TM Prepared for your next patient. Review of Selected Changes to the 2012 Immunization Schedules H. Cody Meissner, MD Floating Hospital for Children Tufts University School of Medicine

TM Disclaimers  Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics.  I have no relevant financial relationships with the manufacturer(s) of any commercial products and/or provider(s) of commercial services discussed in this presentation.  I do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.

TM Rotavirus Vaccines  Two oral vaccines with similar safety and efficacy profiles  No change in timing of doses  Vaccine contraindicated in 3 groups – Infants with history of allergic reaction after a previous dose – Infants with severe combined immunodeficiency – Infants with history of intussusception

TM Tdap Vaccines  Single dose for people 11–18 years who completed recommended DTaP series  For children under-immunized with DTaP, single dose of Tdap at 7–10 years  Pregnant women after week 20 of gestation  Adults ≥65 years if contact with infants <12 months

TM Pneumococcal Vaccine  All children 14–59 months who received an age- appropriate series of PCV7 should receive a supplemental dose of PCV13.  Invasive pneumococcal disease due to 6 serotypes not in PCV7 is occurring in children who do not receive PCV13.  At some CDC sentinel sites, <40% of eligible children are receiving a supplemental dose of PCV13.

TM Influenza Vaccines  Guidance on vaccine dosing for children 6 months– 8 years  Guidance on vaccination of persons with history of egg allergy  Advice regarding risk of febrile seizures when influenza vaccine and PCV13 are administered concurrently

TM Meningococcal Vaccines  Routine vaccination at 11, 12 years followed by booster dose at 16 years −If first dose at 13–15 years, give booster dose at 16–18 years −No booster needed if first dose ≥16 years  For those with risk factors −2-dose primary series for those <56 years with asplenia, complement deficiency −1 dose for children who travel to or reside in hyperendemic areas or during outbreaks −For children 2–10 years and adults ≥19 years without risk factors, vaccine not recommended

TM Burden of HPV-Associated Cancers  Cancers associated with HPV include −Females Cervix, vagina, vulva, anus, oropharynx −Males Penis, anus, oropharynx  Approximately 25,000 HPV-associated cancers and 22,000 HPV 16- and 18-associated cancers annually −~15,000 in women (~11,000 cervical cancer) −~7,000 in men

TM Recommendations for Use of Quadrivalent HPV Vaccine  Routine 3-dose vaccination for females and males at 11–12 years −0.5 mL administered IM −2nd and 3rd doses 2 and 6 months after 1st dose −Can be administered with other vaccines  Catch-up vaccination recommended for females 13–26 years  Catch-up vaccination recommended for males 13–21 years −Permissive recommendation for males 22–26 years

TM Thank You Boston Floating Hospital, circa 1920

TM For more information…  On this topic and a host of other topics, visit Pediatric Care Online is a convenient electronic resource for immediate expert help with virtually every pediatric clinical information need. Must-have resources are included in a comprehensive reference library and time-saving clinical tools.