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Question of the Week

Ask the Experts

Question of the Week

November 2017 Back to top
November 15, 2017
Are there recommendations for meningococcal ACWY vaccination for people who reside in homeless shelters or halfway houses? In addition, can you comment on general vaccination recommendations for people who reside in homeless shelters or halfway houses?
Residence in a homeless shelter or halfway house is not in itself considered a high-risk condition for any vaccine. Recommendations for vaccinating adult residents would be the same as those for all adults on the ACIP adult immunization schedule. Residents with medical conditions identified on Table 2 of the schedule should be vaccinated according to that table.
Any residents 18 or younger should be vaccinated according to the catch-up recommendations on the ACIP child/teen immunization schedule. People age 19 through 21 years are not recommended routinely to receive MenACWY. MenACWY may be administered through age 21 years as a catch-up vaccination for those who have not received a dose after their 16th birthday.
Question of the Week: IAC Express - Issue 1335
November 8, 2017
My 36-year-old patient was diagnosed with idiopathic thrombocytopenic purpura and had a splenectomy three weeks ago. Prior to the splenectomy, the patient had one dose each of Hib, MenB, PCV13, MenACWY (Menactra), and PPSV23 (separated from the PCV13 by 9 weeks). What vaccines are recommended now?
Since the patient is asplenic, the second dose of the primary series of MenACWY should be given 8–12 weeks after the first dose. He/she will need a dose of MenACWY every 5 years for the rest of his/her life. The patient has already received the one dose of PCV13 recommended for adults, so another dose of this vaccine is not needed. A second dose of PPSV23 is recommended at least 8 weeks after the dose of PCV13 AND at least 5 years since the last dose of PPSV23. A third (and final) dose of PPSV should be given after the patient turns age 65. The series of MenB (whether Trumenba or Bexsero) should be completed. The same MenB vaccine should be used for all doses in the series. Based on the patient’s age, the previous dose of Hib vaccine was administered when the patient was old enough to require only one dose of Hib vaccine, so another dose is not needed. The patient should receive influenza vaccine annually.
Any of these vaccines can be given simultaneously (at the same appointment, not in the same syringe) except for PCV13 and PPSV23, and PCV13 and Menactra. If Menactra is used for an asplenic person it should be separated from the PCV13 by at least 4 weeks. Menveo has no spacing restriction.
Question of the Week: IAC Express - Issue 1334
November 1, 2017
I am a pharmacist who administers vaccines. I was recently told by a colleague that pregnant healthcare personnel were not to administer live vaccines to others. I had never heard that in school or practice. Is that true?
This is not true. Pregnant healthcare personnel may administer any vaccine except smallpox vaccine.
Question of the Week: IAC Express - Issue 1333
October 2017 Back to top
October 25, 2017
Our patient is starting college with no documented doses of meningococcal ACWY vaccine and has had titers drawn. The lab test was positive for A, C, W, and Y. Lab reference values show >2.1 as "suggestive of protection." Can we accept this titer in lieu of documented MenACWY vaccine doses?
There are no acceptable serologic titers that can be used as evidence of protection against meningococcal A, C, W, and Y disease. In addition, the immunologic studies used for licensing purposes (serum bactericidal assay, SBA) are likely different from the serologic titers obtained at a doctor’s office (IgG antibody, for example). It is not clear what sort of testing is shown in the results you sent. However, even if SBA results are available, they cannot be used to assess whether there is a level of protection at the individual level.
Question of the Week: IAC Express - Issue 1332
October 18, 2017
I have a pregnant patient who is 26 weeks along and received a Tdap vaccine 2 1/2 months ago because of healthcare employment. Normally we give our pregnant patients Tdap between 27–36 weeks as recommended. Should we give her another dose of Tdap when she reaches 27 weeks gestation?
The Advisory Committee on Immunization Practices does not recommend Tdap more than once during a pregnancy. The Tdap she received earlier in pregnancy may not provide optimal protection from pertussis for the infant, but some protection is expected. More information can be found at https://www.cdc.gov/vaccines/pregnancy/pregnant-women/tdap.html.
