Issue 1442: August 28, 2019
TOP STORIES
- CDC releases ACIP recommendations on the use of influenza vaccines for the 2019–20 influenza season
- CDC publishes “National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years—United States, 2018” in this week’s MMWR
- CDC publishes “Human Papillomavirus–Attributable Cancers—United States, 2012–2016” in this week’s MMWR
- Infectious Disease Society of America and four additional medical societies issue policy statement in response to U.S. Customs and Border Patrol’s announcement that migrant families in border detention centers will not be vaccinated against flu
- Reminder! “Dear Colleague” call-to-action letter from AAFP, AAP, ACHA, ACOG, APhA, SAHM, and IAC stresses implementation of immunization visit at 16 years of age
- Total number of U.S. measles cases for 2019 climbs to 1,215 with 12 new cases reported since last week
- IAC Spotlight! These IAC materials and web pages were updated during July and August
- IAC enrolls six new birthing institutions into its Hepatitis B Birth Dose Honor Roll; seven previously honored institutions qualify for additional years' honors
- Association of Immunization Managers calls for nominations of its members for outstanding leadership awards; open through October 7
IAC HANDOUTS
VACCINE INFORMATION STATEMENTS
WORLD NEWS
FEATURED RESOURCES
EDUCATION AND TRAINING
TOP STORIES
CDC releases ACIP recommendations on the use of influenza vaccines for the 2019–20 influenza season
CDC has released Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2019–20 Influenza Season in the August 23 MMWR Recommendations and Reports. The Summary section is reprinted below.
This report updates the 2018–19 recommendations of the Advisory Committee on Immunization Practices (ACIP) regarding the use of seasonal influenza vaccines in the United States (MMWR Recomm Rep 2018;67[No. RR-3]). Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used. Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and live attenuated influenza vaccine (LAIV) are expected to be available for the 2019–20 season. Standard-dose, unadjuvanted, inactivated influenza vaccines will be available in quadrivalent formulations (IIV4s). High-dose (HD-IIV3) and adjuvanted (aIIV3) inactivated influenza vaccines will be available in trivalent formulations. Recombinant (RIV4) and live attenuated influenza vaccine (LAIV4) will be available in quadrivalent formulations.
Updates to the recommendations described in this report reflect discussions during public meetings of ACIP held on October 25, 2018; February 27, 2019; and June 27, 2019. Primary updates in this report include the following two items. First, 2019–20 U.S. trivalent influenza vaccines will contain hemagglutinin (HA) derived from an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent influenza vaccines will contain HA derived from these three viruses, and a B/Phuket/3073/2013–like virus (Yamagata lineage). Second, recent labeling changes for two IIV4s, Afluria Quadrivalent and Fluzone Quadrivalent, are discussed. The age indication for Afluria Quadrivalent has been expanded from ≥5 years to ≥6 months. The dose volume for Afluria Quadrivalent is 0.25 mL for children aged 6 through 35 months and 0.5 mL for all persons aged ≥36 months (≥3 years). The dose volume for Fluzone Quadrivalent for children aged 6 through 35 months, which was previously 0.25 mL, is now either 0.25 mL or 0.5 mL. The dose volume for Fluzone Quadrivalent is 0.5 mL for all persons aged ≥36 months (≥3 years).
This report focuses on the recommendations for use of vaccines for the prevention and control of influenza during the 2019–20 season in the United States. A brief summary of these recommendations and a Background Document containing additional information are available at https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/flu.html. These recommendations apply to U.S.-licensed influenza vaccines used within Food and Drug Administration–licensed indications. Updates and other information are available from CDC’s influenza website (https://www.cdc.gov/flu). Vaccination and health care providers should check this site periodically for additional information.
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CDC publishes “National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years—United States, 2018” in this week’s MMWR
CDC published National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years—United States, 2018 in the August 23 issue of MMWR (pages 718–723). The first paragraph is reprinted below.
