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.
TIG is recommended for any wound other than a clean minor wound if the person’s vaccination history is either unknown, or the person has not had a full series of 3 doses of tetanus-containing vaccine. People with HIV infection or severe immunodeficiency who have contaminated wounds (including minor wounds) should also receive TIG, regardless of their history of tetanus immunizations. TIG should be given as soon as possible after the injury. The dose is 250 IU administered intramuscularly. See CDC’s web page for details: www.cdc.gov/tetanus/hcp/clinical-guidance/index.html.
No. The series should not be restarted. Continue the series from where you left off.
For all licensed COVID-19 vaccines (Moderna [mNexspike, Spikevax], Sanofi-Novavax [Nuvaxovid], Pfizer-BioNTech [Comirnaty]) healthcare providers are strongly encouraged to report to the Vaccine Adverse Event Reporting System (VAERS) the following:
Information on how to submit a report to VAERS is available at https://vaers.hhs.gov or by calling 1-800-822-7967.
All pneumococcal vaccines should be refrigerated at temperatures between 2°C (36°F) and 8°C (46°F). Do not freeze these vaccines. Vaccine exposed to freezing temperature should not be administered. For details of vaccine storage and handling, see the CDC Vaccine Storage and Handling Toolkit: www.cdc.gov/vaccines/hcp/downloads/storage-handling-toolkit.pdf.
The incubation period of tetanus ranges from 3 to 21 days, averaging about 10 days. In general, the further the injury site is from the central nervous system, the longer the incubation period. In the opinion of the tetanus experts at the CDC, for a person who has been vaccinated but is not up to date, there is probably little benefit in giving TIG more than a week or so after the injury. For a person believed to be completely unvaccinated, it is suggested to increase this interval to 3 weeks (i.e., up to day 21 post injury). Td or Tdap should be given concurrently with TIG.
Because there is no documentation of vaccination, a vaccination series should be administered and postvaccination testing should be performed 1–2 months after the final dose of vaccine. There is no harm in receiving extra doses of vaccine. Postvaccination anti-HBs testing results should also be documented, including the date testing was performed. All healthcare settings should develop policies or guidelines to assure valid hepatitis B immunization.
If the error is discovered on the same clinic day you can administer the other “half” of the FluLaval dose on the same day. If the error cannot be corrected on the same day, the partial dose should not be counted. The child should be recalled to the office as soon as possible and given a full age-appropriate repeat dose, either a 0.5 mL dose of FluLaval, a 0.5 mL dose of Fluarix, a 0.25 or 0.5 mL dose of Fluzone, a 0.25 mL dose of Afluria, or a 0.5 mL dose of Flucelvax.
Multiple national surveillance systems are used to monitor the safety of COVID-19 vaccines in different ways. CDC provides information about vaccine safety surveillance systems, with links to information about the safety of COVID-19 vaccines, here: www.cdc.gov/vaccine-safety/vaccines/covid-19.html.
Each of these products must be stored at 2° to 8°C (36° to 46°F). They should not be frozen or exposed to freezing temperatures.
No. A positive anti-HBs indicates that the vaccinated person is immune at the time the person was tested but does not assure that the person has long-term immunity. Long-term immunity has been demonstrated only for people attaining an adequate anti-HBs result of at least 10 mIU/mL after completing a full vaccination series. The most direct way to deal with this is to vaccinate the employee with a series of hepatitis B vaccine; test for anti-HBs in 1–2 months and document the result in the employee’s health record. An adequate anti-HBs result from a documented vaccine series would assure not only seroprotection, but long-term protection.
All influenza vaccines (inactivated, recombinant, and live attenuated vaccines) should be stored at refrigerator temperature of 2° through 8°C (36° through 46°F). No influenza vaccine should be frozen. Influenza vaccine exposed to freezing temperature should not be used.
V-safe is a safety monitoring system that vaccine recipients can use to share with CDC how they feel after vaccination. It was created initially for COVID-19 vaccines. Currently, recipients of RSV vaccines also may register for V-safe. To learn more about the program and how to guide vaccine recipients who wish to participate, visit CDC’s website: www.cdc.gov/vaccine-safety-systems/v-safe/index.html.
Do nothing. Data show that vaccine-induced anti-HBs levels might decline over time; however, immune memory (anamnestic anti-HBs response) remains intact following immunization. People with anti-HBs concentrations that decline to less than 10 mIU/mL are still protected against HBV infection. For healthcare professionals with normal immune status who have demonstrated adequate anti-HBs (at least 10 mIU/ mL) following full vaccination, booster doses of vaccine or periodic anti-HBs testing are not recommended.
No. COVID-19 vaccines are not currently part of the VICP, although a transition to the VICP is anticipated in the future. The COVID-19 vaccines are currently part of a similar program called the Countermeasures Injury Compensation Program (CICP). For more information, visit this web page: www.hrsa.gov/cicp.
