How Long is that Vaccine Good?

August 16, 2017
Terry Brenneman, MD
Terry Brenneman, MD

Once a vaccine is drawn up, the clock starts ticking. How long do you actually have? Try these 2 questions, and download a CDC guide at the end.

[[{"type":"media","view_mode":"media_crop","fid":"62449","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6784460481366","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"7938","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 300px; float: right; height: 277px;","title":" ","typeof":"foaf:Image"}}]]You arrive at your office at 8:00 am to find a “double header” in your first exam room: two new patients, siblings aged 2 months and 5 years for routine well child exams. Both are healthy, but mom has a history of generalized anxiety and depression so the visit goes way past the scheduled time as she asks question after question.

As you finish up, you dread her reply when you ask if she has any questions about the vaccines: Pentacel, Rotarix, Hep B, and Prevnar for the baby and Proquad and Quadracel for the 5-year-old. You breathe a sigh of relief when she tells you, “Oh, I’m a big fan of vaccines.” You skip your usual spiel about vaccines and fever, hand her the VIS sheets as required by federal law, and tell your nurse to administer the vaccines. You now race to your next appointment 20 minutes behind schedule.

But the next visit is a quick one and you start feeling a little better about how your day is beginning until you walk out of the room and see your nurse waiting for you with 2 trays with drawn-up vaccines. Your nurse tells you the previous mom changed her mind about getting the shots today since she is leaving on a long drive for a 3-day weekend and she read how some children can get a fever from the vaccines. On her way out, she made an appointment in 4 days to return for the vaccines. Your nurse tells you that a 4- month-old needing the same combination of shots will arrive in 15 minutes and will be ready for you in about 25 minutes.

She asks you, “If I put these in the refrigerator, can we use them for this next child?”

1. You tell her:

A. Throw out the Pentacel: it has to be used immediately after reconstitution.

B. Rotarix can be used since it is good for 8 hours after reconstitution.

C. The Hep B and Prevnar vaccines, both drawn from single dose vials need to be used within 24 hours if stored at the correct temperature.

D. Yes, you can give all 4 vaccines to the next child if it is within an hour and they are stored at the proper temperature.

Please leave your answer below.

Please click here for correct answer and discussion.

 

The only fully correct answer is A.Throw out the Pentacel: it has to be used immediately after reconstitution.

Per the PI, Pentacel needs to be used “immediately” after reconstitution. Rotarix can be actually be kept for up to 24 hours after reconstitution. The CDC recommends that vaccines drawn up into a syringe be thrown out at the end of the day. The same is true for a manufacturer-filled syringe once the needle guard has been removed.

2. How much time do you have to use the reconstituted ProQuad?

A. It has to be used immediately

B. 30 minutes

C. 60 minutes

D. Discard at the end of the day

Please leave your answer below.

Please click here for correct answer and discussion.

The correct answer is B. 30 minutes.

This time limit is due to the varicella component of the combination vaccine. An MMR by itself remains viable for 8 hours; a varicella or zoster vaccine is only good for 30 minutes after reconstitution.

This mom’s anxiety and your rush to get out of the room ended up costing you about $240, the private sector cost of a Proquad and Pentacel vaccine.

Once a vaccine is drawn up, the clock starts ticking.

You may want to copy and post this sheet listing time allowed between vaccine reconstitution and administration – Vaccines with Diluents: How to Use Them. And, from the Immunization Action Coalition, an “Ask the Experts” section onvaccine handling and storage, including CDC guidelines on storage of drawn-up vaccines.