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Ask the Experts - What's New

Featured in Recent Publications

Administering Vaccines
Billing and Reimbursement
Combination Vaccines
Diphtheria
Documenting Vaccination
Hib
Hepatitis A
Hepatitis B
HPV
Influenza
MMR
Meningococcal
Pertussis
Pneumococcal
Polio
Precautions and Contraindications
Rabies
Rotavirus
Scheduling Vaccines
Storage and Handling
Tetanus
Vaccine Recommendations
Vaccine Safety
Varicella (chickenpox)
Zoster (shingles)
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Administering Vaccines Back to top
I am a pharmacist who administers vaccines. I was recently told by a colleague that pregnant healthcare personnel were not to administer live vaccines to others. I had never heard that in school or practice. Is that true?
This is not true. Pregnant healthcare personnel may administer any vaccine except smallpox vaccine.
Question of the Week: IAC Express - Issue 1333, November 1, 2017
Is it acceptable to administer vaccines in the nurses' station where vital signs and other patient care is performed?
Yes. Vaccines can be administered in a patient care area. The recommendation from CDC's safe injection practices experts is that storing and preparing vaccines should not be done in the same area where patient care is conducted. These activities should be done in a separate area.
Question of the Week: IAC Express - Issue 1315, July 12, 2017
We received a report of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated?
The rotavirus vaccine dose given by the intramuscular route is not valid and should be repeated by the oral route as soon as possible. In a review of such rotavirus vaccine administration errors, there usually were not adverse reactions, and those documented were limited to local reactions and general, brief irritability. Please see https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6304a4.htm for more information.

Please take steps to ensure that such vaccine administration errors are avoided in the future. This event should be reported to the Vaccine Adverse Event Reporting System at https://vaers.hhs.gov even if an adverse reaction does not result from it.
Question of the Week: IAC Express - Issue 1312, June 21, 2017
If someone received MPSV4 or MenACWY at age 9 years, will two additional doses of MenACWY be needed?
Yes. Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the routine 2-dose series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.
Question of the Week: IAC Express - June 7, 2017
A 5-year-old is in the office for vaccines and is due for MMR, polio, varicella, and DTaP. Is there a specific order I should be giving these vaccines?
The Advisory Committee on Immunization Practices (ACIP) does not address this issue. There is no recommended order in which the vaccines should be given. A best practice strategy to decrease injection or procedural pain is to administer the vaccine that causes the most pain (stinging, for example) last. For more information on vaccine administration, please see the "Vaccine Administration" chapter of Epidemiology and Prevention of Vaccine-Preventable Diseases at www.cdc.gov/vaccines/pubs/pinkbook/chapters.html.
Question of the Week: IAC Express - Issue 1298
>> view all administering vaccines Q&As
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Combination Vaccines Back to top
A 17-year-old received two doses of Twinrix, separated by one month. The second dose was six months ago and she is now 18 years old. Can she receive the third dose of Twinrix to complete the series?
Yes. This was a vaccine administration error since Twinrix, a combination hepatitis A/hepatitis B vaccine, is not licensed for people younger than 18. However, the hepatitis A and hepatitis B components can be counted as valid doses. The third dose of the Twinrix series should be given at least five months after the second dose.
Question of the Week: IAC Express - Issue 1341, December 13, 2017
A 5-year-old patient received Pentacel (DTaP-IPV/Hib) for the 5th dose of DTaP instead of Quadracel (DTaP-IPV). Can I count the Pentacel as a valid dose or will we need to revaccinate this patient?
While administration of Pentacel to a 5-year-old would be considered off-label and a vaccine administration error, the doses of DTaP and IPV can be counted as valid and do not need to be repeated. Hib vaccine is not routinely administered after a child has reached the age of 5 years so it is also a vaccine administration error. You should explain this error to the parents and assure them that the extra Hib dose will cause no harm.
Question of the Week: IAC Express - Issue 1324, September 6, 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 18, 2017
Is there any contraindication to administering Tdap vaccine and Rhogam at the same time to a pregnant woman?
No. Tdap is an inactivated vaccine and may be administered at the same time as Rhogam (in a separate site with a separate syringe).
Question of the Week: IAC Express - Issue 1276, November 23, 2016
>> view all combination vaccines Q&As
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Diphtheria Vaccine Back to top
My 11-year-old patient inadvertently received a dose of Td instead of Tdap. He received a 5-dose series of DTaP in childhood. Do I need to wait a specific interval before giving him Tdap?
No. Tdap should be administered as soon as possible.
Question of the Week: IAC Express - Issue 1339, December 6, 2017
I have a pregnant patient who is 26 weeks along and received a Tdap vaccine 2 1/2 months ago because of healthcare employment. Normally we give our pregnant patients Tdap between 27–36 weeks as recommended. Should we give her another dose of Tdap when she reaches 27 weeks gestation?
The Advisory Committee on Immunization Practices does not recommend Tdap more than once during a pregnancy. The Tdap she received earlier in pregnancy may not provide optimal protection from pertussis for the infant, but some protection is expected. More information can be found at https://www.cdc.gov/vaccines/pregnancy/pregnant-women/tdap.html.
