Adolescent Vaccines Anne Kernan-Grunzke, MD Pediatric Associates of Alexandria

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Adolescent VaccinesAnne Kernan-Grunzke,
MDPediatric Associates of Alexandria
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Objectives

• Discuss the recommended vaccines for adolescents
  (11 and 12yo and up)
• Tdap
• Meningococcus
• Human Papillomavirus

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Tdap

• Tdap is required for all entering 6th graders in
  the state of VA and in many other states.
• Why?
• Pertussis immunity wanes.
• Immunize the big kids to protect the babies.

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Tdap

• Pertussis
• An acute infectious cough illness cause by B.
  pertussis which is a gram negative coccobacillus.
  The bacteria elaborates a toxin that causes
  damage to the respiratory epithelial tissue and
  can have systemic effects such as lymphocytosis.
  It remains endemic in the US despite
  vaccination.

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Tdap Pertussis

• It is transmitted by respiratory droplets and has
  a 7-10d incubation period. Patients are most
  infectious early, but can remain infectious for gt
  6 weeks. Attack rates among non-immunized
  household contacts are 80-90. Antibiotics dont
  modify the illness, but help prevent transmission.

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Tdap Pertussis

• Classis pertussis has 3 phases
• Catarrhal 1-2 weeks, coryza with intermittent
  cough, high fever is uncommon.
• Paroxysmal 4-6 weeks, spasmodic cough,
  posttussive emesis, inspiratory whoop.
• Convalescent 2-6 weeks, but up to months,
  symptoms slowly improve.
• Also called the 100 days cough.

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Tdap Pertussis

• Infants lt12 months more likely to suffer from
  pertussis and pertussis related deaths
• Infants lt12 months are 19 of cases, but 92 of
  deaths. (2000-2004)
• Of 100 deaths in 2000-2004, 76 in infants lt
  1month.

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Tdap Tetanus

• Clostridium tetani spores are ubiquitous in
  the environment and enter through broken skin.
  They elaborate tetanospasmin which is a
  neurotoxin that causes trismus and contractions
  of skeletal muscle leading to respiratory
  failure.

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Tdap Diptheria

• Corneybacterum diptheriae which produces
  diptheria toxincauses cardiac and neurologic
  complications.
• The illness produces a grayish adherent membrane
  in the pharynx, palate or nasal mucosa that can
  obstruct the airway.

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Tdap

• ACIP recommends Tdap for
• Adults 19-64 if gt 10 years from last Td, may go
  lt 10 years if need to boost pertussis (as short
  as 2 years)
• Adults who have close contact with infants lt12
  months including postpartum mothers.
• Healthcare workers

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Tdap

• Reactions
• Local reactions
• Systemic reactions
• Headache
• Body aches
• Tiredness

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Meningococcus

• 1 in 20 cases of meningitis are cause by
  meningococcus and 1 in 3 with meningococcus in
  the bloodstream will die.
• Death can occur within 12 hours one of the
  most rapid and overwhelming infections seen in
  humans.
• 11-19 of survivors will have hearing loss,
  neurologic disability or loss of skin, digits or
  limbs.

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Meningococcus

• Caused by Neisseria meningitidis
• Acquired by close contactsharing food or
  beverages, kissing being in the same house or
  classroom gt 4 hours/day.

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Meningococcus

• 13 meningococcal serogroups.
• 5 are responsible for nearly all cases of
  meningococcal disease.
• A, B, C, Y, W-135.
• The vaccine protects against A, C, Y, W-135.
  Serogroup B causes 2/3 of infant disease and 1/3
  of teen/adult disease, but it has not been
  possible to make a vaccine to B.

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Meningococcus

• The risk of disease is highest in the first year
  of life, lowers from 4-15 years old and then
  increases again at 15 years old.
• College freshman living in dorms are 5X more
  likely to have infection that those not in dorms.

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Meningococus

• Recommended for
• 11-12 year old
• Children and adults without a spleen
• Children and adults with complement defects
• College freshman in dorms
• People exposed during an outbreak
• Children and adults traveling to sub-Saharan
  Africa from December to June

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Meningococcus

• Reactions
• Local reactions
• Questionable association with Guillain-Barre.
  Not recommended for those who have had prior
  Guillain-Barre.

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HPV

• HPV infects skin, genital area and lining of
  cervix. Usually causes warts, can cause cervical
  cancer.
• HPV is the most common STD in the US and world.
  20 million Americans currently are infected, 6
  million new each year. Half are infected between
  15-24 years old.

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HPV

• Most HPV resolves on its own, but some persists
• In US 10,000 women develop cervical cancer, 4,000
  die. Typical length of time from infection with
  HPV to cancer is 15-20 years.

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HPV

• Gardasil protects against HPV types 6,11,16,18.
• HPV 16 and 18 cause
• 70 of cervical cancer, adenocarcinoma in situ,
  CIN3, VIN 2 and 3, VaIN 2 and 3, 50 of CIN2.
• HPV 6,11,16,18 cause
• 35-50 of CIN 1, VIN 1, VaIN 1
• 90 of genital warts

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HPV

• The vaccine is approved for 9-26 year old
  females.
• Recommended for 11-12 year old
• Series of 3 (0,2,6 months)

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HPV

• Reactions
• Fainting
• Local reactions

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Controversy

• Soap Box Time
• AAP, CDC, Children's Hospital of Philadelphia
  websites