Whose Calling the Shots? - A 2019 Vaccine Update. Frank Bell Swedish Pediatric Infectious Disease Jan 2019
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1 Whose Calling the Shots? - A 2019 Vaccine Update Frank Bell Swedish Pediatric Infectious Disease Jan 2019
2 2019 Vaccine Update Vaccines Meningococcal serogroup B HPV Pertussis Influenza Children with uncertain immunization history
3 Disclosures I have no financial conflicts of interest I do not intend to discuss use of off-label, unapproved or investigational products
4 Meningococcal Serogroup B Vaccines
5
6 ACIP recommendations 2018 Clinical Discretion Age 10+ yr Men B vaccine 12 mo Age yr Non-high-risk groups that may receive vaccine, subject to individual clinical decision making
7
8 College Outbreaks
9
10 Meningococcal Disease Multiple (13+) serogroups B, C, Y, W commonest in US, EU A, X in Africa
11 Meningococcal Vaccines Protein-CPS Conjugate (ACWY) Menactra Menveo - MenACWY-D - MenACWY-CRM
12 Meningococcal Vaccines Protein-CPS Conjugate ACWY Menactra Menveo - MenACWY-D - MenACWY-CRM Serogroup B Trumenba Bexsero - MenB-fHbp - MenB-4C
13 Meningococcal serogroup B vaccine components Surface proteins +/- Membrane vesicles
14 MenB-fHbp vaccine components (Trumenba ) MenB-fHbp 2 variants of complement Factor H binding protein
15 MenB-4C vaccine components (Bexsero )
16 Lancet 2016; 388: 2775
17
18 Uncertainties Safety/tolerance Strain coverage Efficacy/effectiveness/impact Cost-effectiveness
19 Meningococcal Vaccines 2019
20 MMWR 2017; 66: 509
21 Current ACIP recommendations for MenB vaccine use Persons aged 10 years at increased risk for (serogroup B) meningococcal disease, including outbreaks Adolescents & young adults (age years, age preferred) (i.e. routinely offered, optional )
22 ACIP recommendations 2018 Serogroup B meningococcal vaccines: Clinical discretion: Adolescents who want vaccine
23
24
25 Practicalities Either MenB vaccine can be used when indicated The two MenB vaccines are not interchangeable; - the same vaccine product must be used for all doses in a series The minimum interval between any 2 doses of MenB vaccine is 4 weeks MenB-FHbp or MenB-4C may be administered concomitantly with other vaccines indicated for this age, but at a different anatomic site MMWR 2017; 66: 509
26 Human Papilloma Virus Vaccine
27
28 ACIP recommendations 2018 HPV9 HPV vaccine Age 9+ yr Age yr Give from age 9 years, 2 doses needed if initiated before 15 years Efficacy in prevention of cervical pre-cancers, genital warts & anal pre-cancers
29 Pertussis Vaccine
30 Acellular Pertussis Vaccines 2 vaccines (3-component & 5-component ) 5+1 doses (5 x DTaP + Tdap) + Tdap each pregnancy (at 27 to 36 weeks) or postpartum if no history of Tdap Cocooning Immunize HCP if no history of Tdap (irrespective of prior Td)
31 Influenza Vaccine
32
33 Influenza Vaccines Egg grown Cell-culture based Recombinant > 6 mo > 4 yrs not (yet) licensed for children Others coming Live attenuated (LAIV) > 2 yrs an option (ACIP)
34 Evaluation of individuals with uncertain immunization history
35 Evaluation of children with uncertain immunization history Obtain (written) individual vaccine records Look up National Schedules; expect DTwP, measles, ± hepb Care with OPV, M(not MR) Limited role for serologic testing Suggest administering MMRVx2, DTaP/Tdap + IPV for most + vaccines not administered in country of origin
36 Management: Age-appropriate Revaccination Vaccine Ag Recommend Alternative DTaP / Tdap Give single dose, then check DT (IgG) Hep B Check HepBsAg (+/- Ab) prior to vaccination MMR(V) (re)vaccinate Serology (IgG) Hep A (re)vaccinate Serology (IgG) Adapted from ACIP
37 Questions?
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