From Immunize.org <[email protected]>
Subject IZ Express #1,785: Standing orders for adult pneumococcal vaccines, nirsevimab effectiveness among Alaska Natives, and more
Date November 20, 2024 11:03 AM
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Issue 1,785: November 20, 2024
Top Stories
* Immunize​.org issues updated “Standing Orders for Administering Pneumococcal Vaccines to Adults” incorporating ACIP recommendation for routine vaccination starting at age 50 years (#IZX1)
* Immunize​.org updates its “Ask the Experts” web page on pneumococcal vaccines to reflect new adult recommendations (#IZX2)
* “Nirsevimab Effectiveness Against Medically Attended Respiratory Syncytial Virus Illness and Hospitalization Among Alaska Native Children—Yukon-Kuskokwim Delta Region, Alaska, October 2023–June 2024” published in MMWR (#IZX3)
* Immunize.org updates Spanish translations of four popular VISs (#IZX4)
* Immunize.org updates two "Questions and Answers" resources, one for polio and one for rabies (#IZX5)
* Immunize.org updates content in three clinical resources (#IZX6)
* Influenza activity beginning to increase among children as of November 9; get vaccinated before the holidays (#IZX7)
* “After the Preteen Dose of Tdap, When Is the Next Tdap Dose Due?” Watch the 1-minute answer, part of the Ask the Experts Video Series on YouTube. (#IZX8)
* Journalists interview Immunize​.org experts (#IZX9)
* Vaccines in the news (#IZX10)


Immunize​.org Website and Clinical Resources
* Spotlight on the website: What’s in Immunize.org’s "Official Release Repository"? (#IZX11)
* Recap: Immunize​.org updates “Measles: Questions and Answers” (#IZX12)
* Recap: Immunize​.org updates its “Vaccine History Timeline” with recent advances (#IZX13)


Featured Resources
* CDC refreshes its “Wild to Mild” influenza vaccination campaign with colorful graphics (#IZX14)
* APhA’s Vaccine Confident website offers resources, including interactive maps of vaccine access points (#IZX15)
* Organizing a new vaccination program? Use Immunize​.org’s Vaccinating Adults: A Step-by-Step Guide—free to download (#IZX16)


Notable Publications
* “Multisystem Inflammatory Syndrome in Children (MIS-C) Cases by Vaccination Status in California” published in Vaccine (#IZX17)
* “Pediatric Rash Illness Outbreak with Initial Positive Measles Immunoglobulin M Antibody Test Results—American Samoa, March–July 2023” published in MMWR (#IZX18)


Global News
* “Progress Toward Measles Elimination—Worldwide, 2000–2023” published in MMWR (#IZX19)
* “Identifying WHO Global Priority Endemic Pathogens for Vaccine Research and Development (R&D) Using Multi-Criteria Decision Analysis (MCDA): An Objective of the Immunization Agenda 2030” published in eBioMedicine (#IZX20)

Upcoming Events
* Virtual: Questions about our website? Register for the next Immunize​.org Website Office Hours on December 4 at 4:00 p.m. (ET) or December 5 at 12:00 p.m. (ET). Previously recorded sessions now available online. (#IZX21)


Editorial Information (#Editorial)
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Top Stories
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Immunize​.org issues updated “Standing Orders for Administering Pneumococcal Vaccines to Adults” incorporating ACIP recommendation for routine vaccination starting at age 50 years

Immunize​.org updated Standing Orders for Administering Pneumococcal Vaccines to Adults ([link removed]) . The template adheres to the October 2024 recommendations for routine vaccination of adults with a pneumococcal conjugate vaccine (PCV) beginning at age 50. It also follows new CDC guidance that eliminates the option for adults with a history of PCV13 (Prevnar 13, Pfizer) and/or PPSV23 (Pneumovax 23, Merck) to follow up with a dose of PPSV23.
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Related Links
* Immunize​.org: Standing Orders Templates for Administering Vaccines ([link removed]) main page
* Immunize​.org: Vaccines A–Z: Pneumococcal ([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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Immunize​.org updates its “Ask the Experts” web page on pneumococcal vaccines to reflect new adult recommendations

Immunize​.org updated the questions and answers in its "Ask the Experts" web page for pneumococcal vaccine ([link removed]) . Updates incorporate the changes to adult pneumococcal vaccine recommendations voted on at the October 23–24 ACIP meeting. Questions and answers reflect the new recommendation to lower the age of routine vaccination of adults with a pneumococcal conjugate vaccine (PCV) from 65 to 50. The content also incorporates CDC guidance specifying that options for vaccination include one dose of either PCV20 or PCV21 alone, or a series of PCV15 followed by a dose of PPSV23 one year later.

