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Question of the Week

May 2015 Back to top
May 26, 2015
Can MMR, varicella, and hepatitis A vaccines be given to a child whose mother is hepatitis C positive?
Yes. These vaccines should be administered at the routinely recommended ages. A history of hepatitis C in the mother or other household contact is not a contraindication for any vaccine.
IAC Express Issue 1184
May 19, 2015
For an adult who experienced probable thrombocytopenic purpura after one dose of MMR as a child, it is my understanding that they should not receive MMR vaccine. Is this correct? This person has a positive serology for mumps and rubella but not measles.
A history of thrombocytopenia is considered a precaution, not a contraindication to MMR vaccine. What that means is that a provider should weigh the benefits of giving a dose of vaccine, even given the history, if circumstances indicate that the risk of disease is high (such as in an outbreak setting).
IAC Express Issue 1183
May 12, 2015
How effective are the current pertussis vaccines and do they provide any protection against parapertussis?
DTaP vaccines are about 98% effective against pertussis within 1 year of receiving the fifth dose. However, 5 years later, protection declines to about 70%. Tdap vaccines are about 73% effective within 1 year of receiving a single dose. However, 2 to 4 years later protection declines to about 34%.
Parapertussis, like pertussis, can cause a whooping cough-like syndrome. Most studies agree that current pertussis vaccines provide limited to no immunity to parapertussis.
IAC Express Issue 1182
May 5, 2015
A 60-year-old patient will be starting corticosteroid therapy. He will start at 20 mg per day for 4 days, and then taper to 15 mg for 3 weeks. He will continue therapy for a year, but the dosing will change depending on his response. Should I administer zoster vaccine now or wait until he is taking a lower dose of corticosteroids? And if the patient should wait, what dose of corticosteroids would be safe for administration of the shingles vaccine?
Give the zoster vaccine now. Live vaccines should be deferred if a person is taking 20 mg or more of prednisone per day for 2 weeks or longer. An individual can receive a live virus vaccine (zoster in this case) one month after he is below 20 mg of prednisone (or equivalent) per day.
IAC Express Issue 1181
April 2015 Back to top
April 28, 2015
If MMR vaccine is given at 9 months of age, it will not count as the first dose. Is this because immunity at this age may not develop?
Studies indicate that about 86% of children vaccinated at 9 months of age respond to the vaccine while the estimate is about 97% for children vaccinated at 12 months or older. Maternal antibodies against measles virus may persist up to 11 months. For these reasons children vaccinated between 6 and 11 months of age should receive two more doses of MMR after their first birthday.
IAC Express Issue 1180
April 21, 2015
I have heard concerns from individuals who are undergoing chemotherapy about being exposed to a child who recently received MMR vaccine. Is there a risk for the vaccinated child to transmit vaccine virus to the chemotherapy patient?
MMR vaccine can be given to the healthy household contacts of immunosuppressed persons, such as those undergoing chemotherapy. Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, so MMR vaccination of a household contact does not pose a risk to an immunocompromised person.
IAC Express Issue 1179
April 14, 2015
In regard to the current measles outbreak, some people are saying that children who have not had the vaccine should pose no threat to vaccinated people. It is my understanding that during an outbreak, vaccinated people can still contract it. Am I correct?
You are correct that vaccinated people can still be infected with infections against which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such as measles, rubella, hepatitis B) to much lower (influenza this year 23%, and 60% in years with a good match of wild and vaccine viruses, and the acellular pertussis vaccines after 5 years or so offer only about 70% protection). Therefore, we encourage as many people as possible to be vaccinated, to avoid outbreaks, while working towards the development of better vaccines (such as for influenza and pertussis). More information is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.
IAC Express Issue 1178
April 7, 2015
If an infant got a dose of the adult formulation of hepatitis B vaccine in error, should the dose be counted? When should the next dose be scheduled for this infant? Do we need to be concerned about a possible adverse event?
If an infant received an adult dose of hepatitis B vaccine (contains twice the antigen in a dose of the infant/child formulation), the dose can be counted as valid and does not need to be repeated. Hepatitis B vaccine is a very safe vaccine and no unusual adverse events would be expected because of this administration error. The next (age appropriate) dose should be given on the usual schedule.
