• The routinely recommended ages for measles, mumps, rubella, and varicella vaccination continue to be 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 measles, mumps, and rubella (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 over separate injections of its equivalent component vaccines (i.e., MMR vaccine and varicella vaccine).
   
• A personal or family (i.e., 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
http://www.cdc.gov/mmwr/pdf/rr/rr5903.pdf

In addition, CDC has issued a new VIS for MMRV, dated 5/21/10, which is available at http://www.immunize.org/vis and http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mmrv.pdf As with all other VISs, it should be given to the parent or vaccine recipient prior to vaccination to facilitate discussion about the vaccine between the patient and provider.


Q: Instead of giving tetanus/diphtheria toxoid and acellular pertussis (Tdap) vaccine to a father-to-be who needed protection against pertussis, we mistakenly gave him tetanus/diphtheria (Td) toxoid. How soon after the Td dose can we give him the dose of Tdap he needs?

A: As long as they are younger than age 65 years and at least age 10 years, parents, grandparents, healthcare workers, and all others who have not already received Tdap, and who are close contacts of infants younger than age 12 months, should receive a single dose of this vaccine as soon as possible to protect infants from pertussis. When giving Tdap to protect infants, one does not need to observe a "minimum interval" between giving Td and Tdap. For example, 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.


Q: Many children in my practice have received their complete series of 7-valent pneumococcal conjugate vaccine (PCV7). Would you please review the recommendations for which of them now need a supplemental dose of 13-valent pneumococcal conjugate vaccine (PCV13)?

A: A single supplemental dose of PCV13 is recommended for all children ages 14 through 59 months who have received the complete 4-dose series of PCV7 or another age-appropriate, complete PCV7 schedule. For children who have underlying medical conditions, a single supplemental PCV13 dose is recommended through age 71 months. This also includes children who have previously received pneumococcal polysaccharide vaccine (PPSV23). Give the single supplemental dose of PCV13 no sooner than 8 weeks after the last dose of PCV7 or PPSV23 was given.

IAC has created a table that explains how to use PCV13 to catch up children who have fallen behind on their PCV7 doses. It's available at http://www.immunize.org/catg.d/p2016.pdf


Q: I have a 13-year-old patient in my practice who recently had his spleen removed. He has been vaccinated with pneumococcal polysaccharide vaccine (PPSV23) but never received 7-valent pneumococcal conjugate vaccine (PCV7). Can I give him the new 13-valent pneumococcal conjugate vaccine, PCV13?

A: Yes. Administer a single dose of PCV13 to children ages 6 through 18 years who are at increased risk for invasive pneumococcal disease because of sickle cell disease, HIV infection or other immunocompromising condition, cochlear implant, functional or anatomical asplenia, or cerebrospinal fluid leak, even if they have previously received PCV7, PPSV23, or both vaccines. A table that details the underlying medical conditions that are indications for pneumococcal vaccination among children is available on page 260 of the related ACIP recommendations at http://www.cdc.gov/mmwr/PDF/wk/mm5909.pdf


Q: We mistakenly gave a patient the diluent for Menveo meningococcal conjugate vaccine (MCV4; Novartis) without adding it to the powdered vaccine. Since vaccine is present in the diluent as well as in the powder, what should we do now?

A: Menveo's liquid vaccine component (i.e., diluent) contains the C, Y, and W-135 serogroups, and the lyophilized vaccine component (i.e., freeze-dried powder) contains serogroup A. Because the patient received only the diluent, he or she is not protected against invasive meningococcal disease caused by Neisseria meningitidis serogroup A.

Invasive disease with N. meningitidis serogroup A is very rare in the United States, but is more common in some other countries, particularly the African meningitis belt. If the recipient (of the C-Y-W135 "diluent" only) does not plan to travel outside the United States then the dose does not need to be repeated. However, if the recipient plans to travel outside the United States the dose should be repeated with either correctly reconstituted Menveo, or with a dose of Menactra brand MCV4. There is no minimum interval between the incorrect dose and the repeat dose.


Q: We now have two meningococcal conjugate vaccines (MCV4) to chose from--Menactra (sanofi pasteur) and Menveo (Novartis). It would be useful to know if they are interchangeable when repeat doses of MCV4 are needed.

A: Although both vaccines are licensed for single-dose use, you can use either vaccine to revaccinate people ages 11 through 55 years who are at prolonged increased risk for meningococcal disease. Only Menactra is licensed for vaccinating and revaccinating children ages 2 through 10 years. Use only meningococcal polysaccharide vaccine (MPSV4; Menomune; sanofi pasteur) when vaccinating or revaccinating people age 56 years and older.

To access updated recommendations for revaccinating people at prolonged increased risk for meningococcal disease, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5837.pdf, and see pages 1042-43.


Q: What is the FDA's current recommendation about the use of rotavirus vaccine in infants?

A: In March 2010, FDA recommended temporary suspension of the use of Rotarix (GSK) after researchers found DNA from porcine circovirus type 1 (PCV1) in the vaccine. In May, Merck confirmed the presence of DNA from PCV1 and PCV2 in its rotavirus vaccine, RotaTeq.

On May 14, FDA updated its recommendations on both Rotarix and RotaTeq vaccines for the prevention of rotavirus disease in infants. Based on careful evaluation of a variety of scientific information, FDA has determined it is appropriate for clinicians and health care professionals to resume the use of Rotarix and to continue the use of RotaTeq. All available evidence supports the safety and effectiveness of Rotarix and RotaTeq, which have been extensively studied, both before and after approval. For more detailed information, go to:
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm205539.htm