COMBINATION VACCINE STANDING ORDER

Transcription

1 VAN BUREN/CASS DSTRCT HEALTH DEPARTMENT COMBNATON VACCNE STANDNG ORDER t is the policy of the Van Buren/Cass District Health Department to follow all the recommendations of the Advisory Committee on mmunization Practices (ACP) when administering vaccines. The Michigan Department of Community Health (MDCH) has developed "Quick Look" guidelines incorporating ACP recommendations to assist in the use of various vaccines (including combination vaccines). Combination vaccines may be used when each of the single products are due to be administered. The antigen requiring the longest minimum interval will determine the spacing between doses. Refer to the appropriate "Quick Look" sheet for the combination vaccine. Note that there may be limitations as to the number of doses that may be given, minimum and maximum ages and schedule variations. Refer to the specific antigen standing orders for contraindications and precautions when administering combination vaccines. The Multiple Vaccines Vaccine nformation Statement (VS) may be used, if appropriate, or the separate VSs for each antigen must be given as required by US Code 300aa and CDC. REFERENCES 1. then search for "quick looks" DSTRBUTON mmunization Manual Frederick A. Joha Medical Director e Date :\Admin\R JOHANSEN\OPPM\ VBCHD\StandingOrders\Current\CombinationVaccine.doc Pagel of 1

2 -.~ -.-~ -.-~ -- :1~ ~~.!! Quick Reference to Combination and Reconstituted Vaccines: Childhood Hiberix, GSK Hib 12 months thru 59 months - 12 months and MMR l, Merck_ MMR older 12 months and Varivax, Merck Var older, (Highlight Vaccines in Your Refrigerator and Post) COMBNATON VACCNES Brand Name What it contains Use for Ages: Use for Dose: Administration Tips Draw up the DTaP/lPV liquid (diluent) Pentacel, SP DTaP, PV, Hib 6 weeks thru 1,2,3 or4 of DTaP, PVor Add diluent to the Hib vial; shake well 4 years Hib Administer within 30 minutes; give 1M 6 weeks thru 1,2, or 3 of PV or DTaP; Premixed Pediarix, GSK DTaP, PV, Hep B 6 years any dose of hep B Shake well before administering; give 1M 5th dose of DTaP', Premixed Kinrix, GSK DTaP,PV 4 to 6lears 4th dose of PV Shake well before administering; give 1M weeks thru Premixed Comvax, Merck Hep B, Hib 4 years Any dose of hep B or Hib Shake well before administering; give 1M MMRV Draw up "diluent for Merck vaccines" ProQuad, Merck (Measles, Mumps, 12 months thru 1 or 2 of MMR and Var Add diluent to MMRV vial; shake well..._._- J3@ella,Varicella) ~?years ~Aclminister vvlthin 30 minutes; give SC -.. -~ RECONSTTUTED VACCNES Brand name What it contains Use for Ages: Use for Dose: Administration Tips 6 weeks thru Draw up diluent packaged with Hib vial ActHB, SP Hib 4 years Any dose of Hib Add diluent to Hib vial; shake well; give 1M Add diluent from packaged pre-filled Only the booster (final) syringe to Hib vial; leave needle inserted dose of Hib series Shake well; redraw into syringe; give 1M Draw up "diluent for Merck vaccines" 1 or 2 of MMR Add diluent to MMR vial;, shake well; give SC 1 or 2 of Var Draw up "diluent for Merck vaccines" Add diluent to Varicella vial; shake well. Administer within 30 minutes; give SC Rotarix, GSK Rotavirus (RV1) 6weeks thru 7 months Any dose of RV Use diluent in pre-filled oral applicator Add to RV1 vial; shake; withdraw; give orally --. Avoid medication errors! Use only the diluent that is packaged or sent with each specific vaccine-don't use any other liquid December 18, 2009

