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| As appeared in the February 2010 issue of Needle Tips |
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Click here for PDF version
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| Q: |
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What has changed in
the 2010 U.S. immunization schedule for children/teens and the
2010 U.S. immunization schedule for adults? |
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Both schedules were
published in early January in Morbidity and Mortality Weekly
Report (MMWR). The schedule for children is available at
www.cdc.gov/mmwr/PDF/wk/mm5851-Immunization.pdf, and the
schedule for adults at
www.cdc.gov/mmwr/PDF/wk/mm5901-Immunization.pdf. Along with
the new schedules, MMWR published a bulleted list of changes with
each schedule. Both lists are reprinted in the paragraphs that
follow. |
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Changes to the
child/teen schedule: |
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The statement concerning
use of combination vaccines in the introductory paragraph
has been changed to reflect the revised ACIP
recommendation on this issue. |
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The last dose in the
inactivated poliovirus vaccine series is now recommended
to be administered on or after the fourth birthday and at
least 6 months after the previous dose. In addition, if 4
doses are administered before age 4 years, an additional
(fifth) dose should be administered at age 4 through 6
years. |
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The hepatitis A
footnote has been revised to allow vaccination of children
older than 23 months for whom immunity against hepatitis A
is desired. |
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Revaccination with
meningococcal conjugate vaccine is now recommended for
children who remain at increased risk for meningococcal
disease after 3 years (if the first dose was administered
at age 2 through 6 years), or after 5 years (if the first
dose was administered at age 7 years or older). |
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Footnotes for human
papillomavirus (HPV) vaccine have been modified to include
(1) the availability of and recommendations for bivalent
HPV vaccine, and (2) a permissive recommendation for
administration of quadrivalent HPV vaccine to males aged 9
through 18 years to reduce the likelihood of acquiring
genital warts. |
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Changes to the
adult schedule: |
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The human
papillomavirus (HPV) footnote (#2) includes language that
a bivalent HPV vaccine (HPV2) has been licensed for use in
females. Either HPV2 or the quadrivalent human
papillomavirus vaccine (HPV4) can be used for vaccination
of females ages 19 through 26 years. In addition, language
has been added to indicate that ACIP issued a permissive
recommendation for use of HPV4 in males. |
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The measles,
mumps, rubella (MMR) footnote (#5) has language added to
clarify which adults born during or after 1957 do not need
1 or more doses of MMR vaccine for the measles and mumps
components, and clarifies which women should receive a
dose of MMR vaccine. Also, interval dosing information has
been added to indicate when a second dose of MMR vaccine
should be administered. Language has been added to
highlight recommendations for vaccinating healthcare
personnel born before 1957 routinely and during outbreaks. |
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The hepatitis A
footnote (#9) has language added to indicate that
unvaccinated persons who anticipate close contact with an
international adoptee should consider vaccination. |
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The hepatitis B
footnote (#10) has language added to include schedule
information for the 3-dose hepatitis B vaccine. |
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The meningococcal vaccine
footnote (#11) clarifies which vaccine formulations are
preferred for adults ages 55 years and younger and 56
years and older, and which vaccine formulation can be used
for revaccination. New examples have been added to
demonstrate who should and should not be considered for
revaccination. |
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The selected
conditions for Haemophilus influenza type b (Hib) footnote
(#13) clarifies which high-risk persons may receive 1 dose
of Hib vaccine. |
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CDC provides
multiple formats of these schedules on its website at
www.cdc.gov/vaccines/recs/schedules/default.htm |
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IAC will make available for purchase full-color, 6-page
laminated versions of both the child and the adult
immunization schedules. For details go to
www.immunize.org/shop |
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| Q: |
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Please review the
recommendations for the use of the two human papillomavirus (HPV)
vaccines, Cervarix (GSK) and Gardasil (Merck). What are the
differences between them? |
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Cervarix is an
inactivated bivalent vaccine (HPV2) that protects against HPV
types 16 and 18. Gardasil is an inactivated quadrivalent
vaccine (HPV4) that protects against HPV types 16 and 18, and
also against types 6 and 11, which are human papillomaviruses
that cause genital warts. |
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| For prevention of cervical
cancers and precancers, ACIP recommends that females ages 9
through 26 years be vaccinated with either Cervarix or
Gardasil. To prevent genital warts, as well as cervical
cancers and precancers, ACIP recommends vaccination with
Gardasil. Gardasil may also be given to males ages 9 through
26 years to reduce their likelihood of acquiring genital
warts. |
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| Ideally, HPV vaccine should be
administered before potential exposure to HPV through sexual
contact. Therefore, for prevention of cervical cancers and
precancers, ACIP recommends that females ages 11 or 12 years
be routinely vaccinated with either Cervarix or Gardasil. HPV
vaccination also is recommended for females ages 13 through 26
years who have not been previously vaccinated or who have not
completed the full vaccination series. The vaccination series
can be started in males and females beginning at age 9 years. |
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| Both HPV vaccines are
administered in a 3-dose schedule, with the second dose
administered 1 to 2 months after the first dose and the third
dose 6 months after the first dose. The minimum interval
