Question: If a child is over 7 years old and has no record of any DT, DTP, Td or DTaP shots, how many Tetanus diphtheria (Td) shots do they need and how should they be spaced?

Answer:  Any person over 7 years of age who has not been previously immunized or lost their record needs 3 Td shots, with at least one month between doses 1 and 2 and six months between doses 2 and 3.  Thereafter they should get a Td shot every ten years unless they receive a significant wound (dirty or extensive).  In this case, they should receive another Td if it has been over 5 years since the last Td.

Answer:  DT is a Diphtheria Tetanus shot for children 6 years and under who cannot receive the Pertussis component of the DTaP or DTP due to a previous reaction.

Question: How often should an adult receive a pneumonia shot?

Answer:  The recommendation is one pneumonia shot after age 65.  If an adult is immunized before age 65, they should get another pneumonia shot after age 65 if at least 5 years has elapsed since the last one.   With certain rare conditions, some people may be immunized more often on the advice of their physician.

Some FAQ's from the CDC website:

Question: Passive immunity interferes with live vaccines. Therefore, if mothers are still nursing their infants at one year of age, do live virus vaccines for the infants need to be delayed? If so, how long after mom stops nursing do we wait?

Answer: There is no reason to delay vaccination because of breastfeeding. Breastfeeding is a good thing and it is not a contraindication to administratin of any vaccine except smallpox. ACIP General Recommendations (see page 18) (2/13/03) More Information  

Question: Can ibuprofen be used safely following a live vaccine (in children) instead of acetaminophen? We have some patients who are allergic to acetaminophen.

Answer: Acetaminophen or ibuprofen can be used following vaccination unless medically contraindicated for that patient. ACIP General Recommendations (see page 13) and "After the Shots" (IAC)

Question: How do I find out about vaccine components in case my patient reports an allergy?

Answer: There are several resources: The manufacturer’s product information (package insert) that accompanies the vaccine, The “Vaccine Excipient and Media Summary” table in Appendix A of Epidemiology and Prevention of Vaccine-Preventable Diseases (the Pink Book), and in the book ImmunoFacts, http://www.immunofacts.com/. (6/26/03)

Question: Please address the latex component in vaccine stoppers in relation to patients with latex allergies.

Answer: If a person reports a severe (anaphylactic) allergy to latex, vaccines supplied in vials or syringes that contain natural rubber should not be administered, unless the benefit of vaccination outweighs the risk of an allergic reaction to the vaccine. For latex allergies other than anaphylactic allergies (e.g., a history of contact allergy to latex gloves), vaccines supplied in vials or syringes that contain dry natural rubber or natural rubber latex can be administered. ACIP General Recommendations (see page 17) (2/13/03) More Information

Question: What is the danger of over-immunizing in cases where you can’t find the immunization records? Is it O.K. to revaccinate?

Answer: Every reasonable effort should be made to locate a patient’s immunization record. However, if it cannot be located, then the recommendation is to revaccinate according to their current age. The concern is the risk of localized reaction with the more immunogenic vaccines like tetanus - and diphtheria-containing vaccines. In some situations you may want to do serologic testing for antibody. There is a good discussion and helpful table in the General Recommendations about which vaccines should be repeated and when you may want to consider testing. ACIP General Recommendations (see pages 8, 20-21). (2/13/03)

Question: If someone has suffered a major blood loss, should they be revaccinated after they recover?

Answer: No, this is not necessary. Your immunologic memory resides primarily in your bone marrow. The only situation where a person should be re-immunized is if their bone marrow is ablated by drugs or radiation as with a bone marrow transplant. (2/13/03)

Question: Should a nurse who is receiving chemotherapy be administering live vaccines?

Answer: It really should not be a problem. The vaccines are in a sealed vial, are drawn into a syringe, and then injected under the skin. Also, the health-care provider administering the vaccines should be immune to measles, mumps, rubella and varicella. It should not be a problem with yellow fever vaccine either. Smallpox vaccine, however, is an exception. Anyone who has not been recently vaccinated against smallpox should not be administering the vaccine. The vaccine is in an open vial and is administered as a drop on the bifurcated needle so there is risk of exposure to the vaccine. (2/13/03)

Question: If a patient is on antibiotics (e.g., tetracycline for acne) for chronic problem , would this have any effect on any live vaccine?

Answer: No. Antibiotics do not have an effect on the immune response to a vaccine. No commonly used antibiotic or antiviral will inactivate a live virus vaccine. (6/26/03)

Question: When we speak of "simultaneous administration" of vaccines, what does “simultaneous” mean? Does it mean the same day, hour, or what?

Answer: Simultaneous means the same day -- the same clinic day. If someone receives a vaccine in the morning and then another that same afternoon, this would be considered simultaneous. (2/13/03)

Question: What are the recommendations regarding spacing of vaccines and PPD testing?

Answer: All vaccines may be given on the same day as a TB skin test, or any time after a TB skin test is applied. However, if MMR has been given, and one or more days have elapsed, we recommend waiting 4-6 weeks before giving a routine TB skin test. No information on the effect of varicella or other live injected vaccines on a TB skin test is available. Until such information is available, it is prudent to apply rules for spacing measles vaccine and TB skin testing to these vaccines. There is no evidence that inactivated vaccines interfere with PPD response. ACIP General Recommendations (see page 16) (2/13/03)