Immunization Works April 2019

April 3, 2019: Content on this page kept for historical reasons.

Immunization Works Newsletter April 2019

Top Stories

National Infant Immunization Week (NIIW) Is Here! This year marks the 25th anniversary of NIIW. From April 27–May 4, 2019, NIIW will highlight the importance of protecting infants from vaccine-preventable diseases and will celebrate the achievements of immunization programs in promoting healthy communities through the U.S. Please visit the newly launched 2019 NIIW digital media toolkit, which includes English and Spanish resources:

  • Sample NIIW announcements
  • Sample social media content
  • NIIW social media graphics, sized for Facebook, Instagram, and Twitter
  • Links to multimedia materials to share with parents, including animated videos, posters, and infographics
  • Links to updated immunization slide decks for clinicians
  • Details about two NIIW digital events:
    • #ivax2protect Twitter Storm on April 30
    • Instagram Q&A event for parents on May 2

During NIIW, CDC will be promoting its new three-part video series called “How Vaccines Work.” In these videos, parents follow baby Jack and his parents, getting answers to common vaccine-related questions and learning about the importance of vaccinating on schedule. We encourage you to share these videos with your members or constituents during NIIW. You can view all three videos here.

Please let us know what you are doing for NIIW by using our online activity form.

If you need additional information, please email

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.

Registration will close on May 1, 2019. Additional information can be found on the course information web page.

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 with questions or for additional information.


Influenza Activity Update: Influenza activity in the U.S. peaked in mid-February and began a gradual decline. As of mid-April, activity remained elevated and relatively high for that time of year. Influenza A(H1N1)pdm09 viruses predominated from October to mid-February, and influenza A(H3N2) viruses predominated thereafter. The 2018–19 season has been relatively long. As of mid-April, key CDC surveillance indicators were consistent with this being a season of moderate severity. CDC estimates that so far this flu season:

  • 9 to 42.4 million people have been sick with flu
  • 0 to 19.9 million people have been to the doctor because of flu
  • 518,000 to 630,000 people have been hospitalized because of flu
  • 35,600 to 63,000 people have died because of flu

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’s web page.

2009 H1N1 Pandemic Commemoration: Ten years ago in the spring of 2009, a novel influenza A (H1N1) virus emerged. It was detected first in the U.S. and spread quickly across the U.S. and the world. This new H1N1 virus contained a unique combination of influenza genes not previously identified in animals or people. This virus was designated as influenza A (H1N1)pdm09 virus. Few young people had any existing immunity (as detected by antibody response) to the (H1N1)pdm09 virus, but nearly one-third of people over the age of 60 years had antibodies against this virus, likely from an exposure to an older H1N1 virus earlier in their lives. The (H1N1)pdm09 virus was very different from H1N1 viruses that were circulating at that time; vaccination with seasonal flu vaccines thus offered little cross-protection against (H1N1)pdm09 virus infection. CDC estimated that between 151,700 and 575,400 people worldwide died from 2009 H1N1 virus infection during the first year the virus circulated.

Learn more about the 2009 H1N1 pandemic and how CDC responded at the pandemic resources web page.

New Lab Method Has Potential to Improve Flu Vaccine Virus Selection: A study published in Scientific Reportspdf iconexternal icon describes CDC’s development and use of a new laboratory method called “HINT” to better antigenically characterize influenza A(H3N2) viruses. HINT, which is short for “high-content imaging-based neutralization test,” has made it possible for scientists to identify specific changes in circulating H3N2 viruses that help the viruses evade immunity associated with vaccination or infection. Antigenic characterization of H3N2 viruses has become increasingly challenging in recent years. The new HINT methodology represents a major step forward in overcoming those challenges, with the potential to speed up and improve selection of candidate vaccine viruses for the H3N2 component of seasonal flu vaccines. Learn more about HINT at the influenza web page.

2019–2020 Northern Hemisphere Flu Vaccination Recommendation: The composition of U.S. flu vaccines is reviewed annually and updated as needed to best match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019–2020, trivalent (three-component) vaccines are recommended to contain:

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
  • A/Kansas/14/2017 (H3N2)-like virus (updated)
  • B/Colorado/06/2017-like (Victoria lineage) virus

Quadrivalent (four-component) vaccines, which protect against a second lineage of B viruses, are recommended to contain:

  • The three recommended viruses above, plus B/Phuket/3073/2013-like (Yamagata lineage) virus.

Learn more about the upcoming 2019–2020 flu season at the influenza web page.

Response to Influenza Outbreak in Laos Hill Tribes: Seasonal flu viruses circulate globally in people and are estimated to cause between 291,000 and 646,000 deaths annually worldwide. Recently, indigenous hill tribes living in a remote northern province of Laos experienced a devastating outbreak of seasonal influenza A(H1N1)pdm09 that caused 16 deaths in December and January. The high flu-related mortality sparked attention and local public health partners trained with U.S. CDC support responded quickly to the outbreak in Phongsaly Province. They rapidly deliver influenza antiviral drugs for treatment, provided health education and hygiene/sanitization interventions to slow the spread of disease, and funnel influenza vaccine to the crisis area for longer-term prevention of flu among the hill tribes. Learn more about how CDC responded to this outbreak at the influenza web page.

Sick With Flu? Know What To Do: While flu activity has been on the decline, activity remains elevated and sporadic activity is expected to continue for weeks. Flu antiviral drugs are an important second line of defense that can be used to treat flu. Prompt antiviral treatment is recommended for people with severe illness or who are at high risk of flu complications, including adults 65 years of age and older, young children, pregnant women, and people with certain medical conditions such as asthma, diabetes and heart disease. These drugs work best the sooner they are started. Prompt treatment with antivirals is especially important for older adults during times when H3N2 viruses are circulating because these are typically associated with more severe illness in older adults.