Question of the Week: IAC Express - Issue 1331, October 18, 2017
A 16-year-old refugee's record indicates 2 doses of Td separated by 1 month and 1 dose of Tdap given 4 months after the second Td. Is he up to date?
The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td 6 months after the invalid Tdap dose. If Td is not available, Tdap can be used for this dose.
Question of the Week: IAC Express - Issue 1306, May 17, 2017
My 11-year-old patient received a dose of Tdap when he was 7 years old. He also received a dose of Td 6 months later in order to finish a primary series of tetanus-toxoid. Can I give him a dose of Tdap now?
Yes. Footnote 12 of the 2017 child and adolescent immunization schedule (available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html) states that a child who receives a dose of Tdap between 7 through 10 years of age as part of the catch-up series (as in this case), may receive another dose of Tdap at age 11 or 12 years.
Question of the Week: IAC Express - Issue 1302, April 26, 2017
A 7-year-old has a history of 3 doses of DTaP, appropriately spaced, between 4 years and 6 years of age. Is her DTaP series complete?
Although the child would be considered complete for tetanus and diphtheria toxoids, she is not complete for pertussis vaccine. ACIP recommends that children age 7 through 10 years who are not fully vaccinated against pertussis (defined as 5 doses of DTaP or 4 doses of DTaP if the fourth dose was administered on or after the fourth birthday) and who do not have a contraindication to pertussis vaccine should receive a single dose of Tdap to provide protection against pertussis. The child may also receive an additional dose of Tdap at 11 or 12 years of age. See MMWR 2011;60(No.1):13–15 and footnote 12 of the 2017 child and adolescent immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html.
Question of the Week: IAC Express - Issue 1297, April 5, 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 8, 2017
>> view all diphtheria Q&As
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Documenting Vaccination Back to top
Is there any plan to change the Influenza Vaccine Information Statement (VIS) for the 2017–2018 influenza season?
The current influenza vaccine VIS may be used for the 2017–2018 influenza season. No changes are planned.
Question of the Week: IAC Express - August 23, 2017
In the past, CDC has recommended to only accept patient-reported history for influenza and pneumococcal polysaccharide vaccines. Is the recommendation to not accept a patient-reported history of pneumococcal conjugate vaccine?
ACIP's recently published "General Best Practice Guidelines for Immunization" still states that a patient’s undocumented history can be accepted as proof of vaccination only for influenza and pneumococcal polysaccharide vaccines. See https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/programs.html. CDC intends to collect data to determine if patients can distinguish between the two pneumococcal vaccines, or if records should be sought for all pneumococcal vaccines.
Question of the Week: IAC Express - Issue 1317, July 26, 2017
I have patients who are in their 70s or 80s and remember getting a pneumococcal vaccine “a few years ago.” Should I assume that this was PPSV23? Should I assume that it was given before the 65th birthday?
You can accept a verbal report of PPSV23. Since the recommendation for routine vaccination with PCV13 is relatively recent (November 2014) it is reasonable to assume that PPSV23 was the pneumococcal vaccine that was administered earlier. Try to ascertain how long ago it was given. If you think the dose was given after the 65th birthday and it has been a year since the dose was administered, give a dose of PCV13 now. If the dose was administered before the 65th birthday, administer a dose of PCV13 now, and then administer a dose of PPSV23 one year later, assuming that it has been 5 years since the first dose of PPSV23 was administered.
Question of the Week: IAC Express - Issue 1255, July 13, 2016
>> view all documenting vaccination Q&As
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Haemophilus influenzae type b (Hib) Vaccine Back to top
Currently there are no new "Questions of the Week" for Haemophilus influenzae type b (Hib) Vaccine
>> view all Haemophilus influenzae type b (Hib) Q&As
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Hepatitis A Vaccine Back to top
Currently there are no new "Questions of the Week" for Hepatitis A Vaccine
>> view all hepatitis A Q&As
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Hepatitis B Vaccine Back to top
My adult patient is traveling to Nigeria in three days. She is already immune to hepatitis A, but we want to provide protection for hepatitis B. She received Twinrix two weeks ago and then a dose of single-component hepatitis B vaccine one week ago. How can we best provide protection in this circumstance?
Even though ACIP does not recommend an accelerated hepatitis B vaccine schedule in routine circumstances, a 4-dose series at 0, 7, 14 days, and 6 months is acceptable (see https://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf, page 27). Although this schedule deviates from the routine recommendation, travel is imminent. Give a dose of hepatitis B vaccine now which will complete 3 of the 4-dose accelerated schedule. She will need a fourth and final dose 6 months after the first dose in the accelerated schedule.
Question of the Week: IAC Express - Issue 1325, September 13, 2017
What is the schedule for hepatitis B vaccine administration for infants who weigh less than 2000 grams? I read that the birth dose should still be given in the hospital, but what would the schedule be after that?
