Ask the Experts is one of our most popular destinations for healthcare professionals. Our experts provide clear, easy-to-understand answers to commonly asked questions about vaccines and their use.
No. Beta thalassemia minor is a hemoglobinopathy, but compared to sickle cell disease, these patients have less risk for functional asplenia, and therefore do not have a significantly increased risk of invasive pneumococcal disease.
The stopper of a single-dose vial (SDV) is often assumed to be sterile. However, not all vaccine manufacturers guarantee the tops of unused vials are sterile, and the manner in which the cover over the stopper is removed can potentially contaminate the stopper. Therefore, using friction and a sterile alcohol pad to swab the stopper may help to assure aseptic technique in preparing the SDV prior to inserting a sterile syringe. Alcohol evaporates quickly and will dry while the needle is being prepared for insertion into the vial.
The risk for zoster and its severe morbidity and mortality is much greater for immunosuppressed people. A 2-dose series of Shingrix recombinant zoster vaccine should be administered as soon as possible while the person’s immune system is intact. In cases such as this, depending upon the timing of chemotherapy initiation, you may wish to consider a shorter interval of at least 4 weeks (1 month) in order to complete the series as soon as possible.
No. You should only use the (0.4% NaCl) diluent provided with the Dengvaxia vaccine vial. Contact your immunization program or the manufacturer for additional guidance.
Yes. There is no need to observe any minimum interval between doses of Td and Tdap except when administered as part of a catch-up primary series of tetanus vaccine.
Yes. Mothers who have received HepB should still be screened for HBsAg early in each pregnancy. Just because a pregnant person has been vaccinated does not mean they are HBsAg negative. Since postvaccination testing is not performed for most vaccinated people, the mother could have been vaccinated when already actively infected.
In published reports of three serologic surveys conducted among United States wastewater workers and appropriate comparison populations, no substantial or consistent increase in the prevalence of anti-HAV was identified among wastewater workers. No work-related instances of hepatitis A transmission have been reported among wastewater workers in the United States. In addition, in the United States, outbreaks of hepatitis A caused by flooding, which can carry raw sewage, have not been reported.
No. Twinrix contains 50% less hepatitis A antigen component than Havrix, GSK’s monovalent HepA vaccine [720 vs. 1440 EL.U.], so the patient would not receive the recommended dose of HepA vaccine antigen.
No. Documented receipt of 2 doses of varicella vaccine supersedes results of subsequent serologic testing. Most commercially available tests for varicella antibody are not sensitive enough to detect vaccine-induced antibody, which is why CDC does not recommend post-vaccination testing. For more information, see page 24 of ACIP’s Immunization of Health-Care Personnel, available at www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.
Yes. However, if two parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are not administered on the same day, they should be separated by an interval of at least 28 days.
Some American Indian or Alaska Native (AI/AN) children experience higher rates of severe RSV disease than the general population. A recent study found that the incidence of hospitalization due to RSV among some AI/AN children in their second year of life was four to ten times higher than that of similar-aged children in multiple study sites in the United States. Also, some AI/AN communities live in remote regions, making transportation of children with severe RSV to obtain medical care more challenging. Although the available data are limited and may not apply to all AI/AN children in all settings, ACIP recommends nirsevimab (Beyfortus, Sanofi) for AI/AN children entering their second RSV season.
The American Academy of Pediatrics (AAP) explains its recommendation for AI/AN children in its August 2025 policy statement (https://doi.org/10.1542/peds.2025-073923) as follows:
American Indian and Alaska Native Children are included in the high-risk category, because they experience significantly higher rates of severe RSV disease and hospitalization, with children living in rural and reservation communities most impacted. Evidence supports that this increased risk is associated with social drivers of health, with specific attention to running water access, transportation difficulties, household crowding, and indoor air quality.
The two doses may be the same or different products.
Yes. COVID-19 vaccination may be given during lactation.
The IDSA guidelines indicate that persons receiving rituximab should be considered to have high-level immunosuppression. Both inactivated and live vaccines should be withheld at least 6 months following treatment with lymphocyte depleting medications such as rituximab. As for the IG, the interval to live vaccination depends on the dose. For guidance, please refer to the Timing and Spacing of Immunobiologics section of the ACIP’s “General Best Practices Guidelines for Immunization”, table 3-5: “Recommended intervals between administration of antibody-containing products and measles- or varicella-containing vaccine, by product and indication for vaccination” at www.cdc.gov/vaccines/hcp/imz-best-practices/timing-spacing-immunobiologics.html. This interval could be as long as 11 months, depending on the dose he receives.
