1 / 56

John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th , 2011

Pediatric Vaccine Update. John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th , 2011. Disclosure.

lola
Download Presentation

John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th , 2011

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pediatric Vaccine Update John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5th, 2011

  2. Disclosure • I have never had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in this presentation.

  3. “I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and that therefore, the safer should be chosen.” ~ Benjamin Franklin

  4. Sources of GOOD Information • www.cdc.gov/vaccines/recs/ACIP • www.aap.org • www.cispimmunize.org • www.fda.gov/cber • www.immunize.org • www.immunizationinfo.org • www.vaccinesafety.edu

  5. Vaccines preventable diseases Anthrax Diphtheria Hemophilus Influenzae type b Hepatitis A Hepatitis B Human Papillomavirus Influenza Japanese Encephalitis Lyme Disease Measles Meningococcal Disease Mumps Pertussis Pneumococcal Disease Polio Rabies Rotavirus Rubella Tetanus Tuberculosis Typhoid Fever Varicella (Chickenpox) Yellow Fever Zoster (Shingles) Pertussis Pneumococcal Disease Polio Rabies Rotavirus Rubella Tetanus Tuberculosis Typhoid Fever Varicella (Chickenpox) Yellow Fever Zoster (Shingles) • Anthrax • Diphtheria • Hemophilus Influenzae type b • Hepatitis A • Hepatitis B • Human Papillomavirus • Influenza • Japanese Encephalitis • Lyme Disease • Measles • Meningococcal Disease • Mumps

  6. Measles, United States, January – June 17, 2011 Source of Importations 70% of importations among U.S. residents traveling abroad *Patient visited more than 1 country during the incubation period † Likely acquired disease from French tourist

  7. Measles – Outbreak 2011 MMWR May 24, 2011

  8. Measles – Outbreak 2011 MMWR May 24, 2011

  9. Measles – Exposure Management • Exposure: • • 6-11 mos • • Community outbreak or travel to endemic • • provide extra dose • • School or day care: give vaccine if <2 doses • • Household exposure: provide IG* if not vaccinated,+ vaccine at appropriate interval • *IG 0.25 mL/kg; 0.5 mL/kg immunocompromised

  10. MMR and VZV: Previously Recommended Schedule • • 1st dose @ 12-15 months • • 2nd dose @ 4-6 years • • May be given as early as 4 weeks after first • • 6-11 month old may receive MMR if at increased risk • • Extra dose (3rd) will be necessary • • Varicella: 2 doses, same time as MMR

  11. MMRV and Febrile Seizure

  12. Klein NP, et al. Pediatrics 2010;126:e1-8.

  13. “One additional febrile seizure occurred among every 2,300 children vaccinated with a first dose of MMRV vaccine compared with children vaccinated with a first dose of MMR vaccine and varicella vaccine administered at the same visit.” … “…Postlicensure data do not suggest that children who received MMRV vaccine as a second dose had an increased risk for febrile seizures after vaccination compared with children who received a second dose of MMR vaccine and varicella vaccine at the same visit.” MMRV and Febrile Seizure MMWR May 7, 2010

  14. MMRV • • First dose(12-47 months): MMR + Varicella • • Unless the parent or caregiver expresses a preference for MMRV • • Second dose: MMRV generally preferred. • Personal or family (i.e., sibling or parent) history of seizures of any etiology is a precaution for MMRV vaccination. Children with a personal or family history of seizures of any etiology generally should be vaccinated with MMR vaccine and varicella vaccine. MMWR May 7, 2010

  15. Neisseria meningitidis • Aerobic gram-negative bacteria • At least 13 serogroups based on characteristics of the polysaccharide capsule • Most invasive disease caused by serogroups A, B, C, Y, and W-135 • Relative importance of serogroups depends on geographic location and other factors (e.g. age) • Aggressive illness that can lead to death within 24-48 hours of the first symptoms

  16. Rosenstein N et al. N Engl J Med 2001;344:1378-1388

  17. Quadrivalent Conjugate Vaccine

  18. Meningococcus - group B Rappuoli R F1000 Medicine Reports 2011, 3:16 (doi:10.3410/M3-16)

  19. Incidence of Meningococcal Disease in Infants <12 months,United States, 1998-2007 *Other includes serogroups W-135, nongroupables, other, and unknown ABCs cases from 1998-2007 and projected to the U.S. population

  20. Meningococcal disease • Conclusions: • Amount of potentially preventable disease among infants is low • Currently at nadir in disease incidence • Low proportion of serogroup C+Y disease • Declining incidence after first 6-8 months of life • Morbidity and mortality in infants is lower than in other age groups

  21. Meningococcal Vaccines for Infants and Toddlers • Hib-MenCY (GSK) • 3 dose priming (2,4,6m) • + 12-15 mo booster • MCV4 (Menactra-Sanofi) • – 9, 12-15 mo 2 dose series • Men4 (Menveo-Novartis) • 3 dose priming (2,4,6m) • + 12-15 month booster