3 A Quick Look at Using DTaP/PV (KNRXTM) ndications for Use and Schedule Approved for. Routine schedule of one dose at 4-6 years Second booster dose of DTaP (5 th dose} and PV (4th dose) Ages 4 years through 6years (6 years, 364 days) Do not use: For dose 1, 2, 3, or 4of DTaP or dose 1, 2. or 3 of PV n children 7years of age and older Make sure minimum age and minimum intervals are met: Minimum age for the 5 th dose ofdtap is 4 years Minimum interval between dose 4 &5of DTaP is 6months [.ntramuscular (1M) injection in the deltoid of the arm or anterolateral thigh 1inch needle; gauge Professional judgment is appropriate when selecting needle length and site Can be given with other vaccines. at the same visit (use separate sites; space at least 1inch apart) Store in the refrigerator between F (2..a C) Do NOT freeze Keep in the original box Shake well before using KNRX CONTRANDCA,.ONS An anaphylactic reaction to a prior dose of DTaPlPV (KNRX n,,). DTaP or PV An anaphylactic reaction to acomponent of DTaP/lPV (KNRXTM) including neomycin or polymyxin B Encephalopathy not due to another cause occurring within 7days after vaccination with a pertussis-containing vaccine Progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy or progressive encephalopathy) PRECAUTONS Moderate to severe acute illness Guillain-Barre syndrome within 6weeks of aprior vaccine containing tetanus toxoid Precautions specific to DTaP vaccine. Temperature greater than or equal to 105 Q Fwithin 48 hours of vaccination with no other identifiable cause Collapse or shock-like state within 48 hours of vaccination Persistent inconsolable crying lasting more than 3 hours within 48 hours of vaccination Convulsions with or without afever within 3 days of vaccination FURTHER PONTS. The second booster dose of DTaP (5 th dose) is not necessary if the 4th dose of DTaP is administered on or after the ~~~. DTaPPV (KNRXTM) does not contain a preservative. After removal of the dose, any remaining vaccine should be discarded. The combined DTaPlPV vaccine may be used when any component of the vaccine is indicated, and if the other components are not contraindicated There is not aseparate Vaccine nformation Statement (VS) for DTaPPV (KNRXTM). Use the current VSs for DTaP and PV. or the Multi-vaccine VS that include information about the Michigan Care mprovement Registry (MCR). VSs with MCR information are available at or at your local health department. Document as "DTaP/PV' in MCR, on the vaccine administration record &immunization record card. Publicly purchased DTapnpV {KNRXTM} can be administered to eligible children 4through 6years of age through the Vaccines for Children "(VFC) Program in private providers' offices. Eligible children include those who are uninsured, underinsured, Medicaid eligible, Native American or Alaskan Natives. Contact your local health department for more information For additional information, refer to YFC Progl1llll Resdu!ioos 011 "Vaccines 10 Prevent Diphtheria, Tetanus and Pertussis" and "Vaccines to Prevent Poliomyelitis" and the ACP Recommendations 011 the use of DTaP and PV vaccines,located at hltptlwww.cdc.gcn/vaccineslrecs January

4 A Quick Look at Using DTaP/PV/Hep B (Pediarix ) ndications for Use and Schedule Approved for: Routine schedule 2, 4, 6 months of age Dose 1, 2, 3of DTaP; dose 1, 2, 3of PV; any dose of hep B Ages 6 weeks through 6yearS (6 years, 364 days) Do not use: For t~e 4th or 5 th dose of DTaP or the 4th dose of PV For children 7 years of age or older.ntramuscular (1M) injection in the deltoid of the arm or anterolateral thigh 1 inch needle; gauge Professional judgment is appropriate when selecting needle length and site Can be given with other vaccines, at the same visit (use separate sites; space at least 1 inch apart) Make sure minimum g)ge and minimum intervals are met: Minimum age for dose 1 is 6weeks Minimum age for dose 3 is 6 months Minimum intervals: - 4 weeks between dose 1 & 2-8weeks between dose 2& 3 Store in the refrigerator between 35 4(;0 F(2 o a C) Do NOT freeze Keep in the original box Shake well before using Pediarb CONTRANDCATONS An anaphylactic reaction to a prior dose of Pediarix, DTaP, PV or Hep Bvaccines An anaphylactic reaction to a component of DTaP/lPVlHep B(Pediarix ) including yeast, neomycin or polymyxin B. Encephalopathy not due to another cause occurring within 7 days after vaccination with a pertussis-containing vaccine Progressive neurologic disorder (such as infantile spasms, uncontrolled epilepsy or progressive encephalopathy). PRECAUTONS Moderate to severe acute illness Guillain-Barre syndrome within 6 weeks of a prior vaccine containing tetanus toxoid Temp~rature greater than or equal to 105 F within 48 hours of vaccination with no other identifiable cause Collapse or shock-like state within 48 hours of vaccination Persistent inconsolable crying lasting more than 3 hours within 48 hours of vaccination Convulsions with or without a fever within 3days of vaccination FURTHER PONTS Continue to give a birth dose of single-antigen hep Bvaccine soon after birth and before hospital discharge. You may follow with 3 doses of Pediarix, spaced appropriately, to children without contraindications. This 4-dose heps series is considered acceptable as long as the last dose of heps vaccine is given auafter age 6 months. Pediarix does not contain a preservative. After removal of the dose, any remaining vaccine should be discarded. The combined DTaP-PV-Hep Bvaccine may be used when any component of the vaccine is indicated, and if the other components are not contraindicated. There is not a separate Vaccine nformation Statement (VS) for Pediarix. Use the current VSs for DTaP, PV, and hep Bor the Multi-vaccine VS that include information about the Michigan Care mproveinentregistry (MCR). VSs with MCR information are available at or at your local health department. Document as "DTaP/lPVlHep B" in MCR, on the vaccine administration record & immunization record card. Publicly purchased DTaP/lPVHep B(Pediarix ) can be administered to eligible children 6weeks through 6years of age through the Vaccines for Children (VFC) Program in private providers' offices. Eligible children include those who are uninsured, underinsured, Medicaid eligible, Native American or Alaskan Natives. Contact your local health department for more information. For additional information, refer to VFC Program Resolutions on 'Vaccines to Prevent Diphtheria, Tetanus and Pertussis,' 'Vaccines to Prevent Poliomyelitis', 'Vaccines to Prevent Hepatitis S' and the ACP Recommendations on the use of DTaP, PV and HepS vaccines, located at January 26, 2009