Adults that received PCV13 should complete the pneumococcal series with PCV20 or PCV21 vaccination at least 1 year after PCV13. PCV15 and PPSV23 are not recommended in this situation.
You should use DTaP to catch up children younger than age 7 years. In addition, ACIP recommends giving one dose of Tdap to children age 7–10 years who were not fully vaccinated against pertussis before their seventh birthday. Children age 7–10 who require more than one dose of tetanus-containing vaccine to be up to date with diphtheria or tetanus immunization may be given either Td or Tdap for doses needed after the initial Tdap dose. Although this is an off-label use of the vaccines, it’s important that you vaccinate these unvaccinated or undervaccinated older children with Tdap as well as any other adolescent or adult who hasn’t received Tdap previously.
A person who was on immunosuppressive chemotherapy in the past but is not expected to be immunocompromised again may follow routine recommendations for shingles vaccination at age 50 years or older. If the patient is age 19 or older and expected to require repeated exposure to immunosuppressive chemotherapy in the future, then it is preferable to vaccinate now while the patient’s immune system is more robust.
ProQuad was licensed in 2005 for use in children ages 12 months through 12 years. It combines the measles-mumps-rubella (MMR) and varicella vaccines and therefore can be used in place of the individual MMR and varicella vaccines given at ages 12–15 months and 4–6 years. For more information, consult the package insert at www.merck.com/product/usa/pi_circulars/p/proquad/proquad_pi_4171.pdf.
The earlier the evaluation is done, the better. Consultation with or referral to a liver disease specialist (such as a hepatologist, gastroenterologist, or infectious disease specialist) should be done. The consulting/referral physician should be aware of the patient’s obstetrical status. In addition, the patient’s sex partner and children or other household contacts should be tested for HBV infection (total anti-HBc and HBsAg) as soon as possible. If any are susceptible to HBV infection (total anti-HBc and HBsAg negative), they should be vaccinated. If any are HBsAg positive, they should be referred to or have consultation with a liver disease specialist.
Using a pre-packaged sterile alcohol prep pad is recommended to maintain aseptic technique. Not only are cotton balls not sterile, but neither is a bottle of sterile alcohol, once it’s opened.
The recommended minimum interval between two doses of varicella vaccine for children 12 months through 12 years of age is 12 weeks. However, the second dose of varicella vaccine does not need to be repeated if records show it was separated from the first dose by at least 4 weeks. See www.cdc.gov/vaccines/hcp/imz-best-practices/timing-spacing-immunobiologics.html, Table 3-2.
The second dose of MMR may be given as early as 4 weeks after the first dose, and be counted as a valid dose, if both doses were given after the first birthday. The second dose is not a booster, but rather it is intended to produce immunity in the small number of people who fail to respond to the first dose. The risk of measles is higher in school-age children than those of preschool age, so it is important to receive the second dose by school entry. It is also convenient to give the second dose at this age, since the child will have an immunization visit for other school entry vaccines.
People with clotting factor disorders were originally recommended to receive hepatitis A vaccine (HepA) in 1996. At that time, the process used to make clotting factor supplements did not reliably inactivate hepatitis A viruses and recipients of these products had an increased risk of hepatitis A virus (HAV) infection. Modern blood donor screening and virus reduction steps have drastically reduced that risk. In addition, more than 80% of people with clotting factor disorders now receive recombinant clotting factor concentrates that are sterilized and have no risk of HAV transmission. As a result of these factors, people with clotting factor disorders now have no greater risk of hepatitis A than the general population and are no longer recommended to receive HepA vaccine unless it is otherwise indicated.
Yes. Adolescents and adults who started the HPV vaccine series prior to the 15th birthday and who are not immunocompromised are considered to be adequately vaccinated with just one additional dose of HPV vaccine.
There is no specific indication for meningococcal vaccine in this patient. Risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of complement inhibitors such as eculizumab [Soliris], ravulizumab [Ultomiris] or sutimlimab [Enjaymo], and HIV infection) and do not include other forms of altered immunocompetence.