IAC Express Issue 1177
March 2015 Back to top
MARCH 31, 2015
I have a female patient who has a history of immune thrombocytopenia and had a splenectomy as treatment. This patient responded to the treatment. She is not currently on medication for this condition. How long after a splenectomy should a person wait before they get an MMR vaccination?
A history of thrombocytopenia is a precaution for MMR vaccine. If there is a risk of disease, the benefit of vaccination would outweigh the risk of vaccination, particularly since the thrombocytopenia has been treated. For more information on vaccination of persons with asplenia, see the "Question of the Week" for January 6, 2015.
IAC Express Issue 1175
MARCH 24, 2015
I need information about the administration of vaccines to 3-month-old conjoined twins (joined at the buttocks). The mother states that a hepatitis B vaccine was given at birth but there is no record of this. For their routine immunization, do we provide one set of vaccinations or two, given that they are conjoined at the buttock but share no major organs?
ACIP does not address this issue. However, CDC recommends that these children should each be vaccinated, notwithstanding they are conjoined. We believe even in conjoined twins who share organs and/or blood supply, vaccination of each child would also be indicated. The rationale is one cannot be sure, even in the latter case, that the common organs/blood supply would eliminate vaccine antigens less quickly, or the immune system(s) would respond adequately, to one dose of each vaccine for the two children. Therefore two doses seems appropriate, that is, one dose of each vaccine for each child.
IAC Express Issue 1173
MARCH 17, 2015
Can varicella vaccine be used as postexposure prophylaxis for a 9-month-old who was exposed to herpes zoster?
Varicella vaccine is neither approved nor recommended for children younger than age 12 months. Assuming that the child is not immunocompromised, varicella zoster immune globulin (VariZIG, Emergent BioSolutions Inc.) is also not recommended. If the child had a condition which was considered to place the child at greater risk for complications than the general population, then VariZIG could be considered (see www.cdc.gov/mmwr/pdf/wk/mm6228.pdf, page 574).
The Advisory Committee on Immunization Practices (ACIP) does not have a recommendation for acyclovir as varicella postexposure prophylaxis, although the American Academy of Pediatrics does provide some guidance on this issue in the 2012 edition of the Red Book.
IAC Express Issue 1171
MARCH 10, 2015
We have a 63-year-old patient who states she had tetanus as a child. She does not know whether she ever had any tetanus-containing vaccines in her lifetime. Should Tdap be given to this patient, and is it safe?
A history of tetanus disease is not a reason to avoid tetanus-containing vaccines. Tetanus disease does not produce immunity because of the very small amount of toxin required to produce illness. As long as your patient has no other contraindications she should receive Tdap now. If she has no documentation of prior tetanus vaccination, she should receive a complete 3-dose primary series (dose #1 of Tdap, followed by dose #2 of Td 4 to 8 weeks later, and dose #3 of Td 6–12 months after dose #2).
IAC Express Issue 1170
MARCH 3, 2015
A patient born in 1970 has a history of measles disease and is also immunosuppressed due to multiple myeloma. The patient wants to travel to California, but is concerned about the measles outbreak. Should the patient receive the MMR vaccine?
A history of having had measles is not sufficient evidence of measles immunity. A positive serologic test for measles-specific IgG will confirm that the person is immune and is not at risk of infection regardless of the multiple myeloma. Multiple myeloma is a hematologic cancer and is considered immunosuppressive so MMR vaccine is contraindicated in this person.
IAC Express Issue 1169
February 2015 Back to top
FEBRUARY 24, 2015
We received a call from a healthcare provider who inadvertently administered MMR vaccine to a woman who was 2 months pregnant. Please advise as to appropriate action steps. 
No specific action needs to be taken other than to reassure the woman that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy alone is not a reason to terminate the pregnancy. You should consult with the provider to determine if there is a way to avoid such vaccination errors in the future. Detailed information about MMR vaccination in pregnancy is included in the most recent MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.
