Behavioral Risk Factor Surveillance System (BRFSS) data for 2021 are now available through CDC’s easy-to-use web-based tool. Topics include self-reported use of preventive services, including adult vaccination. Updated annually, the prevalence and trends tool offers fast access to a large portion of the 2021 data set and can be a helpful resource to reporters, vaccine advocates, students, public-health officials, and decision-makers. The tool is updated every year.



BRFSS prevalence and trends data are available for all states and territories. An example map showing adults aged 65+ vaccinated against influenza within the past year appears below.



Related Links

• CDC Media Release: CDC Releases Data on Chronic Diseases and Related Risk Factors (9/27/22)
• CDC: BRFSS Prevalence & Trends Data

CDC published Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022 in the September 30 issue of MMWR Recommendations and Reports. A portion of the summary appears below.

Cholera is rare in the United States, but cases occur among travelers to countries where cholera is endemic or epidemic and associated with unsafe water and inadequate sanitation. Travelers might be at increased risk for poor outcomes from cholera if they cannot readily access medical services or if they have a medical condition that would be worsened by dehydration, such as cardiovascular or kidney disease. This report describes previously published ACIP recommendations about use of CVD 103-HgR for adults aged 18–64 years and introduces a new recommendation for use in children and adolescents aged 2–17 years. ACIP recommends CVD 103-HgR, the only cholera vaccine licensed for use in the United States, for prevention of cholera among travelers aged 2–64 years to an area with active cholera transmission. Health care providers can use these guidelines to develop the pretravel consultation for persons traveling to areas with active cholera transmission.

Access the MMWR article in HTML or  PDF.

Related Links

• Emergent Biosolutions: Vaxchora Package Insert
• FDA: Product Approval – Cholera
• Immunize.org: Package Inserts and FDA Product Approvals web page
• Immunize.org: ACIP Recommendations web page

Influenza season has begun. CDC expects influenza activity, which is currently low, to increase in the coming weeks or months. CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable snapshot of influenza activity state-by-state.

Influenza Surveillance
For week 38, ending September 24, CDC's Weekly U.S. Influenza Surveillance Report, FluView summary reports that, nationwide, 2.2% of patient visits reported through the Outpatient Influenza-Like Surveillance Network (ILINet) were due to respiratory illness that included fever plus a cough or sore throat (i.e., influenza-like illness [ILI]). Multiple respiratory viruses are co-circulating, and the relative contribution of influenza virus infection to ILI varies by location.



Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard data show that 71.4 million doses of influenza vaccine have been distributed in the United States through September 17, 2022. Vaccine manufacturers project that they will supply the United States with 173.5 million to 183.5 million doses for the 2022–23 season.

CDC recommends everyone age 6 months and older get annual influenza vaccination. Influenza and other vaccines (e.g., 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. To be listed as a provider by VaccineFinder, see the information at this website.

If you don’t provide influenza vaccine at your site, please strongly recommend vaccination and refer people to sites that do vaccinate. The American College of Physicians offers free Adult Vaccination Prescription Pads listing ACIP-recommended vaccines for adults to enable easy referral to vaccinating sites.



“Vaccines.gov” offers VaccineFinder, a service of Boston Children’s Hospital, to help people find influenza, COVID-19, and other vaccines for any age group. 

Related Links

• CDC: Weekly National Flu Vaccination Dashboard main page 
• CDC: FluView main page
• CDC: Influenza (Flu) main page
• Immunize.org: free educational materials and patient handouts related to influenza
• Immunize.org: Vaccines: Influenza main page
• Immunize.org: Ask the Experts: Influenza main page
• Families Fighting Flu: Flu Resources for Healthcare Professionals main page

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World Meningitis Day is observed on October 5. World Meningitis Day is organized by the Confederation of Meningitis Organisations (CoMO), an international organization that works to reduce the incidence and impact of meningitis.

To encourage sharing information about the signs and symptoms of meningitis, CoMo created infographics in 20 languages, all free to download and share. 

