6/18- Immunization for Prevention of IDs Flashcards
History of immunization: broad development of methods?
- Killed viruses -> Protein/CPS -> DNA/rDNA
Vaccine-preventable diseases?
- Smallpox
- Diphtheria
- Measles
- Mumps
- Pertussis (increase in recent cases…)
- Polio (paralytic)
- Rubella
- Congenital Rubella Syndrome
- Tetanus
- Haemophilus influenzae
General requirements for immunization (mechanistic)? Mechanism of Protection?
General requirements:
- Activation of APCs, T and B cells with generation of memory (must incorporate B and T-cell epitopes); antigen must persist
Mechanisms of protection
- Serum and mucosal Abs (prevent and facilitate clearance)
- Cell mediated immune responses (limit extent of infection and facilitate pathogen clearance)
Properties of an ideal vaccine
- Elicits relevant immune response
- Confers long-lived immunity
- Safe and well tolerated
- Stable and retains potency
- Affordable
What is passive immunization? Characteristics?
- Administration of Ig-containing material in order to prevent or modify disease
- Protection conferred immediately
- Protection generally short-lived
- Primary use: postexposure prophylaxis, or when vaccine is not available/indicated
(passive immunotherapy involving infusion of Ag-specific cells is being evaluated)
What diseases are treated with passive immunization?
Pre-exposure prophylaxis:
- CMV
- HAV
- RSV
- (ITP, IG deficiency)
Post-exposure prophylaxis:
- HAV
- HBV
- Measles
- Rabies (with vaccine)
- Rubella
- Tetanus
- VZV
Treatment:
- Botulism
- CMV
- Diphtheria
- RSV
- Lassa fever
- Tetanus
- Complications of vaccinia
- ITP
- Kawasaki disease
What is active immunization? Characteristics?
- Stimulation of protective immune responses via administration of a vaccine
- Weeks to months generally are required for responses to develop
- Protection generally long-lived (may require boosters)
- Primary use: pre-exposure prophylaxis
Two subsets of active immunization? Characteristics?
Non-replicating (inactivated, subunit, conjugate…)
- Generally safer
- Generally more stable
Replicating
- Fewer doses
- Lower antigen content
- Broader responses
- More durable immunity
What factors (vaccine and host) affect immune response to immunization?
Vaccine factors:
- Dosage and route
- Spacing of doses
- Type of antigen
- Adjuvants
- Combinations
Host factors
- Age**
- Immune status
- Genetic factors
- Medications
- Nutritional status
- Underlying diseases
**Ex) poor response to CPS antigens in infants under 2; overcome by conjugating CPS to protein (T-indep -> T-dep)
General recommendations for the timing and spacing of immunobiologics (vaccine or antibody…)?
- Observe recommended ages and minimum intervals between doses; generally no need to repeat doses if interval is exceeded
- Administer recommended vaccines simultaneously unless contraindicated
- Do not combine vaccines unless safety and immunogenicity have been assessed
Specific recommendations:
- Antigen combination: minimum interval between doses
- 2+ inactivated: simultaneous or any interval
- Inactivated and live: simultaneous or at any interval
- 2+ live (intranasal or injected)- 4 week interval if not simultaneous*
*Ty21a and rotavirus vaccine can be given together or at any interval before/after other vaccines
General Recommendations for spacing of Ab-containing products and vaccines?
- In general, antibody-containing products and LIVE vaccines should not be given simultaneously (excluding live typhoid and yellow fever vaccines and LAIV)
- Antibody-containing products and INACTIVATED vaccines can generally be given simultaneously at different sites
Examples of serious adverse events associated with biologics? Table of risk of immunizations…
- Diphtheria antitoxin contaminated with tetanus (Biologics Control Act 1902)
- Incompletely inactivated poliovirus vaccine and vaccine-associated polio (‘the Cutter Incident’)
- Inactivated measles vaccine: Atypical measles after exposure to wild type virus
- Inactivated respiratory syncytial virus vaccine: Exaggerated disease/death after exposure to wild type virus
- Rotavirus vaccine and intussusception
True contraindications to immunization?