  22. Working Group Interpretation:HibMenCY • HibMenCY is an effective vaccine for Hib and serogroup C and Y meningococcal disease after the second or third dose and for one year after the fourth dose • Evidence of waning immunity, especially for serogroup Y, indicates vaccine, unlikely to provide protection until age 11-12 years

  23. Infant Meningococcal VaccinationACIP Recommendations(Pending Approval) • NO routine recommendation for infant meningococcal vaccination • HibMenCY is safe and immunogenic. HibMenCY could be used to complete routine Hib vaccination series (4 doses of HibMenCY required for at least one year of persistence of functional antibody)

  24. Infant Meningococcal VaccinationACIP Recommendations (Pending Approval) • HibMenCY is recommended for infants <2 years at increased risk for meningococcal disease, e.g. persistent complement deficiencies; anatomic or functional asplenia, (HIV?) • HibMenCY can be given to infants <2 years • in a community with a serogroup C or Y meningococcal outbreak • traveling to areas with high endemic rates of serogroups C or Y meningococcal diseases (Does not protect against serogroups A and W-135)

  25. Rate of Meningococcal Disease by Single Age Year: All Serogroups 2 yr 11-12 year old recommendation NETTS data, average annual rate, 2003 - 2006

  26. Estimated Annual Number of Cases of Meningococcal Disease, United States: Age 0 - 21 years Serogroup B- Blue Serogroups A,C,Y,W-135- Yellow Active Bacterial Core surveillance (ABCs) cases from 1996-2005 and projected to the U.S. population

  27. Rates of Meningococcal Disease(A/C/Y/W-135) by Age, 1998-2007 Active Bacterial Core surveillance (ABCs), 1998-2007

  28. Meningococcal Disease Among Young Adults, United States, 1998-1999 Bruce et al, JAMA 2001;286;688-93

  29. Adolescent Meningococcal Vaccination Program • ACIP Recommendation, Oct 2007: • 11-12 year-olds at their pre-teen vaccination visit • 13-18 year-olds who have not been previously vaccinated • Two licensed vaccines (MCV4) • MenACWYD (Menactra) • MenACWYCRM (Menveo)

  30. Coverage of Meningococcal Vaccination among 13-17 year-olds, NIS-Teen, 2006-2008 National Immunization Survey

  31. Adolescent Meningococcal Vaccine: • Antibodies wane prior to peak incidence of disease • Breakthrough cases as severe as in those who never received vaccine • Anamnestic response occurs but is not rapid enough to prevent invasive disease (7-10 days)

  32. Will a single dose early adolescent vaccination program meet our prevention goals? Goals Strategy Vaccinate prior to period of increased risk • Protection through the peak in risk during late adolescence • Protection for college students, especially freshmen living in dormitories

  33. Adolescent Meningococcal Vaccine Options • Stay the course – no change; assess frequency of disease • Waning immunity results in lack of protection at period of greatest risk • Move timing of single dose  15 to 16 years • Same cost • 11-15 year olds vulnerable • Booster dose (11-12 years and 16 years) • greatest number of cases prevented • cost per case prevented better than current policy

  34. Antigenic Drift and Shift Drift – frequent • Minor changes within subtypes • Point mutations • Occurs in both A and B subtypes • May cause epidemics • (2003-2004 : A / H3N2/ Fujian emerged in instead of the previously predominant strain A /H3N2 / Panama

  35. Antigenic Drift and Shift • Shift – infrequent • Major change • Development of new H or N antigen • Exchange of gene segments between influenza stains in mammals • Occurs in A subtypes only • May cause pandemic

  36. Antigenic Drift and Shift • Pandemics: • 1918-19, “Spanish flu”: • A (H1N1). >500,000 deaths in the U.S. • ~50 million deaths globally • 1957-58, “Asian flu”: • A(H2N2). 70,000 deaths in the U.S. • 1968-69, “Hong Kong flu”: • A (H3N2). 34,000 deaths in the U.S. • 2009-2010, “Swine flu”: • A (H1N1). 2,117 deaths in the U.S. (282 pediatric deaths)

  37. Interpandemic attack rate ~30% Interpandemic hospitalization rate <2yo ~ 50%

  38. C PLoSOne March 2011, 6:(3) e17616

  39. Trivalent inactivated Influenza virus vaccines for children 2011-2012 • 2011-12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010-11 vaccine • Only fourth time in 25 years the vaccine has stayed the same in a consecutive season/year • A/California/7/2009 (H1N1)-like • A/Perth/16/2009 (H3N2)-like • B/Brisbane/60/2008

  40. Trivalent inactivated Influenza virus vaccines for children 2011-2012 • Annual vaccination is recommended even for those who received the vaccine for the previous season • Post-vaccination antibody titers decline over the course of a year

  41. Trivalent inactivated Influenza virus vaccines for children 2011-2012 • Children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination to optimize immune response • In previous seasons, children aged 6 months through 8 years who received only 1 dose of influenza vaccine in their first year of vaccination required 2 doses the following season. • As vaccine strains are unchanged between this and the previous season, children in this age group who received at least 1 dose of the 2010-11 seasonal vaccine will require only 1 dose of the 2011-12 vaccine MMWR August 26, 2011

More Related