IAC Express 2011

Issue number 922: April 6, 2011

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Contents of this Issue
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  1. Read "Ask the Experts" Q&As about common vaccination misconceptions
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 922: April 6, 2011
1.  Read "Ask the Experts" Q&As about common vaccination misconceptions

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.

All the Q&As in this edition of IAC Express deal with misconceptions about vaccination that too frequently get in the way of timely immunization. Clinicians might misperceive certain conditions and circumstances as valid contraindications or precautions when they actually do not preclude vaccination. These misperceptions result in missed opportunities to administer recommended vaccines.

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 Edition.

Q: How many vaccines can be given during an office visit?

A: No upper limit exists for the number of vaccines that can be administered during one visit. ACIP and AAP consistently recommend that all needed vaccines be administered during an office visit.

Q: Which vaccines cannot be administered at an office visit along with other vaccines?

A: All routine vaccines can be given during an office visit, as long as a different syringe is used for each vaccine.

Q: If all needed vaccines aren't administered during the same visit, does one need to wait a certain period of time before administering the other needed vaccines?

A: All inactivated vaccines can be given on the same day, or on any day before or after giving other inactivated or live vaccines. However, if two live vaccines are not given on the same day, they need to be spaced at least 4 weeks apart. This recommendation does not apply to rotavirus or oral typhoid vaccine, which can be given at any time before or after another live vaccine.

Q: Do we have to check vital signs before giving vaccines?

A: No. ACIP does not recommend routinely checking a patient's temperature or other vital signs before vaccination. Requiring these extra steps can be a barrier to immunization.

Q: Is it necessary to routinely test young women for pregnancy before administering vaccines?

A: No. However, females of childbearing age should be asked about the possibility of their being pregnant before they are given any vaccine for which pregnancy is a contraindication or precaution. The patient's answer should be documented in the medical record. If the patient thinks she might be pregnant, a pregnancy test should be performed before administering live virus vaccines.

Q: Which vaccines can be given to breastfeeding women?

A: All vaccines except smallpox can be given to breastfeeding women. Breastfeeding is a precaution for yellow fever vaccine. Women who are breastfeeding should be advised to postpone travel to yellow fever endemic or epidemic regions; however, if travel cannot be postponed the woman should receive yellow fever vaccine.

Q: Can I administer vaccine to a child who is taking antibiotics?

A: Treatment with antibiotics is not a valid reason to defer vaccination. If a child or adult is otherwise well, or has only a minor illness, vaccines should be administered. But if the person has a moderate or severe acute illness (regardless of antibiotic use), one should defer vaccination until the person's condition has improved.

Q: We frequently see patients who have a fever or an acute illness and are due for vaccinations. We're never quite sure if we should withhold the vaccines or not. What do you advise?

A: A "moderate or severe acute illness" is a precaution for administering any vaccine. A mild acute illness (e.g., mild diarrhea or upper-respiratory tract infection) with or without fever is not.

Q: Should I vaccinate a child who has recently been exposed to an infectious disease? What about a child who is convalescing from illness?

A: Neither of these situations is a contraindication or precaution to vaccination.

The following resources are useful to check for true contraindications and precautions.

Portions of ACIP's General Recommendations on Immunization:

Chart of Contraindications and Precautions to Commonly Used Vaccines http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm

Conditions Commonly Misperceived as Contraindications to Vaccination http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-misconceptions.htm

From IAC:

Guide to Contraindications and Precautions to Commonly Used Vaccines http://www.immunize.org/catg.d/p3072a.pdf

Guide to Contraindications and Precautions to Commonly Used Vaccines in Adults http://www.immunize.org/catg.d/p3072.pdf

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 admin@immunize.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 nipinfo@cdc.gov There is no charge for this service.

If you have a question about IAC materials or services, email admininfo@immunize.org

Please forward these "Ask the Experts" Q&As to your co-workers and suggest they subscribe to IAC Express at http://www.immunize.org/subscribe

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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 Immunize.org 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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