1 Info for providers about adolescent vaccines.pdf

Information for Health Care Professionals about Adolescent Vaccines

The Centers for Disease Control and Prevention (CDC) recommends four vaccines for adolescents to prevent:

These recommendations are supported by the American Academy of Pediatrics, the American Academy of Family Physicians, and the Society for Adolescent Health and Medicine.

What can YOU do to ensure your patients get fully vaccinated?

Direct parents who want more information on vaccines and vaccine-preventable diseases to visit the CDC website at http://www.cdc.gov/vaccines/teens or to call 800-CDC-INFO.

Note about syncope: For all vaccines given during adolescence, syncope has been reported in both boys and girls. To avoid serious injury related to a syncopal episode, adolescents should always be sitting or lying down to receive vaccines, remain so for 15 minutes, AND be observed during this time. ►

National Center for Immunization and Respitatory Diseases Office of the Director

Overview of Adolescent Vaccination Recommendations

▼ Vaccine

Flu

Age ► 7–10 YEARS 11-12 YEARS 13-18 YEARS

Recommended

MCV4

HPV

Tdap

High-Risk

Childhood Catch-up

Recommended

Recommended

Recommended

Catch-Up

Catch-Up

Recommended

U.S. Department of Health and Human Services Centers for Disease Control and Prevention

Tdap (tetanus toxoid - reduced diphtheria toxoid -acellular pertussis) Vaccine

Because immunity from childhood DTaP vaccines wanes by adolescence, a booster dose is recommended. Of the nearly 17,000 cases of pertussis reported in the United States in 2009, 4265 occurred among 10- through 19-year-olds. Increasing immunization rates among adolescents is an important strategy for reducing disease among both adolescents and infants too young to be fully immunized. According to the 2009 National Immunization Survey-Teen (NIS-Teen), about 57% of 13- through 17-year-olds received Tdap.

Recommendations:

• All 11- through 18-year-olds should receive a single dose of

Tdap vaccine (preferably at age 11 or 12 years) if they have completed the recommended childhood DTP/DTaP vaccina-tion series and have not received Tdap.

• Children aged 7 through 10 years and adolescents aged 11 through 18 years who did not complete the childhood DTaP series or with unknown vaccine history should be given one dose of Tdap as part of the catch-up regimen. Td should be used for any other doses needed.

• Tdap should be administered regardless of interval since the last tetanus or diphtheria toxoid-containing vaccine. While longer intervals between Td and Tdap vaccination could decrease the occurrence of local reactions, the benefits of protection against pertussis outweigh the potential risk for adverse events.

• Tdap vaccine can be administered at the same time as other adolescent vaccines.

Vaccines licensed in the United States:

• Boostrix® (GlaxoSmithKline) is indicated for active booster immunization for the prevention of tetanus, diphtheria and pertussis as a single dose in persons 10 through 64 years of age.

• Adacel® (sanofi pasteur) is indicated for active booster immunization for the prevention of tetanus, diphtheria and pertussis as a single dose in persons 11 through 64 years of age.

Possible side effects:

Pain, redness, swelling at the injection site; mild fever; head-ache; fatigue; nausea, vomiting, diarrhea, or stomach ache.

Contraindications and precautions:

• Tdap is contraindicated for persons with a history of serious allergic reaction (e.g., anaphylaxis) to any component of the vaccine.

• Tdap is contraindicated for adolescents with a history of en-cephalopathy (e.g., coma or prolonged seizures) not attribut-able to an identifiable cause within 7 days of administration of a vaccine with pertussis components. This contraindica-tion is for the pertussis components and these adolescents should receive Td instead of Tdap.

Meningococcal Conjugate Vaccine (MCV4)

Although rates of meningococcal disease are the lowest they have ever been in the United States, about 1000 cases are reported each year in this country. Each case is alarming and potentially deadly. The incidence of meningococcal disease increases in adolescence and early adulthood. About 10-15% of adolescents who contract the disease will die, and about 20% will suffer from a long-term disability. According to the 2009 NIS-Teen, about 54% of 13- through 17-year-olds have received meningococcal vaccine.

Recommendations:

• All 11- or 12-year-olds should receive a single dose of me-ningococcal vaccine, with a booster dose at age 16 years.

• For adolescents who receive the first dose at age 13 through 15 years, a one-time booster dose should be administered, preferably at age 16 through 18 years. Persons who receive their f0irst dose of meningococcal conjugate vaccine at or after age 16 years do not need a booster dose.

• Adolescents with persistent complement component defi-ciencies (e.g., C5-C9, properidin, factor H, or factor D) and asplenia should receive a 2-dose primary series administered 2 months apart and then receive a booster dose every 5 years.

• Adolescents aged 11–18 years with HIV infection should be routinely vaccinated with a 2-dose primary series.

