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| As appeared in the February 2013 issue of Vaccinate Adults |
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Please note: A clarification has
been published for an "Ask the Experts" answer for this issue. To view
the clarification, please click
here. |
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Click here for PDF version |
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| Q: |
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Is it
still acceptable to use combination
household units for storing
vaccines? |
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| A: |
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CDC strongly recommends
using stand-alone
refrigerators and freezers
for the following reasons: |
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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. |
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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. |
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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. |
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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. |
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| Q: |
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What temperature is considered a
temperature excursion on
refrigerated vaccine? Frozen
vaccine? |
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| A: |
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Any temperature readings
outside the ranges noted
below are considered
temperature excursions. |
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For refrigerated vaccines,
the minimum temperature is 35°F (2°C), and the maximum is
46°F (8°C). |
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For frozen vaccines, the
minimum temperature is -58°F (-50°C), and the maximum is 5°F (-15°C). |
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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. |
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| Q: |
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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? |
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| A: |
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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. |
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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: |
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Equipment considerations
for storage units and thermometers |
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Maintenance of the cold
chain |
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Routine storage and
handling practices |
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Inventory management |
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Emergency procedures for
protecting vaccine inventories |
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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. |
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| Q: |
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What are
the new ACIP recommendations for
vaccinating pregnant women with
Tdap? |
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| A: |
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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. |
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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. |
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| Q: |
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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? |
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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. |
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| Q: |
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How soon after taking prednisone for
an asthma attack can a person receive
a flu shot? |
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| A: |
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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. |
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Q: |
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Is fainting after the first or
second dose of HPV vaccine a
contraindication to administering
subsequent doses? |
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| A: |
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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. |
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| Q: |
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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? |
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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. |
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| Q: |
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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? |
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| A: |
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You should use separate alcohol wipes to clean the vial top and the patient's skin. |
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Click here for PDF version |
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Immunization Action Coalition • 1573 Selby Ave • St. Paul, MN 55104 |
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tel 651-647-9009 • fax 651-647-9131 |
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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. |
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