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Issue 1,711: August 30, 2023

Top Stories
* “Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023” published in MMWR
* “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season” published in MMWR
* “Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey–Teen, United States, 2022” published in MMWR
* FDA licenses first vaccine for pregnant individuals to prevent RSV in their infants
* Immunize​.org updates its "Ask the Experts" web page on travel vaccines against cholera and tick-borne encephalitis
* “Four Doses of Polio Vaccine before Age 4. Booster Needed?” Watch the 1-minute answer, part of the Ask the Experts Video Series on Facebook, LinkedIn, Twitter, YouTube, and Instagram.
* Spotlight: Immunize​.org resources on state requirements, exemptions, and the consequences of being unvaccinated
* Vaccines in the news


Immunize​.org Pages and Handouts
* Immunize​.org posts complete suite of materials on vaccination anxiety, designed for healthcare personnel and the public
* Immunize​.org updates “Questions and Answers” handouts on measles, mumps, and rubella


Featured Resources
* “Shop Immunize​.org” offers resources for your practice. Don’t miss getting laminated 2023 U.S. adult immunization schedules for your exam rooms.


Notable Publications
* "Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020–2021" published in Emerging Infectious Diseases
* "COVID-19 Booster Vaccination during Pregnancy Enhances Maternal Binding and Neutralizing Antibody Responses and Transplacental Antibody Transfer to the Newborn” published in Vaccine
* "Differences in SARS-CoV-2 Specific Humoral and Cellular Immune Responses after Contralateral and Ipsilateral COVID-19 Vaccination" published in Lancet
* “Immunization Update: 2024 Vaccine Schedules for Infants, Children, and Adolescents” published in Clinical Advisor


Upcoming Events
* Virtual: Today! CDC hosts webinar titled "New RSV Vaccines for Adults: General Information and Clinical Guidance" on August 30 at 12:00 p.m. (ET); CE credit offered.
* Virtual: Watch September 12 ACIP meeting to discuss updated COVID-19 vaccines for fall 2023
* Virtual: CHOP hosts Current Issues in Vaccines webinar titled “RSV Vaccines Across the Lifespan” on September 13; CE credit offered


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Top Stories
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“Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023” published in MMWR

CDC published Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023 ([link removed]) in the August 25 issue of MMWR ([link removed]). A portion of the summary appears below.

In July 2023, the Food and Drug Administration approved nirsevimab, a long-acting monoclonal antibody, for prevention of respiratory syncytial virus (RSV) lower respiratory tract disease in infants. . . .

On August 3, 2023, the Advisory Committee on Immunization Practices recommended nirsevimab for infants aged <8 months born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk of severe RSV disease entering their second RSV season. . . .

Nirsevimab can prevent severe RSV disease among infants and children aged <20 months at increased risk for severe RSV disease.

This long-acting monoclonal antibody is included in the federal Vaccines for Children (VFC) program to ensure access to all infants, regardless of insurance status. Healthcare providers who care for infants and toddlers should read the full recommendation for details about this important form of RSV prevention in infants. Access the MMWR article in HTML ([link removed]) or PDF ([link removed]) .

Related Links
* MMWR's main page ([link removed]) provides access to the MMWR family of publications
* IZ Express: Immunize​.org summarizes ACIP’s August 3 meeting recommending nirsevimab for RSV prevention in infants and inclusion in Vaccines for Children program ([link removed]) (8/9/23)

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“Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season” published in MMWR

CDC published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023–24 Influenza Season ([link removed]) in the August 25 issue of MMWR: Recommendations and Reports. The primary change in this year’s recommendations is the statement that people with egg allergy of any severity may receive any influenza vaccine with standard precautions. Portions of the summary appear below.

This report updates the 2022–23 recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2022;71[No. RR-1]:1–28). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. All seasonal influenza vaccines expected to be available in the United States for the 2023–24 season are quadrivalent, containing hemagglutinin (HA) derived from one influenza A(H1N1)pdm09 virus, one influenza A(H3N2) virus, one influenza B/Victoria lineage virus, and one influenza B/Yamagata lineage virus. Inactivated influenza vaccines (IIV4s), recombinant influenza vaccine (RIV4), and live attenuated influenza vaccine (LAIV4) are expected to be available. . . .

Any influenza vaccine (egg based or nonegg based) that is otherwise appropriate for the recipient’s age and health status can be used. . . . Egg allergy alone necessitates no additional safety measures for influenza vaccination beyond those recommended for any recipient of any vaccine, regardless of severity of previous reaction to egg. . . . All vaccines should be administered in settings in which personnel and equipment needed for rapid recognition and treatment of acute hypersensitivity reactions are available.