Decreased seroconversion rates might occur among certain preterm infants (i.e., with low birth weights [less than 2,000 grams]) after administration of hepatitis B vaccine at birth. However, by the chronological age of 1 month, all preterm infants, regardless of initial birth weight, are likely to respond as adequately as larger infants. Preterm infants born to HBsAg-positive women and women with unknown HBsAg status must receive immunoprophylaxis with hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth. The initial vaccine dose should not be counted toward completion of the hepatitis B series, and 3 additional doses of hepatitis B vaccine should be administered, beginning when the infant is age 1 month. Infants weighing less than 2,000 g born to HBsAg-negative mothers should receive the first dose of the hepatitis B series at chronological age 1 month or at hospital discharge, whichever comes first.
Question of the Week: IAC Express - Issue 1319, August 9, 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 22, 2017
An adolescent received the first dose of hepatitis B vaccine at age 11 years but did not return for subsequent doses. If the patient comes back at age 16 years, is it necessary to repeat the first dose of the series?
It is not necessary to restart or add doses to the hepatitis B series (or any other routine vaccine series) because of a prolonged interval between doses. Just continue the series from the point where it was interrupted.
Question of the Week: IAC Express - Issue 1274, November 9, 2016
>> view all hepatitis B Q&As
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HPV Vaccine Back to top
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 - February 1, 2017
>> view all HPV Q&As
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Influenza Vaccine Back to top
Is there any plan to change the Influenza Vaccine Information Statement (VIS) for the 2017–2018 influenza season?
The current influenza vaccine VIS may be used for the 2017–2018 influenza season. No changes are planned.
Question of the Week: IAC Express - August 23, 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 - January 11, 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 - January 4, 2017
>> view all influenza Q&As
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MMR Vaccine Back to top
A 22-year-old female is going to pharmacy school and the school wants her to have a second dose of MMR vaccine. She had the first dose as a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not immune to rubella. Can I give her a second dose of the MMR with her having measles after the first dose?
Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. There is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles only one day after getting her first MMR, she must have been exposed to the disease prior to vaccination.
Question of the Week: IAC Express - September 20, 2017
How long can reconstituted MMR vaccine be stored in a refrigerator before it must be discarded?
The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is usually outlined somewhere in the vaccine’s package insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. Handout can be found at the following link: www.immunize.org/catg.d/p3040.pdf.
Question of the Week: IAC Express - August 2, 2017
How effective are three doses of MMR vaccine compared to two doses for the prevention of mumps during an outbreak?
There are no published estimates of the effectiveness of a third dose of mumps-containing vaccine in the setting of a mumps outbreak. However, CDC recommends that a third dose of MMR may be offered in certain outbreak settings (e.g., when a large proportion of cases are in 2-dose MMR recipients). Information about mumps and mumps outbreaks is available on the CDC website at https://www.cdc.gov/mumps/outbreaks.html.
The Advisory Committee on Immunization Practices (ACIP) has established a Mumps Work Group to examine the epidemiology of mumps in more detail and to further assess the utility of a third dose of MMR vaccine in these outbreak situations.
Question of the Week: IAC Express - Issue 1314, July 6, 2017
>> view all MMR Q&As
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Meningococcal Vaccine Back to top
Our practice has an 11-year-old patient who is having a splenectomy. The doctor requested meningococcal serogroup B vaccine (MenB) before the surgery and wants to know if the patient will need booster doses or a repeat MenB series at some point in the future (as in the meningococcal ACWY vaccine recommendations).
The current recommendations for MenB vaccine are to receive one series in a lifetime for high-risk people, such as your patient. There is no recommendation at present for booster doses. The recommendations for those at high-risk for meningococcal serogroup B disease are available at https://www.cdc.gov/mmwr/pdf/wk/mm6422.pdf#page=8.
Question of the Week: IAC Express - Issue 1337, November 22, 2017
Are there recommendations for meningococcal ACWY vaccination for people who reside in homeless shelters or halfway houses? In addition, can you comment on general vaccination recommendations for people who reside in homeless shelters or halfway houses?
Residence in a homeless shelter or halfway house is not in itself considered a high-risk condition for any vaccine. Recommendations for vaccinating adult residents would be the same as those for all adults on the ACIP adult immunization schedule. Residents with medical conditions identified on Table 2 of the schedule should be vaccinated according to that table.
Any residents 18 or younger should be vaccinated according to the catch-up recommendations on the ACIP child/teen immunization schedule. People age 19 through 21 years are not recommended routinely to receive MenACWY. MenACWY may be administered through age 21 years as a catch-up vaccination for those who have not received a dose after their 16th birthday.
Question of the Week: IAC Express - Issue 1335, November 15, 2017
Our patient is starting college with no documented doses of meningococcal ACWY vaccine and has had titers drawn. The lab test was positive for A, C, W, and Y. Lab reference values show >2.1 as "suggestive of protection." Can we accept this titer in lieu of documented MenACWY vaccine doses?
There are no acceptable serologic titers that can be used as evidence of protection against meningococcal A, C, W, and Y disease. In addition, the immunologic studies used for licensing purposes (serum bactericidal assay, SBA) are likely different from the serologic titers obtained at a doctor’s office (IgG antibody, for example). It is not clear what sort of testing is shown in the results you sent. However, even if SBA results are available, they cannot be used to assess whether there is a level of protection at the individual level.
