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Ask the Experts

Question of the Week

December 2015 Back to top
December 23, 2015
A dose of live attenuated influenza vaccine (LAIV, Flumist) was inadvertently given to a 20-month-old. It was the first time the child had received influenza vaccine. Does the LAIV dose need to be repeated? We plan to give pediatric inactivated vaccine as dose #2 in one month.
The minimum approved age for LAIV is age 2 years. However, you can count the dose of LAIV because this vaccine has been demonstrated to be effective in children 1–2 years of age. You are correct that the second dose should be a pediatric dose of inactivated influenza vaccine. You should take steps to avoid this sort of vaccine administration error in the future. 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 - December 23, 2015
December 16, 2015
We are having difficulty getting meningococcal polysaccharide vaccine (MPSV4, Menomune, Sanofi). Does CDC have a recommendation for the use of meningococcal conjugate vaccine (MCV4) off label in vaccine-naïve older adults?
A meningococcal conjugate immunogenicity study in older adults indicated that this group did not have as high of an antibody response to serogroup Y compared to older adults who received polysaccharide vaccine. There is much more polysaccharide in MPSV4 (50 micrograms per serogroup) compared to MCV4 (5–10 micrograms per serogroup), which is thought to be the reason for the better response to polysaccharide vaccine in older adults. However, if there is an urgent need for travel, it is reasonable to administer MCV4 if MPSV4 is not available. If the need for vaccination is not urgent, awaiting availability of MPSV4 is preferred.
ACIP recommends that for meningococcal vaccine-naïve persons age 56 years or older who anticipate requiring a single dose of meningococcal vaccine (such as travelers and persons at risk as a result of a community outbreak), MPSV4 is preferred. For persons now age 56 years or older who were vaccinated previously with MCV4 and are recommended for revaccination or for whom multiple doses are anticipated (such as persons with asplenia and microbiologists), MCV4 is preferred. These recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6202.pdf, page 15.
IAC Express - December 16, 2015
December 9, 2015
There is a debate within my clinical department about not allowing influenza vaccine to be given with DTaP and PCV13. Are there data that state these should not be given concomitantly?
A CDC study has shown a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and the Advisory Committee on Immunization Practices (ACIP) recommends giving these vaccines at the same visit if indicated. See www.cdc.gov/vaccinesafety/concerns/febrile-seizures.html for more information.
IAC Express - December 9, 2015
December 2, 2015
We see many patients with multiple co-morbidities (COPD, heart disease, diabetes, dialysis, etc.). Which influenza vaccine should we give to this patient population?
A person with chronic medical conditions should receive only inactive influenza vaccine. The vaccine should be given only to persons of the approved age range for that vaccine. For persons for whom more than one type of vaccine is appropriate and available, ACIP does not express a preference for use of any particular product over another.
IAC Express - December 2, 2015
November 2015 Back to top
November 25, 2015
It has just come to my attention that the plumbers working for our plumbing contractor receive hepatitis A vaccine because of their exposure to sewage. Is this a CDC recommendation?
Hepatitis A vaccine is not routinely recommended for workers exposed to sewage. More information on this topic can be found in the ACIP hepatitis A recommendations, available at www.cdc.gov/mmwr/PDF/rr/rr5507.pdf (page 8). However, it is important to ensure that people exposed to sewage in their work stay current on their tetanus vaccination with a routine booster dose every 10 years.
IAC Express - November 25, 2015
November 18, 2015
Do you have any information on the use of aborted fetal cells in vaccine development?
Please see this article which summarizes the use of cells which produced the MRC5 and WI138 cell lines for certain vaccines used in humans: http://www.historyofvaccines.org/content/articles/human-cell-strains-vaccine-development.
The cells were taken from infants aborted for other reasons, and no new cells have been harvested since the 1960s. Rubella vaccine is one of those developed with such cells. Other commonly used vaccines from these cell lines include hepatitis A vaccines, varicella vaccine, and zoster (shingles) vaccine.
The National Council of Catholic Bishops has deemed use of such vaccines acceptable, if no other alternatives exist.
IAC Express - November 18, 2015
November 11, 2015
Multiple children were vaccinated with DTaP vaccine in the last month. We discovered after the fact that the vaccine was exposed to freezing temperatures on two occasions before the vaccines were administered. Should these children be revaccinated, and does revaccination depend on the dose number?
