Tdap Recommendations by sofiaie


									Immunization News
July 2008 Chelan Douglas Health District
“Always Working For a Safer & Healthier Community”

Flu Update
Flu Update Recommendations for use of Tdap in pregnant & postpartum women Dorm Style Refrigerators Menactra Syncope after vaccination

Washington will allow the use of state-supplied flu vaccine for all children 6 months-18 years, in accordance with the new recommendations. In February 2008, the ACIP voted to expand the age recommendation for influenza vaccine to include all children aged 6 months through 18 years. The recommendation is based on several factors: the vaccine is very safe & effective for school-aged children and influenza has adverse affects on children in this age group & their contacts. For the first time in many years, all 3 strains will be new, making vaccination especially important this flu season. The 3 strains selected for the 2008-2009 season are A/Brisbane (H1N1), A/Brisbane (H3N2) and B/Yamagata. This year’s presentations include: 1) preservative-free pre-filled syringes for children 6-35 months 2) preservative-free vials for pregnant teens less
Please see Flu Update on page 2

Tdap Recommendations
“Until there is additional safety data, women should receive Td during pregnancy.”

Although pregnancy is not a contraindication for receiving Tdap vaccine, health-care providers should weigh the theoretical risks and benefits before choosing to administer Tdap vaccine to a pregnant woman. Available evidence does not address the safety of Tdap for pregnant women, their fetuses, or pregnancy outcomes. Until there is additional safety data, women should receive Td during pregnancy for tetanus and diphtheria protection when indicated. For women who have not received Tdap previously (including women who are breastfeeding), Tdap is recommended as soon as feasible in the immediate postpartum period to protect the women from pertussis and reduce the risk of exposing their newborns to pertussis. The vaccine
Please see Tdap on page 3

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Immunization News

Dorm-style Refrigerators
THINGS TO CONSIDER BEFORE BUYING A CLINIC REFRIGERATOR 1. Dorm or bar style refrigerators that have a small freezer compartment are NOT allowed for general vaccine storage. This type of unit can only be used for a single day’s supply; do not store vaccine on the shelf below the freezer compartment. You must return all vaccine to a full-size or standalone unit at the end of every day. You can’t store frozen vaccines in this type of unit at all, although you still have to defrost it regularly. 2. Using a household refrigerator may void the warranty. Household units are made to open about a dozen times a day, while commercial units are made to open a dozen times an hour and maintain stable temperatures. 3. If each section in the unit does not have its own thermostat, you may have to constantly adjust the temperature to prevent refrigerated vaccines from freezing and frozen vaccines from getting too warm. 4. Keep in mind that back-to-school and flu season will increase your storage needs. Pre-filled syringes, which take up more space than vials, are also becoming more common for packaging.

“Dorm style refrigerators that have a freezer compartment are not allowed for general vaccine storage.”

Flu Update from page 1
Don’t miss an opportunity to vaccinate your patients this flu season.

than 19 years of age 3) multi-dose vials for children 3- 18 years 4) FluMist. This is the first time FluMist has been provided by the state. Enclosed, you will find more information about this vaccine. Data from the 2006 National Health Interview Survey reveals that only 36.2% of Americans with asthma received a flu shot during the 2005-06 flu season. People with asthma have a higher risk of flu-related complications. The Healthy People 2010 target is to vaccinate 60% of people in the 18-64 age range. Inadequate access to care and missed opportunities at doctor’ visits might be the reasons for the low level of vaccination. Vaccinating throughout the entire flu season could help boost the flu vaccine rate among people with asthma (National Network for Immunization Information, 2008).

Immunization News

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Menactra is now licensed for 2-10 year olds; however, the ACIP does not recommend it routinely for this age group and Washington State’s VFC Program does not provide it for this age, with the exception of high-risk children and travelers. ACIP recommends and Washington’s VFC program provides Menactra to the following: Adolescents age 11 up to the 19th birthday. A single dose is recommended for:    Adolescents 11-12 years of age Adolescents who have not previously been vaccinated with MCV4, before high school entry Adolescents less than 19 years of age who have not previously been vaccinated
Routine vaccination of 11-12 year olds is recommended.

Children age 2 up to the 19th birthday meeting the following high-risk criteria:     Children who travel or reside in high-risk areas Children with terminal complement component deficiencies Children with anatomic or functional asplenia Providers may elect to vaccinate children infected with HIV

Tdap from page 1

should be administered before discharge from the hospital. If Tdap cannot be administered at or before discharge, the dose should be administered as soon as possible thereafter. Elevated levels of pertussis antibodies in the mother are likely within 1-2 weeks after vaccination. Although 10 years is the recommended interval between Td boosters, to reduce the risk of women exposing their infants to pertussis, an interval as short as 2 years between the most recent Td and administering Tdap is suggested for postpartum women. In this setting, the benefit of Tdap to protect against pertussis typically outweighs the risk for local and systemic reactions after vaccination. The protection that results from B. pertussis infection or pertussis vaccines persists for an estimated 5--10 years or more. Protection wanes over time, leaving persons susceptible to infection or reinfection. (MMWR, 2008/57 (04); 1-47, 51)

“Td vaccination may be deferred during pregnancy to ensure protection against pertussis if the patient has sufficient tetanus and diphtheria protection.”

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Immunization News

Syncope Following Vaccination
During 2005-2007, ACIP added several newly licensed vaccines to the adolescent immunization schedule. After these vaccines were licensed, the number of VAERS reports for syncope following vaccine administration increased. Only 7% of the reports were classified as serious, but potentially life-threatening injuries were described and one fatality, resulting from an intracranial hemorrhage caused by head trauma, was reported. The ACIP and AAP have published recommendations to prevent post vaccination syncope and related injuries. These strategies apply to all ages and all vaccines. Due to underreporting and lack of age-specific data on vaccine doses administered, the VAERS data does not represent actual incidence rates of syncope following vaccination. Although the vaccines most commonly noted in the VAERS syncope reports are universally recommended for adolescents, this age group has a higher background rate of syncope than other age groups. There was a predominance of female patients reporting syncope, but this could be due to the fact that the HPV vaccine is a 3-dose series compared to the single dose Tdap and Menactra. All providers need to be aware of the possibility of syncope following the administration of the recommended adolescent vaccines. Recommendations:  Vaccine providers should strongly consider observing patients for 15 minutes after they are vaccinated. If syncope develops, patients should be observed until symptoms resolve. Providers should be aware of presyncopal manifestations and take the appropriate measures to prevent injuries if weakness, dizziness, loss of consciousness occurs. Having vaccine recipients sit or lie down for 15 minutes after vaccination could prevent syncopal episodes and injuries.



(MMWR Vol. 57, No. 17, 2008) **Reminding patients to eat before vaccination will also help prevent syncopal episodes.

Prepare for the backto-school rush. Order varicella, Tdap, Menactra, and Gardasil now!!
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Chelan Douglas Health District
200 Valley Mall Parkway East Wenatchee, WA 98802 Phone: (509) 886-6411 Fax: (509) 886-6478 E-mail:

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