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IZ Express #1,772: COVID-19 vaccines for 2024-25, change of Bexsero schedule, Ask the Experts updates, and more
| From | Immunize.org <[email protected]> |
| Subject | IZ Express #1,772: COVID-19 vaccines for 2024-25, change of Bexsero schedule, Ask the Experts updates, and more |
| Date | August 28, 2024 10:00 AM |
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Issue 1,772: August 28, 2024
Top Stories
* FDA licenses and authorizes updated mRNA COVID-19 vaccines to better protect against currently circulating variants
* FDA changes schedule for GSK MenB (Bexsero): now same schedule as Pfizer MenB (Trumenba) with 2 doses 6 months apart or 3 doses given at 0, 1–2, and 6 months
* Immunize.org updates “Ask the Experts: Influenza” web section for the 2024–25 influenza season
* Immunize.org adds new PCV21 to “Ask the Experts: Pneumococcal” web section
* “National Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2023” published in MMWR
* “Human Papillomavirus Vaccination Coverage among Adolescent Girls Aged 13–17 Years—U.S.-Affiliated Pacific Islands, 2013–2023” published in MMWR
* Immunize.org adds new vaccines to popular resource “Before You Vaccinate Adults, Consider Their ‘H-A-L-O’!”
* Immunize.org updates “Vaccines with Diluents: How to Use Them” resource
* Watch and share the latest installment in Immunize.org’s Orientation Video Series: Introducing VIS and VIS Translations
* Journalists interview Immunize.org experts
* Vaccines in the news
Immunize.org Website and Clinical Resources
* Spotlight on the website: This season’s influenza VISs and access to translations
* Recap: Immunize.org introduces standing orders template for RSV vaccination of adults age 60 years and older
* Recap: Immunize.org updates the screening checklists for contraindications to injectable and live attenuated influenza vaccines for the 2024–25 season
* Recap: Immunize.org updates “Administering Vaccines: Dose, Route, Site, and Needle Size” and companion version for adults
* Recap: Immunize.org updates “Notification of Immunization Letter Template” to include newly recommended vaccines
Featured Resources
* HHS launches "Risk Less. Do More." campaign to increase awareness about influenza, COVID-19, and RSV vaccines
* Resources to ease children’s fears about vaccines—from Daniel Tiger to Immunize.org’s clinical resources on improving the vaccination experience
Upcoming Events
* Virtual: Society of Infectious Diseases Pharmacists hosts webinar titled "Update Your Vaccination Toolbox: When and How to Use the Vaccine for Mpox" on September 19 at 1:00 p.m. (ET); CPE credit offered
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Top Stories
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FDA licenses and authorizes updated mRNA COVID-19 vaccines to better protect against currently circulating variants
On August 22, the FDA licensed and granted emergency use authorization (EUA) for updated mRNA COVID-19 vaccines ([link removed]) (2024–2025 Formula) to include a single component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. Comirnaty (Pfizer) and Spikevax (Moderna) are licensed for routine use in people age 12 years or older. The Pfizer and Moderna vaccines are authorized for emergency use (requiring use of EUA fact sheets) in children younger than age 12 years.
At its June 2024 meeting, ACIP voted in advance to approve the use of new 2024–2025 Formula COVID-19 vaccines in the manner licensed or authorized by FDA. Therefore, clinicians may begin using these vaccines as indicated by FDA as soon as they receive them. A portion of the FDA press release appears below.
What You Need to Know
* Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated, authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated, authorized Moderna COVID-19 Vaccine.
* Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
* Individuals 5 years through 11 years of age regardless of previous vaccination are eligible to receive a single dose of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines; if previously vaccinated, the dose is administered at least 2 months after the last dose of any COVID-19 vaccine.
* Individuals 12 years of age and older are eligible to receive a single dose of the updated, approved Comirnaty or the updated, approved Spikevax; if previously vaccinated, the dose is administered at least 2 months since the last dose of any COVID-19 vaccine.
* Additional doses are authorized for certain immunocompromised individuals ages 6 months through 11 years of age as described in the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine fact sheets.
On August 23, CDC posted 2024–2025 Formula COVID-19 vaccine guidance on its website regarding interim clinical considerations for the use of COVID-19 vaccines ([link removed]). Based upon that guidance, Immunize.org will revise our COVID-19 content. Watch for document and website revisions coming soon, including new standing orders templates from CDC for the use of 2024–2025 mRNA COVID-19 vaccines. These updates will be reflected in new versions of Immunize.org’s Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools ([link removed]).
Do not administer any remaining dose of any 2023–2024 Formula COVID-19 vaccine; remove them from storage units and dispose of them or return them as appropriate. All doses of the protein-based 2023–2024 Formula Novavax COVID-19 vaccine expired earlier in the summer, and the 2024–2025 Formula Novavax COVID-19 vaccine is not yet authorized by FDA.
CDC will post updated interim clinical considerations for the use of 2024–2025 Formula Novavax COVID-19 vaccine after FDA reaches decisions about it; Immunize.org will revise our content at that time.