You need to repeat all the doses that were exposed to freezing temperatures regardless of dose number. There is no need for an interval with inactivated vaccines. Repeat the doses as soon as possible.
IAC Express - November 11, 2015
November 4, 2015
A 16-year-old female came to us prior to having an elective splenectomy for a congenital splenic cyst. Her primary doctor has given her PCV13, Menactra brand MCV4, and a dose of meningococcal B vaccine—all on the same day. Since PCV13 and Menactra were given on the same day, should I give her another dose of PCV13 and if so, when? She will also receive PPSV23 8 weeks after PCV13.
While it is ideal if all recommended doses are given prior to splenectomy, this schedule is acceptable, since PCV13 is being given before PPSV23 and splenectomy. The recommendation to separate PCV13 and Menactra applies only to asplenic persons. When she received the vaccines she was not asplenic.
IAC Express - November 4, 2015
October 2015 Back to top
October 27, 2015
Why is human papillomavirus (HPV) vaccine (Cervarix, GSK; Gardasil and Gardasil 9, Merck) not recommended for people who are known to have had an HPV infection—similar to shingles vaccine—to reduce chances of another outbreak?
Recommendations for use of HPV vaccine are based on age and not history of prior infection. Contrary to the assumption in your question, routine HPV vaccination is recommended for females through age 26 years and males through age 21 years (and certain males through age 26 years) regardless of their history of prior HPV infection. The chance of being infected with all nine vaccine-preventable strains of HPV included in the vaccine is very low, so there will most likely be benefit from the vaccine even in people with prior HPV infection.
IAC Express Issue 1211
October 20, 2015
My state has an immunization recommendation for school and child care employees, which states that prior to employment, all full- and part-time employees show proof of vaccination against measles, mumps, rubella, hepatitis B, tetanus, diphtheria, pertussis, influenza, varicella, and hepatitis A. It states that this recommendation is in accordance with the recommendations of CDC. I have not found anything from CDC that makes recommendations for employees in schools and child care centers. Is there any information that you can offer on vaccine recommendations for these populations other than the standard adult vaccine recommendations for the general population?
There is no specific ACIP document that addresses school and day care employees. High-risk persons are outlined in each vaccine’s published recommendations. You may access these at www.cdc.gov/vaccines/hcp/acip-recs.
IAC Express Issue 1210
October 13, 2015
If a child only received a half dose of live attenuated influenza vaccine (LAIV, FluMist, MedImmune), I understand they are not considered immunized. Can the child receive inactivated influenza vaccine (IIV) on the same day?
You are correct that a half dose of LAIV (or any other vaccine) is a non-standard dose and should not be counted. If you weren't able to give the second half of the LAIV at that same appointment, you will need to provide another full dose of influenza vaccine at another visit. If you want to try using a different type of vaccine, you can give IIV any time after the partial dose of LAIV. If you want to give LAIV again, you should wait four weeks because it is a live vaccine.
IAC Express Issue 1209
October 6, 2015
Do you recommend staff who provide immunizations be certified in cardiopulmonary resuscitation (CPR) training or only have some CPR training?
ACIP's General Recommendations on Immunization states that all vaccination providers should be familiar with the office emergency plan and be currently certified in CPR. Epinephrine and equipment for maintaining an airway should be available for immediate use. Access the recommendations (see page 12) at www.cdc.gov/mmwr/pdf/rr/rr6002.pdf.
IAC Express Issue 1208
September 2015 Back to top
September 29, 2015
A child in our practice received her first dose of varicella vaccine when she was 12 months old and her second dose when she was 14 months old, rather than at age 4–6 years. Is the second dose valid or does it need to be repeated?
The recommended minimum interval between two doses of varicella vaccine for children 12 months through 12 years of age is 12 weeks. However, the second dose of varicella vaccine does not need to be repeated if it was separated from the first dose by at least 28 days, which is the "minimum interval." For more information, access CDC's table: Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines..
IAC Express Issue 1207
September 22, 2015
The Advisory Committee on Immunization Practices now designates a vaccine recommendation as either "A" or "B." My interpretation is that an A recommendation means the vaccine is routinely recommended for all children in an age or risk group, and a B recommendation is for permissive use (at the clinician’s discretion). Does the Affordable Care Act (ACA) require health plans (non-grandfathered) to provide benefit coverage on permissive B recommended vaccines?
