Immunization Works February 2019

February 27, 2019: Content on this page kept for historical reasons.

Immunization Works Newsletter January 2019

Top Stories

2019 Immunization Schedules: Every year, the Advisory Committee on Immunization Practices (ACIP) develops recommendations for routine use of vaccines in children, adolescents, and adults. When adopted by the CDC Director, these recommendations become official CDC/HHS policy. On February 8, the child and adolescent immunization schedule and the adult immunization schedule were released on the CDC website. The schedule website has also been redesigned. The redesign allows for easier access to information and a broader range of immunization schedule-related-materials, including resources for health care providers, parents, and adults.

CDC encourages organizations to syndicate content rather than copy a PDF version of the schedule onto their websites to share with visitors. Content syndication allows other organizations’ websites to mirror CDC web content, with automatic updates whenever changes are made to the CDC site. This helps ensure that all schedules are current across the Internet. See how to display the schedules on your site.

CDC Childhood Immunization Schedule Catch-Up Job Aids: CDC has released updated job aids that complement table 2 of the child and adolescent immunization schedule. These job aids will help health care providers easily navigate information about four of the vaccines in the childhood immunization catch-up schedule. They enable providers to look at the current age of the child and the number of previous doses they have had, and then show when the next dose is due.

The job aids are available for the following vaccines:

Updated Vaccine Storage and Handling Toolkit: The Vaccine Storage and Handling Toolkit is a comprehensive guide that reflects best practices for vaccine storage and handling from ACIP recommendations, product information from vaccine manufacturers, and scientific studies. The toolkit has been redesigned for 2019 to help health care providers find the information they need quickly and easily. Revisions include:

  • A reorganized layout with color-coded sections to help better navigate the toolkit
  • Updated job aids and resource documents
  • Updated visuals for vaccine storage and handling recommendations and best practices
  • Clarifying language on CDC recommendations versus best practices

Please contact or questions and additional information.


Influenza Activity Update: Influenza activity remained elevated through February in the U.S. Influenza A(H1N1) viruses predominated nationwide; however, in recent weeks, influenza A(H3N2) viruses accounted for an increasing proportion of reported flu viruses in several regions. During the week ending February 22, the percentage of outpatient visits for influenza-like illness (ILI) increased to 5.1%, which is above the national baseline of 2.2% and was equal or above the region-specific baselines in all 10 regions. The rate of influenza-associated hospitalizations remained relatively low. The percentage of deaths attributed to pneumonia and influenza remained below the epidemic threshold. A total of 41 laboratory-confirmed, influenza-associated pediatric deaths during the 2018–19 flu season have been reported to CDC. Please read the February 15 MMWR for the full report.

The most up-to-date influenza surveillance data in the U.S. for the 2018–19 flu season can be found in the current FluView. To receive weekly e-mails with technical flu season updates, sign up at the flu partner web page.

Interim Estimates of 2018–2019 Seasonal Influenza Vaccine Effectiveness: Preliminary vaccine effectiveness (VE) estimates indicate the 2018–19 seasonal flu vaccine is reducing the overall risk of having to seek medical care for flu illness by about half among people who were vaccinated this season. The estimates show an overall 47% VE across all age groups. This is within the range (40% to 60%) of what has been observed during recent seasons when the recommended vaccine viruses were well-matched to most circulating viruses. The interim VE estimates do suggest that the vaccine may not be working the same across all age groups:

  • 6 months through 17 years: 61% (95% Confidence Interval [CI] of 44% to 73%)
  • 18 through 49 years: 37% (95% CI of 9% to 56%)
  • 50 years and older: 24% (95% CI of -15% to 51%)

Flu vaccine reduced the risk of medically attended illness against the vastly predominant H1N1 virus by 46% overall. Estimates were particularly good for children who were vaccinated, reducing their risk of H1N1 medically attended flu illness by 62%. CDC continues to recommend flu vaccination because it can still prevent some infections, hospitalizations, and deaths due to currently circulating influenza viruses or other influenza viruses that may circulate later in the season. Please read the February 15 MMWR for the full report.

