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Immunization Action Coalition • (651) 647‐9009 • www.immunize.org • www.immunize.org/catg.d/S8005.pdf • Item #S8005 (8/19) 1

Adolescent Immunization Updateand the 16-year-old Platform

Sharon G. Humiston, MD, MPHAssociate Director for ResearchImmunization Action Coalition

Deborah L. Wexler, MDExecutive DirectorImmunization Action Coalition

August 2019・Item #S8005

Overview

• 16-year-old adolescent immunization platform

• Adolescent immunization rates

• Vaccination recommendations & updates

• Wrap up

ImmunizationPlatforms

Benefits of Immunization Platforms

• Ensure we give our patients all their recommended vaccines, and if not done earlier, catch them up on any vaccines they may have missed

• Using the 16-year-old platform

– Helps ensure that vaccines recommended at age 16 are given while the patients are still covered by public or private insurance

– Benefit of creating the opportunity to provide

• Developmentally targeted care and

• Anticipatory guidance

5Auslander B et al. J Adolescent Health 2017;60:475-6.

“Dear Colleague” or “Call to Action” Letter

Signed by:

• AAFP

• AAP

• ACHA

• ACOG

• APhA

• IAC

• SAHM

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www.immunize.org/catg.d/p4022.pdf www.immunize.org/catg.d/p4022.pdf

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IAC has a lot of handouts on these topics.Here’s how to find them. www.immunize.org

IAC has a lot of handouts on these topics.Here’s how to find them. www.immunize.org

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Adolescent Immunization Rates

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www.healthypeople.gov/2020/topics-objectives/ topic/immunization-and-infectious-diseases/objectives

Estimated coverage with selected vaccines and doses among adolescentsage 13–17 years, by survey year and ACIP recommendation—National Immunization Survey-Teen, United States, 2006–2017

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Tdap


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Tdap

HPV dose 1


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Tdap

HPV dose 2

HPV dose 1


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MenACWYdose 1

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MenACWYdose 1

MenACWYdose 2

MeningococcalDisease and Vaccines

Meningococcal Disease

Relatively rare – In 2017, there were ~350 cases of meningococcal disease reported (all serogroups)

Large toll

• Invasive meningococcal disease: 10%–15% patients die, even with antibiotic treatment

• Meningococcemia: up to 40% die

• Among survivors: Up to _____ sustain lifelong disability such as arm or leg amputation, hearing loss, or neurologic damage

33 MMWR 2013;62(RR-2):15; MMWR 2015;64:608-12

Meningococcal Disease

Relatively rare – In 2017, there were ~350 cases of meningococcal disease reported (all serogroups)

Large toll

• Invasive meningococcal disease: 10%–15% patients die, even with antibiotic treatment

• Meningococcemia: up to 40% die

• Among survivors: Up to _____ sustain lifelong disability such as arm or leg amputation, hearing loss, or neurologic damage

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20%

MMWR 2013;62(RR-2):15; MMWR 2015;64:608-12

Two Types of Meningococcal Vaccines

• Meningococcal Serogroup ACWY Vaccines (MenACWY)

– Available since 2005

– ACIP routine recommendations• In 2005 – Routinely recommended at age 11−12

• In 2010 – Booster dose recommended at age 16

35 MMWR 2013;62(RR-2):15; MMWR 2015;64:608-12

Two Types of Meningococcal Vaccines

• Meningococcal Serogroup ACWY Vaccines (MenACWY)

– Available since 2005

– ACIP routine recommendations• In 2005 – Routinely recommended at age 11−12

• In 2010 – Booster dose recommended at age 16

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• Meningococcal Serogroup B Vaccines (MenB)

– Available since late 2014

– ACIP routine recommendations• In 2015 – Routinely recommended for people at increased risk

age >10 years

• Later in 2015 – “May be given” to healthy persons 16 to 23 years of age, preferred at 16−18

MMWR 2013;62(RR-2):15; MMWR 2015;64:608-12

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W

C A

Y

There is currently no vaccine that contains all 5 serogroups

B

BMeningococcal ACWY Vaccine (MenACWY)

www.immunize.org/askexperts/experts_meningococcal_acwy.asp

MenACWY Vaccination

• Two brands

– Menactra (Sanofi Pasteur)

– Menveo (GlaxoSmithKline)

• Routine schedule

– 1st dose: Recommended at age 11–12 years

– 2nd dose (booster): Recommended at age 16 years

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Routine Recommendations

Risk-based Recommendations

www.immunize.org/catg.d/p2018.pdf

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Good vaccines

Bad disease

Ugly rates of vaccine series completion

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How can we make a change for the better?

