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| As appeared in the
August 2012 issue of Needle Tips |
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Click here for PDF version
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| Q: |
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Pneumococcal polysaccharide vaccine
(PPSV23) is recommended for all adults
who smoke. Are there recommendations
for those who use smokeless tobacco
products (e.g., chewing tobacco)? |
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| A: |
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No. ACIP does not identify people
who use smokeless tobacco products
as being at increased risk for
pneumococcal disease or as being
in a risk group for vaccination. |
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| Q: |
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Now that FDA has licensed Prevnar 13
(PCV13; Pfizer) for adults, does
ACIP have recommendations for its
use? |
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| A: |
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To
date, ACIP has not made
recommendations for routine
use of PCV13 for adults;
however, at its June 2012
meeting, ACIP voted to
recommend administering 1 dose
of PCV13 to adults age 19 and
older who are at highest risk
for invasive pneumococcal
disease. This includes adults
who are immunosuppressed and
those with functional or
anatomic asplenia, renal
disease, CSF leak, and
cochlear implants. ACIP voted
to recommend that when
healthcare providers vaccinate
highest-risk patients who have
never received a pneumococcal
vaccine, the provider
administer PCV13 first, then
follow with a dose of
pneumococcal polysaccharide
vaccine (PPSV23) 8 weeks
later, and follow with a
second dose of PPSV23 5 years
later. For highest-risk
patients who have already
received PPSV23, ACIP voted to
recommend that healthcare
professionals wait 1 year
since the previous dose of
PPSV23 before giving PCV13 to
avoid interference between the
vaccines. More detail will be
included when MMWR publishes
the recommendations. |
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| Q: |
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I am confused about which adults to
vaccinate with Tdap vaccine and
which product to use. Please help! |
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| A: |
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CDC published updated
recommendations on Tdap
vaccination for adults in
MMWR on June 29, 2012,
pages 468–470. ACIP
recommends that ALL adults
age 19 years and older who
have not yet received a
dose of Tdap receive a
single dose. Tdap should
be administered regardless
of interval since the last
tetanus- or
diphtheria-toxoid-containing
vaccine (e.g., Td). After
receiving Tdap, people
should receive Td every 10
years for routine booster
immunization against
tetanus and diphtheria,
according to previously
published guidelines. |
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Providers should not miss
an opportunity to
vaccinate adults age 65
and older with Tdap.
Therefore, providers may
administer any Tdap
vaccine they have
available. When feasible,
providers should
administer Boostrix (Tdap;
GSK) to adults age 65 and
older as it is licensed
for this age group. Adacel
(Tdap; sanofi) is licensed
for use in people age 11
through 64. However, ACIP
concluded that either
vaccine administered to a
person age 65 or older is
immunogenic and will
provide protection. A dose
of either vaccine is
considered valid. |
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When a
tetanus-toxoid-containing
vaccine is needed for
wound management in a
person who has not
previously received Tdap,
the use of Tdap is
preferred over Td. |
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| Q: |
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Is there guidance for pertussis
protection for an adult who cannot
receive the tetanus portion of the
Tdap vaccine because of allergy? |
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| A: |
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Usually, an "allergy" to
tetanus toxoid is
anecdotal and not a true
anaphylactic reaction to
modern tetanus toxoid.
Patients often claim to be
allergic to tetanus toxoid
because of (1) an
exaggerated local reaction
(which is not an allergy)
or (2) a reaction to a
tetanus vaccine received
many years ago (probably
serum sickness from equine
tetanus antitoxin). A
history of one of these
events is not a
contraindication to modern
tetanus toxoid, Td, or
Tdap. |
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Only an
allergist-confirmed
anaphylactic allergy to
tetanus toxoid should be
accepted as a valid
contraindication to a
modern
tetanus-toxoid-containing
product. A person who has
an allergist-confirmed
anaphylactic allergy to
tetanus toxoid has no
recourse for pertussis
vaccination because no
single-antigen pertussis
vaccine is licensed for
use in the United States. |
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| Q: |
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Who should get a second dose of Tdap
vaccine? |
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| A: |
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Currently, no one is
recommended to receive
more than 1 dose of Tdap.
