IAC Express 2010
Issue number 906: December 21, 2010
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- 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 906: December 21, 2010
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.
Most of the Q&As in this edition of IAC Express deal with new immunization
recommendations from ACIP.
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: When will the 2011 recommended immunization schedules for
children, adolescents, and adults be published?
A: The publication of these schedules in CDC's MMWR is
expected in early February 2011. Publication of the annual
schedules has been moved to February this year (and probably
will continue to be in subsequent years) to allow time to
update the immunization schedules with recommendations that
ACIP makes at its annual late-October meeting.
Q: What are the new changes to recommendations for use of
A: In response to an increased incidence of pertussis in the
U.S., in October 2010, ACIP voted on the following new
recommendations for the use of Tdap vaccine:
- Tdap can be given regardless of the interval since the
last Td was given. There is NO need to wait 2-5 years to
administer Tdap following a dose of Td.
- Adolescents should receive a one-time dose of Tdap
(instead of Td) at the 11- to 12-year-old visit.
- Adolescents and adults younger than age 65 years who have
not received a dose of Tdap, or for whom vaccine status
is unknown, should be immunized as soon as feasible. (As
stated above, Tdap can be administered regardless of
interval since the previous Td dose.)
- Adults age 65 years and older who have not previously
received a dose of Tdap, and who have or anticipate
having close contact with children younger than age 12
months (e.g., grandparents, other relatives, child care
providers, and healthcare personnel), should receive a
one-time dose to protect infants. (As stated above, Tdap
can be administered regardless of interval since the
previous Td dose.)
- Other adults 65 years and older who are not in contact
with an infant, and who have not previously received a
dose of Tdap, may receive a single dose of Tdap in place
of a dose of Td.
- Children ages 7-10 years who are not fully immunized
against pertussis (i.e., did not complete a series of
pertussis-containing vaccine before their seventh
birthday) should receive a one-time dose of Tdap.
Q: Aren't the October 2010 ACIP recommendations for expanded
use of Tdap vaccine in children ages 7 through 9 years and
in adults age 65 years and older different from what is on
the package inserts?
A: Yes. Sometimes ACIP makes recommendations that differ
from the FDA-approved package insert indications, and this
is one of those instances. ACIP recommendations represent
the standard of care for vaccination practice in the United
States. In general, to determine recommendations for use,
one should follow the recommendations of ACIP rather than
the information in the package insert.
Q: I understand that ACIP recently voted to recommend
administering a routine booster dose of quadrivalent
meningococcal conjugate vaccine (MCV4) to all teens. Can you
tell me more?
A: At its October 2010 meeting, ACIP voted to recommend that
providers administer initial doses of MCV4 to all
adolescents at age 11-12 years with a booster dose at age 16
Q: Why did ACIP vote to recommend a routine booster dose of
MCV4 for adolescents age 16 years and older?
A: In October 2005, ACIP recommended routine MCV4
vaccination for all adolescents at ages 11-12 years to
protect them from meningococcal disease as older teens. The
peak age for meningococcal disease is 16-21 years. In 2005,
ACIP reasoned that higher MCV4 vaccination rates could be
achieved if administering the dose were coupled with giving
the Td booster dose at the 11- to 12-year-old visit. (The Td
dose for 11- to-12-year-olds was replaced by Tdap in 2006.)
Current data now indicate that the protection provided by
MCV4 wanes within 5 years following vaccination. For this
reason, in October 2010, ACIP voted to recommend an MCV4
vaccine booster dose to provide continuing protection during
the peak years of vulnerability.
Q: We are trying to provide influenza vaccination to all
eligible patients during their stay in our hospital. If a
patient does not remember if he or she has already received
the vaccine this season, should we go ahead and vaccinate?
A: If a patient or family member cannot remember if the
patient received influenza vaccine this season and no record
is available, proceed with administering influenza vaccine,
even if it might mean an extra dose is given. When a patient
reports that they HAVE received influenza vaccine but does
not have written documentation, ACIP states that in the
specific case of influenza vaccination, patient self-report
of being vaccinated should be accepted as evidence of
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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