Question of the Week: IAC Express - Issue 1332, October 25, 2017
If you choose to give Trumenba brand MenB vaccine (Pfizer) to a 16-year-old with HIV infection (under the Category B recommendation for all adolescents), should you use the 2-dose (standard) schedule or the 3-dose (high-risk) schedule?
The CDC meningococcal subject matter experts recommend that the 3-dose Trumenba schedule should be used for people with HIV infection. People with HIV infection do not appear to be at higher risk for meningococcal serogroup B disease, but because of their HIV infection they might not respond to the vaccine as well, so the 3-dose schedule is preferred. When Bexsero brand MenB vaccine (GSK) is used, the schedule is 2 doses, regardless of risk status.
Question of the Week: IAC Express - Issue 1329, October 4, 2017
If a patient received Trumenba meningococcal B vaccine (Pfizer) 2 months ago and Bexsero meningococcal B vaccine (GSK) yesterday, should they complete the series with Trumenba or with Bexsero since the two brands are not interchangeable? What would be the intervals from the Bexsero dose to the subsequent dose(s)?
The patient can complete the series with either vaccine. If Bexsero is chosen, the second and final dose should be administered at least 1 month after yesterday’s dose. If Trumenba is chosen and the patient is healthy (i.e., does not have a high-risk condition for meningococcal B disease such as asplenia), the second and final dose of Trumenba should be administered at least 5 months after yesterday’s Bexsero dose. If the person is at increased risk for meningococcal B disease and Trumenba is being used, a second Trumenba dose should be administered 1 month after yesterday’s Bexsero dose and a third dose should be administered 4 months after the second Trumenba dose.
Question of the Week: IAC Express - Issue 1320, August 16, 2017
I have a 3-month-old patient whose family will be doing mission work in sub-Saharan Africa. They are leaving as soon as the child is 6 months old. We gave her the first dose of Menveo brand MenACWY vaccine today. I know the usual Menveo schedule for an infant is 2, 4, 6, and 12 months. If we maintain usual spacing, she will only get 1 more dose before she leaves. Can we compress the schedule so she can get 2 more doses prior to travel?
The meningococcal ACIP recommendations don't clearly state a minimum interval for MenACWY in this situation. However, the minimum interval for a pediatric MenACWY schedule would presumably be 4 weeks like for other pediatric vaccines on a 2-4-6 schedule. You should try to give a third dose before travel begins.
Question of the Week: IAC Express - Issue 1307, May 24, 2017
Can the meningococcal serogroup B (MenB) vaccine and meningococcal conjugate (MenACWY) vaccine be given at the same visit?
MenB and MenACWY vaccines can be administered at the same visit or at any interval before or after each other. There is no need for spacing between these two vaccines.
Question of the Week: IAC Express - Issue 1282, December 21, 2016
Several healthy adult college students from Asia (ages 24 years and older) presented to our clinic. They will be living in a residence hall. None have a record of having received meningococcal conjugate vaccine (MenACWY). Should they receive a dose of MenACWY now?
ACIP does not routinely recommend MenACWY for college students 22 years of age and older. It is recommended for previously unvaccinated first-year college students who are age 21 years and younger who are or will be living in a residence hall. However, some colleges and universities may require incoming freshmen and others to be vaccinated with MenACWY and some may also require that a dose have been given after 16 years of age.
Question of the Week: IAC Express - Issue 1275, November 16, 2016
A 32-year-old patient with ulcerative colitis is taking high-dose immunosuppressive medications (6-mercaptopurine). Should he receive meningococcal vaccine?
There is no specific indication for meningococcal vaccine in this patient. He is older than 21 years, and the risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of eculizumab and HIV infection) and are not inclusive of other forms of altered immunocompetence.
Question of the Week: IAC Express - Issue 1273, November 2, 2016
>> view all meningococcal Q&As
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Pertussis Vaccine Back to top
My 11-year-old patient inadvertently received a dose of Td instead of Tdap. He received a 5-dose series of DTaP in childhood. Do I need to wait a specific interval before giving him Tdap?
No. Tdap should be administered as soon as possible.
Question of the Week: IAC Express - Issue 1339, December 6, 2017
I have a pregnant patient who is 26 weeks along and received a Tdap vaccine 2 1/2 months ago because of healthcare employment. Normally we give our pregnant patients Tdap between 27–36 weeks as recommended. Should we give her another dose of Tdap when she reaches 27 weeks gestation?
The Advisory Committee on Immunization Practices does not recommend Tdap more than once during a pregnancy. The Tdap she received earlier in pregnancy may not provide optimal protection from pertussis for the infant, but some protection is expected. More information can be found at https://www.cdc.gov/vaccines/pregnancy/pregnant-women/tdap.html.
Question of the Week: IAC Express - Issue 1331, October 18, 2017
A 16-year-old refugee's record indicates 2 doses of Td separated by 1 month and 1 dose of Tdap given 4 months after the second Td. Is he up to date?
The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td 6 months after the invalid Tdap dose. If Td is not available, Tdap can be used for this dose.
