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Immunization IQ: What’s New and Review

Immunization IQ: What’s New and Review. Carolyn A. Parry, MPH CDC Public Health Advisor Montana Immunization Program 2013 Regional Immunization Workshops. Discussion. Resources New ACIP Recommendations Troublemakers Test Your K nowledge. Recommended IZ Schedules.

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Immunization IQ: What’s New and Review

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  1. Immunization IQ: What’s New and Review Carolyn A. Parry, MPH CDC Public Health Advisor Montana Immunization Program 2013 Regional Immunization Workshops

  2. Discussion • Resources • New ACIP Recommendations • Troublemakers • Test Your Knowledge

  3. Recommended IZ Schedules

  4. IZ Schedule Footnotes

  5. Catch-Up Schedule

  6. Recommended Minimum Ages and Intervals

  7. imMTrax Forecasting Algorithm

  8. CDC’s IZ Schedulers www.cdc.gov/vaccines

  9. Update on ACIP Recommendations • Hepatitis A • Initiate the 2-dose series for children aged 12 through 23 months of age • Separate the 2 doses by 6 to 18 months • For any person 2 years and older who has not already received the Hep A vaccine series, 2 doses of Hep A vaccine separated by 6 to 18 months may be administered if immunity against hepatitis A virus infection is desired. • MMR • Provisional recommendation – Documentation of provider-diagnosed disease is not considered acceptable evidence of immunity for measles, mumps, or rubella.

  10. Pneumococcal Vaccines for Adults (PCV13 and PPSV23) • One dose of PCV13 is recommended for adults aged > 19 years with • immunocompromising conditions; • functional or anatomic asplenia; • CSF leaks, or cochlear implants • For those that have not received PCV13 or PPSV23, they should receive a dose of PCV13 first, followed by a dose of PPSV23 at least 8 weeks later. • For those that have received >1 doses of PPSV23, a dose of PCV13 should be given >1 year after the last PPSV23.

  11. Pneumococcal for Adults continued • If an additional dose of PPSV23 is recommended, it should be given no sooner than 8 weeks after PCV13 and at least 5 years after the most recent dose of PPSV23. • A second dose of PPSV23 is recommended 5 years after the first dose for persons 19-64 years • for persons with functional or anatomic asplenia • for persons with immunocompromising conditions • PPSV23 should be administered to all persons at age 65 years • If PPSV23 was received before age 65 years, another dose should be administered at age 65 years or later if at least 5 years have passed since previous dose. • If PPSV23 is received on or after 65 years, only one dose should be administered.

  12. Hib-MenCY-TT • June 14, 2012, MenHibrix ® was licensed by the FDA for the prevention of Hib and serogroups C and Y meningococcal disease in children 6 weeks though 18 months. • October 2012 ACIP meeting, Hib-MenCY-TT was approved for infants at increased risk for meningococcal disease. • Infants with recognized persistent complement pathway deficiencies • Infants who have anatomic or functional asplenia, including sickle cell disease • Infants who are in communities with serogroups C and Y meningococcal disease outbreaks • It is not adequate for infants traveling to the Hajj or “meningitis belt” of sub-Saharan Africa

  13. Hib-MenCY-TT continued • At this time ACIP does not recommend routine meningococcal vaccination for infants who are not at increased risk for meningococcal disease. • Hib-MenCY-TT follows a four dose schedule, 2, 4, 6, and 12-15 months of age or catch-up schedule • If given at or after 12 months of age, 2 doses should be administered at least 8 weeks apart • For infants at increased risk for meningococcal disease who have received or are going to receive a different Hib product, ACIP recommends a 2-dose series of MenACWY-D if they are aged 9 through 23 months or either of the two quadrivalent meningococcal products after age 23 months. • It may be co-administer with other routine infant vaccinations, but should not be co-administered with other Hib-containing vaccines.

  14. Tdap for Adults • Administer one dose of Tdap vaccine to pregnant women during each pregnancy (preferred during 27 through 36 weeks gestation) regardless of the number of years from prior Td or Tdap vaccination. • Providers should not miss an opportunity to vaccinate persons aged 65 years and older with Tdap. • Providers may administer the Tdap vaccine they have available. • When feasible, Boostrix®should be used for adults aged 65 years and older. • However, ACIP concluded that either vaccine administered to a person 65 years or older is immunogenic and would provide protection. A dose of either vaccine may be considered valid.

  15. Troublemakers • Minimum intervals • HPV • Hib • PCV • Rotavirus

  16. Intervals • Vaccines should not be administered at intervals less than the minimum interval or at an age younger than the minimum age. • The repeat dose should be spaced after the invalid dose by the recommended minimum interval. • If the first dose in a series is administered before the minimum age, the dose should be repeated on or after the date when the child reaches at least the minimum age. • If the vaccine is a live vaccine, ensure that a minimum interval of 28 days has elapsed from the invalid dose.

  17. Human Papillomavirus (HPV) • Currently, there are two licensed HPV products in the market in the U.S. • Cervarix® - Bivalent HPV vaccine (HPV2) • Gardasil® - Quadrivalent HPV vaccine (HPV4) • HPV4 may be administered in a 3-dose series to males aged 9 through 26 years. • The schedule for both vaccines is: • Licensed for ages 9 through 26 years • Minimum spacing between dose 1 & 2 - at least 4 weeks • Minimum spacing between dose 2 & 3 - at least 12 weeks • Administer dose 3 at least 24 weeks after dose 1 • Dose 3 need not be repeated if it is given at least 16 weeks after the first dose (and if the intervals between doses 1 and 2 and doses 2 and 3 are maintained at 4 weeks and 12 weeks, respectively).

  18. Hib catch-up • Healthy children aged 7-59 months who have not been vaccinated with Hib should receive 1-3 doses, depending on when vaccination begins. • Infants 7-11 months – 3 doses • Children aged 12-14 months – 2 doses • Children 15 months and older – 1 dose

  19. PCV catch-up • Healthy children aged 7-59 months who have not been vaccinated with PCV7 or PCV13 previously should receive 1-3 doses of PCV13, depending on when vaccination begins. • Infants 7-11 months – 3 doses • Children aged 12-23 months – 2 doses • Children 24 months and older • Unvaccinated healthy children – 1 dose • Unvaccinated children 24-71 months with underlying medical conditions – 2 doses • The fourth dose of PCV is only necessary for children aged 12 through 59 months who received 3 doses before age 12 months or for children at high risk who received 3 doses at any age.

  20. Rotavirus • Administer the first dose at age 6 through 14 weeks, 6 days • Vaccination should not be initiated for infants aged 15 weeks 0 days or older. • The maximum age for the final dose in the series is 8 months 0 days • The schedule is: • 2, 4, and 6 months of age • However, there are two different vaccines, RotaTeq® (3-dose schedule) and Rotarix® (2-dose schedule) • If Rotarix® is administered at ages 2 and 4 months, a dose at 6 months is not indicated.

  21. Questions????

  22. Test Your Knowledge

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