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| As appeared in the November 2011 issue of Needle Tips |
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Click here for PDF version
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| Q: |
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If a child
younger than age 9 years did not receive a flu vaccine last year
but did receive 2 doses of influenza vaccine the previous year,
how many doses of flu vaccine should the child receive this year? |
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| A: |
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ACIP's influenza recommendations
for children age 6 months through 8 years have changed for the
2011–12 season. According to the new algorithm, such a child
needs 2 doses of influenza vaccine this influenza season,
separated by at least 4 weeks. Here is a summary: |
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| A child's influenza
vaccination history prior to the 2010–11 influenza season is
irrelevant to determining the number of influenza vaccine
doses needed for a child age 6 months through 8 years. Ignore
any influenza vaccine (including monovalent) received prior to
the 2010–11 season. |
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Children age 6
months through 8 years who are receiving influenza vaccine
for the FIRST time should receive 2 doses,
separated by at least 4 weeks. |
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Children whose
influenza vaccination status from the previous season is
not known should also receive 2 doses at least 4
weeks apart. |
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Children age 6
months through 8 years who did not receive AT LEAST 1 dose
of the 2010–11 vaccine should also receive 2 doses,
separated by at least 4 weeks, REGARDLESS of their
previous influenza vaccination history. |
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Children age 6
months through 8 years who received 1 dose of seasonal
influenza vaccine during the 2010–11 season need ONLY 1
dose this season. This is because the vaccine strains are
the same this season as last season. |
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| You may find this Immunization
Action Coalition handout helpful:
www.immunize.org/catg.d/p3093.pdf. |
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| Q: |
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If a child age 2
through 8 years needs 2 doses of influenza vaccine and receives
TIV as the first dose, does the second dose have to be TIV, or can
live attenuated influenza vaccine (LAIV) be used? |
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| A: |
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As long as a child is eligible
to receive nasal spray vaccine (i.e., is healthy and is in the
approved age range), it is
acceptable to give the child 1 dose of each type of influenza
vaccine. The doses should be spaced at least 4 weeks apart. |
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| Of the 118 cases, 47 (40%)
resulted in hospitalization. All but one hospitalized patient
were unvaccinated. The vaccinated patient reported having
received 1 dose of measles-containing vaccine and was
hospitalized for observation only. |
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| Measles-mumps-rubella (MMR)
vaccine is safe and highly effective in preventing measles and
its complications. Maintaining high immunization rates with
MMR vaccine is the cornerstone of outbreak prevention. |
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| Q: |
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Has ACIP
recommended the use of high-dose and intradermal influenza
vaccines? |
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| A: |
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Yes, ACIP has recommended the use
of high-dose and intradermal influenza vaccines, along with all
other FDA-approved trivalent inactivated influenza vaccines (TIV).
ACIP has not stated a preference for any TIV product over another.
