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| As appeared in the
October 2012 issue of Needle Tips |
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Click here for PDF version
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| Q: |
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Which children younger than age 9
years will need 2 doses of influenza
vaccine in the 2012–13 influenza
season? |
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| A: |
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Children age 6 months
through 8 years should
receive a second dose 4
weeks or more after the
first dose if they (1) are
receiving influenza
vaccine for the first time
or (2) did not get at
least 2 doses of seasonal
influenza vaccine since
July 1, 2010. |
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CDC has developed the
following alternative
approach that healthcare
providers can use for
children who have
well-documented histories
(e.g., maintained in electronic registries) of
influenza vaccination.
Children age 6 months
through 8 years need only
1 dose of vaccine in 2012–13
if they have received any
of the following: (1) 2 or
more doses of seasonal
influenza vaccine since
July 1, 2010; (2) at least
2 doses of seasonal
vaccine before July 1,
2010, and at least 1 dose
of monovalent 2009 H1N1
vaccine; or (3) at least 1
dose of seasonal vaccine
before July 1, 2010, and
at least 1 dose of
seasonal vaccine since
July 1, 2010. |
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For more details about the
recommendations for which
children need 2 doses, see
"Guides for determining
the number of doses of
influenza vaccine to give
to
children ages 6 months
through 8 years during the
2012–2013 influenza
season" on page 10 of this
issue of Needle Tips or
find it online at
www.immunize.org/catg.d/p3093.pdf.
You can also consult
"Prevention and Control of
Influenza with Vaccines:
Recommendations of the
ACIP—U.S., 2012–13
Influenza Season" at
www.cdc.gov/mmwr/pdf/wk/mm6132.pdf
(pages 613–614). |
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| Q: |
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What is the latest CDC guidance on
influenza vaccination and egg
allergy? |
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| A: |
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People who have
experienced a serious
systemic or anaphylactic
reaction (e.g., hives,
swelling of the lips or
tongue, acute respiratory
distress, or collapse)
after eating eggs should
consult a specialist for
appropriate evaluation to
help determine if vaccine
should be administered. |
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A previous severe allergic
reaction to influenza
vaccine, regardless of the
component suspected to be
responsible for the
reaction, is a
contraindication to future
receipt of the vaccine. |
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People who have documented
immunoglobulin E (IgE)-mediated
hypersensitivity to eggs,
including those who have
had occupational asthma or
other allergic responses
to egg protein, might also
be at increased risk for
allergic reactions to
influenza vaccine.
Protocols have been
published for safely
administering influenza
vaccine to people with egg
allergies. |
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Some people who report
allergy to egg might not
be egg allergic. If a
person can eat lightly
cooked eggs (e.g.,
scrambled eggs), they are
unlikely to have an egg
allergy. However, people
who can tolerate egg in
baked products (e.g.,
cake) might still have an
egg allergy. If the person
develops hives only after
ingesting eggs, CDC
recommends (1) they
receive TIV (not LAIV),
(2) the vaccine be
administered by a
healthcare provider
familiar with the
potential manifestations
of egg allergy, and (3)
the vaccine recipient be
observed for at least 30
minutes after receipt of
the vaccine for signs of a
reaction. |
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For more details about
giving influenza vaccine
to people with a history
of egg allergy, see
"Influenza Vaccination of
People with a History of
Egg Allergy"
on page 18 of this issue
of Needle Tips or visit
www.immunize.org/catg.d/p3094.pdf.
You can also consult pages
616–617 of "Prevention and
Control of Influenza with
Vaccines: Recommendations
of the ACIP—U.S., 2012–13
Influenza Season" at
www.cdc.gov/mmwr/pdf/wk/mm6132.pdf. |
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| Q: |
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Which formulations of influenza
vaccines (i.e., nasal spray,
intradermal, injectable high-dose, and
injectable standard-dose) are
recommended for various age groups? |
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| A: |
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Six
manufacturers are producing
influenza vaccines for the U.S.
market for the 2012–13 season.
Page 11 of this issue of Needle
Tips has a table titled "Influenza
Vaccine Products for the 2012–2013
Influenza Season." It summarizes
the vaccine products and age
groups for which they are
licensed. |
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| Q: |
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Can a clinic vaccinate children
younger than age 3 years with a 0.25
mL dose of influenza vaccine taken
from a multi-dose vial of Fluzone (TIV;
sanofi)? The multi-dose vial
contains thimerosal as a
preservative. |
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| A: |
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Yes. Fluzone is the only
inactivated influenza
vaccine licensed for use
in children younger than
age 3 years. It is
available in single-dose
and multi-dose vials.