The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of persons aged 11–12 years to protect against certain diseases, including human papillomavirus (HPV)–associated cancers, meningococcal disease, and pertussis. A booster dose of quadrivalent meningococcal conjugate vaccine (MenACWY) is recommended at age 16 years, and serogroup B meningococcal vaccine (MenB) may be administered to persons aged 16–23 years. To estimate vaccination coverage among adolescents in the United States, CDC analyzed data from the 2018 National Immunization Survey–Teen (NIS-Teen) which included 18,700 adolescents aged 13–17 years. During 2017–2018, coverage with ≥1 dose of HPV vaccine increased from 65.5% to 68.1%, and the percentage of adolescents up-to-date with the HPV vaccine series increased from 48.6% to 51.1%, although the increases were only observed among males. Vaccination coverage increases were also observed for ≥1 MenACWY dose (from 85.1% to 86.6%) and ≥2 MenACWY doses (from 44.3% to 50.8%). Coverage with tetanus and reduced diphtheria toxoids and acellular pertussis vaccine (Tdap) remained stable at 89%. Disparities in coverage by metropolitan statistical area (MSA) and health insurance status identified in previous years persisted. Coverage with ≥1 dose of HPV vaccine was higher among adolescents whose parents reported receiving a provider recommendation; however, prevalence of parents reporting receiving a recommendation for adolescent HPV vaccination varied by state (range = 60%–91%). Supporting providers to give strong recommendations and effectively address parental concerns remains a priority, especially in states and rural areas where provider recommendations were less commonly reported.
In conjunction with this report, CDC issued a press release on August 22 titled An Estimated 92% of Cancers Caused by HPV Could Be Prevented by Vaccine. An excerpt from the press release follows:
“A future without HPV cancers is within reach, but urgent action is needed to improve vaccine coverage rates,” said ADM Brett P. Giroir, MD, HHS Assistant Secretary for Health. “Increasing HPV vaccination coverage to 80% has been and will continue to be a priority initiative for HHS, and we will continue to work with our governmental and private sector partners to make this a reality.”
Related Links
- National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years—United States, 2018 (HTML)
- National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years—United States, 2018 (PDF)
- CDC's TeenVaxView website, designed to help you access CDC's survey data and translate it into action
- CDC press release: An Estimated 92% of Cancers Caused by HPV Could Be Prevented by Vaccine (8/22/19)
- MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements
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CDC publishes “Human Papillomavirus–Attributable Cancers—United States, 2012–2016” in this week’s MMWR
CDC published Human Papillomavirus–Attributable Cancers—United States, 2012–2016 in the August 23 issue of MMWR (pages 724–728). A summary made available to the press is reprinted below.
Human papillomavirus (HPV) is a common virus that can lead to certain types of cancer later in life. The current HPV vaccine could prevent 92% percent of cancers attributable to HPV. A new CDC study found that there were 43,999 HPV-associated cancers (cancers in organ sites where HPV often causes cancer) from 2012 through 2016. CDC researchers estimated the annual number of cancers that can potentially be prevented by the current vaccine for the nation and for each state. The current HPV vaccine protects against 92% or 32,100 of the 34,8000 cancers thought to be caused by HPV from 2012 through 2016. In addition to HPV vaccination, cervical cancer screening is routinely recommended for women ages 21–65 regardless of HPV vaccination status.
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Infectious Disease Society of America and four additional medical societies issue policy statement in response to U.S. Customs and Border Patrol’s announcement that migrant families in border detention centers will not be vaccinated against flu
National news media, including CNBC News, have reported that border officials will not be vaccinating migrants in detention facilities against flu. To express their serious concerns about this policy, the Infectious Disease Society of America (IDSA), along with the HIV Medicine Association, the Society for Healthcare Epidemiology of America, the Pediatric Infectious Diseases Society, and the American Society of Tropical Medicine & Hygiene, have issued a policy statement titled Customs and Border Patrol's Flu Vaccine Policy Breaches Basic Public Health Tenet. On August 19, AAP had published a policy statement titled Providing Care for Children in Immigrant Families, by J.M. Linton, et al., in its journal Pediatrics. On August 1, several healthcare professionals from Johns Hopkins and Harvard had written a letter to key congressmen regarding the deaths of three children in detention centers last flu season, whose deaths reflect a much higher incidence of flu mortality than occurred in the general population.
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Reminder! “Dear Colleague” call-to-action letter from AAFP, AAP, ACHA, ACOG, APhA, SAHM, and IAC stresses implementation of immunization visit at 16 years of age
On August 1, IAC and six professional societies published a "Dear Colleague" letter titled 16-Year-Old Patients: Make Sure They Receive Their Annual Well Visit and Vaccinations. Selections from this call-to-action letter are reprinted below.
