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| As appeared in the October 2012 of Vaccinate Adults |
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Click here for PDF version |
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| Q: |
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What is
the latest CDC guidance on influenza
vaccination and egg allergy? |
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| A: |
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People who have
experienced a serious
systemic or anaphylactic
reaction (e.g., hives,
swelling of the lips or
tongue, acute respiratory
distress, or collapse)
after eating eggs should
consult a specialist for
appropriate evaluation to
help determine if vaccine
should be administered. |
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A previous severe allergic
reaction to influenza
vaccine, regardless of the
component suspected to be
responsible for the
reaction, is a
contraindication to future
receipt of the vaccine. |
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People who have documented
immunoglobulin E (IgE)-mediated
hypersensitivity to eggs,
including those who have
had occupational asthma or
other allergic responses
to egg protein, might also
be at increased risk for
allergic reactions to
influenza vaccine.
Protocols have been
published for safely
administering influenza
vaccine to people with egg
allergies. |
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Some people who report
allergy to egg might not
be egg allergic. If a
person can eat lightly
cooked eggs (e.g.,
scrambled eggs), they are
unlikely to have an egg
allergy. However, people
who can tolerate egg in
baked products (e.g.,
cake) might still have an
egg allergy. If the person
develops hives only after
ingesting eggs, CDC
recommends (1) they
receive TIV (not LAIV),
(2) the vaccine be
administered by a
healthcare provider
familiar with the
potential manifestations
of egg allergy, and (3)
the vaccine recipient be
observed for at least 30
minutes after receipt of
the vaccine for signs of a
reaction. |
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For more details about
giving influenza vaccine
to people with a history
of egg allergy, see
"Influenza Vaccination of
People with a History of
Egg Allergy" on page 14 of
this issue of Vaccinate
Adults or visit
www.immunize.org/catg.d/p3094.pdf.
You can also consult pages
616–617 of "Prevention and
Control of Influenza with
Vaccines: Recommendations
of the ACIP—U.S., 2012–13
Influenza Season" at
www.cdc.gov/mmwr/pdf/wk/mm6132.pdf. |
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| Q: |
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Which
formulations of influenza vaccines
(i.e., nasal spray, intradermal,
injectable high-dose, and injectable
standard-dose) are recommended for
various age groups? |
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| A: |
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Six
manufacturers are producing
influenza vaccines for the U.S.
market for the 2012–13 season.
Page 12 of this issue of Vaccinate
Adults has a table titled
"Influenza Vaccine Products for
the 2012–2013 Influenza Season."
It summarizes the vaccine products
and age groups for which they are
licensed. |
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| Q: |
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In
recommending influenza vaccination
for people age 65 and older, does
CDC prefer that healthcare
professionals administer high-dose
influenza vaccine or standard-dose
influenza vaccine? |
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| A: |
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CDC has no preference. CDC
stresses that vaccination is
the first and most important
step in protecting against
influenza. |
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| Q: |
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If a
patient received a dose of influenza
vaccine in June (e.g., for
international travel), how long
should the patient wait before
getting vaccinated with the next
season's flu vaccine? |
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| A: |
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There should be a minimum
of 4 weeks between the
doses in such situations. |
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| Q: |
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Can
adolescents and adults who have been
exposed to pertussis be vaccinated
if they haven't had a one-time dose
of Tdap yet? |
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| A: |
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Yes. Exposure to a person
with pertussis is not a
reason to avoid Tdap
vaccination. All
adolescents and adults who
haven't had a one-time
dose of Tdap should
receive a dose as soon as
possible. |
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| Q: |
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Should a
person who received 2 doses of
varicella vaccine be vaccinated with
zoster vaccine when they turn 60? |
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| A: |
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No. CDC does not currently
recommend zoster vaccine
for people who received 2
doses of varicella
vaccine. However,
healthcare providers do
not need to inquire about
varicella vaccination
history before
administering zoster
vaccine because virtually
all people currently or
soon to be in the
recommended age group have
not received varicella
vaccine. For details, see
page 19 of the CDC
recommendations Prevention
of Herpes Zoster available
at
www.cdc.gov/mmwr/PDF/rr/rr5705.pdf. |
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| Q: |
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Can we
accept receipt of a single
documented dose of zoster vaccine as
proof of varicella immunity in a
healthcare employee who has no other
evidence of immunity? |
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| A: |
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No. Receipt of zoster
vaccine is not proof of
prior varicella disease.
According to CDC,
acceptable evidence of
varicella immunity in
healthcare personnel
includes (1) documentation
of 2 doses of varicella
vaccine given at least 28
days apart, (2) history of
varicella or herpes zoster
based on physician
diagnosis, (3) laboratory
evidence of immunity, or
(4) laboratory
confirmation of disease.
If a healthcare employee
has already received a
dose of zoster vaccine but
has no evidence of
immunity to varicella, the
zoster dose can be
considered the first dose
of the 2-dose varicella
series. |
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| Q: |
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I work
in employee health. Several hospital
employees have told me they have had
chickenpox, but their titers show no
antibodies. Should I offer varicella
vaccination to them even though they
insist they've had the illness? |
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| A: |
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If you cannot verify a
healthcare employee's
history of chickenpox, the
employee should receive 2
doses of varicella vaccine
at least 4 weeks apart.
For details, refer to
pages 16 and 26 of the CDC
recommendations Prevention
of Varicella at
www.cdc.gov/mmwr/pdf/rr/rr5604.pdf. |
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| Q: |
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Does the
recommendation to administer
hepatitis B vaccine to diabetics
younger than age 60 extend to women
with gestational diabetes? |
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| A: |
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No. The 2011 CDC
recommendations for
hepatitis B vaccination of
people with diabetes
pertain to those with
type-1 and type-2
diabetes. They do not
apply to
women with gestational
diabetes. It is worth
noting that pregnancy is
not a contraindication to
hepatitis B vaccination,
and that women with
gestational
diabetes are more likely
to develop type-1 or
type-2 diabetes later in
life. Diabetic women who
become pregnant can be
vaccinated, if indicated.
The CDC
recommendations "Use of
Hepatitis B Vaccination
for Adults with Diabetes
Mellitus" are available at
www.cdc.gov/mmwr/pdf/wk/mm6050.pdf
on pages 1709–11. |
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| Q: |
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I still
am not clear about the need for
testing if the hepatitis B vaccine
series was completed many years ago—can
you advise? |
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| A: |
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All healthcare personnel (HCP)
with risk of exposure to
hepatitis B should be
tested 1–2 months after
receiving the third dose
of hepatitis B vaccine.
CDC does not recommend
testing healthcare
personnel who were not
tested within the 1–2
month postvaccination time
frame. HCP who are exposed
can be tested as part of
postexposure management,
if indicated. For more
information, see
"Hepatitis B and the
Healthcare Worker" at
www.immunize.org/catg.d/p2109.pdf. |
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| Q: |
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Should
women who have not received HPV
vaccine get Pap tests more often
than women who have received HPV
vaccine? |
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| A: |
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No. Receipt of HPV vaccine
does not replace the need
for cervical cancer
screening. Women should
consult their healthcare
provider for
recommendations regarding
the frequency of cervical
cancer screening, which
includes Pap testing and
HPV testing. |
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| Q: |
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Is it
acceptable practice to administer
MMR, Tdap, and influenza vaccines to
a postpartum mom at the same time as
administering RhoGam? |
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| A: |
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Click here for PDF version |
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