The Advisory Committee on Immunization Practices (ACIP) has updated the federal immunization guidelines, including more nuances of the guidelines visually represented on the schedule to enhance clarity.
Changes to vaccination protocols against meningococcal serotype B (MenB) and human papillomavirus (HPV) are some of the most significant in the 2016 immunization schedule released recently by the Advisory Committee on Immunization Practices (ACIP), a branch of the Centers for Disease Control and Prevention (CDC).
The new schedule has been endorsed by a number of medical groups including the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the American Academy of Pediatrics (AAP). The immunization schedule is revised annually.
“Changes in the child/adolescent schedule reflect new ACIP recommendations and provide additional information on existing recommendations,” says Candice L Robinson, MD, MPH, of United States Public Health Service and the CDC’s National Center for Immunization and Respiratory Diseases. “The purpose of the recommended immunization schedule is to protect infants and children by providing immunity early in life, before they are exposed to potentially life-threatening diseases. Healthcare professionals are the greatest source of vaccine information for patients and parents. We encouraged them to stay up-to-date on the latest ACIP recommendations.”
Robinsons says the new MenB vaccine recommendation now applies to groups that are not normally considered high-risk-healthy individuals aged 16 to 18 years-plus anyone aged older than 10 years that may face increased risks of developing the disease, including children with sickle cell disease or other immune problems.
Meningococcal serotype B attacks the lining of the brain and the spinal cord, and causes death in 10% of cases and permanent disability in 14% of cases. This particular strain accounts for about one-third of the meningitis cases in the United States, according to CDC.
Two MenB vaccines are available-Trumemba and Bexsero. The ACIP advised that either vaccine could be used, but they should not be interchanged once the vaccination series begins.
The change in the recommendation on the HPV vaccine reflects recent guidance from various medical groups over the last year, following the US Food and Drug Administration’s approval of 9-valent HPV vaccine (9vHPV), which protects against 9 types of HPV.
Two other formulations of the vaccine-2-valent HPV and 4-valent HPV-are also available, but do not protect against as many strains of the virus. These vaccines cover strains responsible for about 66% of HPV cases, while the 9vHPV vaccine covers additional strains that are responsible for 14% of HPV cancers in females and 4% in males, according to CDC.
“The new vaccine covers 9 strains of HPV, offering protection against at least 80% of the cervical, vulvar and anal cancers caused by HPV,” AAP writes in a statement on the new vaccine schedule. “The schedule continues to recommend HPV vaccination beginning at age 11 years, but it now advises that because children with a history of sexual abuse are at increased risk of HPV, the first dose should be administered at age 9 years.”
Robinson says the order of the vaccines were also changed this year to group vaccines by the recommended age of administration. Colors were changed, as well, to improve the readability of the guidelines.
• A purple bar was added for Haemophilus influenzae type b vaccine for children aged 5 to 18 years, and ACIP emphasizes the recommendation to vaccinate high-risk children in this age group who were are unimmunized.
• A purple bar was added for the HPV vaccine for children aged 9 to 10 years of age, with the recommendation to vaccinate high-risk children in this age group, including children with a history of sexual abuse.
• A new row was also been added for the MenB vaccine containing a purple bar denoting the recommendation to vaccinate high-risk individuals aged 10 years and older. This row also contains a blue bar with the recommendation for administration to non-high-risk groups subject to individual clinical decision making, for persons aged 16 to 23 years (the preferred age range is 16 to 18 years), says Robinson.
• Combined green and purple bars indicate the recommended age when vaccine catch-up is encouraged for certain high-risk groups, and white boxes show the ages when a vaccine is not recommended routinely. The catch-up schedule also offers recommendations for children and adolescents aged 4 months to 18 years who start vaccinations late or are more than 1 month behind, according to AAP.
Robinson says while many of these are not new recommendations, it is the first year the recommendations have been visually represented on the schedule.
The following changes were also made to the footnotes on the 2016 schedule, Robinson says.
• The Hepatitis B vaccine footnote was revised to more clearly present the timing for post-vaccination serologic testing for infants born to hepatitis B surface antigen-positive mothers, as well as to present the new CDC recommended interval for post-vaccination serologic testing.
• The diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine footnote was revised to more present recommendations following an inadvertently early administered fourth dose of DTaP vaccine.
• The inactivated polio vaccine footnote was updated to provide guidance for vaccination of persons who received only oral polio vaccine and received all doses before age 4 years.
• The meningococcal vaccines footnote has been updated to include a “clinical discretion” category for vaccination of non-high-risk persons aged 16 to 23 years.
• The HPV footnote reflects the new HPV vaccine nomenclature (from HPV9 to 9vHPV) plus guidance for vaccination beginning at age 9 years for children with a history of sexual abuse.