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IAC Express 2010

Issue number 906: December 21, 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 906: December 21, 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.

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

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: 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 Tdap vaccine?

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 years.

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 vaccination.

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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