Adolescent and Adult ACIP Update Immunization Coordinators Meeting

Adolescent and Adult ACIP Update Immunization Coordinators Meeting May 10, 2012

Overview • Adult ACIP Updates § Hepatitis B vaccine for adults with diabetes • Adult and Adolescent ACIP Updates § Tdap Recommendations § Quadrivalent HPV vaccine for males • Adolescent ACIP Update § ACIP MCV 4 for Adolescents • Pertussis Booster Requirement • Adolescent Immunization Data

Adults with Diabetes and Hepatitis B

Background • Since 1996, 25 of 29 outbreaks of hepatitis B infection in long-term care facilities were reported to CDC involving adults with diabetes receiving assisted blood glucose monitoring • Infection control initiatives alone have not been successful in halting outbreaks

Hepatitis B Vaccine Safety and Efficacy • Hepatitis B vaccination appears safe at any age but is less efficacious and less-cost effective among older adults.

ACIP Recommendations: Hepatitis B Vaccine and Adults with Diabetes • Hepatitis B vaccination should be administered to unvaccinated adults with diabetes who are aged 19 through 59 years of age. § Complete series as soon as feasible after diagnosis. • Hepatitis B vaccination may be administered to unvaccinated adults with diabetes who are ≥ 60 years of age at the discretion of the treating clinician. § Assessing their risk and the likelihood of an adequate immune response to vaccination MMWR. December 23, 2011; 60 (50): 1709 -1711. http: //www. cdc. gov/mmwr/pdf/wk/mm 6050. pdf

HPV Vaccine

Updated ACIP Recommendations: Quadrivalent HPV Vaccine (HPV 4) for Males • ACIP recommends routine vaccination of males aged 11 or 12 years with a 3 dose series of HPV 4. § The vaccination series can be started beginning at age 9 years. MMWR. December 23, 2011; 60 (50): 1705 -1708. http: //www. cdc. gov/mmwr/pdf/wk/mm 6050. pdf

Updated ACIP Recommendations: Quadrivalent HPV Vaccine for Males • HPV 4 vaccination is recommended for males aged 13 through 21 years who have not been vaccinated previously or who have not completed the 3 -dose series. • HPV 4 vaccination is recommended for men who have sex with men (MSM) and immunocompromised males who are aged 22 through 26 years who haven’t been vaccinated previously or who have not completed the 3 -dose series. • Other males aged 22 through 26 years may also be vaccinated.

VFC Eligibility: HPV Vaccine • For VFC-eligible patients: Gender Age Bivalent HPV Vaccine Quadrivalent HPV Vaccine Females 9 through 18 years Eligible Males 9 through 18 years Not Eligible

Meningococcal Conjugate Vaccine (MCV 4)

ACIP Recommendations: Meningococcal Conjugate Vaccine Booster • Routine immunization age at 11 – 12 years • Booster dose recommended at age 16 years for those who received a dose at age 11 through 12 years § If vaccinated at age 13 through 15 years, they should receive a one-time booster at age 16 through 18 years § Routine vaccination of healthy (non-high risk) persons is not recommended after age 21 years http: //www. cdc. gov/mmwr/pdf/wk/mm 6003. pdf http: //www. cdc. gov/mmwr/pdf/wk/mm 6040. pdf

ACIP Recommendations: Meningococcal Conjugate Vaccine • MCV 4 is recommended for high-risk persons ages 9 months through 55 years • Two-Dose MCV 4 Primary Series is recommended for persons: § 9 through 23 months of age § Who have functional or anatomic asplenia, persistent complement deficiency or who are HIV positive (with an indication for MCV 4 vaccination) http: //www. cdc. gov/mmwr/pdf/wk/mm 6003. pdf

ACIP Updated Tdap Recommendations

ACIP Recommendations: Tdap • Adolescents should routinely receive a dose of Tdap at age 11 -12 years. • All adolescents through age 18 years should receive a dose of Tdap if they have not yet received Tdap.

ACIP Recommendations: Tdap • Children age 7 through 10 years who are not fully vaccinated against pertussis and who don’t have a contraindication, should receive Tdap for pertussis protection. http: //www. cdc. gov/mmwr/pdf/wk/mm 6001. pdf

ACIP Recommendations: Tdap • For adults aged 19 years and older who previously have not received a dose of Tdap, a single dose of Tdap should be given. § Includes persons 65 years and older • Tdap should be administered regardless of interval since the last tetanus or diphtheria toxoid-containing vaccine. • Adults should receive a Tdap dose if the dose is recommended and no record of previous administration exists.

