Am Fam Physician. 2010 Jan 15;81(2):232.
Guideline source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices
Literature search described? No
Evidence rating system used? No
Published source: Morbidity and Mortality Weekly Report. In press.
This issue of American Family Physician introduces the 2010 schedules for recommended immunizations in young children (birth through six years of age), older children and adolescents (seven through 18 years of age), and adults. In addition to the formal recommendation of routine influenza vaccination in all children, new options for human papillomavirus (HPV) vaccination and guidance for revaccination with meningococcal vaccine are included.
A bivalent HPV vaccine—offering protection from the high-risk HPV serotypes 16 and 18—was licensed in October 2009 by the U.S. Food and Drug Administration for use in females. The quadrivalent HPV vaccine was licensed for use in males for prevention of genital warts caused by HPV serotypes 6 and 11. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention has added the bivalent vaccine to the child and adolescent immunization schedules, providing recommendations for harmonization between the schedules for both vaccines. However, it did not give preference to either vaccine for use in females. Rather, physicians should provide thorough information to patients or their parents about the benefits and expected coverage of each vaccine.
In a departure from recent recommendations, ACIP provided a permissive, but not routine, recommendation for the use of quadrivalent HPV vaccine to prevent genital warts in males. This recommendation was based on the projected high cost of a routine program for males, with limited benefit if females are already vaccinated.1
In the past year, the emergence of 2009 influenza A H1N1 complicated the planned implementation of routine influenza vaccination for children and adolescents six months through 18 years of age. The arrival of this pandemic strain of influenza reminds us of the unrelenting threat of infectious disease and provides an opportunity to learn how to better tackle the challenges inherent in immunizing 78 million children on an annual basis. Within the chaos of distributing seasonal and pandemic influenza vaccine lies the opportunity for creative approaches to improve the current estimated coverage rates of 20.8 to 40.9 percent in children.2
1. Kim JJ, Goldie SJ. Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States. BMJ. 2009;339:b3884.http://www.bmj.com/cgi/content/full/339/oct08_2/b3884?view=long&pmid=19815582. Accessed November 23, 2009.
2. Centers for Disease Control and Prevention. Influenza vaccination coverage among children and adults—United States, 2008–09 influenza season. MMWR Morb Mortal Wkly Rep. 2009;58(39):1091–1095.
editor's note: The author is a member of ACIP.
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