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| As appeared in the June 2010 issue of Needle Tips |
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Click here for PDF version
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| Q: |
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Please review the
specifics of the new CDC recommendations for the use of the
combination measles, mumps, rubella, and varicella (MMRV) vaccine. |
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| A: |
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On May 7, 2010, CDC issued new
recommendations for the use of combination MMRV vaccine. Prior
to issuing these recommendations, ACIP reviewed results of
post-licensure studies that suggest that, during the 5–12 day
post-vaccination period, approximately one additional febrile
seizure occurred among every 2,600 children ages 12 through 23
months vaccinated with a first dose of MMRV vaccine, when
compared with children in the same age group vaccinated with
separate first doses of MMR vaccine and varicella vaccine
administered during a single office visit. |
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The summary of the recommendations
for use of MMRV vaccine are as follows: |
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The routinely recommended
ages for measles, mumps, rubella, and varicella
vaccination continue to be age 12 through 15
months for the first dose and age 4 through 6 years for
the second dose. |
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For the first dose of
measles, mumps, rubella, and varicella vaccines at age 12
through 47 months, providers may use either
MMR vaccine and varicella vaccine or MMRV vaccine.
Providers who are considering administering MMRV vaccine
should discuss
the benefits and risks of both vaccination options with
the parents or caregivers. Unless the parent or caregiver expresses a
preference for MMRV vaccine, CDC recommends that providers
administer MMR vaccine and varicella vaccine for the first
dose in
this age group. |
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For the second dose of
measles, mumps, rubella, and varicella vaccines at any age
(15 months through 12 years) and for the
first dose at age 48 months and older, use of MMRV vaccine
generally is preferred over separate injections of its
equivalent
component vaccines (i.e., MMR vaccine and varicella
vaccine). |
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A personal or family
(i.e., sibling or parent) history of seizures of any
etiology (i.e., cause) is a precaution for MMRV
vaccination, and such children generally should be
vaccinated with MMR vaccine and varicella vaccine. |
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| The complete recommendations
for the use of MMRV vaccine are available on CDC's website at
www.cdc.gov/mmwr/pdf/rr/rr5903.pdf. |
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| In addition, CDC has issued a
new VIS for MMRV vaccine, dated 5/21/10, which is available at
www.immunize.org/vis/mmrv.pdf
and
www.cdc.gov/vaccines/pubs/vis/downloads/vis-mmrv.pdf. As
with all other VISs, it should be given to the parent or
vaccine
recipient prior to vaccination to facilitate discussion about
the vaccine between the patient and provider. |
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| Q: |
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What is the FDA's
current recommendation about the use of rotavirus vaccine in
infants? |
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| A: |
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In March 2010, FDA
recommended temporary suspension of the use of Rotarix (GSK)
after researchers found DNA from porcine circovirus type 1
(PCV1) in the vaccine. In May, Merck confirmed the presence of
DNA from PCV1 and porcine circovirus type 2 (PCV2) in its
rotavirus vaccine, RotaTeq. |
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On May 14, FDA updated its
recommendations for both Rotarix and RotaTeq vaccines for the
prevention of rotavirus disease in infants. Based on careful
evaluation of a variety of scientific information, FDA has
determined it is appropriate for clinicians and healthcare
professionals to resume the use of Rotarix and to continue the
use of RotaTeq. All available evidence supports the safety and
effectiveness of Rotarix and RotaTeq. Both vaccines were
extensively studied before and after approval. For more
detailed information go to
www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205539.htm. |
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Many children in my
practice have received their complete series of 7-valent
pneumococcal conjugate vaccine (PCV7). Would you
please review the recommendations for which of them now need a
supplemental dose of 13-valent pneumococcal conjugate vaccine
(PCV13)? |
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| A: |
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A single supplemental
dose of PCV13 is recommended for all children ages 14 through
59 months who have received the complete
4-dose series of PCV7 or another age-appropriate, complete
PCV7 schedule. For children who have underlying medical
conditions, a single supplemental PCV13 dose is recommended
through age 71 months. This also includes children who have
previously received pneumococcal polysaccharide vaccine
(PPSV23). Give the single supplemental dose of PCV13 no sooner
than 8
weeks after the last dose of PCV7 or PPSV23 was given. |
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IAC has created a table that
explains how to use PCV13 to catch up children who have fallen
behind on their PCV7 doses. It's
available at
www.immunize.org/catg.d/p2016.pdf and also on
page 7 of this issue of Needle Tips. |
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I have a
13-year-old patient in my practice who recently had his spleen
removed. He has been vaccinated with pneumococcal
polysaccharide vaccine (PPSV23) but never received 7-valent
pneumococcal conjugate vaccine (PCV7). Can I give him the new 13-valent pneumococcal conjugate vaccine, PCV13? |
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Yes. Administer a single dose
of PCV13 to children ages 6 through 18 years who are at
increased risk for invasive
pneumococcal disease because of sickle cell disease, HIV
infection or other immunocompromising condition, cochlear
implant,
