Ask the Experts: All Questions

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Results (1355)

Yes, but there should be sufficient time between the blood product and the MMR to reduce the chance of interference. The interval depends on the blood product received. See Table 3-6 of ACIP’s “General Best Practice Guidelines for Immunization” for more information, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Last reviewed: June 19, 2023

Although PCV and PPSV23 should not be administered at the same visit, CDC does not recommend repeating either vaccine dose should this occur. You should inform the patient of the error and let them know that they will not need to repeat either dose.

Last reviewed: December 28, 2022

ACIP does not recommend repeated doses of Tdap for fathers or other family members or caregivers of infants during every pregnancy. The recommendation for Tdap vaccination with each pregnancy to optimize immunity for the infant applies only to the pregnant mother.

The practice of “cocooning” infants by making a particular effort to vaccinate caregivers who have not received Tdap vaccination has been recommended by ACIP since 2005; however, the practice has been difficult to implement fully and may not be effective alone as a strategy for protecting newborns from pertussis exposure. The combined strategy of Tdap vaccination during each pregnancy, cocooning, and administering the childhood DTaP series on schedule provides the best protection to the infant.

Last reviewed: March 31, 2022

For details on preexposure protection of international travelers age 12 months and older, refer to Appendix A on page 35 of the current ACIP recommendations for the prevention of hepatitis A: www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf.

Healthy people age 12 months through 40 years who are planning travel to an area with high or intermediate HAV endemicity and have not received HepA vaccine should receive a single dose of HepA vaccine as soon as travel is considered and should complete the 2-does series according to the routine schedule.

People with chronic liver disease as well as adults older than 40 years of age, immunocompromised people, and people with other chronic medical conditions planning to depart to an area with high or intermediate HAV endemicity in less than 2 weeks should receive the initial dose of HepA vaccine and may also simultaneously be administered immune globulin (IG) at a separate anatomic injection site (for example in separate limbs).

ACIP revised its recommendations for preexposure hepatitis A vaccination for travelers in 2018 to include vaccination of infants 6 through 11 months of age. All infants of this age traveling internationally should be given a dose of measles, mumps, rubella vaccine (MMR) before travel. Due to the potential interference of hepatitis A IG with MMR vaccine effectiveness, an off-label dose of HepA vaccine is recommended instead of IG in this situation. The travel-related dose for infants 6–11 months of age should not be counted toward the routine 2-dose series. The routine 2-dose HepA and MMR vaccination series should be initiated at age 12 months according to the routine, age-appropriate vaccination schedule.

Infants younger than 6 months and travelers who elect not to receive vaccine or for whom vaccine is contraindicated should receive a single 0.1 mL/kg dose of IG before travel when protection against HAV is recommended. If travel is for more than 1 month, a dose of 0.2 mL/kg should be administered. A 0.2 mL/kg dose can be repeated every 2 months for travel of more than 2 months duration.

Last reviewed: June 25, 2023

Because HCP provide care to patients at high risk for complications of influenza, they should be considered a high-priority group for receiving vaccination. Achieving high rates of vaccination among HCP will protect staff and their patients and reduce disease burden and healthcare costs.

In 2011, ACIP published “Immunization of Health-Care Personnel,” which includes information about all recommended vaccines (see www.cdc.gov/mmwr/pdf/rr/rr6007.pdf).

Last reviewed: August 11, 2024

Nirsevimab (Beyfortus, Sanofi) is contraindicated in persons with a history of severe allergic reactions (e.g., anaphylaxis) after a previous dose or to a product component. As with any injection, when administering nirsevimab to children with increased risk for bleeding, providers should follow ACIP’s general best practice guidelines for immunization.

Last reviewed: August 25, 2024

Everyone age 6 months and older is recommended to receive at least one dose of 2024–2025 Formula COVID-19 vaccine, regardless of past vaccination history. Any 2024–2025 Formula COVID-19 vaccine received in another country that is listed for emergency use by the World Health Organization (WHO-EUL) or authorized or licensed for use by the FDA counts toward fulfilling this recommendation.

CDC has provided additional details based upon age and immunocompromised status at its website: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us-appendix.html#appendix-a.

A list of the vaccines that have already received WHO-EUL status is available here: https://extranet.who.int/prequal/vaccines/covid-19-vaccines-who-emergency-use-listing.

Last reviewed: August 31, 2024

In general, one HepB series is needed in a lifetime, with rare exceptions described at the end of this answer.