When used for treatment, antiviral drugs can lesson symptoms and shorten the time you are sick by one or two days. They also can prevent serious flu complications like pneumonia. For people at high risk of serious flu complications, treatment with antiviral drugs can mean the difference between milder or more serious illness, possibly resulting in a hospital stay. Take everyday preventive actions to help stop the spread of germs:

  •  Try to avoid close contact with sick people
  •  Limit contact with others as much as possible to keep from infecting them if you do get sick
  •  Clean and disinfect surfaces and objects that may be contaminated with germs
  •  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
  •  Use an alcohol-based hand rub if soap and water are not available

Continue to fight flu this season. Share CDC’s infographic on what to do when you’re sick with flu. Use CDC’s campaign toolkit, which includes social media content, posters, website assets, media prep material, and information on 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.


Surveillance to Track Progress toward Polio Eradication—Worldwide, 2017–2018: When the Global Polio Eradication Initiative (GPEI) began in 1988, cases of poliomyelitis were reported from 125 countries. Since then, only Afghanistan, Nigeria, and Pakistan have experienced uninterrupted transmission of wild poliovirus (WPV). The primary means of detecting poliovirus is through surveillance for acute flaccid paralysis (AFP) among children age 15 years and younger with testing of stool specimens for WPV and vaccine-derived polioviruses (VDPVs) in World Health Organization (WHO)–accredited laboratories of the Global Polio Laboratory Network (GPLN). AFP surveillance is supplemented by environmental surveillance for polioviruses in sewage at selected locations. Analysis of genomic sequences of isolated polioviruses enables assessment of transmission by time and place, potential gaps in surveillance, and emergence of VDPVs. The April 5 MMWR presents 2017–2018 poliovirus surveillance data, focusing on 31 countries identified as high-priority countries because of a “high risk of poliovirus transmission and limited capacity to adequately address those risks.” Some of these countries are located within WHO regions with endemic polio, and others are in regions that are polio-free. In 2018, 26 (84%) of the 31 countries met AFP surveillance indicators nationally; however, subnational variation in surveillance performance was substantial. Surveillance systems need continued strengthening through monitoring, supervision, and improvements in specimen collection and transport to provide sufficient evidence for interruption of poliovirus circulation.

Resources and Information

CDC Launches Video Series–“How Vaccines Work”: In April, CDC and NCIRD launched the third video of their latest animated video series for parents, titled “What to Expect When Your Child Is Vaccinated.” The first two videos, titled “How Do Germs Make Your Baby Sick” and “How Do Vaccines Help Babies Fight Infections,” are also available for viewing. 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.  Please share this new educational resource with parents! Learn more at the parents/childhood vaccines web page.

Immunization Quality Improvement for Providers (IQIP): IQIP will be replacing Assessment, Feedback, Incentives, and eXchange (AFIX) as CDC’s national immunization quality improvement program on July 1, 2019. The purpose of IQIP is to promote and support the implementation of provider-level immunization quality improvement strategies designed to increase vaccine uptake among children and adolescents in adherence to the routine schedule recommended by the Advisory Committee on Immunization Practices (ACIP). IQIP provides technical assistance to providers to support three core quality improvement strategies plus one optional custom quality improvement strategy developed at the immunization program level to advance local priorities. The three core strategies are:

  • Schedule the next immunization visit before the patient leaves the office.
  • Leverage IIS functionality to support immunization practice.
  • Give a strong vaccine recommendation (with an emphasis on HPV vaccination for providers serving adolescent patients).

Look for additional information and the launch of CDC’s IQIP website.

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 icon, 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 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. An updated 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 icon, 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

American College of Obstetricians and Gynecologists (ACOG) Resources: ACOG is pleased to share a new health care provider resource, Optimizing Immunization Programs in Obstetric-Gynecologic Practicesexternal icon. This toolkit provides information and resources for women’s health care providers as they implement strategies to improve immunization processes and increase patient immunization rates. This toolkit can assist ob-gyn practices in effectively integrating immunizations into workflow and routine practice. Within the toolkitpdf iconexternal icon, you will find the following ACOG immunization resources for providers:

  • Immunization implementation strategies for obstetrician-gynecologists committee opinion 772
  • Strategies for effectively integrating immunizations into routine obstetric-gynecologic care tip sheet
  • Seasonal influenza vaccination programs: Tips for optimizing practice management tip sheet
  • Developing an immunization referral system tip sheet
  • 2019 immunization coding for obstetrician-gynecologists quick reference coding card

Additional immunization resources, including clinical guidance and practice management tools, can be found at ACOG’s Immunization for Womenexternal icon website.

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 on March 13, 2019, and covered the 2019 adult immunization schedule and the 2019 child and adolescent immunization schedule. 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 icon, 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.” The 2019 recommended immunization schedules are available for ordering.

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

Epidemiology and Prevention of Vaccine-Preventable Diseases Pink Book Coursepdf icon, April 30–May 2, 2019, Bloomington, IL

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

Epidemiology and Prevention of Vaccine-Preventable Diseases Pink Book Course, May 28–30, 2019, Atlanta, GA

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

West Virginia Immunization Summitexternal icon, June 13–14, 2019, Charleston, WV

Iowa Immunization Summit and Epidemiology and Prevention of Vaccine-Preventable Diseases Pink Book Courseexternal icon, 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 icon, Hawaii Immunization Coalition and the Hawaii Public Health Institute, November 13–15, 2019, Honolulu, HI

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

Clinical Vaccinology Course (URL available soon), National Foundation for Infectious Diseases (NFID), November 16–17, 2019 Washington, D.C.

NCIRD Calendar of Events

Immunization Action Coalition (IAC) Calendarexternal icon

Page last reviewed: May 3, 2019