 2011 to 1.3% for children born in 2015. Coverage was lower for most vaccines among uninsured children and those insured by Medicaid, compared with those having private health insurance, and for children living outside of metropolitan statistical areas (MSAs), compared with those living in MSA principal cities. These disparities could be reduced with greater awareness and use of the Vaccines for Children (VFC) program, eliminating missed opportunities to vaccinate children during visits to health care providers and minimizing interruptions in health insurance coverage. Please read the October 12 MMWR for the full report.

Update on Vaccine-Derived Polioviruses—Worldwide, January 2017–June 2018: Since the Global Polio Eradication Initiative was launched in 1988, the number of polio cases worldwide has declined substantially. Among the three wild poliovirus serotypes, only type 1 has been detected since 2012. This decline is attributable primarily to use of the live, attenuated oral poliovirus vaccine in national routine immunization schedules and mass vaccination campaigns. The success and safety record of oral poliovirus vaccine use is offset by the rare emergence of genetically divergent vaccine-derived polioviruses (VDPVs), whose genetic drift from the parental oral poliovirus vaccine strains indicates prolonged replication or circulation. Circulating VDPVs (cVDPVs) can emerge in areas with low immunization coverage and can cause outbreaks of paralytic polio. In addition, immunodeficiency-associated VDPVs (iVDPVs) can emerge in persons with primary immunodeficiencies and can replicate and be excreted for years. The October 25 MMWR presents data on VDPVs detected during January 2017–June 2018 and updates previous VDPV summaries. During this reporting period, new cVDPV outbreaks were detected in five countries. Fourteen newly identified persons in nine countries were found to excrete iVDPVs. Ambiguous VDPVs, isolates that cannot be classified definitively, were found among immunocompetent persons and environmental samples in seven countries.


Flu Vaccine Reduces Risk of Flu Hospitalization among Pregnant Women: An annual flu shot reduced pregnant women’s risk of flu-related hospitalization by an average of 40%, according to a new CDC-coauthored study. While previous studies have shown that a flu shot can reduce a pregnant woman’s risk of flu illness, this is the first study to show flu vaccination protected against flu-related hospitalization. The study includes data from 2 million pregnant women collected over six flu seasons across four countries, and found that more than 80% of pregnancies overlapped with flu season, underscoring the likelihood that pregnant women will be exposed to flu at some point during their pregnancy. The study is available online from the Clinical Infectious DiseasesExternal journal website.

CDC recommends pregnant women get a flu shot because they are at high risk of developing serious flu illness, including illness resulting in hospitalization. Other studies have shown that in addition to helping to protect the pregnant woman, a flu shot given during pregnancy helps protect the baby from flu infection for several months after birth before he or she is old enough to be vaccinated.

Flu shots have a good safety record. Millions of flu vaccines have been given for decades, including to pregnant women, with a good safety record. Observational and prospective studies in pregnant women support the safety of influenza vaccination during pregnancy. Please visit the CDC pregnant women and flu web page for additional information.

Influenza Activity Update in the U.S. and Worldwide, May 20–October 13, 2018: During May 20 through October 13, 2018, there was little influenza activity in the U.S. Influenza A and B viruses were both detected; during recent weeks, A(H1N1) were most common. Seasonal influenza activity in the Southern Hemisphere was low overall with influenza A(H1N1)pdm09 predominating in many regions. Laboratory testing of available recently circulating influenza A and B viruses indicated that most continue to be like the vaccine viruses recommended for production of 2018–19 Northern Hemisphere flu vaccines. It’s not possible to say what flu virus will predominate during the current flu season, but flu vaccination is the best way to prevent influenza infection. Please read the October 26 MMWR for the full report.

National Press Conference Kicks Off 2018–2019 Flu Vaccination Campaign: On September 27, 2018, CDC and the National Foundation for Infectious Diseases (NFID), along with other public health and medical groups kicked off the 2018–19 flu vaccine campaign at a press conferenceExternal held at the National Press Club in Washington, D.C. Early estimates from CDC indicate that more than 900,000 people were hospitalized and almost 80,000 people died from flu last season. These estimates are record-breaking, and emphasize the seriousness and severity of flu illness and serve as a strong reminder of the importance of flu vaccination. Please visit the flu web page for additional information.

2018–2019 Flu Season Vaccination Campaign: CDC encourages everyone 6 months and older to “fight flu” by getting their annual flu vaccination. You can support and join the campaign by sharing messages on the importance of flu vaccination, preventive actions, and antiviral treatment. Details on events/activities, sample social media and newsletter content, graphics, web assets, and media prep material are available in our digital campaign toolkit. This material is downloadable, shareable, and some of the material is customizable.

Learn more about how you can #FightFlu this season and stay up to date on the latest flu information from CDC by following @CDCFlu on Twitter and signing up for CDC’s weekly Influenza Newsletter.

Communication Resources for Health Care Providers: As a health care professional, your strong recommendation of flu vaccination is critical to your patients getting vaccinated. Most adults know vaccines are important, but they need a reminder from you to get their flu vaccination. They also need to understand how important it is to protect themselves and their families from serious illness caused by flu. CDC has developed a new toolkit containing a variety of resources to help communicate CDC vaccination recommendations and prepare your practice to fight flu. The tools will help you to make a strong influenza vaccine recommendation, facilitate productive conversations with your patients, and ultimately reduce the prevalence of flu in your community.

