Adults that received PCV13 should complete the pneumococcal series with PCV20 or PCV21 vaccination at least 1 year after PCV13. PCV15 and PPSV23 are not recommended in this situation.
Last reviewed:
November 13, 2024
There is no specific indication for meningococcal vaccine in this patient. Risk–based recommendations are restricted to specific forms of altered immunocompetence (persistent complement component deficiency, functional or anatomic asplenia, use of complement inhibitors such as eculizumab [Soliris], ravulizumab [Ultomiris] or sutimlimab [Enjaymo], and HIV infection) and do not include other forms of altered immunocompetence.
Last reviewed:
November 15, 2024
Hepatitis C infection is not a contraindication for Shingrix vaccination. However, if someone with hepatitis C is receiving a medication that can cause immunosuppression, they should consult with their healthcare provider to discuss the clinical considerations for the timing of vaccination. Detailed guidance is available at www.cdc.gov/shingles/vaccination/immunocompromised-adults.html#clinical-guidance.
Last reviewed:
March 9, 2022
ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the United States. Before their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a copy of their immunization records with them as they travel. For additional information on the worldwide measles situation, and on CDC’s measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.
Last reviewed:
June 19, 2023
- Infants born to mothers for whom HBsAg testing results during pregnancy are not available but other evidence suggestive of maternal HBV infection exists (for example presence of HBV DNA, HBeAg-positive, or mother known to be chronically infected with HBV) should be managed as if born to an HBsAg-positive mother.
- Mothers admitted for delivery without documentation of HBsAg test results should have blood drawn and tested as soon as possible after admission.
- While test results are pending, all infants with birth weights of 2,000 grams or more born to mothers without documentation of HBsAg test results should receive the first dose of single-antigen HepB (without HBIG) within 12 hours of birth. Only single antigen HepB vaccine should be used for the birth dose.
- If the mother is determined to be HBsAg positive, the infant should receive HBIG as soon as possible but no later than age 7 days, and the vaccine series should be completed according to a recommended schedule for infants born to HBsAg-positive mothers.
- If the mother is determined to be HBsAg negative, the vaccine series should be completed according to a recommended schedule for infants born to HBsAg-negative mothers.
Last reviewed:
July 21, 2023
Although second-hand smoke and other environmental conditions have been identified as risk factors for meningococcal disease, ACIP does not include them as indications for MenACWY vaccination. Providers may always use their clinical judgment in situations not addressed by ACIP.
Last reviewed:
November 15, 2024
In general the entire volume should be used even if it is a little more than 0.5 mL. Discarding the excess vaccine is not required or recommended. An exception to this is recombinant zoster vaccine (RZV; Shingrix, GSK). The RZV adjuvant solution may contain up to 0.75 mL of liquid. The entire volume of the adjuvant solution should be withdrawn and used to reconstitute the lyophilized vaccine. After mixing, withdraw the recommended dose of 0.5 mL. Any reconstituted vaccine left in the vial should be discarded.
Last reviewed:
December 28, 2022
Post-licensure studies of MMRV suggested that, during the 5–12 days after vaccination, approximately one additional febrile seizure occurred among every 2,600 children ages 12 through 23 months vaccinated with a first dose of MMRV vaccine compared with children in the same age group vaccinated with separate first doses of MMR vaccine and varicella vaccine administered during a single office visit.
For this reason, the recommendations for use of MMRV vaccine are as follows:
- The routinely recommended ages for measles, mumps, rubella, and varicella vaccination are age 12 through 15 months for the first dose and age 4 through 6 years for the second dose.
- For the first dose of measles, mumps, rubella, and varicella vaccines at age 12 through 47 months, providers may use either MMR vaccine and varicella vaccine or MMRV vaccine. Providers who are considering administering MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers. Unless the parent or caregiver expresses a preference for MMRV vaccine, CDC recommends that providers administer MMR vaccine and varicella vaccine for the first dose in this age group.
- For the second dose of measles, mumps, rubella, and varicella vaccines at any age (15 months through 12 years) and for the first dose at age 48 months and older, use of MMRV vaccine generally is preferred, if available, over separate injections of its equivalent component vaccines (i.e., MMR vaccine and varicella vaccine).
- A personal or family (e.g., sibling or parent) history of seizures of any etiology (i.e., cause) is a precaution for MMRV vaccination, and such children generally should be vaccinated with MMR vaccine and varicella vaccine.
