Immunization Works May 2019

May 31, 2019: Content on this page kept for historical reasons.

Immunization Works Newsletter May 2019

Top Stories

2019 Pink Book Webinar Series: CDC is offering a weekly series of 15 one-hour webinars that will provide an overview of vaccination principles, general recommendations, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each webinar will explore a chapter from the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (the Pink Book) and also include updated information from recent Advisory Committee on Immunization Practices (ACIP) meetings and votes. The webinars start June 5, 2019, and will air live most Wednesdays from 12–1 p.m. EDT through September 25, 2019. Please visit the Pink Book webinar web page for the schedule and additional information. Continuing Education (CE) will be available for each event.


Influenza Activity Update: In the U.S., influenza activity is low and continues to decline after peaking in mid-February. As of May 18, key CDC surveillance indicators were consistent with this being a season of moderate severity. CDC estimates that this flu season:

  • 4 million – 42.9 million people have been sick with flu
  • 3 million – 20.1 million people have been to the doctor because of flu
  • 531,000 – 647,000 people have been hospitalized because of flu
  • 36,400 – 61,200 people have died because of flu

The final full FluView for the 2018–19 season was published May 24, 2019, and reports on activity through May 18, 2019. Several influenza surveillance components operate year-round and an abbreviated FluView report will be published throughout the summer and early fall. To receive weekly e-mails with technical flu season updates, sign up at the flu partners web page.

Flu Season Breaks Record for Duration: Influenza-like illness activity was at or above baseline for 21 weeks during the 2018–19 flu season, breaking the previous 10-year record of 20 weeks, which occurred during the 2014–15 flu season. Influenza A(H1N1) pdm09 viruses predominated from October to mid-February, and influenza A (H3N2) predominated after that. H3N2 viruses are typically associated with more severe illness in older adults.

Human Infection with H5N1 Bird Flu Reported in Nepal: The first human infection with an avian influenza A(H5N1) virus since September 2017 was reported by Nepal. This was the South Asian country’s first human infection with H5N1 bird flu. Asian-lineage H5N1 viruses have been linked with poultry outbreaks in Asia, the Middle East, Europe, and Africa since 2003. These outbreaks are associated with high mortality in poultry and rare human infections. Nepal has experienced sporadic outbreaks of H5N1 bird flu among poultry in recent months. Nepal is the 17th country worldwide to report a human infection with an Asian H5N1 virus.

Variant Flu Medscape Commentary: During summer and early fall, many people attend agricultural fairs, and state and county fairs where they may be exposed to pigs who can carry swine influenza viruses. While rare, people can be infected with flu viruses that normally spread in pigs. Most often, these infections are associated with fair attendance. Find out more in this Medscape CDC expert commentaryexternal icon. Clinicians can find guidance on human infections with variant flu viruses here.

2009 H1N1 Pandemic Commemoration: Ten years ago, a flu virus that had never been seen before in humans emerged. This novel H1N1 flu virus was first detected in April 2009 in the U.S. and spread quickly around the world. On June 11, 2009, the World Health Organization declared the first global flu pandemic in 40 years. CDC estimates that between 151,700 and 575,400 people died worldwide from the 2009 H1N1 virus infection during the first year the virus circulated. Since 2009, CDC has worked with 37 countries under 30 cooperative agreements to improve influenza public health infrastructure. Earlier this year, the World Health Organization launched a 10-year global strategyexternal icon aimed at reducing the burden and impact of seasonal, zoonotic, and pandemic influenza. Please visit the 2009 H1N1 flu pandemic page to learn more. Click on this timeline for a look at the major events associated with the 2009 H1N1 flu pandemic.


