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Immunization Action Coalition
Ask the Experts
As appeared in the November 2013 issue of Vaccinate Adults
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Influenza vaccine
Q:
We inadvertently administered intradermal influenza vaccine (Fluzone ID, sanofi) to a patient who is not in the recommended age range of 18 through 64 years. What should we do now?
A:  
Because people younger than age 9 years or older than 65 years are more likely to have skin that is too thin for proper intradermal administration, a dose given to a person in these age ranges should be considered invalid, and the patient should be revaccinated. For people age 9 through 17 years, the dose is considered valid and does not have to be repeated if the clinician is certain that the dose was administered intradermally rather than subcutaneously. If there is any doubt about whether the dose was injected intradermally, it should be repeated.
 
Q:
Is it acceptable to administer a dose of the quadrivalent influenza vaccine to a patient who has already received the trivalent vaccine? We've had a few patients request this.
A:  
No. ACIP does not recommend that anyone receive more than one dose of influenza vaccine in a season, except for certain children age 6 months through 8 years for whom two doses are recommended.
 
Q:
Sometimes patients age 65 years and older who have received the standard-dose influenza vaccine hear about the high-dose product (Fluzone High-Dose, sanofi) and want to receive that, too. Is this okay to administer?
A:  
No. ACIP does not recommend that anyone receive more than one dose of influenza vaccine in a season except for certain children age 6 months through 8 years for whom two doses are recommended.
 
Q:
Would giving an older patient 2 doses of standard-dose influenza vaccine be the same as administering the high-dose product?
A:  
No, and this is not recommended.
 
Q:
How soon after bone marrow transplant do we start to vaccinate our patients against influenza?
A:  
Inactivated influenza vaccine should be administered beginning at least 6 months after bone marrow transplant and annually thereafter for the life of the patient. A dose of inactivated influenza vaccine can be given as early as 4 months after transplant, but a second dose should be considered in this situation. A second dose is recommended routinely for all children receiving influenza vaccine for the first time. For more information about vaccination of people who receive hematopoietic stem cell transplantation, visit this CDC web page: www.cdc.gov/vaccines/pubs/hemato-cell-transplts.htm.
Pneumococcal polysaccharide vaccine
Q:
Pneumococcal polysaccharide vaccine (PPSV, Pneumovax, Merck) is recommended for people with diabetes. Does this include gestational diabetes?
A:  
No.
Transporting vaccines
Q:
We plan to keep our influenza vaccine in coolers when we travel to off-site vaccination events. How can we ensure the vaccine remains within the proper temperature range?
A:  
CDC does not recommend keeping vaccines in transport containers unless they are portable refrigerator or freezer units. If vaccines must be kept in transport containers during off-site clinics:
The containers should remain closed as much as possible.
  Only the amount of vaccine needed at one time should be removed for preparation and administration.
  A calibrated thermometer (preferably with a bio-safe glycol-encased thermometer probe) should be placed as close as possible to the vaccines within the container.
  The temperature inside the container should be read and documented at least hourly.
If you have concerns that vaccines or diluents may have been compromised (exposed to inappropriate conditions/temperatures or handled improperly), label them "DO NOT USE" and store them under appropriate conditions separated from other vaccine supplies. Then contact your immunization program and/or vaccine manufacturer for guidance. Do not discard the vaccines or diluents unless directed to by your immunization program and/or the manufacturer. For more information, see the Transporting Vaccine in an Emergency or to Off-Site Facilities section on pages 91–96 of CDC's Vaccine Storage and Handling Toolkit at www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf. Additional information is available on IAC's Vaccine Storage and Handling website at www.immunize.org/handouts/vaccine-storage-handling.asp.
 
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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.