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Immunization Action Coalition

IAC Express 2010

Issue number 891: October 1, 2010

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Contents of this Issue
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  1. Golden oldies edition: Read the most common questions sent to "Ask the Experts"
 
Abbreviations
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
  
Issue 891: October 1, 2010
1.  Golden oldies edition: Read the most common questions sent to "Ask the Experts"

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 "Ask the Experts" Q&As answered by CDC experts.

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.

Usually we publish "Ask the Experts" Q&As about cutting-edge topics, featuring questions that arise with new vaccine licensures and recommendations. In this "golden oldies" edition, however, we have collected vaccination questions most commonly asked by healthcare professionals. Although the topics are not new, they continue to be a source of confusion as evidenced by the calls and emails to IAC.

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 Edition.


Q: Is it necessary to start a vaccine series over if a patient doesn't come back for a dose at the recommended time, even if there's been a year or more delay?

A: For routinely administered vaccines, there is no vaccine series that needs to be restarted because of an interval that is longer than recommended. In certain circumstances, oral typhoid vaccine (which is sometimes given for international travel) needs to be restarted if the vaccine series isn't completed within the recommended time frame.


Q: We gave a dose of vaccine too soon after the previous dose. When can we give the additional dose that will rectify this error?

A: The repeat dose should be spaced after the invalid dose by an interval at least equal to the recommended minimum interval. You can find the table of minimum intervals and ages for routinely given vaccines here: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/A/age-interval-table.pdf


Q: Which vaccines can be given simultaneously?

A: All vaccines used for routine vaccination in the United States can be given simultaneously (i.e., at the same visit, not in the same syringe).

If two live vaccines are not given simultaneously, you must wait at least 4 weeks before administering the second live vaccine.

Inactivated vaccines can be given at any time before or after each other and/or live vaccines.


Q: What vaccines are safe to give to a breastfeeding mother?

A: Women who are breastfeeding can receive all routine vaccines, including live vaccines. The only vaccine that should not be given to breastfeeding women is smallpox.


Q: Do you need to aspirate before vaccinating?

A: No. ACIP guidance does not recommend aspirating (pulling back on the syringe plunger once the needle is in the arm before injecting, to see if you get blood return) when administering vaccines. No data exist to justify the need for this practice. IM injections are not given in areas where large vessels are present. Given the size of the needle and the angle at which you inject the vaccine, it would be very difficult to administer the vaccine intravenously.


Q: Is it necessary to wear gloves when we administer vaccinations?

A: No. Occupational Safety and Health Administration (OSHA) regulations do not require healthcare personnel to wear gloves when administering vaccinations, unless the healthcare worker is likely to come into contact with potentially infectious body fluids or has an open lesion on her or his hand.

If a healthcare worker chooses to wear gloves, he or she must change them between each patient encounter.


Q: If a dose of vaccine is given by the wrong route (IM instead of SC or vice versa), does it need to be repeated?

A: Although vaccines should always be given by the route recommended by the manufacturer, if a vaccine is inadvertently given by the wrong route, ACIP recommends that it be counted as valid with two exceptions: Hepatitis B or rabies vaccine given by any route other than IM should not be counted as valid and should be repeated.


Q: What is the law regarding patients/parents signing consent for vaccination?

A: There is no federal requirement for signed consent for vaccination. Local governmental units, institutions, and clinics may have their own requirements.


Q: Where can I get VISs for some of the newer combination vaccines?

A: CDC currently has no plans to develop VISs for Pediarix, Comvax, Twinrix, TriHIBit, Kinrix, or Pentacel. When administering these combination vaccines, use the VISs for all component vaccines. For certain combination vaccines given to children, you can use the multi-vaccine VIS and check the appropriate box(es), just as you would if you were administering the individual vaccines.

A VIS was developed for MMRV vaccine because of its unique adverse reaction profile.

For VISs in more than 35 languages, go to: http://www.immunize.org/vis


Q: What are some of the most commonly used references for information about immunization for healthcare professionals who want to get answers on their own?

A: The following are some basic resources for anyone providing immunization services.

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 admin@immunize.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 nipinfo@cdc.gov There is no charge for this service.

If you have a question about IAC materials or services, email admininfo@immunize.org

Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at http://www.immunize.org/subscribe

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