Immunization Works June 2019

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

Immunization Works Newsletter June 2019

Top Stories

ACIP Meeting: The Advisory Committee on Immunization Practices (ACIP) met June 26–27, 2019. The following recommendations were voted on but are not yet official policy. They will become official policy once they are adopted by the CDC Director and published in MMWR.

  • Human Papillomavirus (HPV) Vaccine
    • ACIP recommends catch-up vaccination for persons through age 26 years who are not adequately vaccinated.
    • ACIP recommends vaccination based on shared clinical decision making for individuals ages 27 through 45 years who are not adequately vaccinated. HPV vaccines are not licensed for use in adults older than age 45 years.
  • Pneumococcal Vaccines
    • ACIP recommends PCV13 based on shared clinical decision making for adults 65 years or older who do not have an immunocompromising condition and who have not previously received PCV13. All adults 65 years or older should receive a dose of PPSV23.
  • Influenza Vaccines
    • ACIP recommends annual influenza vaccination for all persons age 6 months and older who do not have contraindications.
  • Hepatitis A Vaccines
    • ACIP recommends that all children and adolescents age 2 through 18 years who have not previously received Hepatitis A vaccine be vaccinated routinely at any age (i.e., children and adolescents are recommended for catch-up vaccination).
    • ACIP recommends all persons with HIV age 1 year and older be routinely vaccinated with Hepatitis A vaccine.
  • Meningococcal Vaccines
    • For persons age 10 years and older with complement deficiency, complement inhibitor use, asplenia, or who are microbiologists:
      • ACIP recommends a MenBbooster dose 1 year following completion of a MenB primary series followed by MenB booster doses every 2–3 years thereafter, for as long as increased risk remains.
    • For persons age 10 years and older determined by public health officials to be at increased risk during an outbreak:
      • ACIP recommends a one-time booster dose if it has been more than one year since completion of a MenB primary series.
      • A booster dose interval of at least 6 months may be considered by public health officials depending on the specific outbreak, vaccination strategy, and projected duration of elevated risk.

Please visit the ACIP meeting web page for agendas, presentation slides, meeting minutes, and archived video broadcasts. The minutes from the latest meeting will be posted soon.

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 started 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.


2018–2019 Influenza Activity Summary: U.S. influenza-like illness activity began increasing in November 2018, peaked during mid-February, and returned below baseline in mid-April 2019. Influenza A viruses were predominant, with very little influenza B activity. Two waves of influenza A were notable during this extended season: A(H1N1)pdm09 from October 2018 to mid-February 2019 and A(H3N2) from February through May 2019. Compared to the 2017–2018 flu season, hospitalization rates were lower among adults but higher among children. The majority of A(H1N1)pdm09 and influenza B viruses characterized antigenically and genetically were similar to recommended Northern Hemisphere 2018–19 cell-grown vaccine reference viruses. However, the majority of A(H3N2) viruses were antigenically different from the vaccine virus, which prompted a change to the 2019–20 Northern Hemisphere A(H3N2) vaccine component to an A/Kansas/14/2017 (H3N2)-like virus. Read the June 21 MMWR for the full report.

CDC Looks Back at Progress Since the 2009 H1N1 Flu Pandemic: June 11, 2019, marked 10 years since the World Health Organization declared the start of the 2009–2010 flu pandemic, which was caused by a newly emerged influenza A(H1N1) virus. Since 2009, the 2009 H1N1 pandemic virus has continued to circulate seasonally worldwide. CDC commemorated the decennial of the 2009 H1N1 pandemic with the release of estimates of the cumulative toll of H1N1 in the U.S. and a look at major progress made in the science of influenza since that time. Learn more here.

Swine Flu Virus Reported: CDC has reported the first human infection of 2019 with an influenza virus that normally circulates in swine (pigs) and not people. Sporadic human infections with influenza viruses that normally spread in pigs do happen. These are called “variant” flu infections and happen most often after exposure to pigs at agricultural fairs. The patient in this instance did not report any exposure to pigs; an epidemiologic investigation is ongoing. The risk to the public from these types of infections is considered low; however, CDC does have guidance for people attending fairs or other venues where pigs are present.

