Safe to administer live vaccines for healthcare professionals?

haiku16

Any health care professionals (or anyone really!) know if there is a consensus on the safety of administering live vaccines? I'm a pharmacist and work for a chain that is big on vaccine services. The other day, an intern and I were talking about handling unsafe drugs during pregnancy, and she mentioned me not being able to administer live vaccines. Apparently she worked with a pharmacist who wouldn't do zoster while pregnant. I'd never considered this.

I can't find anything on it, either. I imagine an accidental needle stick with the shingles vaccine would be bad news, and while I've never had a needle stick injury, that doesn't mean it's impossible. Is there any information or guidelines out there? What are any nurses, physicians, pharmacists, and other vaccine givers doing in regards to this?

I have my anatomy scan next week and plan to ask, but I thought I'd come here first!

NachosAndPeaches

Totally not what you asked, but is the shingles vaccine something I should get after pregnancy (since its live right?), and encourage DH to get? We both had chicken pox as kids and while DS had his varicella vaccine, the new baby won't until they're 1. Or is the vaccine something only older people can get like in the commercials?


Edited for words

haiku16

That's a good question honestly. The shingles vaccine is only FDA indicated for ages 50 and up (and you have to be 60 or older to get it from a pharmacy without a prescription.)

While anyone of any age can get shingles, it's much more likely to occur when you're older with a weakened immune system. That's why they don't recommend it younger than 50. It might be given off label to certain populations, but that's outside of my area of practice so I can't comment.

I don't believe you or your husband would be indicated for it, nor would it be warranted. The risk of either of you developing shingles and passing it on to the child before he or she is immunized is pretty remote.

I hope that helps!

spatter1

Ditto @haiku16. Shingles vaccine is for older adults. Although it's licensed by the FDA for adults 50 and older, CDC doesn't recommend it until age 60. It's also contraindicated in pregnancy so even if it was for younger people you'd have to wait until pp. It's true you can get shingles at any age if you've had chicken pox, it's just not very likely. That said, I know someone who had it while pregnant (scary!) and my husband had it when he was 16!

Edited because grammar is hard.

jonesl12

Also the shingles vaccine is legit over 200 dollars and I've only given it to people over the age of 57.

I give live flu mists and I just wear gloves and a mask when I do it. The other 20 vaccines we have I don't have to worry about because they aren't live.

Actually is rotateq live? If so its oral anyway but I should look into that one

Edit: crap I just looked up MMR and Varicella and from what I gathered those are live. Whoops

spatter1

Yes they are!

haiku16

jonesl12 said:

Also the shingles vaccine is legit over 200 dollars and I've only given it to people over the age of 57.

I give live flu mists and I just wear gloves and a mask when I do it. The other 20 vaccines we have I don't have to worry about because they aren't live.

Actually is rotateq live? If so its oral anyway but I should look into that one

Edit: crap I just looked up MMR and Varicella and from what I gathered those are live. Whoops

I actually found a thing from the CDC saying flumist is safe for pregnant women to administer, which makes sense. We haven't been able to even get it in in my area. I didn't think about the mask thing though! I would have just done gloves. Thanks for the suggestion!

I think the oral polio one and rotavirus are live too, but I usually refer anyone who wants one to our travel center pharmacies because I completely forget everything about them

jonesl12

Sometimes I'm so busy i just give the vaccines and keep running without thinking about it. I should probably be more mindful but when you are busy and you have 5 vaccines to give to a crying infant all I can think is " get this baby in and out" and hope the other 20 people waiting on me are in a good mood today lol

NachosAndPeaches

Okay good to know RE shingles. My friend's husband got it like 2 weeks before her RSC so I didn't realize how rare it was in our age group. Thank goodness it cleared up before little man was born.