Your understanding of A and B recommendations is correct. ACA requires coverage of vaccines with both A and B recommendations. The Vaccines for Children program also includes vaccines with a B recommendation.
IAC Express Issue 1206
September 15, 2015
I have never seen a case of hepatitis A in my pediatric population, even before hepatitis A vaccine was licensed. Is this vaccine necessary among pediatric patients?
One reason you may not have seen hepatitis A in your pediatric patients is because the likelihood of having symptoms with hepatitis A infection is related to age. In children younger than age 6 years, 70 percent of infections are asymptomatic. When illness does occur in young children, it is typically not accompanied by jaundice. In older children and adults, infection typically is symptomatic, with jaundice occurring in more than 70 percent of patients. However, in 2000, children age 0 through 9 years had the highest rate of acute hepatitis A (6.56 per 100,000 persons). Rates were particularly high in states west of the Mississippi. In 2006, hepatitis A was recommended as a routine vaccine for all children. Since that time, hepatitis A has become very rare in pediatric patients. In 2013, there were 0.14 cases of acute hepatitis A per 100,000 children age 0 through 9 years of age. This dramatic decline is the result of the hepatitis A vaccination program.
IAC Express Issue 1205
September 8, 2015
My patient is a 16-year-old male who has asthma and is on corticosteroid therapy, which is inhaled. Should he receive a meningococcal conjugate vaccine (MCV4) booster dose every 5 years as is recommended for people who are immunosuppressed with asplenia or HIV? He had the first dose of MCV4 at age 11.
The Advisory Committee on Immunization Practices (ACIP) does not consider inhaled corticosteroids to be immunosuppressive for the purposes of MCV4 revaccination. The patient should receive a routine second dose of MCV4 at 16 years or older, and needs no further doses.
IAC Express Issue 1204
September 1, 2015
I was taught that gloves should be worn when giving vaccines. Other nurses say that this is not necessary. Which is correct?
Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations are likely to come into contact with potentially infectious body fluids or have open lesions on their hands. If gloves are worn, they should be changed between patients. For more information on vaccine administration, see ACIP's General Recommendations on Immunization.
IAC Express Issue 1203
August 2015 Back to top
August 25, 2015
Should international travelers receive both meningococcal conjugate vaccine and meningococcal serogroup B vaccine?
Travelers are not considered to be a group at increased risk for serogroup B meningococcal disease and are not recommended to receive serogroup B vaccine. Meningococcal conjugate vaccine continues to be recommended for certain international travelers (residents of and travelers to sub-Saharan Africa and the Hajj in Saudi Arabia).
IAC Express Issue 1200
August 18, 2015
Can teens receive Vaccines For Children (VFC) vaccines without a parent being present?
Each state has their own law as to the age limitations/requirements for a child to receive VFC services without parental consent.
IAC Express Issue 1199
August 11, 2015
The protective cap on a single-dose vial was removed but the vaccine was not needed. No needle punctured the rubber seal. According to CDC's Vaccine Storage & Handling Toolkit, the vial without the cap should be discarded at the end of workday. If no needle punctured the seal, what is the reasoning for discarding the vaccine?
Removing the protective cap increases the likelihood the septum or stopper could be punctured. The puncture may not be visible. Once the protective cap has been removed, the vaccine should be discarded at the end of the workday because it may not be possible to determine if the rubber seal has been punctured.
IAC Express Issue 1198
August 4, 2015
An adult patient had a bone marrow transplant and had previously received a Tdap vaccine. The oncologist recommended another dose of Tdap. Is this acceptable in this situation?
Yes. A dose of Tdap 6 months after a bone marrow transplant is appropriate.
IAC Express Issue 1197
July 2015 Back to top
July 28, 2015
A healthy child received only one dose of pneumococcal conjugate vaccine (PCV) at age 10 months. She is now 6 years old. Our state requires one dose of PCV13 after the first birthday for school attendance. Her physician says because she is older than 59 months, she does not need another dose of PCV. What should we do in this situation?
ACIP does not recommend routine PCV vaccination of healthy children 60 months of age or older. If there is a school requirement, the simplest solution is to give the child one dose of PCV13. However, health insurance may not pay for this dose. For more information on the ACIP recommendations for PCV13, go to www.cdc.gov/mmwr/pdf/rr/rr5911.pdf.