Question of the Week: IAC Express - Issue 1306, May 17, 2017
My 11-year-old patient received a dose of Tdap when he was 7 years old. He also received a dose of Td 6 months later in order to finish a primary series of tetanus-toxoid. Can I give him a dose of Tdap now?
Yes. Footnote 12 of the 2017 child and adolescent immunization schedule (available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html) states that a child who receives a dose of Tdap between 7 through 10 years of age as part of the catch-up series (as in this case), may receive another dose of Tdap at age 11 or 12 years.
Question of the Week: IAC Express - Issue 1302, April 26, 2017
Tenivac Td (Sanofi Pasteur) for adults is expected to be unavailable until the second half of 2017. Another Td vaccine produced by MassBiologics is available at our wholesaler, but it looks like the components are slightly different from Tenivac. Are the two products interchangeable during the shortage?
Yes, the Td products are equivalent and interchangeable.
Question of the Week: IAC Express - Issue 1299, April 19, 2017
A 7-year-old has a history of 3 doses of DTaP, appropriately spaced, between 4 years and 6 years of age. Is her DTaP series complete?
Although the child would be considered complete for tetanus and diphtheria toxoids, she is not complete for pertussis vaccine. ACIP recommends that children age 7 through 10 years who are not fully vaccinated against pertussis (defined as 5 doses of DTaP or 4 doses of DTaP if the fourth dose was administered on or after the fourth birthday) and who do not have a contraindication to pertussis vaccine should receive a single dose of Tdap to provide protection against pertussis. The child may also receive an additional dose of Tdap at 11 or 12 years of age. See MMWR 2011;60(No.1):13–15 and footnote 12 of the 2017 child and adolescent immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html.
Question of the Week: IAC Express - Issue 1297, April 5, 2017
If a person received a Tdap vaccine and then had a positive pertussis PCR two weeks later, could it be a false positive from the vaccine or should we consider this a case of pertussis? The patient had a cough, nausea, and vomiting for 2–3 days prior to PCR testing.
Recent Tdap vaccination does not affect PCR testing. PCR tests are used to detect DNA sequences of the Bordetella pertussis bacterium. PCR tests are very sensitive and could give a false positive result for other reasons. For more information on the interpretation of pertussis diagnostic tests, see www.cdc.gov/pertussis/clinical/diagnostic-testing/diagnosis-confirmation.html.
Question of the Week: IAC Express - Issue 1296, March 29, 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 8, 2017
>> view all pertussis Q&As
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Pneumococcal Vaccine Back to top
A dose of pneumococcal conjugate vaccine was administered into my patient's dialysis port. Does this dose count?
There are no data on the effectiveness of pneumococcal conjugate vaccine given by the intravenous route. The patient has renal disease, so it is important to ensure that the dose they receive is effective. CDC recommends repeating the dose.
Question of the Week: IAC Express - Issue 1338, November 29, 2017
Please explain why pneumococcal polysaccharide vaccine is recommended for smokers or people with diabetes younger than age 65 but pneumococcal conjugate vaccine is not recommended for these groups.
The level of risk for pneumococcal disease in smokers and people with diabetes is not as high as in immunocompromised persons, and persons with asplenia, HIV infection, hematologic cancer, or with cochlear implant. Because of the lower risk, ACIP recommended that smokers and people with diabetes receive only pneumococcal polysaccharide vaccine (PPSV, Pneumovax 23; Merck) once before age 65 years, and the pneumococcal conjugate vaccine (PCV, Prevnar 13; Pfizer) at age 65 years or older. At this age, pneumococcal disease rates increase regardless of health status. More information on this issue is available at https://www.cdc.gov/mmwr/pdf/wk/mm6140.pdf and https://www.cdc.gov/mmwr/pdf/wk/mm5934.pdf.
Question of the Week: IAC Express - Issue 1330, October 11, 2017
We have a 45-year-old patient taking Mesalamine for ulcerative colitis. Should he receive PCV13 and/or PPSV23?
Mesalamine (mesalazine) is a non-steroidal anti-inflammatory drug. It is not immunosuppressive, so its use would not be an indication for early pneumococcal vaccination with either of these vaccines (i.e., prior to the routine vaccination age of 65 years).
Question of the Week: IAC Express - Issue 1304, May 3, 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 22, 2017
>> view all pneumococcal Q&As
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Polio Vaccine Back to top
Currently there are no new "Questions of the Week" for Polio Vaccine
>> view all polio Q&As
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Precautions and Contraindications Back to top
I am a pharmacist who administers vaccines. I was recently told by a colleague that pregnant healthcare personnel were not to administer live vaccines to others. I had never heard that in school or practice. Is that true?
This is not true. Pregnant healthcare personnel may administer any vaccine except smallpox vaccine.
Question of the Week: IAC Express - Issue 1333, November 1, 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 - January 11, 2017
Is there any contraindication to administering Tdap vaccine and Rhogam at the same time to a pregnant woman?
No. Tdap is an inactivated vaccine and may be administered at the same time as Rhogam (in a separate site with a separate syringe).