No. There are no regulations that require removal from job situations where exposure to bloodborne pathogens could occur; this is an individual policy decision within the organization. OSHA regulations require that employees in jobs where there is a reasonable risk of exposure to blood be offered HepB vaccine. In addition, the regulation states that adequate personal protective equipment be provided and that standard precautions be followed. Check your state OSHA regulations regarding additional requirements. If there are no state OSHA regulations, federal OSHA regulations should be followed. Adequate documentation should be placed in the employee record regarding non-response to vaccination. HCP who do not respond to vaccination should be tested for HBsAg and total anti-HBc to determine if they have chronic HBV infection. If the HBsAg and total anti-HBc tests are positive, HCP should receive appropriate counseling for preventing transmission to others as well as referral for ongoing care to a specialist experienced in the medical management of chronic HBV infection. People who are HBsAg-positive and who perform exposure-prone procedures should seek counsel from a review panel comprised of experts with a balanced perspective (for example, infectious disease specialists and their personal physician[s]) regarding the procedures that they can perform safely. They should not be excluded from work. People who test negative for HBsAg should be considered susceptible to HBV infection and should be counseled about precautions to prevent HBV infection and the need to obtain HBIG prophylaxis for any known or likely exposure to HBsAg-positive blood (see Table).
For details, refer to the specific vaccine’s package insert.
Immunize.org has assembled links to key COVID-19 vaccine resources, including package inserts, in the Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools: www.immunize.org/catg.d/p3130.pdf.
Yes. HCP should not be discriminated against because of their hepatitis B status. All HCP should practice standard precautions, which are designed to prevent HBV transmission, both from patients to HCP and from HCP to patient. There is, however, one caveat concerning HBV-infected HCP. Those who have HBV levels 1000 IU/mL or 5000 genomic equivalents/mL or higher should not perform exposure-prone procedures (for example, gynecologic, cardiothoracic surgery) unless they have sought counsel from an expert review panel and been advised under what circumstances, if any, they may continue to perform these procedures. For more information on this issue, see “Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students,” MMWR, 2012; 61(RR03):1–12. This document is available at www.cdc.gov/mmwr/pdf/rr/rr6103.pdf.
Although routine transportation of vaccines to different facilities is not generally recommended, there are times when this is necessary. CDC recommends transporting COVID-19 vaccine in unopened vials or manufacturer-filled syringes (MFS) and always with a continuous temperature monitoring device to ensure adherence to authorized storage times and temperatures. See the product package insert for details on permissible conditions for transport.
Yes. HepB vaccines have been demonstrated to be safe when administered to infants, children, adolescents, and adults. Since 1982, well over 100 million people, including infants, children, and adults living in the United States have received at least one dose of HepB vaccine; more than a billion doses of HepB vaccine have been given worldwide. Vaccination causes a sore arm occasionally, but serious reactions are very rare.
Many years of experience with Engerix-B and Recombivax HB vaccines and recent studies of Heplisav-B indicate no apparent risk for adverse events to a developing fetus. Current vaccines contain noninfectious HBsAg and pose no risk to the fetus. If the mother is being vaccinated because of a risk factor for HBV infection (for example, a healthcare worker, a person with a sexually transmitted disease, an injection drug user, a person with multiple sex partners), vaccination should be initiated as soon as the risk factor is identified during the pregnancy. HBV infection during pregnancy might result in severe disease for the mother and chronic infection for the newborn.
Any of the available HepB vaccines (Engerix-B, Heplisav-B, Recombivax HB) or the HepA-HepB combination vaccine, Twinrix, may be used during pregnancy.
No. Administration of HepB soon after birth has not been associated with an increased rate of elevated temperatures or subsequent evaluations for possible sepsis in the first 21 days of life.
A serious allergic reaction to a prior dose of HepB or a vaccine component is a contraindication to further doses of HepB. Engerix-B, Recombivax HB, Twinrix, and Heplisav-B are synthesized in yeast cells into which a plasmid containing the gene for HBsAg has been inserted. People with a severe allergic reaction to yeast should not be vaccinated with vaccines produced in yeast cells.
As with other vaccines, vaccination of people with moderate or severe acute illness, with or without fever, should be deferred until the illness improves. Vaccination is not contraindicated in people with a history of multiple sclerosis, Guillain-Barré syndrome, or autoimmune diseases such as systemic lupus erythematosus or rheumatoid arthritis.
All hepatitis B-containing vaccines should be stored at refrigerator temperature at 2°C to 8°C (36°F to 46°F). The vaccines must not be frozen. Any vaccine exposed to freezing temperature should not be used. Do not use these or any other vaccines after the expiration date shown on the packaging. Any vaccine administered after its expiration date should be repeated.