Question of the Week: IAC Express - Issue 1331
October 11, 2017
Please explain why pneumococcal polysaccharide vaccine is recommended for smokers or people with diabetes younger than age 65 but pneumococcal conjugate vaccine is not recommended for these groups.
The level of risk for pneumococcal disease in smokers and people with diabetes is not as high as in immunocompromised persons, and persons with asplenia, HIV infection, hematologic cancer, or with cochlear implant. Because of the lower risk, ACIP recommended that smokers and people with diabetes receive only pneumococcal polysaccharide vaccine (PPSV, Pneumovax 23; Merck) once before age 65 years, and the pneumococcal conjugate vaccine (PCV, Prevnar 13; Pfizer) at age 65 years or older. At this age, pneumococcal disease rates increase regardless of health status. More information on this issue is available at https://www.cdc.gov/mmwr/pdf/wk/mm6140.pdf and https://www.cdc.gov/mmwr/pdf/wk/mm5934.pdf.
Question of the Week: IAC Express - Issue 1330
October 4, 2017
If you choose to give Trumenba brand MenB vaccine (Pfizer) to a 16-year-old with HIV infection (under the Category B recommendation for all adolescents), should you use the 2-dose (standard) schedule or the 3-dose (high-risk) schedule?
The CDC meningococcal subject matter experts recommend that the 3-dose Trumenba schedule should be used for people with HIV infection. People with HIV infection do not appear to be at higher risk for meningococcal serogroup B disease, but because of their HIV infection they might not respond to the vaccine as well, so the 3-dose schedule is preferred. When Bexsero brand MenB vaccine (GSK) is used, the schedule is 2 doses, regardless of risk status.
Question of the Week: IAC Express - Issue 1329
September 2017 Back to top
September 27, 2017
Is it okay to administer rotavirus vaccine and immune globulin at the same time?
Yes. The effectiveness concerns with antibody-containing blood products (ACBP) do not apply to rotavirus vaccine, since it is administered orally and replication of the vaccine virus occurs in the GI tract, “separate” from the site of the ACBP. Note that the child should be carefully screened for other potential contraindications or precautions to vaccination since administration of immune globulin could indicate immunosuppression.
Question of the Week: IAC Express - Issue 1328
September 20, 2017
A 22-year-old female is going to pharmacy school and the school wants her to have a second dose of MMR vaccine. She had the first dose as a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not immune to rubella. Can I give her a second dose of the MMR with her having measles after the first dose?
Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. There is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles only one day after getting her first MMR, she must have been exposed to the disease prior to vaccination.
Question of the Week: IAC Express - Issue 1327
September 13, 2017
My adult patient is traveling to Nigeria in three days. She is already immune to hepatitis A, but we want to provide protection for hepatitis B. She received Twinrix two weeks ago and then a dose of single-component hepatitis B vaccine one week ago. How can we best provide protection in this circumstance?
Even though ACIP does not recommend an accelerated hepatitis B vaccine schedule in routine circumstances, a 4-dose series at 0, 7, 14 days, and 6 months is acceptable (see https://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf, page 27). Although this schedule deviates from the routine recommendation, travel is imminent. Give a dose of hepatitis B vaccine now which will complete 3 of the 4-dose accelerated schedule. She will need a fourth and final dose 6 months after the first dose in the accelerated schedule.
Question of the Week: IAC Express - Issue 1325
September 6, 2017
A 5-year-old patient received Pentacel (DTaP-IPV/Hib) for the 5th dose of DTaP instead of Quadracel (DTaP-IPV). Can I count the Pentacel as a valid dose or will we need to revaccinate this patient?
While administration of Pentacel to a 5-year-old would be considered off-label and a vaccine administration error, the doses of DTaP and IPV can be counted as valid and do not need to be repeated. Hib vaccine is not routinely administered after a child has reached the age of 5 years so it is also a vaccine administration error. You should explain this error to the parents and assure them that the extra Hib dose will cause no harm.
Question of the Week: IAC Express - Issue 1324
August 2017 Back to top
August 30, 2017
I have a healthy 11-month-old patient whose family is traveling to Zimbabwe. Where they are traveling has a high rate of varicella. Should I give varicella vaccine to the infant before she travels to Africa?
