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Issue 1475: January 29, 2020

-TOP STORIES-
* CDC publishes "Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices—United States, 2019" in January 24 MMWR
* CDC publishes "Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type—Florida, 2016–2018" in January 24 MMWR
* IAC Spotlight! IAC adds state mandate information for DTaP, Hib, MMR, and polio vaccines for child care and school entry to its “Laws” section on immunize.org
* CDC reports influenza activity remains high and increased slightly this week; please continue vaccinating through the winter months to prevent flu from spreading further
* There are now 1,125 organizations enrolled in IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination
* Not-to-miss immunization articles in the news

WORLD NEWS
* WHO reports on December 2019 meeting of the Global Advisory Committee on Vaccine Safety in this week's Weekly Epidemiological Record

-FEATURED RESOURCES-
* New book by Spokane family physician Dr. Gretchen LaSalle titled Let’s Talk Vaccines will assist healthcare professionals in communicating with parents about vaccines
* ShotByShot.org adds “Melissa’s Story,” about HPV and cervical cancer, to its collection of stories about people with vaccine-preventable diseases
* Minnesota Department of Health releases new video, “Lily's Story,” about a 27-year-old woman who battled cervical cancer caused by HPV
* IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide is available for free download either by chapter or in its entirety (142 pages)

-EDUCATION AND TRAINING-
* AAP to host webinar titled “Pediatric Providers & Census 2020” on February 19

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-TOP STORIES-
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CDC publishes "Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices—United States, 2019" in January 24 MMWR

CDC published Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices—United States, 2019 ([link removed]) in the January 24 issue of MMWR (pages 77–83). The Introduction from the ACIP policy update is reprinted below.

Since 2005, a single dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and adults. After receipt of Tdap, booster doses of tetanus and diphtheria toxoids (Td) vaccine are recommended every 10 years or when indicated for wound management. During the October 2019 meeting of ACIP, the organization updated its recommendations to allow use of either Td or Tdap where previously only Td was recommended. These situations include decennial Td booster doses, tetanus prophylaxis when indicated for wound management in persons who had previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons aged ≥7 years with incomplete or unknown vaccination history. Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility. This report updates ACIP recommendations and guidance regarding the use of Tdap vaccines.

Access the MMWR article in HTML format. ([link removed])

Related Links
* MMWR Weekly Report, January 24, 2020, ([link removed]) in PDF format
* MMWR main page ([link removed]) provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements
* All ACIP recommendations related to pertussis (Tdap) ([link removed])
* View IAC's ACIP Recommendations ([link removed]) web page

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CDC publishes "Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type—Florida, 2016–2018" in January 24 MMWR

CDC published Variation in Tdap and Influenza Vaccination Coverage Among Pregnant Women by Insurance Type—Florida, 2016–2018 ([link removed]) in the January 24 issue of MMWR (pages 72–76). A media summary of the MMWR article is reprinted below.

Vaccinations during pregnancy keep pregnant women and their infants safe. Barriers to receiving vaccines, such as lack of insurance coverage, should be removed. Infants are at increased risk for pertussis-associated disease and even death, and pregnant women and their infants are more likely to experience severe illness if they get influenza (“flu”). The tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) and influenza vaccines during pregnancy reduce the risk of illness in mothers and their babies. In this study, as in other studies, women who receive Medicaid had lower rates of vaccination for both Tdap and flu vaccines during pregnancy. However, when a hospital offered these vaccines for free to women after their children were born, Tdap vaccination rates of Medicaid-insured women increased from 13% during pregnancy to 51% during the period immediately after birth. This suggests that Medicaid-insured women might receive Tdap and flu vaccines as recommended during pregnancy if cost barriers were removed.

