- Immunize.org summarizes ACIP’s June 21–23 meeting recommending RSV and polio vaccines for adults, PCV20 for children, influenza vaccine for the 2023–2024 season, and discussing additional vaccines
- Immunize.org updates its "Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools.” New version dated June 22.
- Register for July 13 webinar! Immunize.org presents “Hepatitis B-Gone! Implementing universal adult screening and vaccination. Your practical questions answered.”
- CDC issues Health Advisory concerning measles during summer travel season
- “Effectiveness of Up-to-Date COVID-19 Vaccination in Preventing SARS-CoV-2 Infection among Nursing Home Residents—United States, November 20, 2022–January 8, 2023” published in MMWR
- “Emergence of an Mpox Cluster Primarily Affecting Persons Previously Vaccinated against Mpox—Chicago, Illinois, March 18–June 12, 2023” published in MMWR
- “Pneumococcal Vaccination at Age 65”: watch the 2-minute talk, part of the Ask the Experts Video Series on Facebook, LinkedIn, Twitter, YouTube, and Instagram
- Spotlight: Immunize.org resources focused on adult vaccination
- Vaccines in the news
Immunize.org summarizes ACIP’s June 21–23 meeting recommending RSV and polio vaccines for adults, PCV20 for children, influenza vaccine for the 2023–2024 season, and discussing additional vaccines
The Advisory Committee on Immunization Practices (ACIP) met on June 21–23. The 3-day meeting included votes on recommendations for the use of respiratory syncytial virus (RSV) and polio vaccines in adults, pneumococcal 20-valent conjugate vaccine (PCV20, Prevnar 20, Pfizer) in children, and influenza vaccination for the 2023–2024 season. The Committee also received updates on RSV vaccine use in pediatric/maternal populations, as well as vaccines against dengue, chikungunya, mpox, meningococcal disease, and COVID-19. Details appear in presentation slides posted on the ACIP website. Highlights of the meeting, focused on votes, appear below.
RSV vaccine in older adults (vote)
RSV is a frequent, often unrecognized, cause of severe respiratory illness in adults. In May, FDA licensed two RSV vaccines (Arexvy, GSK, and Abrysvo, Pfizer) to prevent RSV disease in adults age 60 years and older. Manufacturers presented updated clinical trial data from a second RSV season following a single dose of RSV vaccine administered 14–18 months earlier. While it is not possible to directly compare the performance of the two vaccines because the studies defined severe RSV disease outcomes differently, both vaccines showed durable, good effectiveness against severe disease for two seasons following a single dose in the study populations. A CDC review of updated cost-effectiveness data followed. CDC economists concluded the vaccines were costly, but could be cost-effective, depending upon factors such as vaccine price, hospitalization costs, and severity of a given RSV season.
ACIP initially considered the work group proposal for a routine recommendation for RSV vaccine for adults age 65 years and older, in addition to a shared clinical decision-making (SCDM) recommendation for adults age 60 through 64, to provide the option to protect adults in the younger age group at increased risk for severe RSV disease. However, several committee members expressed hesitation to commit to a routine recommendation beginning at age 65. Members cited limited or no data available on effectiveness among the adults most likely to be hospitalized or to die with serious RSV complications (e.g., those older than 75 years, in long-term care, or with immunocompromising conditions). Data on the immune response to a second dose of RSV vaccine showed some increase in antibody levels, but did not boost to the levels of the initial dose, raising questions about the benefit of repeated doses. In addition, several members wanted to wait for more information about safety, due to the inconclusive safety signal related to inflammatory neurologic conditions reported in a very small number of vaccine recipients in each clinical trial. Some members were unsatisfied with incomplete cost-effectiveness conclusions because the final commercial prices of the licensed products had not been disclosed.
After extensive discussion about these uncertainties, members voted to approve a single dose of RSV vaccine for adults age 60 and older with shared clinical decision-making. Considerations favoring vaccination include comorbid conditions and advanced age, in addition to other variables. Details will be included in the final policy statement. ACIP may revise the recommendation as more data become available.