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Immunize​.org's Ask the Experts ([link removed]) main page leads you to 30 distinct web pages on a variety of topics with more than 1,300 common or challenging questions and answers (Q&As) 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: Pneumococcal ([link removed]) main page
* Immunize​.org: Ask the Experts ([link removed]) main page to access more than 1,300 questions and answers

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Nirsevimab Effectiveness Against Medically Attended Respiratory Syncytial Virus Illness and Hospitalization Among Alaska Native Children—Yukon-Kuskokwim Delta Region, Alaska, October 2023–June 2024” published in MMWR

CDC published Nirsevimab Effectiveness Against Medically Attended Respiratory Syncytial Virus Illness and Hospitalization Among Alaska Native Children—Yukon-Kuskokwim Delta Region, Alaska, October 2023–June 2024 ([link removed]) on November 14 in MMWR. A portion of the summary appears below.

To prevent severe respiratory syncytial virus (RSV) illness, nirsevimab [Beyfortus, Sanofi] is recommended for all infants aged <8 months (born during or entering their first RSV season) who are not protected through maternal vaccination and for children aged 8–19 months (entering their second season) who are at increased risk for severe RSV, including all American Indian and Alaska Native (AI/AN) children. . . .

In Alaska’s Yukon-Kuskokwim Delta, nirsevimab was 89% effective in preventing RSV-associated hospitalization for infants in their first RSV season and 76% and 88% effective against medically attended illness for children in their first and second seasons, respectively.

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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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Immunize​.org updates Spanish translations of four popular VISs

Immunize​.org posted up-to-date Spanish translations of four VISs:
* COVID-19 Vaccine VIS ([link removed]) (view in English ([link removed]) )
* RSV Vaccine VIS ([link removed]) (view in English ([link removed]) )
* Typhoid Vaccine VIS ([link removed]) (view in English ([link removed]) )
* Yellow Fever Vaccine VIS ([link removed]) (view in English ([link removed]) )

To locate VIS translations for a particular vaccine, click on “Vaccines & VISs” at Immunize​.org, click on “VISs,” and then select a specific vaccine. Scrolling down the resulting page, you will see the current English VIS (the official federal version), followed by a list of translations of the current English version. If applicable, current translations are followed by a list of any translations of past English versions that are still usable because they are the most recent translations available in those languages. When a patient is given any VIS translation, they should also receive the current VIS in English. Additional tips on using VISs appear at the bottom of the page.

Check the version date of your inventory of VIS translations. Discard translations of previous versions as translations of current versions become available.

Related Links
* Immunize​.org: Vaccine & VISs: Translations ([link removed]) main page for access to all translations of VISs
* Immunize​.org: Dates of Current Vaccine Information Statements ([link removed]) (PDF)
* CDC: What's New with VISs ([link removed]) web page
* CDC: Current VISs ([link removed]) web page

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Immunize​.org updates two "Questions and Answers" resources, one for polio and one for rabies

Immunize​.org updated two of its "Questions and Answers" resources.
* Polio: Questions and Answers ([link removed]) : Edits update epidemiology and clarify adult vaccination recommendations and the interpretation of OPV records. A new question addresses the fact that serologic testing for evidence of previous polio vaccination is not available and not recommended.
* Rabies: Questions and Answers ([link removed]) : Edits update data on reported animal rabies.

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Related Links
* Immunize​.org: Vaccines A–Z: Polio ([link removed]) main page
* Immunize​.org: Vaccines A–Z: Rabies ([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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Immunize​.org updates links in three clinical resources

Immunize​.org is reviewing its clinical resources and web pages to update broken URLs resulting from the recent reorganization of the CDC website. Immunize​.org updated URLs on three clinical resources:
* Key Vaccination Resources for Healthcare Professionals ([link removed])
* Vaccinations Are Safe: Explaining Why ([link removed])
* Don't Be Guilty of These Preventable Errors in Vaccine Administration! ([link removed])

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Related Link
* 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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Influenza activity beginning to increase among children as of November 9; get vaccinated before the holidays

The 2024–25 U.S. influenza season is underway and now is the time to vaccinate. For week 45, ending November 9, CDC’s Weekly U.S. Influenza Surveillance Report, FluView ([link removed]) , shows influenza activity increasing slightly among children and involving more states.