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

Related Link
* MMWR's main page ([link removed]) provides access to the MMWR family of publications

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“Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey–Teen, United States, 2022” published in MMWR

CDC published Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey–Teen, United States, 2022 ([link removed]) in the August 25 issue of MMWR ([link removed]). A portion of the summary appears below.

Analyses of recent trends in routine vaccination coverage show declines in coverage by age 13 and 14 years among adolescents born in 2008. Among adolescents aged 13–17 years, routine vaccination coverage in 2022 was similar to coverage in 2021. Coverage with ≥1 HPV vaccine dose declined among adolescents insured by Medicaid.

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

Related Link
* MMWR's main page ([link removed]) provides access to the MMWR family of publications

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FDA licenses first vaccine for pregnant individuals to prevent RSV in their infants

On August 21, FDA announced the licensing of Abrysvo ([link removed]) [respiratory syncytial virus (RSV) vaccine, Pfizer] for use in pregnant individuals to prevent lower respiratory tract disease (LRTD) and severe LRTD caused by RSV in infants from birth through 6 months of age. ACIP will meet at a future date to discuss recommendations for the use of RSV vaccine during pregnancy, including how maternal vaccination would affect clinical decisions concerning the use of nirsevimab during infancy. A portion of the news release appears below.

Abrysvo is approved for use at 32 through 36 weeks gestational age of pregnancy. Abrysvo is administered as a single dose injection into the muscle. The FDA approved Abrysvo in May for the prevention of LRTD caused by RSV in individuals 60 years of age and older.

Related Link
* FDA: FDA Approves First Vaccine for Pregnant Individuals to Prevent RSV in Infants ([link removed]) (8/21/23)

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Immunize​.org updates its “Ask the Experts” web page on travel vaccines against cholera and tick-borne encephalitis

Immunize​.org's popular Ask the Experts: Travel Vaccines ([link removed]) web page was updated with a thorough review. Information was added about the temporary unavailability of FDA-licensed cholera vaccine in the United States. Basic questions and answers were added about the newly recommended vaccine against tick-borne encephalitis (TBE, Ticovac, Pfizer).

Immunize​.org’s Ask the Experts ([link removed]) main page leads you to 30 web pages on various topics with more than 1,200 common or challenging questions and answers about vaccines and their administration. Immunize​.org’s team of experts includes Kelly L. Moore, MD, MPH (team lead), Carolyn B. Bridges, MD, FACP, and Iyabode Beysolow, MD, MPH.

Related Links
* Immunize​.org: Ask the Experts ([link removed]) main page with more than 1,200 questions and answers
* Immunize​.org: Ask the Experts: Travel Vaccines ([link removed]) web page

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“Four Doses of Polio Vaccine before Age 4. Booster Needed?” Watch the 1-minute answer, part of the Ask the Experts Video Series on Facebook, LinkedIn, Twitter, YouTube, and Instagram.

Immunize​.org's social media channels make it easy for you to learn a little more every day. This week, our featured episode from the Ask the Experts Video Series is Four Doses of Polio Vaccine before Age 4. Booster Needed? ([link removed]) This is available on our YouTube channel ([link removed]) , along with our full collection of quick video answers to popular Ask the Experts ([link removed]) questions.

Like, follow, and share Immunize​.org’s social media accounts and encourage colleagues and others interested in vaccination to do likewise:
* Facebook at ImmunizeOrg ([link removed])
* Instagram at ImmunizeOrg ([link removed])
* LinkedIn at Immunize​.org ([link removed])
* Twitter at ImmunizeOrg ([link removed])
* YouTube at ImmunizeOrg ([link removed])

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Spotlight: Immunize​.org resources on state requirements, exemptions, and the consequences of being unvaccinated

In this week’s Spotlight, we summarize resources at Immunize​.org that can aid your vaccine advocacy efforts.

State Requirements by Vaccine ([link removed]) main page contains links to vaccine-specific requirements state by state for daycare, K-12, and post-secondary education settings. State-specific information about exemption policies appears as well. All of Immunize​.org’s resources related to state requirements were updated with current information collected from state immunization program managers in March 2023. In addition, new state maps visually represent vaccine-specific requirements and state policies related to exemptions. These maps are ideal for use in presentations by policymakers, healthcare professionals, and advocates.


State Exemptions ([link removed]) web page offers information on state requirements by vaccine-preventable disease. It includes policy statements from medical organizations endorsing strong school and childcare vaccination requirements and the elimination of non-medical exemptions.

Exemptions Permitted for State Childcare and School (Kg–Gr 12) Immunization Requirements ([link removed]) web page shows which states accept medical, religious, and personal vaccination exemptions and offers a map of exemptions permitted for school and child care.