Access the MMWR article in HTML format. ([link removed])

Related Links
* MMWR Weekly Report, January 24, 2020, ([link removed]) in PDF format
* MMWR main page ([link removed]) provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements

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IAC SPOTLIGHT! IAC ADDS STATE MANDATE INFORMATION FOR DTAP, HIB, MMR, AND POLIO VACCINES FOR CHILD CARE AND SCHOOL ENTRY TO ITS “LAWS” SECTION ON IMMUNIZE.ORG

IAC recently posted new state-by-state vaccine mandate web pages and maps for DTaP, Hib, MMR, and polio vaccines. The tables and maps provide information on child care and school immunization requirements for each state. These new web pages and maps were compiled using information provided by state health departments and are listed here.
* DTaP Vaccine Mandates ([link removed]) web page
* Hib Vaccine Mandates ([link removed]) web page
* MMR Vaccine Mandates ([link removed]) web page
* Polio Vaccine Mandates ([link removed]) web page

IAC’s State Laws and Mandates by Vaccine ([link removed]) section on immunize.org contains mandate tables and maps for 13 routinely recommended vaccines. The vaccine mandate tables and maps contain information on state immunization requirements for child care, schools, and colleges/universities.

The “State Laws and Mandates by Vaccine” section also includes a link to a web page titled State Information: Exemptions Permitted for State Immunization Requirements ([link removed]), which details the types of immunization exemptions each state allows: medical, religious, or personal belief.

Additional resources on vaccine exemptions, such as a summary of journal articles on personal exemptions and position statements from medical organizations, are available in the Exemptions section ([link removed]) of the web page.

Visit the State Laws and Mandates by Vaccine ([link removed]) section on immunize.org to learn more about state vaccine mandates and exemptions.

Related Link
* IAC’s State Immunization Websites ([link removed]) web page

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CDC REPORTS INFLUENZA ACTIVITY REMAINS HIGH AND INCREASED SLIGHTLY THIS WEEK; PLEASE CONTINUE VACCINATING THROUGH THE WINTER MONTHS TO PREVENT FLU FROM SPREADING FURTHER

Seasonal influenza activity in the United States remains high and, after falling during the first two weeks of the year, increased slightly according to CDC's Weekly U.S. Influenza Surveillance Report, FluView ([link removed]). Forty-nine states and Puerto Rico reported regional or widespread activity, while the District of Columbia, Hawaii, and the U.S. Virgin Islands reported local or sporadic activity for the week ending January 18.

Fifteen influenza-associated pediatric deaths were reported to CDC during the three weeks ending January 18, 2020. A total of 54 influenza-associated pediatric deaths have been reported for the 2019–20 season, 37 associated with influenza B viruses.

Visit the CDC’s Weekly U.S. Influenza Surveillance Report, FluView ([link removed]), for details.

Influenza vaccination is recommended for everyone six months of age and older, so please continue to vaccinate all your patients in this age range. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder ([link removed]) to locate influenza vaccination services near them.

Related Links:
* CDC's Seasonal Flu web section ([link removed])
* CDC's FluView web section ([link removed])
* CDC's Free Resources related to influenza ([link removed])
* IAC's Influenza Educational Materials ([link removed]) , ([link removed]) free, and ready to print
* IAC’s Ask the Experts: Influenza ([link removed]) web page
* IAC’s Vaccines: Influenza ([link removed]) web page
* National Adult and Influenza Immunization Summit ([link removed]) website
* The Summit Buzz: ([link removed]) Newsletter of the National Adult and Influenza Immunization Summit (NAIIS)
* Influenza Vaccine Availability Tracking System—IVATS: ([link removed]) a resource for healthcare settings looking to purchase influenza vaccine (made available from NAIIS)

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THERE ARE NOW 1,125 ORGANIZATIONS ENROLLED IN IAC'S INFLUENZA VACCINATION HONOR ROLL FOR MANDATORY HEALTHCARE WORKER VACCINATION

There are now 1,125 organizations enrolled in IAC's Influenza Vaccination Honor Roll ([link removed]). The honor roll recognizes hospitals, long-term care facilities (LTCFs), medical practices, pharmacies, professional organizations, health departments, and other government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.