ACIP recommendation (votes: 9 to 5 for 65+; 13 and one abstention for 60 through 64):
Adults 60 years of age and older may receive a single dose of RSV vaccine, using shared clinical decision-making.
Polio vaccine in adults (vote)
ACIP clarified and modernized inactivated polio vaccine (IPV) recommendations for adults. This was motivated by a reported case of paralytic polio in a young adult resident of New York State during summer 2022 and subsequent repeated detections of poliovirus in wastewater, indicating the presence of additional asymptomatic cases in the community. While most U.S. adults completed primary vaccination against polio in early childhood and still have protective antibodies, unvaccinated adults remain vulnerable. Although the likelihood of polio exposure in the United States is extremely low, the risk is not zero. IPV has been used in children and adults for decades, is safe, and has minimal side effects.
In addition, the committee affirmed its longstanding position on booster doses in adults who have received a primary series of trivalent oral polio vaccine (tOPV) or IPV, or a combination. Although some forms of increased risk are predictable (e.g., travel to a country experiencing a polio epidemic), some increased risks may be defined within U.S. jurisdictions by local or state public health officials based upon indicators such as wastewater poliovirus detection. One member pointed out that a single lifetime adult booster dose of IPV may be insufficient for immunocompromised adults, but no data exist for a different recommendation in that population at this time.
ACIP vote for adults incompletely immunized against polio (unanimous):
Adults (age 18 or older) who are known or suspected to be unvaccinated or incompletely vaccinated against polio should complete a primary series with IPV.
ACIP vote for the option of one adult polio booster, if at risk of exposure (unanimous):
Adults who received a primary series of trivalent OPV (tOPV) or IPV in any combination and who are at increased risk of poliovirus exposure may receive another dose of IPV. Available data do not indicate the need for more than a single lifetime booster dose with IPV for adults.
Influenza vaccine for the 2023–2024 season (vote)
Each year, ACIP reviews changes and approves the updated influenza vaccine policy statement for the coming influenza season. In 2023–2024, all influenza vaccines will again be quadrivalent, although the type A/H1 strains will be updated. There are no changes to the licensed ages and no new products licensed. ACIP members reviewed data supporting further simplification of the previous recommendations for individuals with severe egg allergy to receive any influenza vaccine, but to receive egg-based products only in a setting where a clinician would be available to respond to anaphylaxis, should it occur. In fact, any vaccination provider should be prepared to respond properly to anaphylaxis, because it is a remote risk for any vaccine recipient. In addition, by restricting locations for vaccination, guidance may increase barriers to vaccination for egg-allergic individuals.
The committee unanimously approved the 2023–2024 recommendations, including new language indicating that no additional safety measures are needed for those with severe egg allergy, beyond the routine expectation that all vaccination sites be prepared with the supplies and staff to respond appropriately to anaphylaxis in any vaccine recipient. Corresponding updates to the VFC resolution were unanimously approved.
ACIP egg-allergy statement vote (unanimous):
All persons age 6 months and older with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or non-egg based) that is otherwise appropriate for the recipient’s age and health status can be used.
Pneumococcal 20-valent conjugate (PCV20) vaccine in children (vote)
ACIP approved recommendations for use of PCV20 in children age 18 years or younger. In April, PCV20 was licensed by FDA for use in children as young as age 6 weeks. PCV15 (Vaxneuvance, Merck) is already licensed and recommended as an option for use in infants and children in any situation where a pneumococcal conjugate vaccine is indicated. Because PCV20 covers additional serotypes, the committee also considered its use as an alternative to 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax 23, Merck) in older children with chronic medical conditions (CMC) or immunocompromise (IC), as recommended for adults. The committee noted that, although PCV20 covers a wider range of serotypes than any other conjugate product, only immunologic response evidence is available for either PCV15 or PCV20 (not real-world effectiveness data), so it is not yet known if there are differences among the conjugate vaccines in actual effectiveness for the serotypes covered by more than one conjugate vaccine. For this reason, no particular PCV is preferred among available options for children at this time.