Question of the Week: IAC Express - Issue 1276, November 23, 2016
>> view all precautions and contraindications Q&As
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Rabies Vaccine Back to top
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 15, 2017
>> view all rabies vaccine Q&As
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Rotavirus Vaccine Back to top
Is it okay to administer rotavirus vaccine and immune globulin at the same time?
Yes. The effectiveness concerns with antibody-containing blood products (ACBP) do not apply to rotavirus vaccine, since it is administered orally and replication of the vaccine virus occurs in the GI tract, “separate” from the site of the ACBP. Note that the child should be carefully screened for other potential contraindications or precautions to vaccination since administration of immune globulin could indicate immunosuppression.
Question of the Week: IAC Express - Issue 1328, September 27, 2017
We received a report of an infant who received rotavirus vaccine intramuscularly rather than orally. Is this dose valid? If not, when should it be repeated?
The rotavirus vaccine dose given by the intramuscular route is not valid and should be repeated by the oral route as soon as possible. In a review of such rotavirus vaccine administration errors, there usually were not adverse reactions, and those documented were limited to local reactions and general, brief irritability. Please see https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6304a4.htm for more information.

Please take steps to ensure that such vaccine administration errors are avoided in the future. This event should be reported to the Vaccine Adverse Event Reporting System at https://vaers.hhs.gov even if an adverse reaction does not result from it.
Question of the Week: IAC Express - Issue 1312, June 21, 2017
>> view all rotavirus vaccine Q&As
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Scheduling Vaccines Back to top
Does live oral cholera vaccine need to be administered at an interval from other live oral or injectable vaccines?
No. According to ACIP's General Best Practice Guidelines for Immunization, concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. So, live oral cholera vaccine may be administered simultaneously with another vaccine, or at any interval before or after administration of another vaccine.
Question of the Week: IAC Express - Issue 1308, May 31, 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, March 1, 2017
Can the meningococcal serogroup B (MenB) vaccine and meningococcal conjugate (MenACWY) vaccine be given at the same visit?
MenB and MenACWY vaccines can be administered at the same visit or at any interval before or after each other. There is no need for spacing between these two vaccines.
Question of the Week: IAC Express - Issue 1282, December 21, 2016
An adolescent received the first dose of hepatitis B vaccine at age 11 years but did not return for subsequent doses. If the patient comes back at age 16 years, is it necessary to repeat the first dose of the series?
It is not necessary to restart or add doses to the hepatitis B series (or any other routine vaccine series) because of a prolonged interval between doses. Just continue the series from the point where it was interrupted.
Question of the Week: IAC Express - Issue 1274, November 9, 2016
>> view all scheduling vaccines Q&As
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Storage and Handling Back to top
How long can reconstituted MMR vaccine be stored in a refrigerator before it must be discarded?
The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is usually outlined somewhere in the vaccine’s package insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. Handout can be found at the following link: www.immunize.org/catg.d/p3040.pdf.
Question of the Week: IAC Express - August 2, 2017
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Tetanus Vaccine Back to top
My 11-year-old patient inadvertently received a dose of Td instead of Tdap. He received a 5-dose series of DTaP in childhood. Do I need to wait a specific interval before giving him Tdap?
No. Tdap should be administered as soon as possible.
Question of the Week: IAC Express - Issue 1339, December 6, 2017
I have a pregnant patient who is 26 weeks along and received a Tdap vaccine 2 1/2 months ago because of healthcare employment. Normally we give our pregnant patients Tdap between 27–36 weeks as recommended. Should we give her another dose of Tdap when she reaches 27 weeks gestation?
The Advisory Committee on Immunization Practices does not recommend Tdap more than once during a pregnancy. The Tdap she received earlier in pregnancy may not provide optimal protection from pertussis for the infant, but some protection is expected. More information can be found at https://www.cdc.gov/vaccines/pregnancy/pregnant-women/tdap.html.
Question of the Week: IAC Express - Issue 1331, October 18, 2017
What is the dosing for tetanus immune globulin for an adult with suspected tetanus?
ACIP recommends a single dose of tetanus immune globulin (TIG) for treatment of persons with tetanus. Although the optimal therapeutic dose has not been established, experts recommend 500 international units (IU), which appears to be as effective as higher doses ranging from 3,000 to 6,000 IU and causes less discomfort. Available preparations must be administered intramuscularly; TIG preparations available in the United States are not licensed or formulated for intrathecal or intravenous use. Infiltration of part of the dose locally around the wound is usually recommended if feasible, although the efficacy of this approach has not been proven. If TIG is not available, intravenous immune globulin (IGIV) can be used at a dose of 200 to 400 milligrams per kilogram (mg/kg). However, the Food and Drug Administration has not approved IGIV for this use. In addition, anti- tetanus antibody content varies from lot to lot. See https://www.cdc.gov/tetanus/clinicians.html for more information on this issue.
Question of the Week: IAC Express - Issue 1316, July 19, 2017
A 16-year-old refugee's record indicates 2 doses of Td separated by 1 month and 1 dose of Tdap given 4 months after the second Td. Is he up to date?
The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td 6 months after the invalid Tdap dose. If Td is not available, Tdap can be used for this dose.
