Read "Ask the Experts" Q&As on new vaccine recommendations and licensures
Many readers of Needle Tips and Vaccinate Adults
consistently rank "Ask the Experts" as their favorite
feature in these publications. As a thank-you to our loyal
IAC Express readers, we periodically publish Extra Editions
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.
Almost all the Q&As in this edition of IAC Express deal with
new immunization recommendations and vaccine licensures.
We encourage you to reprint any of these Q&As in your own
newsletters. Please credit the Immunization Action Coalition
and the Centers for Disease Control and Prevention.
Information about IAC's preferred citation style can be
found at http://www.immunize.org/citeiac
You can access more "Ask the Experts" Q&As in our online
archive at http://www.immunize.org/askexperts
Editor's note: Information about submitting a question to
"Ask the Experts" is provided at the end of this Extra
Q: Please review the recommendations for the use of the two
human papillomavirus (HPV) vaccines, Cervarix (GSK) and
Gardasil (Merck). What are the differences between them?
A: Cervarix is an inactivated bivalent vaccine (HPV2) that
protects against HPV types 16 and 18. Gardasil is an
inactivated quadrivalent vaccine (HPV4) that protects
against HPV types 16 and 18, and also against types 6 and
11, which are human papillomaviruses that cause genital
For prevention of cervical cancers and precancers, ACIP
recommends that females ages 9 through 26 years be
vaccinated with either Cervarix or Gardasil. To prevent
genital warts, as well as cervical cancers and precancers,
ACIP recommends vaccination with Gardasil. Gardasil may also
be given to males ages 9 through 26 years to reduce their
likelihood of acquiring genital warts.
Ideally, the HPV vaccine should be administered before
potential exposure to HPV through sexual contact. Therefore,
for prevention of cervical cancers and precancers, ACIP
recommends that females ages 11 or 12 years be routinely
vaccinated with either Cervarix or Gardasil. HPV vaccination
also is recommended for females ages 13 through 26 years who
have not been previously vaccinated or who have not
completed the full vaccination series. The vaccination
series can be started in males and females beginning at age
Both HPV vaccines are administered in a 3-dose schedule,
with the second dose administered 1 to 2 months after the
first dose and the third dose 6 months after the first dose.
The minimum interval between the first and second doses of
vaccine is 4 weeks. The minimum interval between the second
and third doses of vaccine is 12 weeks. The minimum interval
between the first and third doses is 24 weeks.
Whenever possible, use the same brand of HPV vaccine for all
doses in the series. In situations when that's not possible,
use the second HPV brand to complete the series. A total of
3 doses of HPV vaccine (either of a single brand or of a
combination of brands) completes the series. Do not start
the series over again. If fewer than 3 doses of Gardasil are
received, protection against HPV types 6 and 11 may not be
To access the provisional recommendations for HPV vaccine,
Q: What are the recommendations for using Gardasil to
prevent genital warts in boys and men?
A: ACIP's provisional recommendations state: "The 3-dose
series of quadrivalent HPV vaccine may be given to males
aged 9 through 26 years to reduce their likelihood of
acquiring genital warts." The schedule and minimum intervals
are the same as for females. See the question and answer
above for details.
Q: Use of HPV vaccine is covered under the Vaccines for
Children (VFC) program. Can VFC-eligible boys receive HPV
vaccine under the program?
A: Yes. Since ACIP states that Gardasil can be administered
to males to protect them from genital warts, VFC vaccine
provided by the VFC program can be used for VFC-eligible
males ages 9 through 18 years.
Q: Please describe the recommendations for the use of the
Japanese encephalitis (JE) vaccine, Ixiaro (Intercell
A: FDA licensed Ixiaro in March 2009. The other U.S.-licensed vaccine, JE-VAX, available in the U.S. since 1992,
is no longer being manufactured, but existing supplies are
still available for children ages 1 through 16 years who are
at risk for exposure to Japanese encephalitis.
