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Question of the Week

July 2014 Back to top
JULY 22, 2014
Can you please guide me in finding storage containers and bins for vaccines?
CDC recommends the use of bins, baskets, or some other type of uncovered containers that allow for organization and air circulation for vaccines and diluents within the storage unit. Storage in any boxes or bins can help maintain temperature longer, especially if power is lost. Perforated bins may allow for better air circulation around the vaccine, thus helping to maintain correct temperature.
CDC does not have a specific recommendation for brands of containers or bins for storage of vaccine. We recommend that you contact your state immunization program, as they may find resources for purchasing this equipment. If you are a Vaccines for Children (VFC) program provider, you should contact your immunization program to ensure that you are in compliance with VFC policy.
JULY 15, 2014
We have an adult who was diagnosed with polio as a child with some residual effects. This adult will be traveling overseas and the CDC travel website recommends a dose of polio vaccine. Should he be vaccinated with polio vaccine even though he had polio in the past?
Immunity to one of the serotypes of polio does not produce significant immunity to the other serotypes. A history of having recovered from polio disease should not be considered evidence of immunity to polio. It would be appropriate to vaccinate this adult if he will be traveling to an area for which polio vaccination is recommended.
JULY 8, 2014
Should adult patients who are not asplenic but who have hypogammaglobulinemia receive Haemophilus influenzae type b (Hib) conjugate vaccine? The February 2014 Hib ACIP statement includes immunoglobulin deficiency in its "high-risk groups" for Hib disease, but the recommendations seem to imply that Hib vaccine is not necessarily for adults with immunoglobulin deficiency whose spleens are intact. Am I interpreting ACIP correctly on this matter?
You are interpreting the recommendations correctly, and age is an important factor in this issue. The recommendation for Hib vaccination for asplenia applies to persons of all ages. The recommendation for Hib vaccination for immunoglobulin deficiency applies only to children 12 through 59 months of age.
JULY 1, 2014
Many travelers do not return for their second dose of hepatitis A vaccine and present years later, about to travel again. Is there a maximum interval between the first and second doses of hepatitis A vaccine? Should the series be restarted if it has been 5 or more years since the first dose?
No. There is no maximum interval between doses of hepatitis A vaccine. An interruption in the vaccination schedule does not require restarting the entire series of any other vaccine or toxoid or addition of extra doses, with the exception of oral typhoid vaccine. See the ACIP's "General Recommendations on Immunization" at www.cdc.gov/mmwr/pdf/rr/rr6002.pdf, page 10.
June 2014 Back to top
JUNE 24, 2014
I have a five-month-old patient who received hepatitis B vaccine at birth, at 2 months, and at 5 months of age. I realize that the third dose was given too early and so the child should be given another dose after they turn 6 months old. However, I am unclear how long I have to wait to give the fourth (repeat) dose? Is it 4 or 8 weeks?
This is addressed in the ACIP’s General Recommendations on Immunization: "Doses of any vaccine administered 5 or more days earlier than the minimum interval or age should not be counted as valid doses and should be repeated as age appropriate. The repeat dose should be spaced after the invalid dose by the recommended minimum interval” (see www.cdc.gov/mmwr/pdf/rr/rr6002.pdf, page 5 and Table 1, page 36). So in this situation you would repeat the dose 8 weeks after the invalid dose.
JUNE 17, 2014
Is there any harm in giving an extra dose of MMR to a child of age seven years whose record is lost and the mother is not sure about the last dose of MMR?
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 the ACIP's General Recommendations on Immunization at www.cdc.gov/mmwr/pdf/rr/rr6002.pdf, page 8.
Vaccination providers frequently encounter people 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, 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.
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 receive age-appropriate vaccination. Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, hepatitis A, diphtheria, and tetanus).
JUNE 10, 2014
For the purpose of vaccine spacing, what constitutes a month: 28 days (4 weeks), 30 days, or 31 days?
For intervals of 3 months or less, you should use 28 days (4 weeks) as a "month." For intervals of 4 months or longer, you should consider a month a "calendar month": the interval from one calendar date to the next a month later. This is a convention that was introduced on the childhood schedule in 2002 and discussed in the paper "Evaluation of Invalid Vaccine Doses" (Stokley S, Maurice E, Smith PJ, et al. American Journal of Preventive Medicine, 2004: 26[1]: 3440).
JUNE 3, 2014
Is pneumococcal polysaccharide vaccine (PPSV23) contraindicated in pregnancy? Our patient has asthma and is pregnant.
No. According to the 2014 adult immunization schedule, PPSV23 is recommended in pregnancy if some other risk factor is present (e.g., on the basis of medical, occupational, lifestyle, or other indications). See footnote 9 of the 2014 adult immunization schedule at www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf.
May 2014 Back to top
MAY 27, 2014
If a woman's rubella test result shows she 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?
In 2013 ACIP changed its recommendation for this situation. It is now recommended that women of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity. This is the only situation where ACIP recommends a third dose of MMR vaccine. MMR should not be administered to a pregnant woman.
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This page was reviewed on July 22, 2014
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