The complete recommendations for the use of MMRV vaccine are available on CDC’s website at www.cdc.gov/mmwr/pdf/rr/rr5903.pdf.
Last reviewed:
July 15, 2023
Because of measles. Measles is highly communicable and poses a serious threat to the health of unvaccinated infants. For this reason, all infants age 6 through 11 months who travel internationally are recommended to receive a dose of measles, mumps, and rubella vaccine (MMR) to reduce the risk of measles infection during travel.
The antibodies in immune globulin (IG) typically used to prevent HAV infection in infants before the first birthday can interfere with the effectiveness of MMR vaccine. An infant who is given IG should not be vaccinated with MMR or varicella vaccines for at least 6 months after IG administration. If an infant age 6 through 11 months is traveling to a destination where protection from infection with HAV is desired, ACIP recommends off-label use of HepA vaccine (not IG) in addition to MMR. The HepA and MMR doses administered before the first birthday do not count toward the routine vaccination series of either vaccine: these infant travelers will still need two doses of HepA and two doses of MMR when age appropriate.
Last reviewed:
June 25, 2023
The conditions and treatments that CDC specifies may result in moderate or severe immunocompromise include but are not limited to:
- Active treatment for solid tumor and hematologic malignancies
- Hematologic malignancies associated with poor responses to COVID-19 vaccines regardless of current treatment status (e.g., chronic lymphocytic leukemia, non-Hodgkin lymphoma, multiple myeloma, acute leukemia)
- Receipt of solid-organ transplant or an islet transplant and taking immunosuppressive therapy
- Receipt of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic cell transplant (HCT) (within 2 years of transplantation or taking immunosuppressive therapy)
- Moderate or severe primary immunodeficiency (e.g., common variable immunodeficiency disease, severe combined immunodeficiency, DiGeorge syndrome, Wiskott-Aldrich syndrome)
- Advanced HIV infection (people with HIV and CD4 cell counts less than 200/mm³, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV) or untreated HIV infection
- Active treatment with high-dose corticosteroids (i.e., 20 mg or more of prednisone or equivalent per day when administered for 2 or more weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory (e.g., B-cell-depleting agents)
Additional factors to consider in assessing the general level of immune competence in a patient include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immune-suppressing treatment. A patient’s clinical care team is in the best position to evaluate the degree of immunocompromise and timing of vaccination.
See CDC’s interim clinical considerations for this population: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#immunocompromised.
Last reviewed:
August 31, 2024
People who have received 2 doses of HPV vaccine separated by less than 5 months should receive a third dose 6–12 months after dose #1 and at least 12 weeks after dose #2, regardless of their age at the time of the first dose. The recommended interval for the second dose in the 2-dose schedule (indicated when the first dose is given before age 15) is 6 months and the minimum interval is 5 months.
Last reviewed:
March 2, 2024
Contraindications:
- History of a serious allergic reaction (e.g., anaphylaxis) after a previous dose of varicella vaccine or to a varicella vaccine component. For information on vaccine components, refer to the manufacturer’s package insert (www.immunize.org/fda).
- Pregnancy
- Severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, long-term immunosuppressive therapy [e.g., two weeks or more of daily receipt of 20 mg or more, or 2 mg/kg body weight or more, of prednisone or equivalent] or patients with HIV infection who are severely immunocompromised [a child age 1 through 5 years with CD4+ T-lymphocyte percentage less than 15% or a person age 6 years or older with a CD4+ T-lymphocyte count less than 200 cells per microliter])
- Family history of congenital or hereditary immunodeficiency in first-degree relatives (e.g., parents, siblings) unless the immune competence of the potential vaccine recipient has been clinically substantiated or verified by a laboratory
Precautions:
- Recent receipt (within the previous 11 months) of antibody-containing blood product (specific interval depends on product)
- Moderate or severe acute illness with or without fever (defer until recovery)
- Use of aspirin or aspirin-containing products
- Receipt of specific antiviral drugs (acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination)
Precautions for combination MMRV (ProQuad, Merck) only (approved for children 1 through 12 years of age) also include: history of thrombocytopenia or thrombocytopenic purpura, a personal or family history of seizures of any etiology, and a need for tuberculin skin testing or interferon-gamma release assay (IGRA) testing.
