CDC 2015 Guidelines for Influenza Vaccination of Persons With a History of Egg Allergy
For the 2015–16 influenza season, ACIP recommends the following:
Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive influenza vaccine. Because relatively few data are available for use of LAIV in this setting, IIV or trivalent recombinant influenza vaccine (RIV3) should be used. RIV3 may be used for persons aged ≥18 years who have no other contraindications. However, IIV (egg- or cell culture-based) may also be used, with the following additional safety measures: Vaccine should be administered by a health care provider who is familiar with the potential manifestations of egg allergy; and Vaccine recipients should be observed for ≥30 minutes for signs of a reaction after administration of each vaccine dose.
Persons who report having had reactions to egg involving such symptoms as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may receive RIV3 if they are aged ≥18 years and there are no other contraindications. If RIV3 is not available or the recipient is not within the indicated age range, IIV should be administered by a physician with experience in the recognition and management of severe allergic conditions.
Regardless of allergy history, all vaccines should be administered in settings in which personnel and equipment for rapid recognition and treatment of anaphylaxis are available.
Persons who are able to eat lightly cooked egg (e.g., scrambled egg) without reaction are unlikely to be allergic. Egg-allergic persons might tolerate egg in baked products (e.g., bread or cake). Tolerance to egg-containing foods does not exclude the possibility of egg allergy. Egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for immunoglobulin E directed against egg proteins.
For persons with no known history of exposure to egg, but who are suspected of being egg-allergic on the basis of previously performed allergy testing, consultation with a physician with expertise in the management of allergic conditions should be obtained before vaccination. Alternatively, RIV3 may be administered if the recipient is aged ≥18 years.
A previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.
Interim Infection Prevention and Control Recommendations for Suspect Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness that is new to humans. It was first reported in Saudi Arabia in 2012 and has since spread to several other countries. In 2014, there were two cases in the United States. Since May 2015, South Korea has been investigating an outbreak of MERS. It is the largest known outbreak of MERS outside the Arabian Peninsula. At this time, there have been at least 154 confirmed cases and 19 deaths in South Korea. An additional 3,680 persons are being monitored for development of MERS. All have been linked to a single patient through exposure in a health care facility. Preventing transmission of respiratory pathogens including MERS-CoV in our facilities is critical to ensuring everyone’s safety. Standard, contact and airborne precautions including the use of a face shield for eye protection should be followed. MERS-CoV infection should be considered in anyone with:
- fever, respiratory symptoms and a history of travel from countries in or near the Arabian Peninsula within 14 days before symptom onset
- close contact with a symptomatic traveler who developed fever and an acute respiratory illness within 14 days after traveling from countries in or near the Arabian Peninsula
- fever and symptoms of respiratory illness and being in a health care facility (patient, worker or visitor) within 14 days before symptom onset in or near the Arabian Peninsula
- history of being in a health care facility (patient, worker or visitor) in South Korea within 14 days before symptom onset (travel to South Korea without this history is not currently considered a risk factor)
- fever or symptoms or respiratory illness and close contact with a known MERS patient
It is imperative that patients at risk for having MERS-CoV infection are identified before or immediately upon arrival to a facility for care. All patients must be asked when making an appointment, during registration or in triage about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of MERS-CoV or contact with possible MERS-CoV patients. Those identified to be at risk should immediately be isolated. In the hospital, an airborne isolation room should be used. In an ambulatory area without an airborne isolation room, a patient should be placed in a single room with the door closed. Infection Control should be called and Infectious Diseases consulted for treatment recommendations, and to ensure that proper reporting and diagnostic testing are coordinated with local health authorities Infection Prevention and Control can be reached at: Infection Prevention Contacts
Mount Sinai Health System 212-824-8700 Mount Sinai Hospital 212-659-9450
Hepatitis A Associated with Travel to Tulum, Mexico:
- As of May 1, 2015, 27 cases of hepatitis A infection have been reported among United States travelers who went to Tulum, Mexico; 11 of the 27 are New York City residents.
- The Centers for Disease Control and Prevention (CDC) has issued a travel advisory recommending vaccination against hepatitis A before travel to Tulum, Mexico.
- CDC and the Health Department recommend that all people who traveled to Tulum, Mexico and returned within the last 14 days receive one dose of hepatitis A vaccine.
As of May 2, 2015, 27 cases of hepatitis A infection have been reported among United States travelers to Tulum, Mexico. CDC has issued a Level 1 Travel Advisory recommending hepatitis A vaccination for all previously unimmunized individuals who plan to travel to Tulum, Mexico. To date, 11 cases have been reported among New York City travelers to Tulum. In addition, CDC and the Health Department recommend that all people who traveled to Tulum, Mexico and returned within the last 14 days receive one dose of hepatitis A vaccine, which can prevent or reduce the symptoms of hepatitis A if given within 14 days of exposure.
Contraindications to hepatitis A vaccine include history of reaction to the vaccine or vaccine components. Special considerations should be taken for two populations: women who are pregnant and people with immune-compromising conditions.
Pregnancy In women who are pregnant, gamma globulin is preferred over hepatitis A vaccination. The Advisory Committee on Immunization Practices says, “Hepatitis A vaccine should not be administered to persons with a history of a severe allergic reaction to a previous dose of hepatitis A vaccine or to a vaccine component. The safety of hepatitis A vaccination during pregnancy has not been determined; however, because hepatitis A vaccine is produced from inactivated hepatitis A virus, the theoretic risk to the developing fetus is expected to be low. The risk associated with vaccination should be weighed against the risk for hepatitis A in pregnant women who might be at high risk for exposure to hepatitis A virus.”
Immune-compromised persons Because hepatitis A vaccine is inactivated, no special precautions need to be taken when vaccinating immune-compromised persons. Nevertheless, the Health Department recommends that individuals with immune-compromising conditions who traveled to Tulum during the specified period consult with their physicians about receiving both vaccine and gamma globulin.
Reporting Cases Providers should suspect hepatitis A infection in any ill persons who report travel to Tulum, Mexico. When evaluating for hepatitis A, clinicians should test for hepatitis A IgM and check liver function tests. Confirmed cases should be promptly reported to the Health Department by calling 1-866-692-3641
Additional information on the travel advisory and hepatitis A can be found at the CDC website at:
http://wwwnc.cdc.gov/travel/notices/watch/hepatitis-a-mexico http://www.cdc.gov/hepatitis/HAV/index.htm.