The formulation or presentation a provider uses is the provider's
choice as long as an age-appropriate product is used and is
administered correctly. Providers need to choose the type of
vaccine most appropriate for their patient population. The
Immunization Action Coalition (IAC) website has manufacturers'
package inserts for every influenza vaccine product licensed for
U.S. use during the 2011–12 influenza season. Go to
www.immunize.org/packageinserts/pi_influenza.asp. |
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| Q: |
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The 2011–12
Influenza VIS states that giving pneumococcal conjugate vaccine
(PCV13) and inactivated influenza vaccine simultaneously may
increase febrile seizures. Can we continue to give these two
vaccines at the same time? |
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| A: |
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| Yes, you can. Increased rates
of febrile seizures have been reported among children,
especially those age 12 through 23 months, who received
simultaneous vaccination with TIV and PCV13, when compared
with children who received these vaccines separately. However,
because of the risks associated with delaying either of these
vaccines, ACIP does not recommend administering them at
separate visits or deviating from the recommended vaccine
schedule in any way. |
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Febrile seizures are
not uncommon, occurring in 2% to 5% of all children; and they
are generally benign. Healthcare providers should be prepared
to discuss parents' questions about this issue, including
questions about fever and febrile seizures. The 2011–12
inactivated influenza vaccine VIS states: "young children who
get inactivated flu vaccine and pneumococcal
vaccine (PCV13) at the same time appear to be at increased
risk for seizures caused by fever." ACIP chose to include this
statement on the VIS to inform parents of this potential risk. |
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For more information, see
these CDC resources:
www.cdc.gov/vaccinesafety/Concerns/FebrileSeizures.html
and
www.cdc.gov/vaccines/pubs/vis/tiv-pcv-note.htm. |
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| Q: |
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Can you explain the
newest recommendation for vaccinating people with egg allergies? |
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| A: |
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Any allergic reaction to eggs
severe enough to cause hives is a contraindication for LAIV;
however, it is only a precaution for receipt of TIV. If the
reaction consists of hives only, the person should be given TIV by
a healthcare provider who is familiar with the potential
manifestations of egg allergy. The person should also be observed
for at least 30 minutes after being vaccinated. If the reaction
includes more severe symptoms, including but not limited to
swelling of the lips and throat, angioedema, lightheadedness,
cardiovascular symptoms (e.g., hypotension), respiratory symptoms
(e.g., wheezing), gastrointestinal symptoms (e.g., nausea,
vomiting), a history of required use of epinephrine following egg
ingestion, or a history of required emergency medical
intervention, then the patient should be referred to a physician
familiar with the management of allergic conditions. |
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| Q: |
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How do you suggest
we screen patients for potential egg allergy in our busy clinic? |
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| A: |
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People who indicate that they can
eat lightly cooked eggs (e.g., scrambled eggs) without reaction
are unlikely to have an egg allergy. Don't rely on their ability
to eat eggs in baked products (e.g., cakes, cookies), however,
since the baking might denature the protein and mask an intrinsic
anaphylactic allergy to eggs. |
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| Q: |
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With Boostrix
(Tdap, GSK) now licensed for use in people age 65 years and older,
should we stop using Adacel (Tdap, sanofi pasteur) for this age
group and use only Boostrix? |
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No. CDC allows use of either
product for people age 65 years and older. |
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| Q: |
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We have a local
provider who gives immunizations in the buttocks. This isn't the
preferred anatomic site for any age, is it? |
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| A: |
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No, it isn't. Such information is
covered in ACIP's General Recommendations on Immunization:
www.cdc.gov/mmwr/pdf/rr/rr6002.pdf (pages 13–16). |
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| Helpful related handouts from
IAC |
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| Q: |
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Which vaccines
does ACIP specifically recommend that healthcare personnel (HCP)
receive in order to work in a healthcare setting? |
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| A: |
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ACIP recommends that all
HCP be vaccinated with 2 doses of MMR vaccine (or have evidence of
measles, mumps, and rubella immunity), annual influenza
vaccination, 1 dose of Tdap (especially to protect against
pertussis), 3 doses of hepatitis B vaccine for those who might be
exposed to blood or body fluids at work, and 2 doses of varicella
vaccine (or have evidence of varicella immunity). For definitions
of evidence of immunity to mumps measles, rubella, and varicella,
please refer to
www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunity-Aug2009-508.pdf
(for MMR) and
www.cdc.gov/mmwr/pdf/rr/rr5604.pdf (page 26, for varicella). |
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| Q: |
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For which workers
in healthcare settings does the Occupational Safety and Health
Administration (OSHA) require that hepatitis B vaccine be
provided? |
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OSHA requires that hepatitis B
vaccine be provided free of charge to HCP who have reasonably