Related Links
* FDA: FDA Approves and Authorizes Updated mRNA COVID-19 Vaccines to Better Protect against Currently Circulating Variants ([link removed]) (8/22/24)
* FDA: Comirnaty ([link removed]) (COVID-19 Vaccine, mRNA) (2024–2025 Formula)
* FDA: Spikevax ([link removed]) (COVID-19 Vaccine, mRNA) (2024–2025 Formula)
* FDA: Moderna COVID-19 Vaccine ([link removed]) (2024–2025 Formula)
* FDA: Pfizer-BioNTech COVID-19 Vaccine ([link removed]) (2024–2025 Formula)
* CDC: Use of COVID-19 Vaccines in the United States: Interim Clinical Considerations ([link removed])
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FDA changes schedule for GSK MenB (Bexsero): now same schedule as Pfizer MenB (Trumenba) with 2 doses 6 months apart or 3 doses given at 0, 1–2, and 6 months
On August 19, FDA approved a new dosing schedule for GSK meningococcal B (MenB) vaccine ([link removed] OR [link removed]) (Bexsero) that matches the schedule for Pfizer MenB vaccine (Trumenba), with 2 doses given 6 months apart or 3 doses given at 0, 1–2, and 6-month intervals. Bexsero’s original 2-dose schedule, with a 1-month interval between the two doses, is no longer licensed.
ACIP is expected to review the new schedule at its October 2024 meeting. Questions about recipients of the previously approved 2-dose (1-month interval) Bexsero schedule are likely to be discussed by ACIP at that time. In the interim, healthcare providers should refer to the updated Bexsero package insert for the currently approved schedule.
Related Links
* FDA: Bexsero product information ([link removed]) web page
* CDC: Meningococcal Vaccine Recommendations ([link removed]) web page
* Immunize.org: Vaccines A–Z: Meningococcal B ([link removed])
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Immunize.org updates “Ask the Experts: Influenza” web section for the 2024–25 influenza season
Immunize.org updated all the questions and answers on its popular Ask the Experts: Influenza ([link removed]) web page. Clinical content now reflects 2024–25 influenza season recommendations. Changes include:
* References to the 2024–25 trivalent vaccines (containing two influenza A and one influenza B virus vaccine antigen) following removal of the B/Yamagata virus from the vaccine because it is no longer circulating
* Unless necessary for understanding, references to the number of strains in vaccines (also called “valency”) were removed
* ACIP affirmation that everyone age 6 months and older who has an egg allergy may receive any age-appropriate influenza vaccine without special precautions
* ACIP allowance for off-label use of high-dose (HD-IIV, Fluzone High Dose, Sanofi) or adjuvanted influenza vaccine (aIIV, Fluad, CSL Seqirus) as an option for solid organ transplant recipients age 18 through 64 years who are on immunosuppressive medication regimens, without a preference over any other age-appropriate injectable influenza vaccine
* Updated hyperlinks, as needed
Immunize.org’s Ask the Experts ([link removed]) main page leads you to 30 web pages on various topics with more than 1,300 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; Iyabode Beysolow, MD, MPH; and Jane R. Zucker, MD, MPH.
Related Links
* Immunize.org: Ask the Experts ([link removed]) main page with more than 1,300 questions and answers
* Immunize.org: Ask the Experts: Influenza ([link removed]) web section
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Immunize.org adds new PCV21 to “Ask the Experts: Pneumococcal” web section
Immunize.org updated all the questions and answers on its popular Ask the Experts: Pneumococcal ([link removed]) web page. The clinical content now reflects updated recommendations for PCV21 vaccine (Capvaxive, Merck) as an option for adults age 18 years or older who are recommended to receive a pneumococcal conjugate vaccine. Hyperlinks were also updated as needed.
Immunize.org’s Ask the Experts ([link removed]) main page leads you to 30 web pages on various topics with more than 1,300 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; Iyabode Beysolow, MD, MPH; and Jane R. Zucker, MD, MPH.
Related Links
* Immunize.org: Ask the Experts ([link removed]) main page with more than 1,300 questions and answers
* Immunize.org: Ask the Experts: Pneumococcal ([link removed]) web section
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“National Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2023” published in MMWR
CDC published National Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2023 ([link removed]) on August 22 in MMWR. A portion of the summary appears below.
Vaccinations are the best defense to protect persons and communities from serious vaccine-preventable diseases. Three vaccines are routinely recommended for adolescents. The Vaccines for Children (VFC) program provides recommended vaccines at no cost to eligible children and adolescents. . . .
Overall, vaccination coverage among VFC-eligible adolescents remained stable across recent birth years, except for a decline in human papillomavirus vaccine up-to-date coverage by age 13 years among those born in 2010 compared with those born in 2007. . . .
Health care providers should make strong recommendations for all routine vaccines and verify if adolescents, particularly those eligible for the VFC program, are up to date with all recommended vaccines.
Access the MMWR article in HTML ([link removed]) or PDF ([link removed]) .
Related Link
* CDC: MMWR main page ([link removed]) providing access to the MMWR family of publications
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“Human Papillomavirus Vaccination Coverage among Adolescent Girls Aged 13–17 Years—U.S.-Affiliated Pacific Islands, 2013–2023” published in MMWR
CDC published Human Papillomavirus Vaccination Coverage among Adolescent Girls Aged 13–17 Years—U.S.-Affiliated Pacific Islands, 2013–2023 ([link removed]) on August 22 in MMWR. A portion of the summary appears below.
Cervical cancer is the fourth most common cancer among women worldwide, and the World Health Organization Western Pacific Region, where the U.S.-affiliated Pacific Islands (USAPI) are located, accounts for one quarter of all estimated cases. Human papillomavirus (HPV) vaccines prevent most cervical cancers and are recommended for girls at age 11–12 years. . . .
This is the first comprehensive report of trends in HPV vaccination coverage among adolescent girls since the vaccines were introduced in USAPI jurisdictions
[Northern Mariana Islands and American Samoa, but not four others]. Coverage with HPV vaccine is on track to meet 2030 goals in two jurisdictions, but disparities need to be addressed. . . .
Adolescent vaccination coverage assessment identifies progress toward regional goals. To target increased vaccine access and coverage, this assessment identifies populations and areas with low coverage.
Access the MMWR article in HTML ([link removed]) or PDF ([link removed]) .