Economic analyses of the use of PCV20 in place of PPSV23 for CMC/IC children age 2 through 18 years who had completed PCV vaccination with another product showed the use of PCV20 would likely be cost-saving and prevent more disease, because PCV20 is expected to provide longer-lasting protection and produce higher quality cell-mediated immunity than PPSV23. Some committee members expressed a desire to retain options including PPSV23 to be consistent with adult pneumococcal recommendations.
ACIP updated its definition of CMC/IC conditions in children who have not previously received PCV20 for whom additional PCV20 or PPSV23 vaccination is indicated. Liver disease was added as an indication in children (already an indication for adults), moderate or severe persistent asthma was added (asthma is an adult indication), and chronic kidney disease was added (not limited to end-stage renal disease).
ACIP voted unanimously to include PCV20, as recommended, in the VFC Program.
ACIP recommendations (multiple unanimous votes, summarized below):
- Either PCV15 or PCV20 is recommended for all children age 2 through 23 months according to currently recommended PCV dosing and schedules
- For older children with an incomplete PCV vaccination status, use of either PCV15 or PCV20 according to currently recommended PCV dosing and schedule is recommended for:
- Healthy children age 24 through 59 months
- Children with specified risk conditions age 24 through 71 months
- For children age 2 through 18 years with any risk condition who have received all recommended doses before age 6 years:
- If they received at least 1 dose of PCV20: No additional doses of any pneumococcal vaccine are indicated. This recommendation may be updated as additional data become available.
- If they received PCV13 or PCV15 (but no PCV20): ACIP recommends a dose of PCV20 alone, or PPSV23 using previously recommended doses and schedule
- For children ages 6 through 18 years with any risk condition who have not received any dose of PCV13, PCV15, or PCV20, give a single dose of PCV20 alone, or PCV15 followed by a dose of PPSV23 at least 8 weeks later, if not previously given
RSV vaccine—pediatric/maternal (information)
Respiratory syncytial virus (RSV) is the leading cause of hospitalization of infants in the United States: 2–3% of young infants are hospitalized with RSV. Products currently under consideration by FDA include a vaccine (Pfizer) administered to the mother in the latter weeks of pregnancy to protect infants through transfer of maternal antibodies to the fetus before delivery, and a long-acting monoclonal antibody (mAb, nirsevimab, Sanofi) administered directly to the infant. Both would give protection for at least 6 months.
Modeling data suggest both products would be effective, and maternal vaccination less costly; however, maternal vaccination would be of less benefit to infants born outside RSV season, those born prematurely, and those born less than 14 days after maternal vaccination. ACIP members extensively discussed the maternal vaccine clinical trial, which showed a trend toward a higher likelihood of preterm birth among clinical trial participants who received vaccine, particularly in the low- and middle-income country study sites; no such imbalance was seen in the U.S. study cohort. Available data are insufficient to conclude whether this is a coincidence or not; however, because the maternal RSV vaccine study conducted by GSK (using a different vaccine) was halted due to an imbalance of preterm births, ACIP would like additional information. They also discussed that co-administration of the RSV vaccine and Tdap vaccine resulted in lower pertussis antibody levels in the mother than administration of Tdap separately. The clinical significance of this finding is unknown.
ACIP discussed how recommendations for maternal vaccination and passive immunization of infants with nirsevimab might be integrated in a cost-effective manner. Members noted that in most circumstances there would not be sufficient additional benefit from administering nirsevimab to infants whose mothers were adequately vaccinated. If maternal vaccination were not done or if the infant were unlikely to benefit (e.g., due to prematurity or time of year), administration of nirsevimab would be warranted. The committee anticipates voting at the routine October ACIP meeting; a vote could be earlier if a special session is held.