Dear Colleague:
The American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College Health Association (ACHA), American College of Obstetricians and Gynecologists (ACOG), American Pharmacists Association (APhA), Society for Adolescent Health and Medicine (SAHM), and Immunization Action Coalition (IAC) urge you and your fellow healthcare professionals to make sure that your patients who are 16 years of age receive the vaccines that are recommended for them in accordance with the Recommended Child and Adolescent Immunization Schedule for ages 18 years or younger, United States, 2019, approved by AAFP, AAP, ACOG, and CDC....
Immunization coverage rates for several adolescent vaccines are poor
According to data from CDC, coverage rates for several recommended adolescent vaccinations are quite low. For example:
- The coverage rate for the second (booster) dose of quadrivalent meningococcal conjugate vaccine (MenACWY), which is recommended at age 16, was only 44% by the 18th birthday.
- Human papillomavirus (HPV) vaccine coverage for ≥1 dose among all adolescents was only 66% (69% for females; 63% for males); and only 49% of all adolescents were fully vaccinated with a complete series (53% for females; 44% for males).
- Less than half (47%) of adolescents age 13–17 years had received influenza vaccine....
Vaccination at age 16 years has been highlighted on the U.S. Immunization Schedule
Beginning in 2017, the official U.S. immunization schedule implemented a significant format change by creating a stand-alone column for age 16 years. Like the 4–6 years and 11–12 years columns, it is highlighted by a gray-shaded heading. The “16 year” age column was also separated out from the previous “16–18 year” age range to highlight the need for the recommended MenACWY 2nd dose at age 16 years.
Along with MenACWY at age 16, influenza vaccine (seasonally) is recommended. In addition, vaccination with meningococcal serogroup B vaccine (MenB) is recommended for individual clinical decision making. Focusing on a 16-year-old visit also allows catch-up on vaccine doses for adolescents who may have fallen behind on vaccines such as HPV, Tdap, and others....
Access the complete "Dear Colleague" letter: 16-Year-Old Patients: Make Sure They Receive Their Annual Well Visit and Vaccinations.
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Total number of U.S. measles cases for 2019 climbs to 1,215 with 12 new cases reported since last week
CDC has posted its latest update on 2019 measles cases in the U.S. on its Measles Cases and Outbreaks web page. The web page shows a preliminary estimate of 1,215 cases across 30 states as of August 22. This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated from the U.S. in 2000.
- Measles can cause serious complications. As of August 22, 2019, 125 of the people who got measles this year were hospitalized, and 65 reported having complications, including pneumonia and encephalitis.
- The majority of cases are among people who were not vaccinated against measles.
- More than 75% of the cases this year are linked to outbreaks in New York and New York City. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.
- All measles cases this year have been caused by measles wild-type D8 or B3.
The states that have reported cases to CDC are Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia, and Washington.
Access additional information about U.S. measles cases in 2019 on CDC's Measles Cases and Outbreaks web page.
Measles outbreaks (defined as three or more cases) are currently ongoing in 2019 in the following jurisdictions:
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IAC Spotlight! These IAC materials and web pages were updated during July and August
In almost every issue of IAC Express, we provide readers with information about new and updated educational materials for healthcare professionals and handouts for patients that have been posted during the past week on IAC’s website for healthcare professionals, www.immunize.org. All these materials are CDC-reviewed and available free for you to download, print, copy, and distribute in your healthcare settings. We also announce major updates to the content on various web sections and pages on immunize.org.
Below you’ll find a listing of the new and updated educational materials and web pages we’ve announced in IAC Express during the months of July and August, in case you’ve missed any of them.
Educational Materials for Healthcare Professionals
Handouts for Your Patients
Updated Web Sections and Pages
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IAC enrolls six new birthing institutions into its Hepatitis B Birth Dose Honor Roll; seven previously honored institutions qualify for additional years' honors
The Immunization Action Coalition (IAC) is pleased to announce that six new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 476 honorees. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.
