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Immunization Action Coalition
Ask the Experts
As appeared in the February 2010 issue of Vaccinate Adults
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Immunization questions
Q:
What has changed in the 2010 U.S. immunization schedule for adults?
A:   The 2010 immunization schedule was published in early January in Morbidity and Mortality Weekly Report (MMWR). The schedule for adults is available at www.cdc.gov/mmwr/PDF/wk/mm5901-Immunization.pdf. Along with the new schedule, MMWR published a bulleted list that details how the 2010 schedule differs from the 2009 schedule. The list is reprinted in the paragraphs that follow.
 
Changes to the adult schedule:
 
•
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 the Advisory Committee on Immunization Practices (ACIP) issued a permissive recommendation for use of HPV4 in males.
•
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.
•
The hepatitis A footnote (#9) has language added to indicate that unvaccinated persons who anticipate close contact with an international adoptee should consider vaccination.
•
The hepatitis B footnote (#10) has language added to include schedule information for the 3-dose hepatitis B vaccine.
•
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.
•
The selected conditions for Haemophilus influenzae type b (Hib) footnote (#13) clarifies which high-risk persons may receive 1 dose of Hib vaccine.
CDC provides multiple formats of these schedules on its website at www.cdc.gov/vaccines/recs/schedules/default.htm.
The Immunization Action Coalition (IAC) makes available for purchase a full-color, 6-page laminated version of the adult immunization schedule and also of the child/teen schedule. For details, go to www.immunize.org/shop.
 
Q:
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?
A:  
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.
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.
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.
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.
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.
Read the ACIP's provisional recommendations here: www.cdc.gov/vaccines/recs/provisional/downloads/hpv-vac-dec2009-508.pdf.
 
Q:
What are the recommendations for using Gardasil to prevent genital warts in males?
A:   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.
 
Q:
Please describe the recommendations for the use of the Japanese encephalitis (JE) vaccine Ixiaro (Intercell Biomedical).
A:  
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.
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.
To access the provisional recommendations for the use of JE vaccine, go to www.cdc.gov/vaccines/recs/provisional/downloads/je-july2009-508.pdf.
The Ixiaro package insert is located at www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM142570.pdf.
Information about the 1993 recommendations for use of JE-VAX is available at www.cdc.gov/mmwr/pdf/rr/rr4201.pdf
 
Q:
What's new regarding yellow fever vaccination recommendations?
A:  
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.
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.
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.
To access the yellow fever vaccine provisional recommendations, go to www.cdc.gov/vaccines/recs/provisional/downloads/yf-vac-dec-2009-508.pdf.
 
Q:
Is CDC planning to release any new or updated VISs in the near future?
A:  
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.
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.
 
Q:
Is enough H1N1 influenza vaccine available now to start vaccinating people who are not in one of the targeted high-risk groups?
A:   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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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.