Related Links
* CDC: MMWR main page ([link removed]) providing access to the MMWR family of publications
* Immunize.org: Vaccines A–Z: Human Papillomavirus ([link removed])
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Immunize.org adds new vaccines to popular resource “Before You Vaccinate Adults, Consider Their ‘H-A-L-O’!”
Immunize.org recently updated its resource for healthcare professionals titled Before You Vaccinate Adults, Consider Their “H-A-L-O” ([link removed])!
H-A-L-O refers to four factors:
* Health condition
* Age
* Lifestyle
* Occupation
The document now includes mpox vaccine and updated polio (IPV) vaccination recommendations for previously unvaccinated adults. The RSV vaccine section was revised to match the June 2024 ACIP recommendations for routine vaccination of adults age 75 years and older, and risk-based vaccination of adults age 60 through 74 years.
Related Links
* Immunize.org: Clinic Tools: Vaccine Recommendations ([link removed]) web page
* Immunize.org: Clinical Resources A–Z ([link removed]) main page, where you can filter by topic, vaccine, language, or other criteria
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Immunize.org updates “Vaccines with Diluents: How to Use Them” resource
Immunize.org recently added Penbraya (MenABCWY, Pfizer) to its Vaccines with Diluents: How to Use Them ([link removed]) and updated the resource to specify the formulation of Pfizer-BioNTech COVID-19 vaccine that requires dilution.
Related Links
* Immunize.org: Clinical Resources: Storage & Handling ([link removed]) main page
* Immunize.org: Clinical Resources A–Z ([link removed]) main page, where you can filter by topic, vaccine, language, or other criteria
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Watch and share the latest installment in Immunize.org’s Orientation Video Series: Introducing VIS and VIS Translations
Immunize.org is pleased to share the latest installment in the Orientation Video Series, a 3-minute video introducing our VIS and VIS translations ([link removed]). This is one of the most popular sections of the Immunize.org website, featuring hundreds of VIS translations.
Available now on our YouTube channel ([link removed]), this is the third in our new Orientation Video Series. These videos will help both new and experienced users get the most out of all the online resources we offer. Horizontal versions of these videos, like the one below, orient viewers to the desktop format of the website. Vertical versions feature the mobile view displayed for smartphone users.
Please share this video with anyone who needs to learn how to get the most out of Immunize.org’s website to support effective immunization practices.
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 ImmunizeOrg ([link removed])
* YouTube at ImmunizeOrg ([link removed])
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Journalists interview Immunize.org experts
Journalists seek out Immunize.org experts to help explain vaccines to the public and policy makers. We help the media understand and communicate the complex work vaccinators do. Here is a selection of our recent citations.
* Wall Street Journal: The FDA Approved New COVID Vaccines. Should You Get One? ([link removed]) (8/23/24)
* NPR: FDA Approves Two Updated COVID Vaccines ([link removed]) (8/22/24)
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Vaccines in the news
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
* New York Times: Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need ([link removed]) (8/23/24)
* New York Times: Whooping Cough Is Coming Back ([link removed]) (8/22/24)
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Immunize.org Website and Clinical Resources
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Spotlight on the website: This season’s influenza VISs and access to translations
As facilities prepare for influenza vaccination season, several readers asked if the August 6, 2021, versions of influenza (inactivated or recombinant) ([link removed]) and influenza (live, intranasal) ([link removed]) VISs are the ones to use this season. The answer is yes! Unlike the vaccine products themselves, influenza VISs are not necessarily revised each year.
Find current influenza VISs and available translations at Immunize.org by clicking the "Vaccines & VISs" tab at the top of any page. Select “VISs” in the left column to display the menu of VIS pages. There are separate links labeled Influenza (inactivated or recombinant) ([link removed]) and Influenza (live, intranasal) ([link removed]). Each individual VIS web page lists all available translations of that VIS.
If you prefer to access all the VISs available in a particular language, select the "VIS Translations" option in the left column of the main menu. On the VIS translations page, select your language of interest from the "Choose Language" dropdown list.
Immunize.org offers a new, 3-page resource that allows users to scan a QR code for instant digital access to an injectable influenza vaccine VIS in any available language: QR Code Links to Vaccine Information Statement (VIS) Translations: Influenza (Flu) Vaccine (Inactivated or Recombinant) ([link removed]).
Scan any QR code with your smartphone to open a translation in a specific language. Spanish and English QR codes are on the front page, followed by an alphabetical list of all available translations. Under each QR code, the title of the VIS is included in that language.
Related Links
* Immunize.org: Influenza (Inactivated or Recombinant) VIS ([link removed]) web page
* Immunize.org: Influenza (Live Intranasal) VIS ([link removed]) web page
* Immunize.org: VIS Translations ([link removed]) web page
* Immunize.org: QR Codes Links to Vaccine Information Statement (VIS) Translations: Influenza (Flu) Vaccine (Inactivated or Recombinant) ([link removed])
* CDC: About VISs ([link removed]) web page
* CDC: Current VISs ([link removed]) web page
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Recap: Immunize.org introduces standing orders template for RSV vaccination of adults age 60 years and older
A new template, Standing Orders for Administering Respiratory Syncytial Virus Vaccine (RSV) to Adults Age 60 Years and Older ([link removed]), is available from Immunize.org. This template reflects current ACIP recommendations for any of the three licensed RSV vaccines: Abrysvo (Pfizer), Arexvy (GSK), and mResvia (Moderna).
In June 2024, ACIP recommended routine RSV vaccination of two groups:
* All unvaccinated adults age 75 years and older
* Unvaccinated adults age 60–74 years who experience health or living conditions that increase their risk of serious RSV disease
ACIP no longer recommends the use of shared clinical decision-making for RSV vaccination of adults age 60–74 years who are not at increased risk for serious RSV disease. People who previously received RSV vaccine should not be revaccinated this season.
