Single antigen vaccine is no longer available in the U.S.; the student should get the combined MMR vaccine. If a college student or other person at increased risk of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive two doses of MMR.
Last reviewed:
June 19, 2023
Yes. Pfizer’s RSV vaccine (Abrysvo) may be administered from 32 weeks through 36 weeks and 6 days’ gestation. RSV vaccine should not be administered to someone at 37 weeks’ gestation or beyond.
RSV vaccine should be administered at least 2 weeks before delivery to allow time for the maternal immune system to create antibodies and transfer sufficient antibodies to the fetus for adequate protection after birth. If the gestational age is appropriate, but clinical judgment is that delivery is likely to occur within 2 weeks, it is reasonable to defer vaccination and plan to administer nirsevimab RSV preventive antibody to the infant after delivery. Infants born less than 14 days after maternal RSV vaccination are recommended to receive nirsevimab RSV preventive antibody after birth to ensure adequate protection.
Last reviewed:
January 22, 2024
Protection from influenza vaccine wanes over time post-vaccination (the speed of waning varying by strain and by recipient age) but generally persists for at least 5–6 months.
Last reviewed:
September 10, 2023
For all ages, when the HepB schedule is interrupted, the vaccine series does not need to be restarted. If the Heplisav-B series is interrupted, the second (final) dose should be given as soon as possible. For Engerix-B, Recombivax HB, and PreHevbrio, if the series is interrupted after the first dose, the second dose should be administered as soon as possible, and the second and third doses should be separated by at least 8 weeks. If only the third dose has been delayed, it should be administered as soon as possible.
Last reviewed:
July 21, 2023
Although aspiration is not recommended, if you do aspirate and get a flash of blood, then the procedure is to withdraw the needle and start over. The syringe, needle, and contaminated dose of vaccine should be discarded in a sharps container, and a new syringe and needle should be used to draw up and administer another dose of vaccine. This is a waste of expensive vaccine that could be avoided by simply not aspirating.
Last reviewed:
December 28, 2022
ACIP and CDC do not recommend revaccination with 9vHPV of people who have completed a recommended series of another HPV vaccine given at appropriate dosing intervals.
Last reviewed:
March 2, 2024
Having an immunocompromised household contact is not usually a reason for delaying routine vaccination for others in the household. Rotavirus vaccine should be administered to susceptible household contacts and other close contacts of immunocompromised patients when indicated. All members of the household should wash their hands after changing the diaper of an infant. This minimizes rotavirus transmission from an infant who received rotavirus vaccine. Additional information on this topic can be found in the ACIP “General Best Practice Guidelines for Immunization”, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html.
Last reviewed:
June 7, 2023
All Hib-containing vaccines should be administered by the intramuscular route.
Last reviewed:
July 31, 2022
The effectiveness of Novavax COVID-19 Vaccine against currently circulating variants of SARS-CoV-2 is not precisely known. Clinical trials of this vaccine were conducted against earlier variants no longer in circulation; however, the vaccine showed very good effectiveness against moderate to severe disease during clinical trials. Testing conducted on antibodies in the serum of Novavax vaccine recipients suggests that vaccination provides substantial protection against severe disease and death caused by currently circulating variants, consistent with other available COVID-19 vaccines.
Last reviewed:
March 19, 2024
The recommended interval is 6 calendar months between each dose, and the minimum interval is 5 calendar months between each dose. In accordance with CDC’s general best practice guidelines, a dose administered up to 4 days before the minimum interval may be counted as valid. If a dose is given too early, the recommendation is to repeat the dose at the minimum interval of 5 months.
Last reviewed:
February 16, 2022
The only way to determine whether the rash is caused by wild-type varicella or vaccine virus is to try to isolate virus from the rash and send it to a laboratory that is capable of differentiating wild and vaccine-type virus. This is generally not practical. Given the history, the conservative approach is to assume she has an active case of chickenpox and act according to your infection control guidelines.
Last reviewed:
May 16, 2023
If the DTaP brand used for previous doses is not known or not in stock, use whatever DTaP vaccine you have available for all subsequent doses.
Last reviewed:
March 31, 2022
Fever after vaccination was more common, reported in almost half of infants, compared to about one-third of infants who received Pentacel (DTaP-IPV/Hib). However, the rates of fever-related medical visits or febrile seizures were similar in both groups.
