Issue 1,570: June 2, 2021
Top Stories
- CDC posts clinical considerations on myocarditis and pericarditis after mRNA COVID-19 vaccination
- “COVID-19 Vaccine Breakthrough Infections Reported to CDC—U.S., January 1–April 20, 2021” published in MMWR
- “Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity—United States, December 14, 2020–May 1, 2021” published in MMWR
- IAC updates Ask the Experts: COVID-19 web page to answer questions about latest ACIP recommendations and revised CDC clinical considerations
- “Be Sure You Know the Anatomical Landmarks for Administering Intramuscular Injections in the Arm,” Dr. Wexler’s Technically Speaking monthly column, available on immunize.org
- Stay current! With all the changes in COVID-19 vaccination in the last few months, make sure you are using the most recent CDC and FDA document versions
- Voices for Vaccines releases new podcast, "Kids and COVID-19 Vaccines," with ACIP liaison Patsy Stinchfield, MS, CPNP
- IAC experts called on by news media
- Not-to-miss immunization articles in the news
- Celebrating the legacy of Deborah L. Wexler, MD
Featured Resources
Journal Articles and Newsletters
Education and Training
Immunization PSAs from the Archive
Top Stories
CDC posts clinical considerations on myocarditis and pericarditis after mRNA COVID-19 vaccination
CDC posted Clinical Considerations: Myocarditis and Pericarditis after Receipt of mRNA COVID-19 Vaccines among Adolescents and Young Adults, as well as related resources for the public. Several cases of myocarditis and pericarditis have been reported in the United States after mRNA COVID-19 vaccination (Pfizer-BioNTech and Moderna). There has not been a similar reporting pattern observed after receipt of the Janssen COVID-19 Vaccine (Johnson & Johnson).
In most cases, vaccinated patients who presented for medical care have responded well to medications and rest and had prompt improvement of symptoms. Reported cases have occurred predominantly in male adolescents and young adults age 16 years and older. Onset was typically within several days after mRNA COVID-19 vaccination, and cases have occurred more often after the second dose than the first dose. CDC and its partners are investigating these reports of myocarditis and pericarditis following mRNA COVID-19 vaccination.
CDC continues to recommend COVID-19 vaccination for everyone age 12 years and older, given the greater risk of COVID-19 illness and related, possibly severe complications.
Providers of COVID-19 vaccines are required to report any serious adverse event (including myocarditis and pericarditis) after vaccination to the Vaccine Adverse Event Reporting System (VAERS).
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“COVID-19 Vaccine Breakthrough Infections Reported to CDC—U.S., January 1–April 20, 2021” published in MMWR
CDC published COVID-19 Vaccine Breakthrough Infections Reported to CDC—United States, January 1–April 30, 2021 in the May 28 issue of MMWR. For this surveillance, a vaccine breakthrough infection was defined as the detection of SARS-CoV-2 RNA or antigen in a respiratory specimen collected from a person at least 14 days after receipt of all recommended doses of an FDA-authorized COVID-19 vaccine. State health departments voluntarily reported vaccine breakthrough infections to CDC.
A total of 10,262 SARS-CoV-2 vaccine breakthrough infections had been reported from 46 U.S. states and territories as of April 30, 2021. Among these cases, 63% occurred in females, and the median patient age was 58 years. Based on preliminary data:
- 27% were asymptomatic
- 10% were known to be hospitalized (Among these patients, 29% were asymptomatic or hospitalized for a reason unrelated to COVID-19.)
- 2% died (Among these patients, median age was 82 years; 18% were asymptomatic or died from a cause unrelated to COVID-19.)
Access the MMWR article in HTML format or in PDF format.
Related Link
- MMWR's gateway page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements
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“Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity—United States, December 14, 2020–May 1, 2021” published in MMWR
CDC published Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity—United States, December 14, 2020–May 1, 2021 in the May 28 issue of MMWR. A portion of the article appears below.