- Hypersensitivity to component
- Moderate or severe illness (delay)
- Encephalopathy within 7 days of immunization with DTP/DTaP
- OPV: Immunosuppressed & HIV-infected persons and their contacts
- MMR: Immunodeficient patients
- Rotavirus: Patients with SCID or history of intussusception
Immunization not contraindicated when?
- Mild acute illness/convalescence
- Prior mild/moderate local reaction
- Antimicrobial therapy
- Prematurity
- Recent exposure to infectious agent
- Nonspecific/penicillin allergies
- Family history: Allergies, seizures, SIDS
Special considerations for vaccinations?
- Pregnancy
- Family Hx of immunodeficiency states
Misconceptions of long term side effects?
- Asthma
- Attention deficit disorder
- Autism
- Chronic fatigue syndrome
- Diabetes
- Inflammatory bowel disease
- Multiple sclerosis
- SIDS
T/F: The right of states to pass and enforce compulsory immunization has been confirmed and upheld?
True
Exemptions to compulsory immunization include what?
- Medical
- Religious
- Philosophical (vary by state)
What is contained in the DTaP vaccine? Recommended immunization schedule?
Diphtheria-Tetanus-Acellular Pertussis Vaccine
- Contain up to 5 pertussis components and purified diphtheria and tetanus toxoids (all proteins)
- Protection correlated with serum Ab (DT); no Ab correlate for pertussis antigens
- Primary immunization schedule: 5 doses between birth and 6 yrs
Recommendations for use of DTaP vaccine?
- Indications
- Contraindications
- Precautions
Indications:
- Universal immunization of all infants and children up to age 6 years
Contraindications:
- Encephalopathy within 7 days of receipt of previous dose
- Progressive neurologic disorder (conditional)
Precautions:
- High fever, collapse or shock-like state
- Inconsolable crying >3 hours within 2 days of prior dose
- Seizure within 3 days of prior dose
What is the Td/Tdap vaccine?
- Contents
- Uses
- Dosage schedule
- Precautions
- Inactivated toxoids (ap contains several pertussis antigens: PT, FHA, PRN, FIM 2&3
Uses:
- Routine immunization
- Wound care
- Adolescent and adult immunization
Schedule:
- Booster doses of Td or Tdap (once only) recommended for adults every 10 years
- Tdap during each pregnancy
- Tdap can be given regardless of interval since last Td for pertussis prevention; replaces next scheduled dose of Td
Precautions:
- GBS
DTaP; Tdap summary
- All infants should _____
- All adolescents and adults should _____
- Pregnant women should _____
- Travelers should _____
DTaP; Tdap summary
- All infants should be immunized with DTaP vaccine (series)
- All adolescents and adults should receive Tdap vaccine, as should children 7-10 yrs who have not been fully vaccinated
- Pregnant women should receive Tdap during each pregnancy
- Travelers should be boosted with Td or Tdap if it has been at least 5 yrs since last booster
What kind of vaccine is used for H. influenzae?
- Mechanism
- Indications
- Immunization schedule
HIB conjugate vaccine
- Protein-polysaccharide conjugates of the CPS of H. influenzae type B conjugated to one of several proteins: OMP, CRM, or TT
- Protection mediated by Ab vs. CPS
Indications:
- Universal immunization of infants Immunization schedule
- 3-4 doses over 18 months (3 for OMP-CV)
Where is polio endemic?
- Afghanistan
- Nigeria
- Pakistan
- Horn of Africa (type 2 eradicated in 1999)
Characteristics of the poliovirus vaccine? Components/mechanism
- Formalin-inactivated vaccine (IPV)
- Oral live attenuated vaccine (OPV)
Protection mediated by neutralizing Abs against the 3 serotypes
Because the risk of developing vaccine- associated polio in the U.S. is greater than the risk of infection, routine use of OPV is no longer recommended
Polio immunization:
- Indications
- Contraindications
- Risk groups
- Schedule
Indications:
- Universal immunization of infants and children (4 doses) with IPV
- Not usually recommended for persons over the age of 17 years
- Consider a 1 time booster dose for adult travelers to endemic areas.