The child should always receive the dose appropriate for his or her age at the time of the clinic visit; at age 37 months that would be a 0.5 mL dose of Afluria.
Palivizumab (Synagis, AstraZeneca) is a short-acting monoclonal antibody product that is administered monthly. Synagis is no longer recommended for use by the American Academy of Pediatrics (AAP). The manufacturer is discontinuing the product in December 2025.
Store both the vaccine antigen and the diluent in a refrigerator at 36°F–46°F (2°C–8°C). Do not freeze. Protect from light. After reconstitution, administer Dengvaxia immediately or store refrigerated at 36°F–46°F (2°C–8°C) and use within 30 minutes.
Do not use the vaccine if it has been reconstituted for over 30 minutes. Contact your public health immunization program or the manufacturer for advice if vaccination occurs using vaccine that has been reconstituted more than 30 minutes, or in the event of other storage or handling errors.
The manufacturer package insert contains additional information and can be found at www.fda.gov/media/124379/download.
For complete information on vaccine storage and handling best practices and recommendations, please refer to CDC’s Vaccine Storage and Handling Toolkit at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf.
Please see CDC’s Interim Clinical Considerations for the Use of COVID-19 Vaccines for dosage guidance for detailed tables, including dosing intervals and options (www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html). You will also find the vaccination schedules for people who are moderately or severely immunocompromised in the Immunize.org standing orders templates for administration of COVID-19 vaccines:
In general, people who are moderately or severely immunocompromised and previously unvaccinated are recommended to receive a 2-dose (protein subunit) or 3-dose (mRNA) initial series of COVID-19 vaccine, with an additional dose 6 months later of any age-appropriate COVID-19 brand (minimum interval of 2 months for Nuvaxovid, Spikevax, or Comirnaty; 3-month minimum interval for mNexspike). CDC recommends use of the same manufacturer for all doses of the initial series when feasible. Spikevax and mNexspike are both made by Moderna and are interchangeable in ages 12 years and older.
Those who completed an initial series before the 2025–2026 formula vaccines were available should receive 2 doses of 2025–2026 Formula COVID-19 vaccine (any age-appropriate brand) about 6 months apart (minimum interval of 2 months for Nuvaxovid, Spikevax, or Comirnaty; 3-month minimum interval for mNexspike).
Immunocompromised people should be counseled that they may have a reduced immune response to COVID-19 vaccination. Continuing other infection prevention measures, such as wearing a face mask and avoiding crowds, can help limit their risk of exposure to the SARS-CoV-2 virus.
Pemivibart (Pemgarda, Invyvid) is a monoclonal antibody for COVID-19 pre-exposure prophylaxis in people who are moderately or severely immunocompromised and unlikely to mount an adequate immune response to COVID-19 vaccination and who meet the FDA-authorized conditions for use. See additional information from CDC at the immunocompromised link in the first paragraph.
What you describe is a good strategy for administration of the 2-dose pneumococcal vaccine series of PCV15 and PPSV23 to people age 50 years and older if you prefer not to complete their PCV vaccination with a single dose of either PCV20 or PCV21. ACIP does not define “one year” but this is assumed to be one calendar year. Receiving PPSV23 a few days or weeks earlier than one calendar year after PCV15 is not a medical problem. However, it could be a problem for reimbursement since Medicare will only pay for both a PCV15 vaccine and a PPSV23 vaccine if they are given at least 11 months apart. Private insurance may have similar rules. Here is the wording from the Centers for Medicare and Medicaid (CMS): “An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered (i.e., 11 full months have passed following the month in which the last pneumococcal vaccine was administered).”
Because of measles. Measles is highly communicable and poses a serious threat to the health of unvaccinated infants. For this reason, all infants age 6 through 11 months who travel internationally are recommended to receive a dose of measles, mumps, and rubella vaccine (MMR) to reduce the risk of measles infection during travel.
The antibodies in immune globulin (IG) typically used to prevent HAV infection in infants before the first birthday can interfere with the effectiveness of MMR vaccine. An infant who is given IG should not be vaccinated with MMR or varicella vaccines for at least 6 months after IG administration. If an infant age 6 through 11 months is traveling to a destination where protection from infection with HAV is desired, ACIP recommends off-label use of HepA vaccine (not IG) in addition to MMR. The HepA and MMR doses administered before the first birthday do not count toward the routine vaccination series of either vaccine: these infant travelers will still need two doses of HepA and two doses of MMR when age appropriate.
