CHAMPS 2012 Immunization Update with Iyabode A. Beysolow, M.D., - PowerPoint PPT Presentation

CHAMPS 2012 Immunization Update with Iyabode A. Beysolow, M.D., M.P.H. National Center for Immunization and Respiratory Diseases Teleconference (HRSA – Region VIII) July 25, 2012 7/19/2012

Disclosures  Dr. Beysolow has no financial conflict or interest with the manufacturer of any product named during this course.  I will not discuss the use of vaccines in a manner that differs from the product insert with the exception of Tdap and PCV13 vaccines.  I will not discuss vaccines not licensed by the FDA 7/19/2012

Objectives  Increase provider knowledge regarding immunizations and the importance of promoting immunizations in the community.  Explain one recent change to immunization recommendations coming from the Advisory Committee for Immunization Practices 7/19/2012

What do providers want to know about vaccines? What are CDC/ACIP Recommendations? What’s new in the vaccine world? What should I tell my patients/parents? Where can I find resources quickly? 7/19/2012

Overview  Introduction  ACIP overview – who is the ACIP?  2012 Immunization Schedules  Feb 2012 and June 2012 ACIP Meeting Updates  Updated ACIP recommendations  PCV13 in Immunocompromised Adults  Tdap – adults and adolescence  Influenza Updates  HepB – adults with diabetes  HPV4 – routine recommendation for males  Health Care Worker Recommendations  Vaccine Administration (S and H)  Resources  Q and A 7/19/2012

Who is the ACIP? 7/19/2012

Changes to the Schedules  Concerns:  Increasing complexity of the schedule  Limited space for footnotes  Solutions:  In order to improve footnote readability:  Redundancy between footnotes and figures eliminated  Reference to respective MMWR documents for more details 7/19/2012

Changes to the Childhood Schedule  Providers are asked to use all 3 schedules and their footnotes together and not separately 7/19/2012

CDC Vaccines Webpage http://www.cdc.gov/vaccines/recs/schedules/ch ild-schedule.htm#printable 7/19/2012

MMWR webpage http://www.cdc.gov/mmwr/ 7/19/2012

Changes to the Childhood Schedule  0-6 year schedule:  MCV bar extended  Hep A ‘hashed’ bar clarification  MMR use in 6 through 11 month olds 7-18 year schedule: - HPV4 routine use in males Catch-up Schedule: - HepA and HepB footnotes removed - MCV footnotes added 7/19/2012

Changes to Recommended Immunization Schedule for Persons Aged 0 Through 6 years 7/19/2012

Changes to Figure 2. Recommended Immunization Schedule for Persons Aged 7 Through 18 Years 7/19/2012

Changes to the 2012 “Catch - up” Schedule 7/19/2012

Changes to the Adult Schedule  Table summarizing precautions and contraindications to vaccination was added.  HepB Footnote updated to include recommendation to vaccinate adults younger than 60 years old who have diabetes, as soon as possible after diabetes is diagnosed.  A new footnote to links for the full ACIP vaccine recommendations and where to find additional information on specific vaccine recommendations for travelers. 7/19/2012

7/19/2012

7/19/2012

Overview  Introduction  ACIP overview – who is the ACIP?  2012 Immunization Schedules  Feb 2012 and June 2012 ACIP Meeting Updates  Updated ACIP recommendations  PCV13 in Immunocompromised Adults  Tdap – adults and adolescence  Influenza Updates  HepB – adults with diabetes  HPV4 – routine recommendation for males  Health Care Worker Recommendations  Vaccine Administration (S and H)  Resources  Q and A 7/19/2012

February 2012 ACIP Meeting Highlights  Tdap Vote: Use of Tdap in persons 65 years and older  Discussion of PCV13 use in adults 50 yrs and older  Discussion of meningococcal vaccine for infants – No vote, no recommendation 7/19/2012

June 2012 ACIP Meeting Highlights  PCV13 use in immunocompromised males – vote taken – new recommendation  Influenza vaccine recommendations – including dosing for 6 mos thru 8 years old  Updates on HPV vaccine uptake, Adult immunizations Meeting slides and minutes: http://www.cdc.gov/vaccines/recs/acip/meetin gs.htm

