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NANCY SMITH, DNP, CRNP, FNP-BC ASSISTANT PROFESSOR

SALISBURY UNIVERSITY

Update on Childhood Immunization Schedule Changes

and Promoting Compliance

Disclosure

� I have no actual or potential conflict of interest related to this presentation.

� I have no relevant financial relationships with any commercial interest relative to the subject of this lecture.

Introduction

� Three million people worldwide die every year from vaccine-preventable diseases

� Multiple barriers to immunizations � Public safety vs. personal freedom??

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MEASLES MUMPS PERTUSSIS

Recent Vaccine Preventable Outbreaks in US

§ Travelers with measles § Majority were unvaccinated § Ohio- Amish travel

unvaccinated § California- Disneyland § Minnesota-Fear Autism

Number  of  Measles  Cases  by  Year  

Year Cases

2010 63

2011 220

2012 55

2013 187

2014 667

2015 188

2016 86

2017 118

2018 13*

Measles Outbreaks U.S.

Measles Cases and Outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables. https://www.cdc.gov/mmwr/publications/index.html

§ Predominantly college-aged students living in the Midwest

§ 18 to 22 years old, most of whom had had the requisite two doses of mumps vaccine in childhood

Mumps Cases Reported U.S.

*Preliminary data reported to CDC’s National Center for Immunization and Respiratory Diseases, updated monthly. Mumps outbreaks are not reportable. Mumps Cases and Outbreaks. https://www.cdc.gov/mumps/outbreaks.html Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables. https://www.cdc.gov/mmwr/publications/index.html

Year Cases 2010 2,612 2011 404 2012 229 2013 584 2014 1,223 2015 1,329 2016 6,366 2017 5,629 2018 304**

Number  of  Mumps  Cases  by  

Year  

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Pertussis Cases Reported U.S.

Sources: https://www.cdc.gov/pertussis/surv-reporting/cases-by-year.html https://www.cdc.gov/pertussis/surv-reporting.html https://wonder.cdc.gov/nndss/static/2016/annual/2016-table2k.html

§ More than 20,000 cases per year in recent years

§ For U.S. infants under 1 year old: – 2,041 cases in 2016 – 6 deaths in 2016

Number  of  Pertussis  Cases  

by  Year  Year Cases

2012 48,277

2013 28,639

2014 32,971

2015 20,762

2016 17,972

Pertussis Incidence 1990-2016

N A T I O N A L C E N T E R F O R I M M U N I Z A T I O N A N D R E S P I R A T O R Y D I S E A S E S ( 2 0 1 8 )

Childhood Immunization Update

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Smallpox

Polio Diphtheria Pertussis Tetanus Measles

1964 (6) Polio

Diphtheria Pertussis Tetanus Measles Rubella Mumps

1985 (7)

Polio Diphtheria Pertussis Tetanus Measles Rubella Mumps

Hib HepB

Varicella

1995 (10) 2018 (16)

Polio Diphtheria Pertussis Tetanus Measles Rubella Mumps

Hib

HepB HepA

Chickenpox Pneumococcal

Influenza Meningococcal

Rotavirus HPV

Vaccines Included in the Routine Child/Adolescent Immunization Schedule

Serogroups ACWY (MPSV4)

Serotype B (MenB)

� Menactra® or Menveo®

� Two doses 11 through 18 years old

� First dose 11 or 12 years old

� Booster dose at age 16

� Bexsero® or Trumenba®

� Increased risk age 10 yrs and older

� 16 through 18 years preferred

Meningococcal Vaccines

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Meningococcal Incidence in Adolescents and Young Adults by Serogroup, 2009–2013

0.0

0.1

0.2

0.3

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

INC

IDE

NC

E P

ER

10

0,0

00

Serogroup B Serogroup C and Y

NNDSS data supplemented with additional serogroup data from ABCs and state health departments

AGE (years)

MenACWY Second Dose

Age for MenB

Serogroup B Indications

� Serogroup B meningococcal disease outbreak � 10 years or older who are at increased risk:

¡ Spleen is damaged or has been removed ¡ Rare immune system condition ¡ Eculizumab (Soliris®) ¡ Microbiologists

� Anyone 16 through 23 years-based on the clinical judgment of the provider

Girls  &  Boys  can  start  HPV  vaccina=on  at  age  9  

Preteens should finish the HPV vaccine series before their 13th birthday

Plus  girls  13-­‐26  years  old  who  haven’t  started  or  

finished  HPV  vaccine  series  

Plus  boys  13-­‐21  years  old  who  haven’t  started  or  

finished  HPV  vaccine  series  

HPV Vaccination -11 or 12 Years

Source:  Meites  et  al.  MMWR.  2016.  

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New recommendations HPV Vaccine Dosing Schedules

Starting BEFORE the 15th birthday

�  2 doses ÷ 0, 6–12 ÷ 5 months

minimum interval between dose 1 and dose 2

Starting ON OR AFTER the 15th birthday* � 3 doses ÷ 0, 1–2, 6 ÷ Second dose 1–2

months after the first dose

÷ Third dose 6 months after the first dose

Mumps

� Optional third dose of a mumps-containing vaccine during a mumps outbreak.

� Recommendation in October 2017 after noting an increase in cases and outbreaks since 2006

� People in close contact settings

Influenza

� The nasal spray Flumist vaccine-live attenuated influenza vaccine (LAIV) is NOT recommended for use in the U.S.

� The American Academy of Pediatrics (AAP) recommends annual flu shots for everyone 6 months of age and older, including children and adolescents.

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Pertussis TDAP

� Tdap should be administered to children 7 through 10 years of age who were underimmunized or who have an incomplete vaccine history

� Pregnant women �  A single dose should be given to adults who

have contact with infants, even if they are older than 65, and for health care workers of any age.

The Way Forward Talking to Parents

Promoting Compliance !

Vaccine Conversations with Parents

§ Vaccines Safety § Diseases Vaccines

Prevent § If You Choose Not to

Vaccinate, Understand the Risk and Your Responsibilities

www.cdc.gov/vaccines/conversations

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� Participatory versus presumptive approach

� Give your strong recommendation ¡ Use science and anecdotes

� Listen and respond to parents’ questions ¡ Realize that success comes in many

forms

Talking with Parents

� Written for parents of children

� English and Spanish

Infant Immunization FAQs

www.cdc.gov/vaccines/parents/parent-­‐ques=ons.html