As of April 2022, CDC recommends HepB vaccination of all adults age 60 or older who are in any of the following risk groups (vaccination also may be offered to age 60 and older, regardless of risk):

  • All adults age 60 years and older with risk factors for hepatitis B:
    • People at risk for infection by sexual exposure
      • Sex partners of people testing positive for HBsAg
      • Sexually active people who are not in a long-term, mutually monogamous relationship (e.g., those with more than one sex partner during the previous 6 months)
      • People seeking evaluation or treatment for a sexually transmitted infection
      • Men who have sex with men
    • People at risk for infection by percutaneous or mucosal exposure to blood
      • People with current or recent injection drug use
      • Household contacts of people testing positive for HBsAg
      • Residents and staff members of facilities for people with developmental disabilities
      • Healthcare and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids
      • People on maintenance dialysis, including in-center or home hemodialysis and peritoneal dialysis, and people who are predialysis
      • People with diabetes, at the discretion of the treating clinician
    • Others
      • International travelers to countries with high or intermediate levels of endemic hepatitis B virus (HBV) infection (HBsAg prevalence of 2% or higher)
      • People with hepatitis C virus infection
      • People with chronic liver disease (including, but not limited to, people with cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase or aspartate aminotransferase level greater than twice the upper limit of normal)
      • People with HIV infection
      • People who are incarcerated

The official CDC recommendations for HepB vaccination of adults are available at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7113a1-H.pdf. Immunize.org has developed a standing order template for adult HepB vaccination: www.immunize.org/catg.d/p3076.pdf.

In general, people who have documented completion of a HepB series at any point or who have a history of previous HBV infection should not receive additional HepB vaccination, although there is no evidence that additional vaccination is harmful. In settings where the patient population has a high rate of previous HBV infection, prevaccination testing, which may be performed at the same visit when the first dose of vaccine is administered, might reduce costs by avoiding complete vaccination of people who are already immune. However, prevaccination testing is not required and should not create a barrier to vaccination.

Revaccination may be indicated for certain high-risk adults, including healthcare workers who are documented non-responders to an initial HepB series, and certain people who receive dialysis or who are immunocompromised. For specific revaccination guidance, see the 2018 ACIP recommendations for the prevention of hepatitis B at www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6701-H.pdf (pages 23–24).

Last reviewed: July 21, 2023

CDC’s guidance is to ignore the remote history of PCV7 and evaluate the patient as if he has never had pneumococcal vaccination. The patient should receive PCV20 or PCV21 alone or PCV15 in series with PPSV23 given at least one year later. If using PCV15, and if the high-risk condition is immunocompromising or if the patient has a cochlear implant or cerebrospinal fluid leak, you may consider administering the PPSV23 as soon as 8 weeks after PCV15.

Last reviewed: November 13, 2024

Prior vaccine recommendations put the burden on the patient to ask for HepB vaccination if they wanted it. The recommendations published in 2022 make vaccinating adults much easier because CDC recommends that healthcare providers routinely offer HepB vaccine to ALL adult patients, including those over 60 without known risk factors. The idea of this change is to shift the burden of requesting vaccination off the patient and instead allow the provider to offer the vaccine routinely.

Last reviewed: July 21, 2023

The HepB series is now recommended for all people age 59 years and younger. Among older age groups the risk of acute hepatitis B is lower: HepB may be administered to unvaccinated adults with diabetes age 60 years and older at the discretion of the treating clinician.

In 2011, CDC first published ACIP recommendations that HepB vaccine be given to adults with diabetes because of studies showing that adults with diabetes and no other hepatitis B risk factors had twice the odds of developing acute hepatitis B compared to adults without diabetes or other risk factors. There also have been a number of outbreaks of HBV infection in settings that provide assisted blood glucose monitoring for people with diabetes.

No serologic testing or additional HepB vaccination is recommended for adults who have documentation of receiving a complete HepB series at any time in the past. For those who did not complete the vaccination series, no maximum interval between doses exists that would make the HepB vaccination series ineffective or that would require restarting the series.

Last reviewed: July 21, 2023

There is no waiting period. The varicella vaccine dose can be given at any time after the Shingrix dose. Review your procedures to prevent this from happening again. Always check the label 3 times to ensure you are administering the product intended. Such an error also should be reported to the Vaccine Adverse Event Reporting System (VAERS) by phone 1-800-822-7967 or online at https://vaers.hhs.gov.

Last reviewed: March 9, 2022

It is important to vaccinate all healthcare personnel, including paid and unpaid workers who may be exposed to patients or infectious materials. This includes direct patient care staff (e.g., physicians, nurses, and therapists), and staff and volunteers in pharmacy, radiology, laboratory, human resources, facilities management (housekeeping), food services, and laundry. Vaccination should include healthcare staff in all settings, such as hospitals, outpatient clinics, pharmacies, emergency response, nursing homes and assisted living facilities, and home care.