Prevent Vaccine Administration Errors: “Know the site and get it right” to prevent vaccine administration errors. As influenza season approaches, now is a great opportunity to remind providers to ensure staff members who administer vaccines know how to do it right. ISD has developed tools to share with members of your health care community. These products educate and remind providers about proper influenza vaccine administration techniques to help avoid shoulder injuries and other adverse events. The materials include links to comprehensive vaccine administration information, a short video on the correct technique for intramuscular injection, an infographic on administering flu vaccine to an adult, and a link to our vaccine administration e-Learn.

Influenza Vaccine Information Statements (VISs): Don’t forget to give a VIS every time you give a flu shot! Influenza VISs are no longer updated every year and the edition dated August 7, 2015, should be used for the 2018–19 season. You can find influenza VISs here.

Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition (the Pink Book): Published by CDC, NCIRD, and the Public Health Foundation (PHF), the Pink Book provides health care professionals with the most comprehensive information available on vaccines and vaccine-preventable diseases. The Pink Book is available for purchase from the PHF Learning Resource CenterExternal, and the chapters and appendices can be viewed or downloaded from the NCIRD vaccines site.

2018 Webinar Series for Pink Book: This 2018 online series of 15 webinars, which concluded on October 3, 2018, provides an overview of vaccination principles, general recommendations, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each webinar explored a chapter from the 13th edition of the Pink Book. All of the recordings can be viewed online at the Pink Book webinar web page. Continuing Education (CE) is available for each webinar.

“Keys to Storing and Handling Your Vaccine Supply” Video: Two of the most important safeguards for the nation’s vaccine supply are proper storage and handling. A new web-on-demand video, titled “Keys to Storing and Handling Your Vaccine Supply,” is designed to decrease vaccine storage and handling errors by demonstrating recommended best practices and addressing frequently asked questions. Continuing Education (CE) is available.

Vaccine Administration e-Learn: An e-Learn on vaccine administration is now available. Proper vaccine administration is critical for ensuring that vaccines are both safe and effective. Vaccine administration errors happen more often than you might think. Of the average 36,000 reports received annually by the Vaccine Adverse Event Reporting System (VAERS)External, about 1,500 are directly related to administration error.

Some of the most common vaccine administration errors include:

  • Not following the recommended immunization schedule
  • Administering improperly stored or expired vaccine and/or diluent
  • Administering the wrong vaccine—confusing look-alike or sound-alike vaccines such as DTaP/Tdap or administering products outside age indications

The e-Learn is a free, interactive, online educational program that serves as a useful introductory course or a great refresher on vaccine administration. The self-paced e-Learn provides comprehensive training, using videos, job aids, and other resources to accommodate a variety of learning styles, and offers a certificate of completion and/or Continuing Education (CE) for those that complete the training.

For more information, please contact

Current Issues in Immunization NetConferences: Immunization netconferences are live, one-hour events combining an online visual presentation with simultaneous audio via telephone conference call, along with a live question-and-answer session. Registration, Internet access, and a separate phone line are needed to participate. The latest netconference was September 25, 2018, and provided health care professionals with an update on DTaP/Tdap vaccine recommendations and hepatitis vaccine recommendations. The next netconference is scheduled for November 28, 2018. Please visit the netconference web page for additional information and to view archived webcasts.

HPV Video: Immunization providers play a critical role in getting parents to accept HPV vaccination for their children. A new video, titled “You Are the Key to HPV Cancer Prevention,” provides up-to-date information on HPV infection/disease, HPV vaccine, and ways to successfully communicate with parents about HPV vaccination. HPV vaccination is cancer prevention. While most U.S. adolescents are starting the HPV vaccine series, less than half have finished the series. Every year that adolescents aren’t vaccinated is another year they are left unprotected against cancer-causing infections. Continuing Education (CE) is available.

You Call the Shots Modules: You Call the Shots is a web-based training course developed through the Project to Enhance Immunization Content in Nursing Education and Training. The Vaccine Administration module has recently been updated and is now available. Please visit the You Call the Shots web page to view all the modules. Continuing Education (CE) is available for viewing a module and completing an evaluation.

Vaccine Information Statement (VIS) Update: CDC recently released a new Hepatitis B VIS. The VIS received a minor update, noting that a 2-dose series is available. Stocks of the existing edition may be used up before switching to this updated edition. Please visit the CDC VIS web page for additional information.

Measles and Mumps Resources: CDC aims to continue increasing awareness of measles and mumps among individuals and families and to encourage MMR vaccination. To support disease prevention and vaccination educational efforts, CDC has developed a variety of measles and mumps resources, including fact sheets, podcasts, and matte articles. Some of the measles graphics are also available in Spanish.

CDC and Medscape: This special series of commentariesExternal, part of a collaboration between CDC and Medscape, is designed to deliver CDC’s authoritative guidance directly to Medscape’s physicians, nurses, pharmacists, and other health care providers. In this series, CDC experts offer video commentaries on current topics important to practicing clinicians. NCIRD has contributed to a variety of commentaries. You will need to sign up and log in as a member to view the commentaries and registration is free.

Immunization Resources: Various publications are available for ordering at CDC-INFO On Demand. You can search for immunization publications by using the “Programs” drop-down menu and selecting “Immunization and Vaccines,” or you can search by “Title.” Numerous items are available for ordering, including the 2018 recommended immunization schedules.

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization and other positions. Researchers, medical officers, epidemiologists, and other specialists are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit CDC’s employment web page.

Calendar of Events

Got Your Shots? Immunization ConferenceExternal, Minnesota Department of Health, November 1–2, Minneapolis, MN

Clinical Vaccinology CourseExternal, National Foundation for Infectious Diseases (NFID), November 9–10, Bethesda, MD

NCIRD Calendar of Events

Immunization Action Coalition (IAC) CalendarExternal

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Page last reviewed: November 1, 2018 (archived document)