- AdventHealth DeLand, DeLand, FL (93%)
- Aspirus Ironwood Hospital, Ironwood, MI (92%)
- Fort Walton Beach Medical Center, Fort Walton Beach, FL (97%)
- Hutchinson Regional Medical Center, Hutchinson, KS (94%)
- Norwalk Hospital, Norwalk, CT (91%)
- UF Health Jacksonville, Jacksonville, FL (93%)
The following institution is being recognized for a second year:
- Sterling Regional Medical Center, Sterling, CO (94%)
In addition, the following three institutions are being recognized for a third year:
- Families Are First Birthing Center Bristol Hospital, Bristol, CT (99%)
- Starr County Memorial Hospital, Rio Grande City, TX (95%)
- Sterling Regional Medical Center, Sterling, CO (96%)
The following institution is being recognized for a fourth year:
- Families Are First Birthing Center Bristol Hospital, Bristol, CT (97%)
The following institutions are being recognized for a fifth year:
- Families Are First Birthing Center Bristol Hospital, Bristol, CT (91%)
- JBER 673rd Medical Group, Anchorage, AK (95%)
The following institutions are being recognized for a sixth year:
- Arkansas Valley Regional Medical Center, La Junta, CO (93%)
- Sinai-Grace Hospital, Detroit Medical Center, Detroit, MI (90%)
Finally, the following institution is being recognized for a seventh year:
- Beaumont Hospital–Wayne, Wayne, MI (91%)
Note: Two of these institutions qualified for two 12-month periods at one time.
The Honor Roll now includes 476 birthing institutions from 44 states, Puerto Rico, Guam, and an overseas U.S. military base. One hundred thirteen institutions have qualified for two years, 54 institutions have qualified three times, 29 institutions have qualified four times, 19 institutions have qualified five times, seven institutions have qualified six times, four institutions have qualified seven times, and one institution has qualified eight times.
The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give Birth to the End of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.
To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90 percent or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.
Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.
Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.
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Association of Immunization Managers calls for nominations of its members for outstanding leadership awards; open through October 7
Each year, the Association of Immunization Managers (AIM) presents awards to its selected members in recognition of their outstanding initiatives, service, dedication, and leadership. The awards will be presented at the 2019 AIM Leadership in Action Conference in New Orleans in December. The Natalie J. Smith, MD Award, Bull’s-Eye Awards, and Rising Star Awards have an open nomination process.
For more detailed information about each award and the nomination process, visit theawards page on the AIM website. Nominations are due by October 7. Contact Mary Waterman at mwaterman@immunizationmanagers.org with any questions.
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IAC HANDOUTS
IAC updates "Standing Orders for Administering Haemophilus influenzae Type B Vaccine to Children and Teens"
IAC recently revised Standing Orders for Administering Haemophilus influenzae Type B Vaccine to Children and Teens. Changes were made to incorporate edits in section 1 and to correct and incorporate a new table in section 5c.
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VACCINE INFORMATION STATEMENTS
Reminder! CDC released new “interim” VISs for hepatitis B; influenza, inactivated or recombinant; influenza, live intranasal; MenACWY; MenB; MMR; MMRV; and varicella vaccines; as well as a “final” VIS for Japanese encephalitis vaccine
CDC recently released new “interim” VISs for hepatitis B; influenza, inactivated or recombinant; influenza, live intranasal; MenACWY; MenB; MMR; MMRV; and varicella vaccines; as well as a “final” VIS for Japanese encephalitis vaccine.
Access these new VISs on IAC's website, immunize.org/vis:
Interim VISs
Final VIS
Providers are encouraged to begin using these VISs immediately, but stocks of the previous editions may be used until their supply has run out.
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.
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WORLD NEWS
CDC publishes “Progress toward Poliomyelitis Eradication—Afghanistan, January 2018–May 2019” in this week’s MMWR
CDC published Progress toward Poliomyelitis Eradication—Afghanistan, January 2018–May 2019 in the August 23 issue of MMWR (pages 729–733). A summary for the press is reprinted below.
To achieve polio eradication in Afghanistan, the vaccination program needs to reach approximately 10 million children, the majority of whom are currently not receiving oral poliovirus vaccine through house-to-house polio campaigns. This could be achieved by regaining access to communities and building community trust. A new report describes the progress toward polio eradication in Afghanistan during January 2018–May 2019. Afghanistan and Pakistan are the only two countries with reported cases of wild poliovirus type 1 (WPV1) since 2016. The number of WPV1 cases in Afghanistan has been increasing yearly since 2017. While circulation has remained confined to the Southern and Eastern regions of the country, the geographic range of WPV1 in Southern districts increased in 2019. A nationwide ban on house-to-house campaigns by antigovernment groups that has been in effect since April 2019 has left millions of children unvaccinated. To achieve polio eradication, the program needs to regain access to house-to-house campaigns and increase community demand for polio vaccine.