Good vaccines

Bad disease

Ugly rates of vaccine series completion

Just updated! www.Give2MenACWY.org

• New website design

• Highlights importance of:

– Booster dose ofMenACWY vaccine

– ALL recommendedvaccines for 16-year-olds

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www.Give2MenACWY.org

Meningococcal Serogroup BVaccine(MenB)

www.immunize.org/vis/vis_meningococcal_b.asp

MenB Vaccination

• Two brands

– Bexsero (GlaxoSmithKline)

– Trumenba (Pfizer)

• Schedule for the primary series

– For healthy people – 2-dose schedule

✓ Bexsero: >1 month apart

✓ Trumenba: 6 months apart

– For high-risk people

✓ Bexsero: 2 doses >1 month apart

✓ Trumenba: 3-dose schedule (0, 2, 6 months)

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MenB primary series – More on scheduling

• Minimum intervals between doses have not been defined; use only the routine schedule

• MenB vaccines can be given at the same time as other vaccines, including MenACWY and all other vaccines that are indicated the 16-year-old visit

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MenB vaccines are NOT interchangeable

• The same vaccine must be used for all doses in the series

• If a person got a dose of both vaccines, pick one and complete the routine series with that brand

• The dose of the other brand of vaccine will NOT count as part of the series

66MMWR 2015;64(No.41):1171-76

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For whom is MenB recommended?

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• Routine (formerly Category A) for persons age 10 or older at high risk:– Functional or anatomic asplenia

– Persistent complement component deficiency, including people taking eculizumab (Soliris)

– At risk during an outbreak caused by a vaccine serogroup, such as on college campuses

– Microbiologists who work with meningococcus bacteria in a laboratory

• Shared Clinical Decision-Making (formerly Category B)

– ACIP recommends a MenB primary series for individuals aged 16–23 years based on shared clinical decision-making

– Preferred age of vaccination of 16 through 18 years

CDC will publish an updated statement

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• Will include new “shared clinical decision-making” language

• Will incorporate all existing ACIP recommendations for MenACWY and MenB vaccines into a single document

• Will include the new booster recommendations for high risk individuals

Watch for an announcement in IAC Express

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Routine Recommendations

Risk-based Recommendations


MenB Vaccines ARE Covered by VFC & ACA

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Vaccines are included in the Vaccines For Children (VFC) program and the Affordable Care Act (ACA) if there is either kind of ACIP recommendation for them:

• Routine (for MenB high-risk groups)

• Shared Clinical Decision-Making (for healthy persons)

Both MenB vaccine formulations are covered for both high-risk persons (routine) and healthy persons (shared clinical decision-making)

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Tdap

www.immunize.org/photos/pertussis-photos.asp

Tdap Vaccines

• Tdap vaccines recommended by ACIP for persons >10

– Adacel (Sanofi Pasteur) for ages 10 through 64 years, can be used off-label for older individuals according to ACIP

– Boostrix (GlaxoSmithKline) for ages 10 years and older

• Everyone ages >11 should receive their first Tdap at the next visit if not done already

• Neither FDA-approved for persons <10, but ACIP recommends use as young as age 7 in some cases

• Both approved for a single dose currently

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www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm

April 2018 – Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines

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Tdap in Pregnancy

• Administer a dose of Tdap vaccine during each pregnancy, regardless of the woman’s prior history of receiving Tdap

• Optimal timing of Tdap is between 27 and 36 weeks gestation – preferably earlier in the interval

• Tdap may be administered earlier in pregnancy if necessary (e.g., wound management)

– Not needed to give another dose during that pregnancy

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Human PapillomavirusVaccine

Average numbers of HPV-related cancers per year by location, U.S.