Contraindications:
Precautions:
Precautions for combination MMRV (ProQuad, Merck) only (approved for children 1 through 12 years of age) also include: history of thrombocytopenia or thrombocytopenic purpura, a personal or family history of seizures of any etiology, and a need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing.
For additional information, see the “General Best Practice Guidelines for Immunization” section on contraindications and precautions, table 4–1 and associated footnotes, at www.cdc.gov/vaccines/hcp/imz-best-practices/contraindications-precautions.html.
This child needs to complete the primary series with 1 dose of Td or Tdap, administered no earlier than 6 months after the Tdap dose given at age 11 years. After that, the child needs a booster dose of Td or Tdap every 10 years. An easy way to determine how to catch up a child is to consult “Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, U.S.” The schedule is approved by CDC, AAP, and AAFP and is released early in each calendar year. It includes a catch-up schedule for children who have fallen behind (see www.cdc.gov/vaccines/hcp/imz-schedules/index.html).
Although second-hand smoke and other environmental conditions have been identified as risk factors for meningococcal disease, ACIP does not include them as indications for MenACWY vaccination. Providers may always use their clinical judgment in situations not addressed by ACIP.
In general, the entire volume should be used even if it is a little more than 0.5 mL. Discarding the excess vaccine is not required or recommended.
An exception to this general rule is the presentation of recombinant zoster vaccine (Shingrix, GSK) that requires reconstitution. The Shingrix adjuvant solution vial may contain up to 0.75 mL of liquid. The entire volume of the adjuvant solution should be withdrawn and used to reconstitute the lyophilized vaccine. After mixing, withdraw the recommended dose of 0.5 mL. Any reconstituted Shingrix vaccine left in the vial should be discarded.
Hepatitis C infection is not a contraindication for Shingrix recombinant zoster vaccination. However, if someone with hepatitis C is receiving a medication that can cause immunosuppression, they should consult with their healthcare provider to discuss the clinical considerations for the timing of vaccination. Detailed guidance is available at www.cdc.gov/shingles/hcp/vaccine-considerations/immunocompromised-adults.html.
People who have received 2 doses of HPV vaccine separated by less than 5 months should receive a third dose 6–12 months after dose #1 and at least 12 weeks after dose #2, regardless of their age at the time of the first dose. The recommended interval for the second dose in the 2-dose schedule (indicated when the first dose is given before age 15) is 6 months and the minimum interval is 5 months.
Post-licensure studies of MMRV suggested that, during the 5–12 days after vaccination, 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.
For this reason, the recommendations for use of MMRV vaccine are as follows:
The complete recommendations for the use of MMRV vaccine are available on CDC’s website at www.cdc.gov/mmwr/pdf/rr/rr5903.pdf.
ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the United States. Before their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a copy of their immunization records with them as they travel. For additional information on the worldwide measles situation, and on CDC’s measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.
If you are unable to obtain prenatal records or verify receipt of maternal RSV vaccine, CDC recommends that the baby receive nirsevimab (Beyfortus, Sanofi) or clesrovimab (Enflonsia, Merck), particularly if it is shortly before or during the RSV season. Don’t forget to check the state immunization information system (IIS) for the mother’s vaccination record. RSV vaccination during a previous pregnancy does not protect through later pregnancies. If the mother received RSV vaccine during a previous pregnancy, nirsevimab or clesrovimab is indicated for this infant. It is also important to attempt to verify from the birthing facility records whether this baby received an RSV preventive antibody product prior to discharge to avoid giving an unnecessary second dose.
Multidose vials of inactivated influenza vaccine contain a small amount of thimerosal to prevent bacterial and fungal growth in the vial.
Thimerosal-containing vaccines from multidose vials are safe to use in children. No scientific evidence indicates that the small amount of thimerosal in vaccines causes adverse events unless the patient has a severe allergy to thimerosal. In June 2025, CDC’s ACIP voted to no longer recommend use of influenza vaccines in MDVs containing thimerosal as a preservative. In addition, a few states have enacted legislation that restricts the use of thimerosal-containing vaccines in children. To find out if your state has such restrictions, check with your state immunization program (see www.immunize.org/official-guidance/state-policies/state-resources/ for program contact information).
