LAIV can be administered simultaneously with another live vaccine (e.g., MMR, varicella), but if not given at the same time, ACIP recommends waiting four weeks before administering the second live vaccine.

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A FIVE-YEAR-OLD CHILD RECEIVED HER SECOND MMR WEEK AGO. HOW LONG SHOULD SHE WAIT BEFORE RECEIVING LIVE ATTENUATED INFLUENZA VACCINE (LAIV)?

ACIP's influenza recommendations for children age 6 months through 8 years have changed for the 2011–12 season. According to the new algorithm, certain children need 2 doses of influenza vaccine this influenza season, separated by at least 4 weeks. Here is a summary:

• Children age 6 months through 8 years who did not receive AT LEAST 1 dose of the 2010–11 vaccine should receive 2 doses, separated by at least 4 weeks, REGARDLESS of their previous influenza vaccination history.
• Children age 6 months through 8 years whose influenza vaccination status from the previous season is not known should also receive 2 doses at least 4 weeks apart.
• Children age 6 months through 8 years who received 1 dose of seasonal influenza vaccine during the 2010–11 season need ONLY 1 dose this season. This is because the vaccine strains are the same this season as last season.

You may find this Immunization Action Coalition handout helpful: www.immunize.org/catg.d/p3093.pdf.

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WHICH OF OUR PEDIATRIC PATIENTS WILL NEED 2 DOSES INFLUENZA VACCINE FOR THE 2011–12 VACCINATION SEASON?

Beginning with the 2010-11 vaccination season, ACIP recommends annual vaccination for all people ages 6 months and older who do not have a contraindication to the vaccine.

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RECOMMENDED TO GET VACCINATED AGAINST INFLUENZA (THE FLU)?

As of January 1, 2006, the use of a VIS for influenza vaccine given to a child or an adult became mandatory under the National Vaccine Injury Compensation Program. Two VISs are published annually, one for LAIV and one for TIV. Each can be found at www.immunize.org/vis along with many translations.

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A VACCINE INFORMATION STATEMENT (VIS) MANDATORY OR IT ONLY RECOMMENDED WHEN ADMINISTERING INFLUENZA VACCINE?

Yes. You are referring to Afluria, which is manufactured in Australia by CSL Laboratories for the U.S. market. CSL's 2010 Southern Hemisphere influenza vaccine (Fluvax and Fluvax Junior) has been associated with increased post-marketing reports of fever and febrile seizures in children predominantly younger than age 5 years as compared to previous years. For this reason, on August 5, 2010, ACIP recommended that Afluria, 0.5 mL, licensed for use in people age 36 months and older, not be used in children younger than age 9 years. ACIP further recommended that Afluria could be administered to children ages 5 through 8 years who are at high risk for influenza complications if there is no other age-appropriate TIV available, after risks and benefits of using this vaccine in this age group have been discussed with the parent or guardian. The vaccine should not be given to children younger than age 5 years. For detailed information, go to www.cdc.gov/media/pressrel/2010/s100806.htm.

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WE'VE HEARD THAT ACIP HAS LIMITED THE USE OF ONE INFLUENZA VACCINE PRODUCTS FOR CHILDREN BEGINNING WITH 2010-11 VACCINATION SEASON. TRUE?

VFD settings........
1) To program the VFD, wire it up, plug it in. It takes several seconds to come to life.

2) Push the PRGM button to enter programing mode.

3 )Push the SET button. The display will read PD000.

4) If you push the SET button again, it will display the present setting of PD000.

5 )By pushing the up or down arrows, you can change the setting to whatever it needs to be. (This is just an example. PD000 needs no changes)

6)Push the SET button again to lock in the setting of PD000 and advance to the next number, in this case, PD001.

7) Push the SET button and it will display the present setting of PD001. Again, use the up and down arrows as necessary to set PD001, then push SET again to lock it in.

Note: You can also scroll through the PD numbers with the up and down arrows.

8) make all settings this way.

