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?

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?

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)?

Yes, unless you live in a state that has enacted legislation restricting use in pregnant women. There is no scientific evidence that thimerosal in vaccines, including influenza vaccines, is a cause of adverse events, unless the patient has a systemic allergy to thimerosal.

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CAN THIMEROSAL-CONTAINING VACCINE BE GIVEN TO PREGNANT WOMEN?

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?

ACIP recommends annual influenza vaccination for all children age 6 months and older who do not have a contraindication to the vaccine.

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WHICH CHILDREN SHOULD RECEIVE INFLUENZA FLU VACCINE?

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?

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?

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?

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?

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?

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.

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

Healthcare providers should vaccinate any person who failed to get vaccinated in the previous vaccination season and who wants to reduce their risk of acquiring influenza during their upcoming travel, particularly if they are at high risk for influenza-related complications. This includes persons who are traveling to the tropics, traveling with organized tourist groups at any time of year, or traveling to the Southern Hemisphere during April-September.

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WHICH TRAVELERS ARE RECOMMENDED TO BE VACCINATED?

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)?

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?

The following answer assumes "radio Base Station Antennas" refers to base stations used for personal wireless communications services such as cellular telephone, Personnel Communications Services (PCS), and Enhanced Specialized Mobile radio (ESMR). In the United States, the frequency band allocated for base stations used for personal wireless communications is 869-894 MHz for cellular service, 851-866 MHz for ESMR, and 1930-1990 MHz for PCS. The IEEE exposure limits (maximum permissible exposure—MPE) for occupational exposure (controlled environments where exposures may be incurred by persons who are aware of the potential for exposure) are frequency dependent and are expressed in terms of incident power density. The appropriate value to compare with the MPE is the incident power density averaged over the vertical cross-section of the human body. The occupational exposure limits are also time-averaged over any six-minute interval. The IEEE C95.1-1991 MPE values are shown in the table below:
IEEE C95.1-1991 Maximum Permissible Exposure (MPE) Values
Frequency Band Power Density
General mw/cm2 W/cm2
851-866 MHz f/300 mW/cm2 2.84-2.88 28.4-28.8
869-894 MHz f/300 mW/cm2 2.90-2.98 29.0-29.8
1930-1990 MHz f/300 mW/cm2 6.43-6.63 64.3-66.3
NOTE: f is in MHz
As indicated above, these values are for continuous exposure (t > 6 minutes) and are to be compared with the spatial average of the incident power density. all base stations used for personal wireless telecommunications services in the United States are required to comply with the FCC limits (as mandated by the Telecommunications Act of 1996). The FCC limits are based on a hybrid of the IEEE limits and the 1986 recommendations of the National Council on Radiation Protection and Measurements. The FCC MPEs are the same as the IEEE values for frequencies below 1500 MHz but are capped at 5 mW/cm2 (50 W/cm2) for frequencies greater than 1500 MHz.

Both the FCC and IEEE MPEs for exposure of the public (uncontrolled environments) are one-fifth of the above values. As above, the value to compare with the MPE is the incident power density averaged over the vertical cross-section of the human body. The averaging time for the general public is 30 minutes. Thus, for transient exposures lasting six minutes or less, the MPEs for occupational exposure and exposure of the general public MPEs are the same. For cases of simultaneous exposure from antennas operating in different frequency bands, the ratio of the spatially averaged incident power density in each frequency band to the corresponding MPE for that band is determined and the sum of all such ratios must be less than unity in order to comply.

R. C. Petersen
Manager, Wireless and Optical
Technologies Safety Department

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WHAT ARE CURRENT RECOMMENDED IEEE EMF OCCUPATIONAL EXPOSURE LEVELS AND GUIDELINES FOR RADIO BASE STATION ANTENNAS?

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?

The most important factor in preventing outbreaks is annual vaccination of all occupants of the facility, and all persons in the facility who share the same air as the high-risk occupants. Groups that should be targeted include physicians, nurses, and other personnel in hospitals and outpatient settings who have contact with high-risk patients in all age groups, and providers of home care to high-risk persons (e.g., visiting nurses, volunteers).

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ARE THERE RECOMMENDATIONS FOR THE PREVENTION OF INSTITUTIONAL OUTBREAKS INFLUENZA?

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.

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WHICH INFLUENZA VACCINES CAN WE GIVE TO CHILDREN?