Last reviewed:
July 15, 2023
No. Vaccines available in the United States do not contain peanut products.
Last reviewed:
August 29, 2022
There is no waiting period in such a situation. Shingles is not caused by exposure to another person with shingles. Shingles is caused by the reactivation of varicella zoster virus (VZV) in people who have had a prior VZV infection or varicella vaccination. However, exposure to someone with shingles can possibly cause chickenpox in a person with no immunity to varicella zoster virus (VZV) from either vaccination or prior chickenpox infection.
Last reviewed:
March 9, 2022
This is a complex question that requires case-by-case review. First, while you’re assessing the situation, return the vaccine to proper storage temperatures and mark it “Do Not Use.” Then, contact your state or local immunization program or the appropriate vaccine manufacturer(s) to discuss the potential usability of the vaccine. They will need to consider several variables related to vaccine storage conditions. For example, their guidance will be affected by the type and accuracy of the temperature monitoring device, whether the temperature probe was in a liquid or was reading the temperature of the air, the type of vaccine involved, the length of time of the excursion, etc.
In general, if it can be reliably determined that the vaccine in question was not stored below 32°F and the manufacturer’s stability data concurs, most immunization programs and vaccine manufacturers would not recommend wasting the vaccine or revaccinating recipients.
Last reviewed:
July 26, 2023
For people who are age 2 years or older, a 2-dose series of MenACWY, spaced 8–12 weeks apart, is recommended if they have functional or anatomic asplenia, HIV infection, persistent complement component deficiency (an immune disorder including C3, C5–C9, properdin, factor H, and factor D deficiency), or if they take a complement inhibitor (for example, eculizumab [Soliris] or ravulizumab [Ultomiris]). People with these high-risk medical conditions also need booster doses of MenACWY.
Last reviewed:
March 24, 2024
Last reviewed:
March 2, 2024
Many pregnant people will have a choice about whether to get Abrysvo during pregnancy or to give nirsevimab to their infant after birth. Those who are between 32 and 36 weeks 6 days’ gestation between September and January, may be vaccinated with Abrysvo or have their infant receive nirsevimab soon after birth (preferably within the first week of life if born during a month when nirsevimab administration is recommended).
It is important to note that both Abrysvo RSV vaccine and nirsevimab products may not be available to all people in all settings. In some facilities or circumstances, only one option might be available: those offered Abrysvo during pregnancy may not wish to defer that option unless they are confident that nirsevimab will be available for their infant. All infants up to 8 months 0 days of age whose mothers were not vaccinated may be given nirsevimab when feasible, before or during their first RSV season.
Last reviewed:
January 22, 2024
Selective IgA deficiency is a B-cell immunodeficiency, so additional pneumococcal vaccination beyond the routine age-based schedule is indicated for this 3-year-old with an immunocompromising condition. Because the child received a complete PCV13 series, the current recommendation is to administer a single dose of PCV20 or PPSV23 at least 8 weeks following the most recent PCV dose. If PCV20 is given, no further doses of pneumococcal vaccine are recommended. If PPSV23 is given now, then at least 5 years later give a dose of PCV20 or a second dose of PPSV23.
Last reviewed:
April 5, 2024
The minimum interval between the two doses of Heplisav-B is 4 weeks. For the 3-dose series vaccines, Engerix-B, PreHevbrio, and Recombivax HB, the minimum interval between the first and second doses is 4 weeks. The final dose of vaccine must be administered at least 8 weeks after the second dose and should follow the first dose by at least 16 weeks. Vaccine doses administered 4 or fewer days before the minimum interval or age are considered valid. Doses received 5 or more days before the minimum interval or age should be repeated using the correct schedule. Because of the unique accelerated schedule for Twinrix, the 4-day “grace period” does not apply to the first three doses of this vaccine when administered on a 0-, 7-, 21–30-day, and 12-month schedule.
Last reviewed:
July 21, 2023
There are several reasons why this misconception persists:
- Fewer than 1% of people who are vaccinated with the injectable vaccine develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having influenza, but people confuse the symptoms.
- Protective immunity doesn’t develop until 1–2 weeks after vaccination. Some people who get vaccinated later in the season (December or later) may be infected with influenza virus shortly afterward. These late vaccinees develop influenza because they were exposed to someone with the virus before they became immune. It is not the result of the vaccination.
