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Needle Tips June 2010

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Needle Tips June 2010 Volume 20 – Number 4 June 2010 (content current NEEDLE TIPS as of June 16) Visit www.immunize.org for up-to-date immunization information from the Immunization Action Coalition What’s Inside Prepare Now to Vaccinate Healthcare Workers in the Fall Ask the Experts: CDC immunization experts Take time now to plan your medical setting's best practices for increasing staff vaccination answer your questions ...................................... 1 healthcare personnel influenza vaccination cam- rates include contact information, and the tool- kits from state and national organizations of- IAC’s “Handouts” for Patients and Staff paign. For a succinct summary of why staff vac- fer steps for conducting successful vaccination on www.immunize.org ....................................... 2 cination is necessary, an outline of CDC's recom- mendations, and a list of practical online resources, campaigns Vaccine Highlights: Recommendations, see the one-page handout “First do no harm” on • American Society of Health System Pharma- schedules, and more ......................................... 4 page 10 of this issue of Needle Tips. cists: The web-based resource center "Stop the Standing Orders for Administering Pneumo- To get started, gather key staff members to plan, flu—it starts with you!" includes a toolkit, suc- coccal Conjugate Vaccine to Children ............... 6 implement, and promote staff vaccination. Then, cess stories, and resources for improving staff Recommendations for Pneumococcal consult recommendations, toolkits, and educational vaccination rates Vaccine Use in Children .................................... 7 materials. Here are some: Mandatory policies attain high vaccination rates Vaccine Refrigerator Setup ................................ 8 • Centers for Disease Control and Prevention During 2009, many healthcare institutions achieved Monthly Care of Vaccine Storage Units ............. 9 recommendation: "Influenza Vaccination of high influenza vaccination rates among staff by First Do No Harm: Vaccinate all healthcare Health-Care Personnel" instituting mandatory influenza vaccination poli- workers (HCWs) against influenza ....................10 • Association for Professionals in Infection Con- cies. The policies protect patients' health and safety trol and Epidemiology: The toolkit "Protect your Honor Roll for Patient Safety: Institutions by requiring employees who refuse vaccination to patients. Protect yourself" includes a month-by- wear masks or by dismissing such employees. For a that mandate influenza vaccination for HCWs ...11 month planning checklist Need Help Responding to Vaccine-Hesitant list of medical settings with stellar mandatory influ- • National Influenza Vaccine Summit website: enza vaccination policies, see page 11 of this issue. Parents? ............................................................12 The one-page summaries of various institutions' IAC’s Immunization Resources Order Form ......13 vaccine, when compared with children in the same MMR vaccine and varicella vaccine. Ask the age group vaccinated with separate first doses of The complete recommendations for the use of MMR vaccine and varicella vaccine administered MMRV vaccine are available on CDC’s website during a single office visit. at www.cdc.gov/mmwr/pdf/rr/rr5903.pdf. Experts The summary of the recommendations for use In addition, CDC has issued a new VIS for IAC extends thanks to our experts, William L. Atkin- of MMRV vaccine are as follows: MMRV vaccine, dated 5/21/10, which is available son, MD, MPH, and Andrew T. Kroger, MD, MPH, • The routinely recommended ages for measles, at www.immunize.org/vis/mmrv.pdf and www. medical epidemiologists at the National Center for mumps, rubella, and varicella vaccination con- cdc.gov/vaccines/pubs/vis/downloads/vis-mmrv. Immunization and Respiratory Diseases, Centers tinue to be age 12 through 15 months for the first pdf. As with all other VISs, it should be given to for Disease Control and Prevention (CDC). dose and age 4 through 6 years for the second the parent or vaccine recipient prior to vaccination dose. to facilitate discussion about the vaccine between Vaccine questions • For the first dose of measles, mumps, rubella, the patient and provider. and varicella vaccines at age 12 through 47 Please review the specifics of the new CDC months, providers may use either MMR vac- What is the FDA’s current recommendation recommendations for the use of the combina- cine and varicella vaccine or MMRV vaccine. about the use of rotavirus vaccine in infants? tion measles, mumps, rubella, and varicella Providers who are considering administering In March 2010, FDA recommended temporary (MMRV) vaccine. MMRV vaccine should discuss the benefits and