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PIC QUESTION OF THE WEEK: 01 /31/05 Q: A 45-year-old kindergarten teacher received her final dose of hepatitis B vaccine approximately one week ago. Can she now receive a dose of FluMist™? A: As a general rule, there is no contraindication to the simultaneous administration of any vaccine. Guidelines for non-simultaneous administration of immunobiologics are dependent on the type of vaccine and, to a lesser extent, the route of administration. Live parenteral vaccines (MMR, varicella, and yellow fever) that are not given simultaneously should be separated by at least four weeks. Otherwise, antibody response to the second vaccine may be reduced. The only exception involves use of yellow fever and measles vaccine. A 1999 study concluded that immune response to yellow fever vaccine was not affected if given < 4 weeks after measles vaccine. This does not apply to rubella, mumps, varicella, and yellow fever combinations. Live vaccines administered by a nonparenteral route (OPV; oral typhoid; live, attenuated influenza vaccine-FluMist™) are not felt to interfere with each other or with simultaneously administered live parenteral vaccines. Oral polio vaccine (OPV) is no longer available in the United States. All other combinations of two inactivated vaccines or live and inactivated vaccines may be given at any time before or after each other. Hepatitis B virus vaccine is an inactivated, fractional vaccine while FluMist™ is an intranasal, live attenuated product. Thus, there is no need to separate the products if they are not administered simultaneously. This patient can now receive her dose of FluMist™. References: • ACIP. Prevention and control of influenza. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5306a1.htm (accessed 2005 Jan 26). • Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. Atkinson W, Hamborsky J, Wolfe S, eds. 8th ed. Washington DC: Public Health Foundation, 2004. Michelle L. Rosko, Pharmacy Clerkship Student Tracy L. Zilka, Pharmacy Clerkship Student


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