Question, just bc I always like being informed. I know it's not recommended, but what were to happen if a pregnant woman were exposed to a live vaccine? Is it just a small risk to the fetus or is it likely something would actually happen? Should pregnant women avoid others who have recently gotten live vaccines such as how immune compromised people have to? Just curious!
Thanks.

spatter1

I don't think CDC recommends that pregnant women avoid others who have received live vaccines. Dr. Paul Offit, a well known infectious disease expert and physician at CHOP commented on this on babycenter: https://www.babycenter.com/404_is-it-safe-to-have-my-child-vaccinated-while-im-pregnant_1246914.bc

Also, the only reason pregnant women aren't recommended to have live vaccines is because of the theoretical risk to the fetus, not because they have been proven dangerous. So, pregnant women who accidentally receive a live vaccine shouldn't panic, and it's certainly no reason to terminate a pregnancy. ACOG addresses this a bit in their guidance on Tdap vaccine during pregnancy:
https://m.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Update-on-Immunization-and-Pregnancy-Tetanus-Diphtheria-and-Pertussis-Vaccination?IsMobileSet=true

Hope this helps!

spatter1

Also sorry OP for totally ignoring your question! Does your company have a policy on this? I would check. Even if you got a needle stick, the vaccine probably wouldn't actually get in you, or it would be a TINY amount so I'd be more worried about the needle stick and possible blood exposure than the possible exposure to a live vaccine. And again, inadvertent administration of a live vaccine is not a cause for panic. Definitely something to make sure to call your OB about, but the risk should be extremely small.

AmadorRose

NachosAndPeaches said:

Okay good to know RE shingles. My friend's husband got it like 2 weeks before her RSC so I didn't realize how rare it was in our age group. Thank goodness it cleared up before little man was born.

Question, just bc I always like being informed. I know it's not recommended, but what were to happen if a pregnant woman were exposed to a live vaccine? Is it just a small risk to the fetus or is it likely something would actually happen? Should pregnant women avoid others who have recently gotten live vaccines such as how immune compromised people have to? Just curious!
Thanks.

To my knowledge, the only vaccine that shouldn't be given to people with young children or pregnant housemates is smallpox. I very strongly recommend avoiding it like the plague anyway, because that sucker blows. You change a skin-dissolving bandage every day; to properly dispose of it, you must put it in plastic Baggie with bleach, then put it in the garbage. This is because the virus sheds through the scab and can be VERY bad for the immunocompromised. Otherwise, the slight reaction in people around you from live vaccines shouldn't be enough to put you or baby at risk.

But seriously, don't get the smallpox vaccine if you don't have to. It's better than having smallpox, obviously, but don't go volunteer to get stabbed with the same needle 15 times just for the ugly scar it'll leave you.

Edit because it's late and grammar is hard

jonesl12

AmadorRose said:

NachosAndPeaches said:

Okay good to know RE shingles. My friend's husband got it like 2 weeks before her RSC so I didn't realize how rare it was in our age group. Thank goodness it cleared up before little man was born.

Question, just bc I always like being informed. I know it's not recommended, but what were to happen if a pregnant woman were exposed to a live vaccine? Is it just a small risk to the fetus or is it likely something would actually happen? Should pregnant women avoid others who have recently gotten live vaccines such as how immune compromised people have to? Just curious!
Thanks.

To my knowledge, the only vaccine that shouldn't be given to people with young children or pregnant housemates is smallpox. I very strongly recommend avoiding it like the plague anyway, because that sucker blows. You change a skin-dissolving bandage every day; to properly dispose of it, you must put it in plastic Baggie with bleach, then put it in the garbage. This is because the virus sheds through the scab and can be VERY bad for the immunocompromised. Otherwise, the slight reaction in people around you from live vaccines shouldn't be enough to put you or baby at risk.

But seriously, don't get the smallpox vaccine if you don't have to. It's better than having smallpox, obviously, but don't go volunteer to get stabbed with the same needle 15 times just for the ugly scar it'll leave you.

Edit because it's late and grammar is hard

I had no idea they still did this!

ivyvines6

What is the likelihood of developing smallpox nowadays anyway?

thaisac1

NachosAndPeaches said:

Totally not what you asked, but is the shingles vaccine something I should get after pregnancy (since its live right?), and encourage DH to get? We both had chicken pox as kids and while DS had his varicella vaccine, the new baby won't until they're 1. Or is the vaccine something only older people can get like in the commercials?


Edited for words

We only recommend shingles vaccine for those who are elderly (>60). So you have to wait a few more years.