Standing orders templates help vaccine providers establish protocols to streamline routine immunization without requiring individual patient orders.
Immunize.org also offers other standing orders templates for RSV prevention:
* Standing Orders for Administering Nirsevimab RSV Preventive Antibody (Beyfortus, by Sanofi) to Infants ([link removed])
* Standing Orders for Administering Pfizer Respiratory Syncytial Virus (RSV) Vaccine (Abrysvo) during Pregnancy ([link removed])
Immunize.org provides general information about the use of standing orders templates at Using Standing Orders for Administering Vaccines: What You Should Know ([link removed]).
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Recap: Immunize.org updates the screening checklists for contraindications to injectable and live attenuated influenza vaccines for the 2024–25 season
Immunize.org updated its screening checklists for the 2024–25 influenza season to remove references to the number of strains contained in influenza vaccine products. All vaccines for this season contain three strains, following the removal of the B/Yamagata strain that is no longer detected anywhere in the world. The checklists are:
* Screening Checklist for Contraindications to Injectable Influenza Vaccination ([link removed])
* Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination ([link removed])
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Recap: Immunize.org updates “Administering Vaccines: Dose, Route, Site, and Needle Size” and companion version for adults
Immunize.org recently updated two clinical resources:
* Administering Vaccines: Dose, Route, Site, and Needle Size ([link removed])
* Administering Vaccines to Adults: Dose, Route, Site, and Needle Size ([link removed])
Updates to both documents include the following:
* The volume for Fluzone High-Dose (HD-IIV, Sanofi) vaccine changed from 0.7 mL to 0.5 mL for the 2024–25 season
* References were removed for the specific number of strains in influenza vaccines
* A footnote now indicates that 2024–25 HD-IIV and adjuvanted IIV (Fluad, CSL Seqirus) are options for administration to people age 18–64 years who are solid organ transplant recipients on an immunosuppressive medication regimen
* The mpox (Jynneos, Bavarian Nordic) footnote was updated to state that subcutaneous administration is preferred over intradermal administration
* Readers are directed to the latest COVID-19 vaccine information in Immunize.org's frequently updated Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools ([link removed])
* MenABCWY (Penbraya, Pfizer) was added
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Recap: Immunize.org updates “Notification of Immunization Letter Template” to include newly recommended vaccines
Immunize.org recently updated its Notification of Immunization Letter Template ([link removed]) to incorporate the new pneumococcal conjugate vaccine, PCV21 (Capvaxive, Merck), the new mRNA RSV vaccine (mResvia, Moderna), MenABCWY (Penbraya, Pfizer), and mpox vaccine (Jynneos, Bavarian Nordic).
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Featured Resources
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HHS launches "Risk Less. Do More." campaign to increase awareness about influenza, COVID-19, and RSV vaccines
HHS launched a national campaign, Risk Less. Do More. ([link removed]), that aims to increase awareness of vaccines that reduce serious illness from influenza, COVID-19, and RSV. The campaign will provide resources to facilitate provider conversations with patients about vaccines against these viruses.
Related Links
* HHS: Risk Less. Do More. ([link removed]) campaign web page
* HHS: HHS Launches National Public Education Campaign Ahead of Respiratory Virus Season ([link removed]) (8/19/24)
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Resources to ease children’s fears about vaccines—from Daniel Tiger to Immunize.org’s clinical resources on improving the vaccination experience
The University of Pittsburgh Medical Center (UPMC) Health Plan partnered with Fred Rogers Productions to create two 4-minute Daniel Tiger’s Neighborhood audio stories to help young ones prepare for their vaccinations. The stories follow Daniel Tiger’s journey from the moment he learns he is getting a shot to talking with Dr. Anna about what it will be like and why it’s important. This is part of a PBS series on children and fear ([link removed]).
Access the audio stories by prompting your Amazon Alexa or Google Assistant device to “Ask UPMC Health Plan for a Daniel Tiger story.”
Also related to easing children’s fears, Immunize.org offers a suite of resources to help vaccination providers, recipients, caregivers, and companions effectively address vaccination pain and anxiety. Specific guidance is available for infants and toddlers or older children, including a short video for parents ([link removed]) . All Immunize.org’s print and video resources are available in one convenient location on our Clinical Resources: Improving the Vaccination Experience ([link removed]) web page. Links to additional resources from trusted partner organizations are also provided.
Related Links
* Pittsburgh Magazine: Who Better than Daniel Tiger to Calm Children’s Fears about Vaccines? ([link removed]) (1/3/23)
* PBS: Fred Rogers Timeless Wisdom: Children and Fears ([link removed])
* PBS: It's Time for Daniel's Shot | Daniel Tiger's Neighborhood ([link removed]) video
* PBS: Why Do I Need to Get a Shot? | Daniel Tiger's Neighborhood ([link removed]) video
* Immunize.org: Improving the Vaccination Experience ([link removed]) main page
* Immunize.org: Improving the Vaccination Experience Video Series ([link removed]) on YouTube
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Upcoming Events
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Virtual: Society of Infectious Diseases Pharmacists hosts webinar titled "Update Your Vaccination Toolbox: When and How to Use the Vaccine for Mpox" on September 19 at 1:00 p.m. (ET); CPE credit offered
The Society of Infectious Diseases Pharmacists will present a 1-hour webinar titled Update Your Vaccination Toolbox: When and How to Use the Vaccine for Mpox ([link removed]) beginning at 1:00 p.m. (ET) on September 19. The webinar will include a presentation by an expert faculty, active learning engagement questions throughout, and a live question and answer session.
