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Pediatric vaccination updates: The latest news physicians should know

SAN FRANCISCO — Following a meeting last week in which the CDC Advisory Committee on Immunization Practice approved several updates to its 2016-17 vaccination guideline, Joseph A. Bocchini Jr., MD, FAAP, discussed the latest changes to vaccine recommendations for influenza, human papilloma virus and meningitis B.

Speaking in San Francisco at the 2016 AAP National Conference and Exhibition, Bocchini reviewed the latest guidelines, including the ACIP no longer recommending the live attenuated influenza vaccine, and that children with egg allergies can receive the influenza vaccine with no additional precautions.

Joseph A. Bocchini Jr., MD, FAAP

Other updates include a recommendation to use a 2-dose regimen for the HPV vaccine, with the second dose given 6 to 12 months after the first, and the use of a 3-dose series of Trumenba (MenB-FHbp, Wyeth Pharmaceuticals) for those who are at high-risk of meningitis B, while those who are healthy and aged 16 to 23 years can receive 2 doses.

“Some new changes have been recommendations in vaccine policy just this past week,” Bocchini, who is a professor and chairman of the department of pediatrics at Louisiana State University Health in Shreveport, said. “They will become official when the ACIP publishes them in the Morbidity and Mortality Weekly Report.”

Influenza

In a reversal of its recommendation last year, the ACIP in June recommended that live attenuated influenza vaccine (LAIV), offered as a nasal spray, should not be used in any setting. The members based their decision on data showing LAIV had been ineffective against influenza A (H1N1) in children aged 2 to 17 years.

In addition, according to Bocchini, children aged 6 to 8 months who have received 2 or more total doses of any trivalent or quadrivalent vaccine prior to July 1, 2016, can receive a single dose of seasonal influenza vaccine. For those who have not, or in cases in which the parents are not sure, 2 doses, in 4-week intervals, are recommended.

Bocchini also discussed recent studies showing that inactivated influenza vaccines are unlikely to cause a severe reaction among patients with egg allergies, and that they can be given with no precautions.

“Egg allergy is no longer considered a contraindication for giving the influenza vaccine,” he said. “This is in part because the egg-related content in the vaccine is now so low that it does not cause a reaction. We observe those children as we do for any other vaccine, watching for 15 minutes. Those children with severe reaction to egg by history should be immunized in a site where a provider can recognize and manage allergic reactions as a safety measure.”

Pertussis

According to Bocchini, a resurgence of pertussis has led to more cases among infants, with a high mortality rate in those younger than 3 months.

The ACIP has recommended that all pregnant women should receive Tdap during each pregnancy at 27 to 36 weeks to protect the infant at birth, Bocchini said. Providers should then vaccinate infants with DTaP in accordance with the childhood immunization schedule.

Meningococcal B vaccines

There are 50 to 60 cases of serogroup B meningococcal disease annually among 11- to 23-year-olds, with 5 to 10 deaths, Bocchini said. In addition, there were 7 outbreaks on college campuses from 2009 to 2013, including 41 cases and 3 deaths.

The ACIP recommends the meningococcal B vaccine for adolescents and young adults aged 10 to 25 years who are at increased risk, including those with component deficiency, functional or anatomic asplenia, clinical laboratory microbiologists who are routinely exposed and those involved in outbreak situations.

“The decision that the ACIP made last week was to continue to recommend the 3-dose [regimen] for Trumenba for individuals that are at high risk, even though there is a 2-dose schedule,” he said. “However, there is no preference for the 2 vaccines [Trumenba or Bexsero (MenB-4C, Novartis Vaccines)]. Either can be used for high-risk patients.”

HPV

The ACIP last week also approved a recommendation to use a 2-dose regimen for the HPV vaccine, with the second dose given 6 to 12 months after the first.

Despite HPV’s status as the most common sexually transmitted pathogen among males and females, and its role in causing cervical, vaginal, penile and anal cancers, vaccination remains underutilized, Bocchini said.

“Many adolescents and young adults are leaving our practices without being immunized for HPV, or have started immunization and have not completed it,” he said. “The recommendation is 80%, and only 62.8% of girls are receiving 1 dose, and only 41.9% have completed the 3-dose regimen, and these are girls who are 13 to 17 years of age. Among boys, it’s even lower.”

In addition to data showing the efficacy of the two-dose regimen, the ACIP and CDC said the simpler regimen may increase compliance when they made their recommendation.

According to Bocchini, physicians need to make a strong recommendation for using the vaccine, help parents recognize it as a form of cancer prevention, and emphasize that it is best to receive it at 11 to 12 years of age. In addition, providers should be familiar with HPV epidemiology outcomes of infection and indications for vaccination. – by Jason Laday

Reference:

Bocchini JA. Vaccine Update: What’s new and what’s changed; AAP National Conference & Exhibition; Oct. 22, 2016, San Francisco.

Disclosure: Bocchini reports no relevant financial disclosures.