Since January 8, when IAC Express last reported on the Influenza Vaccination Honor Roll, five additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply by visiting the Application page ([link removed]).

Newly added healthcare organizations, hospitals, government agencies, medical practices, long-term care facilities, and pharmacies
* Augusta University Medical Center, Augusta, GA
* LMH Health, Lawrence, KS
* Montrose Memorial Hospital, Montrose, CO
* Summit County Health Department, Park City, UT
* Zufall Health Center, Dover, NJ

Related Links
* Listing of all Influenza Vaccination honorees ([link removed]) by state
* Long-term care/assisted living Influenza Vaccination honorees ([link removed]) by state
* Position statements ([link removed]) from professional societies and leading healthcare organizations in support of mandatory influenza vaccination
* Application form for the Influenza Vaccination Honor Roll ([link removed])
* Influenza Vaccination Honor Roll ([link removed]) section on immunize.org ([link removed]), which includes access to the application form (see the gold honor badge in right column, and click on the words "Apply for the Influenza Vaccination Honor Roll")
* IAC'sHonor Roll for Patient Safety ([link removed]) web page
* IAC'sHepatitis B Birth Dose Honor Roll ([link removed]) section on immunize.org ([link removed])

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NOT-TO-MISS IMMUNIZATION ARTICLES IN THE NEWS

Five articles that appeared in the media recently are particularly compelling in conveying the potential risks of vaccine-preventable diseases and the importance of vaccination.
* Shot of Prevention: Families Fighting Flu Executive Reflects on What She Has Learned Since Losing Her Son to the Flu ([link removed]) (1/23/20)
* RTV6 Indianapolis: Central Indiana Teen Recovering from Near-Death Experience with Flu ([link removed]) (1/17/20)
* Minnesota Department of Health Press Release: MDH Reports Pertussis-Related Death of Infant: Health Officials Stress Importance of Vaccination, Especially during Pregnancy ([link removed]) (1/8/20)
* American Academy of Family Physicians: Survey Reveals Common Misconceptions about Flu, Vaccination ([link removed]) (1/22/20)
* Health Affairs: Vaccine Infrastructure and Education Is the Best Medical Investment Our Country Can Make ([link removed]) (1/21/20)

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WORLD NEWS
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WHO reports on December 2019 meeting of the Global Advisory Committee on Vaccine Safety in this week's Weekly Epidemiological Record

WHO published Global Advisory Committee on Vaccine Safety, 4–5 December 2019 ([link removed]) in the January 24 issue of Weekly Epidemiological Record. The first paragraph is reprinted below.

The Global Advisory Committee on Vaccine Safety (GACVS), an independent expert clinical and scientific advisory body, provides WHO with scientifically rigorous advice on vaccine safety issues of potential global importance. GACVS held its 41st meeting in Geneva, Switzerland, on 4–5 December 2019. The Committee examined data on the safety of vaccines against rotavirus, Ebola virus and human papilloma viruses. It also reviewed 2 generic issues: updating of the global vaccine safety strategy and case reviews of communications on vaccine safety.

Related Link
* Current issue and archives of the Weekly Epidemiological Record ([link removed])

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-FEATURED RESOURCES-
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New book by Spokane family physician Dr. Gretchen LaSalle titled Let’s Talk Vaccines will assist healthcare professionals in communicating with parents about vaccines

Gretchen LaSalle, MD, family physician at MultiCare Rockwood Clinic in Spokane, Washington, has written a book titled Let’s Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives ([link removed]). A selection from a description of the book from the publisher's website is reprinted below.

Engaging, accessible, and filled with practical communication advice, Let’s Talk Vaccines helps you educate patients on the importance of life-saving vaccines using a patient-centered and empathetic approach. Covering everything from the science of vaccine safety to the psychology of risk communication, this essential guide includes real-life examples and thoughtful, evidence-based techniques that will help patients understand vaccines and make informed decisions. Ideal for primary care providers, pediatricians, family physicians, nurse practitioners, and public health advocates, it provides an excellent framework for how to approach difficult discussions, with the goal of improving the health of each patient as well as the community at large.