Free continuing pharmacy education credits will be offered for the live event.
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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Issue 1,772: August 28, 2024
Top Stories
* FDA licenses and authorizes updated mRNA COVID-19 vaccines to better protect against currently circulating variants
* FDA changes schedule for GSK MenB (Bexsero): now same schedule as Pfizer MenB (Trumenba) with 2 doses 6 months apart or 3 doses given at 0, 1–2, and 6 months
* Immunize.org updates “Ask the Experts: Influenza” web section for the 2024–25 influenza season
* Immunize.org adds new PCV21 to “Ask the Experts: Pneumococcal” web section
* “National Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2023” published in MMWR
* “Human Papillomavirus Vaccination Coverage among Adolescent Girls Aged 13–17 Years—U.S.-Affiliated Pacific Islands, 2013–2023” published in MMWR
* Immunize.org adds new vaccines to popular resource “Before You Vaccinate Adults, Consider Their ‘H-A-L-O’!”
* Immunize.org updates “Vaccines with Diluents: How to Use Them” resource
* Watch and share the latest installment in Immunize.org’s Orientation Video Series: Introducing VIS and VIS Translations
* Journalists interview Immunize.org experts
* Vaccines in the news
Immunize.org Website and Clinical Resources
* Spotlight on the website: This season’s influenza VISs and access to translations
* Recap: Immunize.org introduces standing orders template for RSV vaccination of adults age 60 years and older
* Recap: Immunize.org updates the screening checklists for contraindications to injectable and live attenuated influenza vaccines for the 2024–25 season
* Recap: Immunize.org updates “Administering Vaccines: Dose, Route, Site, and Needle Size” and companion version for adults
* Recap: Immunize.org updates “Notification of Immunization Letter Template” to include newly recommended vaccines
Featured Resources
* HHS launches "Risk Less. Do More." campaign to increase awareness about influenza, COVID-19, and RSV vaccines
* Resources to ease children’s fears about vaccines—from Daniel Tiger to Immunize.org’s clinical resources on improving the vaccination experience
Upcoming Events
* Virtual: Society of Infectious Diseases Pharmacists hosts webinar titled "Update Your Vaccination Toolbox: When and How to Use the Vaccine for Mpox" on September 19 at 1:00 p.m. (ET); CPE credit offered
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Top Stories
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FDA licenses and authorizes updated mRNA COVID-19 vaccines to better protect against currently circulating variants
On August 22, the FDA licensed and granted emergency use authorization (EUA) for updated mRNA COVID-19 vaccines ([link removed]) (2024–2025 Formula) to include a single component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. Comirnaty (Pfizer) and Spikevax (Moderna) are licensed for routine use in people age 12 years or older. The Pfizer and Moderna vaccines are authorized for emergency use (requiring use of EUA fact sheets) in children younger than age 12 years.
At its June 2024 meeting, ACIP voted in advance to approve the use of new 2024–2025 Formula COVID-19 vaccines in the manner licensed or authorized by FDA. Therefore, clinicians may begin using these vaccines as indicated by FDA as soon as they receive them. A portion of the FDA press release appears below.
What You Need to Know
* Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated, authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated, authorized Moderna COVID-19 Vaccine.
* Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines (timing and number of doses to administer depends on the previous COVID-19 vaccine received).
* Individuals 5 years through 11 years of age regardless of previous vaccination are eligible to receive a single dose of the updated, authorized Moderna or Pfizer-BioNTech COVID-19 vaccines; if previously vaccinated, the dose is administered at least 2 months after the last dose of any COVID-19 vaccine.
* Individuals 12 years of age and older are eligible to receive a single dose of the updated, approved Comirnaty or the updated, approved Spikevax; if previously vaccinated, the dose is administered at least 2 months since the last dose of any COVID-19 vaccine.
* Additional doses are authorized for certain immunocompromised individuals ages 6 months through 11 years of age as described in the Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine fact sheets.
On August 23, CDC posted 2024–2025 Formula COVID-19 vaccine guidance on its website regarding interim clinical considerations for the use of COVID-19 vaccines ([link removed]). Based upon that guidance, Immunize.org will revise our COVID-19 content. Watch for document and website revisions coming soon, including new standing orders templates from CDC for the use of 2024–2025 mRNA COVID-19 vaccines. These updates will be reflected in new versions of Immunize.org’s Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools ([link removed]).
Do not administer any remaining dose of any 2023–2024 Formula COVID-19 vaccine; remove them from storage units and dispose of them or return them as appropriate. All doses of the protein-based 2023–2024 Formula Novavax COVID-19 vaccine expired earlier in the summer, and the 2024–2025 Formula Novavax COVID-19 vaccine is not yet authorized by FDA.
CDC will post updated interim clinical considerations for the use of 2024–2025 Formula Novavax COVID-19 vaccine after FDA reaches decisions about it; Immunize.org will revise our content at that time.
Related Links
* FDA: FDA Approves and Authorizes Updated mRNA COVID-19 Vaccines to Better Protect against Currently Circulating Variants ([link removed]) (8/22/24)
* FDA: Comirnaty ([link removed]) (COVID-19 Vaccine, mRNA) (2024–2025 Formula)
* FDA: Spikevax ([link removed]) (COVID-19 Vaccine, mRNA) (2024–2025 Formula)
* FDA: Moderna COVID-19 Vaccine ([link removed]) (2024–2025 Formula)
* FDA: Pfizer-BioNTech COVID-19 Vaccine ([link removed]) (2024–2025 Formula)
* CDC: Use of COVID-19 Vaccines in the United States: Interim Clinical Considerations ([link removed])
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FDA changes schedule for GSK MenB (Bexsero): now same schedule as Pfizer MenB (Trumenba) with 2 doses 6 months apart or 3 doses given at 0, 1–2, and 6 months
On August 19, FDA approved a new dosing schedule for GSK meningococcal B (MenB) vaccine ([link removed] OR [link removed]) (Bexsero) that matches the schedule for Pfizer MenB vaccine (Trumenba), with 2 doses given 6 months apart or 3 doses given at 0, 1–2, and 6-month intervals. Bexsero’s original 2-dose schedule, with a 1-month interval between the two doses, is no longer licensed.
