1. 1 Cover page Let’s Review Changes in CDC Recommendations in 2011 Carolee’s Corner January 2012 MPCA cbesteman@mpca.net

2. This edition is designed to review the many changes in CDC Recommendations from 2011 Q #1 Best Practice dictates that we understand and follow CDC Recommendations as they come out. But what is a good way to keep up with all the changes? A #1 First, sign up for I.A.C. Express at www.immunize.orgwww.immunize.org This is a weekly email newsletter that briefly discusses all the important immunization news. It also contains links to access further information. Secondly, and just as importantly, watch for updates to the Quick Looks on www.michigan.govwww.michigan.gov Quick Looks are written by the Immunization Nurse Educators at MDCH and are very practical guides to implementing both old and new CDC recommendations. Print them and keep them handy for everyone on staff to refer to as they work with vaccines. 2

3. Tdap Recommendations Q #2 Does the new recommendation about vaccinating pregnant women with Tdap apply only to health centers with an OB/GYN practice? Q #3 If a pregnant woman has not had a Tdap, when during her pregnancy should it be given to her? A #2 No. One of the purposes of this recommendation is to offer protection against pertussis (as well as diphtheria & tetanus protection) not only to the woman but also to “cocoon” her newborn baby and others who cannot be immunized. That means it is Best Practice to vaccinate all women of childbearing age with a Tdap before they become pregnant. Women of this age are frequently seen in all health centers. A #3 If she has not had a previous dose, give Tdap to a pregnant woman in her 3 rd trimester or late 2 nd trimester (after 20 weeks gestation). 3

4. Tdap Recommendations (cont) Q #4 An adult patient had a Td three months ago. What is the minimum interval between a Td and a Tdap? Q #5 A 70 year old patient is in your office requesting Zoster vaccine. Should you also discuss Tdap vaccine with this patient? A #4 There is now NO minimum interval between the last dose of Td and a dose of Tdap when it is indicated. This patient should be immunized with Tdap now if he has not had a previous dose. A #5 Yes, definitely. CDC recommends that Tdap be given to this age group if they have close contact with an infant less than 12 months of age. Others in this age group may be given a Tdap. Either brand of Tdap may be used for this age group. 4

5. Tdap Recommendations (cont) Q #6 CDC recommends that we administer a Tdap at 11-12 years of age. But when should a child who is 7, 8, 9, or 10 years old be given a Tdap? Q #6 Some children aged 7 through 10 years of age are undervaccinated because their DTaP or Td primary series is not complete. This means they have not had either ● 5 doses of DTaP by age 7 years of age ● or 4 doses of DTaP with one dose at/after 4 years of age. Children in this age group who are under- vaccinated should be given one dose of Tdap as you complete their primary series. Either brand of Tdap may be used for this dose. Minimum intervals should be used for this age group as you complete their primary series 5

6. MCV4 Recommendations Q #7 What is the minimum interval between a routine dose of MCV4 and the booster? Q #8 You gave an 11 year old a MCV4 today. When do you tell him to come back for his booster? Q #9 You gave a 14 year old a MCV4 today. When do you tell him to come back for his booster? Q #10 You gave a 17 year old a MCV4 today. When do you tell him to come back for his booster? A #7 Minimum interval is 8 weeks. However, a 3-5 year interval is preferred for adolescents A #8 If routine MCV4 is given at 11-12 yrs of age, give booster dose at age 16 years A #9 If 1 st dose is given at ages 13 through 15 yrs, give booster dose at ages 16 through 18 yrs A #10 If 1 st dose is given at ages 16 years and older, a booster dose is not needed 6

7. HPV Recommendations Q #11 Now that HPV is recommended for males, may we administer either brand to males and females? Q #12 Are both brands of HPV vaccine on Vaccine for Children (VFC)? Q #13 HPV vaccine is now recommended for males through age 21 years. It may be given to males 22 through 26 years. Does that mean we can use VFC vaccines for males who are older than 18 years of age? A #11 No. Gardasil® (HPV4) by Merck may be given to males and to females. Cervarix® (HPV2) by GSK may only be given to females A #12 Yes. A #13 No. VFC guidelines are very clear. Once either a male or a female turns 19 years of age, VFC vaccine may no longer be used for that person. 7

8. Influenza Vaccine Recommendations Q #14 Flu vaccine is now recommended for everyone 6 months of age and older. How well are we doing at immunizing the children of Michigan? Q #15 It’s February and we have a great deal of flu vaccine left in our frig. What should we do with it? A #14 We must do better. Last season only 51.2% of children 6 mos through 4 yrs of age were vaccinated with flu vaccine. That puts us in 45 th place nation-wide. Six children in Michigan were involved in pediatric deaths from the flu last season. Our children remain at risk! A #15 Continue to vaccinate until your vaccine expires. Offer it to every child 6 mos of age and older, every adolescent, every adult – including every pregnant woman. Make a plan on how to reach your hard- to-reach populations Check out Materials for the Current Influenza Season on MDCH’s website 8

9. PCV13 Recommendations Q #16 FDA has now licensed PCV13 for people 50 years of age and older. Does that mean CDC’s recommendation automatically changes too? A #16 No. As of January 31, 2012 there is no CDC recommendation for the use of PCV13 in adults. Once a vaccine is licensed or a change is made in the licensure, the Advisory Committee on Immunization Practices (ACIP) holds discussions on whether or not they will advise CDC to make the recommendation. ACIP will again be discussing PCV13 for adults at their Feb 2012 meeting. 9

10. Zoster Recommendations Q #17 A patient who is 52 years old has heard that Zostavax® is now licensed by FDA for adults 50 through 59 years of age. He is asking for the vaccine. You check CDC Recommendations and find that Zoster vaccine is still recommended only for adults 60 years of age and older. Why has CDC not changed this recommendation? A #17 The recommended age for Zoster vaccine continues to be to vaccinate people 60 years and older. There are several reasons, including ● There is not enough evidence to show how long the vaccine protection will last ● There are supply issues which impact Zoster vaccine 10

11. Hep B Recommendations Q #18 Should you now give Hep B vaccine to adults with both type 1 and type 2 diabetes? Q #19 Does this mean that adults with diabetes who have already had the Hep B vaccine in the past should now have a repeat series? Q #20 What age adults with diabetes are included in the new Hep B vaccine recommendation? A #18 Yes. The new recommendations do not make a distinction between the two types. A #19 No. This new recommendation is for adults with diabetes who have not yet had the Hep B vaccine series. A #20 It is now recommended that adults with diabetes age 19 through 59 years of age be vaccinated. Adults 60 years of age and older may be vaccinated. 11

12. Vaccine Handling and Storage Recommendations Q #21 Is it possible for your freezer to get too cold for the vaccines you store in it? Q #22 May we store the diluent for MMR & Varicella vaccine in the freezer too? Thank you. Was this issue helpful? If you have requests for future subjects, please let me know. Carolee A #21 Yes. We used to say that a freezer should be +5˚F (-5˚C) or colder. The requirement is now more specific: Maintain vaccine continuously in a frozen state at an average temperature of -58˚F to +5˚F (-50˚C to -5˚C) A #22 No. Store the diluent separately from the vaccine in the frig between 35˚F to 46˚F (2˚F to 8˚C) or at room temperature between 68°F and 77°F (20°C and 25°C). Do not freeze or expose to freezing temperatures 12