Contraindications:
- Anaphylactic reactions to streptomycin, neomycin, or polymyxin B Risk groups:
- Non-immune travelers to Asia and Africa
- Members of communities or groups with disease caused by wild type polio
- Lab workers who handle samples containing polio
- HCW in contact with infected patients; unvaccinated adults in contact with children given
OPV Schedule for unvaccinated adults:
- 3 doses at least 4 weeks apart (0, 1-2 mo., 6-12 mo. preferable)
- 2 doses or even 1 dose can be given if time is not available
What age groups is most affected by measles in the US?
> 14 yo
(followed by 0-4 yo)
Outbreak of measles recently where?
Measles- Disneyland in CA
What age group is at greater risk for severe disease and death with measles? What should be done?
Infants
- Infants who travel or live abroad should be vaccinated at an earlier age (6-11 mo; dose doesn’t count)
Outbreak of mumps recently where?
UT Austin (7 cases)
Principles for mumps control?
- Timely vaccination with 2 doses of MMR vaccine
- High awareness among HCPs
- Ongoing surveillance and prompt reporting of mumps cases - Isolation of persons with suspected and confirmed mumps for 5 days after onset of parotitis
- In congregate settings (colleges, schools): early recognition, diagnosis, and public health intervention
- During outbreaks: 1 dose of MMR vaccine for adults and children whose vaccination status is unknown or who have not received the number of MMR doses recommended by the ACIP; consideration of a second dose of MMR vaccine for children aged 1 thru 4 years and adults who have received 1 dose
Characteristics of MMR vaccine?
- Components
- Dosage schedule
- Contraindications
- Live attenuated virus
Schedule
- Universal immunization of infants with 2 doses of MMR at 12-15 mo. and 4-6 yrs of age (dose 2 should be given at least 4 wks after dose 1)
- Children 6-12 months old traveling to endemic areas should receive a dose of vaccine prior to travel; dose doesn’t count (still need 2 doses on or after 12 mo. of age). For others born after 1980: h/o receipt of 2 doses, or verify immunity
- Update: 2 doses recommended for people born after 1956 (in post-high school educational institutions, medical personnel, and those traveling to measles-endemic areas) who lack evidence of immunity: documentation of 2 doses of MMR on/after 1st birthday, measles diagnosis with lab confirmation, lab evidence of immunity
Contraindications:
- Immune deficiency disorders (OK in HIV infxn if not severely immunocompromised)
- Anaphylactic reactions to neomycin
- Pregnancy
HIB, Polio, MMR summary
- All infants should _______
- Preferred polio vaccine is ___. Adult travelers should consider ______
- MMR vaccine: __ doses are recommended for _______ and _____.
Infants traveling to areas where ____ is occurring should be vaccinated at ____ of age.
HIB, Polio, MMR summary
- All infants should be vaccinated with HIB conjugate vaccine
- Preferred polio vaccine is IPV. Adult travelers should consider a single dose if traveling to areas where polio persists
- MMR vaccine: 2 doses are recommended for infants and certain adults who only received a single dose.
Infants traveling to areas where measles is occurring should be vaccinated at 6 months of age.
What is this?
Left: Varicella
Right: Zoster
Characteristics of the Varicella vaccine?
- Components
- Schedule
- Live attenuated lyophilized virus (Oka strain)
- Reconstituted vaccine contains >1,350 PFUs of virus per dose, gelatin, and trace amounts of neomycin
Primary immunization schedule:
- 2 SQ doses at 12-15 mo and 4-6 yrs or
- 2 SQ doses at least 4 wks apart
(MMRV can be used for persons 12 mo - 12 yo; assd with increased risk of febrile seizures after 1st dose)
Recommendation for use of varicella vaccine?
