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IAC Express 2010
Issue number 860: April 7, 2010
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Contents of this Issue
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  1. Read "Ask the Experts" Q&As on current immunization issues
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 860: April 7, 2010
1.  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.

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 the use of acetaminophen at the time of vaccination, new influenza and Prevnar 13 vaccine recommendations, the temporary suspension of Rotarix use in the U.S., and 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

You can access more "Ask the Experts" Q&As in our online archive at

Editor's note: Information about submitting a question to "Ask the Experts" is provided at the end of this Extra Edition.

Q: Can we start vaccinating on the basis of a provisional ACIP recommendation? Or do we need to wait until the recommendation is made final by publication in MMWR?

A: Consider a provisional recommendation as you would a final recommendation. The basic recommendation will not change. Getting a recommendation officially approved and published can be a lengthy process. It is more a matter of internal government procedures than anything of significance to a practitioner.

Q: On Oct. 17, 2009, The Lancet published a study that found that infants who received three doses of acetaminophen following immunization had reduced immune responses to certain vaccines. Based on these findings, should we stop recommending acetaminophen for fever or discomfort after infant immunization?

A: No. Evidence from this study would discourage the prophylactic use of acetaminophen prior to or immediately following vaccination. Acetaminophen can be used to treat pain or fever if it should occur following vaccination. In the upcoming 2010 General Recommendations on Immunization, CDC will remove all recommendations for prophylactic use of acetaminophen or other analgesics BEFORE or AT THE TIME OF vaccination. AAP has already removed such recommendations from the Red Book.

Q: Why were U.S. healthcare providers recommended to temporarily suspend administering Rotarix rotavirus vaccine (RV1; GSK) in late March 2010?

A: GSK reported to FDA that an independent academic research team using a novel technique to look for viruses had discovered DNA components from porcine circovirus type 1 (PCV1) in Rotarix vaccine. GSK conducted additional studies and confirmed that DNA from PCV1 is present in the finished Rotarix vaccine (as well as in the cell bank and seed from which the vaccine is derived) and that it has been present since the early stages of the vaccine's development. FDA decided to suspend the vaccine's use while learning more about the situation and until further studies are done. PCV1 is not known to cause disease in people or animals. PCV1 was not found in RotaTeq rotavirus vaccine (RV5; Merck).

Q: How should we complete the rotavirus vaccine series in infants who have already received 1 dose of Rotarix?

A: If you started an infant on Rotarix, complete the series by administering 2 doses of RotaTeq. RotaTeq is routinely given using a 3-dose schedule at ages 2, 4, and 6 months. It is important that you keep infants on schedule as they must complete the third and final dose by age 8 months, 0 days.

Q: Should we return our existing supply of Rotarix to the manufacturer or distributor where we bought it?

A: No. FDA will be convening an expert advisory committee to review available data and will then issue subsequent recommendations. For now, you should keep Rotarix in proper storage (i.e., store the lyophilized Rotarix at refrigerated temperatures [35 degrees to 46 degrees F; 2 degrees to 8 degrees C] and store the diluent at room temperatures [68 degrees to 77 degrees F; 20 degrees to 25 degrees C]).

Q: Has the World Health Organization (WHO) also recommended temporary suspension of the use of Rotarix?

A: No. WHO issued a statement on March 22 titled "WHO does not recommend any change to use of Rotarix vaccine." It includes the following: ". . . WHO concurs with the views of the FDA and EMA [European Medicines Agency] that the findings do not present a threat to public health. Moreover, rotaviruses are the most common cause of severe diarrhoeal disease in young children throughout the world, with an estimated 527,000 deaths among children under five years old, most of whom live in low-income countries. Therefore, WHO does not recommend any change to use of the vaccine. . . ." To read the full WHO statement on Rotarix, go to

Q: Please tell me about the new pneumococcal conjugate vaccine, Prevnar 13.

A: On February 24, FDA licensed the 13-valent pneumococcal vaccine, Prevnar 13, (PCV13; Pfizer). It contains the 7 Streptococcus pneumoniae serotypes included in the first pneumococcal conjugate vaccine (PCV7, Prevnar), plus 6 additional serotypes (1, 3, 5, 6A, 7F, and 19A). Together, these 13 serotypes account for the majority of invasive pneumococcal disease (IPD) in the U.S., including serotype 19A, which is now the most common IPD-causing serotype in young children. On February 24, ACIP voted to approve recommendations for the use of Prevnar 13, and on March 12 the recommendations were published in MMWR. To access them, go to and scroll down to pages 258-261.

Q: What vaccination schedule should we follow for PCV13?

A: Generally, you should follow the same 4-dose schedule you followed for PCV7, administering doses at ages 2, 4, 6, and 12-15 months. Following are additional recommendations concerning PCV 13:

(1) For children who have begun a series of PCV7, replace all remaining doses with PCV13. If you are unsure how to assess and complete the pneumococcal conjugate vaccine immunization schedule for children who may have fallen behind, consult the pneumococcal vaccine catch-up schedule that can be found at

(2) For children who have completed an age-appropriate 4-dose series of PCV7

(a) Give one additional dose of PCV13 to all healthy children who have not yet reached their fifth birthday.

(b) Give one additional dose of PCV13 to children with underlying medical conditions who have not yet reached their sixth birthday.

(c) For children ages 6 through 18 years with functional or anatomic asplenia, including sickle cell disease, HIV infection or other immunocompromising condition, cochlear implant, or CSF leak, consider giving one dose of PCV13 regardless of previous history of PCV7 or pneumococcal polysaccharide vaccine (PPSV).

Q: I've heard that the recommendations for influenza vaccination have been expanded for the 2010-11 season. Tell me more.

A: At its February 2010 meeting, ACIP voted to recommend routine annual influenza vaccination for all people age 6 months and older, beginning with the 2010-11 influenza vaccination season. This change expands the existing recommendations to include all healthy adults ages 19 through 49 years who hadn't previously been included in routine vaccination recommendations.

Q: The new Zostavax vaccine (Merck) package insert says that Zostavax should not be given simultaneously with pneumococcal polysaccharide vaccine (PPSV). What does ACIP say about this?

A: ACIP has not changed its recommendation on the simultaneous administration of these two vaccines (i.e., they can be given at the same time or any time before or after each other).

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 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

You can also email CDC's immunization experts directly at There is no charge for this service.

If you have a question about IAC materials or services, email

Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at

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About IZ Express

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 and do not necessarily represent the official views of CDC.

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Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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