CONCISE REVIEW FOR CLINICIANS
An Update on Childhood and Adolescent Vaccines

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In 2008, the recommendations for vaccines in children and adolescents changed substantially. The Advisory Committee on Immunization Practices expanded the routine use of influenza vaccines. New recommendations also addressed the newly licensed rotavirus vaccine. Furthermore, the Advisory Committee on Immunization Practices addressed the use of the meningococcal conjugate vaccine in children aged 2 to 10 years who are at high risk of that disease. Finally, the Food and Drug Administration and the Centers for Disease Control and Prevention reviewed the safety data collected about the human papillomavirus vaccine since its licensure and reaffirmed their recommendations for its use. This article discusses some of the important changes that should be of concern to the practitioner.

Section snippets

INFLUENZA VACCINATION

The Advisory Committee on Immunization Practices (ACIP) has made new recommendations regarding the influenza vaccine, advising that all children should now routinely receive the influenza vaccine and expanding the upper age limit of routine childhood vaccination to 18 years.1 The ACIP also recommends the continued focus on vaccinating children aged 6 to 59 months as well as those who are at higher risk and their contacts. Furthermore, the ACIP recommends that the live attenuated influenza

ROTAVIRUS VACCINATION

Two rotavirus vaccines have been approved by the Food and Drug Administration (FDA): the RotaTeq vaccine (Merck, Whitehouse Station, NJ) in February 2005 and the Rotarix vaccine (GlaxoSmithKline Biologicals, Rixensart, Belgium) in 2008. The ACIP recommends using either vaccine, with RotaTeq administered as a 3-dose series and Rotarix as a 2-dose series.3 The ACIP harmonized the dosing schedule and age eligibility (Table).

The ACIP recommends completing the rotavirus vaccine schedule with the

MENINGOCOCCAL VACCINATION

On October 17, 2007, the FDA expanded the age indications for the use of the meningococcal conjugate vaccine (MCV) Menactra (Sanofi Pasteur, Swiftwater, PA).4 The new indications include children aged 2 to 10 years. Previously, the vaccine was licensed only for those aged 11 to 55 years. Studies showed that, in children aged 2 to 10 years, the MCV compared favorably with the meningococcal polysaccharide vaccine (MPSV) or Menomune (Sanofi Pasteur). The MCV was shown to be noninferior to the MPSV

HUMAN PAPILLOMAVIRUS VACCINATION

The FDA licensed the human papillomavirus (HPV) vaccine or Gardasil (Merck) on June 8, 2006, for females aged 9 to 26 years.5 The ACIP approved its routine use in girls aged 11 to 12 years with catch-up vaccinations for those aged 13 to 26 years. The media have recently focused on HPV safety, and the FDA and the Centers for Disease Control and Prevention (CDC) have conducted a review of the data available.6

To date, 16 million doses of HPV have been distributed. As of August 31, 2008, the

CONCLUSION

The newest recommendations from the ACIP call for physicians to expand the group of children they are vaccinating against influenza to include all children aged 18 years or younger. Physicians should also routinely provide 1 of the 2 licensed rotavirus vaccines using the new infant rotavirus vaccine schedule. Furthermore, they should stop using the MPSV in children aged 2 to 10 years at high risk of meningococcal disease and instead use the MCV. Finally, physicians should continue to reassure

CME Questions About Childhood and Adolescent Vaccines

  • 1.

    The Advisory Committee on Immunization Practices (ACIP), which formerly recommended routine annual influenza vaccination of healthy children aged up to 5 years, recently expanded the upper age limit. Which one of the following is the new upper age limit recommended by the ACIP?

    • a.

      9 years

    • b.

      11 years

    • c.

      13 years

    • d.

      17 years

    • e.

      18 years

  • 2.

    If a toddler aged 18 months received only 1 dose of influenza vaccine previously and that dose was given during the previous fall, which one of the following represents what

REFERENCES (6)

  • AE Fiore et al.

    Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008

    MMWR Recomm Rep

    (2008)
  • US Department of Health and Human Services, Centers for Disease Control and Prevention

    Interim within-season estimate of the effectiveness of trivalent inactivated influenza vaccine—Marshfield, Wisconsin, 2007-08 influenza season

    MMWR Morb Mortal Wkly Rep

    (2008)
  • MM Cortese et al.

    Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP)

    MMWR Recomm Rep

    (2009)
There are more references available in the full text version of this article.

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On completion of this article, you should be able to (1) put into practice the new influenza vaccination recommendations, (2) adopt the new infant rotavirus vaccine schedule and incorporate that schedule into practice, and (3) summarize the safety information regarding human papillomavirus vaccine.

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