IAC Express: Extra Edition - Q&As About Common Vaccination Misconceptions

[Guest guest]

IAC Express: Extra Edition

Immunization news from the Immunization Action Coalition

More than 42,000 subscribers read IAC Express.

Subscribe to IAC Express and our other free publications at

http://www.immunize.org/subscribe

A web page version of this issue is available at

http://www.immunize.org/express/issue922.asp

New! Laminated child/teen and adult CDC Immunization

Schedules. Great for exam rooms. Order at

http://www.immunize.org/shop

===========================================================

Issue Number 922

April 6, 2011

CONTENTS OF THIS ISSUE

1. Read " Ask the Experts " Q & As about common vaccination

misconceptions

-----------------------------------------------------------

ABBREVIATIONS: AAFP, American Academy of Family Physicians;

AAP, American Academy of Pediatrics; ACIP, Advisory

Committee on Immunization Practices; AMA, American Medical

Association; CDC, Centers for Disease Control and

Prevention; FDA, Food and Drug Administration; IAC,

Immunization Action Coalition; MMWR, Morbidity and Mortality

Weekly Report; NCIRD, National Center for Immunization and

Respiratory Diseases; NIVS, National Influenza Vaccine

Summit; VIS, Vaccine Information Statement; VPD, vaccine-

preventable disease; WHO, World Health Organization.

-----------------------------------------------------------

(1 of 1)

April 6, 2011

READ " ASK THE EXPERTS " Q & As ABOUT COMMON VACCINATION

MISCONCEPTIONS

Many readers of Needle Tips and Vaccinate Adults

consistently rank " Ask the Experts " as their favorite

feature in these publications. As a thank-you to our loyal

IAC Express readers, we periodically publish Extra Editions

with " Ask the Experts " Q & As answered by CDC experts.

IAC thanks L. Atkinson, MD, MPH, and T.

Kroger, MD, MPH, medical epidemiologists at the National

Center for Immunization and Respiratory Diseases, CDC, for

agreeing to answer the following questions.

All the Q & As in this edition of IAC Express deal with

misconceptions about vaccination that too frequently get in

the way of timely immunization. Clinicians might misperceive

certain conditions and circumstances as valid

contraindications or precautions when they actually do not

preclude vaccination. These misperceptions result in missed

opportunities to administer recommended vaccines.

We encourage you to reprint any of these Q & As in your own

newsletters. Please credit the Immunization Action Coalition

and the Centers for Disease Control and Prevention.

Information about IAC's preferred citation style can be

found at http://www.immunize.org/citeiac

You can access more " Ask the Experts " Q & As in our online

archive at http://www.immunize.org/askexperts

Editor's note: Information about submitting a question to

" Ask the Experts " is provided at the end of this Extra

Edition.

**************************

Q: How many vaccines can be given during an office visit?

A: No upper limit exists for the number of vaccines that can

be administered during one visit. ACIP and AAP consistently

recommend that all needed vaccines be administered during an

office visit.

Q: Which vaccines cannot be administered at an office visit

along with other vaccines?

A: All routine vaccines can be given during an office visit,

as long as a different syringe is used for each vaccine.

Q: If all needed vaccines aren't administered during the

same visit, does one need to wait a certain period of time

before administering the other needed vaccines?

A: All inactivated vaccines can be given on the same day, or

on any day before or after giving other inactivated or live

vaccines. However, if two live vaccines are not given on

the same day, they need to be spaced at least 4 weeks apart.

This recommendation does not apply to rotavirus or oral typhoid

vaccine, which can be given at any time before or after another

live vaccine.

Q: Do we have to check vital signs before giving vaccines?

A: No. ACIP does not recommend routinely checking a

patient's temperature or other vital signs before

vaccination. Requiring these extra steps can be a barrier to

immunization.

Q: Is it necessary to routinely test young women for

pregnancy before administering vaccines?

A: No. However, females of childbearing age should be asked

about the possibility of their being pregnant before they

are given any vaccine for which pregnancy is a

contraindication or precaution. The patient's answer should

be documented in the medical record. If the patient thinks

she might be pregnant, a pregnancy test should be performed

before administering live virus vaccines.

