Read "Ask the Experts" Q&As on current immunization issues
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.
The Q&As in this edition of IAC Express deal with the use of
acetaminophen at the time of vaccination, new influenza and
Prevnar 13 vaccine recommendations, the temporary suspension
of Rotarix use in the U.S., and questions frequently
submitted to IAC and CDC.
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: Can we start vaccinating on the basis of a provisional
ACIP recommendation? Or do we need to wait until the
recommendation is made final by publication in MMWR?
A: Consider a provisional recommendation as you would a
final recommendation. The basic recommendation will not
change. Getting a recommendation officially approved and
published can be a lengthy process. It is more a matter of
internal government procedures than anything of significance
to a practitioner.
Q: On Oct. 17, 2009, The Lancet published a study that found
that infants who received three doses of acetaminophen
following immunization had reduced immune responses to
certain vaccines. Based on these findings, should we stop
recommending acetaminophen for fever or discomfort after
A: No. Evidence from this study would discourage the
prophylactic use of acetaminophen prior to or immediately
following vaccination. Acetaminophen can be used to treat
pain or fever if it should occur following vaccination. In
the upcoming 2010 General Recommendations on Immunization,
CDC will remove all recommendations for prophylactic use of
acetaminophen or other analgesics BEFORE or AT THE TIME OF
vaccination. AAP has already removed such recommendations
from the Red Book.
Q: Why were U.S. healthcare providers recommended to
temporarily suspend administering Rotarix rotavirus vaccine
(RV1; GSK) in late March 2010?
A: GSK reported to FDA that an independent academic research
team using a novel technique to look for viruses had
discovered DNA components from porcine circovirus type 1
(PCV1) in Rotarix vaccine. GSK conducted additional studies
and confirmed that DNA from PCV1 is present in the finished
Rotarix vaccine (as well as in the cell bank and seed from
which the vaccine is derived) and that it has been present
since the early stages of the vaccine's development. FDA
decided to suspend the vaccine's use while learning more
about the situation and until further studies are done. PCV1
is not known to cause disease in people or animals. PCV1 was
not found in RotaTeq rotavirus vaccine (RV5; Merck).
Q: How should we complete the rotavirus vaccine series in
infants who have already received 1 dose of Rotarix?
A: If you started an infant on Rotarix, complete the series
by administering 2 doses of RotaTeq. RotaTeq is routinely
given using a 3-dose schedule at ages 2, 4, and 6 months. It
is important that you keep infants on schedule as they must
complete the third and final dose by age 8 months, 0 days.
Q: Should we return our existing supply of Rotarix to the
manufacturer or distributor where we bought it?
A: No. FDA will be convening an expert advisory committee to
review available data and will then issue subsequent
recommendations. For now, you should keep Rotarix in proper
storage (i.e., store the lyophilized Rotarix at refrigerated
temperatures [35 degrees to 46 degrees F; 2 degrees to 8
degrees C] and store the diluent at room temperatures [68
degrees to 77 degrees F; 20 degrees to 25 degrees C]).
Q: Has the World Health Organization (WHO) also recommended
temporary suspension of the use of Rotarix?
A: No. WHO issued a statement on March 22 titled "WHO does
not recommend any change to use of Rotarix vaccine." It
includes the following: ". . . WHO concurs with the views of
the FDA and EMA [European Medicines Agency] that the
findings do not present a threat to public health. Moreover,
rotaviruses are the most common cause of severe diarrhoeal
disease in young children throughout the world, with an
estimated 527,000 deaths among children under five years
old, most of whom live in low-income countries. Therefore,
WHO does not recommend any change to use of the vaccine. . . ."
To read the full WHO statement on Rotarix, go to
Q: Please tell me about the new pneumococcal conjugate
vaccine, Prevnar 13.
A: On February 24, FDA licensed the 13-valent pneumococcal
vaccine, Prevnar 13, (PCV13; Pfizer). It contains the 7
Streptococcus pneumoniae serotypes included in the first
pneumococcal conjugate vaccine (PCV7, Prevnar), plus 6
additional serotypes (1, 3, 5, 6A, 7F, and 19A). Together,
these 13 serotypes account for the majority of invasive
pneumococcal disease (IPD) in the U.S., including serotype
19A, which is now the most common IPD-causing serotype in
young children. On February 24, ACIP voted to approve
recommendations for the use of Prevnar 13, and on March 12
the recommendations were published in MMWR. To access them,
go to http://www.cdc.gov/mmwr/PDF/wk/mm5909.pdf and scroll
down to pages 258-261.
Q: What vaccination schedule should we follow for PCV13?
A: Generally, you should follow the same 4-dose schedule you
followed for PCV7, administering doses at ages 2, 4, 6, and
12-15 months. Following are additional recommendations
concerning PCV 13:
(1) For children who have begun a series of PCV7, replace
all remaining doses with PCV13. If you are unsure how to
assess and complete the pneumococcal conjugate vaccine
immunization schedule for children who may have fallen
behind, consult the pneumococcal vaccine catch-up schedule
that can be found at
(2) For children who have completed an age-appropriate 4-dose series of PCV7
(a) Give one additional dose of PCV13 to all healthy
children who have not yet reached their fifth birthday.
(b) Give one additional dose of PCV13 to children with
underlying medical conditions who have not yet reached their
(c) For children ages 6 through 18 years with functional or
anatomic asplenia, including sickle cell disease, HIV
infection or other immunocompromising condition, cochlear
implant, or CSF leak, consider giving one dose of PCV13
regardless of previous history of PCV7 or pneumococcal
polysaccharide vaccine (PPSV).
Q: I've heard that the recommendations for influenza
vaccination have been expanded for the 2010-11 season. Tell
A: At its February 2010 meeting, ACIP voted to recommend
routine annual influenza vaccination for all people age 6
months and older, beginning with the 2010-11 influenza
vaccination season. This change expands the existing
recommendations to include all healthy adults ages 19
through 49 years who hadn't previously been included in
routine vaccination recommendations.
Q: The new Zostavax vaccine (Merck) package insert says that
Zostavax should not be given simultaneously with
pneumococcal polysaccharide vaccine (PPSV). What does ACIP
say about this?
A: ACIP has not changed its recommendation on the
simultaneous administration of these two vaccines (i.e.,
they can be given at the same time or any time before or
after each other).
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
emails each month, we cannot guarantee that we will print
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
email@example.com There is no charge for this service.
If you have a question about IAC materials or services,
Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at