TM
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
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 Incidence
1970-2012

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 vaccines
o MenACWY-D (Menactra, Sanofi Pasteur)
• Approved for 9 months through 55 years
o MenACWY-CRM (Menveo, Novartis)
• Approved for 2 months through 55 years
o HibMenCY-TT (MenHibRix, GlaxoSmithKline)
• Approved for infants at 2 through 18 months
TM
Infant Meningococcal Vaccines:
Number Needed to Vaccinate (NNV)
Meningococcal
incidence
(Year Range Data)
Cases
prevented
(4 dose infant
series)
Deaths
Prevented
NNV to
prevent
one 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
Data from Ortega-Sanchez CE model, presented at ACIP, October 2011
Infant and Toddler Meningococcal
Vaccines for High Risk Children
TM
TM
Bordetella pertussis
Major Antigens and Virulence Factors
 Pertussis toxin (PT), also
known as lymphocytosispromoting 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 years
o Adults aged 19 and older
o 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 Tdap
o 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 Tdap
o Preferably during 27-36 weeks’ gestation
o 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 viruses
o 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 lifetime
o Most people not aware when infected
o Necessary but not sufficient for development of cancer
 Estimate 79 million Americans currently HPV infected
o Most common sexually transmitted pathogen in males and
females
o 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 years
o Catch-up: age 13 though 26 years
o Either HPV4 or HPV2 is recommended
 Males
o Routine: age 11 or 12 years
o Catch-up: age 13 through 21 years
age 22 through 26 years may be vaccinated
o 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, 20032010. 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 musthave resources that are included in a comprehensive
reference library and time-saving clinical tools.