Question of the Week: IAC Express - Issue 1306, May 17, 2017
My 11-year-old patient received a dose of Tdap when he was 7 years old. He also received a dose of Td 6 months later in order to finish a primary series of tetanus-toxoid. Can I give him a dose of Tdap now?
Yes. Footnote 12 of the 2017 child and adolescent immunization schedule (available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html) states that a child who receives a dose of Tdap between 7 through 10 years of age as part of the catch-up series (as in this case), may receive another dose of Tdap at age 11 or 12 years.
Question of the Week: IAC Express - Issue 1302, April 26, 2017
Tenivac Td (Sanofi Pasteur) for adults is expected to be unavailable until the second half of 2017. Another Td vaccine produced by MassBiologics is available at our wholesaler, but it looks like the components are slightly different from Tenivac. Are the two products interchangeable during the shortage?
Yes, the Td products are equivalent and interchangeable.
Question of the Week: IAC Express - Issue 1299, April 19, 2017
A 7-year-old has a history of 3 doses of DTaP, appropriately spaced, between 4 years and 6 years of age. Is her DTaP series complete?
Although the child would be considered complete for tetanus and diphtheria toxoids, she is not complete for pertussis vaccine. ACIP recommends that children age 7 through 10 years who are not fully vaccinated against pertussis (defined as 5 doses of DTaP or 4 doses of DTaP if the fourth dose was administered on or after the fourth birthday) and who do not have a contraindication to pertussis vaccine should receive a single dose of Tdap to provide protection against pertussis. The child may also receive an additional dose of Tdap at 11 or 12 years of age. See MMWR 2011;60(No.1):13–15 and footnote 12 of the 2017 child and adolescent immunization schedule, available at www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html.
Question of the Week: IAC Express - Issue 1297, April 5, 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 8, 2017
>> view all tetanus Q&As
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Vaccine Recommendations Back to top
A dose of pneumococcal conjugate vaccine was administered into my patient's dialysis port. Does this dose count?
There are no data on the effectiveness of pneumococcal conjugate vaccine given by the intravenous route. The patient has renal disease, so it is important to ensure that the dose they receive is effective. CDC recommends repeating the dose.
Question of the Week: IAC Express - Issue 1338, November 29, 2017
Our practice has an 11-year-old patient who is having a splenectomy. The doctor requested meningococcal serogroup B vaccine (MenB) before the surgery and wants to know if the patient will need booster doses or a repeat MenB series at some point in the future (as in the meningococcal ACWY vaccine recommendations).
The current recommendations for MenB vaccine are to receive one series in a lifetime for high-risk people, such as your patient. There is no recommendation at present for booster doses. The recommendations for those at high-risk for meningococcal serogroup B disease are available at https://www.cdc.gov/mmwr/pdf/wk/mm6422.pdf#page=8.
Question of the Week: IAC Express - Issue 1337, November 22, 2017
My 36-year-old patient was diagnosed with idiopathic thrombocytopenic purpura and had a splenectomy three weeks ago. Prior to the splenectomy, the patient had one dose each of Hib, MenB, PCV13, MenACWY (Menactra), and PPSV23 (separated from the PCV13 by 9 weeks). What vaccines are recommended now?
Since the patient is asplenic, the second dose of the primary series of MenACWY should be given 8–12 weeks after the first dose. He/she will need a dose of MenACWY every 5 years for the rest of his/her life. The patient has already received the one dose of PCV13 recommended for adults, so another dose of this vaccine is not needed. A second dose of PPSV23 is recommended at least 8 weeks after the dose of PCV13 AND at least 5 years since the last dose of PPSV23. A third (and final) dose of PPSV should be given after the patient turns age 65. The series of MenB (whether Trumenba or Bexsero) should be completed. The same MenB vaccine should be used for all doses in the series. Based on the patient’s age, the previous dose of Hib vaccine was administered when the patient was old enough to require only one dose of Hib vaccine, so another dose is not needed. The patient should receive influenza vaccine annually.
Any of these vaccines can be given simultaneously (at the same appointment, not in the same syringe) except for PCV13 and PPSV23, and PCV13 and Menactra. If Menactra is used for an asplenic person it should be separated from the PCV13 by at least 4 weeks. Menveo has no spacing restriction.
Question of the Week: IAC Express - Issue 1334, November 8, 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, March 1, 2017
For our "Mother's Day Out" program, one of the teachers has shingles. The program serves moms of 2-month-olds to 4-year-olds. All children are up to date with their vaccinations, but some are too young to have received varicella vaccine. Is it safe for the teacher to work?
In a school setting, an immunocompetent person with zoster (staff or students) can remain at school as long as the lesions can be completely covered. People with zoster should be careful about personal hygiene, wash their hands after touching their lesions, and avoid close contact with others. If the lesions cannot be completely covered and close contact avoided, the person should be excluded from the school setting until the zoster lesions have crusted over. See www.cdc.gov/chickenpox/outbreaks/manual.html for more information.

If your program is licensed by a state or county, you should check their regulations as well.
