IAC Express 2010
Issue number 891: October 1, 2010
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oldies edition: Read the most common questions
sent to "Ask the Experts"
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
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
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
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:
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
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
Q: Is it necessary to wear gloves when we administer
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:
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.
- ACIP's "General Recommendations on Immunization"
To obtain a ready-to-print (PDF) version, go to:
- All ACIP recommendations can be accessed on CDC's website
at http://www.cdc.gov/vaccines/pubs/ACIP-list.htm or from
IAC's website at http://www.immunize.org/acip
- The American Academy of Pediatrics' vaccine policy
statements can be found on IAC's website at
- CDC's "Pink Book"
To read or download this book as a whole or by chapter, go
- CDC's immunization schedules for infants, children,
adolescents, and adults
To access the schedule(s) of your choice, including catch-up
schedules that contain minimum intervals, go to:
- "Ask the Experts"
To read IAC's collection of challenging questions answered
by CDC experts, go to: http://www.immunize.org/askexperts
- "Immunization Techniques: Best Practices for Infants,
Teens, and Adults"
This DVD was developed by the California Department of
Health Services and is available for sale on IAC's website
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 firstname.lastname@example.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
email@example.com There is no charge for this service.
If you have a question about IAC materials or services,
Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at
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