- For many people, “the flu” is any illness with fever, cold symptoms or gastrointestinal symptoms. If they get any viral illness, they may blame it on flu vaccine or think they got “the flu” despite being vaccinated. Influenza vaccine only protects against certain influenza viruses, not all viruses.
- Influenza vaccination is our best protection against influenza disease; however, some people who are vaccinated will still get influenza illness despite vaccination.
While vaccine effectiveness (VE) can vary, recent studies show that influenza vaccination reduces the risk of illness by between 40% and 60% among the overall population during seasons when most circulating influenza viruses are well-matched to the vaccine. VE is generally lower for adults age 65 years and older. Influenza vaccination has also been shown to reduce influenza disease severity even if someone does get sick after vaccination, and reduces the risk of influenza hospitalization, and deaths in children and adults. Influenza vaccination also reduces the risk of acute cardiac events, like heart attack and heart failure, among people with heart disease.
For more information on this topic, go to: www.cdc.gov/flu/vaccines-work/index.html.
Last reviewed:
September 10, 2023
In general, no. Occupational Safety and Health Administration (OSHA) regulations do not require the wearing of gloves when administering vaccinations, unless the person administering the vaccine is likely to come into contact with potentially infectious body fluids or has an open lesion on their hand. If a healthcare worker chooses to wear gloves, he or she must change them between each patient encounter.
In 2020, in response to the COVID-19 pandemic, CDC temporarily recommended the use of gloves when administering oral and intranasal vaccines to patients in communities where SARS-CoV-2, the virus that causes COVID-19, is circulating. Gloves were recommended to prevent contact with the recipient’s potentially infectious mucous membranes or respiratory secretions. In the setting of widely available and effective COVID-19 vaccines and treatments, CDC resumed recommending standard pre-pandemic infection control practices during vaccination.
Last reviewed:
December 28, 2022
Either Trumenba (MenB-FHbp) or the Bexsero MenB vaccine brand (MenB-4C) may be used for people with HIV infection. If Trumenba is administered, the CDC meningococcal subject matter experts recommend that the 3-dose schedule should be used. 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, and the 3-dose schedule is preferred. When Bexsero is used, the schedule is 2 doses, regardless of risk status. Booster doses of MenB are not recommended for people with HIV in the absence of another indication for MenB vaccination.
Penbraya (MenABCWY, Pfizer) is an option for people age 10 years and older only when both MenACWY and MenB (Trumenba) vaccines are due at the same visit and at least 6 months have elapsed since the most recent dose of Penbraya. An adolescent with HIV should receive a 2-dose primary MenACWY series (with the doses given 8 weeks apart), followed by MenACWY booster doses every 5 years. If this teen needs the MenACWY primary series vaccination and also chooses to receive the 3-dose Trumenba schedule (0, 1-2 months, 6 months), Penbraya may only be used for one of the doses because dose 2 in the MenACWY primary series and dose 2 of the Trumenba 3-dose primary series are both due only 8 weeks after dose 1.
Last reviewed:
March 24, 2024
In the RotaTeq clinical trials in the first week after any dose vaccine recipients had a small but statistically significant increased rate of diarrhea (18.1% in the RotaTeq group, 15.3% in the placebo group) and vomiting (11.6% in the RotaTeq group, 9.9% in the placebo group). During the 42-day period following any dose, statistically significantly greater rates of diarrhea, vomiting, otitis media, nasopharyngitis and bronchospasm occurred in RotaTeq recipients compared with placebo recipients.
In the Rotarix clinical trials, in the first week after vaccination, Grade 3 (i.e., those that prevented normal everyday activities) cough or runny nose occurred at a slightly but statistically higher rate in the Rotarix group (3.6 %) compared with placebo group (3.2%). During the 31-day period after vaccination, these unsolicited adverse events occurred at a statistically higher incidence among vaccine recipients: irritability (11.4% in Rotarix group, 8.7% in placebo group) and flatulence (2.2% in Rotarix group, 1.3% in placebo group).
In clinical trials of both vaccines the occurrence of intussusception was studied very carefully; see the separate question and answer on this topic.