Last reviewed: August 11, 2024

Yes. Receipt of RhoGam is not a reason to delay vaccination. For more information see the ACIP “General Best Practice Guidelines for Immunization”, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Last reviewed: June 19, 2023

Varicella zoster immune globulin, VariZIG (Saol Therapeutics), is recommended for patients without evidence of immunity to varicella who are at high risk for severe varicella and complications, who have been exposed to varicella or herpes zoster, and for whom varicella vaccine is contraindicated. Patient groups recommended by CDC to receive VariZIG include the following:

  • Immunocompromised patients without evidence of immunity
  • Newborn infants whose mothers have signs and symptoms of varicella around the time of delivery (i.e., 5 days before to 2 days after)
  • Hospitalized preterm infants born at 28 weeks or more of gestation whose mothers do not have evidence of immunity to varicella
  • Hospitalized preterm infants born at less than 28 weeks of gestation or who weigh 1,000 grams or less at birth, regardless of their mothers’ evidence of immunity to varicella
  • Pregnant people without evidence of immunity

CDC recommends administration of VariZIG as soon as possible after exposure to varicella-zoster virus, ideally within 96 hours, but not beyond 10 days after exposure. The most recent recommendations for the use of VariZIG were published in 2013 and are available at www.cdc.gov/mmwr/pdf/wk/mm6228.pdf on pages 574—576.

Last reviewed: May 16, 2023

To maximize maternal antibody response and passive antibody transfer to the infant, the optimal time to administer Tdap is between 27 and 36 weeks’ gestation, preferably during the early part of that window. However, Tdap can be administered at any time during pregnancy.

Last reviewed: March 31, 2022

Yes. If time allows, use the standard Twinrix schedule of 3 doses given intramuscularly on a 0-, 1-, and 6-month schedule. If travel is imminent the accelerated 4-dose Twinrix schedule can be used, which is 3 doses given on days 0, 7, and 21-30 days and a booster dose at 12 months.

Last reviewed: June 25, 2023

CDC recommends that if a provider mistakenly administers varicella vaccine to a person for whom zoster vaccine is indicated, no specific safety concerns exist, but the dose should not be considered valid. You should administer a dose of Shingrix to the patient during that same visit (same day). If the error is not detected and corrected on the same day, Shingrix should be administered at least 8 weeks after receipt of the varicella vaccine. However, if Shingrix is inadvertently administered less than 8 weeks after the varicella vaccine, CDC experts state that the Shingrix dose does not need to be repeated if given at least 24 days after the varicella vaccine (in other words, 4 weeks minus the 4-day grace period). A second dose of Shingrix should be given 2–6 months after the first dose of Shingrix.

These events should be documented and procedures put in place, such as checking the vial label 3 times to be sure you are administering the product you intend, to prevent this from happening again.

Last reviewed: December 28, 2022

RSV vaccines are contraindicated for and should not be administered to persons with a history of severe allergic reaction, such as anaphylaxis, to any component of the vaccine. People experiencing moderate or severe acute illness with or without fever should delay RSV vaccination until they are improved, as a precaution.

Last reviewed: August 25, 2024

This patient, like other adults who are not moderately or severely immunocompromised, is considered up to date after receiving a single dose of 2024–2025 Formula COVID-19 vaccine at least 8 weeks after his most recent COVID-19 vaccination.

Last reviewed: August 31, 2024

No. As of October 2024, CDC recommends that adults with immunocompromising conditions who received a dose of PPSV23 in the past and were previously recommended to receive a second PPSV23 dose at least 5 years after that initial PPSV23 dose should now complete their pneumococcal immunization schedule with PCV20 or PCV21 at least 5 years after the PPSV23 dose. 

Last reviewed: November 13, 2024

No, gestational diabetes is not classified as a risk factor for acute hepatitis B infection. The increased risk of acute hepatitis B infection has been associated with type 1 and type 2 diabetes; however, all people age 59 years or younger are now recommended to be vaccinated against hepatitis B.

Last reviewed: July 21, 2023

No. The Shingrix vaccine does not count as a vaccination against primary varicella infection (chickenpox). The first varicella vaccine dose can be given at any time after the Shingrix dose. The second dose of varicella vaccine should be given 4 to 8 weeks after the first dose. You should always check the label 3 times to ensure you are administering the product intended.

Last reviewed: March 9, 2022

All people working in long-term care facilities who do not have a valid contraindication should receive annual influenza vaccination.

Last reviewed: August 11, 2024

VariZIG is supplied in 125-IU vials and should be administered intramuscularly as directed by the manufacturer. The recommended dose is 125 IU/10 kg of body weight, up to a maximum of 625 IU (five vials). The minimum dose is 62.5 IU (0.5 vial) for patients weighing 2.0 kg or less and 125 IU (one vial) for patients weighing 2.1–10.0 kg. VariZIG is available from Saol Therapeutics. For ordering information see varizig.com/liquid-product_info.html.