For additional information, see the “General Best Practice Guidelines for Immunization” section on contraindications and precautions, table 4–1 and associated footnotes, at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
Last reviewed:
July 26, 2024
Yes. Multidose vials of inactivated influenza vaccine contain a small amount of thimerosal to prevent bacterial and fungal growth in the vial. Thimerosal-containing vaccines are safe to use in children. No scientific evidence indicates that thimerosal in vaccines causes adverse events unless the patient has a severe allergy to thimerosal. Despite this, a few states have enacted legislation that restricts the use of thimerosal-containing vaccines in children. To find out if your state has such restrictions, check with your state immunization program (see www.immunize.org/official-guidance/state-policies/state-resources/ for program contact information).
Last reviewed:
August 11, 2024
This child needs to complete the primary series with 1 dose of Td or Tdap, administered no earlier than 6 months after the Tdap dose given at age 11 years. After that, the child needs a booster dose of Td or Tdap every 10 years. An easy way to determine how to catch up a child is to consult “Recommended Immunization Schedules for Persons Aged 0 Through 18 Years, U.S.” The schedule is approved by CDC, AAP, and AAFP and is released early in each calendar year. It includes a catch-up schedule for children who have fallen behind (see www.cdc.gov/vaccines/hcp/imz-schedules/index.html).
Last reviewed:
August 23, 2024
If you are unable to obtain prenatal records or verify receipt of maternal RSV vaccine, CDC recommends that the baby receive nirsevimab (Beyfortus, Sanofi), particularly if it is shortly before or during the RSV season. Don’t forget to check the state immunization information system (IIS) for the mother’s vaccination record. RSV vaccination during a previous pregnancy does not protect through later pregnancies. If the mother received RSV vaccine during a previous pregnancy, nirsevimab is indicated for this infant. It is also important to attempt to verify from the birthing facility records whether this baby received nirsevimab prior to discharge to avoid giving a second dose.
Last reviewed:
August 25, 2024
What you describe is a good strategy for administration of the 2-dose pneumococcal vaccine series of PCV15 and PPSV23 to people age 50 years and older if you prefer not to complete their PCV vaccination with a single dose of either PCV20 or PCV21. ACIP does not define “one year” but this is assumed to be one calendar year. Receiving PPSV23 a few days or weeks earlier than one calendar year after PCV15 is not a medical problem. However, it could be a problem for reimbursement since Medicare will only pay for both a PCV15 vaccine and a PPSV23 vaccine if they are given at least 11 months apart. Private insurance may have similar rules. Here is the wording from the Centers for Medicare and Medicaid (CMS): “An initial pneumococcal vaccine may be administered to all Medicare beneficiaries who have never received a pneumococcal vaccine under Medicare Part B. A different, second pneumococcal vaccine may be administered 1 year after the first vaccine was administered (i.e., 11 full months have passed following the month in which the last pneumococcal vaccine was administered).”
Last reviewed:
November 13, 2024
Last reviewed:
August 27, 2024
Yes. Shingrix can be administered in this situation. Optimally, vaccination should occur when the disease is well-controlled and not during an acute disease flare.
Last reviewed:
March 9, 2022
Yes. Any person who ever received 2 doses of any combination of HPV vaccines can be considered fully vaccinated if dose #1 was given before the 15th birthday and the 2 doses were separated by at least 5 months.
Last reviewed:
March 2, 2024
The CDC “General Best Practice Guidelines for Immunization” section on altered immunocompetence recommends varicella vaccination of children with humoral (but not cellular) immunodeficiencies. In addition, single-antigen varicella vaccine should be considered for HIV-infected children age 1 through 5 years with CD4+ T-lymphocyte percentages greater than or equal to 15% for at least 6 months or for children age 6 years and older with CD4+ T-lymphocytes count greater than or equal to 200 cells per microliter for at least 6 months. Eligible children should receive 2 doses of varicella vaccine with a 3-month interval between doses. Additional details of these recommendations can be found in table 8-1 and associated footnotes at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html.
Last reviewed:
May 16, 2023
The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of age and older. A dose given earlier than 4 days before the first birthday does not count as part of the MMR vaccine two-dose series.
Last reviewed:
June 19, 2023
Immunize.org has developed suggested standing orders for all vaccines commonly given to children and adults. They are based on CDC’s Advisory Committee on Immunization Practices (ACIP) recommendations. You can find the standing orders and protocols for medical management of vaccine reactions at www.immunize.org/standing-orders.
