IZ Express #1,828: Prepare to resume maternal RSV vaccination, teen vaccination coverage, support for CDC staff, and more

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Issue 1,828: August 20, 2025

Top Stories

Prepare to resume evaluating for RSV vaccination during pregnancy in September; plan for RSV immunization of older infants and high-risk children in October

As RSV season approaches, recommendations for maternal RSV vaccination with Abrysvo (Pfizer) will resume in most of the contiguous United States in September. A single dose is recommended during pregnancy between 32 and 36 6/7 weeks’ gestation. Abrysvo is not recommended if the mother has received a previous RSV vaccine dose for any reason. If Abrysvo is not given or if the baby is born less than 14 days after Abrysvo is given, the infant should receive an RSV preventive antibody for protection.

October is when giving RSV preventive antibody to eligible infants generally begins. All infants younger than 8 months, 0 days, whose mothers were not effectively vaccinated against RSV during pregnancy are eligible. Below are a few important points to remember as you plan for immunization of infants born this past spring and summer:

Two product options are available for infants younger than 8 months: nirsevimab (Beyfortus, Sanofi) or clesrovimab (Enflonsia, Merck), given as a single dose
Infants younger than 8 months whose mothers were effectively vaccinated against RSV with Abrysvo during pregnancy or who received a dose of Beyfortus last spring should not be given an RSV preventive antibody now
Beyfortus (and only Beyfortus) is recommended for certain children age 8 through 19 months at increased risk for severe RSV in their second RSV season, regardless of their history of maternal vaccination or preventive antibody administration during their first RSV season
Pediatric healthcare staff should prepare now for reminders and scheduling of infants born during the spring and summer who are due for RSV preventive antibody in October; these infants may be missed if waiting for them to return to clinic for other reasons
An unprotected infant who is not at high risk and turns 8 months of age is no longer eligible to receive RSV preventive antibody protection
In regions with atypical RSV seasonality, such as Alaska, Hawaii, southern Florida, and certain U.S. territories, immunization timing should follow state or local public health guidance

Immunize.org standing order templates for RSV preventive antibody products will be announced in an upcoming issue of IZ Express.

Related Links

AAP: AAP Recommendations for the Prevention of RSV Disease in Infants and Children (7/8/25)
Immunize.org: Vaccines A–Z: RSV (Respiratory Syncytial Virus) main page

"Vaccination Coverage Among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2024" published in MMWR

CDC published Vaccination Coverage Among Adolescents Aged 13–17 Years—National Immunization Survey-Teen, United States, 2024 in MMWR. A portion of the summary appears below.

Three vaccines are routinely recommended for adolescents: tetanus, diphtheria, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine. On the basis of shared clinical decision-making, adolescents may also receive meningococcal B vaccine and should catch up on any missed childhood vaccines. . . .

In this 2024 national study, coverage with ≥1 dose of Tdap, ≥1 dose of MenACWY, ≥1 dose of meningococcal B vaccine, ≥3 doses of hepatitis B vaccine, and ≥2 doses of measles, mumps, and rubella vaccine increased among adolescents aged 13–17 years compared with 2023. Coverage with ≥1 dose of HPV vaccine (78%) remains lower than ≥1-dose Tdap (91%) and ≥1-dose MenACWY (90%) coverage. HPV vaccination coverage did not increase for the third consecutive year; coverage continues to vary by metropolitan statistical area classification. . . .

Health care providers can support adolescent health by discussing and strongly recommending Tdap, MenACWY, HPV vaccine, and other recommended vaccines and regularly reviewing patient records to check for recommended vaccines.

Access the MMWR article in HTML or PDF.

Related Link

CDC: MMWR main page providing access to the MMWR family of publications

Immunize.org statement of support for CDC staff

Everyone at Immunize.org, including the IZ Express team, expresses our unreserved support for friends and colleagues at CDC in response to the horrible act of violence directed at them on August 8, 2025. On that day, a Georgia man who was reported to mistakenly attribute his ill-health to COVID-19 vaccination fired hundreds of bullets at the people of CDC. We are especially grateful to Officer David Rose of the DeKalb County Police Department who died protecting CDC staff and the children at the adjacent Clifton School daycare center.

Most of us at Immunize.org have close connections with CDC. Our CEO began her career there as an Epidemic Intelligence Service officer. CDC has helped fund Immunize.org's educational work since 1994. This vicious attack on our CDC colleagues whose work saves lives and supports our entire public health community is an outrage.

