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Vaccine Update 2009 Advances in the Practice of Pediatrics San Diego, California February 1315, 2009

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Age of chickenpox 1 year need for VZV. Zoster. Measles Outbreak in the USA ... http://www.cdc.gov/vaccines/vpd-vac/measles/photos.htm ... – PowerPoint PPT presentation

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Title: Vaccine Update 2009 Advances in the Practice of Pediatrics San Diego, California February 1315, 2009


1
Vaccine Update 2009Advances in the
Practice of PediatricsSan Diego,
CaliforniaFebruary 13-15, 2009
  • Richard F. Jacobs, M.D., FAAP
  • Robert H. Fiser, Jr. MD Endowed Chair in
    Pediatrics
  • Professor and Chairman, Department of Pediatrics
  • University of Arkansas for Medical Sciences
  • President, Arkansas Childrens Hospital Research
    Institute
  • Pediatric Infectious Diseases
  • Arkansas Childrens Hospital

2
OBJECTIVES
  • To understand the new 2009 vaccine
    recommendations and be prepared to implement
    appropriate immunization practices in their
    office.
  • To review the Harmonized schedule for 2009 and
    discuss the new catch-up and pre-adolescent
    immunization recommendations, including the new
    influenza vaccine recommendations
  • To be prepared in their offices for the new
    issues related to immunization for 2009 and the
    new vaccines that may be released this year

3
REFERENCESInternet Resources
  • American Academy of Pediatrics (AAP)
  • www.aap.org
  • www.aap.org/family/vaccine.htm
  • National Immunization Program (CDC)
  • www.cdc.gov/nip
  • National Network for Immunization Information
    (NNii
  • www.immunizationinfo.org
  • Institute of Medicine
  • www.iom.edu
  • FDA (Drug/Vaccine Shortages)
  • www.fda.gov/cder/drugs/shortages/
  • Immunization Action Coalition
  • www.immunize.org
  • Every Child By Two
  • www.ecbt.org
  • Parents of Kids with Infectious Diseases (PKIDS)
  • www.pkids.org

4
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5
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6
Issues in Childhood ImmunizationsUSA 2009
AAP/ACIP/AAFP
  • Conjugate meningococcal vaccine
  • Conjugate pneumococal vaccine
  • Tdap booster dose
  • MMRV
  • Hepatitis A Vaccine
  • Update on influenza
  • Human papillomavirus vaccine

7
Invasive Meningococcal Diseasein Children and
Adolescents
Courtesy of R Rudoy, MD, Honolulu, Hawaii, USA
8
Menactra (MCV4)
  • Licensed FDA (1/2005) Age 11 to 55 years
  • MCV4 supply re-established (Summer 2007)
  • Program High School entry
  • College Freshmen
    (dormitories)
  • All 11 to 18 year olds
  • Catch up 11 to 12 year olds
  • Alternative - Menomune (MPSV4)
  • www.cdc.gov/nip/news/shortages/default.htm

9
  • NEW FOR 2009
  • PCV7 Minimum age (PCV-76 weeks/PPV2 years).
    1 dose of PCV-7 to all 24-59 month olds
    (incomplete)
  • LAIV 2 years of age younger than 9 years (2
    doses). If one does previous year 2 doses.
  • MCV4 Children 2-10 years of age with terminal
    complement deficiencies, anatomic or functional
    asplenia, and other high risk groups.
  • ACIP - 2009
  • www.cdc.gov

10
Pneumococcal cases for lt 5 Years old and gt 65
Years old 2000 - 2007 Year-to-date  
 
11
  • Invasive Pneumococcal Disease (IPD)
  • Conjugate Vaccine (PCN 7) 1998-2005
  • Prior to PCN-7 Serotypes (4, 6B, 9V, 14 18C,
    19F, 23F) 80
  • Children lt 5 Years
  • 77 reduction
  • 13,000 fewer IPD cases
  • Reduction in unvaccinated children NP
    colonization
  • Overall IPD rates leveled off in 2002
  • Increase of IPD due to serotype 19A
  • 10- and 13-valent PCV (19A) in clinical trials
  • CDC
  • MMWR 57144-148, 2008

12
Pertussis Cases by State, 2006
13
Report by Haytham Safi 661-2920
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15
ACIP Adolescent Pertussis Recommendation
  • Routine Tdap recommendation for adolescents
  • Tdap should replace Td for all 11 12 year olds
  • Tdap should be administered to all 13-18 year
    olds who did not receive Td
  • 11-18 year olds who have received Td should
    receive Tdap a 5-year interval since Td is
    encouraged, but intervals as short as 2 years are
    acceptable in situations of increased pertussis
    risk
  • Tdap should be administered simultaneously with
    Menactra non-simultaneous administration is
    acceptable
  • If otherwise indicated, administering Tdap to
    adolescents who are in the second or third
    trimester of pregnancy should be considered.
    Pregnancy is not a contraindication for Tdap or
    Td.

