Immunizations for Adolescents

Question 1

Meningococcal Doses (4)

Answer 1

1. Serogroups A, C, Y and W-135
2. IM single dose
3. Age 11 or 12 years, with a booster dose at age 16 years.
4. After a booster dose of meningococcal conjugate vaccine, higher antibody titers protecting adolescents through the period of increased risk through age 21

Question 2

Menactra: Additional Recommendations (3)

Answer 2

1. If the first dose at age 13 through 15 years, a one-time booster dose should be administered, preferably at age 16 through 18 years, before the peak in increased risk.
2. Persons who receive their first dose of meningococcal conjugate vaccine at or after age 16 years do not need a booster dose.
3. Routine vaccination of healthy persons over 21 year who are not at increased risk for exposure to N. meningitidis is not recommended

Question 3

Trumenba/Bexsero (10-25 years) (3)

Answer 3

1. Active immunization to prevent invasive disease caused by Neisseria meningitidis serogroup B.
2. Approved for use in individuals 10 through 25 years of age.
3. No universal recommendation

Question 4

Trumenba (2 and 7 ADEs)

Answer 4

1. 0.5 mL IM
2. 3-dose series at months 0, 2, and 6

Adverse Reactions

1. Injection site pain (≥85%)
2. Fatigue (≥40%)
3. Headache (≥35%)
4. Muscle pain (≥30%)
5. Joint pain (17-21.6%)
6. Chills (≥15%)
7. Diarrhea (8.9-15.2%)

Question 5

Bexsero (2 and 8 ADEs)

Answer 5

1. 0.5 mL IM
2. 2-dose series administered at least 1 month apart

Adverse Reactions

i. Pain at the injection site (≥83%)
ii. Myalgia (≥48%)
iii. Erythema (≥45%)
iv. Fatigue (≥35%)
v. Headache (≥33%)
vi. Induration (≥28%)
vii. Nausea (≥18%)
viii. Arthralgia (≥13%)

Question 6

Tdap 2017 (4)

Answer 6

1. Two products
   - Boostrix (10-18 years of age)
   - Adacel (11-64 years of age)
2. Removal of a minimum interval between receipt of a tetanus- or diphtheria-toxoid-containing vaccine and Tdap when Tdap is otherwise indicated
3. Administration of a single dose of Tdap to children
4. 7 through 10 years of age with incomplete or unknown pertussis vaccine history

Question 7

Tdap and Menactra (3)

Answer 7

1. Can be administered together
2. Need one month interval if not coadministered
3. Menactra contains 48 units of diphtheria toxoid and TD 8 units of diphtheria
   * Administered together increased response to diphtheria

Question 8

Tdap Injection Site Events (3)

Answer 8

1. Typical event: Local pain, redness, induration, fever, headache,
2. Entire or extensive Limb swelling (ELS)
   * 4-6% following DTaP
   * Not a precaution or contraindication for Tdap
3. Severe Injection Site Event
   - Arthus reaction: Local inflammatory reaction with formation and deposition of immune complex and activation of complement
   * Severe pain, swelling induration, edema hemorrhage and occasional necrosis

Question 9

Tdap C/I (2)

Answer 9

1. History of serious allergic events

2. History of encephalopathy within 7 days of pertussis vaccine in the past

Question 10

Tdap Precautions (3)

Answer 10

1, Gillian Barre syndrome 6 week or less after tetanus vaccine

2. Progressive neurologic disorder
3. Deferral if:
   - Moderate or severe acute illness
   - History of severe Arthus hypersensitivity events

Question 11

Cervarix

Answer 11

HPV Vaccine

Vaccination in females 9 through 26 years of age for prevention of the following diseases caused by Human Papillomavirus (HPV) Types 6, 11, 16, and 18

Question 12

Gardasil 9 (2)

Answer 12

HPV Vaccine

1. Cervical, vulvar, vaginal, and anal cancer caused by Human Papillomavirus (HPV) types 16, 18, 31, 33, 45, 52, and 58. (1.1)
2. Genital warts (condyloma acuminata) caused by HPV types 6 and 11. (1.1)

Question 13

HPV Vaccine Recommendations between 11-15 years old (3)

Answer 13

1. Administer the first dose to females at age 11 or 12 years
2. Administer the second dose six month to one year later
3. No recommendations for revaccination with Gardasil 9 for those adolescent who received regular Gardasil

Question 14

HPV Vaccine Recommendations between 15-26 years old

Answer 14

Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose)

Question 15

Burden of HPV Related to Disease in Males (5)

Answer 15

1. HPV-associated cancers in males include some anal, penile, and oropharyngeal cancers caused primarily by HPV 16 (6–9).
2. About 22,000 HPV 16- and 18-associated cancers occur annually, including an estimated 7,000 HPV 16- and 18-associated cancers in males
3. Data from U.S. cancer registries have shown increases in the incidence of oropharyngeal and anal cancers in men
4. Nononcogenic HPV types, primarily 6 and 11, cause >90% of genital warts (condylomata) and most cases of recurrent respiratory papillomatosis.
5. Approximately 250,000 cases of genital warts occur each year in the United States among sexually active males

Question 16

Varicella (3)

Answer 16

1. For persons aged 7 through 18 years without evidence of immunity, administer 2 doses if not previously vaccinated or the second dose if only 1 dose has been administered.
2. For persons aged 7 through 12 years, the minimum interval between doses is 3 months. However, if the second dose was administered at least 28 days after the first dose, it can be accepted as valid.
3. For persons aged 13 years and older, the minimum interval between doses is 28 days.

Question 17

Hep B Vaccine

Answer 17

1. Administer the 3-dose series to those not previously vaccinated.
2. A 2-dose series (separated by at least 4 months) of adult formulation Recombivax HB is licensed for children aged 11 through 15 years.