functional or anatomical asplenia, or cerebrospinal fluid
leaks, regardless of whether they have previously received
PCV7 or
PPSV23. A table that details the underlying medical conditions
that are indications for pneumococcal vaccination among
children is available on page 260 of the related ACIP
recommendations at
www.cdc.gov/mmwr/PDF/wk/mm5909.pdf. |
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We see children
ages 7 through 9 years who are behind on their diphtheria-tetanus
toxoids and acellular pertussis (DTaP)
series or their tetanus-diphtheria toxiods (Td) series. Though FDA
hasn't licensed Tdap for children in this age group, when
pertussis is circulating in the community or a new infant is in
the home, I believe it would be prudent to give Tdap instead
of Td. What is your opinion? |
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No Tdap product is licensed for
this age group, so the official recommendation is to give Td
to children this age who need
additional doses. Providers may certainly choose to exercise
their professional judgment and give Tdap vaccine "off-label"
in
cases where they think the patient is at risk of either
acquiring or transmitting pertussis. |
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Instead of giving
tetanus/diphtheria toxoid and acellular pertussis (Tdap) vaccine
to a father-to-be who needed protection
against pertussis, we mistakenly gave him tetanus/diphtheria (Td)
toxoid. How soon after the Td dose can we give him the dose
of Tdap he needs? |
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As long as they are younger
than age 65 years and at least age 10 years, parents,
grandparents, healthcare workers, and all
others who have not already received Tdap, and who are close
contacts of infants younger than age 12 months, should receive
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single dose of this vaccine as soon as possible to protect
infants from pertussis. When giving Tdap to protect infants,
one
does not need to observe a "minimum interval" between giving
Td and Tdap. For example, if you had immediately realized that
you had mistakenly given the father-to-be Td instead of Tdap,
you could have given him the needed Tdap dose at the same
visit
at which you gave him the erroneous Td dose. |
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CDC recommendations
state that the minimum intervals for human papillomavirus (HPV)
vaccination are at least 4 weeks between
doses #1 and #2, and at least 12 weeks between doses #2 and #3.
This adds up to a total of 16 weeks between doses #1 and #3.
But the recommendations also say that there must be a minimum of
24 weeks between doses #1 and #3. This doesn't make sense to
me. |
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| A: |
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When administering HPV vaccine,
you must meet ALL the minimum intervals. For example, if you
give dose #2 at the minimum
interval of 4 weeks after dose #1, you must wait 20 weeks to
give dose #3 in order to meet the 24-week minimum interval
between #1 and #3. Determination of these minimum intervals
was based on extensive discussion with the manufacturers and
on
data from the HPV clinical trials. |
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We mistakenly gave
a patient the diluent for Menveo meningococcal conjugate vaccine
(MCV4; Novartis) without adding it to the
powdered vaccine. Since vaccine is present in the diluent as well
as in the powder, what should we do now? |
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| A: |
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Menveo's liquid
vaccine component (i.e., diluent) contains the C, Y, and W-135
serogroups, and the lyophilized vaccine
component (i.e., freeze-dried powder) contains serogroup A.
Because the patient received only the diluent, he or she is
not
protected against invasive meningococcal disease caused by
Neisseria meningitidis serogroup A. |
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Invasive disease with N.
meningitidis serogroup A is very rare in the United States; it
is more common in some other
countries, particularly the African meningitis belt. If the
patient who received only the C-Y-W135 diluent does not plan
to
travel outside the United States, the dose does not need to be
repeated. However, if the patient plans to travel outside the
United States, the dose should be repeated with either
correctly reconstituted Menveo, or with a dose of Menactra
brand
(sanofi pasteur) MCV4. There is no minimum interval between
the incorrect dose and the repeat dose. |
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We now have two
meningococcal conjugate vaccines (MCV4) to chose from—Menactra
(sanofi pasteur) and Menveo (Novartis). It
would be useful to know if they are interchangeable when repeat
doses of MCV4 are needed. |
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| A: |
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Although both
vaccines are licensed for single-dose use, you can use either
vaccine to revaccinate people ages 11 through 55
years who are at prolonged increased risk for meningococcal
disease. Only Menactra is licensed for vaccinating children
ages
2 through 10 years. Use only meningococcal polysaccharide
vaccine (MPSV4; Menomune; sanofi pasteur) when vaccinating or
revaccinating people age 56 years and older. |
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To access updated recommendations
for revaccinating people at prolonged increased risk for
meningococcal disease, go to:
www.cdc.gov/mmwr/PDF/wk/mm5837.pdf, and see pages 1042–43. |
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| Q: |
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If an adult or
child has not had documented chickenpox but has had shingles, is
varicella vaccination recommended? |
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No. Shingles is caused by
varicella zoster, the same virus that causes chickenpox. A history
of shingles based on a
healthcare provider diagnosis is evidence of immunity to
chickenpox. Therefore, a person who has had shingles does not need
to be vaccinated against varicella. He/she should still receive
zoster vaccine, however, if it is not contraindicated and
he/she is age 60 or older. |
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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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