IAC Express Issue 1196
July 21, 2015
A physician ordered a 40-µg dose of hepatitis B vaccine for a hemodialysis patient. The clinic does not stock the Recombivax HB (40 µg/dose) formulation and would like to give 2 adult doses of Engerix B (20 µg/dose) for each dose in the series. Is this acceptable?
Yes. If given on the same day as separate injections in separate sites, the Energix B doses can be counted as the equivalent of one 40-µg dose. According to the package insert, Engerix B is licensed for use in this manner. Vaccine package inserts are available at www.immunize.org/packageinserts.
IAC Express Issue 1195
July 14, 2015
We have a child who received the second dose of hepatitis A vaccine 3 months after the first dose. A repeat dose (dose #3) was given 4 months after the (invalid) second dose. Both dose #2 and dose #3 appear to be invalid because the intervals were less than 6 months. Should this child receive a fourth dose of hepatitis A vaccine? 
It is true that the recommended minimum interval between doses of hepatitis A vaccine is 6 calendar months. If the second dose is given too early, the repeat dose should be given 6 months after the invalid dose. However, in this situation CDC has recommended that dose #3 can be counted as valid if it was separated by at least 6 months from the first dose. So a fourth dose would not be recommended for this child.
IAC Express Issue 1193
July 7, 2015
If a patient began the human papillomavirus (HPV) vaccine series with 4-valent HPV vaccine (4vHPV, Gardasil, Merck), can the series be completed with 9-valent HPV vaccine (9vHPV; Gardasil 9)? Should a booster dose of 9vHPV be given to persons who have already completed the 4vHPV series?
ACIP recommendations, published in March 2015 (www.cdc.gov/mmwr/pdf/wk/mm6411.pdf, page 300), state that 9vHPV may be used to complete a series begun with a different HPV vaccine. There is currently no recommendation for supplemental doses of 9vHPV following a completed series of 2vHPV or 4vHPV.
IAC Express Issue 1192
June 2015 Back to top
June 30, 2015
Does a patient living in the U.S. who has documentation of having had meningococcal vaccine at age 2 and 5 years in Saudi Arabia still need to have doses at ages 11–12 years and age 16 years or are the previous doses sufficient?  
Even though Saudi Arabia uses a quadrivalent meningococcal vaccine routinely at those ages, doses given to a healthy child prior to the 10th birthday should not be counted as part of the U.S. series. The child should still receive meningococcal vaccine according to the routine U.S. schedule.
IAC Express Issue 1191
June 23, 2015
Is it necessary for us to record the actual date that the Vaccine Information Statement (VIS) was provided or can it be assumed that the VIS was provided on the day the shot was given?
Federal law requires that the provider record in the medical record the date the VIS was provided and the date the vaccine was administered. In addition, providers are required to record the edition date of the VIS (found on the back at the right bottom corner), the name, office address, and title of the healthcare provider who administers the vaccine, and the vaccine manufacturer and lot number.
IAC Express Issue 1190
June 16, 2015
An 8-year-old child received three doses of oral polio vaccine before his first birthday. Should he receive an additional dose of inactivated poliovirus vaccine (IPV)?
Yes. This patient should receive a dose of IPV now. The final dose of the polio series should be received on or after the fourth birthday.
IAC Express Issue 1188
June 9, 2015
Should a male postpone receiving the MMR vaccine if he and his spouse are trying to conceive?
No. If a man receives a dose of MMR vaccine, he does not need to avoid conception for any interval. There is no risk of transmission of MMR vaccine virus from a vaccinated man to a woman, regardless of the level of intimacy.
IAC Express Issue 1187
June 2, 2015
An infant is going to be traveling internationally before turning one year of age, but is not scheduled to travel for a few months. Do we need to wait to vaccinate with MMR vaccine until some point closer to departure?
Infants 6 through 11 months of age are recommended to receive MMR vaccine if they will be traveling internationally. There is no need to wait until travel is imminent. Optimally there should be one month between vaccine administration and travel, so vaccinate now if the infant is at least 6 months old and you know travel will occur before the child’s first birthday.
IAC Express Issue 1185
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 patient’s 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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