Multi-dose vials of
Fluzone contain a small
amount of thimerosal to
prevent bacterial growth
in the vials. Thimerosal-containing
vaccines are safe to use
in children. No scientific
evidence indicates that
thimerosal in vaccines
causes adverse events
unless the patient has a
severe allergy to
thimerosal. However, a few
states have enacted
legislation that restricts
the use of thimerosal-containing
vaccines in children. To
find out if your state has
such restrictions, check
with your state
immunization program. |
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| Q: |
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In recommending influenza
vaccination for people age 65 and
older, does CDC prefer that
healthcare professionals administer
high-dose influenza vaccine or
standard-dose influenza vaccine? |
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| A: |
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CDC has no preference. CDC
stresses that vaccination is
the first and most important
step in protecting against
influenza. |
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| Q: |
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If a patient received a dose of
influenza vaccine in June (e.g., for
international travel), how long
should the patient wait before
getting vaccinated with the next
season's flu vaccine? |
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| A: |
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There should be a minimum
of 4 weeks between the
doses in such situations. |
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| Q: |
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Can adolescents and adults who have
been exposed to pertussis be
vaccinated if they haven't had a
one-time dose of Tdap yet? |
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| A: |
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Yes. Exposure to a person
with pertussis is not a
reason to avoid Tdap
vaccination. All
adolescents and adults who
haven't had a one-time
dose of Tdap should
receive a dose as soon as
possible. |
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| Q: |
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Should a person who received 2 doses
of varicella vaccine be vaccinated
with zoster vaccine when they turn
60? |
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| A: |
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No. CDC does not currently
recommend zoster vaccine
for people who received 2
doses of varicella
vaccine. However,
healthcare providers do
not need to inquire about
varicella vaccination
history before
administering zoster
vaccine because virtually
all people currently or
soon to be in the
recommended age group have
not received varicella
vaccine. For details, see
page 19 of the CDC
recommendations Prevention
of Herpes Zoster available
at
www.cdc.gov/mmwr/PDF/rr/rr5705.pdf. |
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| Q: |
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Can we accept receipt of a single
documented dose of zoster vaccine as
proof of varicella immunity in a
healthcare employee who has no other
evidence of immunity? |
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| A: |
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No. Receipt of zoster
vaccine is not proof of
prior varicella disease.
According to CDC,
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.
If a healthcare employee
has already received a
dose of zoster vaccine but
has no evidence of
immunity to varicella, the
zoster dose can be
considered the first dose
of the 2-dose varicella
series. |
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| Q: |
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I work in employee health. Several
hospital employees have told me they
have had chickenpox, but their
titers show no antibodies. Should I
offer varicella
vaccination to them even though they
insist they've had the illness? |
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| A: |
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If you cannot verify a
healthcare employee's
history of chickenpox, the
employee should receive 2
doses of varicella vaccine
at least 4 weeks apart.
For details, refer to
pages 16 and 26 of the CDC
recommendations Prevention
of Varicella at
www.cdc.gov/mmwr/pdf/rr/rr5604.pdf. |
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| Q: |
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Does the recommendation to
administer hepatitis B vaccine to
diabetics younger than age 60 extend
to women with gestational diabetes? |
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| A: |
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No. The 2011 CDC
recommendations for
hepatitis B vaccination of
people with diabetes
pertain to those with
type-1 and type-2
diabetes. They do not
apply to women with
gestational diabetes. It
is worth noting that
pregnancy is not a
contraindication to
hepatitis B vaccination,
and that women with
gestational diabetes are
more likely to develop
type-1 or type-2 diabetes
later in life. Diabetic
women who become pregnant
can be vaccinated, if
indicated. The CDC recommendations "Use of
Hepatitis B Vaccination
for Adults with Diabetes
Mellitus" are available at
www.cdc.gov/mmwr/pdf/wk/mm6050.pdf
on pages 1709–11. |
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| Q: |
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I still am not clear about the need
for testing if the hepatitis B
vaccine series was completed many
years ago—can you advise? |
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All healthcare personnel (HCP)
with risk of exposure to
hepatitis B should be
tested 1–2 months after
receiving the third dose
of hepatitis B vaccine.
CDC does not recommend
testing healthcare
personnel who were not
tested within the 1–2
month postvaccination time
frame. HCP who are exposed
can be tested as part of
postexposure management,
if indicated. For more
information, see
"Hepatitis B and the
Healthcare Worker" at
www.immunize.org/catg.d/p2109.pdf. |
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| Q: |
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Should women who have not received
HPV vaccine get Pap tests more often
than women who have received HPV
vaccine? |
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| A: |
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No. Receipt of HPV vaccine
does not replace the need
for cervical cancer
screening. Women should
consult their healthcare
provider for
recommendations regarding
the frequency of cervical
cancer screening, which
includes Pap testing and
HPV testing. |
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| Q: |
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Is it acceptable practice to
administer MMR, Tdap, and influenza
vaccines to a postpartum mom at the
same time as administering RhoGam? |
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| A: |
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