ACIP Recommendations: Tdap • Pregnant females who have not previously received Tdap should receive a dose of Tdap, preferably after 20 weeks gestation. § If not administered during pregnancy, Tdap can be administered immediately postpartum. • Tdap may be given at any time after a prior dose of Td to provide pertussis protection. There is no minimum interval. http: //www. cdc. gov/mmwr/pdf/wk/mm 6041. pdf

Adolescent Immunizations and Pertussis Booster Requirement

Pertussis Booster Requirement • Thanks for your work to implement the pertussis booster requirement for 7 th -12 th grades for 20112012 • Starting 2012 -2013 and annually thereafter, the requirement for a pertussis booster (Tdap) for all students before admission to 7 th grade will continue. § Remind parents and providers to immunize their 6 th graders now! § www. shotsforschool. org

Pertussis Booster Requirement Tools for Schools and Providers www. shotsforschool. org

Recommended Immunizations and Preventive Health Care • Preteen Health Visit § Visit early during 6 th grade school year • Avoid a back-to-school rush during summertime • Can provide early documentation to schools § All recommended immunizations—Tdap, MCV 4, HPV, influenza § Catch-up immunizations— 2 varicella, 3 hep B, 2 MMR, etc. § Recommended preventive care

National Immunization Survey Teen, 13 -17 Years, California – 2009 and 2010 Vaccine Rate 2009 Rate 2010 1 Tdap 53. 1% (46. 7 -59. 5) 1 MCV 4 58. 4% (52. 0 -64. 6) 71. 2% (65. 1 -76. 5) 66. 7% (60. 5 -72. 3) 1 HPV 49. 2% (39. 9 -58. 6) 56. 1% (46. 9 -64. 9) 3 HPV 21. 8% (15. 8 -29. 4) 32. 0% (24. 5 -40. 6) 2 MMR 87. 2% (82. 6 -90. 8) 87. 9% (82. 2 -92. 0) 3 Hep B 89. 6% (85. 5 -92. 7) 89. 0% (83. 5 -92. 8) VAR disease 40. 0% (34. 1 -46. 2) 40. 1% (33. 9 -46. 6) 1 VAR* 88. 0% (81. 6 -92. 4) 90. 8% (84. 1 -94. 8) 2 VAR* 56. 9% (48. 2 -65. 2) 57. 3% (48. 7 -65. 4) Disease or 2 VAR 74. 1% (68. 1 -79. 3) 74. 4% (68. 3 -79. 6) Influenza** - 54. 0% (47. 9 -60. 1) http: //www. cdc. gov/vaccines/stats-surv/default. htm *If no disease **6 mos – 17 years Interim results thru Feb 2011 (2010 -2011)

National Immunization Survey Teen, Recommended Adolescent Immunization by Age (13 -17 Years) -- U. S. -- 2010 13 years 14 years 15 years 16 years 17 years Tdap 73. 7% (71. 2 -76. 2) 77. 2% (74. 8 -79. 3) 72. 0% (69. 5 -74. 3) 65. 4% (62. 6 -68. 1) 54. 6% (51. 7 -57. 4) MCV 4 63. 8% (61. 1 -66. 5) 66. 6% (64. 0 -69. 1) 64. 0% (61. 4 -66. 5) 61. 8% (58. 9 -64. 5) 57. 1% (54. 2 -60. 0) 1 HPV* 38. 9% (34. 9 -43. 1) 48. 5% (44. 5 -52. 6) 51. 1% (47. 0 -55. 3) 51. 7% (47. 8 -55. 7) 53. 1% (49. 1 -57. 1) 3 HPV* 23. 2% (20. 1 -26. 6) 30. 5% (26. 9 -34. 3) 31. 9% (28. 3 -35. 6) 36. 9% (33. 2 -40. 8) 37. 5% (33. 7 -41. 5) Completed 64. 1% § HPV series* (55. 9 -71. 5) 68. 2% (61. 7 -74. 0) 65. 6% (59. 4 -71. 3) 74. 3% (69. 4 -78. 7) 74. 6% (68. 8 -79. 6) *Females only §For those who had at least 24 weeks between first dose and interview

Vaccine coverage for specific vaccines recommended for adults- 2007, 2010 Vaccination Age groups Influenza 18 -49 yrs 50 -64 yrs 65+ yrs Pneumococcal, ever (2010) CA US 22. 3% (21. 0% - 23. 6%) 36. 0% (34. 3% - 37. 7%) 57. 6% (55. 8% - 59. 4%) 30. 5% (29. 9% - 31. 1%) 44. 5% (43. 9% - 45. 1%) 66. 6% (66. 0% - 67. 2%) 18 -64 yrs (HR) 65+ yrs 55. 5% (53. 7% - 57. 3%) 32. 8% (27. 1% - 39. 0%) 65. 6% (62. 6% - 68. 6%) Tetanus in past 10 yrs 18 -49 yrs 50 -64 yrs 65+ 62. 3% (59. 8% - 65. 0%) 63. 0% (60. 2% - 65. 7%) 54. 3% (51. 5% - 57. 2%) 57. 2% (54. 0% - 60. 5%) 57. 2% (53. 8% - 60. 5%) 44. 1% (40. 7% - 47. 6%) Tdap in past 2 yrs 18 -64 yrs 2. 1% (1. 5% - 2. 9%) Source: Unpublished Behavioral Risk Factor Surveillance System, National Health Interview Survey, 2007

Vaccine coverage for specific vaccines recommended for adults- 2007, 2010 Vaccination Zoster/shingles Age groups 60+ yrs CA US ----- 0. 8% (0. 3% - 1. 8%) 1. 9% (1. 3% - 2. 8%) Hep A 2+ doses, 18 -49 yrs ever --- 12. 1% (9. 8% - 14. 7%) Hep B 3+ doses, 18 -49 yrs ever --- 23. 4% (20. 5% - 26. 5%) HPV 1+ doses, ever --- 9. 9% (4. 9% - 19. 0%) 18 -26 yrs, females Source: Unpublished Behavioral Risk Factor Surveillance System, National Health Interview Survey, 2007

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