Last reviewed: September 5, 2020

While the mother should have been given Tdap rather than Td, the Tdap dose may be given at any interval since the Td dose was given and preferably between 27 and 36 weeks’ gestation.

Last reviewed: March 31, 2022

There is no waiting period. The varicella vaccine dose can be given at any time after the RZV dose.

Last reviewed: December 28, 2022

No. There is no recommendation for a booster dose of HepA if a patient has completed the 2-dose series at any age.

Last reviewed: June 25, 2023

People with HIV infection are at increased risk for severe complications if infected with measles. It is safe to vaccinate people with HIV infection who are not severely immunosuppressed. The current criteria for safe MMR vaccination of people with HIV infection are shown below, from the CDC General Best Practices Guidelines (see the section on altered immunocompetence, www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html):

Two doses of MMR vaccine are recommended for all HIV-infected people age 12 months or older who do not have evidence of current severe immunosuppression (individuals age 5 years or younger must have CD4+T lymphocyte [CD4+] percentages at least 15% for at least 6 months, and individuals older than age 5 years must have CD4+ percentages at least 15% and CD4+ cell counts of at least 200 lymphocytes/mm3 for at least 6 months) and do not have current evidence of measles, rubella, and mumps immunity.

In cases when only CD4+ cell counts or only CD4+ percentages are available for those older than age 5 years, the assessment of severe immunosuppression can be based on the CD4+ values (count or percentage) that are available. In cases when CD4+ percentages are not available for those age younger than 5 years, the assessment of severe immunosuppression can be based on age-specific CD4+ counts at the time CD4+ counts were measured; i.e., absence of severe immunosuppression is defined as at least 6 months above age-specific CD4+ count criteria: CD4+count greater than 750 lymphocytes/mm3 while age 12 months or younger, and CD4+count at least 500 lymphocytes/mm3 while age 1 through 5 years. Similarly, repeat doses of MMR vaccination are recommended for individuals with perinatal HIV infection who were vaccinated before establishing effective combination antiretroviral therapy (cART). They should receive 2 appropriately spaced doses of MMR vaccine once effective cART has been established (individuals age 5 years or younger must have CD4+ percentages of at least 15% for at least 6 months; individuals older than 5 years of age must have CD4+ percentages at least 15% and CD4+ counts of at least 200 lymphocytes/mm3 for at least 6 months) unless they have other acceptable current evidence of measles, rubella, and mumps immunity.

HIV-infected people who are receiving regular doses of IGIV are unlikely to respond to varicella vaccine or MMR vaccine because of the presence of passively acquired antibody. However, because of the potential benefit, MMR and varicella vaccines should be considered approximately 14 days before the next scheduled dose of IGIV (if not otherwise contraindicated), although an optimal immune response might not occur depending on the presence of neutralizing antibodies against the vaccine virus. Vaccination should be repeated (if not otherwise contraindicated) after the recommended interval (see Table 3-6 in the Timing and Spacing of Immunobiologics of this document). In most cases, this is after the therapy has been discontinued.

Administer the first dose at 12 through 15 months and the second dose to children age 4 through 6 years, or as early as 28 days after the first dose.

Last reviewed: June 19, 2023

Both protein-based vaccines (Abrysvo, Pfizer; Arexvy, GSK) are stored in the refrigerator. RSVPreF3 (Arexvy) is supplied as a single-dose vial of lyophilized antigen component (powder) and a single-dose vial of adjuvant suspension component (liquid). Both the liquid and the powder should be stored refrigerated between 2°C and 8°C (36°F and 46°F) in the original package in order to protect vials from light. Do not freeze. Discard if either component has been frozen.

After reconstitution, administer immediately or store in the refrigerator between 2°C and 8°C (36°F to 46°F) or at room temperature (defined for this vaccine as up to 25°C [77°F]) for up to 4 hours before use. Discard reconstituted vaccine if not used within 4 hours.

Last reviewed: August 25, 2024

An asymptomatic person who is scheduled for COVID-19 vaccination and is exposed to SARS-CoV-2 virus may be vaccinated; however, COVID-19 vaccination after exposure is not recommended as post-exposure prophylaxis, so vaccination should not be expected to prevent illness caused by past exposure. A person who is currently sick with a respiratory virus should defer vaccination until at least the recovery from the acute illness, and consider additional measures to prevent spread, in accordance with current CDC guidance. Healthcare facilities may have specific policies in place to reduce the risk of spread of respiratory viruses to healthcare staff and other patients.

