Issue 1042: February 28, 2013
Questions and Answers
Q: I keep hearing about changes to vaccine storage and handling recommendations. Why is CDC making these changes? And how can I make sure I am up to date with all the newest information?
A: Good questions! The why behind these changes has two parts. First, it had become increasingly apparent to CDC and state health departments that improper vaccine storage and handling is a big problem, leading to a huge waste of product, time, and money, and more importantly, to unprotected people. Second, improved technology (e.g., digital data loggers) provides tools that uncover and measure problems and also prevent them.
Every vaccine provider should print out this document and read and reread it carefully. CDC has provided an overview of the new information as a separate item, as well as a set of FAQs about the new recommendations.
Q: Is it still acceptable to use combination household units for storing vaccines?
A: CDC strongly recommends using stand-alone refrigerators and freezers for the following reasons:
Purchasing new vaccine storage equipment requires planning, and you may need to use existing equipment for a while until you can purchase new equipment. In this situation, CDC recommends using a combination refrigerator/freezer unit for refrigerated vaccine only and using a separate stand-alone freezer to store frozen vaccines.
Q: What temperature is considered a temperature excursion on refrigerated vaccine? Frozen vaccine?
A: Any temperature readings outside the ranges noted below are considered temperature excursions.
If there is a question about whether a vaccine has been exposed to a temperature excursion, label the vaccines “DO NOT USE” and store them under appropriate conditions, separate from other vaccines. Then, contact the vaccine manufacturer for further guidance. If you are a VFC provider, contact either the vaccine manufacturer and/or your state or local immunization program as directed by the VFC Program in your area.
Q: What are the new ACIP recommendations for vaccinating pregnant women with Tdap?
A: In October 2012, ACIP voted to recommend that a pregnant woman receive Tdap vaccine during each pregnancy, even if the woman had received Tdap previously. The optimal time to administer Tdap is between 27 and 36 weeks’ gestation. Vaccination during this time maximizes maternal antibody response and passive antibody transfer to the infant. Women who have never received Tdap and who do not receive it during pregnancy should receive it immediately postpartum.
Q: If a woman did not receive Tdap during pregnancy, and it is uncertain whether she received a dose of Tdap prior to her pregnancy, should she receive a dose of Tdap postpartum?
A: Yes. If there is no written documentation that she received a dose of Tdap prior to or during pregnancy, a dose of Tdap should be administered to her immediately postpartum.
Q: I have an adult patient with controlled epilepsy who wishes to receive the Tdap vaccine. May I vaccinate him?
A: Controlled epilepsy is not a contraindication to receipt of Tdap. See IAC’s table of vaccine contraindications and precautions. CDC also makes this information available on its website.
Q: A 7-year-old who needed a tetanus shot for wound management came into our emergency department. My question is, if a child has received the complete 5-dose series of DTaP but has never had Tdap, should the child receive Tdap or Td for wound management?
A: Neither. A child who has completed 5 doses of DTaP has by definition received the fifth dose on or after his/her fourth birthday. In this child’s case, it has been less than four years since receipt of the complete series, so the child does not need either Tdap or Td. The child is fully vaccinated against tetanus according to CDC tetanus wound management guidelines.
Q: What are the new ACIP recommendations for use of MenHibrix, the new combination meningococcal
Groups C and Y and Haemophilus influenzae type b vaccine?
A: Licensed in June 2012, MenHibrix (Hib-MenCY; GSK) is a vaccine indicated for active immunization to prevent invasive disease caused by Neisseria meningitidis serogroups C and Y and Haemophilus influenzae type b. This vaccine does not protect against meningococcal serogroups A, B, and W135.
Q: Is fainting after the first or second dose of HPV vaccine a contraindication to administering subsequent doses?
A: No. Fainting is not a contraindication to administering a subsequent dose of any vaccine. Fainting after vaccination is fairly common in adolescence. Providers should prepare for the possibility by having patients sit or lie down when receiving the vaccine and observing patients for 15 minutes after vaccination. For more information on syncope and vaccination, visit the CDC website.
Q: How soon after taking prednisone for an asthma attack can a child receive a flu shot?
A: Steroid treatment is not a contraindication for vaccination with inactivated influenza vaccine. As this vaccine is not a live virus vaccine, you can (and should) give it to people who are immunosuppressed, although the patient’s immune response may not be optimal. Immunosuppression (e.g., from certain steroid treatments) is a concern only when administering live virus vaccines.
A: Yes. Giving a larger-than-recommended dose of any vaccine does not negate the need for indicated subsequent doses.
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.
IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of Immunize.org and do not necessarily represent the official views of CDC.
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Editor-in-ChiefKelly L. Moore, MD, MPH
Managing EditorJohn D. Grabenstein, RPh, PhD
Associate EditorSharon G. Humiston, MD, MPH
Writer/Publication CoordinatorTaryn Chapman, MS
Courtnay Londo, MA
Style and Copy EditorMarian Deegan, JD
Web Edition ManagersArkady Shakhnovich
Contributing WriterLaurel H. Wood, MPA
Technical ReviewerKayla Ohlde