IAC Express Issue 1168
FEBRUARY 17, 2015
How does being born before 1957 confer immunity to measles?
People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles (see www.cdc.gov/vaccines/vpd-vac/measles/faqs-dis-vac-risks.htm). Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered. Additional information is available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.
IAC Express Issue 1167
FEBRUARY 10, 2015
The Catch-Up Immunization Scheduler on the CDC Vaccines and Immunization website is not working. Can you please fix it? We use it to make schedules for Head Start children who are behind schedule.
The child immunization scheduler tool is no longer available. Please use your state or local immunization information system (IIS) for this service. If you are not familiar with your state or local IIS, you can find your state or local immunization program online where you can access your IIS or contact the program for assistance.
IAC Express Issue 1166
FEBRUARY 3, 2015
Our patient is a 78-year-old female who received PCV13 (Prevnar13, Pfizer), then received PPSV23 (Pneumovax 23, Merck) approximately 10 weeks later. She had not received PPSV23 previously. Is the PPSV23 dose valid, or does it need to be repeated?
Even though the interval was shorter than the recommended 6–12 months, the dose of PPSV23 should be counted and does not need to be repeated. In the future, please note the ACIP recommendations for pneumococcal vaccine-naive patients age 65 and older are as follows: The dose of PPSV23 should be given 6–12 months after a dose of PCV13. If PPSV23 cannot be given during this time window, the dose of PPSV23 should be given during the next visit. The two vaccines should not be coadministered, and the minimum acceptable interval between PCV13 and PPSV23 is 8 weeks. For more information, see ACIP recommendations: Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years.
IAC Express Issue 1165
January 2015 Back to top
JANUARY 27, 2015
A pediatric surgeon's 12-month-old child received the varicella vaccine and two days later developed a varicella-like rash. The surgeon had chickenpox as a child and had a positive varicella titer several years ago. Is it okay for the surgeon to continue to see patients? Also, is the varicella virus in the rash that develops following vaccination as virulent as the wild-type virus?
Because the surgeon is immune, the child's rash is not a problem and there is no need for the surgeon to restrict activity. In comparing a vaccine rash to wild-type chickenpox infection, transmission is less likely with a vaccine rash and, in general, there are fewer skin lesions.
IAC Express Issue 1164
JANUARY 20, 2015
If Kinrix (DTaP-IPV, GlaxoSmithKline) is inadvertently given to a child age 15 through 18 months, as the fourth DTaP dose and the third IPV dose, do the DTaP and IPV doses need to be repeated?
Since Kinrix is licensed and recommended only for children ages 4 through 6 years, you should take measures to prevent this error in the future. However, you can count this as a valid dose for DTaP and IPV as long as you met the minimum interval between administering dose #3 and dose #4 of DTaP (6 months) and dose #2 and dose #3 of IPV (4 weeks).
IAC Express Issue 1163
JANUARY 13, 2015
My patient is a 66-year-old male with a condition that requires treatment with intravenous immune globulin (IVIG) once a month. Can he receive zoster vaccine
Yes. The concern about interference by circulating antibody (from the IVIG), which we have for varicella vaccine, does not apply to zoster vaccine. The amount of antigen in zoster vaccine is high enough to offset any effect of circulating antibody. Also, studies of zoster vaccine were performed on patients receiving antibody-containing blood products with no appreciable effect on efficacy.
IAC Express Issue 1162
JANUARY 6, 2015
Do any of the bacterial vaccines that are recommended for people with functional or anatomic asplenia need to be given before splenectomy? Do the doses count if they are given during the 2 weeks prior to surgery?
Pneumococcal conjugate vaccine (PCV13), Haemophilus influenzae type b vaccine (Hib), and meningococcal conjugate vaccine (MCV4) should be given 14 days before splenectomy, if possible. Doses given during the 2 weeks (14 days) before surgery can be counted as valid. If the doses cannot be given prior to the splenectomy, they should be given as soon as the patientís condition has stabilized after surgery. Pneumococcal polysaccharide vaccine (PPSV23) should be administered 8 weeks after the dose of PCV13 for people 2 years of age and older.
IAC Express Issue 1161
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