16
ACIP Adult Pertussis Recommendation
  • Routine Tdap recommendation for adults
  • Tdap vaccine to replace current recommended Td
    booster vaccine in adults who have received their
    last Td gt 10 years ago
  • Shorter intervals after last Td vaccine may be
    used in increased risk (suggested 2-year
    interval) including pertussis outbreaks and
    contact with infants
  • Prevention of pertussis exposure in infants
  • Adults who anticipate having close contact with
    infants less than 12 months of age (e.g.,
    parents, child-care and health-care givers)
    should receive a single dose of Tdap vaccine at
    least one month before beginning close contact

17
Varicella Vaccine
  • VZV vaccine supply
  • Immunize at 12 months versus gt15 months
  • Two doses (MMR)
  • Outbreak/prophylaxis use vaccine lt1 year
  • Age of chickenpox lt1 year need for VZV
  • Zoster

18
  • Measles Outbreak in the USA
  • On-going outbreak (Arizona ) D5 Switzerland
    (source)
  • Adult Source 1,800 healthcare workers
  • As of 3/31/08 8 cases, 2 suspect cases,
    hundreds of contacts
  • Cases 10 months to 50 years
  • 2nd Outbreak San Diego (D5)
  • 11 cases
  • Source child (Switzerland ongoing outbreak)
  • NYC (D4) Israel
  • CDC Health Advisory
  • www.cdc.gov

19
http//www.cdc.gov/vaccines/vpd-vac/measles/photos
.htm
20
http//www.cdc.gov/vaccines/vpd-vac/measles/photos
.htm
21
  • ACIP Revised Recommendations for MMRV (ProQuad)
  • Children suffered higher rates of fever related
    convulsions with MMRV versus MMR plus VZV
  • Children 12-23 months Seizures twice as high
    one extra convulsion for every 2,000 doses of
    MMRV
  • ProQuad does contain 5 times more VZV antigen
    currently short supply
  • ACIP recommends NO PREFERENCE for use of
    combination MMRV over MMR plus VZV
  • MMWR 57 258-260, 2008

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23
Hepatitis A Vaccine (HAV) Summary
  • Based on a CDC model, the estimated incidence of
    Hepatitis A infections is higher in children 1 to
    2 years of age compared to older children.¹
  • HAV is approved for children as young as 12
    months of age.
  • HAV have been shown to be highly immunogenic when
    given to healthy children as young as 12 months
    of age.
  • The safety and effectiveness of HAV in infants
    below 12 months of age have not been established.
  • HAV is now recommended for post-exposure
    prophylaxis for ages 1 year and older within 14
    days of exposure. Ig is still recommended for
    children less than 1 year of age, IC hosts,
    chronic liver disease and those with HAV
    contraindication
  • 1. Bocchini, AAP News, August, 2007

24
Influenza Vaccine
CDC 2008
  • New strains for 2007-08
  • Candidates A/Wisconsin A/Hiroshima05
  • 2007-08 vaccine
  • A/Solomon Islands/3/2006 (H1N1)
  • A/Wisconsin/67/2005 (H3N2)
  • B/Malaysia/2506/2004 (B)

25
Influenza Vaccine
CDC 2008
  • Children Age 6 months to 5 years
  • Widespread activity in 2007-2008
  • Pediatric deaths reported
  • New strains for 2007-2008
  • Poor immunization coverage in adults
  • Under utilization of vaccine in at-risk children

26
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27
ALL KIDS GET FLU SHOTS
  • Advisory Panel
  • Annual Flu Immunizations
  • All children Ages 6 months to 18 years
  • Total 30,000,000 more children
  • 2007-08 Vaccine Ineffective
  • Flu B 93 different lineage
  • Flu A H3N2 35 different
  • Milder disease 4-5 Tamiflu resistant
  • 44-153 deaths in children
  • (6 children 2008-09)
  • ACIP 2/08
  • www.cdc.gov

28
Human Papillomavirus Vaccines
  • GSK Vaccine L1 virus-like particles types 16
    18 aluminum adjuvant 3 dose (0, 1, 6 month)
    schedule
  • Merck Vaccine L1 virus-like particles types 6,
    11, 16 18 aluminum adjuvant 3 dose (0, 2, 6
    month) schedule
  • Harper DM et at Lancet 20043641757-65
  • Villa LL et al http//oncology.thelancet.com
    20056271-78

29
Efficacy of Human Papillomavirus Types 16
18Vaccine in Young Women Prevention of
Infection
  • GSK Vaccine intention to treat analysis
    follow-up 18 to 27 months
  • Harper DM et al Lancet 2004
    3641757-65

30
Efficacy of Human Papillomavirus Types 16
18Vaccine in Young Women Chronic Infection and
Cervical Dysplasia
  • GSK Vaccine intention to treat
    analysis follow-up 18 to 27 months
  • Harper DM et al Lancet 2004
    3641757-65

31
Recommendations for HPV Vaccine
  • Licensed in 2006 (Gardasil)
  • Begin a 3 dose schedule at the 11-12 year visit
  • Social challenges
  • Anti-cancer vaccine
  • Recommendations published
  • Cost

32
  • FDA Approves New Rotavirus Vaccine (4/3/08)
  • Rotarix A second oral rotavirus vaccine two
    dose schedule (6-24 weeks of age) G1, G3, G4, G9
    strains
  • 24,000 infants Effective in preventing severe
    and mild disease. No increase in
    intussusception. Adverse Reactions Fussiness,
    irritability, fever, loss of appetite, vomiting,
    cough
  • FDA News 2008
  • www.fda.gov

33
Smallpox
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