The forward is written by Peter Hotez, MD, PhD, professor of pediatrics at Baylor College of Medicine and Texas Children’s Hospital. Reviews printed at the beginning of Let’s Talk Vaccines are by Paul A. Offit, MD, professor of pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia and Dorit Reiss, LLB, PhD, professor of law at UC Hastings College of Law.

The book can be purchased through Dr. LaSalle's website ([link removed]); from the publisher, Wolters Kluwer ([link removed]); or through your favorite bookstore or seller.

Related Links
* Read more about Dr. LaSalle on her website ([link removed])
* Here are links to four of her blog posts:
+ How Vaccines Work—and Other Stuff ([link removed])
+ Blowing the Whistle on Anti-Vax False Claims – Part 1 ([link removed])
+ Blowing the Whistle on Anti-Vax False Claims – Part 2 ([link removed])
+ Blowing the Whistle on Anti-Vax False Claims – Part 3 ([link removed])

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SHOTBYSHOT.ORG ADDS “MELISSA’S STORY,” ABOUT HPV AND CERVICAL CANCER, TO ITS COLLECTION OF STORIES ABOUT PEOPLE WITH VACCINE-PREVENTABLE DISEASES

Read the newly posted Melissa's Story ([link removed]), the story of a young mom who was diagnosed with cervical cancer caused by HPV that had gone undetected, despite regular Pap smear and HPV tests. The story is a part of the ShotByShot ([link removed]) collection of stories, a program of the California Immunization Coalition ([link removed]), that features videos and written stories about people affected by vaccine-preventable diseases. Consider promoting Melissa's Story and other such stories on social media, during health events, or in waiting rooms to put a face on vaccine-preventable diseases.

Related Links
* ShotbyShot.org ([link removed])
* IAC's Unprotected People Stories ([link removed]) web section
* IAC's Video of the Week ([link removed]) archive
* Video Library ([link removed]) on IAC's website for the public, www.vaccineinformation.org ([link removed])
* Families Fighting Flu stories ([link removed])
* Vaccinate Your Family ([link removed])
* Vaccine Education Center at Children's Hospital of Philadelphia ([link removed])
* PKIDs videos ([link removed]) of families affected by vaccine-preventable diseases

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MINNESOTA DEPARTMENT OF HEALTH RELEASES NEW VIDEO, “LILY'S STORY,” ABOUT A 27-YEAR-OLD WOMAN WHO BATTLED CERVICAL CANCER CAUSED BY HPV

The Minnesota Department of Health (MDH) has released a new video and web page featuring Lily's Story ([link removed]), about a young woman who battled cervical cancer. The story is part of a collection of stories from Minnesota parents and families ([link removed]) sharing the reasons why they feel immunization is important. A description from the web page is reprinted below.

At 27 years old, Lily learned she had cervical cancer. HPV causes almost all cervical cancers. She is sharing her story to encourage parents to protect their children from HPV-related cancers by getting them vaccinated.

Related Links
* Lily's Story – Cervical Cancer Caused by HPV ([link removed]) web page
* Lily's Story – Cervical Cancer Caused by HPV ([link removed]) video
* MDH Immunization Stories ([link removed]) web page

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IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide is available for free download either by chapter or in its entirety (142 pages)

In late 2017, the Immunization Action Coalition (IAC) announced the publication of its book, Vaccinating Adults: A Step-by-Step Guide (Guide) ([link removed]).

This completely updated "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting. Topics include:
* setting up for vaccination services,
* storing and handling vaccines,
* deciding which people should receive which vaccines,
* administering vaccines,
* documenting vaccinations (including legal issues), and
* understanding financial considerations and billing information.

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

The Guide is available to download/print either by chapter or in its entirety free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.

The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!