The attack also reminds us of the important role each IZ Express subscriber can play in your community. As misunderstandings and misguided ideas about vaccines spread, you can make clear your support for vaccination as a trustworthy authority. You are equipped to ensure your patients, loved ones, and the public consistently receive accurate, understandable updates about the safety and importance of vaccination. Thank you for your partnership in preventing suffering and death from vaccine-preventable diseases and thank you to the public health professionals at CDC who support all of us.

FDA approves updated labeling for live-attenuated chikungunya vaccine (Ixchiq, Valneva) with new clinical considerations and warnings for people age 60 and older

In May, the FDA issued a safety pause on the use of live-attenuated chikungunya vaccine (Ixchiq, Valneva) in individuals age 60 years and older while it investigated reports of serious neurologic and cardiac adverse events following vaccination in adults older than age 60 who had other underlying health conditions. FDA completed an updated benefit-risk assessment of Ixchiq in all adults. Based on available data, FDA updated its prescribing information to take these risks into account and discontinued the safety pause in the use of Ixchiq in people age 60 years and older.

Prescribing information now states that a decision to administer Ixchiq should take into account an individual’s risk of infection (level of disease activity at destination, duration of travel or residence, and likelihood of exposure to mosquitoes); risk of severe or chronic disease outcomes if infected; and risk of serious, severe, or prolonged chikungunya-like illness if vaccinated with Ixchiq.

The warnings and precautions section of the prescribing information now notes that serious chikungunya-like illness, resulting in hospitalization, including a case of encephalitis with fatal outcome, was reported during post-licensure use of Ixchiq. Limited available data suggest that adults age 65 years and older with one or more chronic medical conditions may have an increased risk for serious chikungunya-like illness after vaccination with Ixchiq.

The viral-like particle chikungunya vaccine (Vimkunya, Bavarian Nordic), licensed in the United States in February 2025 and also recommended for use, is not a live vaccine and is not associated with the safety concerns identified with the live-attenuated chikungunya vaccine.

Related Links

FDA: FDA Update on the Safety of Ixchiq (Chikungunya Vaccine, Live): FDA Safety Communication (8/6/25)
FDA: Ixchiq web page
FDA: Vimkunya web page
CDC: Chikungunya Vaccine Information for Healthcare Providers web page
Immunize.org: Vaccines A–Z: Chikungunya main page

When may people younger than age 65 years receive high-dose or adjuvanted influenza vaccine? Watch the 2-minute answer, part of the Ask the Experts Video Series on YouTube.

This week, our featured episode from the Ask the Experts Video Series addresses the one situation when high-dose inactivated influenza vaccine (HD-IIV) or adjuvanted IIV (aIIV) may be used in people below age 65 years. The video explains that adults age 18 through 64 who received a solid organ transplant and are on immunosuppressive medication have the option to receive HD-IIV or aIIV for seasonal influenza protection.

The 2-minute video is available on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts 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
Instagram at ImmunizeOrg
LinkedIn at ImmunizeOrg
YouTube at ImmunizeOrg

Vaccines in the news

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

NBC: HHS Revives Task Force on Childhood Vaccine Safety (8/14/25)
Medscape: Vaccine Skepticism Is Spreading, but You Can Turn the Tide (8/14/25)
Drug Topics: Pharmacists Can Help Dispel Vaccine Misinformation (8/12/25)
USA Today: Medical Journal Rejects RFK Jr.’s Call for Retraction of Vaccine Study (8/12/25)
AP: CDC Union Condemns Vaccine Misinformation After Shooter Blamed COVID Vaccine for Depression (8/12/25)
USA Today: Trump Admin Orders Federal Agencies to Scrub All Worker COVID Vaccination Records (8/10/25)

Immunize.org Website and Clinical Resources

Spotlight on the LetsGetRealAboutVaccines.org website: "Separate Fact from Fiction" 

Our newest website, LetsGetRealAboutVaccines.org, is a trustworthy, parent-friendly platform that delivers factual vaccine guidance. It equips families and providers with tools to advocate for childhood immunization confidently. 

This week, we spotlight the website's Separate Fact from Fiction section. Found at the second menu tab, this section identifies common methods used to create misinformation about vaccines.

