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Adolescent Immunization

Adolescent Immunization. How do you get this?. By doing this. Objectives. List the four recommended vaccines for preteens 11 – 12 years of age Describe the HPV recommendations for male adolescents Explain why the President’s Cancer Panel issued a Call to Action.

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Adolescent Immunization

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  1. Adolescent Immunization

  2. How do you get this?

  3. By doing this

  4. Objectives • List the four recommended vaccines for preteens 11 – 12 years of age • Describe the HPV recommendations for male adolescents • Explain why the President’s Cancer Panel issued a Call to Action

  5. Child and Adolescent Immunization Schedule

  6. Four Vaccines Are Recommended for All Preteens at Age 11 or 12 Years • Tetanus-diphtheria-acellular pertussis vaccine (Tdap) • Meningococcal conjugate vaccine (MCV4) • Human papillomavirus vaccine (HPV) • Influenza (flu) vaccine

  7. Pertussis (whooping cough) and Tdap vaccine Picture courtesy of WebMD

  8. Why Do Adolescents Need Pertussis Vaccine? • Pertussis is endemic in the United States • Outbreaks are still occurring • Whooping Cough in teens and adults may be misdiagnosed as bronchitis, asthma, or a cold • Protection provided by the DTaP vaccine series wanes, so adolescents need Tdap as a booster • Increasing Tdap immunization rates among adolescents is an important strategy for reducing pertussis among infants too young to be fully immunized

  9. Tdap Recommendations for Adolescents • Preteens at age 11 or 12 years • Teens ages 13 through 18 years who did not receive Tdap at age 11 or 12 • Tdap should be given regardless of interval since last Td • Tdap can be given at the same time as other vaccines.

  10. We’re Number 1 • CDC 2013 Provisional Pertussis Surveillance Report shows • Montana had 636 cases • Incidence rate of 63.3 per 100,000 people • We lead the nation in incidence

  11. Meningitis (Neisseria meningitidis) and Meningococcal conjugate vaccine (MCV4) Long Term Effects of Disease •memory loss• concentration problems• disruptive behavior• mood swings• sight problems• deafness• learning difficulties • epilepsy• chronic fatigue syndrome• liver or kidney failure• paralysis• skin scarring due to skin grafts• severe headaches Photo courtesy of ABC Health & Wellbeing, Sydney Australia, www.abc.nrt.au/health/features/stories/2003/ Thomas Nash at 19 survived, but lost 80% of his skin and both arms and legs.

  12. Neisseria meningitidisRisk Factors for Invasive Disease • Crowded living conditions • College students (living in a dormitory) • Immunodeficient persons • Family members of an infected person • The following have been shown to increase the risk • Smoking • Passive exposure to smoke

  13. MCV4 Recommendations for Adolescents • Two doses of MCV4 are recommended for adolescents aged 11 through 18 years: • First dose at age 11 or 12 years • Booster dose at age 16 years • Adolescents who received their first dose of MCV4 at or after age 16 years do not need a booster dose

  14. Recommendations for Adolescents with Certain Medical Conditions • Some adolescents require a 2 dose primary series of MCV4 instead of one dose: • Functional or anatomic asplenia, including sickle cell disease • Complement component deficiency • HIV* • Two doses administered 8-12 weeks apart • Will require a booster dose every five years * HIV infection is not currently an indication for MCV4 vaccination. However, some persons with HIV infection should receive MCV4 for other indications, i.e. adolescents or college freshman living in a dormitory

  15. Human Papillomavirus (HPV) and HPV Vaccine HPV on the lips HPV in the throat

  16. Human Papillomavirus (HPV) • HPV is the most common family of viruses that infect the epithelium • Two risk classification • “low risk” cause warts • “high risk” cause precancerous lesions and can lead to cancer of cervix, anus, penis, and oropharyngeal • Most common sexually transmitted pathogen in males and females • 14 million new infections in US annually • Estimated 79 million people infected in US • Highest prevalence in sexually active adolescents and young adults Jemal A et al. J Natl Cancer Inst 2013;105:175-201

