changes to the 2014 immunization schedules h. cody meissner, md, faap
DESCRIPTION
TM. Prepared for your next patient. Changes to the 2014 Immunization Schedules H. Cody Meissner, MD, FAAP Floating Hospital for Children Tufts University School of Medicine February 4, 2014. Disclaimers. - PowerPoint PPT PresentationTRANSCRIPT
TM
Changes to the2014
Immunization Schedules
H. Cody Meissner, MD, FAAP Floating Hospital for ChildrenTufts University School of Medicine
February 4, 2014
TM
Prepared for your next patient.
TM
Disclaimers I have no relevant financial relationships with the
manufacturer(s) of any commercial product(s) discussed in this presentation.
I may discuss the use of vaccines in a manner not consistent with the Package Insert, but all recommendations are in accordance with recommendations from the Advisory Committee on Immunization Practices (ACIP) and American Academy of Pediatrics (AAP).
Statements and opinions expressed are those of the authors and not necessarily those of the AAP.
TM
TM
Title
TM
Meningococcal Disease Incidence1970-2012
1970-1996 NNDSS data, 1997-2012 ABCs data estimated to U.S. population
TM
Meningococcal Vaccines Quadrivalent polysaccharide vaccine
o MPSV4 (Menomune, Sanofi Pasteur)
Conjugate vaccineso MenACWY-D (Menactra, Sanofi Pasteur)
• Approved for 9 months through 55 yearso MenACWY-CRM (Menveo, Novartis)
• Approved for 2 months through 55 yearso HibMenCY-TT (MenHibRix, GlaxoSmithKline)
• Approved for infants at 2 through 18 months
TM
Infant Meningococcal Vaccines:Number Needed to Vaccinate (NNV)
Data from Ortega-Sanchez CE model, presented at ACIP, October 2011
Meningococcal incidence
(Year Range Data)
Cases prevented
(4 dose infant series)
Deaths Prevented
NNV to preventone case
NNV to prevent
one death
High Incidence(1997-1999)
307 20-30 11,000 127,000
Base-case(1993-2009)
135 5-10 25,000 325,000
Low Incidence(2007-2009)
44 2-4 76,000 642,000
TM
Infant and Toddler Meningococcal Vaccines for High Risk Children
TM
Bordetella pertussisMajor Antigens and Virulence Factors
Pertussis toxin (PT), also known as lymphocytosis- promoting factor (LPF)
Filamentous hemagglutinin (FHA)
Pertactin (PRN), also known as 69 kilodalton protein
Fimbrial agglutinogens (FIM)
TM
Pertussis Deaths, United States, 2000-2009
TM
Current Recommendations for Tdap Adolescents aged 11 through 18 years, preferred at 11 or
12 yearso Adults aged 19 and oldero Special focus on adults in contact with young children
• Pregnant women• Healthcare professionals• Parents and siblings• Grandparents (including those >65 years of age
o The modest impact and short duration of protection from Tdap does not support a recommendation for 2nd dose
Decennial Td booster for those who have received 1 Tdapo 5 years for wound management
TM
Tdap Recommendations for Pregnant Women Administer Tdap to pregnant adolescents and adults
during each pregnancy o Regardless of number of years since prior Td or Tdapo Preferably during 27-36 weeks’ gestationo Additional doses not recommended for fathers or
other family members/caregivers
If not administered during pregnancy, Tdap should be administered immediately postpartum if no previous Tdap
TM
Human Papillomaviruses (HPV) Double stranded DNA virus
o More than 130 closely related viruseso Types numbered in order of discovery (L1)o Classified as low risk (non-oncogenic) or
high-risk (oncogenic) Almost all males and females will be infected at least once in
their lifetimeo Most people not aware when infectedo Necessary but not sufficient for development of cancer
Estimate 79 million Americans currently HPV infectedo Most common sexually transmitted pathogen in males and
femaleso 6.2 million new infections each year o 26,200 new HPV cancers each year
TM
ACIP Recommendations for HPV Vaccination Females
o Routine: age 11 or 12 yearso Catch-up: age 13 though 26 yearso Either HPV4 or HPV2 is recommended
Males o Routine: age 11 or 12 yearso Catch-up: age 13 through 21 years
age 22 through 26 years may be vaccinatedo HPV4 is recommended
Administer second dose 1-2 months after 1st dose and administer 3rd dose 6 months after 1st dose (at least 24 weeks after 1st dose)
TM
HPV Associated Cancers, both Sexes, 2005-2009
TM
Adolescent Vaccine (13-17 Years Old), United States, 2006-2012
Centers for Disease Control and Prevention. National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012. MMWR. 2013;62(34);685-693; NIS-Teen
TM
Prevalence of HPV 6, 11, 16, 18* in Cervicovaginal Swabs, By Age Group NHANES, 2003-2006 and 2007-2010
Markowitz LE, Hariri S, Lin C, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis. 2013;208(3):385-93 *weighted prevalence
TM
Vaccine Preventable Cervical Cancer
Courtesy of National Cancer Institute
TM
Thank You
Boston Floating Hospital, circa 1920
TM
Visit Pediatric Care Online today for additional information on this and other topics.
www.pediatriccareonline.org
Pediatric Care Online is a convenient electronic resource for immediate expert help with virtually
every pediatric clinical information need with must-have resources that are included in a comprehensive
reference library and time-saving clinical tools.