Vaccines, Infectious Diseases and the Canine Immune System:

The Importance of Weighing the Risk to Benefit Ratio

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I have signed up for water aerobics and hoping it will help. A virus may need to be inactivated, possibly with no further purification required. Kennel cough, if it manages to get into a breeding colony, is likely to spread rapidly throughout the breeding facility, however, because of the number of animals located in close proximity to each other; the number of underage, highly-susceptibleanimals around newborn puppies etc. It is not known if hepatitis A vaccine passes into breast milk or if it could harm a nursing baby. The size, shape, structure and coloration of the red blood cellsis assessed and noted.

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Ask the Experts

I have taken one shot of the vaccination but wish to discontinue for some personal reasons. Can I do that or does it have any repercussions or side effects if you leave the course in between. The vaccines are designed to be given in 3 doses to get the most protection against future HPV infections. If you miss the recommended time for the second or third dose, get the next dose as soon as convenient.

You will likely still get all or most of the same protection that you would have gotten had you followed the recommended schedule. But if you do not get the second or third dose ever, then you will not get the full protection against HPV. You will have some protection but less than is recommended. She will be getting the third vaccine on the 25th June. Will this still be effective? I would really appreciate your response.

If there is some variation in this schedule, your daughter is still likely to get the full or nearly full protection afforded by the vaccine. You are to be congratulated for making sure that she gets all 3 doses. Getting all 3 doses provides greater protection than merely getting one or two doses.

A small variation in the schedule happens frequently to all of us busy people. How precisely do you have to comply with the timing of the 2nd and 3rdshots? Does it matter if I get the second shot a week or two before the recommended time? However, if you do not get it on time, there does not appear to be a reduced response non-inferiority in those who get the 2nd and 3rd doses delayed. I had my first shot last June 6, I just read in your publication that it should be administered either in the arm or thigh.

No- but it probably hurt. Will the vaccinations have any side effects in the future. Also after a set number of years will l have to redo any vaccinations? Studies show that the vaccine is extremely safe. There is no live virus in the vaccine. The most common side effects that occur right after receiving the injection are redness and soreness where the shot was given. Headaches like when you have a cold or fever can also happen. Rarely, fever can also occur. Over-the-counter pain and fever medications will help if you have symptoms.

After seven years of research, the efficacy of the vaccine appears to be lasting. Do I have to wait to get it? From what we know from studies conducted on the cervical cancer vaccine so far, it appears to be safe to get the cervical cancer vaccine along with other vaccines co-administration. Long term studies will continue. The most common side effects are redness and soreness where the shot was given.

While there are rare reports of girls or young women having complications after getting the vaccine, to date, this has not affected recommendations or approval for use of the vaccine. Is there any vaccination for those who have already been infected by HPV? The answer is yes, maybe. The only vaccine currently available is Gardasil. It protects against 4 different strains of HPV; two that cause cervical cancer and two that cause genital warts.

Such vaccines are currently in clinical trials. It is also important to remember that there are age restrictions currently for the vaccine. It has been approved for women ages So if you are older than that your insurance generally will not pay for the vaccine. Most insurance plans are currently covering it. Your best bet is to discuss your situation with your healthcare provider before you decide to get the vaccine.

Do you know why older women cannot get the HPV vaccine, even if they have taken the HPV test and results show they do not have any of the cancer causing HPV virus types? Gardasil, the only vaccine currently in the US market, was approved in June in the US by the Food and Drug Administration for girls and women between the ages of 9 and 26 and has been recommended by many organizations for routine use in 11 and 12 year old girls. The vaccine is not approved for women over age 26 in the US.

As more data is generated on clinical trials, this may change. Is it true that some women diagnosed with HPV can also get the vaccine to prevent them from getting other strains? Yes, it is true that women who have been exposed to HPV may still get some benefit from the cervical cancer vaccine. The maximum benefit is achieved when the vaccine is administered prior to any HPV exposure. The vaccine is approved for women between the ages of 9 and I would like to start the 3-series vaccination for my 15 year-old daughter.

This sounds extremely high to me. Are there places that offer this service cheaper? What is a reasonable amount to pay? Your 15 year-old daughter may be eligible for the vaccine under the federally funded Vaccines for Children Program depending on your family income. I would suggest that you contact your local health department and ask them if they offer the vaccine on a sliding fee scale.

I applaud you on taking the preventive step of getting your daughter vaccinated. My daughter has been recommended for the vaccine against cervical cancer.

Will the injection make her get her periods sooner? Would it in any way cause her menstrual problems? I have a patient who is traveling internationally and needs MMR vaccine. He recently received an injectable steroid. How long should he wait before receiving MMR vaccine? There is no need to wait a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern about safety or efficacy of MMR.