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RESP-NET
Visit the CDC Respiratory Virus Hospitalization Surveillance Network (RESP-NET) ([link removed]) for weekly reports of hospitalizations due to three vaccine-preventable seasonal respiratory viruses: COVID-19, influenza, and RSV.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard ([link removed]) shows that, as of November 2, 2024, 30.5% of U.S. children received flu vaccination, lower than last season at this time. The percentage of children who received flu vaccination varies dramatically from state to state, from a low of just 4.2% to a high of 54.9%.

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CDC reports that, nationally, adult vaccination as of November 2, 2024, was 32,1%, similar to last year at this point. State-by-state coverage rates among adults also vary widely, from a low of 18.5% to a high of 59.3%.

CDC recommends everyone age 6 months and older get annual influenza vaccination. Influenza and other vaccines (e.g., COVID-19, RSV) may be given at the same visit, if needed. Infants age 6 months and older may receive influenza and COVID-19 vaccines at the same visit when they receive the RSV preventive antibody, nirsevimab [Beyfortus, Sanofi].

Identify pharmacies in your area that may offer influenza and COVID-19 vaccines by entering a zip code in the VaccineFinder on Vaccines.gov ([link removed]) or Vacunas.gov ([link removed]) .

Related Links
* CDC: Weekly National Flu Vaccination Dashboard ([link removed]) main page
* CDC: FluView ([link removed]) main page
* CDC: RESP-NET ([link removed]) main page
* Immunize​.org: free clinical resources and patient handouts related to influenza ([link removed])
* Immunize​.org: Vaccines A–Z: Influenza ([link removed]) main page
* Immunize​.org: Ask the Experts: Influenza ([link removed]) main page

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“After the Preteen Dose of Tdap, When Is the Next Tdap Dose Due?” Watch the 1-minute answer, part of the Ask the Experts Video Series on YouTube.

This week, our featured episode from the Ask the Experts Video Series is After the Preteen Dose of Tdap, When Is the Next Tdap Dose Due? ([link removed] ) The video explains that someone who received a dose of Tdap at age 11 or 12 years should receive a booster dose of Td or Tdap vaccine 10 years later, unless tetanus prophylaxis is required sooner due to either an injury or pregnancy.

The 1-minute video 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.

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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 one of our recent citations.
* Irish Times: Robert Kennedy Jnr’s Influence over Donald Trump Sparks Big Pharma Alarm ([link removed]) (11/10/24)

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Vaccines in the news

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
* Washington Post: Global Health Experts Sound Alarm over RFK Jr., Citing Samoa Outbreak ([link removed]) (11/15/24)
* CIDRAP: Before RSV Vaccine, Virus Caused Substantial Illness in US Adults ([link removed]) (11/13/24)
* NPR: What Happens When a Vaccine Skeptic Leads Health Policy? Ask Florida ([link removed]) (11/13/24)
* USA Today: Idaho Health Agency Halts COVID Vaccine Program, Joining Backlash ([link removed]) (11/11/24)
* Medical Xpress: Study Reveals Best Timing for Getting the RSV Vaccine During Pregnancy to Protect Newborns ([link removed]) (11/12/24)
* Medical Xpress: Trial Shows Safety of Getting COVID and Flu Vaccines at Same Time ([link removed]) (11/8/24)

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Immunize​.org Website and Clinical Resources
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Spotlight on the website: What’s in Immunize​.org’s "Official Release Repository"?

Do you ever need to locate vaccine-related communications or announcements from ACIP, CDC, or FDA? Immunize​.org gathers them in our Official Release Repository ([link removed]) web page within the "News & Updates" menu atop each page. 

The Official Release Repository ([link removed]) contains a searchable list of announcements from ACIP, CDC, and FDA dating back to 2015. Each document source (ACIP, CDC, FDA) is available from its own tab. Within the category, we include filters allowing you to narrow your search by publication year, vaccine or disease type, or patient age group.

To access the repository: 
* Click on the “News & Updates” tab on the menu bar found atop each page. 
* Select “Official Release Repository” on the left menu. 
* Select the “ACIP,” “CDC,” or “FDA” tab. 
* Filters you choose will indicate the number of available results. Click on the dropdown list to add a filter. Remove a filter by clicking “x” within the blue filter rectangle.

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Recap: Immunize​.org updates “Measles: Questions and Answers”

Immunize​.org updated its resource Measles: Questions and Answers ([link removed]) . Updates revise rates of measles complications, data on current outbreaks, and several URLs.