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CDC releases new web section and educational materials to encourage gay and bisexual men to receive hepatitis A and hepatitis B vaccination
CDC's Division of Viral Hepatitis has released new resources to encourage hepatitis A and hepatitis B vaccination for gay and bisexual men. These resources include a new web page for gay and bisexual men, titled Protect Yourself—Get Vaccinated against Hepatitis A and Hepatitis B, as well as new educational materials, including posters and digital tools. The posters are available in varying sizes and formats and can be customized with local contact information. The digital tools can be used on websites, social media, phone and dating application advertisements, and other digital media platforms.
To learn more about these resources and to hear an update from CDC experts on the hepatitis A outbreaks and information on hepatitis A and hepatitis B vaccination recommendations, please check out this webinar recording: Hepatitis A and B Vaccination for Gay and Bisexual Men: Innovating Practices and New Resources along with its accompanying slides.
CDC invites you to contact ccarnes@cdc.gov with any feedback, additional questions, or other suggestions to support this effort to protect gay and bisexual men against hepatitis A and hepatitis B.
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New! Brightly colored “FLU VACCINE” buttons and stickers now available for purchase from IAC
Start your preparations for the 2019–20 influenza season by ordering IAC's new “FLU VACCINE” buttons and stickers from SHOP IAC. These new resources are modeled after “I Voted” stickers, which are given to voters in many states as they leave the polls on Election Day. The flu vaccine buttons and stickers are bright red to help broadcast your important vaccination message. And the cost is low!
“FLU VACCINE” BUTTONS
Demonstrate your clinic-wide support for protecting everyone from influenza by purchasing buttons for all staff to wear. Measuring 1.25" across, the button is understated in size but carries a bold message! Brightly colored red, round button with white text and a metal pin that clasps on the back.
Pin on your lab coat, uniform, other clothing, tote bag, or backpack to show support for influenza vaccination. Wear it when flu vaccine is available in your clinic to remind patients and the public to protect themselves from influenza.
Buttons are delivered in bags of 10 buttons per bag. Click here for pricing and ordering information.
“FLU VACCINE” STICKERS
These brightly colored red, round stickers measure 1.5" across. Printed on Avery labels, they adhere well to clothing and have an easy-peel-off back.
Wearing these brightly colored stickers, your patients will be letting their communities know that influenza vaccination is important.
Suitable for clinic staff, too! Urge all staff to wear them at work during flu vaccination season. This sends a powerful reminder to patients to get vaccinated.
Stickers are delivered to you cut individually (not on rolls)—available in bundles of 100. Click here for pricing and ordering information.
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IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide is available for free download either by chapter or in its entirety (142 pages)
In late 2017, the Immunization Action Coalition (IAC) announced the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).
This completely updated "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting. Topics include:
- setting up for vaccination services,
- storing and handling vaccines,
- deciding which people should receive which vaccines,
- administering vaccines,
- documenting vaccinations (including legal issues), and
- understanding financial considerations and billing information.
In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.
The Guide is available to download/print either by chapter or in its entirety free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.
The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!
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EDUCATION AND TRAINING
Vaccine Education Center plans Current Issues in Vaccines webinar on September 18
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, beginning at 12:00 p.m. (ET) on September 18. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit's topics for this webinar will be:
- HPV vaccine for 27- to 45-year-olds: Routine recommendation?
- PCV13 vaccine for older adults: Is it making a difference?
- Influenza vaccine: A rough year
- Meningococcal B vaccine: When do you need a booster dose?
Free continuing education credits (CME, CEU, and CPE) will be available for both the live and archived events.
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Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through September 25; register now
Register for CDC's 15-part, live CE-accredited series of 1-hour webinars designed to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). Topics include specific vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.
All sessions begin at 12:00 p.m. (ET). This series began on June 5 and will run through September 25, 2019. The next two webinars are scheduled as follows:
- September 11: HPV
- September 18: Pneumococcal Vaccines
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