- Universal immunization of children starting at 12-18 months of age
- Susceptible older children and adults (consider pre-immunization antibody testing)
Special considerations:
- Susceptible people who have close contact with those at high risk for complications
- Women of childbearing age
- Travelers
- People who live or work in places where VZV transmission is likely
Varicella vaccine: contraindications?
- Congenital or acquired immunodeficiency
- Pregnancy
- Allergy to neomycin or gelatin
- Receipt of ISG within 5 mo (delay)
Precautions or special considerations for varicella vaccine?
- Households with immunocompromised contacts
- Children with ALL in remission
- Children receiving long-term salicylate therapy: contacts should be immune!
T/F: Varicella vaccine can be used for post-exposure prophylaxis?
True
- ACIP recommends vaccine for use in susceptibles following exposure to varicella
- Can be effective in preventing or modifying illness if used 3-5 days after exposure
T/F: Varicella vaccine dramatically reduces occurrence of herpes zoster
False; we don’t really know
- HZ incidence in vaccinated children was 79% lower than unvaccinated children; ~50% were due to wild type virus
Characteristics of Shingles vaccine
- Type
- Indications
- Schedule
- Contraindications
Type: live attenuated virus
- Higher dosage than the varicella vaccine
Indications/Schedule:
- Single SQ dose recommended for immunocompetent persons > 60 (licensed for > 50 yo)
Contraindications:
- Hypersensitivity to vaccine components
- Acquired or iatrogenic immunodeficiency
Varicella-Zoster Summary:
- ____ should be immune to __
- __ doses of varicella vaccine are recommended for _______
- ____ can be given to susceptible persons ___ exposure
- __ dose(s) of shingles vaccine is recommended for ________
Varicella-Zoster Summary:
- Everyone should be immune to VZV
- 2 doses of varicella vaccine are recommended for non-immune people (unless contraindicated)
- Varicella vaccine can be given to susceptible persons after exposure
- A single dose(s) of shingles vaccine is recommended for persons > 60 yo
Epidemiology of Rotavirus infections?
- Most important cause of severe diarrhea in infants and children worldwide (Group A)
- Most primary infections occur during the first 3 years of life
- Epidemics in temperate climates occur during the cooler months
- Accounts for 1/3 of hospitalizations for diarrhea and ~ 1/2 million deaths each year
Characteristics of Rotavirus vaccine?
- Type
- Indications
- Schedule
- Contraindications
Type: live, attenuated virus
Indications: universal vaccination of infants
Schedule:
- 2 or 3 doses between 6-32 wks depending on which vaccine is used
Contraindications:
- Hypersensitivity to vaccine components
- History of intussusception.
- Not recommended for immunodeficient children-has caused failure to thrive, dehydration and prolonged shedding in 3 children with SCIDS
Rotavirus vaccine: An oral vaccine for diarrhea reduced hospitalizations of children with rotavirus by more than __% in some parts of the United States
Rotavirus vaccine: An oral vaccine for diarrhea reduced hospitalizations of children with rotavirus by more than 70% in some parts of the United States
Impact of Pneumococcal infections: annual toll (US)
- Meningitis: 3,000
- Bacteremia: 50,000
- Pneumonia: 500,000
- Acute otitis media: 7 million
* In developing countries, Sp is responsible for 10-20% of all deaths in children under 5!
What age groups are most affected by invasive pneumococcal disease?
- 1 yo
- Followed by under 1 yo
- Resurgence again in 65+
Penumococcal vaccine (PCV):
- Type:
- Contents
- Indications
- Schedule
- Contraindications
Type: conjugate vaccine (PCV)
- Protein-polysaccharide conjugates representing 13 serotypes of S. pneumoniae
Recommended for:
- All children under 5 yo
- Children and adults 5-63 yo with certain medical conditions
- Adults > 65 yo
Primary immunization schedule:
- 4 doeses at 2, 4, and 6 months and at 12-15 months
Contraindications
- Not generally recommended for persons 5-65 yo
Outcomes of pneumococcal CV?