Last reviewed:
June 7, 2023
Not necessarily. Providers do not need to discard their existing printed VIS stocks when nothing but the VIS format has been changed. CDC posts information on its website to alert healthcare providers when the older version of a VIS should not be used. This information is available on CDC’s web section titled “What’s New with VISs”, available at www.cdc.gov/vaccines/hcp/vis/what-is-new.html.
Last reviewed:
June 6, 2023
- [added] All children ages 2 through 18 years not previously vaccinated
- [added] All people age 1 year or older living with HIV infection
- [added] People identified to be at risk for HAV infection during pregnancy
- [removed] People with clotting factor disorders
Last reviewed:
June 25, 2023
There is currently no information on the effect of varicella vaccine on reactivity to a tuberculin skin test (TST). Until information is available, it is prudent to apply the same rules to varicella vaccine as are applied to MMR: a TST (i.e., PPD) may be applied before (preferably) or simultaneously with varicella vaccine. If vaccine has been given, delay the TST for at least 4 weeks.
Last reviewed:
May 16, 2023
If Tdap was inadvertently administered to a child under age 7 years, it should not be counted as either the first, second, or third dose of DTaP. The dose should be repeated with DTaP. Continue vaccinating on schedule. If the dose of Tdap was administered for the fourth or fifth DTaP dose, the Tdap dose can be counted as valid. Please remind your staff to always check the vaccine vial at least 3 times before administering any vaccine.
Last reviewed:
March 31, 2022
Yes. Allergy to bee venom is not a contraindication for any vaccine.
Last reviewed:
August 29, 2022
ACIP recommends vaccination with Shingrix for adults age 19 years or older who are immunodeficient or immunosuppressed due to disease or therapy. Repeated shingles episodes are often associated with immunocompromise. If your patient’s recurrent shingles episodes are evaluated and clinically concluded to be the result of immunodeficiency or immunosuppression, he should be vaccinated with a two-dose series of Shingrix.
Last reviewed:
March 9, 2022
No. Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should only accept a written, dated record as evidence of vaccination.
Last reviewed:
June 19, 2023
Dengvaxia is administered as a 3-dose series, spaced 6 months apart (0, 6, and 12 months). Each dose is 0.5 mL in volume, administered subcutaneously. The vaccine comes in powder form (lyophilized) in single dose vials. Each lyophilized vaccine vial should be mixed with the supplied diluent, a vial of saline diluent (0.4% NaCl). To reconstitute Dengvaxia, withdraw 0.6 ml from the diluent vial and inject it into the lyophilized vaccine vial. Swirl the vial gently. After reconstitution, the suspension is colorless and may develop trace amounts of white to translucent particles.
After reconstitution, 0.5 mL of Dengvaxia should be withdrawn and immediately administered subcutaneously. If not used immediately, the reconstituted vaccine should be refrigerated at 36°F–46°F (2°C–8°C) and used within 30 minutes. Do not use the vaccine more than 30 minutes after reconstitution.
Dengvaxia is for subcutaneous use only. Dengvaxia should not be administered by intramuscular injection; however, if administered intramuscularly in error, the dose does not need to be repeated.
CDC has a web page dedicated to the storage and reconstitution of Dengvaxia: https://www.cdc.gov/dengue/hcp/vaccine/storage-handling.html.
Last reviewed:
February 16, 2022
No. No additional doses of pneumococcal vaccine are recommended.
Last reviewed:
April 5, 2024
Do not restart the series or give additional doses. The previously administered doses of PCV13 are valid. Complete the pneumococcal conjugate vaccination series with either PCV15 or PCV20 in accordance with the routine schedule.
Last reviewed:
April 5, 2024
CDC began adding barcodes to VISs in 2012. The barcode is intended to save time and prevent documentation errors by allowing immunization providers to scan the name and edition date of the VIS, information required to be documented in the permanent record of immunization, into an electronic medical record, immunization information system, or other electronic database. Scanning the barcode instead of manually recording the information is optional but can be helpful.
Using 2D barcodes requires a 2D barcode scanner and software that is programmed to accept and process data contained in the VIS barcodes. Providers may continue to use any VISs without barcodes as long as the VIS content is otherwise the same. For more information about using barcodes, visit www.cdc.gov/vaccines/hcp/vis/barcodes.html.