Related Links
* See Vaccinating Adults: A Step-by-Step Guide ([link removed]) and all its content ([link removed])
* Free download of entire Guide (10.6 MB PDF) ([link removed])
* View the Table of Contents and individual chapters in PDF format:
– Table of Contents ([link removed])
– Step 1: Getting Started ([link removed])
– Step 2: Setting Up for Vaccination Services ([link removed])
– Step 3: Vaccine Storage and Handling ([link removed])
– Step 4: Deciding Whom to Vaccinate ([link removed])
– Step 5: Administering Vaccines ([link removed])
– Step 6: Documentation and Related Issues ([link removed])
– Step 7A: Financial Considerations ([link removed])
– Step 7B: How to Bill for Adult Immunizations ([link removed])
* Promotional flyer for Vaccinating Adults: A Step-by-Step Guide ([link removed])
* IAC’s educational materials (handouts) onadult immunization ([link removed])

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-EDUCATION AND TRAINING-
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AAP TO HOST WEBINAR TITLED “PEDIATRIC PROVIDERS & CENSUS 2020” ON FEBRUARY 19

AAP will offer a webinar titled Pediatric Providers & Census 2020 ([link removed]) on February 19 from 1:00–2:00 p.m. (CST). A description from the registration web page is reprinted below.

The 2020 Census is coming soon. The census count determines how federal funding will be distributed for services and benefits each year. Many go uncounted, particularly young children. As trusted messengers, pediatricians are uniquely positioned to let families know why they should fill out the census form, and that they should include young children and everyone else living in their household.
Access more information about this webinar, including how to register: Pediatric Providers & Census 2020 ([link removed]). ([link removed])

Related Link
* IAC Express #1474: AAP News ([link removed]) article encourages providers to educate parents about the importance of responding to census in order to help fund children’s health programs ([link removed]) (1/22/20)

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Video of the Week
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The Vaccines Project: Episode 1: Washington Post's video series The Vaccines Project addresses common questions about vaccines. Reporter Anna Rothschild interviews researchers to address each question. Part 1 explores the history of vaccines, the way they make us immune to disease, and the history of anti-vax sentiments. Part 2 and 3 discuss ingredients and safety.
Visit the VOTW archive ([link removed])
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Follow Us
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Technically Speaking
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Read Dr. Wexler's column for the Vaccine Education Center's monthly newsletter, Vaccine Update

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Vaccinating Adults:
A Step-by-Step Guide
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IAC's 142-page book available for free download ([link removed]).

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Calendar of Events
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Conferences, meetings, and training opportunities

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Patient Record Cards
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Record cards for patients -- child & teen ([link removed]), adult ([link removed]), and lifetime ([link removed]) -- are printed on durable paper and sized to fit in a wallet when folded

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DVD: Immunization Techniques
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Every practice should have this award winning, "how-to" training video

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Protect Newborns Guidebook

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Comprehensive guide Hepatitis B: What Hospitals Need to Do to Protect Newborns ([link removed])

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Editorial Information

Editor
Deborah L. Wexler, MD ([email protected])

Associate Editors
Carolyn Bridges, MD, MPH ([email protected])
Sharon Humiston, MD, MPH ([email protected])

Consulting Editors
Taryn Chapman, MS ([email protected])
Marian Deegan, JD ([email protected])
Courtnay Londo, MA ([email protected])
Jane Myers, MA, EdM ([email protected])

Assistant Managing Editor
Liv Augusta Anderson, MPP ([email protected])

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Abbreviations
AAFP: American Academy of Family Physicians
AAP: American Academy of Pediatrics
ACIP: Advisory Committee on Immunization Practices
CDC: Centers for Disease Control and Prevention
FDA: Food and Drug Administration
IAC: Immunization Action Coalition
MMWR: Morbidity and Mortality Weekly Report
NCIRD: National Center for Immunization and Respiratory Diseases
VIS: Vaccine Information Statement
WHO: World Health Organization

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue. ([link removed])

If you have trouble receiving or displaying IAC Express messages, visit our online help section ([link removed]).

IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

IAC Express Disclaimer ([link removed])
ISSN: 1526-1786

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