Visit partner websites:

• National Meningitis Association, a parent-led nonprofit organization
• Meningitis B Action Project, a parent-led nonprofit organization
• Meningitis Angels, a parent-led national nonprofit organization

Related Links

• CoMo: World Meningitis Day Toolkit
• WHO: Global Roadmap to Defeat Meningitis by 2030 web page
• WHO:  Meningitis Disease web page
• CDC: Meningococcal Vaccination web page
• Immunize.org: Meningococcal ACWY Disease web page
• Immunize.org: Meningococcal B Disease web page
• Immunize.org: Give2MenACWY.org website

Encourage your co-workers to subscribe to IZ Express so they get all the news that matters to vaccinators in their own inbox each Wednesday. IZ Express, the free weekly e-newsletter produced by Immunize.org, succinctly summarizes each week’s important vaccine developments. IZ Express also features:

• Newly posted Vaccine Information Statements and their translations
• Educational materials from Immunize.org, CDC, AAP, and others
• Notices about online and in-person educational opportunities, many offering free continuing education credit

We appreciate you as a subscriber! Thank you for helping us spread the latest immunization news.

In this week's Spotlight, we highlight the Ask the Experts main page at Immunize.org.

Our Ask the Experts main page offers more than a thousand timely questions on vaccines and vaccine administration answered by our experts. Topics include specific diseases and their vaccines as well as vaccine delivery guidance (e.g., administration, billing, documenting).

Immunize.org's Ask the Experts main page leads you to 30 distinct web pages on a variety of topics with more than 1,200 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.

New and updated Ask the Experts Q&As are published in special editions of IZ Express five times per year. If you have a question that you think may be of interest to our readers, please send it to us using our online form. 

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.

• Human Vaccines & Immunotherapeutics: Lessons Learned from 2 Years of Influenza Vaccinations in the UK and USA during the COVID-19 Pandemic as Respiratory Viruses Return (9/26/22)

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

• NBC: Less than 4% of Eligible People Have Gotten Updated COVID Booster Shots, 3 Weeks into the Rollout (9/30/22)
• Wall Street Journal: Some Who Rushed to COVID-19 Vaccine Hold Off on Boosters (9/22/22)
• Time: Here’s How Effective the Original Vaccines Are against Omicron (9/22/22)
• STAT: Complexity of COVID Vaccine Program Leads to Concerns about Potential for Error (9/14/22)

Immunize.org and the Society for Adolescent Health and Medicine (SAHM) recently updated their patient handout, You're 16...We Recommend These Vaccines for You! The sheet now indicates that:

• Human papillomavirus (HPV) vaccine may be started beginning at age 9 years
• The first dose of MenB vaccine should be administered at age 16–18 years
•  COVID-19 vaccine is recommended for adolescents as a primary series plus booster doses

Related Links

• Immunize.org: Handouts: Adolescent Vaccination main page
• Immunize.org: Parent Handouts main page
• Immunize.org: Handouts main page, sorted by topic
• Immunize.org: Handouts for Patients and Staff—an alphabetical list of more than 230 ready-to-print staff educational materials and patient handouts

In case you missed them during recent weeks, updates were made to these helpful materials:

Updated Influenza Materials and Web pages

• Ask the Experts: Influenza
• Influenza Vaccine Products for the 2022–2023 Influenza Season
• Standing Orders for Administering Influenza Vaccine to Children and Teens
• Standing Orders for Administering Influenza Vaccine to Adults
• Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination, also available in Spanish
• Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination, also available in Spanish
• Influenza: Questions and Answers
• How to Administer Intramuscular and Intranasal Influenza Vaccines
• Influenza Vaccination of People with a History of Egg Allergy
• Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months through 8 Years
• Communicating the Benefits of Influenza Vaccine during COVID-19
• Talking with Your Patients about Contraindications and Precautions to Influenza Vaccination
• Not Sure If You Can Get an Influenza Vaccine?
• Declination of Influenza Vaccination
• Don’t Take Chances with Your Family’s Health – Make Sure You All Get Vaccinated against Influenza Every Year!

• Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools (9/9/22)
• Administering Vaccines: Dose, Route, Site, and Needle Size
• Hepatitis B and Healthcare Personnel
• Zoster Vaccine: Immunize.org Answers Your Questions

• Vaccines: COVID-19
• Ask the Experts: COVID-19
• Ask the Experts: Contraindications and Precautions
• Ask the Experts: Hib
• Ask the Experts: Billing and Reimbursement
• New! Vaccines: Monkeypox

• Vaccinations for Adults – You’re Never Too Old to Get Vaccinated!
• When Do Children and Teens Need Vaccinations?
• Vaccines Work!

