Immunization Works October 2019

November 4, 2019: Content on this page kept for historical reasons.


Immunization Works Newsletter October 2019

Top Stories

ACIP Meeting: The Advisory Committee on Immunization Practices (ACIP) met October 23–24, 2019. ACIP voted that Tdap (the combination tetanus, diphtheria, and pertussis vaccine for adolescents/adults) can be used in situations in which Td (combination tetanus and diphtheria vaccine) is indicated for 1) the recommended 10-year tetanus booster, 2) tetanus vaccine for wound management, and 3) as a catch-up vaccine anytime an additional dose of tetanus and diphtheria vaccine is needed for someone over 7 years of age, including in pregnant women. These recommendations have been adopted by the CDC director and will become official once published in MMWR.

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

Vaccine Information Statements (VISs): Updated VISs for zoster/shingles (live), zoster/shingles (recombinant), pneumococcal conjugate (PCV13), pneumococcal polysaccharide (PPSV23), polio, HPV (human papillomavirus), Hib (Haemophilus influenzae type b), rotavirus, cholera, and typhoid have been posted. We encourage providers to begin using these VISs immediately, but stocks of the previous editions may be used until exhausted. For more information please visit the VIS website.


CDC’s FluView–A Weekly Influenza Surveillance Report Prepared by the Influenza Division: On October 11, CDC began publishing its weekly U.S. influenza surveillance report, called FluView, for the 2019–2020 season. Each Friday at 11:00 am ET, you can see the latest information about what’s happening with flu, including what flu viruses are circulating and maps showing levels of outpatient influenza-like illness visits taking place. Information about hospitalizations will be reported and updated weekly later this season. While flu activity is currently low, CDC expects flu activity to increase in the coming weeks. An annual flu vaccination is the best way to protect against influenza and its potentially serious complications.

Update: Influenza Activity in the U.S. and Worldwide, May 19–September 28, 2019, and Composition of the 2020 Southern Hemisphere Influenza Vaccine: In the U.S., influenza activity remained low, with cocirculation of influenza A and influenza B viruses. Influenza viruses circulated widely in the southern hemisphere, with A(H3) viruses predominating in most regions, although influenza A(H1N1)pdm09 and influenza B/Victoria viruses predominated in several countries. In late September, the World Health Organization (WHO) recommended components for the 2020 southern hemisphere influenza vaccine. It is too early to know which influenza viruses will predominate in the U.S. or how severe the season might be. However, regardless of what is circulating, the best protection against influenza is an influenza vaccination. Influenza vaccination has been shown to reduce the risk for influenza illness associated with outpatient health care visits and hospitalizations and to reduce the risk for serious influenza outcomes that can result in hospitalization or death. CDC recommends that all persons age 6 months and older who do not have contraindications get vaccinated, but vaccination is especially important for persons at high risk for serious influenza-associated complications, including persons age 65 years and older, children age 5 years and younger, pregnant women, and persons with certain underlying medical conditions.

Please read the October 11 MMWR for the full report on flu activity in the U.S. and worldwide and a brief summary of the composition of the 2020 influenza vaccine.

CDC “Vital Signs” Release: Maternal Vaccination: October’s Vital Signs report emphasizes the importance of vaccinating all pregnant women against influenza and pertussis (whooping cough). This will not only help protect the mother during pregnancy, but also will help protect the baby against both diseases during the first few months after birth.

Key Facts:

  • Influenza can be a serious disease in pregnant women. Women with influenza are more than twice as likely to be hospitalized if they are pregnant.
  • Pertussis can be a particularly serious disease in young infants. About 7 in 10 reported deaths from pertussis occur in babies less than 2 months old.
  • Although both influenza and pertussis can be prevented with vaccines, only 1 in 3 pregnant women in the U.S. receive both vaccines during pregnancy.
  • 38% of pregnant women who didn’t get the pertussis vaccine (Tdap) reported not knowing they needed to get the vaccine during each pregnancy.
  • A recommendation from a health care provider is one of the strongest motivators for pregnant women to get vaccinated. However, about 1 in 4 pregnant women reported that their health care provider didn’t offer the vaccines in the office or make a referral to get the vaccines elsewhere.


  • Vaccinating pregnant women is the single best way to protect very young babies from influenza and pertussis.
  • Pregnant women who get vaccinated pass antibodies to their babies, protecting the babies in the first few months of life before they can get the vaccines themselves.
  • The flu vaccine can be administered to the mother anytime during pregnancy.
  • The Tdap vaccine should be administered early in the third trimester of each pregnancy.

Please visit the Vital Signs web page for additional information.

Influenza Video: The best way to prevent the flu is by getting vaccinated each year. This recommendation for annual vaccination means that health care professionals should remain up to date with their knowledge of influenza vaccination and practices. A new CDC video addresses storage and handling requirements and administration considerations for the 2019–20 influenza season.