Q: Which vaccines can be given to breastfeeding women?

A: All vaccines except smallpox can be given to

breastfeeding women. Breastfeeding is a precaution for

yellow fever vaccine. Women who are breastfeeding should be

advised to postpone travel to yellow fever endemic or

epidemic regions; however, if travel cannot be postponed the

woman should receive yellow fever vaccine.

Q: Can I administer vaccine to a child who is taking

antibiotics?

A: Treatment with antibiotics is not a valid reason to defer

vaccination. If a child or adult is otherwise well, or has

only a minor illness, vaccines should be administered. But

if the person has a moderate or severe acute illness

(regardless of antibiotic use), one should defer vaccination

until the person's condition has improved.

Q: We frequently see patients who have a fever or an acute

illness and are due for vaccinations. We're never quite sure

if we should withhold the vaccines or not. What do you

advise?

A: A " moderate or severe acute illness " is a precaution for

administering any vaccine. A mild acute illness (e.g., mild

diarrhea or upper-respiratory tract infection) with or

without fever is not.

Q: Should I vaccinate a child who has recently been exposed

to an infectious disease? What about a child who is

convalescing from illness?

A: Neither of these situations is a contraindication or

precaution to vaccination.

The following resources are useful to check for true

contraindications and precautions.

Portions of ACIP's General Recommendations on Immunization:

Chart of Contraindications and Precautions to Commonly Used

Vaccines

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm

Conditions Commonly Misperceived as Contraindications to

Vaccination

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-misconceptions.htm

From IAC:

Guide to Contraindications and Precautions to Commonly Used

Vaccines

http://www.immunize.org/catg.d/p3072a.pdf

Guide to Contraindications and Precautions to Commonly Used

Vaccines in Adults

http://www.immunize.org/catg.d/p3072.pdf

**************************

HOW TO SUBMIT A QUESTION TO " ASK THE EXPERTS "

IAC works with CDC to compile new " Ask the Experts " Q & As for

our publications based on commonly asked questions. We also

consider the need to provide information about new vaccines

and recommendations. Most of the questions are thus a

composite of several inquiries.

You can email your question about vaccines or immunization

to IAC at admin@... As we receive hundreds of

emails each month, we cannot guarantee that we will print

your specific question in the " Ask the Experts " feature.

However, you will get an answer. To see if your question has

already been answered, you can first check the " Ask the

Experts " online archive at

http://www.immunize.org/askexperts

You can also email CDC's immunization experts directly at

nipinfo@... There is no charge for this service.

If you have a question about IAC materials or services,

email admininfo@...

Please forward these " Ask the Experts " Q & As to your co-

workers and suggest they subscribe to IAC Express at

http://www.immunize.org/subscribe

===========================================================

The Immunization Action Coalition welcomes redistribution of

this issue of IAC Express or selected articles. When you do

so, please add a note that the Immunization Action Coalition

is the source of the material and provide a link to

http://www.immunize.org/express/issue922.asp

Editor: Deborah L. Wexler, MD (deborah@...)

Managing Editor: Dale (dale@...)

Associate Editor: A. , DDS, MPH

(tanderson@...)

Editorial and Operations Assistant: Janelle Tangonan

(janelle@...)

ISSN: 1526-1786

To subscribe to IAC Express, as well as to view past issues,

please visit http://www.immunize.org/express

To update your contact information, please send an email

message to express@... and include both (1) the old

contact information (name and email address) and (2)

instructions describing the changes you wish to make.

To unsubscribe to IAC Express, please send an email message

to express@... and put UNSUBSCRIBE in the subject

line. If your subscription email address differs from the

one from which you are sending the message, please note the

subscription email address in the body of the message.

If you have trouble receiving or displaying IAC Express

messages, visit our online help section at

http://www.immunize.org/express/iacxhelp.asp

This publication is supported in part by Grant No.

5U38IP000290 from the National Center for Immunization and

Respiratory Diseases, CDC. Its contents are solely the

responsibility of IAC and do not necessarily represent the

official views of CDC.

