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IAC Express 2008
Issue number 736: June 12, 2008
Contents of this Issue
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  1. New feature! "Ask The Experts" Q&As from CDC experts now included in IAC Express
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
Issue 736: June 12, 2008
1.  New feature! "Ask The Experts" Q&As from CDC experts now included in IAC Express

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.

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 found at

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
http://www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_revised%204-11-06.pdf AAP includes information for providers regarding the benefits and also the limitations of using such a form.

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 several inquiries.

You can email your question about vaccines or immunization to IAC at admin@immunize.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 http://www.immunize.org/askexperts

You can also email CDC's immunization experts directly at nipinfo@cdc.gov There is no charge for this service.

If you have a question about IAC materials or services, email admin@immunize.org

Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at http://www.immunize.org/subscribe

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