ACIP is expected to review the new schedule at its October 2024 meeting. Questions about recipients of the previously approved 2-dose (1-month interval) Bexsero schedule are likely to be discussed by ACIP at that time. In the interim, healthcare providers should refer to the updated Bexsero package insert for the currently approved schedule.
Related Links
* FDA: Bexsero product information ([link removed]) web page
* CDC: Meningococcal Vaccine Recommendations ([link removed]) web page
* Immunize.org: Vaccines A–Z: Meningococcal B ([link removed])
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Immunize.org updates “Ask the Experts: Influenza” web section for the 2024–25 influenza season
Immunize.org updated all the questions and answers on its popular Ask the Experts: Influenza ([link removed]) web page. Clinical content now reflects 2024–25 influenza season recommendations. Changes include:
* References to the 2024–25 trivalent vaccines (containing two influenza A and one influenza B virus vaccine antigen) following removal of the B/Yamagata virus from the vaccine because it is no longer circulating
* Unless necessary for understanding, references to the number of strains in vaccines (also called “valency”) were removed
* ACIP affirmation that everyone age 6 months and older who has an egg allergy may receive any age-appropriate influenza vaccine without special precautions
* ACIP allowance for off-label use of high-dose (HD-IIV, Fluzone High Dose, Sanofi) or adjuvanted influenza vaccine (aIIV, Fluad, CSL Seqirus) as an option for solid organ transplant recipients age 18 through 64 years who are on immunosuppressive medication regimens, without a preference over any other age-appropriate injectable influenza vaccine
* Updated hyperlinks, as needed
Immunize.org’s Ask the Experts ([link removed]) main page leads you to 30 web pages on various topics with more than 1,300 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; Iyabode Beysolow, MD, MPH; and Jane R. Zucker, MD, MPH.
Related Links
* Immunize.org: Ask the Experts ([link removed]) main page with more than 1,300 questions and answers
* Immunize.org: Ask the Experts: Influenza ([link removed]) web section
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Immunize.org adds new PCV21 to “Ask the Experts: Pneumococcal” web section
Immunize.org updated all the questions and answers on its popular Ask the Experts: Pneumococcal ([link removed]) web page. The clinical content now reflects updated recommendations for PCV21 vaccine (Capvaxive, Merck) as an option for adults age 18 years or older who are recommended to receive a pneumococcal conjugate vaccine. Hyperlinks were also updated as needed.
Immunize.org’s Ask the Experts ([link removed]) main page leads you to 30 web pages on various topics with more than 1,300 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; Iyabode Beysolow, MD, MPH; and Jane R. Zucker, MD, MPH.
Related Links
* Immunize.org: Ask the Experts ([link removed]) main page with more than 1,300 questions and answers
* Immunize.org: Ask the Experts: Pneumococcal ([link removed]) web section
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“National Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2023” published in MMWR
CDC published National Vaccination Coverage among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2023 ([link removed]) on August 22 in MMWR. A portion of the summary appears below.
Vaccinations are the best defense to protect persons and communities from serious vaccine-preventable diseases. Three vaccines are routinely recommended for adolescents. The Vaccines for Children (VFC) program provides recommended vaccines at no cost to eligible children and adolescents. . . .
Overall, vaccination coverage among VFC-eligible adolescents remained stable across recent birth years, except for a decline in human papillomavirus vaccine up-to-date coverage by age 13 years among those born in 2010 compared with those born in 2007. . . .
Health care providers should make strong recommendations for all routine vaccines and verify if adolescents, particularly those eligible for the VFC program, are up to date with all recommended vaccines.
Access the MMWR article in HTML ([link removed]) or PDF ([link removed]) .
Related Link
* CDC: MMWR main page ([link removed]) providing access to the MMWR family of publications
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“Human Papillomavirus Vaccination Coverage among Adolescent Girls Aged 13–17 Years—U.S.-Affiliated Pacific Islands, 2013–2023” published in MMWR
CDC published Human Papillomavirus Vaccination Coverage among Adolescent Girls Aged 13–17 Years—U.S.-Affiliated Pacific Islands, 2013–2023 ([link removed]) on August 22 in MMWR. A portion of the summary appears below.
Cervical cancer is the fourth most common cancer among women worldwide, and the World Health Organization Western Pacific Region, where the U.S.-affiliated Pacific Islands (USAPI) are located, accounts for one quarter of all estimated cases. Human papillomavirus (HPV) vaccines prevent most cervical cancers and are recommended for girls at age 11–12 years. . . .
This is the first comprehensive report of trends in HPV vaccination coverage among adolescent girls since the vaccines were introduced in USAPI jurisdictions
[Northern Mariana Islands and American Samoa, but not four others]. Coverage with HPV vaccine is on track to meet 2030 goals in two jurisdictions, but disparities need to be addressed. . . .
Adolescent vaccination coverage assessment identifies progress toward regional goals. To target increased vaccine access and coverage, this assessment identifies populations and areas with low coverage.
Access the MMWR article in HTML ([link removed]) or PDF ([link removed]) .
