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FOCUS ON
IMMUNIZATIONS John D. Grabenstein,
Section Advisor
ACIP issues 2010 clinical guidelines regarding adult
immunizations
Key point: The CDC Advisory
Committee on Immunization Practices (ACIP) recently issued updated
clinical guidelines for the adult immunization schedule. These
guidelines appear in the January 5 issue of Annals of Internal
Medicine and the January 9 issue of MMWR.
Finer points: ACIP annually reviews the adult
immunization schedule to ensure that it reflects the most current
scientific knowledge related to vaccines and vaccine-preventable
diseases. Changes reflected in the 2010 clinical guide-lines include
recommendations for human papillomavirus (HPV); influenza; measles,
mumps, and rubella (MMR); hepatitis A; meningococcus; and Haemophilus
influenzae (Hib) type b.
- HPV: Young women (19 to 26 years of age) can be immunized with
either the quadrivalent or bivalent HPV vaccine; the latter vaccine was
approved in October 2009 by FDA. A permissive recommendation for the use
of the quadrivalent HPV vaccine in men was also included.
- Influenza: The term “seasonal” was added to the
influenza vaccine to differentiate it from pandemic influenza vaccines
(e.g., H1N1 influenza vaccine).
- MMR: Persons born after 1957 who previously received and have
documentation of MMR vaccination do not require a booster vaccination.
Exceptions include health care workers, college students, international
travelers, and persons exposed to measles or mumps in an outbreak
setting; these individuals should receive two doses of the MMR vaccine
at 4-week intervals. In addition, it is recommended that health care
workers born after 1957 who lack laboratory evidence of immunity receive
a MMR booster vaccination during an outbreak.
- Hepatitis A: All persons (e.g., parents, daycare workers) caring for
an internationally adopted child should receive the hepatitis A
vaccination.
- Meningococcus: The meningococcal conjugate vaccine (MCV4) is
preferred in patients younger than 55 years; meningococcal
polysaccharide vaccine (MPSV4) is preferred in persons 50 years or
older. A one-time revaccination with MCV4 after 5 years is recommended
for all persons previously vaccinated with either MCV4 or MPSV4 who are
at increased risk for developing meningococcal disease (e.g., adults
with anatomic or functional asplenia). Persons who continually reside in
on-campus housing do not require booster revaccination.
- Hib: There is no recommendation for Hib vaccination in persons older
than 5 years. The vaccine is generally not recommended, but is not
contraindicated, in unvaccinated persons older than 5 years who have
sickle-cell disease, leukemia, HIV infection, or splenectomy.
What you need to know: An accompanying editorial in
Annals discussed the importance of adult vaccinations and efforts to
increase adult vaccination rates. According to the editorialists,
evidence-based quality indicators may be both care and cost effective.
These indicators include mandatory vaccination, standing orders for
vaccination of persons meeting specific criteria, and electronic medical
record reminders.
What your patients need to know: Dispel myths that
adult patients do not need vaccinations. Remind adult patients that
vaccinations prevent many illnesses that contribute to morbidity and
mortality.
Sources:
Related resources on www.pharmacist.com
Posted by Beth Farnstrom (bfarnstrom@aphanet.org)
January 29, 2010
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