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March 2017 Back to top
   
March 22, 2017
If a patient receives hepatitis B vaccine while undergoing hemodialysis, will the vaccine be effective? Will the dose need to be repeated?
Neither the Advisory Committee on Immunization Practices (ACIP) nor the manufacturers address the timing of vaccination and dialysis. Persons with end-stage renal disease including predialysis, hemodialysis, peritoneal dialysis, and home dialysis should be tested for hepatitis B surface antibody (anti-HBs) 1–2 months after vaccination, and annually. If the anti-HBs level is below 10mIU/mL, they should be revaccinated. See www.cdc.gov/mmwr/PDF/rr/rr5516.pdf, page 27, for more information.
Question of the Week: IAC Express - Issue 1295
March 15, 2017
What are the recommendations for use of the new oral cholera vaccine?
CVD 103-HgR (Vaxchora, PaxVax) cholera vaccine was approved by the Food and Drug Administration in June 2016. ACIP has not yet published recommendations for Vaxchora. However, at their June 2016 meeting, ACIP voted to recommend vaccination for adults 18 through 64 years old traveling to areas of active cholera transmission. An area of active cholera transmission is defined as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1 and includes areas with cholera activity within the last 1 year that are prone to recurrence of cholera epidemics; it does not include areas where rare sporadic cases have been reported. No country or territory currently requires vaccination against cholera as a condition for entry.

In addition to vaccination, all travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary prevention strategies against cholera infection. Travelers who develop severe diarrhea should promptly seek medical attention for rehydration therapy.
Question of the Week: IAC Express - Issue 1294
March 8, 2017
Are there recommendations for administering Tdap when Td is not available?
If Td is indicated but unavailable, Tdap should be administered in place of Td, and administration should include persons who previously received Tdap.
Question of the Week: IAC Express - Issue 1293
March 1, 2017
If a child falls behind on immunizations, is it recommended to use only minimum intervals to get the child caught up? Or should we use a minimum interval for the same vaccine only once?
If a child is behind on immunizations, the Advisory Committee on Immunization Practices (ACIP) recommends using the minimum intervals between each dose until the child is caught up. The minimum interval for a vaccine can be used as many times as necessary, until the child is back on schedule.
Question of the Week: IAC Express - Issue 1292
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February 2017 Back to top
February 22, 2017
Is systemic lupus erythematosus (SLE, lupus) a risk-based indication for pneumococcal vaccines?
Lupus per se is not an indication for either pneumococcal vaccine. However, immunosuppressive medication that may be used to treat lupus could create an indication for administering both pneumococcal vaccines. Also, if the patient has certain complications of lupus (such as nephrotic syndrome), the person would be a candidate for pneumococcal vaccines. Both immunosuppression and nephrotic syndrome are indications for administering both PCV13 (Prevnar, Pfizer) AND PPSV23 (Pneumovax, Merck). Administer PCV13 first, then PPSV23 8 weeks later. A handy document that summarizes indications for both pneumococcal vaccines is available at www.immunize.org/catg.d/p2019.pdf.
Question of the Week: IAC Express - Issue 1291
February 15, 2017
A patient recently exposed to a bat received the rabies vaccine series. One of the doses was given in the gluteus. Does this dose count?
No. Doses of rabies vaccine given in the gluteus should not be counted as valid and should be repeated. If repeating the invalid dose results in an interval between doses more than 3 days longer than the recommended interval, then you should perform a rabies serology 7–14 days after administration of the final dose in the series to ensure an adequate immune response to the series. For more information, see www.cdc.gov/mmwr/pdf/rr/rr5902.pdf.
Question of the Week: IAC Express - Issue 1290
February 8, 2017
I have a patient who is 62 years old and is immigrating to the U.S. She received a dose of zoster vaccine 2 months ago. The immigration requirements state she should receive 2 doses of varicella vaccine. Does she need additional varicella vaccine?
To meet the immigration requirements, the dose of zoster vaccine counts as the first dose of the varicella vaccine series. You should give a dose of varicella vaccine now since it has been more than 4 weeks since the dose of zoster vaccine. The varicella vaccine dose may not be needed, but it will not be harmful and will allow your patient to meet the regulatory requirement.
Question of the Week: IAC Express - Issue 1289
February 1, 2017
I have a patient who was diagnosed with HPV types 16 and 18. The patient received a properly spaced Gardasil series in 2006 when she was 25 years old. Did the HPV vaccine she received in 2006 fail to protect her?
In clinical trials, HPV vaccines were shown to be highly effective (more than 95%) for prevention of HPV vaccine-type infection and disease among persons without prior infection. The most likely explanation for this situation is that the patient was sexually active prior to vaccination and was infected with HPV before she was vaccinated.
Question of the Week: IAC Express - Issue 1288
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January 2017 Back to top
January 25, 2017
I have a patient who received inactivated influenza vaccine in Brazil in September 2016. Does he need to be revaccinated with the current U.S. formulation?
No. The southern hemisphere influenza vaccine formulation for 2016 contains the same viruses in both trivalent and quadrivalent vaccines as the northern hemisphere vaccine for the 2016–17 season.
Question of the Week: IAC Express - Issue 1287
January 18, 2017
A dose of Kinrix (DTaP-IPV; GSK) should have been administered to a 4-year-old, but Pentacel (DTaP-IPV-Hib; Sanofi Pasteur) was administered instead. Does the dose of DTaP count?
Yes. The DTaP in the Pentacel can be counted. Although Pentacel is licensed as a 4-dose series and this may represent a fifth dose of Pentacel (in which case it would be off-label use), the dose of DTaP counts as the fifth dose of DTaP.
Question of the Week: IAC Express - Issue 1286
January 11, 2017
When I was 5 years old, I had Guillain-Barré syndrome (GBS) unrelated to vaccination. I am now 35 with no residual effects of the GBS. I am a nurse and my facility requires employees to receive influenza vaccine. Is it safe for me to be vaccinated?
Yes. A history of GBS unrelated to influenza vaccine is not a contraindication or precaution to influenza vaccination. GBS within 6 weeks following a previous dose of influenza vaccine is considered a precaution for use of influenza vaccines.
Question of the Week: IAC Express - Issue 1285
January 4, 2017
We have had three employees who have tested positive for influenza by nasal swab within 2 weeks of receiving Fluarix Quadrivalent vaccine. Is there a time period after receiving influenza vaccine that a nasal swab can give a false positive result?
Inactivated influenza vaccines, including Fluarix, are not known to cause false positive nasal swab tests. However, false positive test results are possible with rapid tests, and these are more likely to occur when influenza prevalence in the area is low. For more information regarding interpretation of rapid influenza tests see www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm.
Question of the Week: IAC Express - Issue 1284
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