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 new MMRV,
PCV13, and rotavirus recommendations; the new meningococcal
vaccine Menveo; and other 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: Please review the specifics of the new CDC
recommendations for the use of the combination measles,
mumps, rubella, and varicella (MMRV) vaccine.
A: On May 7, 2010, CDC issued new recommendations for the
use of combination MMRV vaccine. Prior to issuing these
recommendations, ACIP reviewed results of post-licensure
studies that suggest that, during the 5-12 day post-vaccination period, approximately one additional febrile
seizure occurred among every 2,600 children ages 12 through
23 months vaccinated with a first dose of MMRV vaccine
compared with children in the same age group vaccinated with
separate first doses of MMR vaccine and varicella vaccine
administered during a single office visit.
The summary of the recommendations for use of MMRV vaccine
are as follows:
- The routinely recommended ages for measles, mumps,
rubella, and varicella vaccination continue to be age 12 through
15 months for the first dose and age 4 through 6 years for the
- For the first dose of measles, mumps, rubella, and
varicella vaccines at age 12 through 47 months, providers
may use either measles, mumps, and rubella (MMR) vaccine and
varicella vaccine or MMRV vaccine. Providers who are
considering administering MMRV vaccine should discuss the
benefits and risks of both vaccination options with the
parents or caregivers. Unless the parent or caregiver
expresses a preference for MMRV vaccine, CDC recommends that
providers administer MMR vaccine and varicella vaccine for
the first dose in this age group.
- For the second dose of measles, mumps, rubella, and
varicella vaccines at any age (15 months through 12 years)
and for the first dose at age 48 months and older, use of MMRV
vaccine generally is preferred over separate injections of
its equivalent component vaccines (i.e., MMR vaccine and
- A personal or family (i.e., sibling or parent) history of
seizures of any etiology (i.e., cause) is a precaution for
MMRV vaccination, and such children generally should be
vaccinated with MMR vaccine and varicella vaccine.
The complete recommendations for the use of MMRV vaccine are
available on CDC's website at
In addition, CDC has issued a new VIS for MMRV, dated
5/21/10, which is available at http://www.immunize.org/vis and
As with all other VISs, it should be given to the parent or
vaccine recipient prior to vaccination to facilitate discussion
about the vaccine between the patient and provider.
Q: Instead of giving tetanus/diphtheria toxoid and acellular
pertussis (Tdap) vaccine to a father-to-be who needed
protection against pertussis, we mistakenly gave him
tetanus/diphtheria (Td) toxoid. How soon after the Td dose
can we give him the dose of Tdap he needs?
A: As long as they are younger than age 65 years and at
least age 10 years, parents, grandparents, healthcare
workers, and all others who have not already received Tdap,
and who are close contacts of infants younger than age 12
months, should receive a single dose of this vaccine as soon
as possible to protect infants from pertussis. When giving
Tdap to protect infants, one does not need to observe a
"minimum interval" between giving Td and Tdap. For example,
if you had immediately realized that you had mistakenly
given the father-to-be Td instead of Tdap, you could have
given him the needed Tdap dose at the same visit at which
you gave him the erroneous Td dose.
Q: Many children in my practice have received their complete
series of 7-valent pneumococcal conjugate vaccine (PCV7).
Would you please review the recommendations for which of
them now need a supplemental dose of 13-valent pneumococcal
conjugate vaccine (PCV13)?
A: A single supplemental dose of PCV13 is recommended for
all children ages 14 through 59 months who have received the
complete 4-dose series of PCV7 or another age-appropriate,
complete PCV7 schedule. For children who have underlying
medical conditions, a single supplemental PCV13 dose is
recommended through age 71 months. This also includes
children who have previously received pneumococcal
polysaccharide vaccine (PPSV23). Give the single
supplemental dose of PCV13 no sooner than 8 weeks after the
last dose of PCV7 or PPSV23 was given.
IAC has created a table that explains how to use PCV13 to
catch up children who have fallen behind on their PCV7
doses. It's available at http://www.immunize.org/catg.d/p2016.pdf
Q: I have a 13-year-old patient in my practice who recently
had his spleen removed. He has been vaccinated with
pneumococcal polysaccharide vaccine (PPSV23) but never
received 7-valent pneumococcal conjugate vaccine (PCV7). Can
I give him the new 13-valent pneumococcal conjugate vaccine,
A: Yes. Administer a single dose of PCV13 to children ages 6
through 18 years who are at increased risk for invasive
pneumococcal disease because of sickle cell disease, HIV
infection or other immunocompromising condition, cochlear
implant, functional or anatomical asplenia, or cerebrospinal
fluid leak, even if they have previously received PCV7,
PPSV23, or both vaccines. A table that details the
underlying medical conditions that are indications for
pneumococcal vaccination among children is available on page
260 of the related ACIP recommendations at
Q: We mistakenly gave a patient the diluent for Menveo
meningococcal conjugate vaccine (MCV4; Novartis) without
adding it to the powdered vaccine. Since vaccine is present
in the diluent as well as in the powder, what should we do
A: Menveo's liquid vaccine component (i.e., diluent)
contains the C, Y, and W-135 serogroups, and the lyophilized
vaccine component (i.e., freeze-dried powder) contains
serogroup A. Because the patient received only the diluent,
he or she is not protected against invasive meningococcal
disease caused by Neisseria meningitidis serogroup A.
Invasive disease with N. meningitidis serogroup A is very
rare in the United States, but is more common in some other
countries, particularly the African meningitis belt. If the
recipient (of the C-Y-W135 "diluent" only) does not plan to
travel outside the United States then the dose does not need
to be repeated. However, if the recipient plans to travel
outside the United States the dose should be repeated with
either correctly reconstituted Menveo, or with a dose of
Menactra brand MCV4. There is no minimum interval between
the incorrect dose and the repeat dose.
Q: We now have two meningococcal conjugate vaccines (MCV4)
to chose from--Menactra (sanofi pasteur) and Menveo
(Novartis). It would be useful to know if they are
interchangeable when repeat doses of MCV4 are needed.
A: Although both vaccines are licensed for single-dose use,
you can use either vaccine to revaccinate people ages 11
through 55 years who are at prolonged increased risk for
meningococcal disease. Only Menactra is licensed for
vaccinating and revaccinating children ages 2 through 10
years. Use only meningococcal polysaccharide vaccine (MPSV4;
Menomune; sanofi pasteur) when vaccinating or revaccinating
people age 56 years and older.
To access updated recommendations for revaccinating people
at prolonged increased risk for meningococcal disease, go
to: http://www.cdc.gov/mmwr/PDF/wk/mm5837.pdf, and see pages
Q: What is the FDA's current recommendation about the use of
rotavirus vaccine in infants?
A: In March 2010, FDA recommended temporary suspension of
the use of Rotarix (GSK) after researchers found DNA from
porcine circovirus type 1 (PCV1) in the vaccine. In May,
Merck confirmed the presence of DNA from PCV1 and PCV2 in
its rotavirus vaccine, RotaTeq.
On May 14, FDA updated its recommendations on both Rotarix
and RotaTeq vaccines for the prevention of rotavirus disease
in infants. Based on careful evaluation of a variety of
scientific information, FDA has determined it is appropriate
for clinicians and health care professionals to resume the
use of Rotarix and to continue the use of RotaTeq. All
available evidence supports the safety and effectiveness of
Rotarix and RotaTeq, which have been extensively studied,
both before and after approval. For more detailed information,
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.
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