NEW YORK — New indications for vaccines included in the routine
immunization schedule were discussed at the 24th Annual Infectious
Diseases in Children Symposium.
Michael T. Brady, MD, chair of the department of pediatrics at
The Ohio State University/ Nationwide Children’s Hospital, and chair of
the AAP’s Red Book committee, provided an update on new
indications associated with the meningococcal conjugate vaccine; influenza,
including information about egg allergies; and the human papillomavirus.
This year, there were three key updates for meningococcal vaccines from
Advisory Committee on Immunization Practices, Brady
said. The first was related to vaccination of patients at prolonged risk for
the disease, such as those with complement deficiency, asplenia or HIV
“For those who are at prolonged risk due to immunodeficiency and
who have only received one primary does, a second dose should be given at first
convenience as long as it is at least 2 months or more from the first
dose,” Brady said.
If the child was aged 2 to 5 years when last vaccinated against
meningococcal disease, there should be a 3-year interval between revaccination.
Boosters for patients aged older than 5 years should be spaced 5 years apart,
The second update referred to the FDA’s April approval of MCV4
(Menactra, Sanofi-Pasteur) as a two-dose primary series for children aged 9 to
23 months. Brady said although it is the first meningococcal vaccine licensed
in the United States for children aged younger than 24 months, “there is
no current routine recommendation for Menactra in infants.”
In general, the vaccine is recommended for infants aged 9 months or
younger with persistent complement deficiency and those who travel or reside in
meningococcal endemic locations. The vaccine is also indicated for children who
are asplenic. But the vaccine is not recommended until 24 months of age because
of a potential interference of the meningococcal vaccine and the pneumococcal
According to Brady, there is evidence of interchangeability of the two
products: “You should try to give the same, but it is possible to give two
Brady also said there were concerns with current adolescent
meningococcal vaccine recommendations; namely, that the antibodies have been
shown to wane before peak incidence of the disease.
“Breakthrough cases are as severe as in those who never received
the vaccine,” he said, adding that anamnestic response occurs but is not
rapid enough to prevent invasive disease.
The seasonal influenza vaccine for this influenza season is the same
vaccine antigenically as last year, but Brady said it is important to inform
patients that they should still be vaccinated for the 2011-2012 influenza
“Universal immunization of children 6 years of age or older is
recommended, even though this year’s seasonal influenza vaccine strains
are identical to last year’s strains,” he said.
For patients with egg allergy, all vaccines for 2011-2012 have ovalbumin
of less than 0.7 mcg/0.5 mL, and skin testing is no longer necessary before
administering the vaccine. After the administration of a single dose to those
with egg allergy, patients should be observed for 30 minutes; the two-step
graded challenge is no longer recommended, Brady said.
As for the increased rate of febrile seizures reported last year in
concurrent administration of influenza and 13-valent pneumococcal conjugate
vaccines, Brady said available data indicate that there is no need to give them
at separate dates.
HPV and males
In October, ACIP recommended that males be routinely vaccinated against
HPV. With this vaccine, there is efficacy in preventing
HPV infection in males, Brady said. Similar to
females, there is “no evidence of efficacy” in males already infected
with HPV. In females, post-vaccine titers are significantly higher in 9- to
15-year-olds vs. 16- to 26-year-olds. This is expected to be the same in males.
The most common adverse event was injection site reaction.
“The AAP statement is expected in March 2012 and will support the
ACIP recommendation,” he said.
Regarding severe adverse reactions related to HPV vaccines, Brady said
other than syncopy, studies have shown that “some events may be temporally
related, but they are not causally related.” – by Whitney
Disclosure: Dr. Brady reports no relevant financial disclosures.
Dr. Brady summarized several issues for vaccines that are important for
the practitioner. First: Although one meningococcal vaccine is licensed for
infants, more are on the way. Currently, the only recommendation for infant
meningococcal vaccination is for infants at highest risk, such as those with
complement deficiencies or those about to travel to sub-Saharan Africa, where
the disease is prevalent. It will be interesting to see how the CDC and AAP
respond when two other meningococcal vaccines are licensed for infants at 2, 4,
6 and 12 months of age. It is unclear whether either will receive a routine
recommendation. Second: It is comforting to know that advances in protein
purification have led to the production of influenza vaccines that now contain
levels of egg proteins that are sub-immunogenic. Severely egg allergic children
no longer need to be desensitized prior to receiving influenza vaccine. Given
that about 0.5% of the population is severely allergic to egg proteins, this
should make administering influenza vaccine programs much easier. Finally, we
now have a recommendation to vaccinate boys and young men with HPV vaccine.
This recommendation was a long time in coming. Males benefit from HPV vaccine
because 1) HPV causes thousands of cases of oropharyngeal and anal and genital
cancers every year in men; 2) HPV causes about 500,000 cases of anal and
genital warts, which, although not fatal, are disfiguring and emotionally
crippling; 3) women get HPV from men; and 4) men who have sex with men don't
benefit from a female-only recommendation.
Paul A. Offit, MD
Infectious Diseases in
Children Editorial Board member
Disclosure: Dr. Offit reports no relevant financial disclosures.
For more information:
- Brady M. Vaccines 2011-2012: An Update on New Indications.
Presented at: the 24th Annual Infectious Diseases in Children
Symposium; Nov. 19-20, 2011; New York.