Ask the Experts: Needle Tips December 2008

Vaccine may be used through the last day of the month indicated on the expiration date. After that, do not use it. Monitor your vaccine supply carefully so that vaccines do not expire.

If we gave a dose of expired vaccine in error, what is the proper timing for repeating the dose?

The dose should be repeated. If the expired dose is a live virus vaccine, you should wait at least 4 weeks after the expired dose was given before repeating it. If the expired dose is not a live vaccine, the dose should be repeated as soon as possible.

Where can I find Vaccine Information Statement (VIS) translations in Spanish and other languages? We have many patients from outside the U.S. in our practice.

You’re in luck. The Immunization Action Coalition (IAC) has dozens of translations of most VISs at www.immunize.org/vis.

I’m unclear about when to use the multi-vaccine VIS versus the individual VISs.

The multi-vaccine VIS is a 4-page alternative VIS that you can use in place of the individual VISs for any or all of the 6 vaccines routinely given to infants (i.e., DTaP, IPV, Hib, PCV, HepB, and rotavirus). It is not designed to be used with adolescents or adults (risk factors that apply only to older persons are not included on this VIS). Use of this VIS saves paper and staff time. When giving the multi-vaccine VIS to a parent, check the boxes on the first page that correspond to the vaccines you plan to administer at the current visit. The multi-vaccine VIS, as well as all other VISs in English and more than 30 languages, are available on IAC’s website at www.immunize.org/vis. English-language VISs are available on CDC’s website at www.cdc.gov/vaccines/pubs/vis.

We sometimes have differences of opinion among our staff in determining the minimum interval or age for administering vaccines. Recommendations are sometimes written in months, weeks, or days. Can you help clarify?

This is a common source of frustration. Customarily, if the dosing interval is 4 months or more, it is common to use calendar months (e.g., 6 months from October 1 is April 1). If the interval is less than 4 months, it is common to convert months into days or weeks (e.g., 1 month = 4 weeks = 28 days).

Is it okay to store blood products in the same unit as vaccines?

CDC’s vaccine storage and handling toolkit states “If possible, other medications and other biologic products should not be stored inside the vaccine storage unit. If there is no other choice, these products must be stored below the vaccines on a different shelf. This prevents contamination of the vaccines should the other products spill.”

Does CDC still have a vaccine handling and storage toolkit?

Yes. You can access it from CDC’s website at www2a.cdc.gov/vaccines/ed/shtoolkit. The toolkit contains 2 videos on CD-ROM (How to Protect Your Vaccine Supply and Top 10 Storage and Handling Errors); an interactive game; and resources including forms, checklists, posters, and contact information. Single copies of the CD-ROM can be ordered from CDC at https://www2a.cdc.gov/nchstp_od/PIWeb/niporderform.asp.

What is the maximum number of IM or SC doses of vaccines that a child can receive at a single visit? Is it okay for a child to receive 3 live vaccines at one visit (e.g., MMR, Var, and LAIV)?

All vaccines can be administered at the same visit. There is no limit to the number of IM or SC injections that can be given at a single visit. So, an age-appropriate child can get MMR, Var, and LAIV vaccines during a single visit. If live parenteral (injected) vaccines (MMR, Var, MMRV, zoster, and/or yellow fever) and LAIV are not administered during the same visit, they should be separated by 4 weeks or more. For details, consult CDC’s “General Recommendations on Immunization” at www.cdc.gov/mmwr/PDF/rr/rr5515.pdf.

Do Occupational Safety and Health Administration (OSHA) guidelines require the use of gloves when administering vaccines?

OSHA regulations do not require gloves during vaccine administration, unless the administering person is likely to come into contact with potentially infectious body fluids or has an open lesion on their hand.

Where can I find information about vaccine shortages and delays?

Visit CDC’s website at www.cdc.gov/vaccines/vac-gen/shortages/default.htm.

When a parent is unable to produce documentation but insists that their child received the vaccine doses, what should we do?

Vaccination providers frequently encounter persons who do not have adequate documentation of vaccinations. Providers should only accept written, dated records as evidence of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine (PPSV), self-reported doses of vaccine without written documentation should not be accepted. An attempt to locate missing records should be made whenever possible—by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record. However, if records cannot be located or will definitely not be available anywhere because of the patient’s circumstances, children without adequate documentation should be considered susceptible and should be started on the age- appropriate vaccination schedule. Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, hepatitis A, and tetanus).