State Health Departments: Immunization Requirements ([link removed]) main page offers links to each state’s immunization program and to additional pages provided by each state related to its vaccination requirements.

Talking about Vaccines ([link removed]) main page provides medical professionals with background information and practical resources divided into different topics that will help them discuss vaccination with concerned parents or patients.

Unprotected People Stories ([link removed]) main page features 109 real-life accounts of people who suffered or died from vaccine-preventable diseases: compelling personal testimonies, remembrances, case reports, and newspaper articles.

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Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.

* STAT: U.S. Health Officials Lay Out Plans to Cope with Respiratory Virus Season ([link removed]) (8/25/23)

* FDA: Hurricane Season: Be Prepared ([link removed]) (8/22/23)

* CNN: HHS Awards $1.4 Billion to Drive Development of New COVID-19 Vaccines and Therapies ([link removed]) (8/22/23)

* The Hill: A Third of Adults Believe COVID-19 Vaccines Caused Thousands of Sudden Deaths: Poll ([link removed]) (8/22/23)

* The Hill: What Newer Immunizations Mean for This Year’s Respiratory Viral Season ([link removed]) (8/21/23)
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Immunize​.org Pages and Handouts
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Immunize​.org posts complete suite of materials on vaccination anxiety, designed for healthcare personnel and the public

Anxiety about injections is common at all ages and contributes to vaccine hesitancy in those affected. Among some adolescents and adults, anxiety can trigger dizziness or fainting, risking fall-related injuries. Both the vaccinator and the vaccine recipient can take simple and effective steps to improve the recipient’s vaccination experience.

Thanks to support from CDC as part of its work to increase vaccine confidence, Immunize​.org now offers clinical tools for healthcare professionals and corresponding patient handouts on vaccination-related fainting and anxiety:

* Vaccination-Related Syncope: Information for Healthcare Personnel ([link removed])

* Fainting Related to Vaccination: What You Need to Know ([link removed]) ([link removed]) (for patients and parents)

* Addressing Vaccination Anxiety in Adolescents and Adults: Strategies for Healthcare Professionals ([link removed])

* Addressing Vaccination Anxiety in Adolescents and Adults: Strategies for Vaccine Recipients and Caregivers ([link removed])

* Addressing Vaccination Anxiety for Infants and Toddlers: Strategies for Parents and Caregivers ([link removed])

* Addressing Vaccination Anxiety for Infants and Toddlers: Strategies for Healthcare Professionals ([link removed])

* Addressing Vaccination Anxiety for Children: Strategies for Vaccine Recipients and Caregivers ([link removed])

* Addressing Vaccination Anxiety for Children: Strategies for Healthcare Professionals ([link removed])

These 1-page resources highlight major points and include key references. The resources for healthcare personnel are ideal for teaching huddles and in-service trainings. They may also serve as the basis for quality-improvement efforts.

These resources are ideal to use in concert with Immunize​.org’s screening checklists for contraindications to vaccination, recently revised to include questions about vaccination anxiety and fainting.

Related Links
* Immunize​.org: Handouts for Patients and Staff ([link removed]) : Addressing Vaccination Anxiety ([link removed]) main page
* Immunize​.org: Improving the Vaccination Experience: Reducing Pain and Anxiety for Children and Adults ([link removed]) (2/28/23)
* Immunize​.org: Improving the Vaccination Experience: Accessible Vaccination for Neurodiverse People at Any Age ([link removed]) on-demand webinar (12/13/22)
* Immunize​.org: Screening Checklists ([link removed]) main page (includes screening checklists with questions to screen for a history of fainting or feeling faint and for vaccination-related anxiety)

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Immunize​.org updates “Questions and Answers” handouts on measles, mumps, and rubella

Immunize​.org recently updated three of its Questions and Answers: Diseases and Vaccines ([link removed]) handouts to provide updated information on recent measles and mumps outbreaks and current rubella morbidity. In addition to updated epidemiology, the primary update was the addition of Priorix (GSK) as a second MMR vaccine brand that may be used interchangeably with M-M-R II (Merck). Additional edits added a QR code and updated hyperlinks.

