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| As appeared in the April 2010 of Vaccinate Adults |
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Click here for PDF version |
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| Q: |
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I've heard that the
recommendations for influenza vaccination have been expanded for
the 2010–11 season. Tell me more. |
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At its February 2010 meeting, ACIP
voted to recommend routine annual influenza vaccination for all
people age 6 months and
older, beginning with the 2010–11 influenza vaccination season.
This change expands the existing recommendations to include
all healthy adults ages 19 through 49 years who hadn't previously been included in routine vaccination recommendations. On
March 2, the provisional influenza vaccine recommendations were
posted on CDC's website at
www.cdc.gov/vaccines/recs/provisional/downloads/flu-vac-mar-2010-508.pdf. |
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Will we need to give H1N1 vaccine
as a separate vaccine in the next season (2010–11)? |
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No. The 2009 H1N1 virus will be
incorporated into the 2010–11 seasonal influenza vaccine
formulation. The three influenza viruses in the vaccine are
A/California (H1N1) [formerly known as the 2009 H1N1], A/Perth
(H3N2) [replacing the 2009–10 A/Brisbane (H3N2)], and B/Brisbane
[same as in the 2009–10 vaccine]. |
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| Q: |
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I would like to help establish a
policy of mandatory vaccination for healthcare workers in our
facility and would like to
learn from others. Can you help? |
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You will be happy to know that
more and more healthcare facilities are adopting mandatory
vaccination policies for their employees. IAC has included many of
these on its Honor Roll for Patient Safety, which gives special
recognition to institutions that enforce mandatory vaccination for
all personnel who are in the vicinity of a patient (e.g.,
including volunteers, housekeeping staff). To read about the
policies of the various facilities included in the Honor Roll, go
to
www.immunize.org/honor-roll. We hope reviewing
these policies will give you the information you need to assist
you in developing a policy for your facility. |
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We have a mandatory vaccination
policy in our facility; however, we allow employees to choose not
to be vaccinated after
filling out and signing an informed declination form. What can we
do to achieve assurances that patient safety is still
maintained? |
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Though vaccination is the most
effective means of protecting your patients from influenza, there
may be instances where employees are not vaccinated for medical or
personal reasons. In these instances, you may want to consider
reassigning unvaccinated workers to non-patient areas or requiring
that they wear masks throughout the influenza season. |
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When should we stop giving H1N1
influenza vaccine for the 2009–10 season? |
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The answer is the same for both H1N1 and seasonal influenza
vaccines–providers are encouraged to continue vaccinating
patients into the spring months (e.g., through May), as long as
they have vaccine in the refrigerator and unvaccinated
patients in their office. No one knows for sure how the H1N1
influenza epidemic will progress; some experts predict a third
wave of cases in the spring. Be sure to check the expiration date
before administering 2009 H1N1 vaccine–some lots expire
earlier than seasonal influenza vaccine. Expired vaccine should
never be administered. |
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Please tell me about the newly
licensed meningococcal conjugate vaccine, Menveo. |
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FDA licensed Menveo (Novartis) on Feb. 19. It is a quadrivalent
meningococcal conjugate vaccine intended for use in people
ages 11 through 55 years. Menveo protects against Neisseria
meningitidis serogroups A, C, Y, and W-135. The vaccine consists
of two components, a lyophilized vaccine (containing the serogroup
A conjugate) and a buffered saline diluent (containing the
C, W-135, and Y conjugates) used for reconstitution. The
reconstituted vaccine should be used immediately but may be held
at
or below 77°F (25°C) for up to 8 hours. Menveo is administered as
an intramuscular injection.
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ACIP recommends meningococcal conjugate vaccine for all people
ages 11–18 years and for people ages 2–55 years who are at
increased risk for meningococcal disease. These include (1)
college freshmen living in dormitories, (2) microbiologists who
are exposed routinely to isolates of Neisseria meningitidis, (3)
military recruits, (4) people who travel to or reside in
countries where meningococcal disease is hyperendemic or epidemic,
(5) people who have persistent complement component
deficiencies, and (6) people with anatomic or functional asplenia.
Menveo or Menactra (sanofi pasteur) may be used in people
ages 11–55 years. People ages 2–10 years who are recommended to
receive a meningococcal vaccine should receive Menactra
(which is licensed for this age group), and people older than age
55 years should receive meningococcal polysaccharide
vaccine (MPSV). |
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I have a 45-year-old patient who had
an emergency splenectomy. Afterward, I gave her a dose of
meningococcal vaccine. Will she need additional doses of
meningococcal vaccine in the future? |
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Yes. Since asplenia
places her at highest risk for meningococcal infection, you should
give her another dose of a meningococcal conjugate vaccine (MCV4)
5 years after the date you gave her the first dose. Then, give her
additional doses of MCV4 every 5 years. Once she reaches age 56,
all subsequent booster doses should be with meningococcal
polysaccharide vaccine (MPSV4), which should be administered at
5-year intervals. |
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I continue to see conflicting
advice for giving pneumococcal vaccine to patients who do not have
a spleen. Do they get re-immunized with pneumococcal polysaccharide vaccine (PPSV) every 5
years, or do they get only 1 additional dose in their
lifetime? |
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Giving pneumococcal vaccine every 5 years is a widespread myth;
ACIP has never recommended an every-5-year schedule. People
with asplenia age 2 years and older should receive a lifetime
total of 2 doses of PPSV separated by a minimum of 5 years.
Here is a good resource:
www.immunize.org/catg.d/p2015.pdf. |
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We have a newly diagnosed diabetic
who was given the first dose of PPSV at age 65 years. Should I
give him a second dose in 5
years because of his chronic disease? |
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No. For people age 65 years and
older, one-time revaccination is recommended only for those who
are at highest risk for serious pneumococcal infection and those
who are likely to have a rapid decline in pneumococcal antibody
levels. This includes people with functional or anatomic asplenia
(e.g., sickle cell disease), HIV infection, leukemia, or other
conditions associated with immunosuppression. It does not include
diabetics. |
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| Q: |
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The new Zostavax vaccine (Merck)
package insert says that Zostavax should not be given
simultaneously with pneumococcal
polysaccharide vaccine (PPSV). What does ACIP say about this? |
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ACIP has not changed its
recommendation on the simultaneous administration of these two
vaccines (i.e., they can be given at the same time or any time
before or after each other). |
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| Q: |
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Now that there is a second vaccine
licensed for the prevention of Japanese encephalitis (JE) among
travelers, where can I
find the recommendations for its use? |
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CDC recently published updated
recommendations of the Advisory Committee on Immunization
Practices for the use of both vaccines—JE-VAX (sanofi) and Ixiaro
(Intercell Biomedical distributed by Novartis)—in MMWR
2010;59(RR-1):1-26. You can find them on CDC's website at
www.cdc.gov/mmwr/pdf/rr/rr5901.pdf. Ixiaro is licensed for use in people
17 years and older. JE-VAX is no longer being produced, and
remaining supplies are reserved for children ages 1 through 16
years. |
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| Q: |
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My patient got JE-VAX 5 years ago
and is now returning to Asia. Can I use Ixiaro as a booster dose? |
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There are no data on the use of
Ixiaro as a booster for JE-VAX. If a previously vaccinated person
age 17 years or older needs a booster dose, you should administer
a full series (2 doses separated by at least 28 days) of Ixiaro. |
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