Last reviewed:
December 28, 2022
Absolutely not. Vaccines should never be mixed except when specifically approved by FDA and packaged for that specific purpose.
Last reviewed:
July 15, 2023
Preterm infants weighing less than 2,000 grams (4.4 pounds) at birth have a decreased response to HepB administered before age 1 month. By age 1 month, medically stable preterm infants, regardless of initial birth weight or gestational age, have an immunologic response to HepB vaccination that is comparable to that of full-term infants. For preterm infants weighing less than 2,000 grams at birth:
- If maternal HBsAg status is positive:
- Give hepatitis B immune globulin (HBIG) plus HepB vaccine within 12 hours of birth. The birth dose (the initial HepB dose) should not be counted as part of the vaccine series.
- Give 3 additional HepB doses (for a total of 4 doses) at ages 1, 2 to 3, and 6 months, or HepB-containing combination vaccine (Pediarix or Vaxelis) at ages 2, 4, and 6 months. The final dose should not be administered before 24 weeks of age.
- Test for HBsAg and anti-HBs at age 9–12 months, or 1–2 months after the final dose of the vaccine series if completion of the series is delayed. Testing should not be performed before age 9 months (anti-HBs resulting from use of HBIG might still be positive and therefore misleading) or within 1 month of the most recent HepB dose (testing for HBsAg sooner than 1 month of a vaccine dose might produce a transient HBsAg-positivity).
- If maternal HBsAg status is unknown:
- If the mother’s HBsAg status cannot be determined within 12 hours of birth give HBIG plus HepB vaccine. The birth dose of vaccine should not be counted as part of the 3 doses required to complete the HepB series.
- Three additional doses of vaccine (for a total of 4 doses) should be administered according to the recommended schedule on the basis of the mother’s HBsAg test result. The final dose in the series should not be administered before 24 weeks of age.
- If it is not possible to determine the mother’s HBsAg status:
- The vaccine series should be completed according to a recommended schedule for infants born to HBsAg positive mothers.
- If the maternal HBsAg status is negative:
- If you are certain that appropriate maternal testing was done and a copy of the mother’s original laboratory report indicating that she was HBsAg negative during this pregnancy is placed on the infant’s chart, delay the first dose of HepB vaccine until age 1 month or hospital discharge (even if weight is still less than 2,000 grams), whichever comes first. Complete the vaccine series per the recommended schedule.
For preterm infants weighing 2,000 grams or more at birth, follow the recommendations for full-term infants including a HepB dose within 24 hours of birth.
Last reviewed:
July 21, 2023
Since the first DTaP was received before 12 months of age and one Tdap dose has been given, this person needs one dose of Td or Tdap 6 calendar months after the Tdap dose. A routine Td or Tdap booster should be administered every 10 years. See Immunize.org’s handout: DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age: www.immunize.org/catg.d/p2055.pdf.
Last reviewed:
March 31, 2022
Yes. The ACIP recommends that pregnant people at risk for hepatitis A virus (HAV) infection during pregnancy or at risk for a severe outcome from HAV infection should be vaccinated during pregnancy if not previously vaccinated. Pregnant people should be vaccinated for the same indications as non-pregnant people. For additional information, see page 20 of the recommendations: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.
Last reviewed:
June 25, 2023
ACIP recommends adolescents age 11 or 12 years should be routinely vaccinated with MenACWY and receive a booster dose at age 16 years. Adolescents who receive the first dose at age 13 through 15 years should receive a one-time booster dose, preferably at age 16 through 18 years, just before the peak in incidence of meningococcal disease among adolescents occurs. Teens who receive their first dose of MenACWY at or after age 16 years do not need a booster dose, as long as they have no additional risk factors.
Last reviewed:
November 15, 2024
Yes, but only if the 9-year-old meets all of the criteria below:
- they turned 9 years old during the current season, and
- they had received one dose during the current season before turning 9, and
- they have no or unknown history of receiving any previous dose of influenza vaccine before July 1 of the year of the current season.
Last reviewed:
August 11, 2024
Yes. Infants born less than 14 days after the mother received RSV vaccine should receive nirsevimab (Beyfortus, Sanofi). Infants born within 14 days after maternal vaccination may not have had sufficient time in utero to receive adequate protection from maternal RSV antibodies produced after vaccination. Infants born 14 days or more after maternal vaccination are not recommended to receive nirsevimab except in rare circumstances where maternal antibodies may be insufficiently effective. See a separate question for details on those circumstances.