Counties with higher levels of social vulnerability have been disproportionately affected by COVID-19....
...Disparities in county-level vaccination coverage by social vulnerability have increased as vaccine eligibility has expanded, especially in large fringe metropolitan (areas surrounding large cities, e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage among adults was lower among those living in counties with lower socioeconomic status and with higher percentages of households with children, single parents, and persons with disabilities....
...Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in counties with high social vulnerability.
Access the MMWR article in HTML format or in PDF format.
Related Link
- MMWR's gateway page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements
IAC updates Ask the Experts: COVID-19 web page to answer questions about latest ACIP recommendations and revised CDC clinical considerations
IAC has again updated its Ask the Experts: COVID-19 web page to reflect the latest decisions of the ACIP and changes to CDC’s clinical considerations for the use of COVID-19 vaccines. Ask the Experts now includes these topics:
- COVID-19 vaccination of children as young as age 12 years
- Guidance from CDC that COVID-19 vaccines may be co-administered with other vaccines or administered separately, without regard to the timing of other vaccines
- Common questions from immunizers related to the Janssen COVID-19 Vaccine (Johnson & Johnson) and thrombosis with thrombocytopenia syndrome (TTS)
The Ask the Experts: COVID-19 web page is updated regularly as guidance changes and new vaccines are authorized.
IAC's Ask the Experts gateway page leads you to 29 distinct web pages on a variety of topics comprising a total of more than 1,000 common or challenging questions and answers (Q&As) about vaccines and their administration. IAC wishes to recognize its team of experts: Kelly L. Moore, MD, MPH (lead); Carolyn Bridges, MD, FACP; William Atkinson, MD, MPH; and Deborah Wexler, MD.
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“Be Sure You Know the Anatomical Landmarks for Administering Intramuscular Injections in the Arm,” Dr. Wexler’s Technically Speaking monthly column, available on immunize.org
May's Technically Speaking column by IAC's executive director, Deborah L. Wexler, MD, is reprinted below.
Be Sure You Know the Anatomical Landmarks for Administering Intramuscular Injections in the Arm
by Deborah L. Wexler, MD
With tens of thousands of new vaccinators and millions of doses of COVID-19 vaccine being given each month, it is critical that vaccinators—both new and experienced—know how to precisely locate where intramuscular (IM) injections in the arm should be given.
For people age 3 years and older, a correctly placed IM injection is given in the upper arm, in the deltoid muscle, into its middle and thickest part, at a 90-degree angle to the skin. CDC has helpful instructional handouts for vaccinating children age 7 through 18 and adults that illustrate the anatomical landmarks for where to inject into the deltoid muscle.
For COVID-19 vaccinators, CDC highlights this same information on web pages specifically addressing vaccine administration of the three COVID-19 vaccines authorized for use in the U.S.:
One of the most common errors in IM injection is introducing the needle either too high on the shoulder or too low on the arm. Injections given too high (into the shoulder joint) or too low (into tendons and soft tissue) have the possibility of leading to serious shoulder or arm pain that can last several months. SIRVA (shoulder injury related to vaccine administration) is preventable by paying careful attention to the anatomical landmarks for correct placement in the deltoid.
The Immunization Action Coalition (IAC) has free print materials available on its website that teach vaccine administration techniques. Downloads of these IAC materials have skyrocketed since December 2020 when COVID-19 vaccinations began. Here are IAC’s most popular materials on this topic:
Additional IAC materials on vaccine administration
Additional CDC resources on vaccine administration
Technically Speaking is a monthly column written by Dr. Wexler for Vaccine Update, a monthly e-newsletter from the Vaccine Education Center (VEC) at Children's Hospital of Philadelphia. All past columns are available on IAC’s Technically Speaking gateway page at www.immunize.org/technically-speaking.
Access the complete article here.
To subscribe to VEC's Vaccine Update e-newsletter, go to the sign-up form.