In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Receiving excessive doses of tetanus toxoid (e.g., DTP, DTaP, DT, Tdap, or Td) can increase the risk of a local adverse reaction, however. For details, consult CDC’s “General Recommendations on Immunization” at www.cdc.gov/mmwr/PDF/rr/rr5515.pdf.

Some parents are requesting that we space out their infant’s vaccinations because they are concerned that receiving multiple vaccinations at a single office visit might overwhelm the infant’s immune system. What do you think about using alternative schedules?

Vaccine recommendations are determined after extensive studies in large clinical trials. They include studies on how vaccine recipients respond to multiple vaccines given simultaneously. The overall aim is to provide early protection for infants and children against vaccine-preventable diseases that could endanger their health and life. No scientific evidence exists to support that delaying vaccinations or separating them into individual antigens is beneficial for children. Rather, this practice prolongs susceptibility to disease, which could result in a greater likelihood of the child becoming sick with a serious or life-threatening disease. There could also be added expense (e.g., multiple office visits), additional time off from work for parents, and increased likelihood that the child will fail to get all necessary vaccinations.

If a patient or parent refuses recommended vaccinations, is it necessary for them to sign a refusal form, or is the provider’s documentation sufficient?

The American Academy of Pediatrics states that healthcare providers may decide it is in their best interest to formally document a parent’s refusal to accept vaccination for their (minor) child. To read a discussion on this topic and to access a prototype refusal form, go to www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_revised%204-11-06.pdf.

Is it necessary to routinely obtain a pregnancy test before administering any vaccines to young women?

No. Pregnancy tests are not routinely recommended. However, females of childbearing age should be asked about the possibility of their being pregnant prior to being given any vaccine for which pregnancy is a contraindication or precaution. The patient’s answer should be documented in the medical record. If the patient is uncertain if she is pregnant, a test should be performed before administering live virus vaccines (e.g., measles-mumps-rubella [MMR], varicella [Var], LAIV [live attenuated influenza vaccine, i.e., FluMist®]).

What guidance is there for preventing patients from fainting after vaccination?

All providers who administer vaccinations should be aware of the potential for syncope (fainting) after vaccination and take appropriate measures to prevent it. Thus, clinicians should (1) make sure that people who are being vaccinated are always seated; (2) be aware of symptoms that precede fainting (weakness, dizziness, pallor, etc.); and (3) take appropriate measures to prevent injuries if such symptoms occur. [Note: IAC has two pertinent educational pieces for healthcare professionals: “Medical Management of Vaccine Reactions in Children and Teens” at www.immunize.org/catg.d/p3082a.pdf and “Medical Management of Vaccine Reactions in Adult Patients” at www.immunize.org/catg.d/p3082.pdf.]

Since 2005, VAERS has received an increased number of reports of syncope. Fainting among girls and young women ages 11–18 accounted for most of the increase. Serious injuries have occurred, including one fatality from intracranial hemorrhage caused by head trauma. The May 2, 2008, MMWR included a summary of findings on the increase in fainting after vaccination (see www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a2.htm). In people for whom vaccination time and fainting time were reported, it was discovered that 52% of fainting episodes occurred within 5 minutes of vaccination and 70% occurred within 15 minutes. Vaccine providers should strongly consider observing vaccinated people for 15 minutes after vaccination, in accordance with ACIP General Recommendations (see www.cdc.gov/mmwr/PDF/rr/rr5515.pdf). This is particularly important when vaccinating adolescents and young adults.

Please describe the newly licensed rotavirus vaccine, Rotarix ®.

FDA licensed Rotarix (GSK) on April 3, 2008. It is approved for oral administration as a 2-dose series to infants at ages 2 and 4 months. The lyophilized (freeze-dried) vaccine is reconstituted with a 1-mL liquid diluent and administered from a prefilled oral applicator.

How do the two rotavirus vaccines differ?

The rotavirus vaccination series consists of either two 1-mL doses of Rotarix (GSK) given at 2 and 4 months of age or three 2-mL doses of RotaTeq® (Merck) given at 2, 4, and 6 months of age. CDC has revised its recommendations to make the schedule less confusing: neither vaccine should be initiated in an infant once the infant becomes age 15 weeks (i.e., is older than 14 weeks 6 days) and the series should be completed before the infant turns 8 months 0 days. CDC’s provisional recommendations for rotavirus vaccine are available at www.cdc.gov/vaccines/recs/provisional.

