New feature! "Ask The Experts" Q&As from CDC experts now included in IAC
Many readers of Needle Tips, Vaccinate Adults,
and Vaccinate Women
consistently rank "Ask the Experts" as their favorite feature in
these publications. As a thank-you to our loyal IAC Express
readers, we have decided to periodically publish an Extra Edition
with new "Ask the Experts" Q&As answered by CDC experts.
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IAC thanks William L. Atkinson, MD, MPH, and Andrew T. Kroger, MD,
MPH, medical epidemiologists at the National Center for
Immunization and Respiratory Diseases, CDC, for agreeing to answer
the following questions.
Editor's note: Information about submitting a question to "Ask the
Experts" is provided at the end of this IAC Express article.
When administering zoster vaccine, is it necessary to ask patients
if they have ever had chickenpox or shingles?
No. All persons age 60 years or older---whether they have a history
of chickenpox or shingles or not---should be given zoster vaccine
unless they have a medical contraindication. Medical
contraindications are described in detail in the recently released
"Prevention of Herpes Zoster: Recommendations of ACIP." To obtain a
copy, go to: http://www.cdc.gov/mmwr/pdf/rr/rr5705.pdf
How can I use Twinrix in combination with hepatitis B and hepatitis
A vaccines to complete a series that was started with Twinrix but
can't be completed that way?
Twinrix is licensed in the U.S. as a 3-dose series for persons age
18 years and older. If Twinrix is not available or if you choose
not to use Twinrix to complete the series, you must consider the
following: Twinrix contains a standard ADULT dose of hepatitis B
vaccine, but a PEDIATRIC dose of hepatitis A vaccine. Thus, a dose
of Twinrix can be substituted for any dose of the hepatitis B
series, but not for any dose of the hepatitis A series.
Any combination of 3 doses of adult hepatitis B or 3 doses of
Twinrix = a complete series of hepatitis B vaccine
1 dose of Twinrix + 2 doses of adult hepatitis A = a complete
series of hepatitis A vaccine
2 doses of Twinrix + 1 dose of adult hepatitis A = a complete
series of hepatitis A vaccine
I work with college-age students and have two questions about HPV
vaccine. Often it is hard to follow the ideal HPV schedule with
students, especially if they leave for the summer or study abroad.
How close together can HPV doses be given? And, if a student
doesn't come back for her second or third dose on time, do we have
to start the series over?
Although following the recommended schedule is the goal for any
vaccine, certain circumstances call for using an accelerated
schedule. When accelerating the schedule for HPV vaccine, there
must be at least 4 weeks between doses 1 and 2, 12 weeks between
doses 2 and 3, and at least 24 weeks between doses 1 and 3. The
minimum interval for any routinely administered vaccine can be
Regarding your second question, no vaccine series needs to be
restarted because of an interval that is longer than recommended
(with the exception of oral typhoid vaccine in certain
circumstances). You can read more about the recommended spacing
between vaccine doses in the following resources.
ACIP's General Recommendations on Immunization
CDC's Pink Book (chapter 2 on general recommendations)
Where can I find a declination form for parents to sign if they
refuse vaccination for their child?
The American Academy of Pediatrics (AAP) has developed a form and
posted it on its website at
AAP includes information for providers regarding the
benefits and also the limitations of using such a form.
HOW TO SUBMIT A QUESTION TO "ASK THE EXPERTS"
IAC works with CDC to compile new "Ask the Experts" Q&As for our
publications based on commonly asked questions. We also consider
the need to provide information about new vaccines and
recommendations. Most of the questions are thus a composite of
You can email your question about vaccines or immunization to IAC
at firstname.lastname@example.org As we receive hundreds of emails each month,
we cannot guarantee that we will use your question in the "Ask the
Experts" feature. However, you will get an answer. To see if your
question has already been answered, you can first check the "Ask
the Experts" online archive at
You can also email CDC's immunization experts directly at
email@example.com There is no charge for this service.
If you have a question about IAC materials or services, email
Please forward these "Ask the Experts" Q&As to your co-workers and
suggest they subscribe to IAC Express at