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### Question #: 303

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

Current Solution

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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### Other Possible Solutions to this Question

• 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?

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.

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?

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

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.

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

• WHERE CAN I GET INFORMATION ON INFLUENZA (THE FLU) AND ITS SURVEILLANCE?

Information regarding influenza surveillance is available October through May from the CDC influenza website at www.cdc.gov/flu/weekly/fluactivity.htm.

In addition, periodic updates about influenza are published in the MMWR. State and local health departments should be consulted regarding availability of influenza vaccine, access to vaccination programs, information about state or local influenza activity, and for reporting influenza outbreaks and receiving advice regarding their control.

WHERE CAN I GET INFORMATION ON INFLUENZA (THE FLU) AND ITS SURVEILLANCE?

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

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.

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

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

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.

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

• MY QUESTION THAT KNOW CANCER CAN BE CAUSED WHEN OUR BODY EXPOSED TO DOSES OF 50 CGY OR HIGHER. WHAT DOES STAND FOR? DO EMIT?

MY QUESTION THAT KNOW CANCER CAN BE CAUSED WHEN OUR BODY EXPOSED TO DOSES OF 50 CGY OR HIGHER. WHAT DOES STAND FOR? DO EMIT?

• WHICH INFLUENZA VACCINES CAN WE GIVE TO CHILDREN?

There are several vaccines that can be given to children. You can find information on all influenza vaccines available in the U.S. for the current season and the age groups approved by FDA by going to www.immunize.org/catg.d/p4072.pdf.

WHICH INFLUENZA VACCINES CAN WE GIVE TO CHILDREN?

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

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

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

• WHY DO PEOPLE RECEIVED INFLUENZA VACCINE LAST YEAR STILL NEED TO GET VACCINATED THIS WHEN THE VIRUSES HAVEN'T CHANGED?

Although the strains may sometimes be the same as in the previous year's vaccine, you should NOT use the previous season's vaccine you might still have in your refrigerator. Influenza vaccine distributed in the northern hemisphere expires on June 30 after each season; expired vaccine should NEVER be administered. Secondly, antibody titers that persons might have achieved from the previous year's vaccination will have waned and need to be boosted with a dose of the current year's vaccine.

WHY DO PEOPLE RECEIVED INFLUENZA VACCINE LAST YEAR STILL NEED TO GET VACCINATED THIS WHEN THE VIRUSES HAVEN'T CHANGED?

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

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.

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

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

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).

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

• IF AN UNVACCINATED PATIENT HAS JUST RECOVERED FROM A DIAGNOSED CASE OF INFLUENZA COMES INTO OUR CLINIC, SHOULD WE VACCINATE HIM?

Yes. Influenza vaccine commonly contains three influenza vaccine virus strains; two for A viruses and one for a B virus which are prepared based on circulating viruses from the previous influenza season. Infection from one virus type does not confer immunity to other types and it would not be unusual to have exposure to more than one type during a typical influenza season. By all means, vaccinate this person!

IF AN UNVACCINATED PATIENT HAS JUST RECOVERED FROM A DIAGNOSED CASE OF INFLUENZA COMES INTO OUR CLINIC, SHOULD WE VACCINATE HIM?

• Hello I was wondering if you could track your shipment? If you can’t could you give me an estimation of when it will come.

You can track your shipment by logging into your account and clicking on the "[My Account]" link at the top of the page. You will see the items that you purchased and if shipped, will provide the tracking number so you can track the package.

Hello I was wondering if you could track your shipment? If you can’t could you give me an estimation of when it will come.

• 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?

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.

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?

• what type of lubrication should one use on a 20 mm leadscrew and 20 mm round recirculating rail bearings

You will want a grease that can be used in high temperature and heavy load situations also called high load bearing grease. A simple google search will yield many results from which to choose. We plan to carry this product in the near future (by the time you read this, we may already carry it).

what type of lubrication should one use on a 20 mm leadscrew and 20 mm round recirculating rail bearings

• I placed my order online and selected local pick up. How will I know when the order can be picked up and what is the address?

When an order is complete, and is for local pickup, you will be called by the shipping department to let you know it is ready. At that time you will be given the address.

I placed my order online and selected local pick up. How will I know when the order can be picked up and what is the address?

• why do I get the message "RnRMotion.dill was blocked because this type of file can harm your device"?

Rnrmotion.dll is a dynamic link library that is very similar in function to an executable program, or app. Since a dll is executable, malicious code can be embedded in that type of file, so windows will automatically flag all files of this type. You just need to make sure you are downloading from a trusted source. The emotion.dll file on our site is clean, but still, run windows defender against it to make sure.

why do I get the message "RnRMotion.dill was blocked because this type of file can harm your device"?

• I am wiring my estop to the redleaf NC closed using pin 13 and ground to red side of the button is that all that needs to be done

Using pin 13 should be fine as long as it is enabled in Mach3 for the Estop. Go to Mach3, Config> Ports and Pins> Input Signals and make sure EStop is enabled and pin number is set to 13.

I am wiring my estop to the redleaf NC closed using pin 13 and ground to red side of the button is that all that needs to be done

• is there a 3d model of the 2.2 kW (kilowatt) Water Cooled Spindle? i can use about any file type or even if there is a 2D drawing
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