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IZ Express #1,629: Immunize.org summarizes ACIP meeting on COVID-19 vaccine booster doses, and more
| From | Immunization Action Coalition <[email protected]> |
| Subject | IZ Express #1,629: Immunize.org summarizes ACIP meeting on COVID-19 vaccine booster doses, and more |
| Date | April 27, 2022 11:15 AM |
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Issue 1,629: April 27, 2022
Top Stories
* Immunize.org summarizes April 20 ACIP meeting on use of second COVID-19 vaccine booster doses
* "Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year" published in MMWR
* Visit Immunize.org's “Vaccines: COVID-19” main page to locate the latest information on COVID-19 vaccines
* National Infant Immunization Week is here! Before the week is over, use CDC's 2022 digital media toolkit to spread the word.
* CDC reports COVID-19 as third leading cause of death in United States again in 2021
* As masks come off, influenza activity continues its gradual climb nationally; keep offering vaccine if influenza is in your area
* Spotlight: Review of Immunize.org resources grouped by age cohorts
* Journalists interview Immunize.org experts
* Vaccines in the news
Immunize.org Pages and Handouts
* Immunize.org updates “Before You Vaccinate Adults, Consider Their “H-A-L-O”!
* Immunize.org revises "Notification of Vaccination Letter Template"
* Reminder: “Ask the Experts: Hepatitis B” web page updated with new recommendation for universal vaccination of adults through age 59 and added information about PreHevbrio
Vaccine Information Statements
* Immunize.org posts Turkish translations of six Vaccine Information Statements updated in August and October 2021
Featured Resources
* Recognize colleagues and students with Immunize.org's elegantly designed "Vaccines Save Lives" black enamel pins
* Order Immunize.org's redesigned child, adult, and lifetime immunization record cards—wallet-sized, designed to last!
Global News
* "Impact of the SARS-CoV-2 Pandemic on Vaccine-Preventable Disease Campaigns" published in International Journal of Infectious Diseases
Upcoming Events
* Virtual: National Minority Quality Forum hosts “Champions for Total Health: Black Maternal Health and Vaccines” webinar on April 29
Editorial Information
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Top Stories
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Immunize.org summarizes April 20 ACIP meeting on use of second COVID-19 vaccine booster doses
The Advisory Committee on Immunization Practices (ACIP) ([link removed]) met on April 20, 2022 ([link removed]), to discuss COVID-19 vaccine booster doses. No votes were taken at the meeting.
The ACIP meeting followed the FDA’s March 29 authorization of a second mRNA (Pfizer-BioNTech or Moderna) booster dose ([link removed]) for individuals age 50 and older and for certain immunocompromised people age 12 years and older. Evidence from Israel indicated gradually waning protection against serious outcomes from COVID-19 in older and immunocompromised individuals beginning at least 4 months after the first booster dose of mRNA vaccine. Additional data suggested a second booster dose helps increase protection from serious outcomes for these higher-risk individuals. Also on March 29, CDC issued Emergency Use Instructions (EUI) for use of a booster of either Pfizer-BioNTech ([link removed]) or Moderna ([link removed]) mRNA vaccine in people age 18
through 49 years who had received Janssen COVID-19 vaccine as both the primary dose and booster dose. Janssen vaccine is not authorized for use as a second booster.
Through April 11, 2022, over 93 million people in the United States have received a first booster or an additional dose (if immunocompromised) of COVID-19 vaccine since this dose was authorized in August 2021. At the April 20 meeting CDC experts presented information on the safety of these first booster doses, as well as available evidence on the vaccine effectiveness for first and second booster doses.
CDC monitors the safety of first booster doses through its extensive network of surveillance systems, including the Vaccine Safety Datalink (VSD), v-safe, and the Vaccine Adverse Event Reporting System (VAERS). In general, systemic and injection-site reactions to the booster were similar to or less frequent than those seen after the primary series. They did observe a small increased risk of myocarditis or pericarditis, verifying 139 cases among 4.7 million first booster dose recipients monitored in VSD within the first 21 days following the booster dose. Most cases occurred within 5 days of booster receipt. The majority of cases were clinically mild and have fully recovered. Within VAERS, myocarditis after the first booster was reported most frequently among males 12 through 29 years of age. However, the reported rates were not as high as after the second dose in the primary series.
CDC experts presented information on vaccine efficacy (VE) during the Omicron surge. Data from February 2022 indicate that, when compared to people vaccinated with a primary series and single booster dose, unvaccinated people age 12 years and older were 20 times more likely to die from COVID-19. In addition, data indicated that three mRNA doses provided protection against hospitalization but showed waning protection against any infection beginning about 2 months after the last dose. No evidence was found to support theoretical concerns that giving booster doses might lead to immune tolerance or a reduced ability for the immune system to respond to variants that differ from the vaccine strain.
The ACIP’s COVID-19 Vaccine Workgroup recommended that a decision on whether to receive a second booster dose should reflect current conditions in the pandemic, including wide availability of vaccine, high protection against severe disease from earlier doses, low rates of COVID-19 cases and hospitalizations, and the availability of antivirals and monoclonal antibodies for SARS-CoV-2. ACIP discussed general guidance to assist eligible people in deciding whether to get a second booster dose as soon as possible or to wait. These factors are listed in the updated interim clinical considerations for use of COVID-19 vaccines ([link removed]), as follows:
Eligible people who may consider getting the second booster dose as soon as possible
* People with certain underlying medical conditions ([link removed]) that increase the risk of severe COVID-19 illness
* People living with someone who is immunocompromised, at increased risk for severe disease, or who cannot be vaccinated due to age or contraindication
* People at increased risk of exposure to SARS-CoV-2, such as through occupational, institutional, or other activities (e.g., travel or large gatherings)
* People who live or work in or near an area where the COVID-19 community level ([link removed]) is medium or high or are traveling to such an area
Eligible people who may consider waiting to receive a second booster dose
* People who have had a SARS-CoV-2 infection within the past 3 months
* People who may be hesitant about getting another recommended booster dose in the future, as a booster dose may be more important in the fall or if a variant-specific vaccine is needed
The meeting concluded with ACIP members discussing what will be needed to inform recommendations on future doses of COVID-19 vaccines.