Percent protection against acute otitis media, pneumonia, and invasive disease; protective efficacy in infants
- Associated with declines in antibiotic-resistant Sp and invasive disease in older persons (herd immunity)
- Also associated with increase in infections caused by serotypes not in vaccine (serotype replacement)
Pneumococcal vaccine (PPSV)?
- Type
- Indications
Pneumococcal Polysaccharide Vaccine (PPSV)
- Purified polysaccharides of 23 serotypes
Indications:
- Indicated for all persons who are > 65 yo
- Persons 2 yrs or older who are at high risk
High risk:
- Heart and lung disease
- Hypo/asplenia
- Complement deficiency
- Cochlear implant
- Nephrotic syndrome
- Renal failure
- Alcoholism
- Chronic liver disease
- Diabetes
- Asthma
- Cigarette smoking
- Immunodeficiency
What are the 2 different pneumococcal vaccines?
- PCV: pneumococcal conjugate vaccine
- PPSV: pneumococcal polysaccharide vaccine
Protective efficacy of PPSV?
Risk of infection after vaccination with PPSV varies according to age and time
Revaccination with PPSV should be done when?
- People at highest risk of fatal disease (asplenia; immunosuppression) or rapid decline in antibody levels (nephrotic syndrome) > 5 years after dose 1 (a one-time revaccination strategy only for persons aged 19-64 years)
- People who are at least 65 years old if they were under 65 years old when they received dose 1 and that dose was given > 5 years ago
- Children > 3 years after dose 1 if they would be > 10 years old at revaccination
PCV should be used in adults when?
- 13 Valent PCV was recently licensed for use in adults ≥50 years old.
- Recommended for all persons ≥65 years old, and persons 5 thru 64 years with high risk conditions
Influenza:
- Epidemics when
- Epidemics where
- Occurs frequently in…
- Winter in temperate climates (year-round in tropics)
- Frequently in travelers and explosive outbreaks reported on planes and cruise ships
US Influenza Virus Vaccines include what?
Type?
Recommended for who?
Trivalent or quadrialent: Inactivated/Recombinant
- Healthy and high risk > 6 mo
- Intramuscular or intradermal
Live attenuated
- Healthy 2-49 yo
- Intranasal
How do intradermal (ID) immunizations work?
Efficient delivery to dendritic cells ID immunization using a microinjection system ->
- Superior serum Ab responses vs. IM immunization using similar doses of vaccine in the elderly
- ID superior vs. A antigens in younger adults
Primary immunization schedule for influenza?
Unvaccinated kids 6 mo- 9 yo
- 2 doses given at least 4 wks apart
mmunization of others
- 1 dose each fall
Contraindications for influenza vaccine?
For all:
- Anaphylactic hypersensitivity to vaccine components
For IIV/RIV:
- For egg allergy, ok to vaccinate if just hives
- If more severe, refer to a provider with expertise in dealing with allergic reactions, or administer RIV
For LAIV:
- Children on aspirin
- H/O GBS; pregnancy
- Close contact with severely immunocompromised persons
- Egg allergy
- High risk conditions; age 50 years.
Influenza vaccine recommended for who?
- Annual immunization recommended for all persons ≥6 months old!
- Groups at highest risk for complications and death should be given special attention; immunization of these persons and their contacts (including HCWs) is of highest priority.
Specifics:
- HD IIV,(≥65 years)
- ID IIV (18-64 years)
- RIV (18-49 years)
- ccIIV (≥ 18 years)
Recently licensed; are considered suitable alternatives for the indicated age groups
Influenza vaccination for travelers?