Now that there are two licensed vaccines for rotavirus that have different schedules, how can we keep track of which vaccine an infant might have previously received?

That may be difficult at first. The generic abbreviation for the rotavirus vaccine was recently changed to “RV” (it used to be “Rota”). CDC has also developed abbreviations to distinguish the two RV vaccines. Rotarix is now abbreviated as RV1 (a monovalent vaccine containing a live, attenuated human G1P[8] virus), and RotaTeq as RV5 (a pentavalent vaccine comprising 5 live reassortant rotaviruses). Immunization providers should use these new abbreviations when recording the vaccine they administered.

If we don’t know which rotavirus vaccine an infant previously received, how should we complete the schedule?

If you have any doubt about which vaccine the infant previously received and the infant is at an age when the vaccine can still be given, give a total of 3 doses of rotavirus vaccine.

Please describe the new combination vaccine Pentacel ® and how it should be used.

On June 20, 2008, FDA licensed Pentacel (sanofi pasteur), a DTaP-IPV-Hib combination vaccine. It is approved for use as a 4-dose series in infants and children at ages 2, 4, 6, and 15–18 months. It should not be used for any dose in the primary series for children age 5 years or older or as the booster dose for children ages 4–6 years. The DTaP-IPV component is supplied as a sterile liquid, which is used to reconstitute lyophilized (freeze-dried) ActHIB®vaccine. The two components of the vaccine should be stored together in the carton to reduce vaccine administration errors. The DTaP-IPV component should never be administered alone.

Can we give Pentacel to a child who has previously received separate injections of one or more of these antigens?

Yes, as long as minimum intervals are maintained.

Can I use Pentacel to give the 12–15 month booster dose of Hib vaccine even though there is a Hib vaccine shortage?

No. During the Hib vaccine shortage, you should not give Pentacel as dose #4 of the series. Administer a single dose of DTaP for dose #4.

Can we give Pentacel if we don’t know the type of DTaP vaccine the child previously received?

Yes. CDC recommends that whenever feasible, only one manufacturer’s DTaP product be used for the entire pertussis series, but that vaccinations should not be deferred if the DTaP product previously given is unavailable or unknown.

Please tell us about the new combination vaccine Kinrix® and the recommendations for its use.

On June 24, 2008, FDA licensed Kinrix (GSK), a combination DTaP and IPV vaccine. It is approved for use as the fifth dose of DTaP and the fourth dose of IPV in children ages 4 through 6 years who received DTaP (Infanrix®) and/or DTaP-HepB-IPV (Pediarix®) as the first three doses and DTaP (Infanrix) as the fourth dose. It should not be given to children younger than age 4 years.

When administering combination vaccines like Kinrix and Pentacel, which VISs should be used?

You can use either the individual VISs that exist for the separate antigens or you can use the multi-vaccine VIS. Remember to check the appropriate boxes on the front page of the multi-vaccine VIS.

We have a 13-year-old patient who was given DT (pediatric) as a preschooler after she had experienced excessive crying following a dose of DTP. Now, we are wondering if we can give her Tdap since we know she may not be protected against pertussis.

Yes, you can. Many of the precautions to DTaP (e.g., temperature of 105°F or higher, collapse or shock-like state, persistent crying lasting 3 hours or longer, seizure with or without fever) do not apply to Tdap. This issue is discussed in CDC’s Tdap recommendations, available at www.cdc.gov/mmwr/PDF/rr/rr5503.pdf.

We gave Tdap to a child who was just short of their 10th birthday. What should we do?

Use of Tdap in children ages 7–9 years is considered off-label and is not recommended; however, the dose can be counted and does not need to be repeated with Td.

What is the significance of the difference in the abbreviations for the vaccines DTaP (for children younger than age 7 years) and Tdap (used in adolescents or adults)?

Both vaccines provide protection against diphtheria, tetanus, and pertussis, but DTaP has more diphtheria toxoid (3–5 times as much) and more pertussis antigen than the amount in the Tdap vaccines. This larger amount of antigen is reflected by the use of the capital letters “D” and “P” when writing DTaP (the pediatric vaccine). Because both DTaP and Tdap contain equal amounts of tetanus antigen, both vaccine abbreviations contain a capital “T.”