• Immunize.org: Handouts main page to see educational materials sorted by category
• Immunize.org: Ask the Experts main page to access more than 1,200 questions answered by Immunize.org experts
• Immunize.org: Clinic Tools main page and its nine subtopics
• Immunize.org: Educational Materials for Patients and Staff—an alphabetical list of more than 230 ready-to-print staff educational materials and patient handouts

Immunize.org updated its Pre-exposure Management for Healthcare Personnel with a Documented Hepatitis B Vaccine Series Who Have Not Had Post-vaccination Serologic Testing document in three ways:

• Adding the newest recommended hepatitis B vaccine option, PreHevbrio (VBI Vaccines)
• Clarifying considerations for healthcare personnel with documentation of a complete series of HepB vaccination but no documentation of protective levels of anti-HBs antibody
• Adding a link to the April 2022 CDC recommendation for routine HepB vaccination of all adults 19 through 59 years old

Related Links

• Immunize.org: Vaccines: Hepatitis B main page
• Immunize.org: Handouts: Healthcare Personnel main page
• Immunize.org: Handouts for Patients and Staff main page, where you can sort materials by topic, vaccine, or language
• Immunize.org: Educational Materials for Patients and Staff—an alphabetical listing of more than 230 ready-to-print staff educational materials and patient handouts

In August, CDC released an update to the Smallpox/Monkeypox Vaccine VIS.
 
Here are recent languages of VIS translations posted during August and September:

• Haitian Creole – Multi pediatric vaccines and Smallpox/monkeypox vaccine
• Portuguese – Multi pediatric vaccines and Smallpox/monkeypox vaccine
• Turkish – Adenovirus, Anthrax, Japanese encephalitis, Multi pediatric vaccines, PCV, Yellow fever, and Zoster

• Dates of Current Vaccine Information Statements (VISs) 
• You Must Provide Patients with Vaccine Information Statements (VISs) – It's Federal Law!

• Immunize.org: Vaccine Information Statement main page for VISs in 47 languages
• Immunize.org: Dates of Current Vaccine Information Statements (PDF)
• CDC: What's New with VISs web page
• CDC: Current VISs web page

Immunize.org's www.Give2MenACWY.org website promotes the importance of adolescent vaccination, including the recommended MenACWY vaccine booster dose at age 16. Many teens are behind on vaccines because of the pandemic, so vaccination is more important than ever.

Materials on this colorful website for healthcare professionals incorporate the 2020 ACIP meningococcal vaccine recommendations and coverage statistics from CDC’s National Immunization Survey–Teen (NIS–Teen). One particularly popular resource on the site is the updated Algorithm for MenACWY Immunization in Adolescents 11 through 18 Years of Age.

The website is divided into five easy-to-access sections:

• Vaccinate Teens – Teen vaccination schedules and tips for improving vaccination rates
• Give 2 Doses – Tools to help improve second dose coverage of MenACWY vaccine
• 16-Year-Old Visit – Resources to help providers and patients remember the important vaccines recommended for 16-year-olds
• Tools for Providers – Tools to explain meningococcal ACWY vaccine recommendations and improve coverage for all adolescent vaccines
• Resources – Links to print materials, organizations involved in adolescent vaccination, personal stories about the importance of vaccination, and other resources of interest

The site also categorizes materials according to whether they are primarily of interest to providers, to adolescents, or to parents.

Visit Give2MenACWY.org and enjoy browsing (and deploying) its bountiful resources.

Related Links 

• Give2MenACWY.org website
• Algorithm for MenACWY Immunization in Adolescents 11–18 Years of Age
• MenACWY: You're Not Done If You Give Just One: Give 2 Doses to Strengthen Protection
• Recommending MenACWY: What to Say and How to Say It
• Top 10 Ways to Improve Adolescent Immunization Rates
• Developing an Immunization Culture in Your Office
• Know Your Rates: Measuring Immunization Success in Your Practice
• You're 16: We Recommend These Vaccines for You
• Dear Colleague Letter: 16-Year-Old Patients: Make Sure They Receive Their Annual Well Visit and Vaccinations – signed by six medical societies
• Ask the Experts: Meningococcal ACWY
• CDC: 2020 ACIP Meningococcal Vaccine Recommendations
• CDC: National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years — United States, 2020
• CDC: Adolescent Vaccination Coverage in the U.S.