The next scheduled ACIP meeting will be held June 22–23, 2022. However, ACIP may hold additional meeting(s) before then to discuss COVID vaccines. Information about past and future ACIP meetings ([link removed]) may be found on the ACIP website.
Related Links
* ACIP main page ([link removed]) for content from previous meetings, as well as information about future meetings
* CDC: ACIP Presentation Slides: April 20, 2002 Meeting ([link removed]) web page
* CDC: Use of COVID-19 Vaccines in the United States: Interim Clinical Considerations ([link removed])
* CDC Educational Tool: Second COVID-19 Vaccine Booster Dose (for providers ([link removed])) (for patients ([link removed]))
* FDA Fact Sheets for Healthcare Providers Administering Vaccine
+ Pfizer, age 5 through 11 years, orange cap ([link removed]) (04/13/2022)
+ Pfizer, age 12 years and older, purple cap ([link removed]) (03/29/2022)
+ Pfizer, age 12 years and older, gray cap ([link removed]) (04/13/2022)
+ Moderna, age 18 years and older, primary series and 0.25 mL booster dose (red cap) ([link removed]) (03/29/2022)
+ Moderna, age 18 years and older, 0,5 mL booster dose only (dark blue cap) ([link removed]) (03/29/2022)
+ Janssen (J&J), age 18 years and older ([link removed]) (01/31/2022)
* FDA Fact Sheets for Recipients and Caregivers
+ Pfizer, age 5 through 11 years, orange cap ([link removed]) (01/03/2022)
+ Pfizer, age 12 years and older, purple or gray cap ([link removed]) (03/29/2022)
+ Moderna, age 18 years and older ([link removed])
+ Janssen (J&J), age 18 years and older ([link removed]) (01/31/2022)
* CDC: COVID-19 Vaccine Emergency Use Instructions (EUI) Resources ([link removed])
* Immunize.org: Vaccines: COVID-19 ([link removed]) main page
* Immunize.org: Ask the Experts: COVID-19 ([link removed])
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"Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year" published in MMWR
CDC published Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year ([link removed]) in the April 22 issue of MMWR ([link removed]). CDC points are summarized below.
* Data just published by CDC show national vaccination coverage among kindergarten children getting their required vaccines during the 2020–2021 school year, dropped from 95% to below 94%.
+ This amounts to at least 35,000 more children across the United States entering kindergarten without documentation of complete vaccination against common diseases.
* About 400,000 fewer children entered kindergarten than expected based on jurisdictions reporting enrollment data for both years.
+ Those children, too, might not be up to date on their routine vaccinations, further evidence of how pandemic-related disruptions to health care and education could have lingering consequences for school-age children.
* The good news is routine vaccination coverage remains high and we can recover ground lost during the COVID-19 pandemic.
* With most schools back to in-person learning, it’s important that providers, schools, and immunization programs increase efforts to follow up with students who are not fully vaccinated to maintain the high level of coverage necessary to protect children, families, and communities against vaccine-preventable diseases.
Access the MMWR article in HTML ([link removed]) or PDF ([link removed]).
Related Links
* MMWR's main page ([link removed]) provides access to MMWR Weekly and its companion publications
* CDC: Media Telebriefing: Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year ([link removed]) (4/21/22)
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Visit Immunize.org's “Vaccines: COVID-19” main page to locate the latest information on COVID-19 vaccines
Be sure to bookmark Immunize.org's Vaccines: COVID-19 ([link removed]) main page for quick access to links to key COVID-19 vaccine resource pages from Immunize.org, CDC, and other partners.
As policies for COVID-19 vaccines are updated and new CDC materials are released,
Immunize.org’s Vaccines: COVID-19 ([link removed]) main page and resources will continue to be updated.
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National Infant Immunization Week is here! Before the week is over, use CDC's 2022 digital media toolkit to spread the word.
National Infant Immunization Week (NIIW) ([link removed]), April 24–30, highlights the importance of protecting infants from vaccine-preventable diseases and celebrates the achievements of immunization partners. This year, it’s particularly critical to ensure that families get back on track for routine checkups and recommended vaccinations following disruptions from the COVID-19 pandemic.
Public health officials have been tracking a troubling drop in routine childhood vaccination as a result of families missing many in-person clinical visits during the pandemic. Many children remain behind schedule.
Before the week is over, use CDC's 2022 NIIW Digital Media Toolkit ([link removed]) for your NIIW activities. The toolkit includes updated logos, sample social media content, social graphics, and key messages. Please share them, using the hashtags #NIIW and #ivax2protect.
Related Links
* CDC: National Infant Immunization Week ([link removed]) main page
* CDC: 2022 NIIW Digital Media Toolkit ([link removed]) main page
* Immunize.org: Parent Handouts ([link removed]) main page
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CDC reports COVID-19 as third leading cause of death in United States again in 2021
In its April 22 issue of MMWR Early Release, CDC published two related articles:
* Provisional Mortality Data—United States, 2021 ([link removed])
* Provisional COVID-19 Age-Adjusted Death Rates, by Race and Ethnicity—United States, 2020–2021 ([link removed])
Part of CDC’s media statement ([link removed]) appears below.
The [first] study found that the overall age-adjusted death rate increased by almost 1% in 2021 from 2020. Overall death rates were highest among non-Hispanic American Indian/Alaskan Native and non-Hispanic Black or African American people. For the second year, COVID-19 was the third leading cause of death after heart disease and cancer.