Progress toward Polio Eradication—Worldwide, January 2017–March 2019: Since the Global Polio Eradication Initiative (GPEI) began in 1988, transmission of wild poliovirus (WPV) has been interrupted in all countries except Afghanistan, Nigeria, and Pakistan. WPV type 2 (WPV2) was declared eradicated in 2015; WPV type 3 has not been detected since 2012. After the certification of the eradication of WPV2, a global switch from trivalent oral poliovirus vaccine (tOPV, containing vaccine virus types 1, 2, and 3) to bivalent oral poliovirus vaccine (bOPV, containing types 1 and 3) was completed in April 2016. Nigeria last reported WPV type 1 (WPV1) cases in 2016. The May 24 MMWR describes global progress toward poliomyelitis eradication during January 1, 2017–March 31, 2019, and updates previous reports. Afghanistan and Pakistan reported their lowest annual number of WPV cases (22) in 2017; however, 33 WPV1 cases were reported in 2018. During January–March 2019 (as of May 3), 12 WPV1 cases had been reported worldwide, four more than the eight reported during the corresponding period in 2018. The occurrence of polio cases caused by circulating vaccine-derived poliovirus (cVDPV) is rare and occurs where oral poliovirus vaccine (OPV) coverage has been low and vaccine virus reverts to neurovirulence. Eight countries (Democratic Republic of the Congo [DRC], Indonesia, Mozambique, Niger, Nigeria, Papua New Guinea, Somalia, and Syria) reported 210 cVDPV cases during 2017–2019 (as of May 3). Reaching children during supplemental immunization activities (SIAs), accessing mobile populations at high risk, and variations in surveillance performance represent ongoing challenges. Innovative efforts to vaccinate every child and strengthen coordination efforts between Afghanistan and Pakistan will help achieve eradication. For cVDPV outbreak responses to promptly stop transmission, intensified programmatic improvements are needed to make the responses more effective and limit the risk for generating future outbreaks.

Increase in Measles Cases in the U.S. During January 1–April 26, 2019: As of April 26, 2019, CDC had reported 704 cases of measles in the U.S. since the beginning of 2019, representing the largest number of cases reported in the country in a single year since 1994, when 963 cases occurred, and since measles was declared eliminated in 2000. Measles is a highly contagious, acute viral illness characterized by fever and a maculopapular rash; complications include pneumonia, encephalitis, and death. Among the 704 cases, 503 (71%) were in unvaccinated persons and 689 (98%) occurred in U.S. residents. Overall, 66 (9%) patients were hospitalized. Thirteen outbreaks have been reported in 2019, accounting for 663 cases, 94% of all reported cases. Six of the 13 outbreaks were associated with underimmunized, close-knit communities and accounted for 88% of all cases. High 2-dose measles vaccination coverage in the United States has been critical to limiting transmission. However, increased global measles activity poses a risk to U.S. elimination, particularly when unvaccinated travelers acquire measles abroad and return to communities with low vaccination coverage. Health care providers should ensure persons are up to date with measles, mumps, rubella (MMR) vaccine, including before international travel, and rapidly report all suspected cases of measles to public health authorities. Please read the May 3 MMWR for the full report.

Progress toward Measles Elimination in the European Region, 2009–2018: In 2010, all 53 countries in the World Health Organization (WHO) European Region (EUR) reconfirmed their commitment to eliminating measles and rubella and congenital rubella syndrome. This goal was included as a priority in the European Vaccine Action Plan 2015–2020. The WHO-recommended elimination strategies in EUR include 1) achieving and maintaining more than 95% coverage with 2 doses of measles-containing vaccine (MCV) through routine immunization services; 2) providing measles and rubella vaccination opportunities, including supplementary immunization activities (SIAs), to populations susceptible to measles or rubella; 3) strengthening surveillance by conducting case investigations and confirming suspected cases and outbreaks with laboratory results; and 4) improving the availability and use of evidence for the benefits and risks associated with vaccination. The May 3 MMWR updates a previous report and describes progress toward measles elimination in EUR during 2009–2018. During 2009–2017, estimated regional coverage with the first MCV dose (MCV1) was 93%–95%, and coverage with the second dose (MCV2) increased from 73% to 90%. In 2017, 30 (57%) countries achieved at least 95% MCV1 coverage, and 15 (28%) achieved more than 95% coverage with both doses. During 2009–2018, more than 16 million persons were vaccinated during SIAs in 13 (24%) countries. Measles incidence declined to 5.8 per 1 million population in 2016, but increased to 89.5 in 2018, because of large outbreaks in several EUR countries. To achieve measles elimination in EUR, measures are needed to strengthen immunization programs by ensuring at least 95% 2-dose MCV coverage in every district of each country, offering supplemental measles vaccination to susceptible adults, maintaining high-quality surveillance for rapid case detection and confirmation, and ensuring effective outbreak preparedness and response.

Resources and Information

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.

Pneumococcal Vaccination App: CDC has launched a 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.

“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

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. 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

Oregon HPV Summitexternal icon, Oregon Immunization Program, June 11, 2019, Keizer, OR

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

Northwest Immunization Conference and Epidemiology and Prevention of Vaccine-Preventable Diseases Pink Book Courseexternal icon, Oregon Immunization Program, August 13–15, 2019, Portland, OR

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 Courseexternal icon, 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 31, 2019