Dengue vaccine (information)
Dengue vaccine (Dengvaxia, Sanofi) is currently recommended for seropositive children age 9 through 15 years living in dengue-endemic U.S. territories (e.g., Puerto Rico). Dengvaxia is unique because it requires pre-vaccination screening tests to ensure that it is administered only to children with a history of at least one prior dengue infection. Administration of the vaccine to dengue-naïve recipients could result in more serious dengue infection later in life (vaccine-enhanced disease). ACIP heard information about a new dengue vaccine nearing licensure manufactured by Takeda that may not require pre-vaccination screening. The committee heard preliminary information about the cost-effectiveness and potential for use of the new vaccine in the currently recommended childhood age groups, as well as information about the potential benefit of this product in adults.
Chikungunya vaccine (information)
Chikungunya is a mosquito-borne viral infection with no specific treatment that is present in many parts of the world and causes an acute illness, including rash. Chikungunya is typically self-limited, but can cause long-term joint pain and fatigue in up to one in four infected people. ACIP reviewed data on chikungunya and a vaccine developed by Valneva being considered for licensure as early as August 2023. Surveys of travelers and potential recipients of a future vaccine showed a general lack of knowledge about chikungunya, but almost half were willing to be vaccinated if recommended and if risk were significant. Reports of chikungunya infections in laboratory workers handling specimens were described; vaccination could protect them from occupational risks. A report on the large chikungunya epidemic in Paraguay in recent months illustrated the explosive outbreak potential of this virus. Fatalities in the Paraguay outbreak were concentrated in infants and the elderly, most with comorbidities. At future meetings, ACIP will consider policy options for the use of chikungunya vaccine among Americans at risk, including travelers, laboratory workers, and residents of U.S. territories and states with (or at risk of) transmission.
Mpox vaccine (information)
The committee discussed updates on mpox epidemiology, mpox vaccine (Jynneos, Bavarian Nordic) safety and effectiveness, the use of 2-dose Jynneos vaccine (given subcutaneously [Subcut]), and began a discussion of longer-term protection against mpox. Mpox cases continue to occur at low levels in the United States, with 446 reported cases between January and May 2023. U.S. outbreak cases continue to be concentrated among cis-gender men who have sex with men, disproportionately among non-Hispanic Black and Hispanic men. Very few cases have occurred among children (typically household contacts) or healthcare providers. Jynneos vaccine effectiveness ranged from 36% to 75% for one dose and 66% to 89% for two doses. Effectiveness was equivalent for either authorized route of administration (Subcut or intradermal). A cluster of cases among fully vaccinated individuals in Chicago did not reveal any changes in the virus, but may suggest intense exposure or other factors. Such clusters have not been observed elsewhere at this time. The public health priority is to vaccinate unvaccinated or incompletely vaccinated individuals at risk. In the future, the committee will consider additional doses among those at long-term risk of exposure.
CDC presented extensive additional clinical guidance for vaccinating at-risk people younger than age 18 years, pregnant and breastfeeding people, healthcare personnel and certain lab workers. To summarize:
- For children age 6 months through 17 years at risk of a high-risk exposure, Jynneos should be administered as pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP)
- Infants younger than age 6 months should receive intravenous vaccinia immune globulin (VIGIV) instead of vaccine
- Jynneos is not contraindicated in pregnancy or while breastfeeding if high risk exposures cannot be avoided or have already occurred
- Laboratory personnel who perform diagnostic testing for mpox should be vaccinated with Jynneos or ACAM2000
- Clinical laboratory personnel and healthcare workers who handle specimens likely to contain infectious mpox virus, or who administer ACAM2000, may use Jynneos as an alternative to ACAM2000 based on shared clinical decision-making
Additional clinical considerations will be published by CDC on its website.
Meningococcal vaccine (information)
ACIP discussed the possible uses of a new pentavalent meningococcal conjugate vaccine that protects against serogroups A, B, C, W, and Y (MenABCWY, Pfizer). This vaccine candidate contains the Trumenba (Pfizer) MenB components and is expected to be licensed as a 2-dose vaccine, with doses given 6 months apart. Currently, children are recommended to receive one dose of quadrivalent MenACWY vaccine at age 11 or 12, followed by a second dose at age 16 years. Adolescents not at high risk for meningococcal B disease may receive two doses of MenB vaccine, preferably given at age 16 through 18 years, based on shared clinical decision-making; current uptake of MenB vaccine in eligible adolescents is low (about 31% have had at least one of two doses).