between the first and second doses of vaccine is 4 weeks. The
minimum interval between the second and third doses of vaccine
is 12 weeks. The minimum interval between the first and third
doses is 24 weeks. |
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| Whenever possible, use the
same brand of HPV vaccine for all doses in the series. In
situations when that's not possible, use the second HPV brand
to complete the series. A total of 3 doses of HPV vaccine
(either of a single brand or of a combination of brands)
completes the series. Do not start the series over again. If
fewer than 3 doses of Gardasil are received, protection
against HPV types 6 and 11 may not be adequate. |
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| Read the complete provisional
recommendations here:
www.cdc.gov/vaccines/recs/provisional/downloads/hpv-vac-dec2009-508.pdf
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What are the
recommendations for using Gardasil to prevent genital warts in
boys and men? |
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ACIP's provisional recommendations
state: "The 3-dose series of quadrivalent HPV vaccine may be
given to males aged 9 through 26 years to reduce their likelihood
of acquiring genital warts." The schedule and minimum intervals
are the same as for females. See the question and answer above for
details. |
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Use of HPV vaccine
is covered under the Vaccines For Children (VFC) program. Can VFC-eligible
boys receive HPV vaccine under the program? |
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Yes. Since ACIP states that
Gardasil can be administered to males to protect them from
genital warts, VFC vaccine provided by the VFC program can be
used for VFC-eligible males ages 9 through 18 years. |
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Please describe the
recommendations for the use of the Japanese encephalitis (JE)
vaccine, Ixiaro (Intercell Biomedical). |
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FDA licensed Ixiaro in March
2009. The other U.S.-licensed vaccine, JE-VAX, available in
the U.S. since 1992, is no longer being manufactured, but
existing supplies are still available for children ages 1
through 16 years who are at risk for exposure to Japanese
encephalitis. |
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| Ixiaro is indicated for the
prevention of disease caused by Japanese encephalitis virus (JEV)
in people age 17 years and older. People for whom Ixiaro
vaccination is indicated (i.e., travelers age 17 and older who
plan to spend a month or longer in endemic areas during the
JEV transmission season) should receive 2 doses administered
IM 28 days apart. The series should be completed at least 1
week prior to potential exposure to JEV. No data exist on the
interchangeability of JE-VAX and Ixiaro. People age 17 and
older who have received 1 or 2 doses of JE-VAX in the past
should receive a full series of 2 doses of Ixiaro (separated
by at least 28 days) if they are still at risk of exposure to
Japanese encephalitis. |
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| To access the provisional
recommendations for the use of JE vaccine, go to
www.cdc.gov/vaccines/recs/provisional/downloads/je-july2009-508.pdf |
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| The Ixiaro package insert is
located at
www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM142570.pdf. |
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| Information about the 1993
recommendations for use of JE-VAX is available at
www.cdc.gov/mmwr/pdf/rr/rr4201.pdf |
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What's new regarding
yellow fever vaccination recommendations? |
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| A: |
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On December 9, 2009, CDC posted
provisional recommendations for use of yellow fever (YF)
vaccine. The provisional recommendations include two new
contraindications and one new precaution to YF vaccination. |
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| YF vaccine is now
contraindicated for people whose immunologic response is
either suppressed or modulated by current or recent radiation
therapy or drugs, and for people with thymus disorders
associated with abnormal immune cell function, such as
thymomas. |
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| Being age 60 years or older
years is now a precaution for YF vaccine administration,
especially for people who have not previously received YF
vaccine. |
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| To access the yellow fever
vaccine provisional recommendations, go to
www.cdc.gov/vaccines/recs/provisional/downloads/yf-vac-dec-2009-508.pdf
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Is CDC planning to
release any new or updated VISs in the near future? |
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| A: |
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On October 6, 2009,
CDC released three new VISs, one for PPSV, one for zoster
vaccine, and one for rabies. New and updated VISs that will
likely be available within the next few months include
measles-mumps-rubella-varicella (MMRV), human papillomavirus (HPV),
Japanese encephalitis, yellow fever, anthrax, and pneumococcal
conjugate vaccine (PCV). You can find the latest news about
VIS changes on CDC's web page at
www.cdc.gov/vaccines/pubs/vis/vis-news.htm. |
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| All English-language VISs, as
well as their translations in more than 30 languages are
available on IAC's website at
www.immunize.org/vis. In addition, IAC always informs IAC
Express subscribers about new and revised VISs as soon as they
are released. To subscribe to IAC Express, go to
www.immunize.org/subscribe. |
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Is enough H1N1
influenza vaccine available now to start vaccinating people who
are not in one of the targeted high-risk
groups? |
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| A: |
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Supplies of vaccines that protect
against the 2009 H1N1 virus are increasing. In areas where health
department jurisdictions recommend it, providers can give 2009
H1N1 vaccine to anyone who wants it. Most states already allow
this, and CDC is encouraging people who have been waiting to
receive the 2009 H1N1 vaccine to get vaccinated now. |
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Click here for PDF version
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Immunization Action Coalition • 1573 Selby Ave • St. Paul, MN 55104 |
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tel 651-647-9009 • fax 651-647-9131 |
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC. |
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