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Related Links
* Immunize​.org: Vaccines A–Z: Measles ([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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Recap: Immunize​.org updates its “Vaccine History Timeline” with recent advances

Do you need to know the year that CDC made a vaccination recommendation or FDA approved a new vaccine? Refer to Immunize​.org’s Vaccine History Timeline ([link removed]) . This useful reference was recently updated to include new vaccine-related events.

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If you would like to suggest an event to add, contact us at [email protected] (mailto:[email protected]) .
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Featured Resources
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CDC refreshes its “Wild to Mild” influenza vaccination campaign with colorful graphics

CDC’s 2024–25 Wild to Mild campaign ([link removed]) includes updated posters and social media resources to promote influenza vaccination awareness. The campaign emphasizes that influenza vaccination significantly reduces the severity of illness even when it does not prevent infection entirely.

The "Wild to Mild" campaign, in English and Spanish, uses vibrant colors with engaging graphics.

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Use these resources to encourage your friends, loved ones, and followers to get themselves and their families an annual flu vaccine. CDC will update this social media toolkit ([link removed]) soon with customizable graphic frames to add to your photos, sample social media graphics, and printable materials.

Related Links
* CDC: Flu Resource Center: Digital Media Toolkit ([link removed]) main page
* Immunize​.org: Vaccines A–Z: Flu ([link removed]) main page

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APhA’s Vaccine Confident website offers resources, including interactive maps of vaccine access points

The American Pharmacists Association's ([link removed]) (APhA) Vaccine Confident website ([link removed]) offers educational webinars, podcasts, patient resources, and video success stories to build vaccine confidence. The website links to the Conversation Guide ([link removed]) web page, which offers suggestions on multiple communication themes or audience segments. The Vaccine Confident collection is an action-oriented resource to guide and enhance pharmacist-patient conversations regarding vaccines.

The website also offers two interactive vaccine access maps to identify pharmacy vaccination locations ([link removed]) and healthcare provider locations ([link removed]) .

[link removed]

Visit APhA's Vaccine Confident website ([link removed]) .
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Organizing a new vaccination program? Use Immunize​.org’s Vaccinating Adults: A Step-by-Step Guide—free to download

Download Immunize​.org’s free 142-page book on adult vaccination to help build your program and train your team: Vaccinating Adults: A Step-by-Step Guide (Guide) ([link removed]) .

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This thorough "how to" guide on adult vaccination provides easy-to-use, practical information covering all essential activities. It helps vaccine providers enhance their existing adult vaccination services or introduce them into any clinical setting.

The Guide ([link removed]) is available to download/print either by chapter or in its entirety free of charge. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.

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

Please note: this guide was produced in 2017, before the COVID-19 era, and reflects the recommendations of that time.

Related Links
* Vaccinating Adults: A Step-by-Step Guide ([link removed]) main page, permitting download of entire Guide (142 pages, PDF) ([link removed])
* View the table of contents and individual chapters (PDF):
+ 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])
* Immunize​.org’s Clinical Resources on adult immunization ([link removed])

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Notable Publications
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“Multisystem Inflammatory Syndrome in Children (MIS-C) Cases by Vaccination Status in California” published in Vaccine

For its January 1, 2025 issue, Vaccine published Multisystem Inflammatory Syndrome in Children (MIS-C) Cases by Vaccination Status in California ([link removed]) . The abstract appears below.

Multisystem inflammatory syndrome in children (MIS-C) is a rare condition occurring after SARS-CoV-2 infection in children under 21 years of age. Children (5–17 years) with MIS-C meeting the Centers for Disease Control (CDC) case definition were reported via California's passive disease surveillance system. Incidence of MIS-C was compared in unvaccinated and Pfizer-BioNTech vaccinated children aged 12–17 and 5–11 years. . . . Compared with vaccinated children, the incident rate ratio of MIS-C was higher among unvaccinated children in both the 12–17-year-old group (22.9, 95% confidence interval [CI]: 10.5–49.8, p < 0.0001) and the 5–11-year-old group (3.3, % CI: 1.6–6.7, p = 0.0004). While MIS-C is rare, our results suggest that vaccination with the Pfizer-BioNTech vaccine is protective against MIS-C.
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Pediatric Rash Illness Outbreak with Initial Positive Measles Immunoglobulin M Antibody Test Results—American Samoa, March–July 2023” published in MMWR

CDC published Pediatric Rash Illness Outbreak with Initial Positive Measles Immunoglobulin M Antibody Test Results—American Samoa, March–July 2023 ([link removed]) on November 14 in MMWR. A portion of the summary appears below.