5 ndications for Use and Schedule Approved for: Routine schedule of 2, 4, 6, and 15~18 months of age Ages 6 weeks through 4 years (4 years, 364 days} For doses 1,2,3 or 4 of DTaP, PV or Hib Do not use: For any person 5 years of age and older For the 5111 dose of DTaP or, if needed, a 5111 dose of PV ntramuscular (1M) injection in the deltoid of the arm or anterolateral thigh 1inch needle; gauge Professional judgment is appropriate when selecting needle length and site Can be given with other vaccines, at the same visit.see "Further Points" for reconstitution instructions Make sure minimum age and minimum intervals are met: Minimum age for dose 1 is 6 weeks Minimum age for dose 4 is 12 months Minimum intervals: 4 weeks between dose 1& 2 4 weeks between dose 2 & 3. 6 months between dose 3 &4 Store the DTaP-PV vial and the Hib vial in the original box' and in the refrigerator at 3SO 46 F (2' SOC) Shake well before using Administer within 30 min of reconstituting Pentacel CONTRANDCATONS An anaphylactic reaction to a prior dose of Pentacel', DTaP, PVor Hib vaccine An anaphylactic reaction to a component of DTaPPV/Hib (Pentacel) including neomycin or polymyxin B Encephalopathy not due to another cause occurring within 7 days after vaccination with a pertussis-containing vaccine Progressive neurologic disorder (such as infantile spasms. uncontrolled epilepsy or progressive encephalop.athy) PRECAUTONS. Moderate to severe acute illness Guillain-Barre syndrome within 6 weeks of a prior tetanus toxoid-containing vaccine.. Temperature greater than or equal to 105 F within 48 hours of vaccination with no other identifiable cause Collapse or shock-like state within 48 hours of vaccination Persistent inconsolable crying lasting more than 3 hours within 48 hours of vaccination Convulsions with or without a fever within 3days of vaccination FURTHER PONTS.Be sure to reconstitute the Hlb vial with DlaP PV vial before administration. Use only this Clap PV as the diluent. CDC recommends that the lot numbers from the DTaP-PVand the Hib vials be recorded on the vaccine administration record. Currently, MCR will only allow for one lot number to be entered; use the lot number from the Hib vial (matches outer box #)..Pentacel does not contain a preservative. After removal of the dose. any remaining vaccine should be discarded. The combined DTaP-PV-Hib vaccine may be used when any component of the vaccine is indicated. and if the other components are not contraindicated There is not aseparate Vaccine nformation Statement (VS) for Pentacel. Use the current VSs for DTaP, PV, and Hib or the MUlti-vaccine VS that include information about the Michigan Care mprovement Registry (MCR). VSs with MCR information are available at or your local health department Document as "DTaPPVlHib' in MCR, on the vaccine administration record &immunization record card Publicly purchased DTaP/lPVlHib (Pentacel) can be administered to eligible children 6weeks through 4years of age,utilizing the Vaccines for Children (VFC) Program, in private providers' offices. Eligible children include those who are uninsured, underinsured, Medicaid eligible,. Native American or Alaskan Natives. Contact your local health department for more information For additional information, refer to VFC Program Resolutions on 'Vaccines to Prevent Diphtheria, Tetanus and Pertussis', 'Vaccines to Prevent Poliomyelitis', and 'Vaccines to Prevent Haemophilus influenzae type B' and the ACP Recommendations on the use of DTaP, PVand Hib vaccines, located at hhp:llwml.cdc.goyjyaccines/recs January 15, 2010

