FluMist has also been modified in several advantageous ways:
- The dose in the sprayer is now 0.2 mL (previously 0.5 mL). One half of the dose should be administered in each nostril.
- The product no longer has to be stored frozen; it should be kept at 35° to 46°F.
- When 2 doses are needed in children under age 9 being vaccinated for the first time, the interval between doses is now 4 weeks (previously 6 weeks).
TABLE 2
LAIV (FluMist) should not be used in these groups
|
Children under age 9 years who receive only 1 dose of vaccine (either TIV or LAIV) the first year they are vaccinated should receive 2 doses the next year.6 If they fail to receive 2 doses in the next year, only a single dose is recommended after that. This is a slight modification of the previous recommendation that only 1 dose was recommended in this situation.7
Alternative schedule for combined hepatitis A and B vaccine
The FDA approved an alternate, 4-dose schedule for the combined hepatitis A and hepatitis B vaccine (Twinrix): at 0, 7, 21 days, and 12 months.8 It was previously approved only for a 3-dose schedule: at 0, 1, and 6 months. The new alternative schedule allows greater protection for travelers who need to depart in less than a month’s time.
Merck recalls some lots of Hib vaccine
On December 11, 2007, Merck announced a voluntary recall of specific lots of Haemophilus influenza type b (Hib) conjugate vaccine products: 10 lots of a monovalent Hib vaccine, PedvaxHIB, and 2 lots of a combined hepatitis B/Hib vaccine, Comvax.
Consult Merck’s Web site for the lots involved and for instructions on returning vaccine (www.merckvaccines. com/PCHRecall.pdf). The recall was prompted by concern about equipment sterility, although no vaccine has been shown to be contaminated. Children vaccinated with Merck products do not need to be revaccinated or obtain any special follow-up.
Shortage expected. It is unknown when Merck will resume production, but it is not anticipated until at least late in 2008. Other Hib-containing products are produced by Sanofi Pasteur but the supply of these products will not make up for the expected shortage.
Interim recommendations. The recall resulted in interim recommendations from the CDC.9 These recommendations are complicated because the dosing schedule for Hib vaccine differs by the product and the age of receipt of first vaccine when children are not on schedule. TABLE 3 lists the Hib-containing products, the recommended primary series schedule, and booster dose.
TABLE 3
Hib products
| PRIMARY SERIES | BOOSTER | |||
|---|---|---|---|---|
| Merck Products | ||||
| PedvaxHIB | Monovalent Hib vaccine | 2, 4 months | 12–15 months* | |
| Comvax | Combined Hib/hepatitis B vaccine | 2, 4 months | 12–15 months* | |
| Sanofi Pasteur products | ||||
| ActHIB | Monovalent hib vaccine | 2, 4, 6 months | 12–15 months* | |
| TriHIBit | DTaP/Hib vaccine | Not licensed for this age group | 15–18 months* | |
| * Can follow a primary series of any product or serve as the only dose for a child up to 59 months, not previously immunized. | ||||
The main points are:
- Defer the booster dose at age 12 to 15 months until the shortage is resolved, except for high-risk children.
- High-risk children, who should continue to receive the booster at ages 12 to 15 months, include those with asplenia, sickle cell disease, HIV infection, and certain other immune deficiencies and cancers, and American Indian/Alaskan Native children.
- Physicians should keep track of children who have the booster deferred so they can be vaccinated when the supply improves.
- Non-recalled lots of PedvaxHIB and Comvax in the CDC stockpile will be prioritized to providers who care for predominantly American Indian/Alaskan Native children, who are at markedly in creased risk of Hib infection.
- If a child has received only 1 dose of PedvaxHIB or Comvax, their primary series can be completed with ActHIB, but 3 total doses are needed.