1. What’s New in Adult Immunization
William L. Atkinson, MD, MPH
National Immunization Program
National Immunization Conference
8 March 2006

2. Disclosures
The speaker has no financial interest or conflict with the manufacturer of any product named in this presentation
The speaker will discuss the use of acellular pertussis and Hib vaccines in a manner not approved by the U.S. Food and Drug Administration
The speaker will discuss vaccines not currently licensed by the FDA

3. What’s New in Adult Immunization
The schedule
Influenza vaccine
Pertussis vaccine
Meningococcal vaccine
Coming attractions

5. Adult Immunization Schedules, 2002-2003
Age-based
Condition-based

6. Adult Immunization Schedules, 2002-2003
Age-based
Condition-based

8. Adult Immunization Schedules, 2005-2006
Age-based
Condition-
based

9. Adult Immunization Schedules, 2005-2006

10. Adult Immunization Schedule, 2005-2006
Routine use
Conditional use

11. Adult Immunization Schedule, 2005-2006

12. Adult Immunization Schedules, 2005-2006

13. Adult Immunization Schedules, 2005-2006

14. Inactivated Influenza Vaccine Recommendations
A new “high risk” medical condition was added in 2005:
any condition that can compromise respiratory function or the handling of respiratory secretions

15. The Pertussis Paradox
In 2004, pertussis vaccination levels among children months of age were the highest ever recorded
In 2004, the largest number of pertussis cases (25,827) was reported since 1959
More than 15,000 cases were among adolescents and adults
96% for 3+ doses, 85% for 4+ doses

16. Pertussis Among Adults
Disease often milder than in infants and children
Infection may be asymptomatic, or may present as classic pertussis
Adults (19-64 years) accounted for more than 7,000 cases in 2004
Older persons often source of infection for children

17. Tdap Vaccine AdacelTM (sanofi pasteur) Licensed June 10, 2005
Approved for a single (booster) dose*
Approved for persons years of age
*among persons who received a complete series of
4 or 5 dose of DTP/DTaP

18. Pertussis Vaccine For Adults
Only Adacel brand Tdap approved for adults years of age
Do not administer to adults 65 years of age or older

19. Pertussis Vaccine For Adults
Provisional ACIP recommendations*:
Single dose of Tdap should replace a single routine Td dose
Efforts should be made to vaccinate adults who have close contact with an infant <12 months of age (e.g., parents, childcare providers, health-care providers)
Full recommendations expected in mid-2006
*available at

20. Minimum Interval Between Td and Tdap
Interval between Td and Tdap may be shorter than 5-10 years if protection from pertussis needed
ACIP did not define an absolute minimum interval between Td and Tdap
Provider will need to decide based on whether the benefit of pertussis immunity outweighs the risk of a local adverse reaction

21. Tdap For Persons Without A History of DTaP
All adults should have documentation of having received a series of DTAP, DTP, DT, or Td
Persons without documentation should receive a series of 3 vaccinations
Preferred schedule:
Single dose of Tdap*
Td at least 4 weeks after the Tdap dose
Second dose of Td at least 6 months after the Td dose
*off-label recommendation; years of age

22. Approved by FDA January 2005
The U.S. meningococcal conjugate vaccine, or MCV, is called Menactra. It is produced by Sanofi Pasteur and was licensed in the United States in January 1005.
Approved by FDA January 2005

23. Meningococcal Vaccines
Two meningococcal vaccine are available
Menomune (the old vaccine)
Menactra (the new, better vaccine)
Menactra should be given to everyone with an indication who is years of age
Menomune should only be given to persons 2-10 years and >55 years or if Menactra is not available

24. Meningococcal Vaccine Revaccination
Revaccination may be indicated for persons at high risk for infection* who received Menomune at least 5 years ago
Once a person has received MCV no further meningococcal vaccination is recommended (at this time)
*e.g., asplenic persons and those who reside in areas in which disease is endemic (does not include college settings)

25. (for adults)

26. MMRV (ProQuad)
Combination measles, mumps, rubella and varicella vaccine
Approved by FDA in September 2005 for children 12 months through 12 years of age (to age 13 years)
ACIP does NOT recommend off-label use of MMRV for persons 13 years and older

27. Vaccines for Adults on the Horizon
Herpes zoster (shingles)
Human Papillomavirus (cervical cancer and genital warts)
Vaccines for sexually transmitted infections (HSV, GC)

28. Herpes Zoster Vaccine
Administered to persons who had chickenpox to reduce the risk of subsequent development of zoster
Higher titer (18x) of varicella vaccine virus than standard Varivax®
Results of clinical trial published in NEJM June 2, 2005
Merck has filed BLA

30. Herpes Zoster Vaccine Trial
36,716 persons years of age followed for average of 3.12 years after vaccination
Compared to the placebo group the vaccinated group had
51.3% fewer episodes of HZ
Less severe illnesses
66.5% less postherpetic neuralgia
No significant safety issues identified
Oxman et al, NEJM 2005;352(22):

31. “In our country, said Alice, you’d generally get to somewhere else if you ran very fast for a long time.
Now here, said the Red Queen, it takes all the running you can do to keep in the same place.”
-Through the Looking
Glass, 1871