ACIP reviewed complex economic models for the costs and benefits of various strategies for integrating a new pentavalent vaccine into the current meningococcal vaccine schedule. Regardless of choices, all options are very costly because meningococcal disease is extremely rare. ACIP plans additional discussions, including a future re-examination of the current schedule.
Vaccine safety (information)
ACIP heard presentations on new CDC studies underway to examine the safety of the overall childhood immunization schedule. It was emphasized that these studies were not initiated because of any specific scientific concern, but because of concerns expressed by the public that such studies had not been conducted. The studies are methodologically complex. One question was whether asthma might be associated with cumulative doses of vaccine-associated aluminum. Aluminum helps stimulate the immune system to respond to certain vaccines. A small positive association was seen between cumulative aluminum dose before age 2 years and persistent asthma between age 24 and 59 months. Additional studies are needed; this is the first step of the research process. A researcher from Denmark presented data from a very large Danish study of the same question which measured persistent asthma after age 5 years; their study found no association. Overall, the available evidence studied by CDC supported the safety of the routine childhood vaccination schedule: benefits of vaccination continue to strongly outweigh all known and potential risks. Future updates are planned.
COVID-19 vaccines (information)
ACIP reviewed current COVID-19 vaccine epidemiology and vaccine effectiveness. While vaccine effectiveness against hospitalization clearly wanes over about 6 months, protection against severe disease and death persists longer in people of all ages, including pregnant people. Vaccination during pregnancy reduced the likelihood of hospitalization of infants younger than age 6 months. Despite the clear benefit to recipients of all ages, uptake of the recommended bivalent vaccine remains low, with 43% of people age 65 and older having received a dose, but fewer than 5% of children under age 12 years having received one.
Plans are underway for the transition to routine commercial use of COVID-19 vaccines. A new monovalent COVID-19 vaccine containing a current variant XBB.1.5 has been recommended by FDA for fall 2023. This vaccine will be available commercially at no out-of-pocket cost for people with insurance (including Medicaid and Medicare), as well as children eligible for the VFC program. A special 1-year bridge program is being designed to create affordable access to the new COVID-19 vaccines for 25 million uninsured adults. More details of the program are forthcoming. Once updated vaccines are licensed or authorized by FDA, ACIP will review evidence to inform its recommendations.
The next scheduled ACIP meeting will be held on October 25–27, although additional emergency meetings may be announced prior to that time. Information about past and future ACIP meetings may be found on the ACIP website.
Related Links
Immunize.org updates its “Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools.” New version dated June 22. Immunize.org reviews and updates the Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools at least monthly, prominently indicating when it was last revised at the top of the page. Changes on the June 22 update include weblinks to new versions of:
- Bivalent Moderna COVID-19 Vaccine Infographic: When to Use the Pink Versus Blue-Capped Vial (corrected to clarify the appropriate vaccine presentation to use with people who are immunocompetent versus those who are moderately or severely immunocompromised)
- Interim COVID-19 Immunization Schedule for Persons 6 Months of Age and Older
- FAQs for the Interim Clinical Considerations
- Immunize.org’s Ask the Experts: COVID-19 section (updated June 4)
All COVID-19 vaccination providers should review the checklist regularly and download the latest CDC schedule and standing order documents. The checklist is posted on Immunize.org's Vaccines: COVID-19 main page to help practices stay up to date.
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Register for July 13 webinar! Immunize.org presents “Hepatitis B-Gone! Implementing universal adult screening and vaccination. Your practical questions answered.” Anyone can be infected by hepatitis B virus. Everyone can benefit from knowing their status and being protected. For more than 30 years, hepatitis B vaccination has been recommended for all U.S. infants. In 2022, CDC recommended catch-up hepatitis B vaccination of all adults through age 59 years and older adults with risk factors or who want to be vaccinated. In 2023, CDC recommended one-time hepatitis B infection screening of all adults. Integrating these two important recommendations into clinical practice poses unique challenges for healthcare providers.