9) by pushing the SET button you can scroll through the settings. First push of SET moves to the next number, second push displays it's setting, third push moves to the next PD number.

Note- If you take too long, it will leave the programing mode on it's own. If it does, just push PRGM again to return to programing mode. Then press SET and continue what you were doing.

10) Start with PD013. Set it to 1, which returns the settings to the factory settings.

11) Then set PD005 to 400, PD004 to 400, and PD003 to 400 IN THAT ORDER.

12) Then set the following: PD041=8, PD144=3000

13) Set PD209=50

That's it for the programing. You should get 24000RPM when you push RUN.

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I JUST RECEIVED A REPLACEMENT SPINDLE (2.2KW 220V). HOWEVER, WHEN ATTEMPTED IT USE THE NEW SPINDLE, WOULD ONLY REACH 1500 RPM. IS THERE SOMETHING NEED TO CHANGE ON CONTROLLER?

Vaccines can be administered at any time before or after administration of an "allergy injection."

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WHAT THE RECOMMENDED INTERVAL FOR RECEIVING INFLUENZA VACCINE AFTER AN ALLERGY INJECTION?

There are several reasons why this misconception persists: (1) Less than 1% of people who are vaccinated with the injectable vaccine develop flu-like symptoms, such as mild fever and muscle aches, after vaccination. These side effects are not the same as having influenza, but people confuse the symptoms. (2) Protective immunity doesn't develop until 1–2 weeks after vaccination. Some people who get vaccinated later in the season (December or later) may get influenza shortly afterward. These late vaccinees develop influenza because they were exposed to someone with the virus before they became immune. It is not the result of the vaccination. (3) To many people "the flu" is any illness with fever and cold symptoms. If they get any viral illness, they may blame it on the flu shot or think they got "the flu" despite being vaccinated. Influenza vaccine only protects against certain influenza viruses, not all viruses. (4) The influenza vaccine is not 100% effective, especially in older persons. For more information on this topic, go to: www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm

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SOME OF MY PATIENTS REFUSE INFLUENZA VACCINATION BECAUSE THEY INSIST "GOT THE FLU" AFTER RECEIVING INJECTABLE VACCINE IN PAST. WHAT CAN I TELL THEM?

Peak influenza activity does not generally occur until February. Providers are encouraged to continue vaccinating patients throughout the influenza season, including into the spring months (e.g., through May), as long as they have vaccine in the refrigerator and unvaccinated patients in their office.

Because influenza occurs in many areas of the world during April through September, vaccine should be given to travelers who missed vaccination in the preceding fall and winter. Another late season use of vaccine is for children younger than age 9 years who were vaccinated for the first time in the current vaccination season but failed to get their second dose. For each of these situations, vaccine can be given through the month of June since injectable influenza vaccine customarily has a June 30 expiration date.

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HOW LATE IN THE SEASON CAN I VACCINATE MY PATIENTS WITH INFLUENZA VACCINE?

Protection from influenza vaccine is thought to persist for a year or less because of waning antibody and because of changes in the circulating influenza virus from year to year.

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HOW LONG DOES IMMUNITY FROM INFLUENZA (FLU) VACCINE LAST?

You can begin offering vaccine as soon as vaccine becomes available. Early vaccination of children younger than age 9 years who are first time vaccinees can be helpful in assuring routine second doses before the influenza season begins.

Additional Information:
V

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WHEN SHOULD INFLUENZA (THE FLU) VACCINE BE GIVEN?

No. CDC and ACIP express no preference for preservative-free vaccine for infants or any other group of vaccine recipients. See page 22 of the 2010–11 ACIP influenza recommendations: www.cdc.gov/mmwr/pdf/rr/rr5908.pdf.

No scientific evidence exists that thimerosal in vaccines, including influenza vaccines, is a cause of adverse events, unless the patient has a systemic allergy to thimerosal. However, some states have enacted legislation that restricts the use of thimerosal-containing vaccines. Check with your state immunization manager to see if your state is one of them (www.immunize.org/coordinators).