suspension of the use of Rotarix (GSK) after On May 7, 2010, CDC issued new recommenda- risks of both vaccination options with the par- researchers found DNA from porcine circovirus tions for the use of combination MMRV vaccine. ents or caregivers. Unless the parent or caregiv- (continued on page 14) Prior to issuing these recommendations, ACIP re- er expresses a preference for MMRV vaccine, viewed results of post-licensure studies that suggest CDC recommends that providers administer that, during the 5–12 day post-vaccination period, MMR vaccine and varicella vaccine for the first approximately one additional febrile seizure oc- dose in this age group. Stay current with FREE subscriptions curred among every 2,600 children ages 12 through • For the second dose of measles, mumps, rubella, The Immunization Action Coalition’s 23 months vaccinated with a first dose of MMRV and varicella vaccines at any age (15 months 2 periodicals, Needle Tips and through 12 years) and for the first dose at age 48 months and older, use of MMRV vaccine gener- Vaccinate Adults, and our email news Immunization questions? ally is preferred over separate injections of its service, IAC Express, are packed with • Call the CDC-INFO Contact Center at equivalent component vaccines (i.e., MMR vac- up-to-date information. (800) 232-4636 or (800) CDC-INFO cine and varicella vaccine). Subscribe to all 3 free publications in • Email [email protected] • A personal or family (i.e., sibling or parent) his- tory of seizures of any etiology (i.e., cause) is one place. It’s simple! Go to • Call your state health dept. (phone numbers a precaution for MMRV vaccination, and such at www.immunize.org/coordinators) www.immunize.org/subscribe children generally should be vaccinated with Ask the Experts . continued from page 1 type 1 (PCV1) in the vaccine. In May, Merck and acellular pertussis (DTaP) series or their Neisseria meningitidis serogroup A. confirmed the presence of DNA from PCV1 and tetanus-diphtheria toxiods (Td) series. Though Invasive disease with N. meningitidis serogroup porcine circovirus type 2 (PCV2) in its rotavirus FDA hasn’t licensed Tdap for children in this A is very rare in the United States; it is more com- vaccine, RotaTeq. age group, when pertussis is circulating in mon in some other countries, particularly the Af- the community or a new infant is in the home, On May 14, FDA updated its recommendations I believe it would be prudent to give Tdap rican meningitis belt. If the patient who received for both Rotarix and RotaTeq vaccines for the pre- instead of Td. What is your opinion? only the C-Y-W135 diluent does not plan to travel vention of rotavirus disease in infants. Based on No Tdap product is licensed for this age group, so outside the United States, the dose does not need to careful evaluation of a variety of scientific infor- the official recommendation is to give Td to chil- be repeated. However, if the patient plans to travel mation, FDA has determined it is appropriate for dren this age who need additional doses. Providers outside the United States, the dose should be re- clinicians and healthcare professionals to resume may certainly choose to exercise their professional peated with either correctly reconstituted Menveo, the use of Rotarix and to continue the use of Ro- judgment and give Tdap vaccine “off-label” in or with a dose of Menactra brand (sanofi pasteur) taTeq. All available evidence supports the safety cases where they think the patient is at risk of either MCV4. There is no minimum interval between the and effectiveness of Rotarix and RotaTeq. Both acquiring or transmitting pertussis. incorrect dose and the repeat dose. vaccines were extensively studied before and af- ter approval. For more detailed information go to Instead of giving tetanus/diphtheria toxoid and We now have two meningococcal conjugate acellular pertussis (Tdap) vaccine to a father- vaccines (MCV4) to chose from—Menactra www.fda.gov/BiologicsBloodVaccines/Vaccines/ (sanofi pasteur) and Menveo (Novartis). It ApprovedProducts/ucm205539.htm. to-be who needed protection against pertus- sis, we mistakenly gave him tetanus/diphtheria would be useful to know if they are inter- changeable when repeat doses of MCV4 are Many children in my practice have received (Td) toxoid. How soon after the Td dose can we needed. their complete series of 7-valent pneumococ- give him the dose of Tdap he needs? cal conjugate vaccine (PCV7). Would you As long as they are younger than age 65 years Although both vaccines are licensed for single- please review the recommendations for which and at least age 10 years, parents, grandparents, dose use, you can use either vaccine to revaccinate of them now need a supplemental dose of healthcare workers, and all others who have not people ages 11 through 55 years who are at
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