This live, 1-hour webinar, Hepatitis B-Gone! Implementing Universal Adult Screening and Vaccination. Your Practical Questions Answered., will be hosted by Immunize.org on July 13 at 3:00 p.m. (ET). Panelists will discuss the recommendations and your practical clinical questions about how to affect the policies in private and public healthcare settings. Widespread implementation of adult screening and catch-up vaccination brings within reach the goal of eliminating hepatitis B in the United States, along with hepatitis B-related liver damage and cancer.
The panelists will be:
- Carolyn Wester, MD, MPH, Director of CDC’s Division of Viral Hepatitis
- Kelly Moore, MD, MPH, CEO of Immunize.org
- L.J Tan, PhD, MS, Chief Policy and Partnership Officer of Immunize.org
Dr. Wester and Dr. Moore are co-authors of the ACIP hepatitis B vaccination policy statement and are longstanding champions of hepatitis B elimination.
Register now to watch this important session and get your practical questions answered.
This webinar was developed by Immunize.org and was supported by Grant No. NH23IP922654 from CDC and an independent educational grant from VBI Vaccines. Its contents are solely the responsibility of Immunize.org and do not necessarily represent the official views of either CDC or VBI.
CDC issues Health Advisory concerning measles during summer travel season
On June 21, CDC issued a Health Advisory: Guidance on Measles during the Summer Travel Season to its Health Alert Network (HAN). The summary section appears below.
As the summer travel season begins, the Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to remind clinicians and public health officials to provide guidance for measles prevention to international travelers and to be on alert for cases of measles. Guidance is also provided for people planning international travel. Measles (rubeola) is extremely contagious; one person infected by measles can infect 9 out of 10 of their unvaccinated close contacts. As of June 8, 2023, CDC has been notified of 16 confirmed U.S. cases of measles across 11 jurisdictions, with 14 (88%) linked to international travel. Based on current estimates, twice as many Americans are planning to travel internationally in 2023 compared with 2022. Many countries and popular travel destinations, such as London, England, have experienced measles outbreaks in recent years. The United States has seen an increase in measles cases during the first 5 months of 2023, with 16 reported cases compared with 3 in 2022 during the same period. Most of these cases were among children who had not received measles-mumps-rubella (MMR) vaccine. To prevent measles infection and spread from importation, all U.S. residents should be up to date on their MMR vaccinations, especially prior to international travel regardless of the destination.
Access the complete CDC HAN Health Advisory message.
“Effectiveness of Up-to-Date COVID-19 Vaccination in Preventing SARS-CoV-2 Infection among Nursing Home Residents—United States, November 20, 2022–January 8, 2023” published in MMWRCDC published Effectiveness of Up-to-Date COVID-19 Vaccination in Preventing SARS-CoV-2 Infection among Nursing Home Residents—United States, November 20, 2022–January 8, 2023 in the June 23 issue of MMWR. The data used in this study include COVID-19 vaccination status and infection but do not include outcomes such as hospitalization and death. A portion of the summary appears below.
Among nursing home residents who were up to date with COVID-19 vaccination (most had received a bivalent vaccine), vaccine effectiveness against SARS-CoV-2 infection was 31.2%. . . .
Staying up to date with COVID-19 vaccination recommendations and, if eligible, receipt of an additional bivalent dose, provides additional protection against SARS-CoV-2 infection. Nursing home residents would benefit from the protection offered by staying up to date with recommended COVID-19 vaccinations.
Access the MMWR article in HTML or PDF.
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“Emergence of an Mpox Cluster Primarily Affecting Persons Previously Vaccinated against Mpox—Chicago, Illinois, March 18–June 12, 2023” published in MMWRCDC published Emergence of an Mpox Cluster Primarily Affecting Persons Previously Vaccinated against Mpox—Chicago, Illinois, March 18–June 12, 2023 in the June 23 issue of MMWR. A portion of the article appears below.