Updated handouts include:
* Measles: Questions and Answers ([link removed])
* Mumps: Questions and Answers ([link removed])
* Rubella: Questions and Answers ([link removed])

Related Links
* Immunize​.org: Measles: Questions and Answers ([link removed]) (PDF)
* Immunize​.org: Mumps: Questions and Answers ([link removed]) (PDF)
* Immunize​.org: Rubella: Questions and Answers ([link removed]) (PDF)
* Immunize​.org: Handouts for Patients and Staff ([link removed]) main page, where you can sort materials by topic, vaccine, or language
* Immunize​.org: Educational Materials for Patients and Staff ([link removed]) —an alphabetical listing of more than 230 ready-to-print staff educational materials and patient handouts

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Featured Resources
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“Shop Immunize​.org” offers resources for your practice. Don’t miss getting laminated 2023 U.S. adult immunization schedules for your exam rooms.

On the Shop Immunize​.org ([link removed]) web page, you will find many resources such as laminated vaccination schedules, personal immunization record cards, pins for your lapel, and more! Your purchases help Immunize​.org keep delivering free educational materials to healthcare professionals and to the public.

Immunize​.org’s three personal immunization record cards—child & teen, adult, and lifetime ([link removed]) —are printed on durable rip-, smudge-, and water-proof paper. Sized to fit in a wallet when folded, the cards are brightly colored to stand out. Give these nearly indestructible personal record cards to your patients. They're sold in boxes of 250.

You too can show your support for vaccination with Immunize​.org’s elegantly designed “Vaccines Save Lives” pin ([link removed]) on your lapel. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125” x 0.75”. Order yours today to show how much you value vaccination!

Immunize​.org's laminated versions of the 2023 U.S. adult immunization schedule ([link removed]) are still available. Once sold out, we will not print more until 2024.

The schedules' coating can be wiped down, and they’re durable enough to stand up to a year's worth of use. Visit the Shop Immunize​.org: Laminated Immunization Schedules ([link removed]) web page for more information on the schedules.

Related Links
* Immunize​.org: Child & Teen Immunization Record Cards ([link removed])
* Immunize​.org: Adult Immunization Record Cards ([link removed])
* Immunize​.org: Lifetime Immunization Record Cards ([link removed])
* Immunize​.org: “Vaccines Save Lives” pins ([link removed])
* Immunize​.org: Laminated Adult Immunization Schedule ([link removed]) (19 and older)
* Immunize​.org: Shop Immunize​.org ([link removed]) main page

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Notable Publications
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"Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020–2021" published in Emerging Infectious Diseases

In the September 2023 issue, Emerging Infectious Diseases published Temporally Associated Invasive Pneumococcal Disease and SARS-CoV-2 Infection, Alaska, USA, 2020–2021 ([link removed]). The abstract appears below.

Streptococcus pneumoniae can co-infect persons who have viral respiratory tract infections. However, research on S. pneumoniae infections that are temporally associated with SARS-CoV-2 infections is limited. We described the epidemiology and clinical course of patients who had invasive pneumococcal disease (IPD) and temporally associated SARS-CoV-2 infections in Alaska, USA, during January 1, 2020–December 23, 2021. Of 271 patients who had laboratory-confirmed IPD, 55 (20%) had a positive SARS-CoV-2 test result. We observed no major differences in age, race, sex, or underlying medical conditions among IPD patients with and without SARS-CoV-2. However, a larger proportion of IPD patients with SARS-CoV-2 died (16%, n = 9) than for those with IPD alone (4%, n = 9) (p<0.01). IPD patients with SARS-CoV-2 were also more likely to be experiencing homelessness (adjusted OR 3.5; 95% CI 1.7–7.5). Our study highlights the risk for dual infection and ongoing benefits of pneumococcal and COVID-19
vaccination, especially among vulnerable populations.

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"COVID-19 Booster Vaccination during Pregnancy Enhances Maternal Binding and Neutralizing Antibody Responses and Transplacental Antibody Transfer to the Newborn" published in Vaccine

In the August 14 issue, Vaccine published COVID-19 Booster Vaccination during Pregnancy Enhances Maternal Binding and Neutralizing Antibody Responses and Transplacental Antibody Transfer to the Newborn ([link removed]) . Select highlights from the article appear below.
* mRNA vaccines during pregnancy elicited robust binding and nAb [neutralizing antibody] responses.
* Booster vaccination during pregnancy elicited significantly higher Ab [antibody] levels at delivery and in cord blood than 2-dose primary series, including against Delta and Omicron BA.1 variants.
* COVID-19 vaccines, including booster doses, should continue to be strongly recommended during pregnancy.

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"Differences in SARS-CoV-2 Specific Humoral and Cellular Immune Responses after Contralateral and Ipsilateral COVID-19 Vaccination" published in Lancet

In the August 11 issue, Lancet published Differences in SARS-CoV-2 Specific Humoral and Cellular Immune Responses after Contralateral and Ipsilateral COVID-19 Vaccination ([link removed](23)00308-0/fulltext#%20). The interpretation section appears below.