Can the parents of a young infant be given a dose of Tdap right after birth to protect themselves and, indirectly, their newborn from pertussis, even though they had a dose of Td vaccine less than two years ago?

Yes. Parents should receive a single dose of Tdap as soon as possible to protect their baby from pertussis. If a dose of Td was given within the previous 2 years, parents should still be vaccinated with Tdap as soon as possible regardless of the time interval since the last dose of Td. Other household contacts that are not up to date with their pertussis- containing vaccinations should also be appropriately vaccinated.

How soon after a dose of Td can a healthcare worker receive a dose of Tdap, in order to protect vulnerable infants and others?

If they have not previously received Tdap, healthcare personnel in hospitals and ambulatory care settings who have direct patient contact should receive a single dose of Tdap as soon as feasible and without regard to the dosing interval since the last Td. There is no “minimum interval” one needs to wait between receiving Td and Tdap when it is given to protect infants or other vulnerable patients.

When a patient seen in the ER needs tetanus protection, which vaccine should be given, Td or Tdap?

Adolescents and adults ages 11–64 years who require a tetanus toxoid-containing vaccine as part of wound management should receive a single dose of Tdap instead of Td, if they have not previously received Tdap. If Tdap is not available, or was previously administered, these persons should receive Td.

When will the Hib vaccine shortage be over?

It is anticipated that the Hib vaccine supply will improve in mid-2009.

For which age groups of children is influenza vaccination now recommended?

Starting in fall 2008, all children ages 6 months through 18 years are recommended to receive annual vaccination against influenza. CDC issued this expanded recommendation with the intent to begin in the 2008–09 influenza vaccination season and be fully in place by the 2009–10 season.

Which adults should receive influenza vaccine this year?

Influenza vaccination is recommended for the following adults: those age 50 years and older; women who will be pregnant during the influenza season; those with the following medical conditions: a chronic disorder of the pulmonary or cardiovascular system, a chronic disease of the blood, liver, or kidneys, immunosuppression, or diabetes; residents of nursing homes or other chronic-care facilities; all healthcare personnel; and household contacts and caregivers of children ages 0–59 months and of other persons at increased risk of complications of influenza. Influenza vaccine is also recommended for any persons who want to reduce the risk of becoming ill with influenza or of transmitting it to others.

What percentage of the U.S. population is recommended to receive influenza vaccination?

With the new recommendation to vaccinate all children ages 6 months through 18 years, 85% of the U.S. population should be vaccinated every year.

Who can receive the nasal spray influenza vaccine (FluMist) and who can receive injectable influenza vaccine?

FluMist can be given to all healthy, non-pregnant people ages 2 through 49 years. However, FluMist should not be given to healthy children younger than age 5 years who have recurrent wheezing or have had a wheezing episode within the past 12 months. Injectable influenza vaccine can be given to all people age 6 months and older who have no contraindications or precautions to vaccination.

Which children need 2 doses of influenza vaccine?

Children ages 6 months through 8 years who are receiving influenza vaccine for the first time should be given 2 doses at least 4 weeks apart. If they fail to get 2 doses during the current vaccination season, they should get 2 doses during the next season.

When a child needs 2 doses of influenza vaccine, can I give 1 dose of each type (injectable and nasal spray)?

Yes. As long as a child is eligible to receive nasal spray vaccine (i.e., is in the proper age range and health status), it is acceptable to give 1 dose of each type of influenza vaccine. The doses should be spaced at least 4 weeks apart.

Is it true that I can vaccinate pregnant women with influenza vaccine during their first trimester?

Yes. All women who are pregnant or will be pregnant during the influenza season should be vaccinated, including those who are in their first trimester. Only inactivated (injectable) vaccine should be given to pregnant women.

Can thimerosal-containing vaccine be given to pregnant women?

Yes, unless you live in a state that has enacted legislation restricting use in pregnant women. There is no scientific evidence that thimerosal in vaccines, including influenza vaccines, is a cause of adverse events, unless the patient has a systemic allergy to thimerosal.

During which month is it no longer worthwhile to give influenza vaccine to my patients?

If you have influenza vaccine in your refrigerator and unvaccinated patients in your office, you should vaccinate them. Vaccinating in June is likely unnecessary.

What is the Joint Commission’s recommendation on vaccinating healthcare workers against influenza?