Last reviewed:
June 6, 2023
If administered vaccine is found to be stored at an inappropriate temperature, whether too cold or too warm, the provider should contact the state health department to determine whether the vaccine dose is invalid. If the vaccine dose is determined to be invalid, another dose should be given. This applies to both inactivated and live vaccines. If the damaged vaccine was a live virus vaccine (e.g., MMR, MMRV, VAR), you should wait at least 4 weeks after the previous (damaged) dose was given before repeating it. If the damaged vaccine was an inactivated vaccine, you can give the repeat dose on the same day you gave the damaged dose or at any other time, with one exception. The exception is Shingrix (herpes zoster vaccine), which should be repeated at least 28 days later due to the potential for increased side effects due to the chemical adjuvant it contains to enhance its effectiveness. If you prefer, you can perform serologic testing to check for immunity for certain vaccinations (e.g., measles, rubella, hepatitis A, diphtheria, varicella, and tetanus).
Last reviewed:
July 26, 2023
Use of either brand of MenB in persons younger than age 10 years is off-label in the U.S. There is no ACIP recommendation for use of this vaccine for this age group.
Bexsero (MenB-4C) has been studied among infants and is approved for infants by the European Medicines Agency (the European version of the U.S. Food and Drug Administration). It is routinely recommended for infants in the United Kingdom (see www.nhs.uk/conditions/vaccinations/pages/meningitis-b-vaccine.aspx for details). A clinician may choose to use a vaccine off-label if, in their opinion, the benefit of the vaccine exceeds the risk from the vaccine.
Last reviewed:
March 24, 2024
Two pneumococcal conjugate vaccines (PCV15 and PCV20) are recommended as pneumococcal vaccination options for all adults age 65 and older and for adults age 19 through 64 with certain medical conditions or other risk factors for pneumococcal disease; ACIP no longer recommends PCV13 for adults; however, in rare circumstances when only PCV13 is accessible and the patient would otherwise be unvaccinated, CDC states that PCV13 may be used. When PCV15 is used routinely, it should be used in series with PPSV23 given one year later.
For adults eligible for pneumococcal vaccine as a result of age or a high-risk condition who have no or unknown history of pneumococcal conjugate vaccination, the same vaccination schedule options apply to all of them: either give one dose of PCV20 alone, or give a dose of PCV15 followed by a dose of PPSV23 one year later (with a minimum interval option of 8 weeks for people with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak). People age 19 through 64 with immunocompromising and non-immunocompromising underlying medical conditions and other risk factors for pneumococcal disease no longer have different recommendations.
Details of the recommendations can be found in the ACIP recommendations at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7104a1-H.pdf. These recommendations are to be used in conjunction with CDC clinical considerations for the use of pneumococcal vaccines at: www.cdc.gov/vaccines/vpd/pneumo/hcp/recommendations.html.
Immunize.org has developed standing orders for pneumococcal vaccination of adults at www.immunize.org/catg.d/p3075.pdf.
Last reviewed:
April 5, 2024
The third dose of Vaxelis vaccine administered at age 5 months (less than 24 weeks of age) is not considered a valid dose of the HepB component, because the last dose of HepB vaccine should be given at 24 weeks of age or older. The child will need an additional dose of HepB vaccine at age 24 weeks or older, and at least 4 weeks after the inadvertent dose of Vaxelis. The DTaP and IPV components of the Vaxelis dose erroneously administered at age 5 months are considered valid doses and do not need to be repeated, as long as there was a minimum 4-week interval between the second and third doses of either component.
Last reviewed:
July 31, 2022
Giving patients an influenza Vaccine Information Statement (VIS) is mandatory under the National Childhood Vaccine Injury Act of 1986. The VIS must be given to all adults as well as to parents or guardians of children prior to vaccination. Two VISs are available, one for live attenuated influenza vaccine (LAIV) and one for inactivated influenza vaccine (IIV) and recombinant vaccine (RIV). Each can be found at www.immunize.org/vis/ in multiple languages. The current influenza vaccine VISs are dated August 6, 2021.
The latest VIS for all vaccines plus translations in multiple languages are located on the Immunize.org website www.immunize.org/vis/.
Last reviewed:
September 10, 2023
Yes. VFC-eligible pregnant adolescents younger than age 19 may receive VFC-funded Abrysvo during pregnancy, if indicated, in VFC-participating facilities. Contact your state immunization program with questions about VFC and Abrysvo.
Last reviewed:
January 22, 2024
ACIP does not specifically recommend eye protection when administering vaccines to prevent exposure to blood spatter.