The second report shows that from 2020 to 2021, differences in COVID-19 death rates decreased among most racial and ethnic groups. This report found disparities in the age-adjusted COVID-19 death rates decreased by 14%–40% for most racial and ethnic groups, including non-Hispanic White people, who accounted for 60%–65% of all people who died; and increased non-significantly (7.2%) for non-Hispanic Native Hawaiian and other Pacific Islander persons (0.2%–0.3% of people who died) compared with non-Hispanic multiracial people.
Related Links
* CDC: COVID-19 Was Third Leading Cause of Death in U.S.: CDC Reports Examine U.S. Death Rates for 2021 ([link removed]) (4/22/22)
* Provisional Mortality Data—United States, 2021 (MMWR, April 22, HTML ([link removed]) or PDF ([link removed]))
* Provisional COVID-19 Age-Adjusted Death Rates, by Race and Ethnicity—United States, 2020–2021 (MMWR, April 22, HTML ([link removed]) or PDF ([link removed]))
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As masks come off, influenza activity continues its gradual climb nationally; keep offering vaccine if influenza is in your area
Influenza Surveillance
For week 15, ending on April 16, CDC's Weekly U.S. Influenza Surveillance Report, FluView ([link removed]) summary reports that seasonal influenza activity in the United States varies by region. Influenza activity is highest in the northeast, south-central, and mountain regions of the country.
Influenza Vaccination Dashboard
CDC's new Weekly Flu Vaccination Dashboard ([link removed]) shares preliminary vaccination data. This week’s key fact: flu vaccination coverage for children age 6 months to 17 years is 2.3 percentage points lower for all children this season as of week ending March 19, 2022, compared with last season week ending March 20, 2021 (54.7% compared to 57.0%).
CDC recommends everyone age 6 months and older get an annual influenza vaccine. Influenza and COVID-19 vaccines may be given at the same visit, if needed. COVID-19 vaccination alone provides no protection from influenza or any other respiratory virus.
Vaccine Finder
If you don’t provide influenza vaccine at your site, please strongly recommend vaccination and refer people to sites that do vaccinate. Use VaccineFinder, a user-friendly website to help people of all ages find influenza, COVID-19, and other vaccines ([link removed]). Participating providers can update their vaccine inventory estimates on VaccineFinder. For questions or more information, contact [email protected].
Related Links
* CDC: Weekly Flu Vaccination Dashboard ([link removed]) main page
* CDC: FluView ([link removed]) main page
* CDC: Influenza (Flu) ([link removed]) main page
* Immunize.org: free educational materials and patient handouts related to influenza ([link removed])
* Immunize.org: Vaccines: Influenza ([link removed]) main page
* Immunize.org: Ask the Experts: Influenza ([link removed]) main page
* VaccineFinder ([link removed]) website
* Families Fighting Flu: Flu Resources for Healthcare Professionals ([link removed]) main page
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Spotlight: Review of Immunize.org resources grouped by age cohorts
In this week's Immunize.org Spotlight, we summarize resources at Immunize.org grouped by age cohorts.
Our CDC Schedules ([link removed]) main page provides print PDFs of the recommended immunization schedules for children and adolescents and for adults.
Our Schedules for Patients ([link removed]) main page contains links to informational sheets on vaccines recommended for people with varying needs based on their age and/or underlying medical conditions.
Within our Handouts: Topic Index ([link removed]) we feature (in alphabetical order):
* Our Adolescent Vaccination ([link removed]) main page
* Our Adult Vaccination ([link removed]) main page
* Our Handouts: Parents ([link removed]) main page
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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 recent citation.
* Shot of Prevention: Are Vaccines Safe for My Baby? Get Answers from Trusted Nurses ([link removed]) (4/11/22)
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Vaccines in the news
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
* Pharmacy Times: Recognizing the Important Work of Pharmacists as Immunizers during World Immunization Week ([link removed]) (4/21/22)
* CNN: COVID-19 Still Isn’t Like the Flu ([link removed]) (4/20/22)
* Kaiser Health News: Anti-vaccine Ideology Gains Ground as Lawmakers Seek to Erode Rules for Kids’ Shots ([link removed]) (4/21/22)
* New York Times: A Second Global COVID-19 Summit Led by the White House Is Set for May ([link removed]) (4/18/22)
* Politico: Childhood Vaccinations Are Lagging All around amid COVID ([link removed]) (4/18/22)
* Wired: For mRNA, COVID Vaccines Are Just the Beginning ([link removed]) (4/18/22)
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Immunize.org Pages and Handouts
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Immunize.org updates “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 stands for four factors:
* Health condition
* Age
* Lifestyle
* Occupation
Changes were made to incorporate the newest updated ACIP recommendations for:
* Hepatitis B vaccine – expanded to include routine vaccination of all adults through age 59 years
* Pneumococcal vaccine – expanded to include the use of PCV15 in series with PPSV23 or PCV20 vaccines alone
* Zoster vaccine – expanded to include vaccination of immunocompromised adults beginning at age 19
Related Links
* Immunize.org’s Clinic Tools: Vaccine Recommendations ([link removed]) web page
* Immunize.org’s Handouts: Vaccine Recommendations ([link removed]) web page
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Immunize.org revises "Notification of Vaccination Letter Template"
Immunize.org recently revised its Notification of Vaccination Letter Template ([link removed]). Revisions include the addition of newly recommended vaccines for hepatitis B and pneumococcal disease.