The Advisory Committee on Immunization does not recommend varicella vaccination before 12 months of age. It is likely safe to vaccinate the child, but maternal antibodies may limit the benefits of vaccination. If you choose to vaccinate, the child should receive two more doses of varicella vaccine, at 12 months of age or older, separated by at least three months.
Question of the Week: IAC Express - Issue 1323
August 23, 2017
Is there any plan to change the Influenza Vaccine Information Statement (VIS) for the 2017–2018 influenza season?
The current influenza vaccine VIS may be used for the 2017–2018 influenza season. No changes are planned.
Question of the Week: IAC Express - Issue 1322
August 16, 2017
If a patient received Trumenba meningococcal B vaccine (Pfizer) 2 months ago and Bexsero meningococcal B vaccine (GSK) yesterday, should they complete the series with Trumenba or with Bexsero since the two brands are not interchangeable? What would be the intervals from the Bexsero dose to the subsequent dose(s)?
The patient can complete the series with either vaccine. If Bexsero is chosen, the second and final dose should be administered at least 1 month after yesterday's dose. If Trumenba is chosen and the patient is healthy (i.e., does not have a high-risk condition for meningococcal B disease such as asplenia), the second and final dose of Trumenba should be administered at least 4 months after yesterday's Bexsero dose. If the person is at increased risk for meningococcal B disease and Trumenba is being used, a second Trumenba dose should be administered 1 month after yesterday’s Bexsero dose and a third dose should be administered 4 months after the second Trumenba dose.
Question of the Week: IAC Express - Issue 1320
August 9, 2017
What is the schedule for hepatitis B vaccine administration for infants who weigh less than 2000 grams? I read that the birth dose should still be given in the hospital, but what would the schedule be after that?
Decreased seroconversion rates might occur among certain preterm infants (i.e., with low birth weights [less than 2,000 grams]) after administration of hepatitis B vaccine at birth. However, by the chronological age of 1 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 immunoprophylaxis with hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. The initial vaccine dose should not be counted toward completion of the hepatitis B series, and 3 additional doses of hepatitis B vaccine should be administered, beginning when the infant is age 1 month. Infants weighing less than 2,000 g born to HBsAg-negative mothers should receive the first dose of the hepatitis B series at chronological age 1 month or at hospital discharge, whichever comes first.
Question of the Week: IAC Express - Issue 1319
August 2, 2017
How long can reconstituted MMR vaccine be stored in a refrigerator before it must be discarded?
The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is usually outlined somewhere in the vaccine’s package insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. Handout can be found at the following link: www.immunize.org/catg.d/p3040.pdf.
Question of the Week: IAC Express - Issue 1318
July 2017 Back to top
July 26, 2017
In the past, CDC has recommended to only accept patient-reported history for influenza and pneumococcal polysaccharide vaccines. Is the recommendation to not accept a patient-reported history of pneumococcal conjugate vaccine?
ACIP's recently published "General Best Practice Guidelines for Immunization" still states that a patient’s undocumented history can be accepted as proof of vaccination only for influenza and pneumococcal polysaccharide vaccines. See https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/programs.html. CDC intends to collect data to determine if patients can distinguish between the two pneumococcal vaccines, or if records should be sought for all pneumococcal vaccines.
Question of the Week: IAC Express - Issue 1317
July 19, 2017
What is the dosing for tetanus immune globulin for an adult with suspected tetanus?
ACIP recommends a single dose of tetanus immune globulin (TIG) for treatment of persons with tetanus. Although the optimal therapeutic dose has not been established, experts recommend 500 international units (IU), which appears to be as effective as higher doses ranging from 3,000 to 6,000 IU and causes less discomfort. Available preparations must be administered intramuscularly; TIG preparations available in the United States are not licensed or formulated for intrathecal or intravenous use. Infiltration of part of the dose locally around the wound is usually recommended if feasible, although the efficacy of this approach has not been proven. If TIG is not available, intravenous immune globulin (IGIV) can be used at a dose of 200 to 400 milligrams per kilogram (mg/kg). However, the Food and Drug Administration has not approved IGIV for this use. In addition, anti- tetanus antibody content varies from lot to lot. See https://www.cdc.gov/tetanus/clinicians.html for more information on this issue.