Last reviewed:
August 25, 2024
Yes. See revaccination considerations after HCT and for those on B-cell depleting therapies, at www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#considerations-COVID-19-revaccination. This is the most current statement from CDC on COVID-19 vaccination after HCT:
Recipients of HCT or CAR-T-cell therapy who received 1 or more doses of COVID-19 vaccine prior to or during treatment should be revaccinated. Revaccination should start at least 3 months (12 weeks) after transplant or CAR-T-cell therapy and should follow the currently recommended schedule for immunocompromised people who are unvaccinated.
A patient’s clinical team is best positioned to determine the degree of immune compromise, need for revaccination, and appropriate timing of revaccination.
Last reviewed:
August 31, 2024
Studies have shown that administering the pneumococcal conjugate vaccine (PCV) first leads to a better immune response to serotypes common to both vaccines when the polysaccharide vaccine (PPSV23) is given at a later date. For this reason, CDC recommends that pneumococcal vaccine-naive adults receive PCVs either alone (PCV20, PCV21) or first in a sequence (PCV15 first, followed by PPSV23). A provider who stocks only PPSV23 should consider purchasing a recommended PCV or referring patients elsewhere to receive a PCV, if feasible. A patient due for PCV who inadvertently receives PPSV23 first should receive PCV15, PCV20, or PCV21 vaccine at least one year later.
Last reviewed:
November 13, 2024
For patients receiving anti-B cell therapies (e.g., rituximab), CDC recommends administering a dose of RZV approximately 4 weeks prior to the next scheduled therapy.
Last reviewed:
March 9, 2022
No. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in February 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age 6 through 11 months traveling outside the United States when protection against hepatitis A is recommended. MMR and hepatitis A vaccines may be safely co-administered to children in this age group. Neither vaccine is counted as part of the child’s routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.
Last reviewed:
June 19, 2023
While you did not say this explicitly, we assume the concern is about a vaccine injury in a person who was vaccinated using a standing order. Of course, as long as the person is properly screened for contraindications and precautions, an injury from a vaccine is very unlikely. In the event that an injury does occur, the National Vaccine Injury Compensation Program (VICP) provides liability protection for the vaccinator and the clinician who signed the standing order for any vaccine that is covered by the vaccine injury compensation program (all vaccines that are routinely administered to children are covered by the program for all ages of patients). More information about the VICP is available on their website at www.hrsa.gov/vaccinecompensation/index.html.
Last reviewed:
December 28, 2022
Twelve weeks. The spacing between doses of a combination vaccine depends on the longest minimum interval of a component. The minimum interval between doses of MMR is 4 weeks; the minimum interval between doses of varicella vaccine is 12 weeks for a child this age. So, you should wait 12 weeks between the doses of MMRV for the two doses to be valid.
Last reviewed:
July 15, 2023
ACIP recommends the following for the use of Tdap in healthcare personnel:
- All healthcare personnel (HCP), regardless of age, should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap and regardless of the time since last Td dose.
- Tdap may be administered in any situations where Td only was previously recommended. After receipt of Tdap, HCP should receive routine booster immunization against tetanus and diphtheria with either Td or Tdap vaccine. Additionally, pregnant HCP should receive a dose of Tdap during each pregnancy.
- Hospitals and ambulatory-care facilities should provide Tdap for HCP and use approaches that maximize vaccination rates (e.g., education about the benefits of vaccination, convenient access, and the provision of Tdap at no charge).
To view updated recommendations on the use of Td or Tdap in situations where only Td was previously recommended, go to www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6903a5-H.pdf. For details about Tdap and other recommendations for healthcare personnel, go to “Immunization of Health-Care Personnel” (MMWR 2011;60[SS-7]:4-46) at www.cdc.gov/mmwr/pdf/rr/rr6007.pdf.