6 ,!.~:, b~a Quick Look at Using Hep A/Hep B (Twinrix@) ndications for Use and Schedule Approved for: Rouone schedule of 3doses; 0, 1,6 months.persons with indications for both hepatitis A and hepatitis Bvaccines 'Alternate schedule of 4 doses; 0, 7, days and a booster dose 12 months after the first dose.ntramuscular (1M) injection in the deltoid of the arm '1-1.5 inch needle; gauge Professionaljudg'ment is appropriate when selecting needle length Can be given with other vaccines, at the same visit (use separate sites; space at least 1 inch apart) Each dose of Twinrix contains: One adult dose of hepatitis Bvaccine One pediatric dose of hepatitis A vaccine Make sure minimum age and minimum intervals are met: Minimum age for any dose is 18 years Minimum intervals for 3-dose schedule: - 4 weeks between dose 1& 2-5 months between dose 2&3 Store in the refrigerator between 3S D.4&' F(2 S0C) Do NOT freeze.keep in the original box Shake well before using, Twinrix CONTRANDCA1'ONS An anaphylactic reaction to a prior dose of Twinrix, hepatitis A or hepatitis 8 vaccine An anaphylactic reaction to a component of Twinrix (hep Nhep 8) including yeast and neomycin PRECAUTONS Moderate to severe acute illness FURTHER PONTS Because the hepatitis Bcomponent of Twinrix is equivalent to astandard adult dose of hep 8 vaccine, the schedule is the same Whether Twinrix or singe-antigen hep Svaccine is used Because the hepatitis A component of Twinrix is equivalent to a pediatric dose of hep Avaccine, persons 19 years and older who receive only 1or 2doses of Twinrix will need additional adult doses of single-antigen hep A vaccine Completing hepatitis A and hepatitis B series with single antigen hep A. hep B andlor Twinrix An'j combination of 3 doses of adult hepatitis Sor 3doses of Twinrix = a com~ete series of hep_autis B 1dose of Twinrix + 2 doses of adult hepatitis A =a complete series of hepatitis A 2doses of Twinrix + 1 dose of adult hepatitis A = a complete series of hepatitis A There is not aseparate Vaccine nformation Statement (VS) for Twinrix. Use the current VSs for hep A and hep Bthat include information about the Michigan Care mprovement Registry (MCR). V1Ss with MCR information are available at or at your local health department. Document as "Hep NHep S' in MCR, on the vaccine administration record &immunization record card Publicly purchased hep AJhep B(Twinrix ) and single-antigen hep Aand hep Bvaccines are available for persons at high risk for hepatitis A or hepatitis Bvirus infection when served at local health department or select sites. Eligible adults 19 years and older include those who are uninsured or underinsured. Adults who are Medicaid-eligible and meet high risk criteria for hep Aor hep Bmay receive privately purchased single-antigen vaccines or Twinrix; bill Medicaid for the vaccine &administration fee. Medicare part B&Dwill cover privately purchased hep A or hep Bunder certain circumstances-see policies. For persons 18 years and younger,- publicly purchased vaccines (excluding Twinrix ) are available in private provider offices under the Vaccines for Children (VFC) program. Eligible children are those with Medi~" underinsured, uninsured, or Native American or Alaskan Natives. Contact your local health department for more information on these programs. For additional information, refer to the ACP Recommendations on the use of Hap Aand Hep Bvaccines, located at ht!d:/www,cdc.govtvaccinesirecs, January 6, 2009