How do I order an MMR, Tdap, chickenpox vaccine, and a TB test?

How to Order MMR, Tdap, Chickenpox Vaccines, and TB Test

To order MMR, Tdap, chickenpox vaccines, and a TB test, request each immunization separately on a standard immunization order form, ensuring appropriate timing between vaccines and TB testing, with MMR and varicella administered on the same day or separated by at least 28 days from the TB test to prevent false-negative TB results.

Ordering Process for Adult Immunizations

MMR (Measles, Mumps, Rubella) Vaccine

• Order as a single dose (0.5 mL) administered subcutaneously 1
• Indicated for adults born during or after 1957 who lack evidence of immunity 1
• A second dose is recommended for:
  • Healthcare workers
  • Students in postsecondary educational institutions
  • International travelers
  • Those in outbreak settings 1
• Evidence of immunity includes:
  • Documentation of adequate vaccination
  • Laboratory evidence of immunity
  • Birth before 1957 (except for healthcare workers)
  • Physician-diagnosed measles 2

Tdap (Tetanus, Diphtheria, Acellular Pertussis) Vaccine

• Order as a single dose (0.5 mL) administered intramuscularly 1
• Recommended as a one-time dose for adults who have not previously received Tdap 1
• After Tdap, subsequent tetanus and diphtheria boosters (Td or Tdap) should be given every 10 years 1
• For unvaccinated adults, follow the 3-dose series:
  • First dose: Tdap
  • Second dose: Td or Tdap (≥4 weeks after first dose)
  • Third dose: Td or Tdap (6-12 months after second dose) 1

Varicella (Chickenpox) Vaccine

• Order as two doses (0.5 mL each) administered subcutaneously, 4-8 weeks apart 1
• Indicated for adults without evidence of immunity 1
• Evidence of immunity includes:
  • Documentation of 2 doses of varicella vaccine
  • U.S. birth before 1980 (except for healthcare workers)
  • History of varicella confirmed by healthcare provider
  • Laboratory evidence of immunity 1

TB Test

• Order either:
  • Tuberculin skin test (TST/PPD)
  • Interferon-gamma release assay (IGRA) blood test
• Important timing consideration: TB skin testing should be done either on the same day as MMR/varicella vaccination OR ≥4 weeks after vaccination 1
  • MMR and varicella vaccines can temporarily suppress tuberculin reactivity

Important Considerations for Simultaneous Administration

1. Timing between vaccines and TB testing:

   • MMR and varicella vaccines can temporarily suppress tuberculin skin test reactivity 1
   • If TB testing cannot be done on the same day as MMR/varicella vaccination, delay it for at least 4 weeks after vaccination 1

2. Co-administration of vaccines:

   • MMR and varicella vaccines can be administered on the same day 1
   • If not given on the same day, separate MMR and varicella vaccines by at least 28 days 1
   • Tdap can be administered simultaneously with other vaccines at different anatomic sites 1

3. Documentation requirements:

   • Include patient's name, date of birth, and medical record number
   • Specify exact vaccine formulations (e.g., "MMR II")
   • Include route of administration and anatomic site
   • Document lot numbers and expiration dates after administration

Special Situations

• For pregnant women: Defer MMR and varicella vaccines until after pregnancy; Tdap is recommended during each pregnancy (preferably at 27-36 weeks) 1
• For healthcare workers: Additional documentation of immunity may be required; two doses of MMR are recommended regardless of birth year 1
• For immunocompromised individuals: Live vaccines (MMR, varicella) are generally contraindicated; consult specialist guidelines 1

Common Pitfalls to Avoid

1. Not checking immunity status before vaccination: Consider testing for varicella immunity in adults with uncertain history, as unnecessary vaccination is costly 3
2. Incorrect timing between TB testing and live vaccines: This can lead to false-negative TB test results 1
3. Inadequate intervals between doses: Ensure proper spacing between multiple-dose vaccines
4. Failing to document pre-existing immunity: Check for documented history of disease or previous vaccination before ordering

By following these guidelines, you can ensure appropriate ordering and administration of MMR, Tdap, chickenpox vaccines, and TB testing while maximizing effectiveness and minimizing potential interference between tests and vaccines.