Last reviewed:
March 31, 2022
In 2015, CDC revised the recommendation for the timing of hepatitis B serologic testing for infants born to an HBsAg-positive woman. Postvaccination testing (HBsAg and hepatitis B surface antibody [anti-HBs]) is now recommended 1 to 2 months after completion of at least three doses of the HepB vaccine series, but not before 9 months of age. For a child vaccinated on schedule, testing should be done at age 9 to 12 months. Testing should not be performed before age 9 months because hepatitis B immune globulin (HBIG) might still be present at age 6 to 8 months, nor should testing be performed within 1 month of the most recent HepB dose because a transient false positive HBsAg might occur. Antibody to hepatitis B core (anti-HBc) testing of infants or children is not recommended because passively acquired maternal anti-HBc might be detected up to age 24 months in children of HBV-infected mothers. Children who are HBsAg positive should receive medical evaluation and ongoing follow-up. For additional information, see www.cdc.gov/mmwr/pdf/wk/mm6439.pdf, pages 1118–20.
Last reviewed:
July 21, 2023
Hepatitis A vaccine (HepA) should be administered intramuscularly (IM), using the appropriate injection site and needle size as determined by the patient’s age and body mass. See Immunize.org’s clinical resource, “How to Administer Intramuscular and Subcutaneous Vaccine Injections” for details, www.immunize.org/catg.d/p2020.pdf.
Last reviewed:
June 25, 2023
No vaccine series needs to be restarted because of an interval that is longer than recommended (with the exception of oral typhoid vaccine in certain circumstances). You should resume the HPV vaccine series where it was interrupted.
Last reviewed:
March 2, 2024
A CDC study showed a small increased risk for febrile seizures during the 24 hours after a child receives the inactivated influenza vaccine at the same time as the PCV13 vaccine or DTaP vaccine. However, the risk of febrile seizure with any combination of these vaccines is small and ACIP recommends giving these vaccines at the same visit if indicated. The risk for febrile seizures in children who received PCV15 or PCV20 concurrently with an influenza vaccine has not been studied.
See www.cdc.gov/vaccine-safety/about/febrile-seizures.html for more information about febrile seizures after vaccination.
Last reviewed:
November 13, 2024
In rare circumstances, nirsevimab (Beyfortus, Sanofi) may be considered for infants in their first RSV season who were born to RSV-vaccinated mothers. These situations may include:
- infants born to mothers who have health conditions that might prevent an adequate maternal immune response to vaccination (an immunocompromising condition caused by disease or immunosuppressive treatment)
- infants whose mothers have conditions associated with reduced transplacental antibody transfer (such as a mother living with HIV infection)
- infants who might have lost maternal antibodies, such as those who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO)
- infants with substantially increased risk for severe RSV disease (such as hemodynamically significant congenital heart disease or intensive care admission requiring oxygen at hospital discharge).
Infants and children age 8–19 months who are at increased risk for severe RSV disease and are entering their second RSV season are recommended to receive nirsevimab regardless of history of maternal vaccination.
Last reviewed:
August 25, 2024
According to CDC’s interim clinical considerations for the use of COVID-19 vaccines, whenever possible, COVID-19 vaccines should be administered at least 2 weeks before initiation or resumption of immunosuppressive therapies. For patients who receive B-cell-depleting therapies on a continuing basis, COVID-19 vaccines should be administered approximately 4 weeks before the next scheduled therapy.
CDC also notes that timing of COVID-19 vaccination should take into consideration current or planned immunosuppressive therapies, optimization of both the patient’s medical condition and response to vaccination, and individual benefits and risks. Review the CDC’s considerations for COVID-19 vaccination of those on immunosuppressive therapies here: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#considerations-timing-COVID-19-vaccination-immunosuppressive-therapies.
Last reviewed:
August 31, 2024
For people with immunosuppression, ACIP recommends 1 dose of PCV20 or PCV21 alone or one dose of PCV15 followed by a dose of PPSV23 one year later (immunocompromised adults may receive PPSV23 with a minimum 8-week interval after PCV15). MenB is not specifically recommended for immunosuppressed people. However, a patient who is age 16 through 23 years and immunosuppressed may receive routine MenB vaccination with a 3-dose series of either Bexsero (GSK) or Trumenba (Pfizer).
Last reviewed:
November 13, 2024
In 2005, ACIP recommended routine MenACWY vaccination for all preteens at age 11 or 12 years to protect them from meningococcal disease when its incidence rises in the late teens and early 20s. Subsequent studies indicated that the protection provided by MenACWY waned within 5 years following vaccination. For this reason, in 2010, ACIP recommended a MenACWY booster dose at age 16 to provide continuing protection during the age of increased meningococcal incidence.