• Vaccination is also recommended for unvaccinated college freshmen who live in dormitories, and also for unvaccinated military recruits. Older adolescents, including college students, who wish to decrease their risk for meningococcal disease, may elect to receive meningococcal vaccine.

• Meningococcal vaccine can be administered at the same time as other adolescent vaccines.

Vaccines licensed in the United States:

• Menactra® (sanofi pasteur) is indicated for active immuniza-tion of persons 9 months through 55 years of age for the prevention of invasive meningococcal disease caused by N. meningitidis serogroups A, C, Y and W-135.

• Menveo® (Novartis) is indicated for active immunization of persons 2 through 55 years of age to prevent invasive meningococcal disease caused by N. meningitidis serogroups A, C, Y, and W-135.

Possible side effects:

The most commonly reported side effects are redness or pain at the injection site. A small percentage of recipients reported fever.

Contraindications and precautions:

• Meningococcal vaccine is contraindicated among persons known to have a severe allergic reaction to any component of the vaccine, including diphtheria toxoid, or to dry natural rubber latex.

Human Papillomavirus (HPV) Vaccine

Cervical cancer, caused by HPV, is one of the most common can-cers in women—every year in the United States, about 12,000 women are diagnosed with cervical cancer, and about 4,000 women die from this disease. HPV types 16 and 18 are the most common high-risk types associated with cervical cancer, while HPV 6 and 11 are the most common low-risk types associated with genital and respiratory tract warts (recurrent respiratory papillomatosis or RRP). High-risk HPV types have also been associated with other, less common cancers and precancers in women, such as vulvar, vaginal, anal, opharyngeal carcinomas and dysplasia. HPV-associated cancers in males include certain anal, penile, and oropharyngeal carcinomas and dysplasia.

According to the 2009 NIS-Teen, about 44% of 13- through 17-year-old girls have started an HPV vaccine series. However, only about 27% received all 3 doses. Completing the 3-dose HPV vaccine series is very important to ensure protection against cervical cancer and other HPV-related disease.

Vaccines licensed in the United States:

• Cervarix® is indicated for the prevention of cervical cancer and precancers caused by HPV types 16 and 18.

• Gardasil® is indicated for the prevention of cervical, vulvar, vaginal and anal cancers and precancers, as well as genital warts, caused by HPV types 6, 11, 16 and 18.

Recommendations:

• All girls 11 or 12 years old should get 3 doses of HPV vac-cine to protect against cervical cancer. Girls and young women ages 13 through 26 should get all 3 doses of an HPV vaccine if they have not yet received all doses.

• Both brands of vaccine are highly effective for preventing cervical cancer and precancer caused by HPV types 16 and

18. Gardasil also protects against anal cancer and genital warts.

• Gardasil is approved for use in males—boys and young men may choose to get this vaccine to protect against genital warts and anal cancer.

• HPV vaccines are administered in a 3-dose schedule. The second dose should be administered 1 to 2 months after the first dose, and the third dose should be administered 6 months after the first dose. There is no maximum interval between doses. If the HPV vaccine schedule is interrupted, the vaccine series does not need to be restarted.

• Whenever feasible, the same brand of HPV vaccine should be used for the entire vaccination series. However, if the vaccine provider does not know which brand of vaccine was previously administered or have it available, either brand of HPV vaccine can be used to complete the series.

• Individuals will get the greatest benefit from the vaccine if it is administered before they have initiated any type of sexual activity with another person.

• Studies demonstrate that the risk for HPV infection is high immediately following sexual debut. It is also important to note that 1 in 5 women who have only had one lifetime sex partner have been infected with a high-risk HPV type.

• Vaccination is recommended for patients with HPV-related disease and/or apparent HPV infection because the vaccine can offer protection against infection with HPV vaccine types not already acquired. However, vaccination will not have a therapeutic effect on existing HPV infection or HPV-related disease.

• HPV vaccine can be administered at the same time as other adolescent vaccines.

Possible side effects:

Pain, headache, redness or swelling at the injection site are the most commonly reported side effects.

Contraindications and precautions:

• HPV vaccines are not recommended for use in pregnancy. If a patient is found to be pregnant after initiating the vaccina-tion series, the remainder of the 3-dose series should be delayed until completion of pregnancy. However, if a vaccine dose has been administered during pregnancy, no interven-tion is needed. Clinicians should report exposure to Gardasil during pregnancy to Merck at 800-986-8999, and exposure to Cervarix during pregnancy to GlaxoSmithKline at 888-452- 9622.

• HPV vaccines are contraindicated for persons with a history of immediate hypersensitivity to any vaccine component.

Gardasil is contraindicated for persons with a history of immediate hypersensitivity to yeast. Prefilled syringes of Cervarix have latex in the rubber stopper and should not be used in persons with anaphylactic latex allergy. Cervarix single-dose vials contain no latex.