CDC summarizes its current guidance on respiratory viruses (updated March 2024) here: http://www.cdc.gov/respiratory-viruses/guidance/index.html.

People who recently had SARS-CoV-2 infection and are due for a COVID-19 vaccine may consider delaying the dose by up to 3 months from symptom onset or positive test (if infection was asymptomatic). According to CDC, increasing the time between infection and vaccination may result in an improved immune response to vaccination. At this time, there is evidence of a low risk of reinfection in the weeks following infection. A recipient’s individual risks for severe disease and current COVID-19 conditions in the community should be taken into account when deciding whether to delay vaccination up to 3 months after infection.

Last reviewed: August 31, 2024

In October 2024, CDC updated its guidance to state that an adult who received PCV13 should receive PCV20 or PCV21at least 1 year later. PPSV23 is no longer recommended as an option following PCV13.

Last reviewed: November 13, 2024

Both protein-based RSV vaccines (Abrysvo, Pfizer; Arexvy, GSK) are stored in the refrigerator. RSVpreF (Abrysvo) is supplied in a kit that includes a vial of lyophilized antigen component (a white powder), a prefilled syringe with a sterile water diluent, and a vial adapter. Store at refrigerated temperatures between 2°C and 8°C (36°F and 46°F) in the original carton. Do not freeze. Discard if frozen. Follow reconstitution guidelines at www.fda.gov/media/168889/download.

After reconstitution, administer immediately or store at room temperature (defined for this vaccine as 15ºC to 30ºC [59°F to 86°F]) for up to 4 hours. Do not store reconstituted Abrysvo vaccine in the refrigerator or freezer. Discard reconstituted vaccine if not used within 4 hours.

Last reviewed: August 25, 2024

The mRNA RSV vaccine (mResvia, Moderna) is supplied as a manufacturer-filled syringe (MFS) that contains a frozen suspension that must be thawed before administration either in the refrigerator or at room temperature. Vaccine should not be refrozen once thawed. Do not shake any mRNA vaccine because shaking can damage the potency of the vaccine by breaking up the small bubbles of fat (lipid) that contain the mRNA.

  • Freezer storage: The frozen vaccine in the plastic MFS can be stored in the freezer between -40°C to -15°C (-40°F to 5°F) until the expiration date printed on its packaging.
  • Refrigerator storage: The thawed plastic MFS may be stored refrigerated between 2°C to 8°C (36°F to 46°F) for up to 30 days before being used. If stored in the refrigerator, place a label on the vaccine indicating when it was placed in the refrigerator and its ‘use by date’, which is 30 days later. Discard an MFS that has been in the refrigerator beyond its 30-day use-by date.
  • Room temperature storage: The thawed plastic MFS may be stored between 8°C to 25°C (46°F to 77°F) for a total of 24 hours after removal from refrigerated conditions. Discard the MFS if not used within this time. Do not return an MFS to the refrigerator after it has been thawed at room temperature.
  • Refer to the mResvia package insert for specific instructions and additional details on storage and thawing: www.fda.gov/media/179005/download.
Last reviewed: August 25, 2024

The deltoid muscle is recommended for routine intramuscular (IM) vaccination among adults. The anterolateral thigh also can be used. The gluteus muscle should not be used as a site for administering HepB. Please refer to the Immunize.org document Administering Vaccines to Adults: Dose, Route, Site, and Needle Size (available at www.immunize.org/catg.d/p3084.pdf) for complete information on this issue.

Last reviewed: July 21, 2023

A dose less than the full 0.5 mL dose is generally not considered valid and should generally be repeated. If the patient is still in the office the dose can be repeated immediately. If the repeat dose cannot be given on the same day CDC recommends that it should be given 4 weeks after the invalid dose. The provider does have discretion as to whether the amount of vaccine lost is negligible, to make a decision not to repeat the dose of vaccine.

Last reviewed: March 9, 2022

Since January 2007 the Joint Commission has required accredited organizations to offer annual influenza vaccination to staff, volunteers, and licensed independent practitioners who have close patient contact.

Last reviewed: August 11, 2024

There is no evidence that healthy full-term infants born to women in whom varicella occurs more than 48 hours after delivery are at increased risk for serious complications such as pneumonia or death. Varicella zoster immune globulin, VariZIG, can be given up to 10 days after exposure but is only recommended for newborn infants whose mothers have signs and symptoms of varicella around the time of delivery (5 days before to 2 days after), hospitalized premature infants born at 28 or more weeks of gestation whose mothers do not have evidence of immunity to varicella, or hospitalized premature infants born at less than 28 weeks of gestation or who weigh 1,000 grams or less at birth regardless of their mothers’ evidence of immunity to varicella. Assuming this is an infant at home, VariZIG would not be recommended. Varicella, if it develops, would be managed as for any child.