Stay current! With all the changes in COVID-19 vaccination in the last few months, make sure you are using the most recent CDC and FDA document versions
COVID-19 vaccinations have been underway for 6 months and key documents have been revised several times. Be certain your patients benefit from the most recent updates by ensuring that staff are using the most recent versions. This includes Fact Sheets, standing orders, screening forms, training and reference materials, summaries on walls or refrigerator doors, and other memory aids.
Applicable to All COVID-19 Vaccines
Vaccine Preparation and Administration by Manufacturer
Standing Orders by Manufacturer
EUA Fact Sheets by Manufacturer
Voices for Vaccines releases new podcast, "Kids and COVID-19 Vaccines," with ACIP liaison Patsy Stinchfield, MS, CPNP
Voices for Vaccines (VFV) has posted a new entry in its Vax Talk podcast series: Kids and COVID-19 Vaccines (with Patsy Stinchfield). A description from their web page appears below.
CDC’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend the Pfizer vaccine be given to kids ages 12–15.
We invited long-time ACIP [liaison] member Patsy Stinchfield on the podcast to talk us through how this decision was made and when other age groups might be eligible.
Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who values vaccines to become a member, use VFV tools in their own community, and sign up for VFV’s free newsletter. Please spread the word to your friends and colleagues to join VFV!
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IAC experts called on by news media
With vaccines in the news so much lately, journalists have sought out IAC experts to communicate the intricacies of running a quality vaccination program. Our insights have helped explain vaccines to the public and policy makers. We want to help them understand the complex work vaccinators do. We've reached mass markets and local stations, across the U.S. and overseas, via print, radio, television, blogs, and more. This is our most recent citation:
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Not-to-miss immunization articles in the news
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
Celebrating the legacy of Deborah L. Wexler, MD
On June 30, 2021, IAC founder and Executive Director Deborah L. Wexler, MD will be retiring and turning the leadership of IAC over to Kelly L. Moore, MD, MPH. We celebrate Deborah’s extraordinary legacy of immunization advocacy in our IAC Express Special Edition article, “ Never a Dull Moment: A Celebration of the Legacy of Deborah L. Wexler, MD.”
Personal messages and best wishes may be shared with Deborah at [email protected], noting “Retirement” in the subject line. Those who wish to honor Deborah’s career with a donation are invited to contribute to either her specially selected project to preserve and record the history of IAC or to IAC’s general fund, to help ensure that the important work of the organization she founded continues long into the future. Both options are available on the Support IAC page.
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Featured Resources
Hepatitis B Foundation launches first global registry of discrimination against people living with hepatitis B
The Hepatitis B Foundation launched its Hepatitis B Discrimination Registry, a database with a worldwide communications campaign to encourage people living with hepatitis B to share their stories. The registry allows people around the world to document their hepatitis B-related discrimination stories anonymously. A portion of the press release appears below.
The Hepatitis B Foundation has successfully worked to improve protections against discrimination in the U.S., such as winning inclusion of hepatitis B as a protected condition under the Americans with Disabilities Act (ADA) in 2013.
The Discrimination Registry’s data will be used to develop policy and advocacy efforts intended to eliminate hepatitis B-related discrimination in the future. The Foundation will share the data through reports that will include high-level information (country-level, type of discrimination, etc.) on what is reported through the Registry. No identifiable information submitted by a person experiencing discrimination will be made available under any circumstances. The Foundation’s public health staff, which regularly publishes articles in scholarly journals, will publish analyses of the data....
...According to the Foundation, discrimination is defined as the unjust, unfair or prejudicial treatment of a person on the grounds of their hepatitis B status. In other words, being treated differently because of one’s hepatitis B infection. People with hepatitis B often face discrimination in many ways: denied employment or education, treated unfairly while at work or in school, not allowed to enter certain countries, not permitted to serve in the military or treated unfairly by health care providers and institutions.