Related Links
* Immunize.org: Clinic Tools: Documenting Vaccinations ([link removed]) main page
* Immunize.org: Handouts for Patients and Staff ([link removed]) main page, where you can sort materials by topic, vaccine, or language
* Immunize.org: Educational Materials for Patients and Staff ([link removed])—an alphabetical listing of more than 230 ready-to-print staff educational materials and patient handouts
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Reminder: “Ask the Experts: Hepatitis B” web page updated with new recommendation for universal vaccination of adults through age 59 and added information about PreHevbrio
Immunize.org updated its popular Ask the Experts: Hepatitis B ([link removed]) web page. This extensive list of clinical questions and answers incorporates the new recommendation for universal vaccination of adults through age 59 and adds information about PreHevbrio (manufactured by VBI). PreHevbrio is licensed and recommended as a hepatitis B vaccine option for people age 18 and older. It is administered as a 3-dose series.
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 1,100 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, and Iyabode Beysolow, MD, MPH.
Related Links
* Immunize.org: Ask the Experts: Hepatitis B ([link removed]) web page
* Immunize.org: Hepatitis B Facts: Testing and Vaccination ([link removed]) (PDF)
* Immunize.org: Hepatitis A and Hepatitis B Vaccines: Be Sure Your Patients Get the Correct Dose ([link removed]) (PDF)
* Immunize.org: Standing Orders for Administering Hepatitis B Vaccine to Adults ([link removed]) (PDF)
* Immunize.org: Ask the Experts ([link removed]) main page to access more than 1,100 questions
* CDC: Current Issues in Immunization Webinar Series: Immunization Update on ACIP Recommendations for Hepatitis B, Pneumococcal, and Zoster Vaccines ([link removed](CIIW)%20Series%20-%205%2F20%2F2022&deliveryName=USCDC_11_22-DM80244)
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Vaccine Information Statements
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Immunize.org posts Turkish translations of six Vaccine Information Statements updated in August and October 2021
Immunize.org posted Turkish translations ([link removed]) of Vaccine Information Statements ([link removed]) (VISs) issued by CDC on August 6, 2021 and October 15, 2021. These translations were generously donated by Betül Polatdemir, MD, Ankara, Turkey, and Nur Polatdemir Çevik, Near East University, Nicosia, Cyprus.
All translations are available in print-ready PDF format.
VIS translations in Turkish ([link removed]):
* Hepatitis A VIS PDF ([link removed]) (view in English ([link removed]))
* Hepatitis B VIS PDF ([link removed]) (view in English ([link removed]))
* Measles, mumps, rubella (MMR) VIS PDF ([link removed]) (view in English ([link removed]))
* Measles, mumps, rubella, varicella (MMRV) VIS PDF ([link removed]) (view in English ([link removed]))
* Rotavirus VIS PDF ([link removed])(view in English ([link removed]))
* Varicella VIS PDF ([link removed])(view in English ([link removed]))
Translations of previous VIS versions may be used until new translations become available. CDC states that the corresponding up-to-date English-language VIS must also be supplied when providing an out-of-date translation.
Related Links
* Immunize.org: Vaccine Information Statement ([link removed]) main page for VISs in 46 languages ([link removed])
* 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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Featured Resources
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Recognize colleagues and students with Immunize.org's elegantly designed "Vaccines Save Lives" black enamel pins
Immunize.org’s elegantly designed “Vaccines Save Lives” pins ([link removed]) are meaningful gifts for people who care about vaccination. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125" x 0.75".
[link removed]
The pin is a stick-through-post variety with the back end covered by a round rubber cap that holds the pin securely. A gold metal spring-lock clasp is also provided.
Wear these pins on clothing, ([link removed]) uniforms, and white coats to show that you value vaccines!
Click here for "Vaccines Save Lives" pin pricing and ordering information. ([link removed])
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Order Immunize.org’s redesigned child, adult, and lifetime immunization record cards—wallet-sized, designed to last!
Immunize.org's personal immunization record cards ([link removed]), printed on rip-proof, smudge-proof, water-proof paper, are designed to last a lifetime. They’re sized to fit in a wallet when folded. The record cards are for you to give to your patients as a permanent and personal vaccination record and are sold in boxes of 250.
* Child & Teen Immunization Record Cards ([link removed])
* Adult Immunization Record Cards ([link removed])
* Lifetime Immunization Record Cards ([link removed])
Make bulk purchases and receive quantity discounts. For quotes on larger quantities or customizing, or to request sample cards, call 651-647-9009 or email [email protected].
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Global News
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"Impact of the SARS-CoV-2 Pandemic on Vaccine-Preventable Disease Campaigns" published in International Journal of Infectious Diseases
In its April 6 issue, International Journal of Infectious Diseases published Impact of the SARS-CoV-2 Pandemic on Vaccine-Preventable Disease Campaigns ([link removed](22)00204-1/fulltext). The findings section appears below.
Mass vaccination campaigns across all vaccines were disrupted heavily by COVID-19. In May 2020, 105 of 183 (57%) campaigns were postponed or canceled in 57 countries due to COVID-19, with an estimated 796 million postponed or missed vaccine doses. Campaign resumption was observed beginning in July 2020. In December 2021, 77 of 472 (16%) campaigns in 54 countries, mainly in the African Region, were still postponed or canceled due to COVID-19, with about 382 million postponed or missed vaccine doses.
Related Link
* News Medical Life Sciences: Impact of COVID-19 Pandemic on Vaccination Campaigns for Diseases Preventable by Vaccine ([link removed])(4/18/22)
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Upcoming Events
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Virtual: National Minority Quality Forum hosts “Champions for Total Health: Black Maternal Health and Vaccines” webinar on April 29
The National Minority Quality Forum's (NMQF) Center for Sustainable Health Care Quality and Equity, along with the Association of Immunization Managers (AIM), and the Institute for Research and Education to Advance Community Health (iReach) will offer a webinar titled Champions for Total Health: Black Maternal Health and Vaccines ([link removed]) on April 29 at 12:00 p.m. (ET). As part of a webinar series that will explore the intersections of total health and vaccinations in historically excluded populations, April's webinar will focus on flu and COVID-19 vaccination rates among pregnant people of color.
