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Question of the Week

February 2016 Back to top
February 10, 2016
If someone is older than 55 years and had their spleen removed, are they recommended for meningococcal polysaccharide vaccine or meningococcal conjugate vaccine?
Meningococcal conjugate vaccines (MCV4) are licensed for persons through age 55 years. For persons older than 55 years with a high-risk medical condition (such as asplenia), the Advisory Committee on Immunization Practices (ACIP) recommends off-label use of MCV4. Asplenic persons should receive a primary series of two doses of MCV4 separated by eight weeks, followed by a dose every five years thereafter. These recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf, page 15.
IAC Express - Issue 1229
February 3, 2016
We have an 18-year-old male who had a history of chickenpox disease. He now has shingles. We are unsure what we are to advise for future treatment. Should we administer zoster vaccine?
The Advisory Committee on Immunization Practice does not recommend zoster vaccination for people younger than age 60 years regardless of their history of shingles. Zoster vaccine is licensed by the Food and Drug Administration for people age 50 years and older so a clinician may choose to vaccinate a person 50 through 59 years of age. Insurance may not pay for a dose of zoster vaccine given to a person younger than age 60 years.
IAC Express - Issue 1228
January 2016 Back to top
January 27, 2016
What is the schedule for hepatitis B vaccination for infants weighing less than 2000 grams? I read that the birth dose should still be given in the hospital, but what would be the schedule after that?
Decreased seroconversion rates might occur among preterm infants with low birth (less than 2,000 grams) after administration of hepatitis B vaccine at birth. However, by the chronological age of one month, all preterm infants, regardless of initial birth weight, are likely to respond as adequately as larger infants.
Preterm infants born to HBsAg-positive women and women with unknown HBsAg status must receive hepatitis B vaccine within 12 hours after birth. The initial vaccine dose should not be counted toward completion of the hepatitis B series, and three additional doses of hepatitis B vaccine should be administered, beginning when the infant is age one month. For mothers with unknown HBsAg status, attempts should be made to determine HBsAg status. The infant also must be given HBIG within 12 hours of birth unless the mother is found to be HBsAg negative. Infants weighing less than 2,000 grams born to HBsAg-negative mothers should receive the first dose of the hepatitis B series at chronological age one month or at hospital discharge.
IAC Express - Issue 1226
January 20, 2016
An 86-year-old patient came in today and stated he needed a pneumococcal vaccine booster. He reports receiving a dose of "pneumonia vaccine" when he was 77 years old. Which pneumococcal should he receive today, PCV13 or PPSV23?
It is unlikely that the previous dose of pneumococcal vaccine was PCV13, since this vaccine was not routinely recommended for any adult population nine years ago. The patient most likely received pneumococcal polysaccharide vaccine (PPSV23). A dose of PCV13 should be given now. People who receive PPSV23 after age 65 years are not recommended to receive additional doses of PPSV23.
IAC Express - Issue 1225
January 13, 2016
If an egg-free influenza vaccine (FluBlok, Protein Sciences) was given inadvertently to a person younger than 18 years, can it be counted? Would there be any adverse side effects from this error?
Flublok is not licensed for persons younger than 18 years of age, so there are no data regarding safety and efficacy in this age group. However, no serious side effects would be expected. The dose does not need to be repeated. Even if no adverse reaction occurs, we request that vaccine administration errors like this be reported to the Vaccine Adverse Events Reporting System at www.vaers.hhs.gov.
IAC Express - Issue 1224
January 6, 2016
If a patient received Trumenba (MenB; Pfizer) two months ago and Bexsero (MenB, GSK) yesterday, should they complete the series with two additional doses of Trumenba or one more of Bexsero since the two brands are not interchangeable? What would be the interval from the Bexsero to the next dose?
The patient can complete the series with either vaccine. If Bexsero is chosen, the next dose (Bexsero #2) should be administered at least one month after yesterday’s dose. The Bexsero #2 would be the final dose. If Trumenba is chosen, the next dose (Trumenba #2) should be administered at least one month after yesterday’s Bexsero dose. The one-month interval between doses of Trumenba and Bexsero is recommended because one component (FHbp) is contained in both of the vaccine products and there is concern about potential interference. The final dose (Trumenba #3) should be administered four months after Trumenba #2.
IAC Express - Issue 1222
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