Both ipsilateral [same arm] and contralateral [opposite arm] vaccination induce a strong immune response, but secondary boosting is more pronounced when choosing vaccine administration-routes that allows for drainage by the same lymph nodes used for priming [i.e., same arm for both doses]. Higher neutralizing antibody activity and higher levels of spike-specific CD8 T-cells may have implications for protection from infection and severe disease and support general preference for ipsilateral vaccination.

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“Immunization Update: 2024 Vaccine Schedules for Infants, Children, and Adolescents” published in Clinical Advisor

In its August 24, 2023, issue, Clinical Advisor published Immunization Update: 2024 Vaccine Schedules for Infants, Children, and Adolescents ([link removed]). This review was written by Immunize​.org’s Mary Beth Koslap-Petraco, DNP, FAANP. The Conclusions section appears below.

The number one public health achievement has been the development of vaccines and widespread vaccination programs. Although the pandemic and vaccine hesitancy have eroded immunization rates, rates of vaccinations are beginning to increase globally. Vaccine hesitancy is alive and well, but several resources are available that provide guidance on working with those who question the need and safety of vaccines.

What are clinicians going to do to help increase the rate of vaccinations? Establish trust with parents. Use paradigms that do not belittle or harass parents, and keep the conversation going even if patients refuse or delay vaccines. Back to school is the perfect time to get all of those children to catch up on much-needed vaccines. If this opportunity is lost, the next pandemic could be caused by a vaccine-preventable disease.

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Upcoming Events
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Virtual: Today! CDC hosts webinar titled "New RSV Vaccines for Adults: General Information and Clinical Guidance" on August 30 at 12:00 p.m. (ET); CE credit offered.

The Immunization Services Division (ISD) in the National Center for Immunization and Respiratory Diseases (NCIRD) will host a webinar in their Current Issues in Immunization Webinars (CIIW) series titled New RSV Vaccines for Adults: General Information and Clinical Guidance ([link removed]) , 12:00–1:00 p.m. (ET) on August 30. During the webinar, Michael Melgar, MD, NCIRD, and Amadea Britton, MD, MPH, NCIRD, will give updates on RSV vaccination recommendations for adults.

Registration is not needed, but participation is limited. CME, CNE, and CPE credit are available.

A recording will be available following the webinar. View archived CIIW videos ([link removed]).

Join the event directly ([link removed]).

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Virtual: Watch September 12 ACIP meeting to discuss updated COVID-19 vaccines for fall 2023

CDC will convene its Advisory Committee on Immunization Practices ([link removed]) (ACIP), September 12, 10:00 a.m.–4:00 p.m. (ET). The agenda will focus on recommendations for COVID-19 vaccines that target the XBB variants of SARS-CoV-2.

No registration is required to watch webcasts of live ACIP meetings or listen via telephone. Opportunities for public comment are described on the website.

Related Links
* CDC: ACIP main page ([link removed]) for access to webcast, agendas
* CDC: ACIP: Meeting Information ([link removed]) for presentation slides, content from previous meetings, and information about future meetings

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Virtual: CHOP hosts Current Issues in Vaccines webinar titled “RSV Vaccines Across the Lifespan” on September 13; CE credit offered

The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP) will present a 1-hour webinar titled RSV Vaccines Across the Lifespan ([link removed]) beginning at 12:00 p.m. (ET) on September 13. Part of its Current Issues in Vaccines ([link removed]) series, the webinar will feature Paul Offit, MD, director of the VEC.

Free continuing education credits (CME, CEU, and CPE) will be available for both the live and archived events.

Register for the webinar ([link removed]).

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For more upcoming events, visit our Calendar of Events ([link removed]).

Editorial Information

Editor-in-Chief
Kelly L. Moore, MD, MPH

Managing Editor
John D. Grabenstein, RPh, PhD

Associate Editor
Sharon G. Humiston, MD, MPH

Writer/Publication Coordinator
Taryn Chapman, MS
Courtnay Londo, MA

Style and Copy Editor
Marian Deegan, JD

Web Edition Managers
Arkady Shakhnovich
Jermaine Royes

Contributing Writer
Laurel H. Wood, MPA

Technical Reviewer
Kayla Ohlde

About IZ Express
Immunize​.org welcomes redistribution of this issue of IZ Express or selected articles.
When you do so, please add a note that Immunize​.org is the source of the material and provide a link to this issue ([link removed]).

IZ Express is supported in part by Grant No. 1NH23IP922654 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of Immunize​.org and do not necessarily represent the official views of CDC.

IZ Express Disclaimer ([link removed])
ISSN: 2771-8085

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