[Guest guest]

IAC Express: Extra Edition

Immunization news from the Immunization Action Coalition

More than 42,000 subscribers read IAC Express.

Subscribe to IAC Express and our other free publications at

http://www.immunize.org/subscribe

A web page version of this issue is available at

http://www.immunize.org/express/issue922.asp

New! Laminated child/teen and adult CDC Immunization

Schedules. Great for exam rooms. Order at

http://www.immunize.org/shop

===========================================================

Issue Number 922

April 6, 2011

CONTENTS OF THIS ISSUE

1. Read " Ask the Experts " Q & As about common vaccination

misconceptions

-----------------------------------------------------------

ABBREVIATIONS: AAFP, American Academy of Family Physicians;

AAP, American Academy of Pediatrics; ACIP, Advisory

Committee on Immunization Practices; AMA, American Medical

Association; CDC, Centers for Disease Control and

Prevention; FDA, Food and Drug Administration; IAC,

Immunization Action Coalition; MMWR, Morbidity and Mortality

Weekly Report; NCIRD, National Center for Immunization and

Respiratory Diseases; NIVS, National Influenza Vaccine

Summit; VIS, Vaccine Information Statement; VPD, vaccine-

preventable disease; WHO, World Health Organization.

-----------------------------------------------------------

(1 of 1)

April 6, 2011

READ " ASK THE EXPERTS " Q & As ABOUT COMMON VACCINATION

MISCONCEPTIONS

Many readers of Needle Tips and Vaccinate Adults

consistently rank " Ask the Experts " as their favorite

feature in these publications. As a thank-you to our loyal

IAC Express readers, we periodically publish Extra Editions

with " Ask the Experts " Q & As answered by CDC experts.

IAC thanks L. Atkinson, MD, MPH, and T.

Kroger, MD, MPH, medical epidemiologists at the National

Center for Immunization and Respiratory Diseases, CDC, for

agreeing to answer the following questions.

All the Q & As in this edition of IAC Express deal with

misconceptions about vaccination that too frequently get in

the way of timely immunization. Clinicians might misperceive

certain conditions and circumstances as valid

contraindications or precautions when they actually do not

preclude vaccination. These misperceptions result in missed

opportunities to administer recommended vaccines.

We encourage you to reprint any of these Q & As in your own

newsletters. Please credit the Immunization Action Coalition

and the Centers for Disease Control and Prevention.

Information about IAC's preferred citation style can be

found at http://www.immunize.org/citeiac

You can access more " Ask the Experts " Q & As in our online

archive at http://www.immunize.org/askexperts

Editor's note: Information about submitting a question to

" Ask the Experts " is provided at the end of this Extra

Edition.

**************************

Q: How many vaccines can be given during an office visit?

A: No upper limit exists for the number of vaccines that can

be administered during one visit. ACIP and AAP consistently

recommend that all needed vaccines be administered during an

office visit.

Q: Which vaccines cannot be administered at an office visit

along with other vaccines?

A: All routine vaccines can be given during an office visit,

as long as a different syringe is used for each vaccine.

Q: If all needed vaccines aren't administered during the

same visit, does one need to wait a certain period of time

before administering the other needed vaccines?

A: All inactivated vaccines can be given on the same day, or

on any day before or after giving other inactivated or live

vaccines. However, if two live vaccines are not given on

the same day, they need to be spaced at least 4 weeks apart.

This recommendation does not apply to rotavirus or oral typhoid

vaccine, which can be given at any time before or after another

live vaccine.

Q: Do we have to check vital signs before giving vaccines?

A: No. ACIP does not recommend routinely checking a

patient's temperature or other vital signs before

vaccination. Requiring these extra steps can be a barrier to

immunization.

Q: Is it necessary to routinely test young women for

pregnancy before administering vaccines?

A: No. However, females of childbearing age should be asked

about the possibility of their being pregnant before they

are given any vaccine for which pregnancy is a

contraindication or precaution. The patient's answer should

be documented in the medical record. If the patient thinks

she might be pregnant, a pregnancy test should be performed

before administering live virus vaccines.