Click on the image below to register today.
[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
Robin VanOss
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 1,629: April 27, 2022
Top Stories
* Immunize.org summarizes April 20 ACIP meeting on use of second COVID-19 vaccine booster doses
* "Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year" published in MMWR
* Visit Immunize.org's “Vaccines: COVID-19” main page to locate the latest information on COVID-19 vaccines
* National Infant Immunization Week is here! Before the week is over, use CDC's 2022 digital media toolkit to spread the word.
* CDC reports COVID-19 as third leading cause of death in United States again in 2021
* As masks come off, influenza activity continues its gradual climb nationally; keep offering vaccine if influenza is in your area
* Spotlight: Review of Immunize.org resources grouped by age cohorts
* Journalists interview Immunize.org experts
* Vaccines in the news
Immunize.org Pages and Handouts
* Immunize.org updates “Before You Vaccinate Adults, Consider Their “H-A-L-O”!
* Immunize.org revises "Notification of Vaccination Letter Template"
* Reminder: “Ask the Experts: Hepatitis B” web page updated with new recommendation for universal vaccination of adults through age 59 and added information about PreHevbrio
Vaccine Information Statements
* Immunize.org posts Turkish translations of six Vaccine Information Statements updated in August and October 2021
Featured Resources
* Recognize colleagues and students with Immunize.org's elegantly designed "Vaccines Save Lives" black enamel pins
* Order Immunize.org's redesigned child, adult, and lifetime immunization record cards—wallet-sized, designed to last!
Global News
* "Impact of the SARS-CoV-2 Pandemic on Vaccine-Preventable Disease Campaigns" published in International Journal of Infectious Diseases
Upcoming Events
* Virtual: National Minority Quality Forum hosts “Champions for Total Health: Black Maternal Health and Vaccines” webinar on April 29
Editorial Information
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Top Stories
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Immunize.org summarizes April 20 ACIP meeting on use of second COVID-19 vaccine booster doses
The Advisory Committee on Immunization Practices (ACIP) ([link removed]) met on April 20, 2022 ([link removed]), to discuss COVID-19 vaccine booster doses. No votes were taken at the meeting.
The ACIP meeting followed the FDA’s March 29 authorization of a second mRNA (Pfizer-BioNTech or Moderna) booster dose ([link removed]) for individuals age 50 and older and for certain immunocompromised people age 12 years and older. Evidence from Israel indicated gradually waning protection against serious outcomes from COVID-19 in older and immunocompromised individuals beginning at least 4 months after the first booster dose of mRNA vaccine. Additional data suggested a second booster dose helps increase protection from serious outcomes for these higher-risk individuals. Also on March 29, CDC issued Emergency Use Instructions (EUI) for use of a booster of either Pfizer-BioNTech ([link removed]) or Moderna ([link removed]) mRNA vaccine in people age 18
through 49 years who had received Janssen COVID-19 vaccine as both the primary dose and booster dose. Janssen vaccine is not authorized for use as a second booster.
Through April 11, 2022, over 93 million people in the United States have received a first booster or an additional dose (if immunocompromised) of COVID-19 vaccine since this dose was authorized in August 2021. At the April 20 meeting CDC experts presented information on the safety of these first booster doses, as well as available evidence on the vaccine effectiveness for first and second booster doses.
CDC monitors the safety of first booster doses through its extensive network of surveillance systems, including the Vaccine Safety Datalink (VSD), v-safe, and the Vaccine Adverse Event Reporting System (VAERS). In general, systemic and injection-site reactions to the booster were similar to or less frequent than those seen after the primary series. They did observe a small increased risk of myocarditis or pericarditis, verifying 139 cases among 4.7 million first booster dose recipients monitored in VSD within the first 21 days following the booster dose. Most cases occurred within 5 days of booster receipt. The majority of cases were clinically mild and have fully recovered. Within VAERS, myocarditis after the first booster was reported most frequently among males 12 through 29 years of age. However, the reported rates were not as high as after the second dose in the primary series.
CDC experts presented information on vaccine efficacy (VE) during the Omicron surge. Data from February 2022 indicate that, when compared to people vaccinated with a primary series and single booster dose, unvaccinated people age 12 years and older were 20 times more likely to die from COVID-19. In addition, data indicated that three mRNA doses provided protection against hospitalization but showed waning protection against any infection beginning about 2 months after the last dose. No evidence was found to support theoretical concerns that giving booster doses might lead to immune tolerance or a reduced ability for the immune system to respond to variants that differ from the vaccine strain.
The ACIP’s COVID-19 Vaccine Workgroup recommended that a decision on whether to receive a second booster dose should reflect current conditions in the pandemic, including wide availability of vaccine, high protection against severe disease from earlier doses, low rates of COVID-19 cases and hospitalizations, and the availability of antivirals and monoclonal antibodies for SARS-CoV-2. ACIP discussed general guidance to assist eligible people in deciding whether to get a second booster dose as soon as possible or to wait. These factors are listed in the updated interim clinical considerations for use of COVID-19 vaccines ([link removed]), as follows:
Eligible people who may consider getting the second booster dose as soon as possible
* People with certain underlying medical conditions ([link removed]) that increase the risk of severe COVID-19 illness
* People living with someone who is immunocompromised, at increased risk for severe disease, or who cannot be vaccinated due to age or contraindication
* People at increased risk of exposure to SARS-CoV-2, such as through occupational, institutional, or other activities (e.g., travel or large gatherings)
* People who live or work in or near an area where the COVID-19 community level ([link removed]) is medium or high or are traveling to such an area
Eligible people who may consider waiting to receive a second booster dose
* People who have had a SARS-CoV-2 infection within the past 3 months
* People who may be hesitant about getting another recommended booster dose in the future, as a booster dose may be more important in the fall or if a variant-specific vaccine is needed
The meeting concluded with ACIP members discussing what will be needed to inform recommendations on future doses of COVID-19 vaccines.