Question of the Week: IAC Express - Issue 1316
July 12, 2017
Is it acceptable to administer vaccines in the nurses’ station where vital signs and other patient care is performed?
Yes. Vaccines can be administered in a patient care area. The recommendation from CDC's safe injection practices experts is that storing and preparing vaccines should not be done in the same area where patient care is conducted. These activities should be done in a separate area.
Question of the Week: IAC Express - Issue 1315
July 6, 2017
How effective are three doses of MMR vaccine compared to two doses for the prevention of mumps during an outbreak?
There are no published estimates of the effectiveness of a third dose of mumps-containing vaccine in the setting of a mumps outbreak. However, CDC recommends that a third dose of MMR may be offered in certain outbreak settings (e.g., when a large proportion of cases are in 2-dose MMR recipients). Information about mumps and mumps outbreaks is available on the CDC website at https://www.cdc.gov/mumps/outbreaks.html.
The Advisory Committee on Immunization Practices (ACIP) has established a Mumps Work Group to examine the epidemiology of mumps in more detail and to further assess the utility of a third dose of MMR vaccine in these outbreak situations.
Question of the Week: IAC Express - Issue 1314
June 2017 Back to top
June 28, 2017
How can I get yellow fever vaccine? Is there a vaccine shortage?
Yes, there is a yellow fever vaccine (YF-Vax) shortage. If you are a healthcare provider who administers yellow fever vaccine, you can no longer place an order for YF-Vax online. You must call Sanofi Pasteur at 1-800-VACCINE (1-800-822-2463), and a customer service representative will work with you to determine how many doses can be shipped and which vial sizes (single dose or 5 dose). YF-Vax doses will be prioritized for patients who are traveling in the next 30 days to an area where yellow fever vaccine is required or recommended.
Healthcare providers should refer to the section titled Yellow Fever and Malaria Information, by Country (https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/yellow-fever-malaria-information-by-country) in CDC Health Information for International Travel 2018 ("The Yellow Book”) for information about which countries require yellow fever vaccination for entry and for which countries CDC recommends yellow fever vaccination. In the absence of a country requirement, CDC does not recommend yellow fever vaccination if the traveler’s itinerary does not include travel to a yellow fever–endemic area.
This information can be found at https://wwwnc.cdc.gov/travel/news-announcements/yellow-fever-vaccine-shortage-2016.
Question of the Week: IAC Express - Issue 1313
June 21, 2017
We received a report of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated?
The rotavirus vaccine dose given by the intramuscular route is not valid and should be repeated by the oral route as soon as possible. In a review of such rotavirus vaccine administration errors, there usually were not adverse reactions, and those documented were limited to local reactions and general, brief irritability. Please see https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6304a4.htm for more information.

Please take steps to ensure that such vaccine administration errors are avoided in the future. This event should be reported to the Vaccine Adverse Event Reporting System at https://vaers.hhs.gov even if an adverse reaction does not result from it.
Question of the Week: IAC Express - Issue 1312
June 14, 2017
The package insert for VaxChora oral cholera vaccine states that effectiveness and safety have not been established for revaccination or for individuals with previous immunity. Does the CDC have any recommendations on revaccination or is one dose considered lifetime immunity at this time?
At this time, CDC does not have any recommendation related to revaccination with oral cholera vaccine. The duration of immunity following one dose is unknown. As more information becomes available, CDC will update its recommendations accordingly.
Question of the Week: IAC Express - Issue 1310
June 7, 2017
If someone received MPSV4 or MenACWY at age 9 years, will two additional doses of MenACWY be needed?
Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the routine 2-dose series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.
Question of the Week: IAC Express - Issue 1309
May 2017 Back to top
May 31, 2017
Does live oral cholera vaccine need to be administered at an interval from other live oral or injectable vaccines?