Can I give MMR to a child whose sibling is receiving chemotherapy for leukemia? MMR and varicella vaccines should be given to the healthy household contacts of immunosuppressed children. We have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage? Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced.

The IDSA states that administration of varicella vaccine but not MMR can be considered for non-varicella-immune patients treated for chronic inflammatory disease who are receiving long-term low-dose immunosuppression. Low-dose immunosuppression for methotrexate is a dosage of less than 0. See Table 6 and associated footnotes: Is it true that egg allergy is not considered a contraindication to MMR vaccine?

Several studies have documented the safety of measles and mumps vaccine which are grown in chick embryo tissue culture in children with severe egg allergy. ACIP recommends routine vaccination of egg-allergic children without the use of special protocols or desensitization procedures.

Can I give MMR to a breastfeeding mother or to a breastfed infant? Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic.

If a patient recently received a blood product, can he or she receive MMR vaccine? Yes, but there should be sufficient time between the blood product and the MMR to reduce the chance of interference. The interval depends on the blood product received. Is it acceptable practice to administer MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?

Receipt of RhoGam is not a reason to delay vaccination. The current recommendations are as follows: Administer 2 doses of MMR vaccine to all HIV-infected people age 12 months and older who do not have evidence of current severe immunosuppression or current evidence of measles, rubella, and mumps immunity. If laboratory results state only one type of parameter percentage or counts this is sufficient for vaccine decision-making. Administer the first dose at 12 through 15 months and the second dose to children age 4 through 6 years, or as early as 28 days after the first dose.

Unless they have acceptable current evidence of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy ART should receive 2 appropriately spaced doses of MMR vaccine after effective ART has been established. If laboratory results state only one type of parameter percentages or counts this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to top What is the recommended length of time a woman should wait after receiving rubella or MMR vaccine before becoming pregnant? We received a call from a healthcare provider who inadvertently administered MMR vaccine to a woman who was 2 months pregnant.

Please advise as to appropriate action steps. No specific action needs to be taken other than to reassure the woman that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy alone is not a reason to terminate the pregnancy.

You should consult with the provider to determine if there is a way to avoid such vaccination errors in the future. We require a pregnancy test for all our 7th graders before giving an MMR. ACIP recommends that women of childbearing age be asked if they are currently pregnant or attempting to become pregnant. Vaccination should be deferred for those who answer "yes. Can we give an MMR to a month-old whose mother is 2 months pregnant? Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, so MMR vaccination of a household contact does not pose a risk to a pregnant household member.

If a woman's rubella test result shows she is "not immune" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

In , ACIP changed its recommendation for this situation see www. It is recommended that women of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine maximum of 3 doses and do not need to be retested for serologic evidence of rubella immunity.

MMR should not be administered to a pregnant woman. I have a female patient who has a non-immune rubella titer two months after her second MMR vaccination. Should she be revaccinated?

If so, should the titer again be checked to determine seroconversion? ACIP recommends that vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine maximum of three doses.

Repeat serologic testing for evidence of rubella immunity is not recommended. MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant.

Because of the theoretical risk to the fetus when the mother receives a live virus vaccine, women should be counseled to avoid becoming pregnant for 28 days after receipt of MMR vaccine. How soon after delivery can MMR be given? MMR can be administered any time after delivery.

The vaccine should be administered to a woman who is susceptible to either measles, mumps, or rubella before hospital discharge, even if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding. This issue has been studied extensively in recent years, including a thorough review by the independent Institute of Medicine IOM. The IOM issued a report in that concluded there is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism.

For more information on thimerosal and vaccines in general, visit www. A few parents are asking that their children receive separate components of the MMR vaccine because they fear MMR may be linked to autism. What should I do? Only combined MMR is available. You should educate parents about the lack of association between MMR and autism.

IAC has developed several handouts for parents: Examine the evidence" and "Evidence shows vaccines unrelated to autism. You can find these and other related handouts at www.

You can also find information about the fraudulent claim that launched the idea that MMR vaccine was somehow linked to the development of autism see www. How likely is it for a person to develop arthritis from rubella vaccine? Arthralgia joint pain and transient arthritis joint redness or swelling following rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination.

Joint symptoms are uncommon in children and in adult males. When joint symptoms occur, they generally begin 1 to 3 weeks after vaccination, usually are mild and not incapacitating, last about 2 days, and rarely recur.

Is there any harm in giving an extra dose of MMR to a child of age seven years whose record is lost and the mother is not sure about the last dose of MMR? In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Receiving excessive doses of tetanus toxoid e. Vaccination providers frequently encounter people who do not have adequate documentation of vaccinations.

