Immunization Works September 2019

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


Immunization Works Newsletter September 2019

Top Stories

Request for Assistance with Hepatitis A Outbreak: CDC is requesting assistance from health care providers in responding to nationwide outbreaks of hepatitis A. The outbreaks are occurring primarily among people who use drugs, people experiencing homelessness, and men who have sex with men (MSM). Visits to a health care clinic offer an ideal opportunity to provide hepatitis A vaccination to people at highest risk of infection.

Since August 2016, CDC has received reports of more than 25,783 hepatitis A cases and 15,517 hospitalizations and, as of September 13, 2019, 259 deaths associated with person-to-person transmission. While hepatitis A infection is typically self-limited, morbidity and mortality in the current outbreaks are higher than what is normally reported.

CDC is requesting your assistance to help control these hepatitis A outbreaks by vaccinating populations at risk:

  • People who use drugs (injection or noninjection)
  • People experiencing an unstable housing situation or homelessness
  • Men who have sex with men (MSM)
  • People who are or were recently incarcerated
  • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C

One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

  • Prevaccination serologic testing is not required to administer hepatitis A vaccine.
  • Vaccinations should not be postponed if vaccination history cannot be obtained or records are unavailable.

CDC is also requesting that health care providers do the following:

  • Consider hepatitis A as a diagnosis in anyone with jaundice and clinically compatible symptoms. If no alternative diagnoses are likely, serologic testing for acute viral hepatitis (including anti-HAV IgM) and liver function tests should be ordered.
  • Do not test people for hepatitis A who do not have signs of acute hepatitis.
  • Ensure all people diagnosed with hepatitis A are reported to the health department in a timely manner. Screen patients for key risk factors (e.g., drug use, homelessness, MSM status, and incarceration) and document their presence or absence in the medical record.

Please visit the viral hepatitis website for resources and more information.

2019 Pink Book Webinar Series: This 2019 online series of 15 webinars, which just concluded on September 25, 2019, 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. Most of the recordings can be viewed online at the Pink Book webinar web page and the remaining courses will be posted soon. Continuing Education (CE) is available for each webinar.


CDC Study Finds the Number of Babies Hospitalized with Flu is at Least Double Previous Estimates: A multi-country CDC study has found that the number of children younger than 1 year who are hospitalized with flu is at least double previous estimates. CDC researchers and global collaborators enrolled nearly 2,000 hospitalized babies in four middle-income countries (Albania, Jordan, Nicaragua, and the Philippines) and tested them for flu in two different ways: with clinical molecular tests that detect flu viruses in respiratory samples, and with laboratory tests that measure flu antibodies in blood samples. The researchers found that nearly one-third of those hospitalized babies had antibodies suggesting flu infection, but had not been diagnosed with flu at discharge. Instead, they were diagnosed with other things, including febrile seizures, sepsis, dehydration, or other nonrespiratory diseases or syndromes. Also looking at all hospitalized infants with flu, in about 40% of cases, the clinical tests did not pick up infection, but it was later identified in the laboratory testing of blood samples. These findings are another reminder to clinicians that atypical presentations of flu are common among infants and that data collected in surveillance systems often underestimate flu’s real-world impact.

The best way to protect against seasonal flu and its potentially severe consequences in children 6 months and older is annual flu vaccination. Babies and other children receiving flu vaccine for the first time need 2 doses of influenza vaccine. For babies younger than 6 months old who are too young to be vaccinated themselves, the study findings emphasize the importance of flu vaccination during pregnancy, which has been shown to protect both the mother and her baby from flu-related illness and hospitalizations for the first several months of life. Visit the CDC flu site for additional information and read the full report and listen to a podcast on The Lancet websiteexternal icon.

CDC Releases Additional STEM Educational Activities for Teachers to Use with “The Junior Disease Detectives: Operation Outbreak” Graphic Novel: CDC has released additional STEM (science, technology, engineering, math) educational activities for middle and high school (grades 6–12) STEM teachers. These educational materials are intended for teachers to use with the graphic novel published last year entitled “The Junior Disease Detectives: Operation Outbreak.” The graphic novel educates youth audiences about CDC’s real-life disease detective work and encourages them to consider STEM career options in public health and animal health. The graphic novel and its associated STEM educational content is available for free download from CDC’s flu website and the Apple iTunes storeexternal icon.

CDC Publishes Updates to Health Care Professional (HCP) Fight Flu Toolkit: Flu season is coming soon and whether you’re a primary care physician, nurse, pharmacist, or other health care professional, you play an important role in helping protect your patients against influenza. The HCP Fight Flu Toolkit includes materials that can assist you in making a strong influenza vaccine recommendation, facilitating productive conversations with your patients, and improving your influenza vaccination coverage.