Related Links
* CDC: MMWR main page ([link removed]) providing access to the MMWR family of publications
* Immunize.org: Vaccines A–Z: Human Papillomavirus ([link removed])
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Immunize.org adds new vaccines to popular resource “Before You Vaccinate Adults, Consider Their ‘H-A-L-O’!”
Immunize.org recently updated its resource for healthcare professionals titled Before You Vaccinate Adults, Consider Their “H-A-L-O” ([link removed])!
H-A-L-O refers to four factors:
* Health condition
* Age
* Lifestyle
* Occupation
The document now includes mpox vaccine and updated polio (IPV) vaccination recommendations for previously unvaccinated adults. The RSV vaccine section was revised to match the June 2024 ACIP recommendations for routine vaccination of adults age 75 years and older, and risk-based vaccination of adults age 60 through 74 years.
Related Links
* Immunize.org: Clinic Tools: Vaccine Recommendations ([link removed]) web page
* Immunize.org: Clinical Resources A–Z ([link removed]) main page, where you can filter by topic, vaccine, language, or other criteria
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Immunize.org updates “Vaccines with Diluents: How to Use Them” resource
Immunize.org recently added Penbraya (MenABCWY, Pfizer) to its Vaccines with Diluents: How to Use Them ([link removed]) and updated the resource to specify the formulation of Pfizer-BioNTech COVID-19 vaccine that requires dilution.
Related Links
* Immunize.org: Clinical Resources: Storage & Handling ([link removed]) main page
* Immunize.org: Clinical Resources A–Z ([link removed]) main page, where you can filter by topic, vaccine, language, or other criteria
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Watch and share the latest installment in Immunize.org’s Orientation Video Series: Introducing VIS and VIS Translations
Immunize.org is pleased to share the latest installment in the Orientation Video Series, a 3-minute video introducing our VIS and VIS translations ([link removed]). This is one of the most popular sections of the Immunize.org website, featuring hundreds of VIS translations.
Available now on our YouTube channel ([link removed]), this is the third in our new Orientation Video Series. These videos will help both new and experienced users get the most out of all the online resources we offer. Horizontal versions of these videos, like the one below, orient viewers to the desktop format of the website. Vertical versions feature the mobile view displayed for smartphone users.
Please share this video with anyone who needs to learn how to get the most out of Immunize.org’s website to support effective immunization practices.
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 ImmunizeOrg ([link removed])
* YouTube at ImmunizeOrg ([link removed])
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Journalists interview Immunize.org experts
Journalists seek out Immunize.org experts to help explain vaccines to the public and policy makers. We help the media understand and communicate the complex work vaccinators do. Here is a selection of our recent citations.
* Wall Street Journal: The FDA Approved New COVID Vaccines. Should You Get One? ([link removed]) (8/23/24)
* NPR: FDA Approves Two Updated COVID Vaccines ([link removed]) (8/22/24)
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Vaccines in the news
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
* New York Times: Why Mpox Vaccines Aren’t Flowing to Africans in Desperate Need ([link removed]) (8/23/24)
* New York Times: Whooping Cough Is Coming Back ([link removed]) (8/22/24)
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Immunize.org Website and Clinical Resources
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Spotlight on the website: This season’s influenza VISs and access to translations
As facilities prepare for influenza vaccination season, several readers asked if the August 6, 2021, versions of influenza (inactivated or recombinant) ([link removed]) and influenza (live, intranasal) ([link removed]) VISs are the ones to use this season. The answer is yes! Unlike the vaccine products themselves, influenza VISs are not necessarily revised each year.
Find current influenza VISs and available translations at Immunize.org by clicking the "Vaccines & VISs" tab at the top of any page. Select “VISs” in the left column to display the menu of VIS pages. There are separate links labeled Influenza (inactivated or recombinant) ([link removed]) and Influenza (live, intranasal) ([link removed]). Each individual VIS web page lists all available translations of that VIS.
If you prefer to access all the VISs available in a particular language, select the "VIS Translations" option in the left column of the main menu. On the VIS translations page, select your language of interest from the "Choose Language" dropdown list.
Immunize.org offers a new, 3-page resource that allows users to scan a QR code for instant digital access to an injectable influenza vaccine VIS in any available language: QR Code Links to Vaccine Information Statement (VIS) Translations: Influenza (Flu) Vaccine (Inactivated or Recombinant) ([link removed]).
Scan any QR code with your smartphone to open a translation in a specific language. Spanish and English QR codes are on the front page, followed by an alphabetical list of all available translations. Under each QR code, the title of the VIS is included in that language.
Related Links
* Immunize.org: Influenza (Inactivated or Recombinant) VIS ([link removed]) web page
* Immunize.org: Influenza (Live Intranasal) VIS ([link removed]) web page
* Immunize.org: VIS Translations ([link removed]) web page
* Immunize.org: QR Codes Links to Vaccine Information Statement (VIS) Translations: Influenza (Flu) Vaccine (Inactivated or Recombinant) ([link removed])
* CDC: About VISs ([link removed]) web page
* CDC: Current VISs ([link removed]) web page
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Recap: Immunize.org introduces standing orders template for RSV vaccination of adults age 60 years and older
A new template, Standing Orders for Administering Respiratory Syncytial Virus Vaccine (RSV) to Adults Age 60 Years and Older ([link removed]), is available from Immunize.org. This template reflects current ACIP recommendations for any of the three licensed RSV vaccines: Abrysvo (Pfizer), Arexvy (GSK), and mResvia (Moderna).
In June 2024, ACIP recommended routine RSV vaccination of two groups:
* All unvaccinated adults age 75 years and older
* Unvaccinated adults age 60–74 years who experience health or living conditions that increase their risk of serious RSV disease
ACIP no longer recommends the use of shared clinical decision-making for RSV vaccination of adults age 60–74 years who are not at increased risk for serious RSV disease. People who previously received RSV vaccine should not be revaccinated this season.