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Families Against COVID-19 Initiative posts a pro-vaccine video showing perspective of families who lost a loved one to a vaccine-preventable disease
The Families Against COVID-19 Initiative, a joint initiative of The Kimberly Coffey Foundation and The Emily Stillman Foundation, has posted a pro-vaccine video from the perspective of families across the United States who have each lost a loved one to a vaccine-preventable disease. The video highlights the importance of getting your family the COVID-19 vaccine so that you do not lose a loved one to a disease that is now preventable.
The initiative encourages coalitions and advocates to use the video for their own COVID-19 vaccine outreach efforts. Please share this video across your social media platforms!
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Check out the www.Give2MenACWY.org website to increase rates of MenACWY booster and other adolescent vaccinations
The website www.Give2MenACWY.org promotes the importance of adolescent vaccination and administering a booster dose of MenACWY vaccine at age 16.
Designed for healthcare professionals, the site incorporates materials and highlights the importance of all recommended vaccines for 16-year-olds. A simplified navigation structure makes locating information a breeze.
The colorful Give2MenACWY.org website is divided into five easy-to-access sections:
The site’s design categorizes materials according to whether they are primarily of interest to providers or to teens or their parents.
Visit Give2MenACWY.org and enjoy browsing (and deploying) its bountiful resources, brought to you by IAC's collaboration with Sanofi Pasteur.
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Father’s Day is June 20. Order IAC’s “I Got My COVID-19 Vaccine” buttons and stickers for fathers who value prevention
Dad has enough neck ties, so order IAC’s “I Got My COVID-19 Vaccine” buttons for him and every vaccinated person who will celebrate Father’s Day with him.
 
Buttons: Wear them in the clinic to demonstrate your support for COVID-19 vaccination and to remind those around you to protect themselves from COVID-19.
Stickers: Give away to COVID-19 vaccine recipients or vaccinated clinic staff!
- Description: Bright yellow stickers on a roll with an easy-peel-off back and perforations between stickers to make them easy to tear off and share
- Packaging: Roll of 200 stickers
- Dimension: 1.5" across
- To order: See Shop IAC: COVID-19 Vaccine Buttons and Stickers for quantity and pricing options
Please note: Through a separate program supported by CDC, public health departments and CDC’s nonprofit Vaccinate with Confidence campaign, partners are able to receive supplies of these buttons and stickers free of charge. For questions about this program, email [email protected] or call 651-647-9009.
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Vaccinated against COVID-19? Encourage friends to follow your lead by adding IAC’s “I Got My COVID-19 Vaccine” Facebook profile photo frame!
Share your excitement about COVID-19 vaccination and inspire your friends! When you have received your COVID-19 vaccine, add IAC's new "I Got My COVID-19 Vaccine" Facebook photo frame to liven up your profile picture!
You can obtain the frame in three ways:
Together we can end the COVID-19 pandemic!
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Journal Articles and Newsletters
CHOP's Vaccine Education Center publishes May issue of Vaccine Update newsletter
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia (CHOP) publishes a monthly immunization-focused newsletter titled Vaccine Update. The May issue of Vaccine Update includes the following articles:
- "Reproductive Health and COVID-19 Vaccines" by Barbara J. Kuter, PhD, MPH
- "Vaccination after COVID-19—Data Are Starting to Emerge That Might Support Altering the Recommendations" by Paul A. Offit, MD
- "Be Sure You Know the Anatomical Landmarks for Administering Intramuscular Injections in the Arm" by Deborah L. Wexler, MD
Additional resources, including information booklets for patients, are available in the full newsletter.
Access the sign-up form to subscribe to Vaccine Update.
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“Factors Associated with Racial/Ethnic Group-Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the U.S.” published in JAMA
In the May 27 issue, JAMA published Factors Associated with Racial/Ethnic Group-Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the U.S. The Conclusions and Relevance section appears below.
In this survey study of US adults, racial/ethnic group–based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.
“Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates” published in JAMA Pediatrics
In the May 24 issue, JAMA Pediatrics published Effect of Training Pediatric Clinicians in Human Papillomavirus Communication Strategies on Human Papillomavirus Vaccination Rates. IAC’s associate director for research, Sharon G. Humiston, MD, MPH is an author. The key points appear below.