Preliminary In-Season U.S. Influenza Burden Estimates: To better represent the burden of flu nationally, this season, CDC is sharing preliminary estimates of cumulative in-season (2018–19) flu illnesses, medical visits, hospitalizations and deaths. These data are derived using a mathematical model and are based on data collected from a flu-associated hospitalization network that covers about 27 million people. Newly released seasonal estimates of flu illnesses, medical visits, hospitalizations, and deaths occurring between October 1 and February 16 in the U.S. show:

  • 17.7 million to 20.4 million people have been sick with flu
  • 8.2 to 9.6 million people have been to the doctor because of flu
  • 214,000 to 256,000 people have been hospitalized because of flu
  • 13,600 to 22,300 people have died because of flu Please visit the influenza estimates web page for additional information. The data will be updated weekly over the remainder of the flu season.

Benefits of 2017–2018 Seasonal Flu Vaccination: In partnership with academic and public health colleagues, CDC recently published an article in the journal, Clinical Infectious DiseasesExternal, describing the effectiveness of the influenza vaccine and the number of illnesses, hospitalizations, and deaths prevented by flu vaccination during the 2017–18 flu season. The authors found that flu vaccines reduced the chances of getting sick and going to the doctor for flu by 38%. The authors used a mathematical model, combining the vaccine effectiveness, estimated vaccination coverage, and influenza burden. They estimated that influenza vaccination prevented 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths associated with flu during the 2017–18 flu season. Learn more at the seasonal influenza web page.

Take 3 Actions to Fight Flu: Flu is a potentially serious contagious disease that can lead to hospitalization and even death. CDC urges you to take the following actions to protect yourself and others from flu: 

  1. If you have not gotten a flu vaccine this season, get vaccinated nowit’s not too late! As long as flu viruses are circulating, vaccination should continue throughout the flu season, even in February or later. Everyone 6 months of age and older is recommended for vaccination against flu every year, with rare exceptions. With weeks of flu activity expected to continue this flu season, there is still time to get vaccinated if you haven’t already done so.
  2. Take everyday preventive actions to help stop the spread of germs. If possible, try to avoid close contact with sick people. If you do get sick, limit contact with others as much as possible to keep from infecting them. Also, clean and disinfect surfaces and objects that may be contaminated with germs like flu. Avoid touching your eyes, nose or mouth because germs spread this way. Cover your mouth and nose with a tissue when you cough or sneeze. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  3. Take flu antiviral drugs if your doctor prescribes them. Antiviral drugs can be used to treat flu illness. CDC recommends rapid treatment of seriously ill and high-risk flu patients with antiviral drugs. These drugs work best when started early in the illness.

Continue to fight flu this season. Use the resources at CDC’s campaign toolkit website. The toolkit includes social media content, posters, website assets, media prep material, and important events. Stay up to date on the latest flu information from CDC by following @CDCFlu and signing up for CDC’s weekly Influenza Newsletter.


Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness: Hepatitis A (HepA) vaccination is recommended routinely for children at age 12–23 months, and for persons who are at increased risk for hepatitis A virus (HAV) infection. It is also recommended for any person wishing to obtain immunity. Persons at increased risk for HAV infection include international travelers to areas with high or intermediate hepatitis A endemicity, men who have sex with men, users of injection and noninjection drugs, persons with chronic liver disease, persons with clotting factor disorders, persons who work with HAV-infected primates or with HAV in a research laboratory setting, and persons who anticipate close contact with an international adoptee from a country of high or intermediate endemicity. Persons experiencing homelessness are also at higher risk for HAV infection and severe infection-associated outcomes. On October 24, 2018, ACIP recommended that all persons age 1 year and older experiencing homelessness be routinely vaccinated against HAV. The ACIP Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine to persons experiencing homelessness. The review included a set of criteria assessing the benefits and adverse events associated with vaccination. HepA vaccines are highly immunogenic, and more than 95% of immunocompetent adults develop protective antibody within 4 weeks of receipt of 1 dose of the vaccine. HAV infections are acquired primarily by the fecal-oral route by either person-to-person transmission or via ingestion of contaminated food or water. Among persons experiencing homelessness, effective implementation of alternative strategies to prevent exposure to HAV, such as strict hand hygiene, is difficult because of living conditions among the homeless. Integrating routine HepA vaccination into health care services for persons experiencing homelessness can reduce the size of the at-risk population over time, and thereby, reduce the risk for large-scale outbreaks. Please read the February 15 MMWR for the full report.