In its article-in-press version, Academic Pediatrics released Association between Aluminum Exposure from Vaccines before Age 24 Months and Persistent Asthma at Age 24 to 59 Months. A portion of the article, written by Vaccine Safety Datalink (VSD) investigators (including CDC), appears below.

In a large observational study, a positive association was found between vaccine-related aluminum exposure and persistent asthma. While recognizing the small effect sizes identified and the potential for unmeasured confounding, additional investigation of this hypothesis appears warranted.

On September 27, NIH announced results of an international study, linking a temporary increase of less than 1 day in menstrual cycle length with COVID-19 vaccination. The study was published in BMJ Medicine, and titled Association between Menstrual Cycle Length and COVID-19 Vaccination: Global, Retrospective Cohort Study of Prospectively Collected Data. The first paragraph of the press release appears below.

A large international study has confirmed the findings of a previous U.S. study that linked COVID-19 vaccination with an average increase in menstrual cycle length of less than one day. The increase was not associated with any change in the number of days of menses (days of bleeding). Funded by the National Institutes of Health, the new study included data from nearly 20,000 people from Canada, the United Kingdom, the United States, Europe and other parts of the world who received any of nine different vaccines. For most study participants, the increase resolved in the cycle following vaccination.

JAMA Network published Estimation of COVID-19 mRNA Vaccine Effectiveness against Medically Attended COVID-19 in Pregnancy during Periods of Delta and Omicron Variant Predominance in the United States on September 26. The conclusions and relevance section appears below.

In this study, maternal mRNA COVID-19 vaccination, including booster dose, was associated with protection against medically attended COVID-19. VE [vaccine effectiveness] estimates were higher against COVID-19–associated hospitalization than ED/UC [emergency department or urgent care] visits and lower against the Omicron variant than the Delta variant. Protection waned over time, particularly during Omicron predominance.

CDC published Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission—United States, 2016–2020 in the September 30 issue of MMWR. A portion of the summary appears below.

Hepatitis A epidemiology in the United States has shifted as a result of recent and ongoing outbreaks associated with person-to-person transmission. During August 1, 2016–December 31, 2020, 33 states reported hepatitis A outbreaks involving approximately 37,500 cases. Among cases with available information, 56% of persons reported drug use, 14% reported homelessness, and 61% were hospitalized; 380 outbreak-associated deaths were reported. . . .

Increased hepatitis A vaccination coverage, through implementation of nontraditional vaccination strategies to reach disproportionately affected populations, along with improved universal and catch-up childhood vaccination, will be necessary to respond to the current hepatitis A outbreaks and prevent similar outbreaks in the future.

Access the  MMWR article in HTML or PDF.

Related Links

• MMWR main page provides access to MMWR Weekly and its companion publications
• ACIP: Recommendations for the prevention of hepatitis A
• Immunize.org: Vaccines: Hepatitis A

CDC published Effectiveness of a Second COVID-19 Vaccine Booster Dose against Infection, Hospitalization, or Death among Nursing Home Residents—19 States, March 29–July 25, 2022 in the September 30 issue of MMWR. A portion of the summary appears below.

In a large cohort of nursing home residents, receipt of a second mRNA COVID-19 booster dose during circulation of SARS-CoV-2 Omicron subvariants was 74% effective at 60 days against severe COVID-19–related outcomes (including hospitalization or death) and 90% against death alone compared with receipt of a single booster dose. . . .

Efforts should be made to ensure that nursing home residents remain up to date with recommended booster doses of COVID-19 vaccines.

Access the  MMWR article in HTML or PDF.

Related Link

• MMWR main page provides access to MMWR Weekly and its companion publications

The National Foundation of Infectious Diseases (NFID) Clinical Vaccinology Course will be held online November 16–18. This 3-day online course focuses on new developments and issues related to use of vaccines. Expert faculty provide the latest information on vaccines, including updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination.

Continuing medical education (CME) and continuing nursing education (CNE) credit will be offered.

Register for the online course ($750 fee).