In 2020, in response to the COVID-19 pandemic, CDC temporarily recommended the use of protective eyewear in areas where SARS-CoV-2 was circulating widely to reduce the risk of infection with SARS-CoV-2. In the setting of widely available and effective COVID-19 vaccines and treatments, CDC resumed recommending standard pre-pandemic infection control practices during vaccination.
Last reviewed:
December 28, 2022
Yes. Vaccinated women still need to see their healthcare provider for periodic cervical cancer screening. The vaccine does not provide protection against all types of HPV that cause cervical cancer, so even vaccinated women will still be at a small risk for some cancers from HPV.
Last reviewed:
March 2, 2024
All children age 6 months and older should be vaccinated against COVID-19 with at least one dose of an updated (2023–2024) formulation vaccine. COVID-19 vaccination of children in this age group has been demonstrated to be safe and to prevent hospitalization and severe complications of COVID-19 illness. Both Pfizer-BioNTech and Moderna mRNA products are authorized for use in children down to 6 months of age. Novavax adjuvanted protein subunit vaccine is authorized for use beginning at age 12 years.
Most children younger than age 5 years initially require a primary series of two (Moderna) or three (Pfizer-BioNTech) doses of the same brand. The primary series may include doses of previously authorized formulations. CDC recommends use of the same brand (referred to as homologous doses) for all recommended doses given to children younger than age 5 years. If it is not possible to administer a homologous dose (the brand is unavailable at the time and location of the vaccination visit, the brand of a previous dose is unknown, the child would not be vaccinated with the homologous dose due to a contraindication or other reason), then administer the age-appropriate formulation of the available brand. A 3-dose primary series is required for all children and adults who have moderate or severe immunocompromise.
CDC has prepared infographics to make it easier to determine exactly what vaccination is due for each patient, based upon the patient’s age, vaccination history, and immunocompromised status. For most children younger than age 12 years, see this CDC infographic: www.cdc.gov/vaccines/covid-19/downloads/COVID19-vaccination-recommendations-most-people.pdf.
For children younger than 12 years who are moderately or severely immunocompromised, see this CDC infographic: www.cdc.gov/vaccines/covid-19/downloads/COVID19-vaccination-recommendations-immunocompromised.pdf.
Last reviewed:
March 19, 2024
ACIP recommends meningococcal vaccination only for high-risk children younger than 11 years. ACIP defines high-risk children age 2 months and older as (1) those with persistent complement component deficiency (an immune system disorder) or who take a complement inhibitor (examples include eculizumab [Soliris] and ravulizumab [Ultomiris]), (2) those with functional or anatomic asplenia, (3) those with HIV infection, (4) those traveling to or residing in an area of the world where meningococcal disease is hyperendemic or epidemic or (5) those identified by public health officials as being at risk during a community outbreak attributable to a vaccine serogroup.
Menveo (MenACWY-CRM), in its two-vial formulation requiring reconstitution, is approved for children age 2 months and older; the one-vial formulation that does not require reconstitution may be administered to children age 10 years or older. MenQuadfi (MenACWY-TT) is approved for children age 2 years and older. Children at increased risk for meningococcal disease should receive booster doses as long as they remain at increased risk.
Last reviewed:
March 24, 2024
Large pre-licensure clinical trials of both RotaTeq and Rotarix did not find an increased risk for intussusception among vaccine recipients. A large post-licensure study of more than 1.2 million rotavirus vaccine recipients found a very small increased risk of intussusception (1 to 1.5 additional cases of intussusception per 100,000 vaccinated infants) in the 7 to 21 days following the first dose. No increased risk of intussusception was found after the second or third doses. CDC and the Food and Drug Administration (FDA) continue to believe that the benefits of rotavirus vaccination outweigh the risks associated with vaccination and that routine vaccination of infants should continue.
A study conducted by the CDC Vaccine Safety Datalink (VSD) between May 2006 to February 2010 found no increased risk of intussusception following vaccination with RotaTeq. However, the study indicated an increased risk of intussusception following dose 1 and dose 2 of Rotarix. CDC estimates that there is a small increased risk of intussusception, usually within the first week after dose 1 or dose 2 of rotavirus vaccine, resulting in one additional case for every 20,000 to 100,000 U.S. infants who receive the vaccine.