In January 2007, a new infection control standard of the Joint Commission became effective that requires accredited organizations to offer annual influenza vaccination to staff, volunteers, and licensed independent practitioners who have close patient contact.

To accelerate completion of the human papillomavirus (HPV) vaccine series, can doses be given at 0, 1, and 4 months?

No, there is no accelerated schedule for completing the HPV vaccine series. You should follow the recommended schedule of 0, 2, and 6 months.

If a patient receives the third dose of HPV vaccine earlier than recommended, should she be given a fourth dose?

Maybe. If the 3-dose series was given in 16 weeks or more, do not repeat any doses. If the 3-dose series was given in less than 16 weeks, repeat dose #3 at least 12 weeks after the invalid dose.

Can a woman complete the HPV series after age 26 years?

The series should be completed, even if this means that the series is completed after a woman turns 27.

We’ve heard stories in the media lately about severe reactions to the HPV vaccine. Is there any substance to these stories?

No. In summer 2008 some concerns were raised over two issues—reports of deaths and reports of Guillain-Barré syndrome (GBS) following vaccination with Gardasil®. As of August 2008, Merck reported it had distributed more than 20 million doses of Gardasil in the United States. The Vaccine Adverse Events Reporting System (VAERS) had received reports of 27 deaths. CDC reported that there was not a common pattern to the deaths; if there had been a common pattern, it would suggest the deaths might be caused by the vaccine. Occurrences of GBS, a rare neurological disorder, have been reported through VAERS. FDA and CDC reviewed the reports and found no evidence that Gardasil increased the rate of GBS above what is expected in the population. CDC, working with the FDA and other immunization partners, will continue to monitor the safety of Gardasil. You can find complete information on this and other vaccine safety issues at www.cdc.gov/vaccinesafety.

Who is recommended to be vaccinated against meningococcal disease?

CDC recommends routine vaccination against meningococcal disease for the following groups:

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All previously unvaccinated adolescents ages 11 through 18 years

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All previously unvaccinated college freshmen who will be living in dormitories

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All persons ages 2 years and older with anatomic or functional asplenia, or terminal complement component deficiencies

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All persons ages 2 years and older who travel to or reside in countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with the local population will be prolonged; this includes anticipated travel to Mecca, Saudi Arabia, for the annual Hajj

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Any person working as a microbiologist with routine exposure to isolates of N. meningitidis

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Military recruits, and

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Any other person wishing to decrease their risk for meningococcal disease

We mistakenly gave an infant pneumococcal polysaccharide vaccine (PPSV) instead of pneumococcal conjugate vaccine (PCV). What should we do?

PPSV is not effective in children younger than age 24 months. PPSV given at this age should not be considered to be part of the pneumococcal vaccination series. PCV should be administered as soon as the error is discovered.

I have heard that there will be a change in the PPSV recommendations for adults with asthma and for smokers. Is this true?

Yes. The 1997 CDC recommendations for the use of PPSV exclude asthma in the chronic pulmonary disease category because no data on increased risk of pneumococcal disease among persons with asthma were available when the recommendation was issued. At its June 2008 meeting, the Advisory Committee on Immunization Practices (ACIP) reviewed new information that suggests that asthma is an independent risk factor for pneumococcal disease among adults. At its October 2008 meeting, ACIP reviewed new information that demonstrates an increased risk of pneumococcal disease among smokers. Consequently, ACIP voted to include both asthma and cigarette smoking as risk factors for pneumococcal disease among adults age 19 through 64 years and as indications for PPSV. The new recommendations will be included in the 2009 Recommended Adult Immunization Schedule, due to be published in January 2009.

To complete a 21-year-old patient’s hepatitis A vaccine series, how many adult doses should I give if the patient received a single dose of pediatric hepatitis A vaccine 5 years ago?

You should give the patient a dose of adult HepA to complete the 2-dose series. There is never a need to start a vaccine series over.

We have an adult patient who received the correct pediatric series of HepA vaccine as a teenager and is now traveling abroad. Does the patient need an adult booster?

No. There is no recommendation for a booster dose of hepatitis A vaccine if a patient has completed the 2-dose series at any age.

How can I combine hepatitis B (HepB) and hepatitis A (HepA) vaccines to complete a series that was started with Twinrix® but can’t be completed that way?

