Changes to Tdap, HPV, Hepatitis B Vaccine Recommendations Among 2012 Schedule Highlights

More than a dozen changes are reflected in the CDC's 2012 child, adolescent and adult immunization schedules. Developed in conjunction with the AAFP and other groups, several of the 2012 changes are especially pertinent to family physicians, according to the AAFP's liaison to the CDC's Advisory Committee on Immunization Practices (ACIP), Jamie Loehr, M.D., of Ithaca, N.Y.

"Some of the most important changes for family physicians in the 2012 immunization schedules involve the tetanus, diphtheria and acellular pertussis (Tdap) vaccine for pregnant women and health care personnel, as well as the hepatitis B vaccine for patients with diabetes," Loehr told AAFP News Now. Also noteworthy is the ACIP's call for the addition of quadrivalent human papillomavirus vaccine (HPV4) to the schedule for boys and young men.

In June, the ACIP recommended that pregnant women who have never received the Tdap vaccine should be immunized during their second or third trimester rather than in the immediate postpartum period. The 2012 schedule also reflects the ACIP's call for health care personnel to receive a single dose of Tdap vaccine if they have not received it previously.

The ACIP also made a change to the 2012 catch-up immunization schedule with regard to Tdap, adding that, for children who received Tdap as a catch-up dose at age 7 through 10 years, "an adolescent dose should not be given."

In October, the ACIP voted to recommend routine hepatitis B immunization of unvaccinated adults with diabetes who are younger than age 60 and optional use of the vaccine in diabetic adults 60 and older. The recommendation was based on evidence that patients with diabetes are at increased risk for hepatitis B because of shared testing equipment.

Loehr said it is important to note patients 60 and older were relegated to a category B recommendation because the vaccine is more cost-effective in younger patients. A category B recommendation allows for individualized decision-making by the physician and patient about the appropriateness of the vaccine in this older age group. In general, the more robust a patient's health, the greater the likelihood that he or she will respond to the vaccine.

Perhaps some of the most complicated ACIP recommendations, according to Loehr are those specific to the administration of HPV4 vaccine for boys and young men.

"The ACIP now recommends routine HPV4 vaccination in boys 11 to 12 years of age, with catch-up vaccinations at age 13 to 21," Loehr said. "It is acceptable, however, to begin HPV4 vaccination in boys as young as 9 years of age.

"HPV4 vaccination is also recommended in previously unvaccinated men ages 22 to 26 who have human immuno¬deficiency virus infection, those who are immunosupressed or men who have sex with men. For other men ages 22 to 26, the ACIP makes a category B recommendation for HPV4 vaccination."

Loehr said it also should be noted that the ACIP recommends that children 6 months to 8 years of age receive two doses of influenza vaccine during the current season if they did not receive at least one dose of the vaccine during the 2010-11 season.