Last reviewed:
June 7, 2023
No, the dose should not be repeated. In accordance with CDC’s “General Best Practice Guidelines for Immunization”, the immune response to vaccines recommended to be administered by the subcutaneous route is unlikely to be affected if the vaccines are inadvertently administered by the intramuscular route. For this reason, repeating doses of vaccine administered by the intramuscular route when recommended by the subcutaneous route is not necessary (www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html).
Last reviewed:
February 16, 2022
Yes. In this situation, a second dose of Tdap should be administered at the recommended age of 11 or 12 years.
Last reviewed:
March 31, 2022
What you do depends on when the error is identified. If the error is discovered while the person is still in the office, you can administer the other “half” of the Engerix-B dose. If the error is discovered later, the dose should not be counted. The person should be recalled to the office and given a full age-appropriate 1.0 mL repeat dose. The same recommendation would apply if the error was with Recombivax HB.
Last reviewed:
July 21, 2023
Yes, unless the person is allergic to any of the vaccine components. HepA vaccination is safe and effective and is recommended for any person who wishes to obtain immunity.
Last reviewed:
June 25, 2023
In 2008, FDA licensed Kinrix, a combination DTaP and IPV vaccine. It is approved for use as the fifth dose of DTaP and the fourth dose of IPV in children ages 4 through 6 years who received DTaP (Infanrix) and/or DTaP-HepB-IPV (Pediarix) as the first three doses and DTaP (Infanrix) as the fourth dose. It should not be given to children younger than age 4 years.
Last reviewed:
July 15, 2023
Latex is a product of the rubber tree. It is processed and used in various products, including some that come in contact with vaccines. Latex may be present in syringe plungers, vial stoppers, or in the tip caps on prefilled syringes. Some people develop sensitivity to latex, particularly if they have had significant cumulative latex exposure, such as from repeated surgeries early in life or employment in the healthcare industry.
The most common type of latex sensitivity is contact-type allergy; however, on rare occasions, severe (anaphylactic) allergy occurs. People with a history of anaphylactic reactions to latex should generally not be given vaccines that have been in contact with natural rubber or latex, either in the vial or in the syringe, unless the benefit of vaccination outweighs the risk of a potential allergic reaction. People with latex allergies that are not anaphylactic in nature may be vaccinated as usual.
Last reviewed:
August 29, 2022
The Advisory Committee on Immunization Practice (ACIP) does not recommend zoster vaccination for immunocompetent people younger than age 50 years regardless of their history of shingles.
Last reviewed:
March 9, 2022
Adults without evidence of immunity and no contraindications to MMR vaccine can be vaccinated without testing. Only adults without evidence of immunity might be considered for testing for measles-specific IgG antibody, but testing is not needed prior to vaccination.
CDC does not recommend measles antibody testing after MMR vaccination to verify the patient’s immune response to vaccination.
Two documented doses of MMR vaccine given on or after the first birthday and separated by at least 28 days is considered proof of measles immunity, according to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.
Last reviewed:
June 19, 2023
Even with appropriate equipment and temperature monitoring practices in place, power disruption can result in destruction of the entire vaccine supply. Precautions should always be taken to protect the storage unit’s power supply. CDC recommends the following best practices.
- Plug in only one storage unit per electrical outlet to avoid creating a fire hazard or triggering a safety switch that turns the power off.
- Use a safety-lock plug or an outlet cover to prevent the unit from being unplugged.
- Post “DO NOT UNPLUG” warning signs at outlets and on storage units to alert staff, custodians, electricians, and other workers not to unplug units. A sign is available from Immunize.org at www.immunize.org/catg.d/p2090.pdf.
- Label fuses and circuit breakers to alert people not to turn off power to a storage unit. A label is available from Immunize.org at www.immunize.org/catg.d/p2091.pdf.
- Use caution when using power outlets that can be tripped or switched off and avoid using:
- Built-in circuit switches (may have reset buttons)
- Outlets that can be activated by a wall switch
- Multi-outlet power strips.
Include this information as well as what to do if a vaccine storage temperature excursion occurs in your facility’s emergency Standing Operating Procedures.