Last reviewed:
November 15, 2024
ACIP routinely recommends nirsevimab (Beyfortus, Sanofi) only for infants younger than 8 months of age whose mothers were not vaccinated, or not effectively vaccinated, with Abrysvo (Pfizer) RSV vaccine during their pregnancy. Nirsevimab is not recommended for this infant unless there is a clinical reason to believe maternal vaccination was ineffective, for example, if the infant had been born less than 14 days after vaccine administration.
Last reviewed:
September 19, 2024
HBsAg-negative infants with anti-HBs levels 10 mIU/mL or higher are protected and need no further medical management. HBsAg-negative infants with anti-HBs less than 10 mIU/mL should be revaccinated with a single dose of hepatitis B vaccine and receive postvaccination serologic testing 1–2 months later. Infants whose anti-HBs remains less than 10 mIU/mL following single dose revaccination should receive 2 additional doses of HepB to complete the second series, followed by postvaccination serologic testing 1–2 months after the final dose.
Based on clinical circumstances or family preference, HBsAg-negative infants with anti-HBs less than 10 mIU/mL may instead be revaccinated with a second, complete 3-dose series, followed by postvaccination serologic testing performed 1–2 months after the final dose of vaccine.
Last reviewed:
July 21, 2023
Shingrix has not been evaluated for, and is not recommended for, the prevention of primary infection with varicella virus (chickenpox).
In this case, the patient is not yet immunocompromised and has no evidence of immunity to varicella. The simplest next step is to vaccinate the patient with two doses of varicella vaccine, spaced at least 4 weeks apart, before initiating immunosuppressing medication.
If you wish, you may order a commercial serologic assay to look for evidence of past varicella virus exposure. However, remember that the sensitivity and specificity of these tests vary, and while such commercial tests can detect evidence of past varicella infection, they are not sensitive enough to reliably detect evidence of past vaccination with varicella vaccine.
For patients who lack evidence of past infection or vaccination and who are immunocompromised already, CDC has provided additional detailed clinical considerations here: www.cdc.gov/shingles/vaccination/immunocompromised-adults.html#special-populations.
Last reviewed:
March 9, 2022
The IDSA 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 lymphocyte depleting medications such as rituximab. As for the IG, the interval to live vaccination depends on the dose. For guidance, please refer to the Timing and Spacing of Immunobiologics section of CDC’s “General Best Practices Guidelines for Immunization”, table 3–6: “Recommended intervals between administration of antibody-containing products and measles- or varicella-containing vaccine, by product and indication for vaccination” at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html. This interval could be as long as 11 months, depending on the dose he receives.
Last reviewed:
May 16, 2023
Yes. The second dose of MMR may be scheduled a minimum of 28 days after the first dose, if necessary.
Last reviewed:
June 19, 2023
HPV vaccine is not recommended for use during pregnancy. HPV vaccines have not been associated causally with adverse outcomes of pregnancy or adverse events in the developing fetus. However, if a person is found to be pregnant after initiating the vaccination series, the remainder of the series should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination.
If a vaccine dose has been administered during pregnancy, no intervention is needed.
Last reviewed:
March 2, 2024
Yes. Other inactivated and/or live virus vaccines can be administered at the same time as HepA vaccine, but should be given at a different anatomical site, if possible. If given in the same muscle, separate the injections by a minimum distance of 1 inch.
Last reviewed:
June 25, 2023
A booster dose should be given to first-year college students, regardless of age, who are or will be living in a residence hall if the previous dose was given before the age of 16 years or if their most recent dose (given after the 16th birthday) was not given within the past 5 years.
Last reviewed:
November 15, 2024
Findings of this study discourages the prophylactic use of paracetamol (similar to acetaminophen) prior to or immediately following vaccination. Acetaminophen can be used to treat pain or fever if it should occur following vaccination. ACIP’s “General Best Practices Guidelines for Immunization” state: “Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures.” For more information on this issue, see Methods for Alleviating Discomfort and Pain Associated with Vaccination at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html.
Last reviewed:
December 28, 2022
There is no minimum period to wait to correct your error. If you had immediately realized that you had mistakenly given the father-to-be Td instead of Tdap, you could have given him the needed Tdap dose at the same visit at which you gave him the erroneous Td dose.