PCV13 USE IN IMMUNOCOMPROMISED ADULTS

Pneumococcal Conjugate Vaccine (PCV13) for Adults  On December 30, 2011, PCV13 (Pfizer) was licensed for use among adults 50 years of age and older  FDA approved expanded age indications under the Accelerated Approval Pathway 7/19/2012

Pneumococcal Conjugate Vaccine (PCV13) for Adults  PCV13 immunogenicity non-inferior to PPSV23  Indications  Prevention of pneumococcal disease, including pneumonia and invasive disease  Prevention of disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F 7/19/2012

Summary of Feb 2012 ACIP Deliberations: PCV13 for Adults • Deferred universal recommendation pending the further collection of data -Efficacy of PCV13 against pneumonia (CAPITA trial, results in 2013) -Indirect (herd) effects of PCV13 use in children 7/19/2012

ACIP Recommendations June 2012 Pneumococcal Vaccine naïve adults  Adults 19 years of age or older with immunocompromising conditions, functional or anatomic asplenia , CSF leaks or cochlear implants, and those who have not previously received PCV13 or PPSV23 should receive a single dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later. DRAFT LANGUAGE 7/19/2012

Revaccination with PPSV 23  A second dose of PPSV23 is recommended 5 years after the first dose for persons aged 19 – 64 years with functional or anatomic asplenia and for persons with immunocompromising conditions.  Those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose.  Those who receive PPSV23 at or after age 65 years should receive only a single dose of DRAFT PPSV23. LANGUAGE 7/19/2012

ACIP June 2012- Adults previously vaccinated with PPSV 23(2)  Adults 19 years of age or older with immunocompromising conditions , functional or anatomic asplenia , CSF leaks or cochlear implants, who have previously received one or more doses of PPSV23 receive a dose of PCV13 one or more years after the last PPSV23 dose was received.  For those that require additional doses of PPSV23, the first such dose should be given no sooner than 8 weeks after PCV13 and at least 5 years since the most recent dose of PPSV23 DRAFT LANGUAGE 7/19/2012

Potential Scenarios for Adults previously vaccinated with PPSV23  Draft language 7/19/2012

Adults Previously Vaccinated with PPSV23  40-year-old male with asplenia who received PPSV23 three years ago  administer PCV13 today (at least 1 year interval since PPSV23)  administer 2 nd PPSV23 in 2 years (at least 5 year interval after last PPSV23 dose and at least 8 weeks after PCV13 dose)  administer final dose of PPSV23 at 65 years of age 7/19/2012

PERTUSSIS VACCINES IN ADOLESCENTS AND ADULTS

PERTUSSIS IN THE U.S. 2012  As of 7/5/12: 17,000 cases reported  10 deaths reported so far (majority among infants < 3 months of age)  Several outbreaks or increased activity in several states in 2012 so far  2010: 27,550 cases with 27 deaths (25 of these in children under a year old). Also increase in cases in 7-10 year olds. CDC Unpublished data, http://www.cdc.gov/pertussis/outbreaks.html

Why Adolescents and Adults Need Pertussis Vaccine  Pertussis cases increased in the late 1990s and early 2000s  2004 – 25,827 pertussis cases: 67% of cases among adolescents or adults  Severe illness among young infants with pertussis  Pertussis immunity wanes in 5-10 years after vaccination 7/19/2012

Source of Infection for Infants With Pertussis  Household contact – 71%  Parent – 55% (mother 37%, father 18%)  Sibling – 16%  Non-household contact – 29%  Aunt/uncle – 10%  Friend/cousin - 10%  Grandparent – 6% N=44 infants <6 months of age. Pediatr Infect Dis J 2007;26(4):293-9. 7/19/2012

Adolescent and Adult Pertussis Vaccination  Primary objective  protect the vaccinated adolescent or adult  Secondary objective  reduce reservoir of B. pertussis  potentially reduce incidence of pertussis in other age groups and settings 7/19/2012

General Principles for Use of Tdap and Td  Tdap preferred to Td to provide protection against pertussis  Tdap approved only for a single booster dose in persons who have received a full series of pediatric DTaP or DTP  Tdap is NEITHER approved NOR recommended for multiple administrations

Tdap  Tdap reduces the risk of pertussis by 60% - 80%  Tdap approved ages  10 years and older for Boostrix  11 through 64 years for Adacel  Schedule: One time only dose (IM) Wei SC et al. Clin Infect Dis 2010;51:315-21 7/19/2012