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Changes to Tdap, Flu Vaccine Recommendations Among 2011 Immunization Schedules' Highlights
By News Staff
Off-label Tdap Use Recommended
"Tdap is a very underutilized vaccine for adults," said Campos-Outcalt, who is associate head of the department of family and community medicine at the University of Arizona College of Medicine, Phoenix. "We have very low use of that vaccine. People just aren't thinking of it."
Academy Is Key Player in Schedules' Development
The schedules typically are released in January, but according to Doug Campos-Outcalt, M.D., M.P.A., the AAFP's liaison to the ACIP, the 2011 documents were delayed after a particularly busy ACIP meeting in October.
"It took a while for those changes to get approved by everybody involved," he told AAFP News Now.
Several states had pertussis outbreaks last year, at least one of which still is ongoing. As of Jan. 7, California had more than 8,300 reported cases in its lingering outbreak (5-page PDF; About PDFs), which has resulted in hundreds of hospitalizations and 10 infant deaths.
The updated Tdap recommendations also state that the vaccine can be used regardless of the interval since previous immunization with a vaccine that contains tetanus or diphtheria toxoid.
Meningococcal, Flu and Pneumococcal Vaccine Changes Also Reflected
Another change in the 2011 adolescent schedule also was driven by the ACIP's actions during its October meeting. Previously, all adolescents were recommended to receive one dose of MCV4 at age 11 or 12 years (or at 13-18 years if not previously vaccinated). The committee voted in October to recommend a booster dose at age 16 for adolescents who received their first dose at the preteen (age 11 or 12) visit. Those who received their initial dose at ages 13-15 should get a booster dose three to five years after that first dose but prior to age 18, the committee said.
Campos-Outcalt pointed out two other significant changes included in the 2011 immunization schedules:
- expanding the recommendation for annual influenza vaccination to include all people ages 6 months and older in whom the vaccine is not contraindicated; and
- replacing the seven-valent pneumococcal conjugate vaccine Prevnar with the 13-valent Prevnar 13, which contains six additional antigens to protect against Streptococcus pneumoniae. The new vaccine is administered in a four-dose series at ages 2, 4, 6 and 12-15 months.
"Most people get the flu and get over it," said Campos-Outcalt. "It's the very old and very young who tend to have problems with it. For whatever reason, we don't have very high adherence to recommendations. There's a lot of apathy in the general population."
Historically, that apathy has extended to health care personnel, who are recommended to receive flu vaccine to protect themselves, their co-workers and their patients. Uptake by health care workers has hovered for years at less than 50 percent, but Campos-Outcalt said rates are starting to climb.
The Society for Healthcare Epidemiology of America released a position paper last year that called for mandatory influenza vaccination for health care workers, and the American Academy of Pediatrics released a similar policy statement at about the same time.
There are signs, according to Campos-Outcalt, that more health care institutions are encouraging or requiring vaccination for employees. "Workplaces are being more aggressive about it," he said. "We're still not where we need to be."
Additional Changes Include Clarifications and New Guidance
Additional changes to the child and adolescent schedules include the addition of guidance for the hepatitis B vaccine schedule for children who did not receive a birth dose, as well as revised guidance for catch-up doses (1-page PDF; About PDFs) of Haemophilus influenzae type b vaccine in people ages 5 years and older.
Finally, it's worth noting that on Jan. 28, the FDA revised the license for Novartis' MCV4 vaccine, which is marketed as Menveo, lowering the minimum age for administration from 11 years to 2 years. Sanofi Pasteur's MCV4 vaccine, which is marketed as Menactra, already was licensed for use in children as young as 2 years.
The FDA's action resulted in changes in the footnotes of both the childhood and adolescent schedules. Those changes are reflected in the schedules posted online, but they came too late to be updated in printed journals, including American Family Physician.
NFID Urges Docs to Help Boost Adult Immunization Rates
Physician Recommendation Plays Huge Role in Uptake
Most Toddler Vaccination Rates Near National Goals
But Outbreaks Show Need for Docs to Continue Educating Parents
Vaccines and Immunizations Special Report
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