Twinrix is licensed in the U.S. as a 3-dose series for people age 18 years and older. If Twinrix is not available or if you choose not to use Twinrix to complete the series, you must consider the following: a dose of Twinrix contains a standard adult dose of hepatitis B vaccine and a pediatric dose of hepatitis A vaccine. Thus, a dose of Twinrix can be substituted for any dose of the hepatitis B series but not for any dose of the hepatitis A series.

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Any combination of 3 doses of adult hepatitis B or 3 doses of Twinrix = a complete series of hepatitis B vaccine.

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One dose of Twinrix + 2 doses of adult hepatitis A = a complete series of hepatitis A vaccine.

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Two doses of Twinrix + 1 dose of adult hepatitis A = a complete series of hepatitis A vaccine.

Why isn’t hepatitis A vaccine recommended for sewage and solid waste disposal workers?

Existing data do not support the use of hepatitis A vaccine routinely in this setting. In published reports of three serologic surveys conducted among U.S. wastewater workers and appropriate comparison populations, no substantial or consistent increase in the prevalence of anti-HAV was identified among wastewater workers. No work-related instances of HAV transmission have been reported among wastewater workers in the United States.

Who is recommended to receive 2 doses of varicella vaccine?

All persons without evidence of varicella immunity age 12 months and older should receive 2 doses of varicella vaccine. For children ages 12 months through 12 years, the minimum interval between doses is 3 months; for persons age 13 years and older, the minimum interval is 4 weeks.

If a woman’s rubella test is “not immune” during a prenatal visit but she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

CDC does not routinely recommend more than 2 doses of MMR vaccine. A negative serology after 2 documented doses probably represents a false negative (i.e., antibody titer too low to detect with commercial tests). If a person is found to have a negative serology after 2 documented doses of MMR, it is best to stop testing for rubella. CDC’s recommendations for the use of MMR vaccine can be accessed at www.cdc.gov/mmwr/PDF/rr/rr4708.pdf.

I understand there is a zoster vaccine shortage. What is the anticipated date this problem will be resolved?

Merck has obtained FDA approval for resumption of manufacturing of Varicella Zoster Virus (VZV) bulk. VZV bulk is used to manufacture varicella vaccine, MMRV vaccine, and zoster vaccine. There is adequate supply of Varivax® (varicella vaccine) to fully implement the recommended 2-dose immunization schedule for all age groups, including catch-up. ProQuad® (MMRV) is currently unavailable. Zostavax® (zoster vaccine) is available for ordering, however, the manufacturer is experiencing shipping delays. For information on shipping dates, go to www.merckvaccines.com.

I understand that Varivax, ProQuad, and Zostavax each have different concentrations of antigen. Would you tell me how they are different?

A dose of Varivax has 1,530 plaque forming units (PFUs), ProQuad contains 9,800 PFUs (7 times higher than Varivax), and Zostavax contains 19,400 PFUs (13 times higher than Varivax).

When administering zoster vaccine, is it necessary to ask patients if they have ever had chickenpox or shingles?

No. All persons age 60 years or older—whether they have a history of chickenpox or shingles or not—should be given zoster vaccine unless they have a medical contraindication. Medical contraindications are described in detail in the recently released CDC recommendations “Prevention of Herpes Zoster.” To obtain a copy, go to www.cdc.gov/mmwr/pdf/rr/rr5705.pdf.

A 60-year-old patient was given varicella vaccine instead of zoster vaccine. Should the patient still be given the zoster vaccine? If so, how long should the interval be between the 2 doses?

CDC recommendations read as follows: “If a provider mistakenly administers varicella vaccine to a person for whom zoster vaccine is indicated, no specific safety concerns exist, but the dose should not be considered valid and the patient should be administered a dose of zoster vaccine during that same visit. If the error is not immediately detected, a dose of zoster vaccine should be administered as soon as possible but not within 28 days of the varicella vaccine dose to prevent potential interference of 2 doses of live attenuated virus.”

Can we give zoster vaccine to elderly patients who have cancer or an immunosuppressed condition?

No. Zoster vaccine is contraindicated in persons with primary or acquired immunodeficiency.

Can you catch shingles from a person with active shingles infection?

Shingles cannot be passed from one person to another through sneezing, coughing, or casual contact. If a person who has never had chickenpox or been vaccinated against chickenpox comes in direct contact with a shingles rash, the virus could be transmitted to the susceptible person. The exposed person would develop chickenpox, not shingles.

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