Flu Vaccination Coverage in the U.S. during the 2018–19 Influenza Season: To estimate influenza vaccinations received between July 1, 2018, and May 31, 2019, CDC analyzed National Immunization Survey-Flu (NIS-Flu) data for children 6 months through 17 years and Behavioral Risk Factor Surveillance System (BRFSS) data for adults older than 18 years. Vaccination coverage with more than 1 dose of flu vaccine was 62.6% among children 6 months through 17 years, an increase of 4.7 percentage points from the 2017–18 flu season. Flu vaccination coverage among adults older than 18 years was 45.3%, an increase of 8.2 percentage points from the 2017–18 flu season. Vaccination coverage varied by state among children (46.0%–81.1%) and adults (33.9%–56.3%), and many states had low coverage for both children and adults. The September 26 FluVaxView report provides national estimates by age group and race/ethnicity, state-level estimates, and links to additional tables such as place of influenza vaccination estimates for children and more detailed age group by race/ethnicity.


Progress Toward Poliovirus Containment Implementation—Worldwide, 2018–2019: Among the three wild poliovirus (WPV) types, WPV type 2 was declared eradicated globally by the Global Commission for the Certification of Poliomyelitis Eradication (GCC) in 2015. Subsequently, in 2016, a global withdrawal of Sabin type 2 oral poliovirus vaccine from routine use, through a synchronized switch from the trivalent formulation of oral poliovirus vaccine (containing vaccine virus types 1, 2, and 3) to the bivalent form (containing types 1 and 3), was implemented. WPV type 3, last detected in 2012, will possibly be declared eradicated in late 2019. To ensure that polioviruses are not reintroduced to the human population after eradication, World Health Organization Member States committed in 2015 to containing all polioviruses in poliovirus-essential facilities that are certified to meet stringent containment criteria. Implementation of containment activities began that year for facilities retaining type 2 polioviruses (PV2), including oral poliovirus vaccine (OPV) materials. As of August 1, 2019, 26 countries had nominated 74 poliovirus-essential facilities to retain PV2 materials. Twenty-five of these countries have established National Authorities for Containment, which are institutions nominated by ministries of health or equivalent bodies to be responsible for poliovirus containment certification. All designated poliovirus-essential facilities are required to be enrolled in the certification process by December 31, 2019. Please read the September 26 MMWR for the full report.

Resources and Information

Immunization Quality Improvement for Providers (IQIP): On July 1, 2019, IQIP replaced Assessment, Feedback, Incentives, and eXchange (AFIX) as CDC’s national immunization quality improvement program. IQIP promotes and supports the implementation of VFC 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). Visit the IQIP website for additional information.

Pediatricians Answer Parent’s HPV Vaccine Questions in New “Can I Ask You a Question” Videos: CDC’s new “Can I Ask You a Question” video series for parents is now available for viewing. In the series, real pediatricians use their expertise to answer parents’ questions about the HPV vaccine and why it’s important for preventing cancer. The videos feature pediatricians answering friends’ questions about the HPV vaccine in a casual setting and reflect some of the most common questions parents have about the HPV vaccine.

You can find all the videos on the CDC website and on YouTube. There is a Spanish version of one of the videos on YouTube, too.

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 Webinars: Immunization webinars 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 next webinar will be on October 2, 2019. Dr. Lisa Grohskopf will give an update on the recommendations for the 2019–20 influenza season. A question-and-answer chat box will be available for questions. View webinar registration information and visit the webinar web page for additional information and to view archived webcasts.

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 influenza module has recently been updated. 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

Washington State Immunization Summitexternal icon, October 8, 2019, Lynwood, WA

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

24th Annual MIAP Pediatric Immunization Skills Building Conferenceexternal icon, Massachusetts Immunization Action Partnership (MIAP), October 17, 2019, Framingham, MA

Texas Immunization Conferenceexternal icon, Texas DSHS, October 23–25, 2019, Addison, TX

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

Ohio Immunization Conferenceexternal icon, Immunize Ohio, November 6, 2019, Wadsworth, OH

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.

Annual Conference on Vaccinology Research (ACVR)external icon, National Foundation for Infectious Diseases (NFID), March 23–25, 2020, Washington, DC

Northern Utah Immunization Coalition (NUIC) Annual Conferenceexternal icon, April 23, 2020, Ogden, UT

49TH National Immunization Conference (NIC), May 19–21, 2020, Atlanta, GA

NCIRD Calendar of Events

Immunization Action Coalition (IAC) Calendarexternal icon

Page last reviewed: September 27, 2019