The American Academy of Pediatrics (AAP) continues to recommend annual influenza vaccination of all children, beginning at age 6 months, using any available age-appropriate presentation, including MDVs containing thimerosal as a preservative.
The conditions and treatments that CDC specifies may result in moderate or severe immunocompromise include but are not limited to:
Additional factors to consider in assessing the general level of immune competence in a patient include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immune-suppressing treatment. A patient’s clinical care team is in the best position to evaluate the degree of immunocompromise and timing of vaccination.
See CDC’s interim clinical considerations for this population: www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html.
Studies have shown that administering the pneumococcal conjugate vaccine (PCV) first leads to a better immune response to serotypes common to both vaccines when the polysaccharide vaccine (PPSV23) is given at a later date. For this reason, CDC recommends that pneumococcal vaccine-naive adults receive PCVs either alone (PCV20, PCV21) or first in a sequence (PCV15 first, followed by PPSV23). A provider who stocks only PPSV23 should consider purchasing a recommended PCV or referring patients elsewhere to receive a PCV, if feasible. A patient due for PCV who inadvertently receives PPSV23 first should receive PCV15, PCV20, or PCV21 vaccine at least one year later.
Immunize.org has developed suggested standing orders templates for all vaccines routinely given to children and adults. We do not produce standing orders templates for combination products (products that combine vaccines that also are given separately). We also do not routinely produce standing orders templates for vaccines that are infrequently indicated or require clinical risk assessment (by definition, the need for clinical assessment precludes use of a simple standing order for routine administration). These standing orders templates are based on CDC’s Advisory Committee on Immunization Practices (ACIP) recommendations. You can find the standing orders and protocols for medical management of vaccine reactions at www.immunize.org/clinical/topic/standing-orders-templates/.
ACIP recommends adolescents age 11 or 12 years should be routinely vaccinated with MenACWY and receive a booster dose at age 16 years. Adolescents who receive the first dose at age 13 through 15 years should receive a one-time booster dose, preferably at age 16 through 18 years, just before the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their first dose of MenACWY at or after age 16 years do not need a booster dose, as long as they have no additional risk factors.
Preterm infants weighing less than 2,000 grams (4.4 pounds) at birth have a decreased response to HepB administered before age 1 month. By age 1 month, medically stable preterm infants, regardless of initial birth weight or gestational age, have an immunologic response to HepB vaccination that is comparable to that of full-term infants. For preterm infants weighing less than 2,000 grams at birth:
For preterm infants weighing 2,000 grams or more at birth, follow the recommendations for full-term infants including a HepB dose within 24 hours of birth.
Yes. Shingrix can be administered in this situation. Optimally, vaccination should occur when the disease is well-controlled and not during an acute disease flare.
The CDC “General Best Practice Guidelines for Immunization” section on altered immunocompetence recommends varicella vaccination of children with humoral (but not cellular) immunodeficiencies. In addition, single-antigen varicella vaccine should be considered for HIV-infected children age 1 through 5 years with CD4+ T-lymphocyte percentages greater than or equal to 15% for at least 6 months or for children age 6 years and older with CD4+ T-lymphocytes count greater than or equal to 200 cells per microliter for at least 6 months. Eligible children should receive 2 doses of varicella vaccine with a 3-month interval between doses. Additional details of these recommendations can be found in table 8-1 and associated footnotes at www.cdc.gov/vaccines/hcp/imz-best-practices/altered-immunocompetence.html.
The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of age and older. A dose given earlier than 4 days before the first birthday does not count as part of the MMR vaccine two-dose series.
Absolutely not. Vaccines should never be mixed except when specifically approved by FDA and packaged for that specific purpose.
Yes. Any person who ever received 2 doses of any combination of HPV vaccines can be considered fully vaccinated if dose #1 was given before the 15th birthday and the 2 doses were separated by at least 5 months.
Yes, but only if the 9-year-old meets all of the criteria below:
Yes. Infants born less than 14 days after the mother received RSV vaccine should receive nirsevimab (Beyfortus, Sanofi) or clesrovimab (Enflonsia, Merck). Infants born within 14 days after maternal vaccination may not have had sufficient time in utero to receive adequate protection from maternal RSV antibodies produced after vaccination. Infants born 14 days or more after maternal vaccination are not recommended to receive an RSV preventive antibody product except in rare circumstances where maternal antibodies may be insufficiently effective. See a separate question for details on those circumstances.
