Vaccine Update Paul A. Offit, MD Division of Infectious Diseases Vaccine Education Center The Children s Hospital of Philadelphia Perelman School of Medicine The University of Pennsylvania
Topics Hep A: Influenza: Varicella: Mumps: Mening: Updated recommendations How did we do this year? Impact of childhood vaccine on incidence of shingles Time for a 3 rd dose? An extraordinary case
Hepatitis A vaccine: Updated recommendations
Hepatitis A catch-up recommendation The cohort of children vaccinated in 2006, when the hepatitis A vaccine was routinely recommended for children 12-23 months of age will reach adolescence (age 13) in 2018 and adulthood (age 19) in 2024. National vaccine coverage among 13-17 year olds in 2013 for 1 or 2 doses was 62% and 51%, respectively.
Hepatitis A catch-up recommendation Children and adolescents 2-18 years of age who have not previously received hepatitis A vaccine should be vaccinated routinely at any age with the appropriate dose and schedule. Consider adults catch-up recommendation during outbreaks on in areas with increasing disease rates.
Influenza vaccine: How did we do this year?
Influenza: 2016-2017 Severity was moderate, similar to last year where H3N2 influenza virus also dominated. Influenza B viruses became more frequent than influenza A viruses by late March. The majority of circulating influenza viruses were similar to those contained in the vaccine.
Was the influenza vaccine effective in children 6 months of age with cough illnesses lasting 7 days?
Was the influenza vaccine effective in adults 18 years of age hospitalized with cough 10 days duration?
Influenza vaccine effectiveness: 2016-2017 Influenza vaccine reduced outpatient visits by 42% for influenza A/B viruses and by 34% for influenza H3N2 viruses. Vaccine effectiveness similar to previous seasons with H3N2 with good vaccine match. Vaccine reduced influenza hospitalizations by 30% among all adults and 37% among adults 65 years of age for all A/B viruses.
Varicella vaccine for children: Impact on shingles in adults
Background Herpes zoster (HZ) caused by reactivation of varicella virus. HZ influenced by subclinical reactivation (endogenous boosting) and exposure to others with varicella (exogenous boosting). Reducing circulating varicella could decrease exogenous boosting, which made ACIP cautious about varicella vaccine in the 1990s. (Europeans still cautious).
Trends in HZ in the United States Seven studies have shown no evidence of an accelerating trend in HZ since the introduction of varicella vaccine in the U.S. Five of these studies actually show a deceleration. HZ trends cannot be attributed to Zostavax due to slow uptake and moderate effectiveness.
Possible explanations Endogenous boosting is more important than exogenous boosting. Inadequate time to see an impact. U.S. studies incorrect due to cross-study artifacts.
Mumps vaccine: Time for a 3 rd dose?
Mumps pre-vaccine era (1917-1967) Peak incidence in 5-9 year olds. About 90% of children infected by age 14. Most cases late winter, early spring. Adult outbreaks in the military. Significant cause of aseptic meningitis.
Mumps vaccine Licensed in 1967. Live attenuated strain (Jeryl Lynn), genotype A. Effectiveness estimates: One Dose: 77% (CI 49-88) Two Doses: 88% (CI 66-95) Unlike measles and rubella, immunity to mumps fades 10 years after 1 st or 2 nd dose.
Arguments for more aggressive recommendation Memory responses to mumps poorer than for measles or rubella following MMR. For rubella, 5,000 memory B cells per 10 6 cells For measles, 3,000 memory B cells per 10 6 cells For mumps, 300 memory B cells per 10 6 cells Could reasonably argue for 3-dose recommendation for people more than 10 years post 2 nd dose.
Meningococcal vaccine: An extraordinary case
Meningococcal Capsular Polysaccharide
FHbp: Factor H binding protein subfamily A (variant 2,3) or subfamily B (variant 1) NHBA: Neisserial heparin binding antigen NadA: Neisserial adhesin A Vaccine 30S:B87,2012
Additional Resources ACIP meetings on-line - http://www.cdc.gov/vaccines/recs/acip/default.htm Vaccine Education Center at CHOP http://vaccine.chop.edu Centers for Disease Control and Prevention http://www.cdc.gov/vaccines Immunization Action Coalition http://www.immunize.org Every Child By Two http://www.ecbt.org
To obtain continuing education credits, go to: http://vaccine.chop.edu/credits