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ARE WE SUPPOSED TO GIVE INFANTS PRESERVATIVE-FREE INFLUENZA VACCINE?

It is never too early to begin planning for the coming fall's influenza vaccination program. The most important thing you can do initially is to place your order for vaccine from your usual source. Some manufacturers often stop taking pre-orders in mid-May. Be sure to include vaccine for pediatric patients needing two doses and also for your facility's healthcare workers as part of your overall campaign.

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WE ARE ALWAYS CONCERNED THAT THERE WON'T BE ENOUGH VACCINE TO VACCINATE OUR PATIENTS IN THE FALL. WHAT CAN DO ASSURED WE'VE DONE ALL POSSIBLY AVOID THIS TYPE OF SITUATION?

The child should always receive the dose appropriate for his or her age at the time of the clinic visit; at age 37 months that would be 0.5 mL.

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IF A CHILD RECEIVES INFLUENZA VACCINE AT AGE 34 OR 35 MONTHS FOR THE FIRST TIME (0.25 ML DOSE) AND THEN RETURNS SECOND DOSE 37 MONTHS, SHOULD WE GIVE ANOTHER 0.25 0.5 THAT INDICATED AGES 3 OLDER?

Yes, that is highly recommended for all the reasons you can imagine. Say you were doing engraving, not surfacing the spoilboard will either exhibit some areas that have no engraving at all, or areas that have engraving that is too deep. If you are cutting completely through the material, then one end may be cut all the way through but the other end will not have a complete cut, or produce onion skinning on the bottom of the workpiece.

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DO NEED TO GET THE BIG PLANING BIT OR SURFACING AND GO OVER SPOIL BOARD MAKE SURE THAT IT IS PERFECTLY LEVEL IN RELATION ROUTER?

The eyebolts are used in the squaring of the machine. I would use a standard carpenters square and first run the end mill along the edge of the square to first make it parallel with the long axis. Then run the end mill along the other edge with the short axis and adjust the eye bolts and chain according to the angle that the machine is out of square.

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DO NEED TO SQUARE UP THE MACHINE AND IF SO YOU HAVE INSTRUCTIONS OR VIDEO FOR THIS?

Prior to the 2010-11 vaccination season, only children ages 6 months through 18 years and adults age 50 years and older were universally recommended for vaccination; recommendations for adults ages 19 through 49 years were targeted to people with specific risk factors, although other adults could be vaccinated if they wanted protection. Collectively, these targeted risk groups made up 85% of the U.S. population. During the 2009 H1N1 outbreak, additional risk groups were identified, such as obese individuals. The recommendation made by ACIP in February 2010 for universal vaccination simplifies previous recommendations, making it easier for healthcare providers to determine whom to vaccinate. The universal recommendation also makes it easier for patients to remember to get vaccinated every year.

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WE'RE GLAD THAT CDC HAS MADE A UNIVERSAL INFLUENZA VACCINATION RECOMMENDATION TO VACCINATE EVERYONE 6 MONTHS AND OLDER. WOULD YOU TELL US HOW THIS CAME ABOUT?

Yes, you can use lubrication, like 3-in-1 oil to make it a bit easier. You will need to run it up and down to break it in.

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THE LEAD SCREW IS VERY HARD TO TURN. BACKLASH BUSHING SEEMS BE TOO TIGHT AND BINDING ON SCREW. DO IT NEED LUBRICATION OR DID DAMAGE NUT WHEN INSERTING SCREW?

Yes. As long as a child is eligible to receive nasal spray vaccine (i.e., is in the proper age range and health status), it is acceptable to give 1 dose of each type of influenza vaccine. The doses should be spaced at least 4 weeks apart.

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WHEN A CHILD NEEDS 2 DOSES OF INFLUENZA VACCINE, CAN I GIVE 1 DOSE EACH TYPE (INJECTABLE AND NASAL SPRAY)?