Graphic Novel Educates Youth about Variant Flu: CDC partnered with the U.S. Department of Agriculture and 4-H to develop “The Junior Disease Detectives: Operation Outbreak,” a graphic novel intended to educate youth audiences about variant flu. The graphic novel follows a group of teenage 4-H members who participate in a state agricultural fair and later attend CDC’s Disease Detective Camp in Atlanta. One of the boys gets sick after attending the fair, and the rest of the group helps public and animal health experts determine why their friend became ill by using their new disease detective skills! You can find information on downloading the graphic novel and accompanying educational activities for the classroom here.


Trends in the Laboratory Detection of Rotavirus Before and After Implementation of Routine Rotavirus Vaccination in the U.S. from 2000–2018: Before the introduction of rotavirus vaccine in the U.S. in 2006, rotavirus infection was the leading cause of severe gastroenteritis among U.S. children. To evaluate the long-term impact of rotavirus vaccination on disease prevalence and seasonality in the U.S., CDC analyzed national laboratory testing data for rotavirus from laboratories participating in CDC’s National Respiratory and Enteric Viruses Surveillance System (NREVSS) during the prevaccine (2000–2006) and postvaccine (2007–2018) periods. Nationally, the median annual percentage of tests positive for rotavirus declined from 25.6% (range=25.2–29.4) in the prevaccine period to 6.1% (range=2.6–11.1) in the postvaccine period. When compared with the prevaccine period, the postvaccine period saw declines in the annual peak in rotavirus positivity from a median of 43.1% (range=43.8–56.3) to a median of 14.0% (range=4.8–27.3) and in the season duration from a median of 26 weeks (range=23–27) to a median of 9 weeks (range=0–18). In the postvaccine period, a biennial pattern emerged, with alternating years of low and high rotavirus activity. Implementation of the rotavirus vaccination program has substantially reduced prevalence of the disease and altered seasonal patterns of rotavirus in the U.S. These changes have been sustained over 11 seasons after vaccine introduction. Ongoing efforts to improve coverage and on-time vaccination can help maximize the public health impact of rotavirus vaccination. Read the June 21 MMWR for the full report.

Progress toward Measles Elimination in Pakistan, 2000–2018: In 1997, the 21 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) passed a resolution during the 41st session of the Regional Committee for the Eastern Mediterranean to eliminate measles. In 2015, this goal was included as a priority in the Eastern Mediterranean Vaccine Action Plan 2016–2020, approved at the 62nd session of the Regional Committee. To achieve measles elimination, the WHO Regional Office for the Eastern Mediterranean developed the following four-pronged strategy: 1) achieve more than 95% vaccination coverage with the first dose of measles-containing vaccine (MCV) among children in every district of each country through routine immunization services; 2) achieve more than 95% vaccination coverage with a second MCV dose in every district of each country either through implementation of a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs); 3) conduct high-quality, case-based measles surveillance in all countries; and 4) provide optimal measles clinical case management, including dietary supplementation with vitamin A. Pakistan, an EMR country with a population of approximately 200 million, accounts for nearly one third of the overall EMR population. The June 7 MMWR describes progress and challenges toward measles elimination in Pakistan during 2000–2018. During the study period, estimated coverage with the first MCV dose (MCV1) increased from 57% in 2000 to 76% in 2017. The second MCV dose (MCV2) was introduced nationwide in 2009, and MCV2 coverage increased from 30% in 2009 to 45% in 2017. During 2000–2018, approximately 232.5 million children received doses of MCV during SIAs. Reported confirmed measles incidence increased from an average of 24.6 per 1 million persons during 2000–2009 to an average of 80.4 during 2010–2018, with peaks in 2013 (230.3) and 2018 (153.6). In 2017 and 2018, the rates of suspected cases discarded as nonmeasles after investigation were 2.1 and 1.5 per 100,000 population, reflecting underreporting of cases. To achieve measles elimination, additional efforts are needed to increase MCV1 and MCV2 coverage and develop strategies to identify and reach communities.

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. 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

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

VFC Annual Immunization Reviewexternal icon, Tennessee Immunization Program, September 19, 20, 24, and 25, 2019, various cities in Tennessee

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

Texas Immunization Conferenceexternal icon, Texas Department of State Health Services, October 23–25, 2019, Addison, Texas

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

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: July 3, 2019