  17. HPV-Associated Oropharyngeal Cancers • Prevalence increased from 16.3% (1984-89) to 71.7% (2000-04) • Population-level incidence of HPV-positive cancers increased by 225% while HPV-negative cancers declined by 50% If trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020 Chaturvedi, 2011, J ClinOncol-data from SEER(Surveillance, Epidemiology and End Results from National Cancer Institute)

  18. ACIP Recommendations for HPV Vaccine • Routine HPV vaccination recommended for both males and females ages 11 - 12 years • Catch-up ages 13 - 21 years for males; 13 - 26 for females • Permissive use ages 9 - 10 years for both males and females

  19. Recommendation for Females • Either Cervarix or Gardasil is recommended for girls at 11-12 years for prevention of cervical cancer and precancer • Also for girls 13 through 26 who haven’t started or completed the series • Only Gardasil (quadrivalent) is also for prevention of vaginal, vulvar, and anal cancers, as well as genital warts

  20. Recommendation for Males • Gardasil recommended for boys at age 11 or 12 years for prevention of anal cancer and genital warts • Also for boys 13 through 21 who haven’t started or completed the series • Young men, 22 through 26 years of age, may get the vaccine

  21. Why Vaccinate at 11-12 Years of Age? • As with any vaccine, the most effective time to vaccinate is prior to exposure • Robust antibody titer responses were seen in the 11- to 12-year-old age group after vaccination in clinical trials* *Centers for Disease Control and Prevention (CDC). Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007;56(RR-2):1–24

  22. HPV Vaccine Safety • The most common adverse events reported were considered mild • For serious adverse events reported, no unusual pattern or clustering that would suggest that the events were caused by the HPV vaccine • These findings are similar to the safety reviews of MCV4 and Tdap vaccines. • 57 million doses of HPV vaccine distributed in US since 2006

  23. HPV Vaccine Safety Data Sources • Post-licensure safety data (VAERS)1 • Post-licensure observational comparative studies (VSD)2 • Ongoing monitoring by CDC and FDA • Post-licensure commitments from manufacturers • Vaccine in pregnancy registries • Long term follow up in Nordic countries • Official reviews • WHO’s Global Advisory Committee on Vaccine Safety 3 • Institute of Medicine’s report on adverse effects and vaccines, 2011(4) 1 Vaccine Adverse Events Reporting System, https://vaers.hhs.gov/index 2 Vaccine Safety Datalink, http://www.cdc.gov/vaccinesafety/Activities 3 http://www.who.int/vaccine_safety/_June 2009 4 https://www.iom.edu/Reports/2011/Adverse-Effects-of-Vaccines-Evidence-and-Causality.aspx

  24. HPV Efficacy “Real World” settings • Seventy-seven percent reduction in HPV strains 6, 11, 16, and 18 in adolescent girls in Australia within three years of vaccine introduction • Forty-five percent reduction in genital warts in girls 16 - 17 years of age in Denmark • Genital warts in males reduced by 89% after three doses and 67% after one dose in the US (FDA clinical trials) • HPV 16/18-related cervical intraepithelial neoplasia grade 2/3 or adenocarcinoma in situ were reduced by 100% (FDA clinical trials) Pediatricians can lay out evidence to allay fears over HPV vaccine; Michael T. Brady AAP News 2014; 35:9; doi:10.1542/aapnews.2014353-9

  25. HPV Vaccine Impact: High HPV Vaccine Coverage in Australia • Eighty percent of school-age girls in Australia are fully vaccinated • High-grade cervical lesions have declined in women less than 18 years of age • For vaccine-eligible females, the proportion of genital wart cases declined dramatically by 93% • Genital warts have declined by 82% among males of the same age indicating herd immunity Garland et al, Prev Med 2011 Ali et al, BMJ 2013

  26. President’s Cancer Panel: Urgent Call to Action February 2014 “We are confident that if HPV vaccination for girls and boys is made a public health priority, hundreds of thousands will be protected from HPV-associated diseases and cancers over their lifetimes” – Barbara Rimer, Chair of the President’s Cancer Panel. http://deainfo.nci.nih.gov/ADVISORY/pcp/annualReports/HPV/index.htm

