8/10/17 UPDATES IN ADOLESCENT AND ADULT IMMUNIZATIONS IN AMBULATORY CARE. Objectives. Background: ACIP. Membership. Focus

Transcription

1 UPDATES IN ADOLESCENT AND ADULT IMMUNIZATIONS IN AMBULATORY CARE Laurie L. Duran, MSN, CRNP-Adult Texas Nurse Practitioners 29 th Annual Conference Sep 2017 Objectives 1. Use available resources to interpret 2017 Advisory Committee on Immunization Practice (ACIP) recommendations for Adolescents and Adults by vaccine and age group, and given case scenarios, make appropriate vaccination recommendations. 2. Review guidelines for immunizing adults based on medical and other indications, and given case scenarios, make appropriate vaccination recommendations. 3. Review immunization contraindications, precautions and adverse events. Background: ACIP Membership Voting members Nonvoting members Focus Newly licensed vaccines Vaccine formulations Re-evaluation recommendations 1

2 Background: ACIP 2017 Immunization Schedules Children and Adolescents (0 through 18 years) Catch-up Schedule (4 months to 18 years) Adult Schedule, by Vaccine and Age Adult Schedule by Medical and Other Indications Recommendations, not mandates Recommended Immunization Schedule by Vaccine and Age Group: Adults Adult Schedule Changes Influenza vaccination (IIV) Human papillomavirus vaccination (HPV) Hepatitis B vaccination (HepB) Meningococcal vaccination (MenACWY, MenB) Format Footnotes Source: Centers for Disease Control and Prevention 2

3 8/10/17 Influenza Vaccine Egg Allergies Hives only Symptoms other than hives HPV Vaccination Young adults who did not complete HPV series before age 15 Did not start give 3 doses (0,1 2, and 6 months) Received 1 dose give 1 dose Received 2 doses but < 5 months apart give 1 dose Received 2 doses > 5 months apart - considered adequately vaccinated Recommended Immunization Schedule by Vaccine and Age Group: Adolescents 3

4 Adolescent Footnote Updates MenB 16 through 23 year olds may be vaccinated based on clinical discretion Two-dose Trumenba schedule added HPV If series started before 15 th birthday, 2- doses If series started after 15 th birthday, 3-doses 3-dose series for people with certain immunocompromising conditions Tdap One dose administered to pregnant women as early as possible during the 27 to 36 week gestational-age period Children 7 through 10 years who receive Tdap, either Tdap or Td may be administered for the adolescent dose at 11 through 12 years Adolescent Medical Indications Resources CDC, Vaccines & Immunizations Immunization Action Coalition DHA Immunization Healthcare Branch National Foundation for Infectious Diseases, Adult Vaccinations Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP) Epidemiology and Prevention of Vaccine-Preventable Diseases (13th Edition, 2015) 4

5 Recommended immunization schedule by medical and other indications Medical and Other Indications Pregnancy Immunocompromised (excluding HIV infection) HIV infection (CD4+count) Asplenia, persistent complement component deficiencies Kidney failure, ESRD, on hemodialysis Heart or lung disease, chronic alcoholism Chronic liver disease Diabetes Healthcare Personnel Men who have sex with men Hepatitis B Vaccination (HepB) Chronic liver disease conditions for which HepB series is recommended: Hepatitis C virus infection Cirrhosis ALT or AST levels >2x the upper limit of normal Fatty liver disease Alcoholic liver disease Autoimmune hepatitis 5

6 Meningococcal vaccinations (MenACWY, MenB) Asplenic or persistent complement component deficiencies 2-dose primary series of MenACWY, with doses at least 2 months apart Revaccinate every 5 years Receive MenB series Adults with HIV infection No previous MenACWY ü2-dose primary series of MenACWY, with doses at least 2 months apart Received 1 dose of MenACWY üreceive 2nd dose at least 2 months after first dose Revaccinate every 5 years Meningococcal vaccinations (MenACWY, MenB) Microbiologists routinely exposed to N. meningitidis Receive 1 dose of MenACWY Revaccinate every 5 years Receive MenB series Meningococcal disease outbreak 1 dose of MenACWY if the outbreak is attributable to serogroup A, C, W, or Y MenB series if the outbreak is attributable to serogroup B Vaccine Contraindications and Precautions 6

7 Vaccine Adverse Events Adverse Event Following Immunization (AEFI) Any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the use of the vaccine Adverse Reaction A response to a drug which is noxious and unintended, and which occurs at recommended doses Vaccine Adverse Events Local reactions include site pain, swelling, redness Systemic reactions include fever, malaise, myalgia, rashes In rare cases, an aberrant immune reaction results in potentially serious adverse events Allergic reactions to vaccine components Legal Considerations for Immunizations Public Health Provisions: Immunizations Documentation Liability Prescribing State vaccine requirements for Schools Child-Care Facilities Elementary Secondary Exemptions Provisional Enrollment 7