Last reviewed: May 16, 2023

Although the MMR vaccine package insert recommends a 3-month deferral of pregnancy after MMR vaccination, CDC and ACIP recommend deferral of pregnancy for 4 weeks.

Last reviewed: June 19, 2023

Yes. Data have shown that people acquire hepatitis A virus infection even in such places as 4-star hotels located in Latin America.

Last reviewed: June 25, 2023

A dose less than the full 0.5 mL dose is not valid and should be repeated. If the patient is still in the office the dose can be repeated immediately. If the repeat dose cannot be given on the same day CDC recommends that it should be given 4 weeks after the invalid dose.

Last reviewed: December 28, 2022

Yes. ACIP recommends a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks’ gestation (preferably early in that window). For more information, see www.cdc.gov/mmwr/volumes/67/rr/pdfs/rr6702a1-H.pdf, pages 22–23.

Last reviewed: March 31, 2022

Nirsevimab (Beyfortus, Sanofi) comes in two single-dose manufacturer-filled syringe (MFS) formulations: 50-mg and 100-mg. Nirsevimab should be stored in the refrigerator between 36°F to 46°F (2°C to 8°C). It may be kept at room temperature 68°F to 77°F (20°C to 25°C) for a maximum of 8 hours. After removal from the refrigerator, nirsevimab must be used within 8 hours or discarded. Store nirsevimab in the original carton to protect it from light until time of use. Do not freeze. Do not shake. Do not expose to heat.

Last reviewed: August 25, 2024

Yes, COVID-19 vaccines and other routine vaccines, including influenza and RSV vaccines, may be coadministered on the same day, given in different syringes and at different anatomical sites. COVID-19 vaccines may also be given at any interval before or after any other vaccination.

Of note, there is no required minimum interval between receiving a dose of any COVID-19 vaccine and an orthopoxvirus vaccine, either Jynneos or ACAM2000 vaccine (e.g., for mpox prevention), regardless of which vaccine is administered first. However, use of Jynneos vaccine should be prioritized over ACAM2000 when co-administering a COVID-19 vaccine and an orthopoxvirus vaccine.

People, particularly adolescent or young adult males, who are recommended to be vaccinated against both mpox and COVID-19 might consider waiting 4 weeks between vaccines. This is because of the observed risk for myocarditis and pericarditis after receipt of ACAM2000 orthopoxvirus vaccine and COVID-19 vaccines, and the hypothetical risk for myocarditis and pericarditis after Jynneos vaccine. However, if a patient’s risk for mpox or severe disease due to COVID-19 is increased, administration of mpox and COVID-19 vaccines should not be delayed.

Additional information about simultaneous administration with other vaccines is available from CDC: www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#age-transitions.

Last reviewed: August 31, 2024

ACIP and CDC do not recommend revaccination with a second dose of PPSV23 for adults 19 through 49 with asplenia who receive PCV15 (Vaxneuvance, Merck) followed by PPSV23.

If the adult patient with asplenia had received PCV13 (Prevnar 13, Pfizer) followed by PPSV23 (instead of Vaxneuvance), then CDC recommends administration of a dose of PCV20 or PCV21 at least 5 years after the dose of PPSV23.

Last reviewed: November 13, 2024

The CDC zoster subject matter experts recommend that in this situation you should wait 4 weeks before giving a repeat dose.

Last reviewed: March 9, 2022

Live varicella-containing vaccines (varicella, MMRV) must be stored in a freezer at a temperature between -50°C and -15°C (between -58°F and +5°F) until reconstitution and administration. These vaccines can deteriorate rapidly after they are removed from the freezer. A separate stand-alone freezer or a combination refrigerator-freezer purpose-built for vaccine storage (sometimes called “pharmaceutical grade”) should be used to store frozen vaccines that require storage temperatures between -50°C and -15°C (between -58°F and +5°F). A stand-alone storage unit that is frost-free or has an automatic defrost cycle is preferred. Frozen vaccines should not be stored in the freezer compartment of a household-type combination unit because household freezers in combination units cannot reliably maintain proper storage temperatures for frozen vaccines. This applies to both temporary and long-term storage of frozen vaccines. The diluents should be kept separately in the refrigerator or at room temperature. Live varicella-containing vaccines must be administered within 30 minutes of reconstitution.

Last reviewed: May 16, 2023

ACIP recommends that people capable of bearing children be asked if they are currently pregnant or attempting to become pregnant. Vaccination should be deferred for those who answer “yes.” Those who answer “no” should be advised to avoid pregnancy for 4 weeks following vaccination. Pregnancy testing is not necessary.