The next scheduled ACIP meeting will be held June 22–23, 2022. However, ACIP may hold additional meeting(s) before then to discuss COVID vaccines. Information about past and future ACIP meetings ([link removed]) may be found on the ACIP website.
Related Links
* ACIP main page ([link removed]) for content from previous meetings, as well as information about future meetings
* CDC: ACIP Presentation Slides: April 20, 2002 Meeting ([link removed]) web page
* CDC: Use of COVID-19 Vaccines in the United States: Interim Clinical Considerations ([link removed])
* CDC Educational Tool: Second COVID-19 Vaccine Booster Dose (for providers ([link removed])) (for patients ([link removed]))
* FDA Fact Sheets for Healthcare Providers Administering Vaccine
+ Pfizer, age 5 through 11 years, orange cap ([link removed]) (04/13/2022)
+ Pfizer, age 12 years and older, purple cap ([link removed]) (03/29/2022)
+ Pfizer, age 12 years and older, gray cap ([link removed]) (04/13/2022)
+ Moderna, age 18 years and older, primary series and 0.25 mL booster dose (red cap) ([link removed]) (03/29/2022)
+ Moderna, age 18 years and older, 0,5 mL booster dose only (dark blue cap) ([link removed]) (03/29/2022)
+ Janssen (J&J), age 18 years and older ([link removed]) (01/31/2022)
* FDA Fact Sheets for Recipients and Caregivers
+ Pfizer, age 5 through 11 years, orange cap ([link removed]) (01/03/2022)
+ Pfizer, age 12 years and older, purple or gray cap ([link removed]) (03/29/2022)
+ Moderna, age 18 years and older ([link removed])
+ Janssen (J&J), age 18 years and older ([link removed]) (01/31/2022)
* CDC: COVID-19 Vaccine Emergency Use Instructions (EUI) Resources ([link removed])
* Immunize.org: Vaccines: COVID-19 ([link removed]) main page
* Immunize.org: Ask the Experts: COVID-19 ([link removed])
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"Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year" published in MMWR
CDC published Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year ([link removed]) in the April 22 issue of MMWR ([link removed]). CDC points are summarized below.
* Data just published by CDC show national vaccination coverage among kindergarten children getting their required vaccines during the 2020–2021 school year, dropped from 95% to below 94%.
+ This amounts to at least 35,000 more children across the United States entering kindergarten without documentation of complete vaccination against common diseases.
* About 400,000 fewer children entered kindergarten than expected based on jurisdictions reporting enrollment data for both years.
+ Those children, too, might not be up to date on their routine vaccinations, further evidence of how pandemic-related disruptions to health care and education could have lingering consequences for school-age children.
* The good news is routine vaccination coverage remains high and we can recover ground lost during the COVID-19 pandemic.
* With most schools back to in-person learning, it’s important that providers, schools, and immunization programs increase efforts to follow up with students who are not fully vaccinated to maintain the high level of coverage necessary to protect children, families, and communities against vaccine-preventable diseases.
Access the MMWR article in HTML ([link removed]) or PDF ([link removed]).
Related Links
* MMWR's main page ([link removed]) provides access to MMWR Weekly and its companion publications
* CDC: Media Telebriefing: Vaccination Coverage with Selected Vaccines and Exemption Rates among Children in Kindergarten—United States, 2020–21 School Year ([link removed]) (4/21/22)
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Visit Immunize.org's “Vaccines: COVID-19” main page to locate the latest information on COVID-19 vaccines
Be sure to bookmark Immunize.org's Vaccines: COVID-19 ([link removed]) main page for quick access to links to key COVID-19 vaccine resource pages from Immunize.org, CDC, and other partners.
As policies for COVID-19 vaccines are updated and new CDC materials are released,
Immunize.org’s Vaccines: COVID-19 ([link removed]) main page and resources will continue to be updated.
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National Infant Immunization Week is here! Before the week is over, use CDC's 2022 digital media toolkit to spread the word.
National Infant Immunization Week (NIIW) ([link removed]), April 24–30, highlights the importance of protecting infants from vaccine-preventable diseases and celebrates the achievements of immunization partners. This year, it’s particularly critical to ensure that families get back on track for routine checkups and recommended vaccinations following disruptions from the COVID-19 pandemic.
Public health officials have been tracking a troubling drop in routine childhood vaccination as a result of families missing many in-person clinical visits during the pandemic. Many children remain behind schedule.
Before the week is over, use CDC's 2022 NIIW Digital Media Toolkit ([link removed]) for your NIIW activities. The toolkit includes updated logos, sample social media content, social graphics, and key messages. Please share them, using the hashtags #NIIW and #ivax2protect.
Related Links
* CDC: National Infant Immunization Week ([link removed]) main page
* CDC: 2022 NIIW Digital Media Toolkit ([link removed]) main page
* Immunize.org: Parent Handouts ([link removed]) main page
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CDC reports COVID-19 as third leading cause of death in United States again in 2021
In its April 22 issue of MMWR Early Release, CDC published two related articles:
* Provisional Mortality Data—United States, 2021 ([link removed])
* Provisional COVID-19 Age-Adjusted Death Rates, by Race and Ethnicity—United States, 2020–2021 ([link removed])
Part of CDC’s media statement ([link removed]) appears below.
The [first] study found that the overall age-adjusted death rate increased by almost 1% in 2021 from 2020. Overall death rates were highest among non-Hispanic American Indian/Alaskan Native and non-Hispanic Black or African American people. For the second year, COVID-19 was the third leading cause of death after heart disease and cancer.
