Printer Friendly

ACIP immunization update: ACIP's recommendations stress the need to protect vulnerable populations from rising rates of pertussis infection, improve health care personnel Tdap immunization rates, and increase the number of MCV4 doses for those at high risk of meningitis.

Keeping up with the ever-changing immunization schedules recommended by the Centers for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices (ACIP) can be difficult. The most recent changes are the interim recommendations from the February 2011 ACIP meeting pertaining to tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine immunization and postexposure prophylaxis (PEP) for health care personnel. Updated schedules for routine immunization of children and adults that incorporate additions and changes made in the preceding year were published by the CDC in February. (1,2)

ACIP widens the scope of pertussis prevention

The past decade has seen an increase in pertussis cases, including an increase in the number of cases among infants and adolescents (FIGURE). In 2010, California reported 8383 cases, including 10 infant deaths. This was the highest number and rate of cases reported in more than 50 years. (3) Other states have also experienced recent increases.

This evolving epidemiology of pertussis has prompted ACIP to recommend a routine single Tdap dose for adolescents between the ages of 11 and 18 years who have completed the recommended DTP/DTaP (diphtheria and tetanus toxoids and pertussis/diphtheria and tetanus toxoids and acellular pertussis) vaccination series and for adults ages 19 to 64 years. ACIP also recommends a single dose for children ages 7 to 10 if they are not fully vaccinated against pertussis and for adults 65 and older who have not previously received Tdap and who are in close contact with infants. The last 2 are off-label recommendations. ACIP has also eliminated any recommended interval between the time of vaccination with tetanus or diphtheria-toxoid (Td) containing vaccine and the administration of Tdap. (4)

2 new recommendations for clinician postexposure prophylaxis

Interim recommendations from the most recent ACIP meeting in February 2011 (5) reemphasize that health care personnel should receive Tdap and recommend that health care facilities take steps to increase adherence, including providing the vaccine at no cost. (5)

Since health care personnel are at increased risk of exposure to pertussis, ACIP also made 2 recommendations for PEP.

1. All health care personnel (vaccinated or not) in close contact with a pertussis patient (as defined in TABLE 1) who are likely to expose patients at high risk for complications from pertussis (infants <1 year of age and those with certain immunodeficiency conditions, chronic lung disease, respiratory insufficiency, or cystic fibrosis) should receive PEP.

2. Exposed personnel who do not work with high-risk patients should receive PEP or be monitored daily for 21 days, treated at first signs of infection, and excluded from patient contact for 5 days if symptoms develop. The antimicrobials and doses for treatment and prevention of pertussis have been published in the Morbidity and Mortality Weekly Report. (6) Options for PEP include azithromycin, clarithromycin, erythromycin, and trimethoprim-sulfamethoxazole. (6)

[FIGURE OMITTED]

Coming soon: Complete vaccine recommendations for health care workers

Recent experience with pettussis (and influenza) has highlighted the need for health care personnel to be vaccinated against infectious diseases to protect themselves, their patients, and their families. To that end, ACIP plans to publish a compendium later this year that brings together all recommendations regarding immunizations for health care personnel. When it becomes available, family physicians will be able to refer to this document to ensure that they and their staff are immunized in line with CDC recommendations.

The latest on influenza vaccine, PCV13, MCV4, hepatitis B, and HPV

The most notable additions to the routine schedules ACIP announced during the past year are universal, yearly influenza immunization from the age of 6 months on and the replacement of the 7-valent pneumococcal conjugate vaccine (PCV7) with a 13-valent product (PCV13) for infants and children. Details of these recommendations, including how to transition from PCV7 to PCV13, were published late last year by the CDC and described in another Practice Alert. (7-9)

In addition, changes were made in the schedules for meningococcal conjugate vaccine. A 2-dose primary series, instead of a single dose, of MCV4 is now recommended for those with compromised immunity. A booster of MCV4 is now recommended at age 16 for those vaccinated at 11 or 12 years, and at age 16 to 18 for those vaccinated at 13 to 15 years. (10) The MCV4 recommendations are summarized in TABLE 2.

** More schedule details in the footnotes. The new schedules contain a number of clarifications in the footnotes that: (1,11)

* explain the spacing of the 3-dose primary series for hepatitis B vaccine (HepB) for infants if they do not receive a dose immediately after birth

* clarify the circumstances in which children younger than age 9 need 2 doses of influenza vaccine

* describe the availability of both a quadrivalent human papillomavirus vaccine (HPV4) and a bivalent vaccine (HPV2) to prevent precancerous cervical lesions and cancer

* list the option for using HPV4 for males for the prevention of genital warts.

References

(1.) Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0 through 18 years--United States, 2011. MMWR Morb Mortal Wkly Rep QuickGuide. 2011;60(5): 1-4.