Since the first DTaP was received before 12 months of age and one Tdap dose has been given, this person needs one dose of Td or Tdap 6 calendar months after the Tdap dose. A routine Td or Tdap booster should be administered every 10 years. See Immunize.org’s handout: DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age: www.immunize.org/catg.d/p2055.pdf.
Yes. The ACIP recommends that pregnant people at risk for hepatitis A virus (HAV) infection during pregnancy or at risk for a severe outcome from HAV infection should be vaccinated during pregnancy if not previously vaccinated. Pregnant people should be vaccinated for the same indications as non-pregnant people. For additional information, see page 20 of the recommendations: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.
Yes. See revaccination considerations at www.cdc.gov/covid/hcp/vaccine-considerations/immunocompromised.html. This is the most current statement from CDC on COVID-19 revaccination:
Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic cell transplant (HCT) who received 1 or more doses of COVID-19 vaccine prior to or during treatment should be revaccinated. Revaccination should start at least 3 months (12 weeks) after transplant or CAR-T-cell therapy and should follow the currently recommended schedule for people who are unvaccinated.
Revaccination may also be considered for patients who received 1 or more doses of COVID-19 vaccine during treatment with B-cell-depleting therapies (e.g., rituximab, ocrelizumab) that were administered over a limited period (e.g., as part of a treatment regimen for certain malignancies) according to the currently recommended schedule for people who are unvaccinated. The suggested interval to start revaccination is about 6 months after completion of the B-cell-depleting therapy. Timing of vaccination for patients who receive B-cell-depleting therapies on a continuing basis (e.g., for treatment of certain autoimmune conditions such as rheumatoid arthritis or multiple sclerosis) is addressed in CDC’s considerations for timing of COVID-19 vaccination in relation to immunosuppressive therapies.
CDC continues to recommend that a patient’s clinical team is best positioned to determine the degree of immune compromise, need for revaccination, and appropriate timing of revaccination.
For people with immunosuppression, ACIP recommends 1 dose of PCV20 or PCV21 alone or one dose of PCV15 followed by a dose of PPSV23 one year later (immunocompromised adults may receive PPSV23 with a minimum 8-week interval after PCV15). MenB is not specifically recommended for immunosuppressed people. However, a patient who is age 16 through 23 years and immunosuppressed may receive routine MenB vaccination with a 3-dose series of either Bexsero (GSK) or Trumenba (Pfizer).
While you did not say this explicitly, we assume the concern is about a vaccine injury in a person who was vaccinated using a standing order. Of course, as long as the person is properly screened for contraindications and precautions, an injury from a vaccine is very unlikely. In the event that an injury does occur, the National Vaccine Injury Compensation Program (VICP) provides liability protection for the vaccinator and the clinician who signed the standing order for any vaccine that is covered by the vaccine injury compensation program (all vaccines that are routinely administered to children are covered by the program for all ages of patients). More information about the VICP is available on their website at www.hrsa.gov/vaccinecompensation/index.html. Some vaccines used in response to a public health emergency, including COVID-19, are included in the Countermeasures Injury Compensation Program (CICP). More information about the CICP is available at www.hrsa.gov/cicp.
In 2015, CDC revised the recommendation for the timing of hepatitis B serologic testing for infants born to an HBsAg-positive woman. Postvaccination testing (HBsAg and hepatitis B surface antibody [anti-HBs]) is now recommended 1 to 2 months after completion of at least three doses of the HepB vaccine series, but not before 9 months of age. For a child vaccinated on schedule, testing should be done at age 9 to 12 months. Testing should not be performed before age 9 months because hepatitis B immune globulin (HBIG) might still be present at age 6 to 8 months, nor should testing be performed within 1 month of the most recent HepB dose because a transient false positive HBsAg might occur. Antibody to hepatitis B core (anti-HBc) testing of infants or children is not recommended because passively acquired maternal anti-HBc might be detected up to age 24 months in children of HBV-infected mothers. Children who are HBsAg positive should receive medical evaluation and ongoing follow-up. For additional information, see www.cdc.gov/mmwr/pdf/wk/mm6439.pdf, pages 1118–20.
For patients receiving anti-B cell therapies (e.g., rituximab), CDC recommends administering a dose of Shingrix approximately 4 weeks prior to the next scheduled therapy.