Providers should only accept written, dated records as evidence of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should not be accepted. An attempt to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record.

If records cannot be located or will definitely not be available anywhere because of the patient's circumstances, children without adequate documentation should be considered susceptible and should receive age-appropriate vaccination.

Serologic testing for immunity is an alternative to vaccination for certain antigens e. Storage and Handling Back to top How long can reconstituted MMR vaccine be stored in a refrigerator before it must be discarded? MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately.

The Immunization Action Coalition has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. Handout can be found at the following link: How should MMR vaccine be stored? The diluent should not be frozen and can be stored in the refrigerator or at room temperature.

A box of MMR vaccine not reconstituted was left at room temperature for 3 hours. Can I use it? Unfortunately, serious errors in vaccine storage and handling like this occur too often. This is particularly important for live virus vaccines like MMR and varicella.

Once MMR vaccine has been reconstituted with diluent, how soon must it be used? It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within 8 hours, it must be discarded. MMR should always be refrigerated and should never be left at room temperature. I misplaced the diluent for the MMR dose so I used sterile water instead. Is there any problem with doing this? Only the diluent supplied with the vaccine should be used to reconstitute any vaccine.

Any vaccine reconstituted with the incorrect diluent should be repeated. This page was updated on February 9, This page was reviewed on December 14, Standing Orders for Vaccination.

State Laws and Mandates. Handouts for Patients and Staff. Honor Rolls for Patient Safety. IAC Express - Subscribe. Grifols reinforces its commitment to research in the 7th edition of the Martín Villar Awards for Research on Hemostasis Created in , the awards recognize progress made in the field of Hemostasis.

The awards are endowed with 20, euros for each of the two prizes: Grifols launches a continuing education program for transfusion medicine professionals in the United States The program is designed to update knowledge and share advances in the field of transfusion safety. Grifols opens state-of-the-art facility in Clayton, NC to help advance treatment of rare and life-threatening diseases Grifols' North Fractionation Facility will be the world's largest and one of the most technologically advanced plasma fractionation facilities, increasing production capacity in Clayton from 3.

Grifols' sales rose by 4. Grifols takes part in the exhibition "Molecules of Life: Award Winners at the Sixth Edition of the Martín Villar Research Awards Grifols is a company which is committed to encouraging scientific investigation; one of the ways does this is through the Martín Villar Awards for research into haemostasis. Grifols continues to contribute to transfusion medicine training with its second European edition of the Transfusion Science Education Course Each year, Grifols holds a number of courses intended to provide an opportunity for transfusion medicine professionals to learn and progress.

Through training we can ensure the quality and safety of the transfusions that millions of people throughout the world receive each year. Grifols extends its commitment to scientific dissemination with a new publication, Perspectives in Transfusion Medicine The twice-yearly publication is a means of distributing scientific content developed by leading researchers in the field of transfusion medicine.

Grifols Opens New, State of the Art Plasma Testing Laboratory in San Marcos The 72,square-foot-facility will create new jobs as well as provide job opportunities for existing Grifols employees through consolidation of the company's plasma testing operations at the new San Marcos facility and an existing facility in Austin, Texas.

Award Winners at the Fourth Edition of the Martín Villar Research Awards Grifols is a company which is committed to encouraging scientific investigation; one of the ways is does this is through the Martín Villar Awards for research into hemostasis.

Grifols Signs Cooperative Agreement for Commercialization of Immunohematology Diagnostic Products in the US Agreement will facilitate access to state-of-the-art immunohematology products to blood banks and hospitals transfusion centers in the US.

Grifols starts construction of a new plasma fractionation plant in Parets del Vallès The new facilities will deliver up to an additional maximum of two million liters of plasma fractionation capacity in Spain raising total capacity from the current figure of 2.

In the third quarter, the Bioscience division grew by The higher sale volumes of plasma derivatives such as albumin and IVIG, with double-digit increases, confirm the upward trend of the sector. Net profit, at Investment made in production facilities in Australia and Switzerland amounts to 9 million euros.

Grifols to acquire Talecris Biotherapeutics creating a world leading provider of life-saving plasma protein therapies The combination of Grifols and Talecris will create a diversified, global provider of life-saving and life enhancing plasma protein therapeutics built on the strong global presence of Grifols and the established position of Talecris in the United States and Canada.

The merger accelerates key strategic initiatives for both Talecris and Grifols as it creates a more efficient platform for manufacturing, innovation and global sales and marketing. Combining the expertise of both companies will build upon their individual legacies of patient commitment, growth and innovation while increasing the availability of high quality plasma protein therapies for patients worldwide.

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