Resources and Information

CDC Launches New Video Series–“How Vaccines Work”: CDC and NCIRD are excited to launch the first two videos of their latest animated video series for parents, titled “How Do Germs Make Your Baby Sick,” and How Do Vaccines Help Babies Fight Infections.In these short videos, viewers follow baby Jack and his parents as they get answers to common vaccine-related questions and learn more about the importance of vaccinating on schedule. The first video describes how vaccines fight germs and provide long-lasting protection against 14 serious diseases. The second video helps parents learn about their baby’s immune system and how vaccines support their overall health. CDC will launch an additional video in March. Please share this new educational resource with parents! Learn more at the parents/childhood vaccines web page.

New Pneumococcal Vaccination App: CDC has launched a new pneumococcal vaccination app, PneumoRecs VaxAdvisor, for iOS and Android mobile devices. Take the confusion and stress out of interpreting pneumococcal vaccine recommendations. Use this app to quickly and easily determine which pneumococcal vaccines a patient needs and when. Simply enter a patient’s age and note if the patient has specific underlying medical conditions. After answering questions about the patient’s pneumococcal vaccination history, you’ll receive patient-specific guidance consistent with ACIP’s recommended immunization schedule. The app incorporates recommendations for all ages, so internists, family physicians, pediatricians, and pharmacists will all find the tool beneficial. Visit the app web page for additional 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.

Epidemiology and Prevention of Vaccine-Preventable Diseases Course: CDC will host up to 250 state and local public health staff at an Epidemiology and Prevention of Vaccine-Preventable Diseases course (also known as a Pink Book course) in Atlanta at CDC’s Roybal campus May 28–May 30, 2019. This live, on-site course is intended for state, county, and regional immunization program staff. Only a limited number of these on-site courses can be presented each year. The course is based on the Pink Book and the Pink Book webinars. Immunization program updates will also be included.

At the conclusion of the session, the participant will be able to:

  1. Describe the difference between active and passive immunity.
  2. List two characteristics of live, attenuated vaccines.
  3. List two characteristics of inactivated vaccines.
  4. For each vaccine-preventable disease, identify those for whom routine immunization is recommended.
  5. For each vaccine-preventable disease, describe characteristics of the vaccine used to prevent the disease.
  6. Describe an emerging immunization issue.
  7. Locate resources relevant to current immunization practice.
  8. Implement disease detection and prevention health care services (e.g., smoking cessation, weight reduction, diabetes screening, blood pressure screening, immunization services) to prevent health problems and maintain health.

CE is available for physicians, nurses, physician assistants, nurse practitioners, health educators, and pharmacists.Additional information will be posted soon on the immunization education and training web page.

2018 Webinar Series for Pink Book: This 2018 online series of 15 webinars, which concluded in October 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. We will have updated webinars in 2019 and that schedule will be posted soon.

“Keys to Storing and Handling Your Vaccine Supply” Video: Two of the most important safeguards for the nation’s vaccine supply are proper vaccine 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 2019 netconference schedule will be posted soon. 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 series of interactive, web-based training courses developed through the Project to Enhance Immunization Content in Nursing Education and Training. These courses are ideal for medical or nursing students, new vaccination providers, or seasoned health care providers seeking a review. The Vaccines for Children (VFC) and Vaccine Storage and Handling modules have recently been updated and are 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.

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”.

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

ACIP Meeting, February 27–28, 2019, Atlanta, GA

Annual Conference on Vaccinology ResearchExternal, National Foundation for Infectious Diseases (NFID), April 3–5, 2019, Baltimore, MD

California Immunization Coalition SummitExternal, California Immunization Coalition, April 8–9, 2019, Riverside, CA

The National Adult and Influenza Immunization Summit (NAIIS)External, May 14–16, 2019, Atlanta, GA

Wyoming Immunization ConferenceExternal, Wyoming Department of Health, May 21–22, 2019, Casper, WY

Iowa Immunization SummitExternal, (Pink Book Training), Iowa Department of Health, June 19–20, 2019, Altoona, IA

ACIP Meeting, June 26–27, 2019, Atlanta, GA

ACIP Meeting, October 23–24, 2019, Atlanta, GA

National Conference for Immunization Coalitions and Partnerships (NCICP)External, Hawaii Immunization Coalition and the Hawaii Public Health Institute, November 13–15, 2019, Honolulu, HI

Nevada Health ConferenceExternal, Immunize Nevada, October 14–15, 2019, Las Vegas, NV

Clinical Vaccinology Course (URL available soon), National Foundation for Infectious Diseases (NFID), November 16–17, Washington, D.C.

NCIRD Calendar of Events

Immunization Action Coalition (IAC) CalendarExternal

Page last reviewed: February 27, 2019 (archived document)