Reuters Health Information: Key changes highlighted in adult, pediatric immunizations
Key changes highlighted in adult, pediatric immunizations
Last Updated: 2018-02-06
By Marilynn Larkin
NEW YORK (Reuters Health) - Newly released immunization guidelines from the Advisory Committee on Immunization Practices for adults, and from the American Academy of Pediatrics for children and adolescents, feature important changes that physicians should be aware of, experts say.
"The big change to this year's adult immunization schedule is the addition of the new recombinant zoster vaccine (RZV; Shingrix, GSK)," Dr. David Kim of the Centers for Disease Control and Prevention in Atlanta told Reuters Health by email.
"Adults ages 50 and older are recommended to receive two doses, two to six months apart, regardless of past episodes of shingles or receipt of the zoster vaccine live (ZVL; Zostovax, Merck)."
"Physicians should wait at least two months before administering RZV to adults who have received ZVL," he added. "RZV is preferred over ZVL but, for adults 60 or older, ZVL - which is a one-dose regimen - remains an option."
RZV can be given to adults with chronic health conditions; however, currently there are no recommendations for people with immunocompromising conditions, including HIV infection. Those recommendations, he said, "are under discussion."
Another change highlighted in the latest recommendations, published online February 5 in the Annals of Internal Medicine, is that an additional dose of measles-mumps-rubella (MMR) vaccine should be given to people who had previously received up to two doses and are identified by a public health authority to be at increased risk during a mumps outbreak.
"The new zoster vaccination recommendations are a reminder for healthcare providers, including pharmacists, to routinely discuss vaccinations with their adult patients and educate them that there are vaccines specifically recommended for adults," Dr. Kim said.
"The strongest predictor for adults getting vaccinated," he stressed, "is a recommendation from their health care provider."
The full ACIP recommendations for each vaccine are available on the CDC's website (http://bit.ly/2lX2yzn).
The latest pediatric immunization guidelines, published online February 6 in Pediatrics, also emphasize a third dose of a mumps-containing vaccine as an option for children during a mumps outbreak.
Dr. Adam Ratner, director of the Division of Pediatric Infectious Diseases at Hassenfeld Children's Hospital at NYU Langone Health in New York City, told Reuters Health by email that another key recommendation is "the re-emphasis on the importance of influenza vaccine in all children age six months or older."
"This is an especially important recommendation given the severity of this year's epidemic," said Dr. Ratner, who was not involved in developing the guidelines. "It also provides guidance for the use of existing vaccines in outbreak settings, such as clusters of mumps or meningococcal disease, both of which have recently occurred on college campuses."
Among the other items in the 2018 pediatric schedule are:
- A recommendation that 11- or 12-year-olds receive two doses of the human papillomavirus vaccine, and three doses after age 15.
- Information on the timing of the birth dose of a hepatitis B vaccine for infants whose birth weights are greater than 2,000 grams (4.4 pounds).
- A catch-up schedule for children and adolescents who start late or are more than a month behind in vaccines.
"Because immunization is among the safest and most cost-effective methods for protecting children from disease, it is particularly important that pediatricians have access to the most up-to-date information regarding vaccines," Dr. Ratner concluded.
SOURCES: http://bit.ly/2BHrtSh and http://bit.ly/2E8cu5x
Ann Intern Med 2018 and Pediatrics 2018.