In the future, ACIP will
discuss the need for
administering additional
doses of Tdap and the
timing of revaccinating
people who have received
Tdap previously. |
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| Q: |
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Why do we vaccinate pregnant women
against influenza when it is not
recommended to vaccinate infants
younger than age 6 months? |
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| A: |
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ACIP has recommended
vaccinating pregnant women
with inactivated influenza
vaccine (TIV) for a number of
years. Pregnant women are a
high-risk group for
complications,
hospitalization, and even
death from influenza because
of the increased physiologic
strain of pregnancy on their
heart, lungs, and immune
system. Vaccination can occur
in any trimester, including
the first. |
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Influenza vaccine is not
recommended for children
younger than age 6 months
because it is not approved for
this age group. In addition,
there are data that indicate
that vaccinated pregnant women
pass maternal antibodies to
the fetus in the last few
weeks of pregnancy; this helps
protect the young infant
against influenza. Vaccinating
pregnant women thus protects
women, their unborn babies,
and their babies after birth. |
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| Q: |
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A child received a 0.25 mL dose of
inactivated influenza vaccine (TIV) at
age 34 months. She is scheduled to
return for the second dose at age 36
months. Should she receive a 0.25 mL
dose or a 0.5 mL dose? |
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| A: |
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She
should receive a 0.5 mL dose of
TIV. Always administer the
volume of vaccine appropriate to
the age of the patient when the
patient presents at the clinic
for the dose. |
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| Q: |
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If Cervarix (HPV2; GSK) is
inadvertently administered to a male,
does the dose need to be repeated with
Gardasil (HPV4; Merck)? |
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| A: |
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Yes.
Cervarix is recommended for use
only in females. There is no
minimum interval between the
invalid dose of Cervarix and the
dose of Gardasil. |
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ACIP
recommends routine vaccination
of males age 11–12 years with
HPV4 administered as a 3-dose
series. The vaccination series
can be started at age 9 years.
Vaccination with HPV4 is also
recommended for males age 13
through 21 years who have not
been vaccinated previously or
who have not completed the
3-dose series. Males age 22
through 26 years may be
vaccinated with HPV4; ACIP
specifically recommends routine
vaccination with HPV4 through
age 26 years for
immunocompromised males and men
who have sex with men if they
have not been vaccinated
previously or have not completed
the 3-dose series. |
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| Q: |
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Is it safe to give the shingles
vaccine (Zostavax; Merck) to patients
age 60 years and older who have had a
splenectomy? I am concerned because it's a live
virus vaccine. |
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| A: |
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Yes,
it is safe. Asplenic people can
get all vaccines indicated.
Immunosuppression is not a
consideration unless the patient
has other health issues or is
undergoing treatments that
suppress the immune system. A
patient's response to shingles
vaccination should not be
affected by the lack of a
functioning
spleen. |
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| Q: |
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If a healthcare worker does not have a
history of varicella vaccination or
disease but has had a clinically
diagnosed case of shingles, does she
or he still
need varicella vaccination? |
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| A: |
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No.
A healthcare provider's
diagnosis or verification of a
history of shingles is
acceptable evidence of immunity
to varicella. According to ACIP,
acceptable
evidence of varicella immunity
in healthcare personnel includes
(1) documentation of 2 doses of
varicella vaccine given at least
28 days apart, (2) history
of varicella or herpes zoster
based on physician diagnosis,
(3) laboratory evidence of
immunity, or (4) laboratory
confirmation of disease. |
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| Q: |
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ACIP
recommends that adolescents who
receive the first dose of
meningococcal conjugate vaccine (MCV4)
at age 13–15 years receive a one-time booster dose at
age 16–18 years. Given how hard it is
to get teens into a medical office, is
it okay to give the doses close
together if the opportunity arises?
For example,
if a patient got the first dose at age
15, and then came back for a sports
physical at age 16, could we give the second dose of MCV4 then or should we
try to
space it out as far as possible (age
18)? |
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| A: |
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If
the first dose is given at age
13 through 15 years, you can
give the booster dose as early
as age 16 years, with a minimum
interval of 8 weeks from the
previous dose. So, even if the
patient got vaccinated at age 15
years 11 months, you could wait
at least 8 weeks and then give
the booster at age 16 years 1
month (or later) if you chose to
do so. |
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| Q: |
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A
12-year-old patient new to our clinic
brought immunization records from her
previous clinic. Her records show that
she received Menomune (meningococcal
polysaccharide vaccine; MPSV4; sanofi)
when she was age 11. Is this
considered adequate coverage for the
11–12 year-old dose? Can we wait until
she is 16 to
give the meningococcal conjugate
vaccine (MCV4) dose? |
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| A: |
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The
answer to both of your questions
is yes. You can count the MPSV4
dose as valid. Although MCV4 is
preferred, MPSV4 is licensed for
this age group, and a
dose of either vaccine (i.e.,
MCV4 or MPSV4) at age 10 or
older is considered valid. Just
make sure the second dose is
MCV4. |
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| Q: |
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Can you
switch brands of rabies vaccine to
complete the 4-dose series? |
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| A: |
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Yes.
The two rabies vaccines licensed
for use in the United States are
interchangeable. |
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Click here for PDF version
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Immunization Action Coalition • 1573 Selby Ave • St. Paul, MN 55104 |
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tel 651-647-9009 • fax 651-647-9131 |
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC. |
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