The second report shows that from 2020 to 2021, differences in COVID-19 death rates decreased among most racial and ethnic groups. This report found disparities in the age-adjusted COVID-19 death rates decreased by 14%–40% for most racial and ethnic groups, including non-Hispanic White people, who accounted for 60%–65% of all people who died; and increased non-significantly (7.2%) for non-Hispanic Native Hawaiian and other Pacific Islander persons (0.2%–0.3% of people who died) compared with non-Hispanic multiracial people.
Related Links
* CDC: COVID-19 Was Third Leading Cause of Death in U.S.: CDC Reports Examine U.S. Death Rates for 2021 ([link removed]) (4/22/22)
* Provisional Mortality Data—United States, 2021 (MMWR, April 22, HTML ([link removed]) or PDF ([link removed]))
* Provisional COVID-19 Age-Adjusted Death Rates, by Race and Ethnicity—United States, 2020–2021 (MMWR, April 22, HTML ([link removed]) or PDF ([link removed]))
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As masks come off, influenza activity continues its gradual climb nationally; keep offering vaccine if influenza is in your area
Influenza Surveillance
For week 15, ending on April 16, CDC's Weekly U.S. Influenza Surveillance Report, FluView ([link removed]) summary reports that seasonal influenza activity in the United States varies by region. Influenza activity is highest in the northeast, south-central, and mountain regions of the country.
Influenza Vaccination Dashboard
CDC's new Weekly Flu Vaccination Dashboard ([link removed]) shares preliminary vaccination data. This week’s key fact: flu vaccination coverage for children age 6 months to 17 years is 2.3 percentage points lower for all children this season as of week ending March 19, 2022, compared with last season week ending March 20, 2021 (54.7% compared to 57.0%).
CDC recommends everyone age 6 months and older get an annual influenza vaccine. Influenza and COVID-19 vaccines may be given at the same visit, if needed. COVID-19 vaccination alone provides no protection from influenza or any other respiratory virus.
Vaccine Finder
If you don’t provide influenza vaccine at your site, please strongly recommend vaccination and refer people to sites that do vaccinate. Use VaccineFinder, a user-friendly website to help people of all ages find influenza, COVID-19, and other vaccines ([link removed]). Participating providers can update their vaccine inventory estimates on VaccineFinder. For questions or more information, contact [email protected].
Related Links
* CDC: Weekly Flu Vaccination Dashboard ([link removed]) main page
* CDC: FluView ([link removed]) main page
* CDC: Influenza (Flu) ([link removed]) main page
* Immunize.org: free educational materials and patient handouts related to influenza ([link removed])
* Immunize.org: Vaccines: Influenza ([link removed]) main page
* Immunize.org: Ask the Experts: Influenza ([link removed]) main page
* VaccineFinder ([link removed]) website
* Families Fighting Flu: Flu Resources for Healthcare Professionals ([link removed]) main page
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Spotlight: Review of Immunize.org resources grouped by age cohorts
In this week's Immunize.org Spotlight, we summarize resources at Immunize.org grouped by age cohorts.
Our CDC Schedules ([link removed]) main page provides print PDFs of the recommended immunization schedules for children and adolescents and for adults.
Our Schedules for Patients ([link removed]) main page contains links to informational sheets on vaccines recommended for people with varying needs based on their age and/or underlying medical conditions.
Within our Handouts: Topic Index ([link removed]) we feature (in alphabetical order):
* Our Adolescent Vaccination ([link removed]) main page
* Our Adult Vaccination ([link removed]) main page
* Our Handouts: Parents ([link removed]) main page
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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 recent citation.
* Shot of Prevention: Are Vaccines Safe for My Baby? Get Answers from Trusted Nurses ([link removed]) (4/11/22)
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Vaccines in the news
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
* Pharmacy Times: Recognizing the Important Work of Pharmacists as Immunizers during World Immunization Week ([link removed]) (4/21/22)
* CNN: COVID-19 Still Isn’t Like the Flu ([link removed]) (4/20/22)
* Kaiser Health News: Anti-vaccine Ideology Gains Ground as Lawmakers Seek to Erode Rules for Kids’ Shots ([link removed]) (4/21/22)
* New York Times: A Second Global COVID-19 Summit Led by the White House Is Set for May ([link removed]) (4/18/22)
* Politico: Childhood Vaccinations Are Lagging All around amid COVID ([link removed]) (4/18/22)
* Wired: For mRNA, COVID Vaccines Are Just the Beginning ([link removed]) (4/18/22)
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Immunize.org Pages and Handouts
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Immunize.org updates “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 stands for four factors:
* Health condition
* Age
* Lifestyle
* Occupation
Changes were made to incorporate the newest updated ACIP recommendations for:
* Hepatitis B vaccine – expanded to include routine vaccination of all adults through age 59 years
* Pneumococcal vaccine – expanded to include the use of PCV15 in series with PPSV23 or PCV20 vaccines alone
* Zoster vaccine – expanded to include vaccination of immunocompromised adults beginning at age 19
Related Links
* Immunize.org’s Clinic Tools: Vaccine Recommendations ([link removed]) web page
* Immunize.org’s Handouts: Vaccine Recommendations ([link removed]) web page
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Immunize.org revises "Notification of Vaccination Letter Template"
Immunize.org recently revised its Notification of Vaccination Letter Template ([link removed]). Revisions include the addition of newly recommended vaccines for hepatitis B and pneumococcal disease.
Related Links
* Immunize.org: Clinic Tools: Documenting Vaccinations ([link removed]) main page
* Immunize.org: Handouts for Patients and Staff ([link removed]) main page, where you can sort materials by topic, vaccine, or language
* Immunize.org: Educational Materials for Patients and Staff ([link removed])—an alphabetical listing of more than 230 ready-to-print staff educational materials and patient handouts
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Reminder: “Ask the Experts: Hepatitis B” web page updated with new recommendation for universal vaccination of adults through age 59 and added information about PreHevbrio
Immunize.org updated its popular Ask the Experts: Hepatitis B ([link removed]) web page. This extensive list of clinical questions and answers incorporates the new recommendation for universal vaccination of adults through age 59 and adds information about PreHevbrio (manufactured by VBI). PreHevbrio is licensed and recommended as a hepatitis B vaccine option for people age 18 and older. It is administered as a 3-dose series.