Question: Can training pediatric clinicians in human papillomavirus (HPV) communication strategies using online modules reduce missed opportunities for HPV vaccination and increase rates of HPV vaccination?
Findings: In this cluster randomized clinical trial involving 48 pediatric practices across 19 states, online communication training reduced missed opportunities for HPV vaccination, particularly by improving receipt of the first HPV vaccine dose.
Meaning: Online training of pediatric clinicians focused on effective communication may increase rates of HPV vaccination.
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Education and Training
NFID offers webinar “Strategies for Increasing Routine Adult Vaccination Rates” on June 9, CME available
National Foundation for Infectious Diseases (NFID) will host a webinar titled Strategies for Increasing Routine Adult Vaccination Rates from 2:00–3:00 p.m. (ET) on June 9.
Many U.S. adults do not receive all recommended vaccines and, thus, remain unprotected against preventable diseases. This gap in coverage has been exacerbated by the COVID-19 pandemic. This webinar will discuss current adult vaccination recommendations and strategies for increasing coverage among adults in the U.S.
NFID Medical Director William Schaffner, MD will moderate the panel discussion with
- Ruth M. Carrico, PhD, DNP Division of Infectious Diseases, University of Louisville School of Medicine
- Jean-Venable “Kelly” R. Goode, PharmD, BCPS, VCU School of Pharmacy
- Robert H. Hopkins, Jr., MD, National Vaccine Advisory Committee (NVAC) Chair and University of Arkansas for Medical Sciences (UAMS) College of Medicine
There is no fee to participate in this activity, but pre-registration is required. One hour of CME credit will be offered upon completion.
Register for the webinar.
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New Jersey Immunization Network will conduct virtual 2021 Adult Immunization Conference June 14–15, CME available
New Jersey Immunization Network will hold the 2021 Adult Immunization Conference from 11:00–2:00 p.m. (ET) on both June 14 and June 15. The agenda is as follows:
- June 14: Discussion of and Lessons Learned from the NJ COVID Vaccine Roll-Out (Public Health Focus), Panel: Lessons Learned from Telehealth and How it Relates to Adult Immunization, and Barriers to Vaccine Access in Minority Populations
- June 15: An Update on the COVID-19 Vaccine (Clinical Focus), Vaccines: How to Create a Successful Vaccine Program, and Pregnancy and Vaccinations
Continuing education for healthcare professionals will be offered, including CME/MOC Part 2 credit.
Register for the webinar.
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Immunization PSAs from the Archive
In this informative 2004 PSA from Utah Department of Health, mom lets dad know that if insurance doesn’t cover vaccines, then the Vaccines For Children program can help
In this informative 2004 public service announcement (PSA) from the Utah Department of Health, busy mom lets dad know that if their insurance doesn't cover their children's vaccines, then the Vaccines For Children program can help. This PSA is part of a collection curated by vaccine expert William L. Atkinson, MD, MPH.
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Technically Speaking
Read Dr. Wexler's column for the Vaccine Education Center's monthly newsletter, Vaccine Update
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Patient Record Cards
Record cards for patients -- child & teen, adult, and lifetime -- are printed on durable paper and sized to fit in a wallet when folded
DVD: Immunization Techniques
Every practice should have this award winning, "how-to" training video
Protect Newborns Guidebook
Editorial Information
Editor-in-Chief
Kelly L. Moore, MD, MPH
Managing Editor
John Grabenstein, RPh, PhD
Associate Editor
Sharon Humiston, MD, MPH
Writer/Publication Coordinator
Taryn Chapman, MS
Courtnay Londo, MA
Style and Copy Editor
Marian Deegan, JD
Web Edition Manager
Sheila M. Franey, MA
Contributing Writer
Laurel H. Wood, MPA
Technical Reviewer
Robin VanOss
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