During April 17–May 5, 2023, 13 monkeypox (mpox) cases were reported to the Chicago Department of Public Health (CDPH) after 2 months during which only a single case had been reported. The cluster was remarkable because it comprised more than 10 cases at a time when sporadic cases or small clusters (i.e., involving fewer than three cases) were being reported in the United States, and >69% of the persons in this cluster had received 2 doses of JYNNEOS or 1 dose of ACAM2000 vaccine. Some cases among persons who received doses of JYNNEOS vaccine are expected to occur based on vaccine effectiveness data; however, the observed proportion of cases among persons who had received 2 doses of JYNNEOS or 1 dose of ACAM2000 in this cluster was unusual. This increase in cases before large summer events scheduled nationwide and in Chicago raised concerns about possible future case increases.
CDC scientists note that although the cause of this cluster has not yet been determined, leading hypotheses include a potential high number of sexual exposures in a network with many vaccinated persons, decreased vaccine effectiveness due to waning of humoral immunity, or vaccine mishandling or administration errors.
Access the MMWR article in HTML or PDF.
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“Pneumococcal Vaccination at Age 65”: watch the 2-minute talk, part of the Ask the Experts Video Series on Facebook, LinkedIn, Twitter, YouTube, and Instagram Immunize.org’s social media program highlights our educational resources for today’s vaccinators. This week, our featured episode from the Ask the Experts Video Series is Pneumococcal Vaccination at Age 65. This is available on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts questions.
Our social media channels feature our most popular printable resources, our Ask the Experts Video Series, and announcements important to frontline vaccinators. Like, follow, and share Immunize.org’s social media accounts. Encourage colleagues and others interested in vaccination to do likewise:
Spotlight: Immunize.org resources focused on adult vaccination 
In this week's Spotlight, we summarize resources at Immunize.org that focus on adult vaccination.
Resources for Adult Vaccination main page offers all the adult educational materials from Immunize.org and partner organizations.
Vaccinating Adults: A Step-by-Step Guide, a free downloadable book, is a "how to" guide that provides easy-to-use, practical information covering essential adult vaccination activities.
Adult Vaccination main page contains all of the Immunize.org handouts that pertain to adult vaccinations.
CDC Schedules main page provides print PDFs of the recommended immunization schedules for adults, as well as for children and adolescents.
Screening Checklists about Vaccine Contraindications and Precautions main page links you to forms that patients fill out to expedite assessment of vaccination needs and contraindications.
These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.
Immunize.org Pages and Handouts
Immunize.org updates its “Ask the Experts: MMR” web page
Immunize.org updated its Ask the Experts: MMR web page. Updates were made to epidemiologic data on measles, mumps, and rubella cases in the United States; the option to administer MMRII (Merck) brand of measles-mumps-rubella (MMR) vaccine either subcutaneously or intramuscularly; and the option to use Priorix (GSK) brand MMR vaccine in any situation where MMR vaccine is recommended.
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.
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Immunize.org and Autism Science Foundation update parent handout “Evidence Shows Vaccines Unrelated to Autism” Immunize.org and the Autism Science Foundation (ASF), an organization that supports people with autism by funding scientific research, recently updated Evidence Shows Vaccines Unrelated to Autism. The piece explains to parents why experts conclude that vaccines do not cause autism. The updates are based on the results from the latest scientific research on autism provided by ASF.
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Vaccine Information Statements
Immunize.org posts updated Hepatitis B and Pneumococcal Conjugate Vaccine Information Statements in Spanish
Immunize.org posted Spanish translations for two Vaccine Information Statements (VISs) issued by CDC on May 12, 2023:
 
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“Shop Immunize.org” offers many resources for your practice. Order laminated 2023 U.S. immunization schedules for your exam rooms today!