In general, no. According to ACIP's General Best Practice Guidelines for Immunization, concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. So live oral cholera vaccine may be administered simultaneously or at any interval before or after administration of most other vaccines. One exception is Ty21a oral typhoid vaccine and oral cholera vaccine. Oral cholera vaccine should be administered before Ty21a vaccine, and 8 hours should separate the cholera vaccine and the first dose of Ty21a.
Question of the Week: IAC Express - Issue 1308
I have a 3-month-old patient whose family will be doing mission work in sub-Saharan Africa. They are leaving as soon as the child is 6 months old. We gave her the first dose of Menveo brand MenACWY vaccine today. I know the usual Menveo schedule for an infant is 2, 4, 6, and 12 months. If we maintain usual spacing, she will only get 1 more dose before she leaves. Can we compress the schedule so she can get 2 more doses prior to travel?
The meningococcal ACIP recommendations don't clearly state a minimum interval for MenACWY in this situation. However, the minimum interval for a pediatric MenACWY schedule would presumably be 4 weeks like for other pediatric vaccines on a 2-4-6 schedule. You should try to give a third dose before travel begins.
Question of the Week: IAC Express - Issue 1307
May 17, 2017
A 16-year-old refugee's record indicates 2 doses of Td separated by 1 month and 1 dose of Tdap given 4 months after the second Td. Is he up to date?
The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td 6 months after the invalid Tdap dose. If Td is not available, Tdap can be used for this dose.
Question of the Week: IAC Express - Issue 1306
May 10, 2017
I had an 18-year-old in the clinic today for varicella vaccination. He reports having antiphospholipid syndrome being treated with rituximab (a drug that affects the function of B lymphocytes). The next dose of rituximab will be in 2 weeks. He has also had 12 immune globulin (IG) injections in the last year. Should he get the varicella vaccine at all with this condition, and if so, what time frame do we need to be concerned with in relation to the rituximab treatment and/or IG?
The Infectious Diseases Society of America guidelines indicate that persons receiving rituximab should be considered to have high-level immunosuppression. Both inactivated and live vaccines should be withheld at least 6 months following treatment with anti-B cell medications such as rituximab. As for the IG, the interval to live vaccination depends on the dose. Please refer to the table on pages 37–39 of the "General Best Practices Guidelines for Immunization" at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf for guidance. This interval could be as long as 11 months, depending on the dose he receives.
Question of the Week: IAC Express - Issue 1305
May 3, 2017
We have a 45-year-old patient taking Mesalamine for ulcerative colitis. Should he receive PCV13 and/or PPSV23?
Mesalamine (mesalazine) is a non-steroidal anti-inflammatory drug. It is not immunosuppressive, so its use would not be an indication for early pneumococcal vaccination with either of these vaccines (i.e., prior to the routine vaccination age of 65 years).
Question of the Week: IAC Express - Issue 1304
April 2017 Back to top
April 26, 2017
My 11-year-old patient received a dose of Tdap when he was 7 years old. He also received a dose of Td 6 months later in order to finish a primary series of tetanus-toxoid. Can I give him a dose of Tdap now?
Yes. Footnote 12 of the 2017 child and adolescent immunization schedule (available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html) states that a child who receives a dose of Tdap between 7 through 10 years of age as part of the catch-up series (as in this case), may receive another dose of Tdap at age 11 or 12 years.
Question of the Week: IAC Express - Issue 1302
April 19, 2017
Tenivac Td (Sanofi Pasteur) for adults is expected to be unavailable until the second half of 2017. Another Td vaccine produced by MassBiologics is available at our wholesaler, but it looks like the components are slightly different from Tenivac. Are the two products interchangeable during the shortage?
Yes, the Td products are equivalent and interchangeable.
Question of the Week: IAC Express - Issue 1299
April 12, 2017
A 5-year-old is in the office for vaccines and is due for MMR, polio, varicella, and DTaP. Is there a specific order I should be giving these vaccines?
The Advisory Committee on Immunization Practices (ACIP) does not address this issue. There is no recommended order in which the vaccines should be given. A best practice strategy to decrease injection or procedural pain is to administer the vaccine that causes the most pain (stinging, for example) last. For more information on vaccine administration, please see the "Vaccine Administration" chapter of Epidemiology and Prevention of Vaccine-Preventable Diseases at www.cdc.gov/vaccines/pubs/pinkbook/chapters.html.