The main page focuses on distinguishing vaccine fact from fiction. It features examples of common techniques used to create misinformation. Five supporting pages are available on this page and the menu:  

Credibility Checklist: Ten ways to help decide if information is trustworthy
Doing Your Own Research: Tips to get the most out of independent learning and how it differs from scientific research
Correlation vs. Causation: Explanation about events occurring in a similar time frame, but the results are not caused by the event
Understanding Risk: How bad, how likely, and what would happen without any action are the parts of the equation needed to assess risk in context
Five Reasons to Vaccinate Your Child: Science-based facts support that vaccination is the most important thing you can do to protect your child’s health

Please share these links with anyone seeking credible, unbiased information about childhood vaccines. 

View the archived Website Office Hours: Let's Get Real About Vaccines website webinar to learn simple tips and tricks for using the website efficiently.

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Recap: Immunize.org posts “Influenza Vaccine Products for the 2025–2026 Influenza Season”

Immunize.org posted Influenza Vaccine Products for the 2025–2026 Influenza Season, our popular 1-page reference document, to list all products licensed for the 2025–26 influenza season. A new note addresses the ACIP recommendation to use 2025–26 seasonal influenza vaccine packages that do not contain thimerosal as a preservative.

As noted on this reference document, availability of the 2025–26 preservative-containing multidose vials (MDVs) varies by manufacturer. We recently learned that the licensed CSL Seqirus MDV influenza vaccine option will not be available in the United States this season.

Recap: Immunize.org issues updated standing orders template for RSV vaccination of older adults to include high-risk adults age 50 through 74 years

Immunize.org updated its Standing Orders for Administering Respiratory Syncytial Virus Vaccine (RSV) to Adults Age 50 Years and Older template to reflect the recommendation, adopted in June 2025, expanding the vaccination recommendation for adults at high risk from age 60 through 74 to age 50 through 74. The optimal time to be vaccinated begins in August before the typical fall RSV season begins, although vaccination may occur at any time of year, if needed. At this time, revaccination of previously vaccinated people is not recommended. Meaningful RSV protection lasts at least 2 years, and possibly longer. All unvaccinated adults age 75 years or older are also recommended to receive an RSV vaccine. All eligible adults may receive any one of the three licensed vaccines:

Abrysvo, Pfizer
Arexvy, GSK
mResvia, Moderna

Recap: Immunize.org updates “Standing Orders for Administering Recombinant Zoster Vaccine (Shingrix) to Adults” template to include manufacturer-filled syringe option

Immunize.org updated its Standing Orders for Administering Recombinant Zoster Vaccine (Shingrix) to Adults template to include availability of new Shingrix (GSK) packaging. Now, in addition to the 2-vial package that requires reconstitution, there is a manufacturer-filled syringe option that does not require reconstitution.

Recap: Immunize.org updates "Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools"

Immunize.org published the August 7 version of its Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools. This resource checklist is updated when significant changes are made to COVID-19 vaccine resources.

The August 7 version includes revised links to updated 2024–2025 Formula COVID-19 vaccine fact sheets and package inserts reflecting:

Updated labeling of mRNA vaccines to include safety information about the rare risk of myocarditis and pericarditis following vaccination
Revised indications for COVID-19 vaccines based on age and presence of high-risk conditions
Addition of new package inserts for mNexspike (Moderna) and Nuvaxovid (Novavax), licensed by FDA in recent weeks (these vaccines currently are not available)

Several CDC resources were removed from the checklist (e.g., the 2024–25 recommended COVID-19 immunization schedule and vaccine At-a-Glance sheets) because CDC removed them from its website. Resources for the 2025–26 season, including new Immunize.org standing orders templates for 2025–2026 Formula COVID-19 vaccines, will be added as they become available.

The resource checklist is updated when significant new COVID-19 vaccine resources are released. The date of the current version of the checklist appears within the footer. All who offer COVID-19 vaccination should review reference materials in use and replace as needed with the most current versions.

Featured Resources

Washington State’s WithinReach offers free, evidence-based e-courses for healthcare workers to strengthen confidence in talking about vaccines; CE credit offered

Washington State’s WithinReach is offering online e-courses for healthcare providers. These self-paced trainings are free, evidence-based, and designed to strengthen your confidence in talking about vaccines. Some courses offer continuing education (CE) credits. A few of the titles include:

Drop Your Assumptions and Pick Up the Evidence
There Never Was an Age of Reason
Vaccine Training for Medical Assistants

View the courses.