  27. Why a “Call to Action?” There are two approved vaccines that prevent infection by the two most prevalent cancer-causing HPV viruses. Yet the CDC National Immunization Survey 2012 shows that: • About one-third of 13 - 17 year old girls received all three recommended doses of HPV • Rates fall way short of the Healthy People 2020 Goals of 80% • Less than 7% of boys 13 - 17 years of age completed the series. • CDC estimates at 80% vaccination rate an additional 53,000 future cervical cancer cases among girls who are now 12 years and younger will be prevented over their lifetime • Thousands of other HPV – associated cancers, also would be prevented within same time frame

  28. Three Recommendations from the Cancer Panel Reduce missed clinical opportunities to recommend and administer HPV vaccines Increase parents,’ caregivers,’ and adolescents’ acceptance of HPV vaccines Maximize access to HPV vaccination service

  29. Give a Strong Recommendation for HPV Vaccine to Increase Uptake! Thomas K. McInerny , MD President American Academy of Pediatrics Reid B. Blackwelder, MD President American Academy of Family Physicians Jeanne Conry, MD President American College of Obstetricians and Gynecologists Molly Cooke, MD President American College of Physicians Thomas Frieden, MD Director Centers for Disease Control and Prevention Deborah Wexler, MD Executive Director Immunization Action Coalition

  30. Montana’s denominator for ≥ 3 doses HPV for males was less than 30

  31. HPV is so common that almost everyone will be infected with HPV at some point in their lives: • However most people will never know they have been infected. • HPV exposure can occur with any type of intimate sexual contact. • In the U.S., HPV causes about 17,000 cancers in women, and about 9,000 cancers in men each year. • Low HPV vaccination rates are leaving another generation of boys and girls vulnerable to devastating HPV cancers. • Vaccination could prevent most of these cancers • CDC is looking to you to make a strong recommendation for HPV vaccination when kids are 11 and 12 years old. http://www.cdc.gov/vaccines/who/teens/for-hcp/hpv-resources.html

  32. http://www.cdc.gov/vaccines/who/teens/products/downloads/print-materials/f-vaccine-for-cancer.pdfhttp://www.cdc.gov/vaccines/who/teens/products/downloads/print-materials/f-vaccine-for-cancer.pdf

  33. http://www.cdc.gov/vaccines/who/teens/products/downloads/print-materials/f-close-the-door.pdfhttp://www.cdc.gov/vaccines/who/teens/products/downloads/print-materials/f-close-the-door.pdf

  34. Influenza and Adolescents • Flu can be serious, even for healthy adolescents • Adolescents with high – risk conditions more likely to suffer flu complications • Flu seasons are unpredictable and can be severe

  35. Influenza Vaccine • Adolescents should receive a flu shot every year • There are two types of flu vaccine available for adolescents • Injectable (TIV) • Intranasal (LAIV) • Be aware of precautions and contraindications

  36. Screen for Contraindications and Precautions • Key to preventing adverse reactions following vaccination • Ask screening questions every time vaccines are needed • Follow only true contraindications and precautions www.immunize.org

  37. General Adolescent Vaccine Safety • Fainting- can occur after any medical procedure, including vaccination • Adolescents should be seated or lying down during vaccination • Consider observing patients in seated or lying down positions for 15 minutes after vaccination • Concern- risk for serious secondary injuries • Vaccine Adverse Event Reporting System (VAERS) http://vaers.hhs.gov

  38. Take Home Points • Tdap, MCV4, HPV and Influenza vaccines are recommended for all adolescents • HPV vaccine is cancer prevention for females and males • HPV vaccine has been proven to be an effective and safe vaccine • Gardasil is the only vaccine recommended for males to: • prevent anal cancer and genital warts • young men 22 through 26 years of age may be vaccinated • The President’s Cancer Panel has issued an Urgent Call to Action to increase HPV vaccine usage to prevent several types of cancers

  39. Any questions or concerns? Thanks for coming and have a safe trip home.

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