On the Shop Immunize.org web page, you will find many resources such as laminated vaccination schedules, personal immunization record cards, lapel pins, and more! Your purchases help Immunize.org keep delivering free educational materials to healthcare professionals and to the public.
Immunize.org's laminated versions of the 2023 U.S. child and adolescent immunization schedule and the 2023 U.S. adult immunization schedule are still available. Once sold out, we will not print more until 2024.
 
The schedules' coating can be wiped down, and they’re durable enough to stand up to a year's worth of use. Visit the Shop Immunize.org: Laminated Schedules web page for more information on the schedules.
Immunize.org ’s three personal immunization record cards—child & teen, adult, and lifetime—are printed on durable rip-, smudge-, and water-proof paper. Sized to fit in a wallet when folded, the cards are brightly colored to stand out. Give these nearly indestructible personal record cards to your patients. They're sold in boxes of 250.
You too can show your support for vaccination with Immunize.org ’s elegantly designed “Vaccines Save Lives” pin on your lapel. The pin makes a refined statement in hard black enamel with gold lettering and edges, measuring 1.125" x 0.75”. Order yours today to show how much you value vaccination!
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"Uninsured and Not Immune—Closing the Vaccine-Coverage Gap for Adults" commentary published in New England Journal of Medicine
In the June 21 issue, New England Journal of Medicine published a perspective piece titled Uninsured and Not Immune—Closing the Vaccine-Coverage Gap for Adults. The authors include Drs. Erika Wallender, Georgina Peacock, Melinda Wharton, and Rochelle P. Walensky. The final paragraph appears below.
The United States made enormous investments in vaccine development and distribution and in secure data collection during the COVID-19 pandemic. If we continue to move forward without access to vaccines, including long-term access to COVID-19 vaccines, for uninsured adults, we will neglect an important opportunity for advancing health and economic benefits in this population, which includes many essential workers, caregivers, recent college graduates, and others. Building on the success of the VFC [Vaccines for Children] program and associated discretionary funding supporting immunization infrastructure, the VFA [Vaccines for Adults] program has the potential to be a low-cost, high-reward initiative that could help achieve the essential goal of ensuring vaccine availability throughout the life span.
"Comparison of Female Ovarian Reserve before vs. after COVID-19 Vaccination" published in Obstetrics and GynecologyIn the June 16 issue, Obstetrics and Gynecology published Comparison of Female Ovarian Reserve before vs. after COVID-19 Vaccination. Ovarian reserve refers to both the number and quality of eggs in the ovaries. The ovarian reserve naturally decreases with age and the approach of menopause, but a diminished ovarian reserve can occur earlier in life. The discussion section appears below.
These findings suggest that COVID-19 vaccination is not associated with changes in ovarian reserve by multiple biomarker assays of AMH [anti-Mullerian hormone] and AFC [antral follicle count], supporting previous studies on AMH. The AMH difference was not clinically significant on subgroup analysis. Study limitations include the small number of patients who received vaccination, factors associated with ovarian reserve that were not included in the study, and survival bias, as only patients who pursued fertility treatment were included. Outcomes among those who did not pursue treatment were not captured.
“Progress toward Rubella Elimination–World Health Organization South-East Asia Region, 2013–2021” published in MMWR
CDC published Progress toward Rubella Elimination–World Health Organization South-East Asia Region, 2013–2021 in the June 23 issue of MMWR. A portion of the summary appears below.
During 2013, coverage with the first dose of rubella-containing vaccine (RCV1) in the World Health Organization South-East Asia Region was 12%, and only five countries in the region had introduced RCV into their routine immunization programs. . . .
By 2021, all 11 SEAR countries had introduced RCV1, and estimated regional RCV1 coverage increased from 12% to 86%; rubella incidence declined by 80%. Maldives and Sri Lanka achieved rubella elimination; Bhutan, North Korea, and Timor-Leste have halted endemic transmission of rubella virus for >36 months. . . .
SEAR has made substantial progress toward rubella elimination. To achieve regional rubella elimination by 2023, optimal and accelerated measures to implement all elimination strategies are needed.
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