Need to teach vaccine administration? 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).

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 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 main page, permitting download of entire Guide (142 pages, PDF)
View the table of contents and individual chapters (PDF):
Immunize.org’s Clinical Resources on adult immunization

Notable Publications

“Cost-Effectiveness of 2023–2024 COVID-19 Vaccination in U.S. Adults” published in JAMA

In its August 7 issue, JAMA published Cost-Effectiveness of 2023–2024 COVID-19 Vaccination in U.S. Adults. A portion of the abstract appears below.

[COVID-19] Vaccination averted substantial numbers of cases, hospitalizations, intensive care unit stays, and deaths across age groups. For adults aged 18 to 49 years and 50 to 64 years, vaccination yielded incremental cost-effectiveness ratios of $115 588 and $25 787 per quality-adjusted life-year gained, respectively. For individuals aged 65 years or older, vaccination was cost saving. Sensitivity analyses indicated that the results were most sensitive to the cost per vaccine dose, vaccine effectiveness, and probability of hospitalization. In phase 2 analyses, an additional dose strategy was only economically favorable in higher-risk scenarios for individuals aged 65 years or older.

“Changes in Childhood Immunization Rates by County Characteristics in Michigan: 2017–2023” published in Pediatrics

In its August 11 issue, Pediatrics published Changes in Childhood Immunization Rates by County Characteristics in Michigan: 2017–2023. A portion of the abstract appears below.

During the study period, the mean completion rate of the childhood and adolescent immunization composite declined from 75.7% to 66.8% and from 80.7% to 74.7%, respectively. The mean completion rate of the male and female HPV vaccination series increased from 35.1% to 42.3% and from 43.4% to 45.2%, respectively. These increases were smaller than the increase predicted by prepandemic trends. In counties with lower income and higher uninsurance, declines in the mean completion rate of both composite measures were greater compared with counties with higher income and lower uninsurance, whereas increases in the mean completion rate of the male HPV vaccination series were smaller. Changes according to rurality were inconsistent. . . .

Routine childhood and adolescent immunizations are declining in Michigan, and increases in HPV vaccination are slowing, particularly in counties with lower income and higher uninsurance rates. Findings suggest progress toward increasing childhood immunizations is stalling. Targeted efforts to increase immunizations in counties with lower income and higher uninsurance rates may be warranted.

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Upcoming Events

Virtual: AIM hosts webinar titled “2025 Annual Influenza Update” on August 27 at 12:00 p.m. (ET)

Association of Immunization Managers (AIM) will host its 2025 Annual Influenza Update Webinar at 12:00 p.m. (ET) on August 27. This webinar will cover key insights for the upcoming influenza season, provide the latest updates on vaccine recommendations, and offer effective communication strategies to promote vaccination and boost vaccine confidence, especially among underserved communities.

Attendees will hear from a panel of experts:

Michelle Fiscus, MD, FAAP, AIM chief medical officer, will give an overview of the 2024–25 influenza season and the status of seasonal influenza vaccine recommendations
Niki Carelli, JD, executive director of the Coalition to Stop Flu, will provide an update on the Coalition to Stop Flu’s work and outlook for the upcoming season
Louise McNitt, MD, medical officer with the California Department of Public Health Immunization Branch, will discuss how culturally tailored messaging, mobile clinics, and trusted messengers were used to increase flu and COVID-19 vaccination rates among Spanish-speaking farmworkers and other underserved populations

Register for Immunize.org Website Office Hours. Ask questions and learn about the VIS web section on September 10 at 4:00 p.m. (ET) or September 11 at 12:00 p.m. (ET). Recorded sessions archived.

To learn simple tips and tricks for using our website efficiently, please register for our next set of Website Office Hours on Wednesday, September 10, at 4:00 p.m. (ET) or Thursday, September 11, at 12:00 p.m. (ET). The same content will be covered in both sessions.

We will open each 45-minute session with a short, live demonstration on navigating the popular VIS website section on Immunize.org. You can submit questions when you register or live on Zoom during the session.

The archive of previous Website Office Hours content is posted at Immunize.org’s "Webinars & Videos" page.

Mark your calendar for future Immunize.org Website Office Hours.

For more upcoming events, visit our Calendar of Events.

Editorial Information

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

Managing Editor

John D. Gräbenstein, 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.

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.

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ISSN: 2771-8085