Last reviewed: June 19, 2023

Serologic testing for immunity after HepB vaccination is recommended only for people whose subsequent clinical management depends on knowledge of their immune status. Testing is not necessary after routine vaccination of adults.

Post-vaccination anti-HBs testing of certain adults is recommended for the following reasons:

  • To determine the need for revaccination and the type of follow-up testing:
    • HCP and public safety workers at risk for blood or body fluid exposure
    • Hemodialysis patients (and others who might require outpatient hemodialysis)
    • People with HIV, and other immunocompromised people (e.g., hematopoietic stem-cell transplant recipients or people receiving chemotherapy)
  • To determine the need for revaccination and for other methods of protection against HBV infection:
    • Sex partners or needle-sharing partners of HBsAg-positive people

Testing should be performed 1 to 2 months after the last dose of vaccine.

Last reviewed: July 21, 2023

The CDC zoster subject matter experts recommend that in this situation you should wait 4 weeks before giving a repeat dose.

Last reviewed: December 28, 2022

No. Tdap is an inactivated vaccine and may be administered at the same time as Rhogam (in a separate site with a separate syringe).

Last reviewed: March 31, 2022

No. Just give the final dose of HepA vaccine prior to travel.

Last reviewed: June 25, 2023

Every year more healthcare facilities are adopting mandatory vaccination policies for their employees. Immunize.org has included more than 1,200 of these on its Honor Roll for Patient Safety, which gives special recognition to institutions that enforce mandatory vaccination for all personnel who are in the vicinity of a patient (including volunteers and housekeeping staff). To read more about the Honor Roll, or to apply for recognition, go to www.immunize.org/about/excellence/honor-rolls/influenza-vaccination/. In addition, the National Adult and Influenza Immunization Summit (NAIIS) has developed tools to assist post-acute and long-term care facilities that plan to implement influenza vaccination requirements for HCP at www.izsummitpartners.org/naiis-workgroups/influenza-workgroup/tools-for-ltcf/. We hope reviewing these policies and tools will give you the information you need to assist in developing an effective policy for your facility.

Last reviewed: August 11, 2024

No. Seasonal influenza vaccines are reformulated each year; for this reason, all unused seasonal influenza vaccines expire and should be discarded no later than the end of June each season. RSV products (vaccines and preventive antibody) do not change each season and products in your storage unit now may not expire until sometime during or after the next season.

Unless state or territorial public health authorities advise otherwise based upon local conditions, RSV vaccine should not be given during pregnancy after January. Likewise, nirsevimab (Beyfortus, Sanofi) should not be given to infants after March or before October unless specifically instructed by public health authorities.

Vaccination of eligible adults age 60 years or older will have the most benefit if RSV vaccine is administered in late summer or early fall, just before the typical RSV season. However, eligible adults may be vaccinated at any time of year if there is a need to vaccinate at other times of year. Vaccination is expected to provide meaningful protection from serious RSV disease for 2 years or longer. Only one dose of RSV vaccine is recommended: revaccination is not recommended.

Properly store and clearly label unexpired products remaining in your storage unit during periods when they are not in use and train staff on the timing of these products, especially for vaccination during pregnancy and use of nirsevimab. Consider storage and labeling that minimizes the risk of mishandling or administration outside the times when the product is recommended to be used.

Last reviewed: August 25, 2024

Your patient may choose to receive the vaccines at the same visit or separately, without regard to the timing interval. In general, when deciding whether to coadminister other vaccines with COVID-19 vaccine, you should consider whether the patient is behind or at risk of becoming behind on recommended vaccines, their risk of vaccine-preventable disease (e.g., during an outbreak or occupational exposures), and the reactogenicity profile of the vaccines.

When multiple vaccines are administered at a single visit, administer each injection in a different syringe and at a different injection site. For adolescents and adults, the deltoid muscle may be used for more than one injection, though injection sites should be at least one inch apart. It is generally preferable to administer reactogenic vaccines such as Shingrix and COVID-19 vaccine in different arms, if possible. If the patient prefers both injections in the same deltoid, that is also acceptable.

Immunize.org has developed a one-page guide to administering multiple intramuscular vaccinations to an adult at one visit: www.immunize.org/catg.d/p2030.pdf.

