2017 Vaccination Update
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1 2017 Vaccination Update NATHAN BOONSTRA, MD General Pediatrician, Blank Pediatric Clinic TODAY S OBJECTIVES Review the latest recommendations for immunizations, including HPV Meningococcal vaccines Influenza Tdap Exciting bonus: Latest ACIP updates! I have no disclosures to report ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES MEETING OCTOBER 24-25, 2017 MUMPS ACIP recommendations do not become official CDC recommendations until published in MMWR NEW SHINGLES VACCINE: SHINGRIX MENINGOCOCCAL VACCINES Adjuvanted subunit vaccine Preferentially recommended by ACIP over existing shingles vaccine FDA approved October 20 May not be available soon 1
2 NEISSERIA MENINGITIDIS Serotypes A, B, C, W, and Y Cases declining 375 in 2015 Fatality rate is 10-15% with invasive disease Another 20% have permanent sequelae IOWA SCHOOL REQUIREMENT For the school year, and all future school years, all students entering, advancing or transferring into 7th grade and born after September 15, 2004, will need proof of one dose of meningococcal conjugate vaccine (MenACWY). [Menveo or Menactra] All students entering, advancing, or transferring into 12th grade and born after September 15, 1999, will need proof of two doses of meningococcal (A, C W, Y) vaccine (1 dose received on or after 16 years of age); or 1 dose if received when the student was 16 years of age or older. CDC MENINGOCOCCAL ACWY RECOMMENDATIONS Administer a single dose of Menactra or Menveo vaccine at age 11 through 12 years, with a booster dose at age 16 years. Children with high-risk conditions may be immunized earlier No second dose if first dose given at 16 or older HIGH RISK INDIVIDUALS Laboratory personnel who are routinely exposed to meningococcal bacteria Those who might have been exposed to meningococcal disease during an outbreak, such as those on college campuses Travelers People with persistent complement component deficiency, anatomic or functional asplenia, HIV 2
3 CDC MENINGOCOCCAL B RECOMMENDATIONS CATEGORY B or PERMISSIVE RECOMMENDATION Young adults aged 16 through 23 years (preferred age range is 16 through 18 years) who are not at increased risk for meningococcal disease may be vaccinated with a 2 dose series of either Bexsero (0, 1 month) or Trumenba (0, 6 months) vaccine to provide short term protection against most strains of serogroup B meningococcal disease. HPV VACCINES HPV VACCINES For girls and boys starting the vaccination series before the 15th birthday, the recommended schedule is 2 doses of HPV vaccine. The second dose should be given 6 12 months after the first dose. ACIP Recommendation and AAP Guidelines for HPV Vaccine Routine HPV vaccination recommended for both males and females ages years Also ages years for males; for females Vaccine can be given starting at age 9 years of age for both males and females; vaccine can be given ages years for CDC. Quadrivalent Human Papillomavirus Vaccine: Recommendations of ACIP. MMWR 2007;56(RR02):1-24. males 3
4 Numbers of Cancers and Genital Warts Attributed to HPV Infections, U.S. CDC. Human papillomavirus (HPV)-associated cancers. Atlanta, GA: US Department of Health and Human Services, CDC; Available at Providers underestimate the value parents place on adolescent vaccines Graph by Dr. Amy Middleman, OU Children s, Oklahoma Adapted from Healy et al. Vaccine. 2014;32: INFLUENZA VACCINES INFLUENZA VACCINE RECOMMENDATIONS Routine annual influenza vaccination is recommended for all persons aged 6 months who do not have contraindications. First flu season under age 9 = 2 doses Egg allergy? High dose? No LAIV (FluMist) 4
5 VACCINES IN PREGNANCY Influenza: Administer ideally before flu season, regardless of trimester Tdap: Administer during each pregnancy, preferably between 27 and 36 weeks' gestation, regardless of when they last had Tdap Thank you. Thankyouverymuch. Facebook: facebook.com/pedsgeekmd Blog: pedsgeekmd.com Vax Talk Podcast 5
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