Standing orders templates help vaccine providers establish protocols to streamline routine immunization without requiring individual patient orders.
Immunize.org also offers other standing orders templates for RSV prevention:
* Standing Orders for Administering Nirsevimab RSV Preventive Antibody (Beyfortus, by Sanofi) to Infants ([link removed])
* Standing Orders for Administering Pfizer Respiratory Syncytial Virus (RSV) Vaccine (Abrysvo) during Pregnancy ([link removed])
Immunize.org provides general information about the use of standing orders templates at Using Standing Orders for Administering Vaccines: What You Should Know ([link removed]).
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Recap: Immunize.org updates the screening checklists for contraindications to injectable and live attenuated influenza vaccines for the 2024–25 season
Immunize.org updated its screening checklists for the 2024–25 influenza season to remove references to the number of strains contained in influenza vaccine products. All vaccines for this season contain three strains, following the removal of the B/Yamagata strain that is no longer detected anywhere in the world. The checklists are:
* Screening Checklist for Contraindications to Injectable Influenza Vaccination ([link removed])
* Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination ([link removed])
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Recap: Immunize.org updates “Administering Vaccines: Dose, Route, Site, and Needle Size” and companion version for adults
Immunize.org recently updated two clinical resources:
* Administering Vaccines: Dose, Route, Site, and Needle Size ([link removed])
* Administering Vaccines to Adults: Dose, Route, Site, and Needle Size ([link removed])
Updates to both documents include the following:
* The volume for Fluzone High-Dose (HD-IIV, Sanofi) vaccine changed from 0.7 mL to 0.5 mL for the 2024–25 season
* References were removed for the specific number of strains in influenza vaccines
* A footnote now indicates that 2024–25 HD-IIV and adjuvanted IIV (Fluad, CSL Seqirus) are options for administration to people age 18–64 years who are solid organ transplant recipients on an immunosuppressive medication regimen
* The mpox (Jynneos, Bavarian Nordic) footnote was updated to state that subcutaneous administration is preferred over intradermal administration
* Readers are directed to the latest COVID-19 vaccine information in Immunize.org's frequently updated Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools ([link removed])
* MenABCWY (Penbraya, Pfizer) was added
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Recap: Immunize.org updates “Notification of Immunization Letter Template” to include newly recommended vaccines
Immunize.org recently updated its Notification of Immunization Letter Template ([link removed]) to incorporate the new pneumococcal conjugate vaccine, PCV21 (Capvaxive, Merck), the new mRNA RSV vaccine (mResvia, Moderna), MenABCWY (Penbraya, Pfizer), and mpox vaccine (Jynneos, Bavarian Nordic).
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Featured Resources
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HHS launches "Risk Less. Do More." campaign to increase awareness about influenza, COVID-19, and RSV vaccines
HHS launched a national campaign, Risk Less. Do More. ([link removed]), that aims to increase awareness of vaccines that reduce serious illness from influenza, COVID-19, and RSV. The campaign will provide resources to facilitate provider conversations with patients about vaccines against these viruses.
Related Links
* HHS: Risk Less. Do More. ([link removed]) campaign web page
* HHS: HHS Launches National Public Education Campaign Ahead of Respiratory Virus Season ([link removed]) (8/19/24)
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Resources to ease children’s fears about vaccines—from Daniel Tiger to Immunize.org’s clinical resources on improving the vaccination experience
The University of Pittsburgh Medical Center (UPMC) Health Plan partnered with Fred Rogers Productions to create two 4-minute Daniel Tiger’s Neighborhood audio stories to help young ones prepare for their vaccinations. The stories follow Daniel Tiger’s journey from the moment he learns he is getting a shot to talking with Dr. Anna about what it will be like and why it’s important. This is part of a PBS series on children and fear ([link removed]).
Access the audio stories by prompting your Amazon Alexa or Google Assistant device to “Ask UPMC Health Plan for a Daniel Tiger story.”
Also related to easing children’s fears, Immunize.org offers a suite of resources to help vaccination providers, recipients, caregivers, and companions effectively address vaccination pain and anxiety. Specific guidance is available for infants and toddlers or older children, including a short video for parents ([link removed]) . All Immunize.org’s print and video resources are available in one convenient location on our Clinical Resources: Improving the Vaccination Experience ([link removed]) web page. Links to additional resources from trusted partner organizations are also provided.
Related Links
* Pittsburgh Magazine: Who Better than Daniel Tiger to Calm Children’s Fears about Vaccines? ([link removed]) (1/3/23)
* PBS: Fred Rogers Timeless Wisdom: Children and Fears ([link removed])
* PBS: It's Time for Daniel's Shot | Daniel Tiger's Neighborhood ([link removed]) video
* PBS: Why Do I Need to Get a Shot? | Daniel Tiger's Neighborhood ([link removed]) video
* Immunize.org: Improving the Vaccination Experience ([link removed]) main page
* Immunize.org: Improving the Vaccination Experience Video Series ([link removed]) on YouTube
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Upcoming Events
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Virtual: Society of Infectious Diseases Pharmacists hosts webinar titled "Update Your Vaccination Toolbox: When and How to Use the Vaccine for Mpox" on September 19 at 1:00 p.m. (ET); CPE credit offered
The Society of Infectious Diseases Pharmacists will present a 1-hour webinar titled Update Your Vaccination Toolbox: When and How to Use the Vaccine for Mpox ([link removed]) beginning at 1:00 p.m. (ET) on September 19. The webinar will include a presentation by an expert faculty, active learning engagement questions throughout, and a live question and answer session.
Free continuing pharmacy education credits will be offered for the live event.
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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