People who are at high risk and who were not vaccinated during the preceding fall or winter should receive the most up-to-date vaccine before travel if they plan to
- Travel to the tropics
- Travel with organized groups anytime
- Travel to the Southern Hemisphere during April to September
Use of high dose influenza vaccine for who? What type?
Persons > 65 yo
- Fluzone high-dose: altenative inactivated vaccine for persons > 65
- Persons > 65 can receive any of the standard-dose IIV preparations or Fluzone HD
Rota, Pneumo, and Flu Summary
- All infants should _____
- PCV is recommended for ____
- PPS23 is recommended for ______
- Influenza vaccine is recommended annually for ___.
Consider vaccination with the most up-to-date vaccine for _____
- _______ is conferred with these and other vaccines
Rota, Pneumo, and Flu Summary
- All infants should be vaccinated against rotavirus, unless contraindicated
- PCV is recommended for all infants, persons > 65, and high risk 6-64 yo
- PPS23 is recommended for persons > 65, other high risk 6-64 yo
- Influenza vaccine is recommended annually for all persons > 6 mo.
Consider vaccination with the most up-to-date vaccine for travelers
- Herd immunity is conferred with these and other vaccines
Where do hyperendemic-epidemic meningococcal infections occur?
Where are the different strains (A, B, C, W-135, X, and Y) found?
Certain parts of Africa (“meningitis belt”)
- Group A: Africa
- Groups B, C: industrialized countries
- Groups W-135 and X: Africa
- Group Y: US and elsewhere
Risk factors for meningococcal disease?
- Terminal complement deficiencies
- Functional or anatomic asplenia
- Occupational exposures to N. meningitidis in solutions that may be aerosolized
- Travel to the ‘meningitis belt’ between December and June
- Outbreaks/exposure to case
What are the 3 meningococcal vaccines?
- Purified PS of serogroups A, C, Y, and W-135 (MnPS)
- Quadrivalent protein-PS conjugate vaccine (MnCV)
- Men C and Y and Hib CV (Hib-MenCY-TT
MnCV is recommended for who?
- All children at age 11-12 years and again at 16 years
- Catch-up for HS students and college freshmen living in dorms
- Can also be used for infants aged 9 thru 24 months at increased risk for disease
- Vaccination recommended for others ≥2 months old who are at increased risk.
Hib-MenCY-TT recommended for who?
Schedule?
Limits?
Infants aged 6 wks - 18 mo who are at increased risk
- 4 dose schedule
- Does not protect against Men A or W
- Does not obviate need for adolescent immunization
Primary and booster immunization schedule for meningococcal vaccines (MnPS and MnCV)?
Primary Immunization Schedule
- MnCV: 1-2 intramuscular doses (2-55 yrs); the preferred vaccine
- MnPS: One subcutaneous dose (≥2 yrs); an acceptable alternative
Booster Immunization
- May repeat at 3-5 years if risk persists;
- MnCV is the preferred vaccine
Note: US-licensed vaccines do not protect against serotype B infections, but a vaccine is on the horizon!
Recent outbreak of hepatitis A where?
Costco- frozen organic berry mix from Oregon
Active immunization against HAV involves what? Efficacy?
- Formalin inactivated cell culture-grown HAV adjuvanted with aluminum hydroxide
- Protective efficacy 85-95% in healthy younger adults
- Efficacy correlates with antibody to HAV (antibody persists >10 years
Recommendations of ruse of HAV? Indications? Contraindications?
Recommended for:
- All children between 1 and 2 years of age
- For many 2-18 year old children in Texas ( 2 doses ≥ 6 months apart)
Indicated for:
- Other persons who are at high risk for infection or complications (travelers, occupational risk, MSM, clotting factor recipients, etc.)
Contraindications:
- Severe reaction to vaccine
- 2-phenoxyethanol (Havrix®), or alum
Recommendations for HAV in post-exposure prophylaxis?
For exposed persons between the ages of 1 and 40 years
- Administration of a single dose within 14 days of exposure confers significant protection against symptomatic infection
Persons 40 years old should receive ISG.