Last reviewed:
July 26, 2023
Quadracel (Sanofi) is a combination DTaP and IPV vaccine. It was approved by the FDA in 2015 for use in children 4 through 6 years of age as the fifth dose in the DTaP series, and as the fourth or fifth dose in the IPV series in children who have received 4 doses of Pentacel (DTaP-IPV-Hib, Sanofi) and/or Daptacel (DTaP, Sanofi) vaccine. It should not be given to children younger than age 4 years. CDC published a short MMWR article about Quadracel on September 4, 2015 (www.cdc.gov/mmwr/pdf/wk/mm6434.pdf, pages 948–9).
Last reviewed:
July 15, 2023
CDC publishes VISs in English only; all translations have been developed by others. To access all currently available VISs in dozens of languages, go to Immunize.org’s website at www.immunize.org/vis.
Last reviewed:
June 6, 2023
Not all stoppers in vaccine vials contain latex. Some manufacturers have switched to synthetic rubber-like materials that do not contain rubber latex or dry natural rubber. The best approach is to check the package insert, which will indicate if the packaging contains latex. Also, remember that prefilled syringes could contain natural rubber in the plunger, in the needle cover, or in the tip cap. This information is also supplied in the package insert.
Last reviewed:
August 29, 2022
ACIP recommends that microbiologists who work with meningococcal isolates in a laboratory receive both MenB and MenACWY vaccines. MenB can be given at the same time as any other vaccine. You can administer either two doses of Bexsero (MenB-4C) 4 weeks apart, or three doses of Trumenba (MenB-FHbp) on a 0-, 1–2-, and 6-month schedule.
Because protective antibody levels begin to wane within 1–2 years after completing the primary series, ACIP recommends a booster dose of MenB one year after completing the primary series, followed by a booster dose every 2–3 years thereafter, as long as risk remains. MenB vaccine brands work differently and are not interchangeable. All doses, including booster doses, should be of the same type (either MenB-FHbp or MenB-4C). If the primary series type is not known or is not available, restart the primary series with the available brand.
Microbiologists may receive a dose of MenABCWY (Penbraya, Pfizer) as an alternative to separate administration of MenACWY and MenB (MenB-FHbp, Trumenba) when both vaccines would be given on the same clinic day and at least 6 months have elapsed since most recent Penbraya dose.
Last reviewed:
March 24, 2024
Any temperature reading outside the recommended range for vaccine storage is a temperature excursion. However, it is generally the total amount of time, or cumulative time, out of range that affects the viability of vaccine. Any time appropriate vaccine storage temperatures are in question, stop giving vaccinations and contact your state immunization program and/or the vaccine manufacturer for further guidance about whether or not a vaccine may be used. The CDC Storage and Handling Toolkit contains detailed guidance on the management of a temperature excursion. See www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf, pages 12–15. Additional information for COVID-19 and mpox vaccine temperature excursions is available in the addendum at the end of the toolkit.
Last reviewed:
July 26, 2023
Yes. HPV vaccine is recommended for all people through age 26 years, regardless of sexual orientation or gender identity.
Last reviewed:
March 2, 2024
All people age 19 through 64 with the following medical conditions who have no history of pneumococcal vaccination or an unknown pneumococcal vaccination history should receive either a single dose of PCV20 alone or a dose of PCV15 followed by a dose of PPSV23 at least 1 year later. If using the PCV15 + PPSV23 series, clinicians can consider giving the dose of PPSV23 a minimum of 8 weeks later for more rapid protection against the serotypes unique to PPSV23 to people with immunocompromising condition, cochlear implant, or cerebrospinal fluid (CSF) leak. The conditions are:
- Alcoholism or cigarette smoking
- CSF leak
- Chronic heart disease, including congestive heart failure and cardiomyopathies, excluding hypertension
- Chronic liver disease
- Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
- Cochlear implant (including those preparing for cochlear implant)
- Diabetes mellitus
- Decreased immune function from disease or drugs (immunocompromising conditions), including:
- Chronic renal failure or nephrotic syndrome
- Congenital or acquired 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)
- Diseases or conditions treated with immunosuppressive drugs or radiation therapy, including Hodgkin disease, leukemias, lymphomas, malignant neoplasms, and solid organ transplant
- HIV infection
For details of vaccination following hematopoietic stem cell transplantation, see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html
Public health authorities working with Alaska Natives and American Indians may provide additional guidance for individuals in those communities where the overall risk of invasive pneumococcal disease is increased.
Last reviewed:
April 5, 2024
