Immunization Update 2013

1. Immunization Update 2013 Liza Chapman, Pharm.D. GPhA Annual Meeting

2. Faculty disclosure • Liza Chapman has no disclosures to declare at this time

3. objectives • Review the changes/developments made to the immunization recommendations during the past year • Discuss cases and provide vaccine recommendations based upon the ACIP/CDC current schedules • Identify new developments in practice that impact immunizing pharmacists’ practices

4. U.S Adult vaccination Rates, 2011 APhA IMZ CTP, 04.2013 National Health Interview Survey –2011 (http://www.cdc.gov/mmwr/pdf/wk/mm62e0129.pdf) National Immunization Survey 2011-2012 http://www.cdc.gov/MMWR/preview/mmwrhtml/mm6138a1.htm

5. Recent Disease Outbreaks • Measles Outbreak (2011)1 • 222 cases reported • Five times the number of cases in 2007 • 28,000 cases in Europe • Mumps Outbreak (2011)2 • 29 Mumps cases on University campus in California • Source – unvaccinated student – all cases linked • 22 (76%) vaccinated with 2 doses MMR • 2 with 3 doses, 2 with 1 dose, and 2 unknown • Pertussis Epidemic3 • 41,880 cases reported in 2012 • 18 related deaths • 4,783 in Washington State (965 in 2011) • 18,719 cases total reported in U.S. in 2011 • 27,555 in 2010 APhA IMZ CTP, 04.2013 1. Measles. www.cdc.gov/measles 2. MMWRMorb MortalWkly Rep. 2012;61:986-989 3. CDC Pertussis Report (www.cdc.gov/pertussis)

6. Recap from 2013 National adult and Influenza Immunizations Summit

7. Hepatitis b

8. Hepatitis b • Target groups for HBV • Infants • Adolescents who have not been previously vaccinated • High-risk adults • Multiple sex partners • Patients seeking treatment for STDs • HIV patients • IV drug users • Dialysis patients • Patients with chronic liver disease • Health care providers • All diabetics 19-59 years old • Diabetics >60 years (permissive) New ACIP recommendation

9. Self-Assessment • How many doses must a patient receive to complete the Hepatitis B series? • 1 Dose • 2 Doses • 3 Doses • 4 Doses

10. Self-Assessment • It is October and R.J. is 82 y.o. male patient that is moving into an ALC. His medical conditions include: CHF, COPD, and T2DM. R.J.’s PCP cannot locate his vaccination records. Which vaccines would you recommend R.J. receive? • Influenza • Pneumococcal • Zoster • Hepatitis B • All of the above

11. Influenza

12. Review of 2013-13 Influenza Season

13. HCPsand Influenza vaccinations http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm

14. HCPsand Influenza vaccinations http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm

15. HCPsand Influenza vaccinations http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm

16. HCPsand Influenza vaccinations http://www.cdc.gov/flu/fluvaxview/hcp-ips-nov2012.htm

17. 2013-14 Influenza Vaccine Strains • Influenza vaccine contains: • A/California/7/2009 (H1N1)–like virus • A/Texas/50/2012 (H3N2)–like virus • B/Massachusetts/2/2012–like virus • Yamagata lineage • Quadrivalent Addition: • B/Brisbane/60/2008-like virus • Victoria lineage

18. 2013-14 Influenza presentations http://www.cdc.gov/flu/protect/vaccine/vaccines.htm

19. New Manufacturing Technologies • Cell cultured vaccine • Recombinant HA vaccine

20. Selecting the best product for your patient • It is up to the health care provider to determine the best influenza vaccine product for the patient based on patients’ needs • Patient Age • Preservative vs. preservative free • Administration • ID • IM • IN • IIV3 or IIV4

21. Influenza Vaccine and Egg Allergies • According to ACIP, individuals who have only reported hives as a result of vaccination with influenza vaccine should be vaccinated by following these safety measures: • Use IIV rather than LAIV • Vaccine should be administered by a health care professional familiar with egg allergies • Observation after vaccination should be at lease 30 minutes http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm#egg_allergy