Last reviewed: August 31, 2024

Based on changes to the ACIP recommendations made in October 2024, a second dose of PPSV23 is no longer recommended for any adult. Adults age 19 through 49 years with immunocompromising conditions who received a dose of PCV15 followed by a dose of PPSV23 have received a complete pneumococcal vaccine schedule, and no further doses are recommended. If they received PCV13 and PPSV23, instead of PCV15, CDC recommends a dose of PCV20 or PCV21 should be given 5 years after the first dose of PPSV23, if the patient has have one of the following immunocompromising conditions: 

  • Kidney disease and on maintenance dialysis
  • Kidney disease with nephrotic syndrome
  • Asplenia or splenic dysfunction
  • Congenital or acquired immunodeficiency, including B-(humoral) or T-lymphocyte deficiency; complement deficiencies, particularly C1, C2, C3, and C4 deficiency; and phagocytic disorders (excluding chronic granulomatous disease)
  • Treatment with immunosuppressive drugs or radiation therapy (including treatment for Hodgkin disease, leukemias, lymphomas, malignant neoplasm, and solid organ transplant)
  • HIV infection
  • Sickle cell disease or other hemoglobinopathies
Last reviewed: November 13, 2024

Sexually transmitted infections, including hepatitis B, can be transmitted by sexual assault. Unless the victim has a documented history of completed HepB vaccination, a series of HepB alone (2 or 3 doses depending on brand) should be administered with the first dose as soon as possible after the assault. Administration of hepatitis B immune globulin (HBIG) is not necessary.

Last reviewed: July 21, 2023

Any Shingrix, either antigen or diluent, that is exposed to freezing temperature should not be used. If a dose exposed to freezing temperature is given to a patient the dose should be considered invalid and should be repeated 4 weeks after the invalid dose.

Last reviewed: March 9, 2022

Though vaccination is the most effective means of protecting your patients from influenza, there may be instances where employees are not vaccinated for medical or personal reasons. In these instances, you may want to consider reassigning unvaccinated workers to non-patient areas or requiring that they wear masks throughout the influenza season.

Last reviewed: August 11, 2024

Vaccine may lose potency rapidly if not stored according to the manufacturer’s instructions. However, it may still be permissible to use vaccine that has not been properly stored. Put the affected vaccine vials into the freezer after you have marked them so they are not confused with the unaffected vials, then call the manufacturer at 1-800-9-VARIVAX (1-800-982-7482) for further guidance about whether the vaccine is still usable. Unreconstituted varicella vaccine may be stored in the refrigerator for up to 72 hours before use. If refrigerated varicella vaccine is not used within 72 hours, it should be discarded.

If you have inadvertently left your vaccine at room temperature instead of in the freezer or have experienced a power failure, label the affected vaccine to keep it separated from unaffected vaccine and return it to recommended storage conditions in a freezer promptly, then contact the manufacturer for further guidance. Do not administer the vaccine until you have consulted with Merck.

Last reviewed: May 16, 2023

Any RZV, either antigen or diluent, that is exposed to freezing temperature should not be used. If a dose exposed to freezing temperature is given to a patient the dose should be considered invalid and should be repeated 4 weeks after the invalid dose.

Last reviewed: December 28, 2022

Children, age 7 years and older, and adults who have never received tetanus-containing vaccines, or whose vaccination history is unknown, should receive the 3-dose series. In this situation, ACIP recommends Tdap for dose #1, followed 4 weeks later by Td or Tdap for dose #2, followed at least 6 months later by Td or Tdap for dose #3. The amount of protection provided by one or more doses of Tdap in a person who has not previously received pertussis vaccine is not known. Following the primary series, booster doses of Td or Tdap should be given every 10 years thereafter.

Last reviewed: March 31, 2022

Possibly. Since IG protects against hepatitis A infection for only 1 to 2 months, depending on the dosage given, additional IG may be needed if the infant is not yet age 6 months. Once the child has reached six months of age, HepA vaccine should be given.

Last reviewed: June 25, 2023

No specific action needs to be taken other than to reassure the pregnant person that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is not a reason to terminate the pregnancy. You should consult with others in your healthcare setting to identify ways to prevent such vaccination errors in the future. Detailed information about MMR vaccination in pregnancy is included in the 2013 MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Last reviewed: June 19, 2023

They need a dose of PCV20 or PCV21, but not another dose of PPSV23. CDC recommends that people age 50 or older who received PCV13 and either one or two doses of PPSV23 before age 65 should receive a dose of PCV20 or PCV21 at least 5 years after the last pneumococcal vaccine dose. If they received PCV15 followed by PPSV23, they are not recommended to receive any additional pneumococcal vaccine doses at this time.  

A patient age 50 or older who received one or two doses of PPSV23 earlier in life but has not received any PCV product, or their history of PCV vaccination is only PCV7 or unknown, is recommended to receive a single dose of a currently recommended pneumococcal conjugate vaccine (PCV15, PCV20, or PCV21) at least one year after the last dose of PPSV23. 

Last reviewed: November 13, 2024

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