Question of the Week: IAC Express - Issue 1298
April 5, 2017
A 7-year-old has a history of 3 doses of DTaP, appropriately spaced, between 4 years and 6 years of age. Is her DTaP series complete?
Although the child would be considered complete for tetanus and diphtheria toxoids, she is not complete for pertussis vaccine. ACIP recommends that children age 7 through 10 years who are not fully vaccinated against pertussis (defined as 5 doses of DTaP or 4 doses of DTaP if the fourth dose was administered on or after the fourth birthday) and who do not have a contraindication to pertussis vaccine should receive a single dose of Tdap to provide protection against pertussis. The child may also receive an additional dose of Tdap at 11 or 12 years of age. See MMWR 2011;60(No.1):13–15 and footnote 12 of the 2017 child and adolescent immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html.
Question of the Week: IAC Express - Issue 1297
March 2017 Back to top
March 29, 2017
If a person received a Tdap vaccine and then had a positive pertussis PCR two weeks later, could it be a false positive from the vaccine or should we consider this a case of pertussis? The patient had a cough, nausea, and vomiting for 2–3 days prior to PCR testing.
Recent Tdap vaccination does not affect PCR testing. PCR tests are used to detect DNA sequences of the Bordetella pertussis bacterium. PCR tests are very sensitive and could give a false positive result for other reasons. For more information on the interpretation of pertussis diagnostic tests, see www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html.
Question of the Week: IAC Express - Issue 1296
March 22, 2017
If a patient receives hepatitis B vaccine while undergoing hemodialysis, will the vaccine be effective? Will the dose need to be repeated?
Neither the Advisory Committee on Immunization Practices (ACIP) nor the manufacturers address the timing of vaccination and dialysis. Persons with end-stage renal disease including predialysis, hemodialysis, peritoneal dialysis, and home dialysis should be tested for hepatitis B surface antibody (anti-HBs) 1–2 months after vaccination, and annually. If the anti-HBs level is below 10mIU/mL, they should be revaccinated. See www.cdc.gov/mmwr/PDF/rr/rr5516.pdf, page 27, for more information.
Question of the Week: IAC Express - Issue 1295
March 15, 2017
What are the recommendations for use of the new oral cholera vaccine?
CVD 103-HgR (Vaxchora, PaxVax) cholera vaccine was approved by the Food and Drug Administration in June 2016. ACIP has not yet published recommendations for Vaxchora. However, at their June 2016 meeting, ACIP voted to recommend vaccination for adults 18 through 64 years old traveling to areas of active cholera transmission. An area of active cholera transmission is defined as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1 and includes areas with cholera activity within the last 1 year that are prone to recurrence of cholera epidemics; it does not include areas where rare sporadic cases have been reported. No country or territory currently requires vaccination against cholera as a condition for entry.

In addition to vaccination, all travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary prevention strategies against cholera infection. Travelers who develop severe diarrhea should promptly seek medical attention for rehydration therapy.
Question of the Week: IAC Express - Issue 1294
March 8, 2017
Are there recommendations for administering Tdap when Td is not available?
If Td is indicated but unavailable, Tdap should be administered in place of Td, and administration should include persons who previously received Tdap.
Question of the Week: IAC Express - Issue 1293
March 1, 2017
If a child falls behind on immunizations, is it recommended to use only minimum intervals to get the child caught up? Or should we use a minimum interval for the same vaccine only once?
If a child is behind on immunizations, the Advisory Committee on Immunization Practices (ACIP) recommends using the minimum intervals between each dose until the child is caught up. The minimum interval for a vaccine can be used as many times as necessary, until the child is back on schedule.
Question of the Week: IAC Express - Issue 1292
February 2017 Back to top
February 22, 2017
Is systemic lupus erythematosus (SLE, lupus) a risk-based indication for pneumococcal vaccines?