Ixiaro is indicated for the prevention of disease caused by
Japanese encephalitis virus (JEV) in people age 17 years and
older. People for whom Ixiaro vaccination is indicated
(i.e., travelers age 17 and older who plan to spend a month
or longer in endemic areas during the JEV transmission
season) should receive 2 doses administered IM 28 days
apart. The series should be completed at least 1 week prior
to potential exposure to JEV. There are no data on the
interchangeability of JE-VAX and Ixiaro. Persons who have
received 1 or 2 doses of JE-VAX in the past should receive a
full series of 2 doses of Ixiaro (separated by at least 28
days) if they are still at risk of exposure to Japanese
To access the provisional recommendations for JE vaccine, go
The Ixiaro package insert is located at
Information about the 1993 recommendations for use of JE-VAX
is available at http://www.cdc.gov/mmwr/pdf/rr/rr4201.pdf
Q: What's new regarding yellow fever vaccination
A: On December 9, 2009, CDC posted provisional
recommendations for use of yellow fever (YF) vaccine. The
provisional recommendations include two new
contraindications and one new precaution to YF vaccination.
YF vaccine is now contraindicated for people whose
immunologic response is either suppressed or modulated by
current or recent radiation therapy or drugs, and for people
with thymus disorders associated with abnormal immune cell
function, such as thymomas.
Being age 60 years or older years is now a precaution for YF
vaccine administration, especially for people who have not
previously received YF vaccine.
To access the provisional recommendations for yellow fever
vaccine, go to:
Q: Is CDC planning to release any new or updated VISs in the
A: On October 6, 2009, CDC released three new VISs, one for
zoster vaccine, one for PPSV, and one for rabies. New and
updated VISs that will likely be available within the next
few months include MMRV, HPV, Japanese encephalitis, yellow
fever, anthrax, and PCV. You can find the latest news about
VIS changes on CDC's web page at
All English-language VISs, as well as translations in more
than 30 languages, are available on IAC's website at
http://www.immunize.org/vis In addition, IAC always informs
IAC Express subscribers about new and revised VISs as soon
as they are released. To subscribe to IAC Express, go to
Q: Can you give me a list of all the currently available
seasonal and H1N1 influenza vaccine products?
A: IAC has developed a print piece that includes information
(manufacturer, trade name, presentation, mercury content,
and age indication) for all currently available seasonal and
H1N1 influenza vaccines. To access "Influenza Vaccine Products
for the 2009-2010 Influenza Season," go to
Q: I understand that both sanofi pasteur and MedImmune
recalled some H1N1 influenza vaccine lots at the end of
2009. Was safety an issue? Do we have to recall patients to
A: No to both questions. Both recalls were voluntary,
limited, and not safety-related.
As part of their ongoing quality assurance programs,
MedImmune and sanofi pasteur both discovered the potency
levels of certain lots of their H1N1 influenza vaccine had
decreased below a pre-specified limit or were at risk of
falling below that limit soon. MedImmune voluntarily
recalled 13 lots of 2009 H1N1 nasal spray vaccine and sanofi
pasteur voluntarily recalled 4 lots of single-dose,
prefilled-syringe pediatric (0.25 mL) H1N1 vaccine.
The slight decrease in vaccine potency is not expected to
have an impact on the protective response to vaccination,
and a person who received a dose from one of the recalled
vaccine lots does not need to be re-vaccinated. These lots
of vaccine pose no safety concerns.
For more information on the MedImmune recall, including
affected lot numbers, go to:
For more information on the sanofi pasteur recall, including
affected lot numbers, go to:
Q: Is enough H1N1 influenza vaccine available now to start
vaccinating people who are not in one of the targeted high-risk groups?
A: Supplies of vaccines that protect against the 2009 H1N1
virus are increasing. In areas where health department
jurisdictions recommend it, providers can give 2009 H1N1
vaccine to anyone who wants it. Most states already allow
this, and CDC is encouraging people who have been patiently
waiting to receive the 2009 H1N1 vaccine to get vaccinated
Vaccination is the best defense against both H1N1 and
seasonal influenza. Although H1N1 influenza activity in the
United States has recently decreased, seasonal and H1N1
influenza viruses are expected to continue circulating for
months. Influenza is unpredictable, and another wave of H1N1
activity could begin at any time. Providers are encouraged
to continue vaccinating patients throughout influenza
season, including the spring months.
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 several inquiries.
You can email your question about vaccines or immunization
to IAC at firstname.lastname@example.org As we receive hundreds of
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your specific 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
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