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Synthesizing CDC immunization recommendations with Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP


Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, provided a review and reminder of the CDC immunization recommendations and schedule during her session at the 45th National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care in Denver, Colorado.


Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP:

Hi my name is Dr. Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP. I'm a pediatric nurse practitioner. I am a clinical assistant professor at Stony Brook University School of Nursing, and I have a private practice, and I'm a nurse consultant for immunize.org. My job is to synthesize the information that CDC puts out every year that they update on the annual ACIP or Advisory Committee on Immunization Practices schedule. So I go through and I pick out all of the things that are new and then I tell everybody what the new changes are, how it'll affect their practice, and then I show them where to find the information on the schedules. Because, the schedules can be very, very confusing, and I put it in a format that's easy to understand. I also listen to what CDC has done recently, so that I can highlight the important points for anyone who hears my talk.

Contemporary Pediatrics:

Can you provide your update related to pediatric influenza?


I'd love to start with influenza, because honestly, there have been over 100 children who died in the United States, this influenza year, and the saddest part is most of those children were not vaccinated. So, we talked about some of the things that are new for influenza vaccine. Number one is egg allergy is no longer a contraindication. Another thing that we talked about was the new cell-based influenza vaccines that are looking extremely promising and offering even better immune response than our old egg-based technologies. So we will want to stay tuned to that to hear whether, all of the vaccines are going to go that way, but those cell based vaccines are already available.
Contemporary Pediatrics:

What vaccines have been removed from the schedule?


There were several vaccines that were eliminated from the schedule. The previous versions of COVID vaccine were eliminated from the schedule, we now have the new one that's available. We're asking everybody to get that vaccine. We eliminated the pediatric DT from the schedule. Honestly haven't used that in years, that was for children who had an allergy, more specifically had recently had an encephalopathy following a DTaP. And specifically, it's the pertussis component, so that vaccine is no longer available and now we've been advised to use the adults strength tetanus diphtheria vaccine is a substitute with an off label recommendation from ACIP for those children, which is a very, very small number of children who can no longer take the diphtheria tetanus acellular pertussis vaccine. We've also now added a meningococcal combination vaccine. It's now meningococcal ABCWY vaccine that is wonderful for our older children who are getting the 2 vaccines that. We discussed a new schedule on how to give them subsequent doses of meningococcal B vaccine. We talked about where to find things. We talked about polio vaccine, because now the polio vaccine has really been more standardized and we have guidance for adults, because we're seeing immigrants. We may have immigrants or people traveling to endemic countries who were not vaccinated. But on another note, just about every adult in the United States has been vaccinated against polio, but our most recent vaccines over the last 20 years have been the killed virus vaccine. So now there's a recommendation for anyone who received killed virus vaccine, traveling to an endemic area to get a a polio booster. So that's been simplified. We also simplified the tetanus diphtheria, acellular pertussis the number of doses that are required if a child receives a fourth dose on or after the fourth birthday no more doses would be due. There was a simplification of the HPV vaccine because there was some question if some people have received the 2-strain vaccine or was a repeat series of of doses with the updated vaccine was that required for them? CDC has clarified that now and if they received, no matter what vaccine they received with the number of strains they received, as long as they received them at the appropriate intervals with the appropriate vaccine at those intervals, they're good, because we do have some cross data that shows any of the HPV vaccines do offer very high protection against cancer. We had a lot of discussion about RSV because we have two distinct products. For infants, we have a monoclonal antibody and mono means it covers one strain of RSV, and this is specifically for the babies. The optimal time to give it is in the hospital, especially for children who don't live in an area where it's easy to get to providers, the baby would leave the hospital with that protection on board already. But we also have the RSV vaccine for the pregnant moms, and the CDC has been very specific with the windows to give these vaccines within the the RSV season here in the United States. But Alaska really doesn't fall in that, so the recommendation is if you have a question whether or not you should be giving the vaccine to the mom, or the monoclonal antibody to the baby, check with your local health department. I also reminded people that if they have any questions about infectious diseases, especially now that measles has reared its ugly head again, and many of the providers today have not seen measles, please call your local health department they are ready willing and able to advise you help you, whatever support you need, they're there for you.

Contemporary Pediatrics:

What resources are there for providers looking for clarification or refreshers when it comes to updated recommendations
on immunizations?


I highlighted immunize.org, which isthe go-to place for us as healthcare providers for information, it's really CDC information, but they synthesize it so well and make it so easy to find it. They have terrific handouts, because I did talk about making sure with COVID vaccine, that we're giving the right dose, the right amount to the right child, and CDC has come up with some terrific job aids to help them because I do follow the vaccine errors. There have been tons and tons of errors. The wrong vaccine given to the wrong age, the wrong volume given to the wrong age. To go back to the RSV vaccine, there's been, unfortunately, an awful lot of errors being made. The vaccine for adults for the older adults is being given to pregnant ladies, the vaccine for pregnant ladies is being given to the babies, the monoclonal antibodies been given to either pregnant ladies or older people. So we have to be very, very careful and make sure that we're reading those labels carefully. Having the guidelines right in front of us to make sure that we're giving the right dose to the right child in the right volume. The CDC has some really wonderful job aids and remember that the babies are getting the .25 dose that's appropriate for the babies and we have to just remember that and remember using the right, vaccine, but I pointed out the CDC's job aids. There are pictures with color coding on them, and to have those right in front of them when they're giving the vaccines because those job aids note the appropriate vaccine with the appropriate dose. So to have a visual like that is very, very helpful. I'm a visual learner and I liked having the colors I think is really very helpful. You can put them on the refrigerator door where the vaccines are stored, stick them on the countertop where you're drawing up the vaccines, but always keeping top of mind, [that] these are very confusing vaccines, it's very easy to make a mistake. Utilize every tool that we have in our toolbox to make sure that we're doing the right thing.

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