anticipated contact with blood or body fluids on the job. This
requirement does not include HCP who would not be expected to have
occupational risk, such as billing staff and general office
workers. Employers must ensure that workers who decline hepatitis
B vaccination sign a declination form. For a fact sheet about this
OSHA requirement, go to
www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.pdf. |
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| Q: |
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If an employee
has 2 documented doses of MMR but has negative or equivocal titers
for 1 or more of the antigens, what should we do? Same question if
an employee has 2 documented doses of varicella vaccine but tests
negative. |
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| A: |
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Actually, ACIP does not recommend
testing for immunity in such situations. For measles, mumps,
and rubella, ACIP considers 2 documented doses of MMR vaccine
given on or after age 1 year and at least 28 days apart to be
evidence of immunity for HCP. For varicella, ACIP considers 2
documented doses of vaccine to be evidence of immunity for HCP
as long as doses are given no earlier than age 12 months, with
at least 3 months between doses for children younger than age
13 years, or at least 4 weeks between doses for people age 13
years and older. |
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| Because of the limitations of
serologic testing, tests for even properly vaccinated
individuals will often come back as negative or equivocal,
putting the employee health service in the difficult position
of having to do something (e.g., give additional doses,
perform a follow-up titer). |
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| If a healthcare worker does
not have any documented doses of MMR and/or varicella vaccine,
he or she can (1) be tested for immunity or (2) just be given
2 doses of MMR and/or varicella at least 4 weeks apart. ACIP
does not recommend serologic testing after vaccination. |
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| For more information on this
topic, go to |
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| Q: |
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How soon after a
dose of Td can HCP receive a dose of Tdap? |
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If they have not previously
received Tdap, HCP in hospital, long-term care, and ambulatory
care settings should receive a single dose of Tdap as soon as
feasible and without regard to the dosing interval since the last
Td dose. No minimum interval exists between receiving Td and Tdap. |
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| Q: |
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Can Tdap be
administered to pregnant HCP? |
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| A: |
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In June 2011, after studying new
safety and efficacy data, ACIP voted to recommend that pregnant
women who have never received the Tdap vaccine be vaccinated with
Tdap during their third trimester or the second half of their
second trimester (after 20 weeks gestation) to optimize the
concentration of maternal antibodies transferred to the fetus.
ACIP made this recommendation in response to the continuing
pertussis outbreak, with the goal of protecting newborns with
maternal antibodies and decreasing the risk of transmission from
mother to infant after birth. If the vaccine is not administered
during pregnancy, it should be administered immediately
postpartum. On October 21, 2011, CDC issued recommendations for
use of Tdap in pregnant women. To obtain the recommendations, go
to pages 1424–1426 of this document:
www.cdc.gov/mmwr/pdf/wk/mm6041.pdf. |
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| Q: |
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Can pregnant
healthcare personnel administer live-virus vaccines? |
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| A: |
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A pregnant staff member can
administer any vaccine except smallpox vaccine. |
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| Q: |
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Why is it so
important to vaccinate HCP against influenza? |
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| A: |
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| Because HCP frequently provide
care to patients at high risk for complications of influenza,
achieving high rates of vaccination among HCP will reduce
disease burden and healthcare costs. Influenza is readily
transmitted for 24 hours before a person develops influenza
symptoms. That means symptom-free unvaccinated HCP can
transmit influenza virus to patients before developing
symptoms and electing to stay home as a way to prevent
transmission. |
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| Q: |
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Why does CDC
recommend that we consider obtaining a signed declination from HCP
who refuse influenza vaccination? |
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| A: |
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Some studies have shown an
increase in HCP influenza vaccine acceptance when decliners
are required to sign such a statement. In addition, such
statements can help a vaccination program assess the reasons
for declination and plan future educational efforts. |
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| Here is a link to IAC's sample
influenza vaccination declination form:
www.immunize.org/catg.d/p4068.pdf. Please tell me which
professional associations have endorsed mandatory influenza
vaccination for HCP and have created policy statements to that
effect. |
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| The following professional
associations have issued policy statements supporting
mandatory HCP influenza vaccination: |
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You can find
additional information about mandatory influenza vaccination
for HCP, including a list of more than 100 healthcare settings
that have implemented mandatory vaccination programs. Access
IAC's Honor Roll for Patient Safety web section at
www.immunize.org/honor-roll. |
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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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