22. Influenza Vaccine and Egg Allergies APhA IMZ CTP, 04.2013

23. Self-assessment • Which influenza vaccine would you recommend for R.J.? • LAIV • IIV3 • IIV4 • Fluzone HD • Fluzone ID

24. Meningitis

25. Meningococcal Vaccine • As of March, 2013, now an recommended vaccine for high-risk infants • Complement deficiencies • Asplenia • Travel to certain countries • Community outbreaks • Not recommended for routine use • FDA approved vaccines for infant use • Menactra (sanofi-pasteur) – high risk infants only • 2 dose series 8 weeks apart (9-23 months of age) • Dose 0.5mL IM • Menhibrix (GSK) • 4 dose series (2,4,6,12-15 months of age) • Dose: 0.5 mL IM • Used if Hib vaccine needed • Not for travel (only 2 serotypes) • Community outbreaks only if serotypes C and Y • If used, must complete all 4 doses http://www.cdc.gov/mmwr/pdf/rr/rr6202.pdf

26. Pneumococcal

27. Pneumococcal Vaccine • PCV 13 (Prevnar) • Indicated for the active immunization of children ages 6 weeks to 5 years old • For the prevention of invasive disease caused by 13 Streptococcus pneumoniaeserotypes • For the prevention of otitis media caused by 7 Streptococcus pneumoniaeserotypes • FDA approved for adults aged 50 years and older (Not ACIP recommended for routine use) • Dose and route: 0.5 mL IM

28. PCV 13 • Target groups for vaccination • Infants and children • Routine schedule: 2, 4, 6, 12–15 months • Any PCV series begun with PCV7 should be completed with PCV13 • Administer a single supplemental dose of PCV13 for: • Children aged 14–59 months who have received an age-appropriate series of PCV7 • Children aged 60–71 months with underlying medical conditions who have received an age-appropriate series of PCV7 APhA IMZ CTP, 04.2013

29. PCV 13 and Adults • FDA Approved adults >50 years • Approval based upon serology • ACIP • No recommendations for routine use in all adults at this time • Not enough data to evaluate • Studies currently ongoing • Recommended for: • Immunocompromising conditions • Functional or anatomical asplenia • CSF leaks • Cochlear implants APhA IMZ CTP, 04.2013

30. PCV 13 and Immunocompromised Adults It is possible that these patients could receive three doses of PPSV23 in their lifetime. APhA IMZ CTP, 04.2013

31. Self-Assessment • If a patient has already had PPSV23 for a high-risk condition and also needs PCV13 for the same condition, how long should you wait before administering PCV13? • No wait • 4 weeks • 8 weeks • 12 weeks

32. Tdap

33. Pertussis Surveillance http://www.cdc.gov/pertussis/images/incidence-graph-age.jpg

34. Pertussis Outbreaks http://www.cdc.gov/pertussis/images/pertussis-graph-2012-lg.jpg

35. Tdap

36. Self-assessment • Some women have closely spaced pregnancies. Should Tdap be given during each pregnancy, even if it means such women would get 2 doses within 12 months? • Yes • No

37. Travel vaccines • Japanese Encephalitis (Ixiaro) • Approved age now includes children 2 months and over • 2 Dose vaccine series • 0 and 28 days • 2 months to 35 months • 0.25 ml • 36 months and older • 0.5 ml • Yellow Fever (YF-VAX) • WHO has determined there is no need for booster vaccination

38. Make sure you are up to date • www.cdc.gov • MMWR • Epidemiology and Prevention of Vaccine-Preventable Diseases • 2012 Yellow Book • www.immunize.org • IAC Express • Current VISs • www.pharmacist.com/immunization-center

39. Questions • Liza Chapman • liza.chapman@kroger.com