Issue 992: May 2, 2012
Questions and Answers
Q: Please review the new recommendations for the use of Tdap in people 65 years and older.
A: At its February 2012 meeting, ACIP voted to recommend Tdap for adults age 65 years and older. CDC posted the provisional recommendations on its website on March 21 at www.cdc.gov/vaccines/recs/provisional/downloads/Tdap-feb2012.pdf.
Do not miss an opportunity to give Tdap to people age 65 years and older. Administer the vaccine you have available—either Boostrix or Adacel. When feasible, give Boostrix to adults age 65 and older. However, either vaccine product provides protection and is considered valid for use in people in this age group.
Q: Is there an upper age limit for Tdap administration? For example, should I vaccinate an 85-year-old?
A: There is no upper age limit for Tdap vaccination. A one-time dose of Tdap is recommended for all adults.
Q: If HPV vaccine is given subcutaneously (SC) instead of intramuscularly (IM), does the dose need to be repeated?
A: Yes. No data exist on the efficacy or safety of HPV vaccine given by the subcutaneous route. All data on efficacy and duration of protection are based on a 3-dose series given on the approved schedule and administered by the intramuscular route. In the absence of data on subcutaneous administration, CDC and the manufacturers recommend that a dose of HPV vaccine given by any route other than intramuscular should be repeated. There is no minimum interval between the invalid (subcutaneous) dose and the repeat dose.
Q: Which children should receive PPSV vaccine (in addition to PCV7 and/or 13)? At what age should they receive it? What about older high-risk children who never received PCV13—should they get it now?
A: PPSV is recommended for children with an immunocompromising condition, or functional or anatomic asplenia, and also for immunocompetent children with chronic heart disease, chronic lung disease, diabetes mellitus, cerebrospinal fluid leak, or cochlear implant. Administer 1 dose of PPSV to children age 2 years and older; administer it at least 8 weeks after the child has received the final dose of PCV13. Children with an immunocompromising condition, or functional or anatomic asplenia should receive a second dose of PPSV 5 years after the first PPSV. Older high-risk children who have not yet received a dose of PCV13 should receive it now. To view a table describing these recommendations in more detail, see IAC's provider-education piece titled Recommendations for Pneumococcal Vaccine Use in Children.
Q: Which adults need to receive PPSV prior to age 65 years?
A: PPSV is recommended for adults age 19 through 64 years who currently smoke cigarettes; reside in nursing homes or long-term care facilities; have chronic lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma); chronic cardiovascular diseases; diabetes mellitus; chronic liver disease (including cirrhosis); alcoholism; cochlear implants; cerebrospinal fluid leaks; immunocompromising conditions; and functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies, congenital or acquired asplenia, splenic dysfunction, or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]); asymptomatic or symptomatic HIV (vaccinate as soon as possible after diagnosis). Public health authorities may consider recommending PPSV for American Indians/Alaska Natives who live in areas where the risk for invasive pneumococcal disease is increased. Please see IAC's Pneumococcal Polysaccharide Vaccine: CDC answers your questions.
Q: Which adults should receive a second dose of PPSV?
A: A one-time revaccination 5 years after the first dose is recommended for people age 19 through 64 years who have functional or anatomic asplenia (including persons with sickle cell disease or splenectomy patients); chronic renal failure (including dialysis patients) or nephrotic syndrome; are immunocompromised, including those with HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy; are receiving immunosuppressive therapy (including long-term systemic corticosteroids or radiation therapy); or who have received an organ or bone marrow transplant.
Q: PCV13 is now licensed for use in adults, but I don't see anything about it in the 2012 adult immunization schedule. How should it be used?
A: FDA licensed PCV13 (Prevnar13; Pfizer) for adults age 50 years and older in December 2011. At its February 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) reviewed the evidence for the use of PCV13 in adults but did not vote on recommendations for its use in adults. As always, physicians can use their clinical judgment and use FDA-licensed vaccines if they would like to do so.
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.
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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Editor-in-ChiefKelly L. Moore, MD, MPH
Managing EditorJohn D. Grabenstein, RPh, PhD
Associate EditorSharon G. Humiston, MD, MPH
Writer/Publication CoordinatorTaryn Chapman, MS
Courtnay Londo, MA
Style and Copy EditorMarian Deegan, JD
Web Edition ManagersArkady Shakhnovich
Contributing WriterLaurel H. Wood, MPA
Technical ReviewerKayla Ohlde