Summary of HAV infections: Good hygiene and dietary precautions
Pre-exposure prophylaxis
- _______
- _______
Post-exposure prophylaxis
- _______
- _______
Summary of HAV infections:
Good hygiene and dietary precautions
Pre-exposure prophylaxis
- Inactivated HAV vaccine (active)**
- Immune serum globulin, or ISG (passive)
Post-exposure prophylaxis
- ISG for close contacts (under 1 or > 40 yo)
- Inactivated HAV vaccine (12 mo-40 yo)
Hepatitis B vaccine characteristics?
- Efficacy
- Recommended for
- Protection lasts how long
Hepatitis B vaccine characteristics
- Recombinant HBsAG (yeast-derived); adjuvanted with alum
Efficacy: correlates with serum antibody-HBs
Recommended for:
- Certain high-risk groups (occupational and other exposures such as DM, IVDU, etc.)
Protection lasts at least 22 yrs
HBV Vaccine was associated with what disease in 6-14 yo Taiwanese children?
Hepatocellular carcinoma
Prevention and Control of HBV infections: Summary
- Immunization with HBsAG vaccines: _______
- Hepatitis B immune globulin (HBIG) for ______
- Screen _____ ; vaccine and HBIG should be given to _____
- _____ with or without ____ for treatment of _____
Prevention and Control of HBV infections: Summary
- Immunization with HBsAG vaccines: infants, older children, and high-risk adults
- Hepatitis B immune globulin (HBIG) for postexposure prophylaxis of susceptible persons
- Screen pregnant women and others at risk; vaccine and HBIG should be given to infants of infected mothers
- Antivirals with or without steroids for treatment of persistent infection
What cancers are associated with HPV (human papillomavirus)?
- Almost all cervical cancers (most common)
- 90% of anal cancers
- 65% of vaginal cancers 50% of vulvar cancers
- 35% of penile cancers
- 60% of cancers of the oropharynx
Characteristics of HPV vaccines?
- Type:
- Mechanism:
- 3 vaccines
Subunit vaccines based on viral L1 capsid protein (forms virus-like particles); adjuvanted with alum and MPL (2vHPV) or alum alone (4vHPV and 9vHPV)
- Elicit serum-neutralizing Abs 3 vaccines:
- Genotypes 16 & 18 (70% of cervical cancer cases); 2vHPV
- Genotypes 6, 11, 16 &; 18 (genital warts and most cervical cancers); 4vHPV
- Genotypes 6, 11, 16, 18, 31, 33, 45, 52, 58; 9vHPV
HPV vaccine
- Efficacy
- Indications
- Schedule
- Contraindications
Efficacy:
- 91%-100% protection against warts and/or neoplasia-cervical, vaginal, vulvar, anal
Indications:
- Non-pregnant females who are 9-26 yo
- Males who are 9-21 yo (4vHPV and 9vHPV)
- MSM and immunocompromised males through 26 yrs
Schedule:
- 3 IM doses at 0, 2, and 6 mo
Contraindications:
- Latex allergy (2vHPV)
- Yeast allergy- immediate hypersensitivity* (4vHPV and 9vHPV)
New recommendations for HPV
- 9vHPV, 4vHPV, or 2vHPV for routine vaccination of females 11 or 12 years* of age and females through 26 years of age who have not been vaccinated previously or who have not completed the 3-dose series.
- 9vHPV or 4vHPV for routine vaccination of males 11 or 12 years* of age and males through 21 years of age who have not been vaccinated previously or who have not completed the 3-dose series.
- 9vHPV or 4vHPV vaccination for men who have sex with men and immunocompromised men (including those with HIV infection) through age 26 years if not vaccinated previously.
Population effects of HPV immunization?
Recent studies in the US, England and Denmark demonstrate significant reduction in the risk of acquiring genital warts among vaccinated +/- unvaccinated women since the introduction of HPV vaccine.
Overall childhood immunization schedule?
