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Immunization Action Coalition
Ask the Experts
As appeared in the October 2012 of Vaccinate Adults
Click here for PDF version
Influenza vaccines
Q:
What is the latest CDC guidance on influenza vaccination and egg allergy?
A:  
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.
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.
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.
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.
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.
 
Q:
Which formulations of influenza vaccines (i.e., nasal spray, intradermal, injectable high-dose, and injectable standard-dose) are recommended for various age groups?
A:  
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.
 
Q:
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?
A:  
CDC has no preference. CDC stresses that vaccination is the first and most important step in protecting against influenza.
 
Q:
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?
A:  
There should be a minimum of 4 weeks between the doses in such situations.
Other vaccines
Q:
Can adolescents and adults who have been exposed to pertussis be vaccinated if they haven't had a one-time dose of Tdap yet?
A:  
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.
 
Q:
Should a person who received 2 doses of varicella vaccine be vaccinated with zoster vaccine when they turn 60?
A:  
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.
 
Q:
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?
A:  
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.
 
Q:
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?
A:  
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.
 
Q:
Does the recommendation to administer hepatitis B vaccine to diabetics younger than age 60 extend to women with gestational diabetes?
A:  
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.
 
Q:
I still am not clear about the need for testing if the hepatitis B vaccine series was completed many years ago—can you advise?
A:  
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.
 
Q:
Should women who have not received HPV vaccine get Pap tests more often than women who have received HPV vaccine?
A:  
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.
 
Q:
Is it acceptable practice to administer MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?
A:  
Yes. Receipt of RhoGam is not a reason to delay vaccination. See page 9 of CDC's General Recommendations on Immunization at www.cdc.gov/mmwr/pdf/rr/rr6002.pdf.
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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.