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20000

Cervix Vulva &Vagina

Anus &Rectum

Oropharynx Penis

Females

Males

Not Causedby HPV

www.cdc.gov/cancer/hpv/statistics/cases.htm


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Anus &Rectum

Oropharynx Penis

Females

Males

Not Causedby HPV

10,751 caused by HPV

(females)



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Anus &Rectum

Oropharynx Penis

Females

Males

Not Causedby HPV


(females)


(males)


HPV Vaccine Recommendations – Ages

• Recommended age: 11–12 years

• Earliest age: 9 years

• Catch-up: 13–26 years; ACIP recommends that people who begin the HPV series at or before age 26 years may complete it at age 27 years or older

• Adults: Shared clinical decision-making for persons 27 through 45 years of age

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MMWR. 2016;65(49);1405–8

MMWR. 2019;68(32);698–702

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HPV Vaccination Schedule

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• 2-dose series suffices if started before the 15th

birthday (6–12 months between doses)

• 3-dose series if started on/after 15th birthday or immunocompromised in relevant way (1–2 months between doses #1 & #2; 6 months doses #1 & #3)

• If there is a long delay between doses #1–2 or #2–3, you do not have to restart the series.

• For more details, see the schedule atwww.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Increase HPV Vaccination Rates

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• Low coverage has been a persistent problem

• In clinical settings, communication is key

– Same way, on the same day as the other vaccines

– Announcement style

– For an 11-year old it might sound like this:

Today, Cole is due for 3 vaccines: Tdap, HPV vaccine, and a meningitis vaccine.

HPV Vaccine: Same Way, Same Day App

• Brief, interactive role-play simulation

• Designed to enhance healthcare professionals’ ability to introduce HPV vaccine and address hesitant parents’ concerns

• Developed by Academic Pediatric Association, American Academy of Pediatrics

• Free

• Available formobile devices:

– From the Google Play Storehttps://play.google.com/store/apps/details?id=com.kognito.hpv_immunization

– From the Apple iTunes Storehttps://itunes.apple.com/us/app/hpv-vaccine-same-way-same-day/id1356847181?mt=8

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www.immunize.org/resources/apps.asp

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InfluenzaVaccines

www.immunize.org/handouts/influenza-vaccines.asp

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Cumulative monthly influenza vaccination coverage estimates for US adolescents, NIS-Flu, 2017–18 season

www.cdc.gov/flu/fluvaxview/reportshtml/reporti1718/reporti/index.html

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Influenza Vaccination Recommendations 2019–2020

• Routine annual influenza vaccination for all persons aged >6 months

• Any licensed, recommended, and age-appropriate vaccine (nasal spray or injectable) should be used

• New VISs for both nasal spray and injectable flu vaccine will be available on immunize.org, in English and in translation

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To be updated soon for 2019–2020 season

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www.immunize.org/shop

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3 Thoughts on Catch-upVaccination

3 Thoughts on Catch-Up Vaccination

1. Everything that can go wrong has gone wrong, so check the immunization record and give the missing vaccines

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3 Thoughts on Catch-Up Vaccination


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2. Hepatitis B vaccine is often missed!

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3 thoughts on catch-up vaccination


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2. Hepatitis B vaccine is often missed!

3. Hepatitis A deserves your attention, too.

– Catch-up vaccination of children and adolescents

– Persons with HIV infection

– An update on hepatitis A vaccination will be published

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WebinarWrap-up

www.immunize.org/catg.d/u6005.pdf

Summary of today’s webinar

• Establish a 16-year-old visit in your office to make sure these patients receive the vaccines they need

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• Practices should follow the ACIP immunization schedule and help families adhere to it

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• The 11–12 and 16-year-old platforms provide opportunities to review and complete all needed vaccination while the vaccines are covered by public or private insurance

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• The 11–12 and 16-year-old platforms provide opportunities to review and complete all needed vaccination while the vaccines are covered by public or private insurance

• Develop strategies using tools discussed today to improve adolescent vaccination rates in your healthcare setting

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Immunization Action Coalition Resources

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Subscribe to IAC Express, IAC’s weekly e-newsletter

• www.immunize.org/subscribe

Websites

• www.immunize.org (for HCP)

• www.Give2MenACWY.org (for HCP)

• www.vaccineinformation.org (for the public)

Acknowledgements

William L. Atkinson, MD, MPH

Laurel Wood, MPACoordinator for Public Health

This Photo by Unknown Author is licensed under CC BY-NC-ND

Thank you!

This Photo by Unknown Author is licensed under CC BY-NC-ND

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https://creativecommons.org/licenses/by-nc-nd/3.0/

http://sidcrosby.blogspot.com/2007_08_01_archive.html

https://creativecommons.org/licenses/by-nc-nd/3.0/

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