Last reviewed:
March 31, 2022
No. Mesalamine (mesalazine) is a non-steroidal anti-inflammatory drug. It is not immunosuppressive, so its use would not place a person at increased risk of invasive pneumococcal disease.
Last reviewed:
November 13, 2024
Yes. It is especially important to vaccinate during pregnancy because of the increased risk for influenza-related complications during pregnancy and the baby’s increased risk of influenza-related illness and hospitalizations during the first 6 months of life.
Influenza vaccination during pregnancy reduces mothers’ risk of influenza illness, preterm labor, and their infants’ risk of influenza and influenza-related hospitalization in the first 6 months of life.
Vaccination can occur in any trimester, including the first. Only inactivated or recombinant influenza vaccines may be given during pregnancy. FluMist (LAIV), a live vaccine, should not be given during pregnancy.
Last reviewed:
August 11, 2024
Nirsevimab (Beyfortus, Sanofi) dosing is based upon weight and/or age. It is available in 50-mg or 100-mg manufacturer-filled syringes (MFS). Infants younger than 8 months and weighing less than 5 kgs (11 lbs.) should receive a 50-mg dose, given as a 50-mg MFS. Infants younger than 8 months and weighing 5 kg (11 lb.), or more, should receive a single 100-mg dose, given as a 100-mg MFS. Infants and toddlers age 8 months through 19 months who need nirsevimab should receive a 200-mg dose, given as two 100-mg MFS.
Do not administer two 50-mg MFS to an infant who needs a 100-mg MFS. The supply of 50-mg MFS is intended for the smallest infants. The cost of the 50-mg and 100-mg MFS are equivalent, despite the difference in dose; insurance plans may not cover the cost of two doses given to an infant not recommended to receive two doses. Only high-risk children age 8 through 19 months are recommended to receive two (100-mg) MFS doses at the same visit.
See the Immunize.org standing order template for details: www.immunize.org/wp-content/uploads/catg.d/p3097.pdf.
Last reviewed:
August 25, 2024
CDC states that no additional medical documentation is required before vaccination. The patient’s affirmation of moderate or severe immunocompromise is sufficient: vaccinators should not deny COVID-19 vaccination to a person due to lack of documentation.
Last reviewed:
August 31, 2024
Last reviewed:
April 6, 2023
Available data do not suggest a benefit from administering additional HepB vaccine doses to infants who have not attained anti-HBs of mIU/mL or higher following receipt of two complete HepB series. HBsAg-positive infants should be referred for appropriate follow-up with a physician who specializes in evaluating infants with liver disease.
Last reviewed:
July 21, 2023
No. Antiretroviral treatment for HIV may improve immune response to vaccination; however, vaccination for shingles does not have to be delayed in order to achieve viral suppression, especially if this will significantly delay vaccine administration. Patients with advanced HIV should receive RZV, because the risk of shingles is further increased in the setting of such immune compromise.
Last reviewed:
March 9, 2022
No. A measles-containing vaccine administered more than 4 days before the first birthday should not be counted as part of the series. MMR should be repeated when the child is age 12 through 15 months (12 months if the child remains in an area where disease risk is high). The second dose should be administered at least 28 days after the first dose.
Last reviewed:
June 19, 2023
The ACIP’s varicella vaccine recommendations state that no adverse events associated with the use of salicylates after varicella vaccination have been reported, however, the vaccine manufacturer recommends that vaccine recipients avoid using salicylates for 6 weeks after receiving varicella vaccines because of the association between aspirin use and Reye syndrome after varicella disease (chickenpox). Vaccination with subsequent close monitoring should be considered for children who have rheumatoid arthritis or other conditions requiring therapeutic aspirin. The risk for serious complications associated with aspirin is likely to be greater in children in whom natural varicella develops than it is in children who receive the vaccine containing attenuated varicella zoster virus. In other words, the benefit of varicella vaccine likely outweighs the theoretical risk of Reye syndrome. See the ACIP varicella recommendations at www.cdc.gov/mmwr/PDF/rr/rr5604.pdf, page 29.
Last reviewed:
May 16, 2023
You should withhold further HPV vaccine until she is no longer pregnant. After the pregnancy is completed, administer the remaining doses of the series using the usual 2- or 3-dose schedule (depending on the age at initiation of the series).
Last reviewed:
March 2, 2024
Yes. ACIP recommends a dose of Tdap be given to all adults, including those age 65 years or older.
Last reviewed:
March 31, 2022