Influenza Vaccine

CDC recommends universal annual flu vaccination for every-one aged 6 months and older. Flu can be serious, and even fatal, for healthy adolescents, but pre-teens and teens with cer-tain medical conditions are more likely to suffer from serious flu complications. Conditions that place people at high risk include chronic lung disease (such as asthma); heart disease; endocrine disorders (such as diabetes); blood disorders; neurological and neurodevelopmental conditions; kidney, liver, and metabolic disorders; and weakened immune systems due to disease or medication. Flu seasons are unpredictable and can be severe.

Each year in the United States, more than 200,000 people are hospitalized from flu-related complications.

Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications since flu viruses are constantly changing. Protective immunity gener-ally develops in 2 weeks after being vaccinated.

Vaccines Licensed in the United States:

• Trivalent Inactivated Influenza Vaccine (TIV) is given as an injection. It can be used for people 6 months of age or older, including healthy people, those with chronic medical condi-tions, and pregnant women. Brands licensed in the United States include Fluarix®, Fluvirin®, Fluzone®, FluLaval®, and Afluria®.

• Live, Intranasal Influenza Vaccine (LAIV) is given as a nasal spray. It can be used for healthy people 2 through 49 years of age who are not pregnant. FluMist® is the only brand licensed in the United States.

Recommendations:

• Adolescents should receive a single dose of influenza vac-cine every year.

• Influenza vaccine can be administered at the same time as other adolescent vaccines.

Possible side effects:

TIV (injection): Soreness, redness, or swelling at the injection site; hoarseness; sore, red or itchy eyes, cough; fever, aches. If these problems occur, they begin soon after the shot and usu-ally last 1 to 2 days. TIV contains noninfectious killed viruses and cannot cause influenza.

LAIV (nasal spray): Runny nose, nasal congestion, or cough;

fever; headache and muscle aches; wheezing; abdominal pain or occasional vomiting or diarrhea. LAIV contains weakened in-fluenza viruses that cannot replicate outside the nasal passages and cannot cause influenza.

Contraindications and precautions:

• Influenza vaccines should not be administered to people who have anaphylactic hypersensitivity to eggs, unless the recipient has been desensitized.

• Moderate or severe acute illness with or without fever is a precaution for vaccination. People who are moderately or severely ill should not be vaccinated until they recover.

• GBS within 6 weeks following a previous dose of influenza vaccine is a precaution for use of influenza vaccines.

• LAIV (nasal spray) should not be administered to pregnant adolescents, adolescents with chronic medical conditions (including asthma, metabolic disease, or hemoglobinopathy) as well as adolescents receiving aspirin or other salicylates.

Catch-Up Vaccines for Adolescents

Pre-teens and teens should receive doses of these vaccines as indicated to complete each series:

• Hepatitis B vaccine (HepB): Complete the 3-dose series if not previously completed. Note: A 2-dose series (separated by at least 4 months) of Recombivax HB® is licensed for children aged 11 through 15 years.

• Varicella vaccine: Complete the 2-dose series if not previ-ously completed, with at least 3 months between doses for persons aged 12 months through 12 years. (If the second dose was administered at least 28 days after the first dose, it can be accepted as valid.) For persons aged 13 years and older, the minimum interval between doses is 28 days.

• Inactivated poliovirus vaccine (IPV): The childhood series is 4 doses. However, only 3 doses are needed for pre-teens and teens who received their third dose after 4 years of age, as well as pre-teens and teens in your care who have not received any doses. In all cases, a minimum interval of 6 months is needed between the last two doses.

• Measles-mumps-rubella vaccine (MMR): Complete the 2-dose series if not previously completed, with at least 28 days between doses.

A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Refer to the CDC Catch- Up Immunization Schedule for more information.

Vaccine Information Statements

Vaccine Information Statements (VIS) are an excellent source of information for patients about the risks, benefits, and side effects of vaccines. Federal law requires that VIS be given out before vaccines are administered. To download any VIS, visit http://www.cdc.gov/vaccines/pubs/vis/default.htm

Vaccine Adverse Events Reporting System

Doctors and other health care professionals are encouraged to report any adverse events following administration of vaccines to the Vaccine Adverse Event Reporting System (VAERS), which is jointly administered by CDC and the U.S. Food and Drug Ad-ministration. Visit http://vaers.hhs.gov for more information or to file a report.

Vaccines for Children

The Vaccines for Children (VFC) program provides vaccines at no cost to professionals who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian or Alaska Native or have no health insurance. Children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. VFC vaccines cannot be denied to an eligible child if a family can’t afford the administration fee. For more information about par-ticipating in VFC, visit http://www.cdc.gov/vaccines/programs/vfc/

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References to non-CDC sites on the Internet do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed were current as of the date of publication.