(2.) Centers for Disease Control and Prevention. Recommended adult immunization schedule-United States, 2011. MMWR Morb Mortal Wkly Rep. 2011;60(4): 1-4.

(3.) Centers for Disease Control and Prevention. Pertussis (whooping cough): outbreaks. Available at: http://www.cdc.gov/ pertussis/outbreaks.html. Accessed March 19, 2011.

(4.) Centers for Disease Control and Prevention. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010. MMWR Morb Mortal Wkly Rep. 2011;60(1):13-15.

(5.) Centers for Disease Control and Prevention. ACIP presentation slides: February 2011 meeting. Available at www.cdc. gov/vaccines/recs/acip/slides-feb11.htm#pertussis. Accessed March 19, 2011.

(6.) Centers for Disease Control and Prevention. Recommended antimierobial agents for treatment and postexposure prophylaxis of pertussis: 2005 CDC guidelines. MMWR Recomm Rep. 2005;54(RR-14):1-16.

(7.) Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010; 59(RR-8):1-62.

(8.) Centers for Disease Control and Prevention. Prevention of pneumococcal disease among infants and children--use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine--recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59(RR-11):1-18.

(9.) Campos-Outcalt D. Your guide to the new pneumococcal vaccine for children. J Fam Pract. 2010;59:394-398.

(10.) Centers for Disease Control and Prevention. Updated recommendations for use of meningococcal conjugate vaccines-Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep. 2011;60:72-76.

(11.) Centers for Disease Control and Prevention. FDA licensure of bivalent human papillomavims vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010;59:626-629.

Doug Campos-Outcalt, MD, MPA

Department of Family and Community Medicine, University of Arizona

College of Medicine, Phoenix

dougco@u.arizona.edu
TABLE 1

Definition of close contact
with a pertussis patient

* Face-to-face exposure within 3 feet of a
symptomatic patient

* Direct contact with respiratory, oral, or nasal
secretions from a symptomatic patient, via
coughing, sneezing, shared food and eating
utensils, mouth-to-mouth resuscitation, or
examination of the mouth, nose, and throat

* Close proximity with a symptomatic patient
for [greater than or equal to]1 hour in a confined space

Source: Centers for Disease Control and Prevention. MMWR
Morb Mortal Wkly Rep. 2005. (6)

TABLE 2
Meningococcal conjugate vaccine recommendations by risk group,
ACIP 2010

Risk group              Primary series          Booster dose

Individuals ages        1 dose, preferably      * Age 16 years, if
11-18 years             at age 11 or 12 years     primary dose given
                                                  at age 11 or 12
                                                  years
                                                * Age 16-18 years,
                                                  if primary dose
                                                  given at age 13-15
                                                  years
                                                * No booster needed
                                                  if primary dose
                                                  given at [greater
                                                  than or equal to]
                                                  16 years

HIV-infected            2 doses, 2 months       * Age 16 years, if
individuals ages        apart                     primary series
11-18 years                                       given at age 11 or
                                                  12 years
                                                * Age 16-18 years,
                                                  if primary series
                                                  given at age 13-15
                                                  years
                                                * No booster needed
                                                  if primary series
                                                  given at [greater
                                                  than or equal to]
                                                  16 years

Individuals ages        2 doses, 2 months       * Every 5 years
2-55 years with         apart                   * At the earliest
persistent complement                             opportunity if
component deficiency                              primary series was
such as C5-C9,                                    1 dose, then every
properclin, or factor                             5 years thereafter
D, or functional or
anatomic asplenia

Individuals ages        1 dose                  * After 3 years for
2-55 years with                                   individuals ages
prolonged increased                               2-6 years
risk of exposure,                               * After 5 years for
such as                                           individuals
microbiologists                                   [greater than or
routinely working                                 equal to] 7 years
with Neisseria                                    if still at
meningitidis and                                  increased risk
travelers to, or
residents of,
countries where
meningococcal disease
is hyperenclemic or
epidemic

Source: Centers for Disease Control and Prevention. MMWR Morb
Mortal Wkly Rep. 2011. (10)
COPYRIGHT 2011 Quadrant Healthcom, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2011 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Title Annotation:Advisory Committee on Immunization Practices
Author:Campos-Outcalt, Doug
Publication:Journal of Family Practice
Geographic Code:1USA
Date:May 1, 2011
Words:1470
Previous Article:It's time to abandon the sliding scale: use a system that mimics normal insulin secretion--and the 5 principles of insulin management detailed...
Next Article:Is your patient still using rosiglitazone? Many doctors stopped prescribing rosiglitazone in 2007, when a study linked it to an elevated MI risk. an...
Topics:

Terms of use | Privacy policy | Copyright © 2019 Farlex, Inc. | Feedback | For webmasters