Q: Which vaccines can be given to breastfeeding women?

A: All vaccines except smallpox can be given to

breastfeeding women. Breastfeeding is a precaution for

yellow fever vaccine. Women who are breastfeeding should be

advised to postpone travel to yellow fever endemic or

epidemic regions; however, if travel cannot be postponed the

woman should receive yellow fever vaccine.

Q: Can I administer vaccine to a child who is taking

antibiotics?

A: Treatment with antibiotics is not a valid reason to defer

vaccination. If a child or adult is otherwise well, or has

only a minor illness, vaccines should be administered. But

if the person has a moderate or severe acute illness

(regardless of antibiotic use), one should defer vaccination

until the person's condition has improved.

Q: We frequently see patients who have a fever or an acute

illness and are due for vaccinations. We're never quite sure

if we should withhold the vaccines or not. What do you

advise?

A: A " moderate or severe acute illness " is a precaution for

administering any vaccine. A mild acute illness (e.g., mild

diarrhea or upper-respiratory tract infection) with or

without fever is not.

Q: Should I vaccinate a child who has recently been exposed

to an infectious disease? What about a child who is

convalescing from illness?

A: Neither of these situations is a contraindication or

precaution to vaccination.

The following resources are useful to check for true

contraindications and precautions.

Portions of ACIP's General Recommendations on Immunization:

Chart of Contraindications and Precautions to Commonly Used

Vaccines

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-vacc.htm

Conditions Commonly Misperceived as Contraindications to

Vaccination

http://www.cdc.gov/vaccines/recs/vac-admin/contraindications-misconceptions.htm

From IAC:

Guide to Contraindications and Precautions to Commonly Used

Vaccines

http://www.immunize.org/catg.d/p3072a.pdf

Guide to Contraindications and Precautions to Commonly Used

Vaccines in Adults

http://www.immunize.org/catg.d/p3072.pdf

**************************

HOW TO SUBMIT A QUESTION TO " ASK THE EXPERTS "

IAC works with CDC to compile new " Ask the Experts " Q & As for

our publications based on commonly asked questions. We also

consider the need to provide information about new vaccines

and recommendations. Most of the questions are thus a

composite of several inquiries.

You can email your question about vaccines or immunization

to IAC at admin@... As we receive hundreds of

emails each month, we cannot guarantee that we will print

your specific question in the " Ask the Experts " feature.

However, you will get an answer. To see if your question has

already been answered, you can first check the " Ask the

Experts " online archive at

http://www.immunize.org/askexperts

You can also email CDC's immunization experts directly at

nipinfo@... There is no charge for this service.

If you have a question about IAC materials or services,

email admininfo@...

Please forward these " Ask the Experts " Q & As to your co-

workers and suggest they subscribe to IAC Express at

http://www.immunize.org/subscribe

===========================================================

The Immunization Action Coalition welcomes redistribution of

this issue of IAC Express or selected articles. When you do

so, please add a note that the Immunization Action Coalition

is the source of the material and provide a link to

http://www.immunize.org/express/issue922.asp

Editor: Deborah L. Wexler, MD (deborah@...)

Managing Editor: Dale (dale@...)

Associate Editor: A. , DDS, MPH

(tanderson@...)

Editorial and Operations Assistant: Janelle Tangonan

(janelle@...)

ISSN: 1526-1786

To subscribe to IAC Express, as well as to view past issues,

please visit http://www.immunize.org/express

To update your contact information, please send an email

message to express@... and include both (1) the old

contact information (name and email address) and (2)

instructions describing the changes you wish to make.

To unsubscribe to IAC Express, please send an email message

to express@... and put UNSUBSCRIBE in the subject

line. If your subscription email address differs from the

one from which you are sending the message, please note the

subscription email address in the body of the message.

If you have trouble receiving or displaying IAC Express

messages, visit our online help section at

http://www.immunize.org/express/iacxhelp.asp

This publication is supported in part by Grant No.

5U38IP000290 from the National Center for Immunization and

Respiratory Diseases, CDC. Its contents are solely the

responsibility of IAC and do not necessarily represent the

official views of CDC.