CetiAlphaFive

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So, let's say there's a hypothetical patient in her late 60s.
Self reported history of meningitis in her 20s, and she is also asplenic.

They come in with saying their specialist MD told them they need both versions of the meningitis shot, and not to stop going to the pharmacy until they'd received 3 injections over the course of a few months.
I tell them that I'll have to research it to see if I'm allowed to do that under my immunization protocol.

M.D. then faxes me an Rx with "Give both vaccines" for Bexsero and Menactra, along with a sheet detailing the patient's history.

I've been digging for about 30 minutes now in the ACIP recommendations, but I'm wading through pages and pages of info on the schedules for teenagers.


Is giving both shots to this theoretical patient:

A.) No don't do it.
B.) I can't see any reason not to do it.
C.) This is actually exactly the correct way to do it per the guideline that you can't find for some reason, and here's a link to that guideline: ________________.
 

Rouelle

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1. Why doesn’t the physician administer it?

2. In my state (not Texas), your protocol is irrelevant if you have a physician order / script.

3. I would probably look into appropriate timing schedules for the two, then give as appropriately as I could pursuant to a prescribed script
 

owlegrad

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B

All I found was this:

Either quadrivalent meningococcal conjugate vaccine (MenACWY) or meningococcal polysaccharide vaccine (MPSV4) is recommended for adults if you:

  • Have a damaged spleen or your spleen has been removed.

So I couldn't find anything about giving both. Personally I would give both since the potential for harm seems low and the physician has provided you documentation to fall back on if needed. Now if you are asking for an evidence based reason to give both I am sure you won't find it. ;)
 
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CetiAlphaFive

CetiAlphaFive

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B

All I found was this:

Either quadrivalent meningococcal conjugate vaccine (MenACWY) or meningococcal polysaccharide vaccine (MPSV4) is recommended for adults if you:

  • Have a damaged spleen or your spleen has been removed.

So I couldn't find anything about giving both. Personally I would give both since the potential for harm seems low and the physician has provided you documentation to fall back on if needed. Now if you are asking for an evidence based reason to give both I am sure you won't find it. ;)
Same result here.

I emailed ACIP just to be airtight, but I'm gonna see if the most important party involved approves of the duplication...


insurance!
 

RxAndroid

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Always comes in to bite you in the ass when you are distracted with clinical/questionable decisions with no definitive answer
 

PolarPop

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Did she already get Manactra/Bexsero in the past? We give Menactra and Bexsero together 14 days before splenectomy all the time so that part seems fine. (ctrl f 14 days to see the rec)
Ask the Experts about Meningococcal ACWY Vaccine - CDC experts answer Q&As

I know there is a recommendation to give Menactra every 5 years after splenectomy but haven't heard of an indication for Bexsero boosters after splenectomy (assuming she completed the course). It seems like the patient is just very high risk due to her history and the MD doesn't see a downside in giving another dose.
Ask the Experts about Meningococcal B Vaccine - CDC experts answer Q&As

The "ask the experts" section of that website is one of the best resources for vaccine questions.
 
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CetiAlphaFive

CetiAlphaFive

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Did she already get Manactra/Bexsero in the past? We give Menactra and Bexsero together 14 days before splenectomy all the time so that part seems fine. (ctrl f 14 days to see the rec)
Ask the Experts about Meningococcal ACWY Vaccine - CDC experts answer Q&As

I know there is a recommendation to give Menactra every 5 years after splenectomy but haven't heard of an indication for Bexsero boosters after splenectomy (assuming she completed the course). It seems like the patient is just very high risk due to her history and the MD doesn't see a downside in giving another dose.
Ask the Experts about Meningococcal B Vaccine - CDC experts answer Q&As

The "ask the experts" section of that website is one of the best resources for vaccine questions.
You're a champion
 
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Rockinacoustic

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Since Menactra and Bexsero weren't available to your hypothetical patient 40 years ago, it's probably reasonable.

We follow ACIP/CDC recs for asplenic patients:
  • Prevnar 13/Pneumovax 23 depending on prior pneumococcal vaccine history
  • ActHIB
  • Menactra x 1 dose- 2nd dose 8 weeks late, then every 5 years
  • Bexsero x 1 dose - 2nd (and final) dose 4 weeks after
 

Rouelle

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This was a great thread.

Kudos to everyone who pitched in.

I'll post ACIP's response once my plane lands.
I would love to see more threads like this. Although I suppose some of the other threads do have more...”entertainment value”...than these grown-up threads have.
 

txpharmguy

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Depending upon your protocol, since Menomune is no longer available, you may have to punt on this one. My employers protocol in Texas for pt >55 have to get thru doc (even with an rx)
 
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