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 1,100 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, and Iyabode Beysolow, MD, MPH.
Related Links
* Immunize.org: Ask the Experts: Hepatitis B ([link removed]) web page
* Immunize.org: Hepatitis B Facts: Testing and Vaccination ([link removed]) (PDF)
* Immunize.org: Hepatitis A and Hepatitis B Vaccines: Be Sure Your Patients Get the Correct Dose ([link removed]) (PDF)
* Immunize.org: Standing Orders for Administering Hepatitis B Vaccine to Adults ([link removed]) (PDF)
* Immunize.org: Ask the Experts ([link removed]) main page to access more than 1,100 questions
* CDC: Current Issues in Immunization Webinar Series: Immunization Update on ACIP Recommendations for Hepatitis B, Pneumococcal, and Zoster Vaccines ([link removed](CIIW)%20Series%20-%205%2F20%2F2022&deliveryName=USCDC_11_22-DM80244)
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Vaccine Information Statements
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Immunize.org posts Turkish translations of six Vaccine Information Statements updated in August and October 2021
Immunize.org posted Turkish translations ([link removed]) of Vaccine Information Statements ([link removed]) (VISs) issued by CDC on August 6, 2021 and October 15, 2021. These translations were generously donated by Betül Polatdemir, MD, Ankara, Turkey, and Nur Polatdemir Çevik, Near East University, Nicosia, Cyprus.
All translations are available in print-ready PDF format.
VIS translations in Turkish ([link removed]):
* Hepatitis A VIS PDF ([link removed]) (view in English ([link removed]))
* Hepatitis B VIS PDF ([link removed]) (view in English ([link removed]))
* Measles, mumps, rubella (MMR) VIS PDF ([link removed]) (view in English ([link removed]))
* Measles, mumps, rubella, varicella (MMRV) VIS PDF ([link removed]) (view in English ([link removed]))
* Rotavirus VIS PDF ([link removed])(view in English ([link removed]))
* Varicella VIS PDF ([link removed])(view in English ([link removed]))
Translations of previous VIS versions may be used until new translations become available. CDC states that the corresponding up-to-date English-language VIS must also be supplied when providing an out-of-date translation.
Related Links
* Immunize.org: Vaccine Information Statement ([link removed]) main page for VISs in 46 languages ([link removed])
* 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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Featured Resources
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Recognize colleagues and students with Immunize.org's elegantly designed "Vaccines Save Lives" black enamel pins
Immunize.org’s elegantly designed “Vaccines Save Lives” pins ([link removed]) are meaningful gifts for people who care about vaccination. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125" x 0.75".
[link removed]
The pin is a stick-through-post variety with the back end covered by a round rubber cap that holds the pin securely. A gold metal spring-lock clasp is also provided.
Wear these pins on clothing, ([link removed]) uniforms, and white coats to show that you value vaccines!
Click here for "Vaccines Save Lives" pin pricing and ordering information. ([link removed])
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Order Immunize.org’s redesigned child, adult, and lifetime immunization record cards—wallet-sized, designed to last!
Immunize.org's personal immunization record cards ([link removed]), printed on rip-proof, smudge-proof, water-proof paper, are designed to last a lifetime. They’re sized to fit in a wallet when folded. The record cards are for you to give to your patients as a permanent and personal vaccination record and are sold in boxes of 250.
* Child & Teen Immunization Record Cards ([link removed])
* Adult Immunization Record Cards ([link removed])
* Lifetime Immunization Record Cards ([link removed])
Make bulk purchases and receive quantity discounts. For quotes on larger quantities or customizing, or to request sample cards, call 651-647-9009 or email [email protected].
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Global News
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"Impact of the SARS-CoV-2 Pandemic on Vaccine-Preventable Disease Campaigns" published in International Journal of Infectious Diseases
In its April 6 issue, International Journal of Infectious Diseases published Impact of the SARS-CoV-2 Pandemic on Vaccine-Preventable Disease Campaigns ([link removed](22)00204-1/fulltext). The findings section appears below.
Mass vaccination campaigns across all vaccines were disrupted heavily by COVID-19. In May 2020, 105 of 183 (57%) campaigns were postponed or canceled in 57 countries due to COVID-19, with an estimated 796 million postponed or missed vaccine doses. Campaign resumption was observed beginning in July 2020. In December 2021, 77 of 472 (16%) campaigns in 54 countries, mainly in the African Region, were still postponed or canceled due to COVID-19, with about 382 million postponed or missed vaccine doses.
Related Link
* News Medical Life Sciences: Impact of COVID-19 Pandemic on Vaccination Campaigns for Diseases Preventable by Vaccine ([link removed])(4/18/22)
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Upcoming Events
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Virtual: National Minority Quality Forum hosts “Champions for Total Health: Black Maternal Health and Vaccines” webinar on April 29
The National Minority Quality Forum's (NMQF) Center for Sustainable Health Care Quality and Equity, along with the Association of Immunization Managers (AIM), and the Institute for Research and Education to Advance Community Health (iReach) will offer a webinar titled Champions for Total Health: Black Maternal Health and Vaccines ([link removed]) on April 29 at 12:00 p.m. (ET). As part of a webinar series that will explore the intersections of total health and vaccinations in historically excluded populations, April's webinar will focus on flu and COVID-19 vaccination rates among pregnant people of color.
Click on the image below to register today.
[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
Robin VanOss
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])
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