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Immunization Action Coalition
Ask the Experts
As appeared in the February 2013 issue of Vaccinate Adults
Please note: A clarification has been published for an "Ask the Experts" answer for this issue. To view the clarification, please click here.
Click here for PDF version
Immunization questions
Q:
Is it still acceptable to use combination household units for storing vaccines?
A:  
CDC strongly recommends using stand-alone refrigerators and freezers for the following reasons:
 
Most combination household refrigerator/freezers have a combined temperature control unit that can create cold spots and temperature fluctuations in the refrigerator portion of the unit.
The risk of freeze damage to refrigerated vaccines is increased in combination units because air from the freezer is vented into the refrigerator to cool it. This can freeze temperature-sensitive vaccines.
The freezer portions of many combination units are not capable of maintaining the correct storage temperature for frozen vaccines. Purchasing new vaccine storage equipment requires planning, and you may need to use existing equipment for a while until you can purchase new equipment. In this situation, CDC recommends using a combination refrigerator/freezer unit for refrigerated vaccine only and using a separate stand-alone freezer to store frozen vaccines.
It is important to note that most combination refrigerator/freezers share a single condenser, and the very cold air from the freezer compartment is vented into the refrigerator compartment to cool the refrigerator. You should not turn off the freezer portion of the combination unit because it will not maintain the proper temperature for the refrigerated vaccines stored in the refrigerator portion of the unit. If you are using the refrigerator portion of the combination unit, it is important that you not store vaccines directly under the vent coming from the freezer and that you add water bottles to the refrigerator to absorb cold air blown in from the freezer. This will reduce the risk of vaccines becoming too cold.
 
Q:
What temperature is considered a temperature excursion on refrigerated vaccine? Frozen vaccine?
A:  
Any temperature readings outside the ranges noted below are considered temperature excursions.
 
For refrigerated vaccines, the minimum temperature is 35°F (2°C), and the maximum is 46°F (8°C).
For frozen vaccines, the minimum temperature is -58°F (-50°C), and the maximum is 5°F (-15°C).
If there is a question about whether a vaccine has been exposed to a temperature excursion, label the vaccines "DO NOT USE" and store them under appropriate conditions, separate from other vaccines. Then, contact the vaccine manufacturer for further guidance. If you are a VFC provider, contact either the vaccine manufacturer and/or your state or local immunization program as directed by the VFC Program in your area.
 
Q:
I keep hearing about changes to vaccine storage and handling recommendations. Why is CDC making these changes? And how can I make sure I am up to date with all the newest information?
A:  
Good questions! The why behind these changes has two parts. First, it had become increasingly apparent to CDC and state health departments that improper vaccine storage and handling is a big problem, leading to a huge waste of product, time, and money, and more importantly, to unprotected people. Second, improved technology (e.g., digital data loggers) provides tools that uncover and measure problems and also prevent them.
As far as how to keep up, on November 27, 2012, CDC released its updated Vaccine Storage and Handling Toolkit at www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf and posted it on CDC's Vaccine Storage and Handling Toolkit web section at www.cdc.gov/vaccines/recs/storage/toolkit. The Vaccine Storage and Handling Toolkit is based on the recommendations of ACIP, equipment manufacturers' product information, and studies from the National Institute for Scientific Technology. The toolkit outlines best practice strategies and recommendations on the following topics:
 
Equipment considerations for storage units and thermometers
Maintenance of the cold chain
Routine storage and handling practices
Inventory management
Emergency procedures for protecting vaccine inventories
Every vaccine provider should print out this document and read and reread it carefully. CDC has provided an overview of the new information as a separate item at www.cdc.gov/vaccines/recs/storage/interim-storage-handling.pdf, as well as a set of FAQs about the new recommendations at www.cdc.gov/vaccines/recs/storage/interim-faq-storage-handling.pdf.
 
Q:
What are the new ACIP recommendations for vaccinating pregnant women with Tdap?
A:  
In October 2012, ACIP voted to recommend that a pregnant woman receive Tdap vaccine during each pregnancy, even if the woman had received Tdap previously. The optimal time to administer Tdap is between 27 and 36 weeks' gestation. Vaccination during this time maximizes maternal antibody response and passive antibody transfer to the infant. Women who have never received Tdap and who do not receive it during pregnancy should receive it immediately postpartum. When a woman gets Tdap during pregnancy, maternal pertussis antibodies transfer to the newborn, likely protecting the baby against pertussis in early life, before the baby is old enough to have received at least 3 doses of DTaP. Tdap also protects the mother, making it less likely that she will get infected with pertussis during or after pregnancy and thus less likely that she will transmit it to her infant.
The related provisional recommendations for the use of Tdap in pregnancy were published on December 6, 2012. CDC anticipates releasing the final updated recommendations in the Feb. 22 issue of MMWR. To access the new recommendations, visit www.cdc.gov/vaccines/pubs/ACIP-list.htm.
 
Q:
If a woman did not receive Tdap during pregnancy, and it is uncertain whether she received a dose of Tdap prior to her pregnancy, should she receive a dose of Tdap postpartum?
A:  
Yes. If there is no written documentation that she received a dose of Tdap prior to or during pregnancy, a dose of Tdap should be administered to her immediately postpartum.
 
Q:
How soon after taking prednisone for an asthma attack can a person receive a flu shot?
A:  
Steroid treatment is not a contraindication for vaccination with inactivated influenza vaccine. As this vaccine is not a live virus vaccine, you can (and should) give it to people who are immunosuppressed, although the patient's immune response may not be optimal. Immunosuppression (e.g., from certain steroid treatments) is a concern only when administering live virus vaccines.
 
Q:
Is fainting after the first or second dose of HPV vaccine a contraindication to administering subsequent doses?
A:  
No. Fainting is not a contraindication to administering a subsequent dose of any vaccine. Fainting after vaccination is fairly common in adolescence. Providers should prepare for the possibility by having patients sit or lie down when receiving the vaccine and observing patients for 15 minutes after vaccination. For more information on syncope and vaccination, visit the CDC website at www.cdc.gov/vaccinesafety/Concerns/syncope_faqs.html.
 
Q:
Some single-dose pre-loaded vaccines come with an air pocket in the syringe chamber. Do we need to expel the air pocket before vaccinating?
A:  
No. You do not need to get rid of the air pocket. The air will be absorbed. This is not true for syringes that you fill yourself; you should expel air bubbles from these syringes prior to vaccination to the extent that you can readily do so.
 
Q:
Is it recommended to use a new alcohol swab to cleanse the skin before administering a vaccine, or can we swab the skin with the same alcohol swab that we used to wipe off the stopper on the vial?
A:  
You should use separate alcohol wipes to clean the vial top and the patient's skin.
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.