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A Cup of Health with CDC
December 22, 2006
General Recommendations on Immunization

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

[Matthew Reynolds] Welcome to A Cup of Health with CDC, a weekly broadcast of the MMWR, the Morbidity and Mortality Weekly Report. I’m your host, Matthew Reynolds

CDC’s National Immunization Program recently released a revised general reference on vaccines and immunization, providing technical guidance about common vaccination concerns for those who administer vaccines to infants, children, adolescents, and adults.

Here to discuss these guidelines is Dr. Andrew Kroger, of CDC’s National Immunization Program.

It’s great to have you on the show, Dr Kroger.

[Dr. Kroger] Thank you, Matthew. It’s great to be here.

[Matthew Reynolds] Dr. Kroger, your article, “General Recommendations on Immunization” sounds very broad. What’s the article all about?

[Dr. Kroger] The guidance in this report applies broadly across all vaccines routinely provided in a health care setting. CDC regularly provides guidance about specific vaccines like the meningitis vaccine or the vaccine to prevent whooping cough. However, for providers in the field, guidance is needed about the intervals between different vaccines, or how to deal with storing many vaccines at different temperatures or how to administer as many as nine vaccines at one visit, so this document addresses these concerns.

[Matthew Reynolds] How did you first discover the need for this type of guidance?

[Dr. Kroger] Well, some historical context is really necessary here. This document is actually the seventh in a series of publications of the same name written over the years from 1976 to the present. All of these documents have been published in collaboration with a non-governmental advisory group known as the Advisory Committee on Immunization Practices, or A-C-I-P, and this committee is composed of 15 vaccine experts selected by the Secretary of Health and Human Services, basically to render immunization advice to CDC. So to answer the question, topics of concern to providers in the field are communicated to this advisory group during public meetings; they occur 3 times a year. The process of developing the actual content of this document is made through direct conversations with the membership through working groups.

[Matthew Reynolds] What is a typical immunization question that can be addressed by your article?

[Dr. Kroger] Actually a question that was asked in 1976 and continues to be asked even today is: “When you’re giving a multi-dose vaccine and you wait too long between doses, do you have to start the series completely over?” So this is a question that’s typical of the situation that providers experience constantly in their offices and their clinics, but of course centrally, most subject matter experts may not even consider this issue and, honestly, there is very little data to answer such questions. However, upon consultation with vaccine experts and other experts in academia, specialists in immunization, you can establish enough anecdotal evidence to draw an official conclusion. The answer is if you wait too long between doses you do not have to start over, you can just continue with the vaccine series. So this answer has been published over and over again since 1976.

[Matthew Reynolds] So what type of information is provided in the General Recommendations on Immunization?

[Dr. Kroger] Outside of that question, there is an extensive discussion of timing and vaccines, not only between doses of multi-dose vaccines, but also between different vaccines, before or after giving other medicines and giving the vaccine dose. There’s also a discussion of contraindications for vaccines. What is a contraindication? A contraindication is a condition in a recipient that may result in harmful side effects following certain vaccines; where and when a contraindication exists, our recommendation is not to give a vaccine dose. We also address vaccine administration. These are issues concerning route, site, needle length, administration techniques, and then we have some guidance regarding the proper storage and handling of vaccines.

[Matthew Reynolds] Many providers familiar with immunization will note that the last version of the General Recommendations, which was published in 2002, was quite broad as well. What new content can be found in the 2006 version?

[Dr. Kroger] Most of the guidance carries over from 2002. The basic architecture of the document, the headings and sub-headings for instance, have been maintained. This should help people familiar with the 2002 version locate the specific information they need. The 2006 document contains additional tables and figures, primarily in the areas of vaccine administration, vaccine storage and handling, as well as altered immunocompetence. Altered immunocompetence means an altered immune system due to disease or medications. Our concern with altered immunocompetence in the context of vaccination is that, first of all, disease can be more severe so it’s even more important to vaccinate, generally; however, one must exercise caution with live vaccines, since we rely on an intact immune system to prevent side effects from live vaccines. Also, we rely on an intact immune system to allow a vaccine to work, so the effectiveness of the vaccine is relevant when a provider sees a patient with altered immunocompetence.

[Matthew Reynolds] Any final comments for the listeners?

[Dr. Kroger] Well, don’t be overwhelmed by the size of this document; it’s very long. It’s been revised since 1976 over and over again, so it’s quite large. It can be used as a quick reference. I recommend you read the document at least once. Hopefully, the tables will be helpful for everyday use and you can certainly photocopy sections of the document for this purpose. The entire document is going to be available on our website which is www.cdc.gov/nip/publications/acip-list. So basically don’t be overwhelmed by the size of the document. It should prove very useful to the immunization provider in the field.

[Matthew Reynolds] Well, thanks Dr. Kroger, for taking the time to talk with us.

[Dr. Kroger] Thank you very much.

[Matthew Reynolds] That’s it for this week’s show. Don’t forget to join us next week. Until then, be well. This is Matthew Reynolds for A Cup of Health with CDC.

[Announcer] To access the most accurate and relevant health information that affects you, your family, and your community, please visit www.cdc.gov.