AmadorRose

jonesl12 said:

AmadorRose said:

NachosAndPeaches said:

Okay good to know RE shingles. My friend's husband got it like 2 weeks before her RSC so I didn't realize how rare it was in our age group. Thank goodness it cleared up before little man was born.

Question, just bc I always like being informed. I know it's not recommended, but what were to happen if a pregnant woman were exposed to a live vaccine? Is it just a small risk to the fetus or is it likely something would actually happen? Should pregnant women avoid others who have recently gotten live vaccines such as how immune compromised people have to? Just curious!
Thanks.

To my knowledge, the only vaccine that shouldn't be given to people with young children or pregnant housemates is smallpox. I very strongly recommend avoiding it like the plague anyway, because that sucker blows. You change a skin-dissolving bandage every day; to properly dispose of it, you must put it in plastic Baggie with bleach, then put it in the garbage. This is because the virus sheds through the scab and can be VERY bad for the immunocompromised. Otherwise, the slight reaction in people around you from live vaccines shouldn't be enough to put you or baby at risk.

But seriously, don't get the smallpox vaccine if you don't have to. It's better than having smallpox, obviously, but don't go volunteer to get stabbed with the same needle 15 times just for the ugly scar it'll leave you.

Edit because it's late and grammar is hard

I had no idea they still did this!

Only because I spent quality time getting paid to play in the mud in an Asian country for the majority of 2014

imrachellea

Um, I've had shingles :-S I'm "that" person that always gets weird medical crap. I got diagnosed with snapping scapula syndrome at 18 (look it up, random, weird, and OH so annoying), MRSA internally that I had to have surgery and a pickline IV for at 23, shingles at 24, live active group B strep at delivery of my daughter...ugh. The chances of any of them are all so small and I get all of them. Too bad my "luck" is only in bad stuff or I'd play the lottery more often! DH is the one that lucks on the GOOD rare stuff!

AmadorRose

imrachellea said:

Um, I've had shingles :-S I'm "that" person that always gets weird medical crap. I got diagnosed with snapping scapula syndrome at 18 (look it up, random, weird, and OH so annoying), MRSA internally that I had to have surgery and a pickline IV for at 23, shingles at 24, live active group B strep at delivery of my daughter...ugh. The chances of any of them are all so small and I get all of them. Too bad my "luck" is only in bad stuff or I'd play the lottery more often! DH is the one that lucks on the GOOD rare stuff!

Obviously your husband got the good luck - he married you

NachosAndPeaches

DH had smallpox vaccine (military as well). I think it's still standard to give service members before deployment? He said the worst one though was anthrax.

AmadorRose

NachosAndPeaches said:

DH had smallpox vaccine (military as well). I think it's still standard to give service members before deployment? He said the worst one though was anthrax.

Oh my gosh yes. And from what I've read the CDC doesn't even recommend the anthrax vaccine for overseas travel any more because there have been a number of seriously nasty side effects. And even worse is knowing that it's a series and you'll have to go back again and again.

haiku16

imrachellea said:

Um, I've had shingles :-S I'm "that" person that always gets weird medical crap. I got diagnosed with snapping scapula syndrome at 18 (look it up, random, weird, and OH so annoying), MRSA internally that I had to have surgery and a pickline IV for at 23, shingles at 24, live active group B strep at delivery of my daughter...ugh. The chances of any of them are all so small and I get all of them. Too bad my "luck" is only in bad stuff or I'd play the lottery more often! DH is the one that lucks on the GOOD rare stuff!

You poor thing! My best friend is a lot like you. She had shingles at 19, was recently hospitalized for some crazy intrabdiminal infection, and is just constantly dealing with odd aliments. Bless you both!

The merk drug rep came in to my work today, strangely enough. She said the only risk with administering is, like we thought , a needle stick. She brushed that risk off if you've had chicken pox.

I'll still ask my ob, but that's the info I've got for now for others in the same boat.

I've heard anthrax and smallpox are horrible vaccines! Sorry to those who serve and have to get it. Thanks a ton for your service though!!

ivyvines6

Not quite on topic, but still amusing.