{"id":970,"date":"2016-02-11T14:58:06","date_gmt":"2016-02-11T14:58:06","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=970"},"modified":"2017-08-21T11:05:03","modified_gmt":"2017-08-21T11:05:03","slug":"primary-care-corner-with-geoffrey-modest-adult-and-pedi-2016-immunization-schedules","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/02\/11\/primary-care-corner-with-geoffrey-modest-adult-and-pedi-2016-immunization-schedules\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest: Adult and Pedi 2016 Immunization Schedules"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>The Advisory Committee on Immunization Practices and CDC just published their immunization recommendations for adults and kids.<\/p>\n<ol>\n<li><strong>Adults<\/strong>.\u00a0For those &gt;18 years old,\u00a0see\u00a0\u00a0<em>Ann Intern Med.<\/em>2016;164(3):184, or go to\u00a0<a href=\"http:\/\/www.cdc.gov\/vaccines\/schedules\/downloads\/adult\/adult-combined-schedule.pdf\">http:\/\/www.cdc.gov\/vaccines\/schedules\/downloads\/adult\/adult-combined-schedule.pdf<\/a> for a nice color chart and the rather extensive footnotes, ideal for hanging in the immunization room by the refrigerator. Changes from 2015 include:<\/li>\n<\/ol>\n<ul>\n<li>Simplification of the rather complex relationship between the pneumococcal vaccines: for immunocompetent people\u00a0over 65yo, give PCV13 first, then at least one year later (had been 6-12 months), give\u00a0PPSV23; if they already got PPSV23, wait one year at least to give the PCV13.\u00a0In those immunocompromised\u00a0(functional\/anatomic asplenia, CSF leaks, cochlear implants, HIV, etc.),\u00a0and &gt;18yo,\u00a0give\u00a0PCV13 first, then can follow with PPSV23 at least 8 weeks later; \u00a0if they already got PPSV23, then wait at least one year for the single dose of PCV13.In those who should get a PPSV23 booster since they got the first dose &lt;65 yo, they should wait at least 5 years to the next PPSV23 dose. They also note that those with immunocompromise\/asplenia can\u00a0receive\u00a0up to a total of\u00a03 doses of PPSV23. And they deleted the recommendation that adults 19-64 who are in nursing homes get\u00a0PPSV23 (though, I wonder about the real utility of\u00a0this: probably most have an indication for PPSV23\u00a0from asthma, COPD, diabetes, heart failure, alcoholism, smoking, etc.\u00a0Also, I wonder about actual second-hand smoke exposure, though my understanding is that JCAHO requires some isolation of smoking areas.\u00a0Sorry, but this simplification actually is simpler than last year&#8217;s&#8230;<\/li>\n<li>Meningococcal B vaccine has been added: give to those &gt;10 yo at increased risk of serogroup B infections (asplenia, complement deficiencies, local outbreaks of serogroup B). Can be given to adults aged 16-23 (preferably 16-18) to get short-term protection. A 2-dose series administered at least 1 months apart (the 2 different meningococcal B vaccines are not interchangeable). No recommendation about revaccination (vs the regular meningococcal vaccine for serogroups A,C,W,Y; where there should be revaccination every 5 years in those who remain at increased risk). See pedi schedule below for other details.<\/li>\n<li>For the regular meningococcal vaccine, the conjugate A,C,W,Y (MenACWY) is preferred for adults &lt;56yo, and for those &gt;56 who have had prior meningococcal vaccine who need revaccination (whether they got the MenACWY or the polysaccharide MPSV4\u200b vaccine).\u00a0The\u00a0MPSV4 vaccine is preferred in those &gt;56 who have never been vaccinated and need a single dose only (as with a recent outbreak). HIV is not an indication for meningococcal vaccine (despite outbreak in New York in 2014, which spurred some of us, like me, to vaccinate my HIV-positive patients)<\/li>\n<li>HPV vaccine: they added the 9-valent vaccine (9vHPV). Can be used as the\u00a0routine vaccine, given as 1 of the 3 recommended vaccines\u00a0for females (others: 2vHPV and 4vHPV), or as 1 of the 2 for males (other:\u00a04vHPV). The age recommendations have not changed: women beginning age 11-12 until age 26; men till age 21, though okay to give for\u00a022-26 yo and recommended in that group for MSM.<\/li>\n<li>And, they reinforce some of their newer recommendations, such as the importance of giving a Tdap to women for each pregnancy, preferably at 27-36 weeks&#8217; gestation, and an influenza vaccine, to protect the woman and the to-be-born.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ol start=\"2\">\n<li><strong>Pedi<\/strong>.\u00a0The updated\u00a02016\u00a0pediatric immunization schedules were just released\u00a0(see DOI: 10.1542\/peds.2015-4531). For a chart of the immunizations as well as the catch-up schedule, see\u00a0<a href=\"http:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/child-adolescent.html\">http:\/\/www.cdc.gov\/vaccines\/schedules\/hcp\/child-adolescent.html<\/a>. Also ideal to hang the color charts in the\u00a0immunization\u00a0room near the refrigerator.\u00a0\u00a0Summary of changes in brief:<\/li>\n<\/ol>\n<ul>\n<li>They\u00a0added a blue bar to the already colorful chart, which indicates the range of recommended ages of a vaccine for certain high risk groups<\/li>\n<li>See above re: the 9-valent\u00a0HPV vaccine (9vHPV)<\/li>\n<li>HPV: new purple bar (for ages of recommended vaccines in high risk groups), they added age 9-10 for children at high risk because of a history of sexual abuse (though, I wonder about the 5 year olds, etc&#8230;&#8230;)<\/li>\n<li>Meningococcal B vaccine (detailed above): begin at 10 years old if at increased risk, may otherwise consider in those 16-18.<\/li>\n<li>Pneumococcal polysaccharide vaccine (PPSV23): moved to bottom of the list since not routinely indicated for anyone (but should be given to kids aged 6-18 with underlying immunocompromise, hemoglobinopathies, HIV, renal failure, nephrotic syndrome, etc.); in general, give PCV13 first, then PPSV23 at last 8 weeks later.<\/li>\n<li>They clarified that in infants born to mothers with hepatitis B surface antigen (and the infant therefore gets immunized starting within 12 hours of birth), to check the infant for anti-HbsAg and HBsAg at least 1 months after final vaccine dose and\u00a0between 9-18 months old (at time of regular well-child visit). They do not comment further, but I would suggest repeating the 3 doses again if there is a negative surface antigen and antibody in the kid, as we do with adults who are at high hepatitis B risk.<\/li>\n<li>If a kid inadvertently gets a 4th DTaP early, but it was given at least 4 months but less than 6 months after the 3rd dose, no need to repeat (a logical correlate here, it seems to me, is that it might be reasonable to give this 4<sup>th<\/sup> dose earlier to\u00a0a kid who will not be around for the usual 4th dose timing between 15-18 mos old, e.g. if they will be out of\u00a0the country during that time)<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest: Adult and Pedi 2016 Immunization Schedules  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2016\/02\/11\/primary-care-corner-with-geoffrey-modest-adult-and-pedi-2016-immunization-schedules\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-970","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/970","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=970"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/970\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=970"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=970"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=970"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}