Question of the Week: IAC Express - Issue 1279, December 7, 2016
A 32-year-old patient with ulcerative colitis is taking high-dose immunosuppressive medications (6-mercaptopurine). Should he receive meningococcal vaccine?
There is no specific indication for meningococcal vaccine in this patient. He is older than 21 years, and the risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of eculizumab and HIV infection) and are not inclusive of other forms of altered immunocompetence.
Question of the Week: IAC Express - Issue 1273, November 2, 2016
>> view all vaccine recommendations Q&As
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Vaccine Safety Back to top
Why are zoster, pneumococcal polysaccharide (PPSV23) and meningococcal serogroup B (MenB) vaccines not covered by the National Vaccine Injury Compensation Program?
The National Vaccine Injury Compensation Program includes payment only for injuries determined to have occurred following vaccination with a vaccine routinely recommended for children in the United States. The recipient can be of any age, but the vaccine must be routinely recommended for children and teens through age 18 years. Zoster, PPSV23 and MenB vaccines are not routinely recommended for children. Zoster is only licensed and recommended for adults. PPSV23 and MenB vaccines are routinely recommended only for select high-risk groups of children and adults. More information about the program and the covered vaccines is at www.hrsa.gov/vaccinecompensation/coveredvaccines/index.html.
Question of the Week: IAC Express - Issue 1277, November 30, 2016
Do you have any information on the use of aborted fetal cells in vaccine development?
Please see this article which summarizes the use of cells which produced the MRC5 and WI138 cell lines for certain vaccines used in humans: http://www.historyofvaccines.org/content/articles/human-cell-strains-vaccine-development.
The cells were taken from infants aborted for other reasons, and no new cells have been harvested since the 1960s. Rubella vaccine is one of those developed with such cells. Other commonly used vaccines from these cell lines include hepatitis A vaccines, varicella vaccine, and zoster (shingles) vaccine.
The National Council of Catholic Bishops has deemed use of such vaccines acceptable, if no other alternatives exist.
IAC Express Question of the Week - November 18, 2015
>> view all vaccine safety Q&As
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Varicella (chickenpox) Vaccine Back to top
I have a healthy 11-month-old patient whose family is traveling to Zimbabwe. Where they are traveling has a high rate of varicella. Should I give varicella vaccine to the infant before she travels to Africa?
The Advisory Committee on Immunization does not recommend varicella vaccination before 12 months of age. It is likely safe to vaccinate the child, but maternal antibodies may limit the benefits of vaccination. If you choose to vaccinate, the child should receive two more doses of varicella vaccine, at 12 months of age or older, separated by at least three months.
Question of the Week: IAC Express - Issue 1323, August 30, 2017.
I had an 18-year-old in the clinic today for varicella vaccination. He reports having antiphospholipid syndrome being treated with rituximab (a drug that affects the function of B lymphocytes). The next dose of rituximab will be in 2 weeks. He has also had 12 immune globulin (IG) injections in the last year. Should he get the varicella vaccine at all with this condition, and if so, what time frame do we need to be concerned with in relation to the rituximab treatment and/or IG?
The Infectious Diseases Society of America guidelines indicate that persons receiving rituximab should be considered to have high-level immunosuppression. Both inactivated and live vaccines should be withheld at least 6 months following treatment with anti-B cell medications such as rituximab. As for the IG, the interval to live vaccination depends on the dose. Please refer to the table on pages 37–39 of the "General Best Practices Guidelines for Immunization" at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf for guidance. This interval could be as long as 11 months, depending on the dose he receives.
Question of the Week: IAC Express - Issue 1305, May 10, 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 8, 2017.
For our "Mother's Day Out" program, one of the teachers has shingles. The program serves moms of 2-month-olds to 4-year-olds. All children are up to date with their vaccinations, but some are too young to have received varicella vaccine. Is it safe for the teacher to work?
In a school setting, an immunocompetent person with zoster (staff or students) can remain at school as long as the lesions can be completely covered. People with zoster should be careful about personal hygiene, wash their hands after touching their lesions, and avoid close contact with others. If the lesions cannot be completely covered and close contact avoided, the person should be excluded from the school setting until the zoster lesions have crusted over. See www.cdc.gov/chickenpox/outbreaks/manual.html for more information.

If your program is licensed by a state or county, you should check their regulations as well.
Question of the Week: IAC Express - Issue 1279, December 7, 2016
>> view all chickenpox (varicella) Q&As
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Zoster (shingles) Vaccine Back to top
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 8, 2017.
My healthy 29-year-old son recently had a mild episode of herpes zoster. He has no underlying medical problems. He was treated with famcyclovir. Should he now get zoster vaccine?
The Advisory Committee on Immunization Practices (ACIP) does not recommend zoster vaccine for persons younger than 60 years of age regardless of their history of zoster. The currently available vaccine is licensed for persons 50 years and older. A clinician may choose to give the vaccine to a person younger than 50 years, but such use would be off-label.
Question of the Week: IAC Express - Issue 1280, December 14, 2016
>> view all zoster Q&As
This page was updated on December 13, 2017.
This page was reviewed on January 12, 2016.
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