In settings with low measles prevalence, measles immunoglobulin (Ig) M antibody testing results have low positive predictive value and can result in difficulties with interpreting results. . . .

In 2023, the occurrence of positive measles IgM test results for two vaccinated children in American Samoa led to suspicion of a measles outbreak and resulted in declaration of a public health emergency and a mass vaccination campaign to improve coverage. Additional testing from these two children was not possible. Review of medical records and additional laboratory testing of subsequent persons under investigation confirmed alternative viral etiologies. . . .

Confirmation of measles cases relies on a combination of clinical, serologic and molecular laboratory, and vaccination data. High measles vaccination coverage can prevent outbreaks.

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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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Global News
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Progress Toward Measles Elimination—Worldwide, 2000–2023” published in MMWR

CDC published Progress Toward Measles Elimination—Worldwide, 2000–2023 ([link removed]) on November 14 in MMWR. A portion of the summary appears below.

Measles vaccination is effective at preventing measles, a highly contagious disease that can cause severe complications and death and requires high population immunity to interrupt transmission. . . .

During 2000–2023, measles vaccination saved an estimated 60 million lives. From 2022 to 2023, coverage with the first dose of measles-containing vaccine (MCV) remained at 83%, estimated measles cases increased 20%, and the number of countries affected by large or disruptive outbreaks increased from 36 to 57. Coverage was lower and measles incidence was higher in low-income countries and countries with fragile, conflict-affected, and vulnerable settings. . . .

Progress toward eliminating measles will require strengthened surveillance and urgent and targeted improvements in coverage to reach all children with 2 MCV doses.

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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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“Identifying WHO Global Priority Endemic Pathogens for Vaccine Research and Development (R&D) Using Multi-Criteria Decision Analysis (MCDA): An Objective of the Immunization Agenda 2030” published in eBioMedicine

A new World Health Organization (WHO) study Identifying WHO Global Priority Endemic Pathogens for Vaccine Research and Development (R&D) Using Multi-Criteria Decision Analysis (MCDA): An Objective of the Immunization Agenda 2030 ([link removed](24)00460-2/fulltext) was published in eBioMedicine. The report identifies high-burden pathogens that are top priorities for new vaccine development. This WHO study is the first global effort to systematically prioritize endemic pathogens based on criteria that include regional disease burden, antimicrobial resistance risk, and socioeconomic impact.

The highest priority pathogens include:
* Pathogens for which vaccine research is needed: Group A streptococcus, hepatitis C virus, HIV-1 virus, and Klebsiella pneumoniae
* Pathogens for which vaccine candidates need further development: Cytomegalovirus, influenza virus (for a broadly protective vaccine), Leishmania species, non-typhoidal Salmonella, norovirus, Plasmodium falciparum (malaria), Shigella species, and Staphylococcus aureus

View the article ([link removed](24)00460-2/fulltext) .

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Upcoming Events
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Virtual: Questions about our website? Register for the next Immunize​.org Website Office Hours on December 4 at 4:00 p.m. (ET) or December 5 at 12:00 p.m. (ET). Previously recorded sessions now available online.

To learn simple tips and tricks for using our website efficiently, please register for our next set of Website Office Hours on Wednesday, December 4 at 4:00 p.m. (ET) ([link removed]) or Thursday, December 5 at 12:00 p.m. (ET) ([link removed]) . The same content will be covered in both sessions.

We will open each 45-minute session with a short, live demonstration on navigating two web sections: the new “Travel Vaccines” section and the “Vaccine Confidence and Addressing Concerns” section. You can submit questions when you register or live on Zoom during the session.

Register today for Immunize​.org Website Office Hours (content is the same for both): 
* Wednesday, December 4 at 4:00 p.m. (ET) ([link removed])
* Thursday, December 5 at 12:00 p.m. (ET) ([link removed])

To view Immunize​.org Website Office Hours sessions, visit Immunize​.org’s Webinars & Videos ([link removed]) page. Recent topics include “Vaccines A–Z,” “Clinical Resources,” “Vaccine Information Statements (VIS),” and “Ask the Experts” web sections.

Mark your calendar ([link removed])  for future Immunize​.org Website Office Hours. The next pair of sessions will be held in January.

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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. NH23IP922654 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])
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