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Changes to the2014

Immunization Schedules

H. Cody Meissner, MD, FAAP Floating Hospital for ChildrenTufts University School of Medicine

February 4, 2014

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Prepared for your next patient.

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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.

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Title

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Meningococcal Disease Incidence1970-2012

1970-1996 NNDSS data, 1997-2012 ABCs data estimated to U.S. population

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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

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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

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Infant and Toddler Meningococcal Vaccines for High Risk Children

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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)

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Pertussis Deaths, United States, 2000-2009

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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

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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

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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

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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)

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HPV Associated Cancers, both Sexes, 2005-2009

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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

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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

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Vaccine Preventable Cervical Cancer

Courtesy of National Cancer Institute

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Thank You

Boston Floating Hospital, circa 1920

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