Lupus per se is not an indication for either pneumococcal vaccine. However, immunosuppressive medication that may be used to treat lupus could create an indication for administering both pneumococcal vaccines. Also, if the patient has certain complications of lupus (such as nephrotic syndrome), the person would be a candidate for pneumococcal vaccines. Both immunosuppression and nephrotic syndrome are indications for administering both PCV13 (Prevnar, Pfizer) AND PPSV23 (Pneumovax, Merck). Administer PCV13 first, then PPSV23 8 weeks later. A handy document that summarizes indications for both pneumococcal vaccines is available at www.immunize.org/catg.d/p2019.pdf.
Question of the Week: IAC Express - Issue 1291
February 15, 2017
A patient recently exposed to a bat received the rabies vaccine series. One of the doses was given in the gluteus. Does this dose count?
No. Doses of rabies vaccine given in the gluteus should not be counted as valid and should be repeated. If repeating the invalid dose results in an interval between doses more than 3 days longer than the recommended interval, then you should perform a rabies serology 7–14 days after administration of the final dose in the series to ensure an adequate immune response to the series. For more information, see www.cdc.gov/mmwr/pdf/rr/rr5902.pdf.
Question of the Week: IAC Express - Issue 1290
February 8, 2017
I have a patient who is 62 years old and is immigrating to the U.S. She received a dose of zoster vaccine 2 months ago. The immigration requirements state she should receive 2 doses of varicella vaccine. Does she need additional varicella vaccine?
To meet the immigration requirements, the dose of zoster vaccine counts as the first dose of the varicella vaccine series. You should give a dose of varicella vaccine now since it has been more than 4 weeks since the dose of zoster vaccine. The varicella vaccine dose may not be needed, but it will not be harmful and will allow your patient to meet the regulatory requirement.
Question of the Week: IAC Express - Issue 1289
February 1, 2017
I have a patient who was diagnosed with HPV types 16 and 18. The patient received a properly spaced Gardasil series in 2006 when she was 25 years old. Did the HPV vaccine she received in 2006 fail to protect her?
In clinical trials, HPV vaccines were shown to be highly effective (more than 95%) for prevention of HPV vaccine-type infection and disease among persons without prior infection. The most likely explanation for this situation is that the patient was sexually active prior to vaccination and was infected with HPV before she was vaccinated.
Question of the Week: IAC Express - Issue 1288
January 2017 Back to top
January 25, 2017
I have a patient who received inactivated influenza vaccine in Brazil in September 2016. Does he need to be revaccinated with the current U.S. formulation?
No. The southern hemisphere influenza vaccine formulation for 2016 contains the same viruses in both trivalent and quadrivalent vaccines as the northern hemisphere vaccine for the 2016–17 season.
Question of the Week: IAC Express - Issue 1287
January 18, 2017
A dose of Kinrix (DTaP-IPV; GSK) should have been administered to a 4-year-old, but Pentacel (DTaP-IPV-Hib; Sanofi Pasteur) was administered instead. Does the dose of DTaP count?
Yes. The DTaP in the Pentacel can be counted. Although Pentacel is licensed as a 4-dose series and this may represent a fifth dose of Pentacel (in which case it would be off-label use), the dose of DTaP counts as the fifth dose of DTaP.
Question of the Week: IAC Express - Issue 1286
January 11, 2017
When I was 5 years old, I had Guillain-Barré syndrome (GBS) unrelated to vaccination. I am now 35 with no residual effects of the GBS. I am a nurse and my facility requires employees to receive influenza vaccine. Is it safe for me to be vaccinated?
Yes. A history of GBS unrelated to influenza vaccine is not a contraindication or precaution to influenza vaccination. GBS within 6 weeks following a previous dose of influenza vaccine is considered a precaution for use of influenza vaccines.
Question of the Week: IAC Express - Issue 1285
January 4, 2017
We have had three employees who have tested positive for influenza by nasal swab within 2 weeks of receiving Fluarix Quadrivalent vaccine. Is there a time period after receiving influenza vaccine that a nasal swab can give a false positive result?
Inactivated influenza vaccines, including Fluarix, are not known to cause false positive nasal swab tests. However, false positive test results are possible with rapid tests, and these are more likely to occur when influenza prevalence in the area is low. For more information regarding interpretation of rapid influenza tests see www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm.
Question of the Week: IAC Express - Issue 1284
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