Global Routine Vaccination Coverage, 2018: Endorsed by the World Health Assembly in 2012, the Global Vaccine Action Plan 2011–2020 (GVAP) calls on all countries to reach at least 90% national coverage with all vaccines in the country’s national immunization schedule by 2020. Building on previous analyses and using the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) global vaccination coverage estimates as of 2018, the October 25 MMWR presents global, regional, and national vaccination coverage estimates and trends, including vaccination dropout rates. According to these estimates, global coverage with the first dose of diphtheria and tetanus toxoids and pertussis-containing vaccine (DTP1) remained relatively unchanged from 2010 (89%) to 2018 (90%). Global coverage with the third DTP dose (DTP3) followed a similar global trend to that of DTP1, remaining relatively consistent from 2010 (84%) to 2018 (86%). Globally, 19.4 million children (14%) were not fully vaccinated in 2018 and, among them, 13.5 million (70%) did not receive any DTP doses. Overall, dropout rates from DTP1 to DTP3 decreased globally from 6% in 2010 to 4% in 2018. Global coverage with the first dose of measles-containing vaccine (MCV1) remained between 84% and 86% during 2010–2018. Among countries that offer a second MCV dose (MCV2) during the second year of life, coverage increased from 19% in 2007 to 54% in 2018. Among countries offering MCV2 to older age groups (children age 3–14 years), coverage also increased from 36% in 2007 to 69% in 2018. Globally, the estimated difference in coverage with MCV1 and MCV2 in 2018 was 17%. However, among new and underused vaccines, global coverage increased from 2007 to 2018 for completed series of rotavirus vaccine, pneumococcal conjugate vaccine (PCV), rubella vaccine, Haemophilus influenzae type b vaccine (Hib), and hepatitis B vaccine (HepB). To reach global vaccination coverage goals for vaccines recommended during childhood, adolescence, and adulthood, tailored strategies that address local determinants for incomplete vaccination are needed, including targeting hard-to-reach and hard-to-vaccinate populations.

Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten in the U.S. during the 2018–19 School Year: State and local school vaccination requirements exist to ensure that students are protected against vaccine-preventable diseases. The October 18 MMWR summarizes data collected by state and local immunization programs on vaccination coverage among children in kindergarten in 49 states, exemptions for kindergartners in 50 states, and provisional enrollment and grace period status for kindergartners in 30 states. Nationally, vaccination coverage was 94.9% for the state-required number of doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP); 94.7% for 2 doses of measles, mumps, and rubella vaccine (MMR); and 94.8% for the state-required doses of varicella vaccine. Whereas 2.5% of kindergartners had an exemption from at least one vaccine, 2.8% of kindergartners were not up to date for MMR and did not have a vaccine exemption. Nearly all states could achieve the recommended 95% MMR coverage if all nonexempt kindergartners were vaccinated in accordance with local and state vaccination policies.

Vaccination Coverage by Age 24 Months among Children Born in 2015 and 2016 in the U.S. during 2016–2018: ACIP recommends that children be vaccinated against 14 potentially serious illnesses during the first 24 months of life. CDC used data from the National Immunization Survey-Child (NIS-Child) to assess vaccination coverage with the recommended number of doses of each vaccine at the national, state, territorial, and selected local levels among children born in 2015 and 2016. Coverage by age 24 months was at least 90% nationally for at least 3 doses of poliovirus vaccine (IPV), at least 1 dose of measles, mumps, and rubella vaccine (MMR), at least 3 doses of hepatitis B vaccine (HepB), and at least 1 dose of varicella vaccine (VAR), although MMR coverage was less than 90% in 20 states. Children were least likely to be up to date by age 24 months with at least 2 doses of influenza vaccine (56.6%). Only 1.3% of children born in 2015 and 2016 had received no vaccinations by the second birthday. Coverage was lower for uninsured children and for children insured by Medicaid than for those with private health insurance. Vaccination coverage can be increased by improving access to vaccine providers and eliminating missed opportunities to vaccinate children during health care visits. Increased use of local vaccination coverage data is needed to identify communities at higher risk for outbreaks of measles and other vaccine-preventable diseases. Please read the October 18 MMWR for the full report.

National Update on Measles Cases and Outbreaks in the U.S. from January 1–October 1, 2019: During January 1 through October 1, 2019, a total of 1,249 measles cases and 22 measles outbreaks were reported in the U.S. This represents the most U.S. cases reported in a single year since 1992, and the second highest number of reported outbreaks annually since measles was declared eliminated in the U.S. in 2000. Measles is an acute febrile rash illness with an attack rate of approximately 90% in susceptible household contacts. Domestic outbreaks can occur when travelers contract measles outside the U.S. and subsequently transmit infection to unvaccinated persons they expose in the U.S. Among the 1,249 measles cases reported in 2019, 1,163 (93%) were associated with the 22 outbreaks, 1,107 (89%) were in patients who were unvaccinated or had an unknown vaccination status, and 119 (10%) measles patients were hospitalized. Closely related outbreaks in New York City (NYC) and New York state (NYS, excluding NYC), with ongoing transmission for nearly one year in large and close-knit Orthodox Jewish communities, accounted for 934 (75%) cases during 2019 and threatened the elimination status of measles in the U.S. Robust responses in NYC and NYS were effective in controlling transmission before the one-year mark. However, continued vigilance for additional cases within these communities is essential to determine whether elimination has been sustained. Collaboration between public health authorities and undervaccinated communities is important for preventing outbreaks and limiting transmission. The combination of maintenance of high national vaccination coverage with measles, mumps, and rubella vaccine (MMR) and rapid implementation of measles control measures remains the cornerstone for preventing widespread measles transmission. Please read the October 11 MMWR for the full report.

Resources and Information

Pediatricians Answer Parents’ 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.

Each video answers a different question, including:

  • Why do kids need protection against HPV?
  • Do boys need the HPV vaccine?
  • Does the HPV vaccine really prevent cancer?

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.

2019 Pink Book Webinar Series: This 2019 online series of 15 webinars, which 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. The webinars can be viewed online at the Pink Book webinar web page. Continuing Education (CE) is available for each webinar.

“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 latest webinar was held on October 2, 2019. Dr. Lisa Grohskopf gave an update on the recommendations for the 2019–20 influenza season. View the webinar web page for additional information and the archived webinar, which will be posted soon.

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 polio and influenza modules have 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

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: November 4, 2019