CDC recommends MenB, HPV vaccines for adults

The Centers for Disease Control and Prevention (CDC) has updated its immunization schedule for adults, and it includes a number of changes including the addition of new options to fight serogroup B meningococcal disease and human papillomavirus.

The new guidance was developed by the Advisory Committee on Immunization Practices (ACIP), a branch of the CDC.

David Kim, MD, MA, of the U.S. Public Health Service and the Centers for Disease Control and Prevention’s (CDC) National Center for Immunization and Respiratory Diseases, helped craft the new guidelines and says American adults are under-immunized and physicians should make themselves familiar with the guidelines and advise their patient accordingly.

“Adults are not getting the recommendations from their healthcare providers to get vaccines to help prevent diseases like pneuomococcal pneumonia, influenza, and shingles, and help protect their loved ones from diseases like whooping cough,” Kim told Medical Economics. “Talk to your patients about the vaccines they need based on their age, medical conditions, and other indications. Then either give the vaccines or refer them to a place where they can get them.”

In a report released last year on adult immunization, the CDC notes adult vaccination coverage remains low for the most routinely recommended vaccines.

According to data the CDC sampled from the 2013 National Health Interview Survey (NHIS), adults had only modest increases over 2012 in Tdap vaccination in adults over 19 years of age, herpes zoster vaccination among adults over 60 years, and HPV vaccination among males aged 19 to 26. Coverage among adults for did not improve for any other vaccine, according to the CDC.

“Increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults,” the CDC notes. “Awareness of the need for vaccines for adults is low among the general population, and adult patients largely rely on health care provider recommendations for vaccination.”

The CDC recommends that physicians assess vaccination needs and make recommendations at every clinical encounter.

Major changes in the 2016 adult immunization schedule from the 2015 include:

• Interval change for 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) from “6 to 12 months” to

“at least 1 year” for adults aged 65 years or older who do not have conditions that might contraindicate these recommendations. This simplifies the pneumococcal vaccination for older adults, says Kim, and aligns the ACIP recommendation with the current Medicare policy that allows coverage of a different, second pneumococcal vaccine one year after the first vaccine.

• Serogroup B meningococcal (MenB) vaccine series should be administered to certain groups of persons aged 10 years of age or older who are at increased risk for serogroup B meningococcal disease, Kim says. MenB vaccine series may be administered to young adults aged 16 through 23 years to provide short-term protection against most strains of serogroup B meningococcal disease.

MenB attacks the lining of the brain and the spinal cord, and causes death in 10% of cases and permanent disability in 14% of cases. This particular strain accounts for about one-third of the meningitis cases in the U.S., according to the CDC.

Two MenB vaccines are available-Trumemba and Bexsero. ACIP advised that either vaccine could be used, but they should not be interchanged once the vaccination series begins.

• Nine-valent human papillomavirus (HPV) vaccine (9vHPV) has also been added to the schedule and can be used for routine vaccination of females and males against HPV.

The change in the recommendation on the HPV vaccine reflects recent guidance from various medical groups over the last year, following the U.S. Food and Drug Administration’s approval of 9vHPC, which protects against 9 types of human papilloma virus.

Two other formulations of the vaccine-2vHPV and 4vHPV-are also available, but do not protect against as many strains of the virus. These vaccines cover strains responsible for about 66% of HPV cases, while the 9vHPV vaccine covers additional strains that are responsible for 14% of HPV cancers in females and 4% in males, according to CDC.

For females, 2vHPV, 4vHPV, or 9vHPV is recommended in a 3-dose series for routine vaccination at age 11 or 12 years and for those 13 through 26 years of age if not previously vaccinated. For males, 4vHPV or 9vHPV is recommended in a 3-dose series for routine vaccination at age 11 or 12 years and for those 13 through 21 years of age, if not previously vaccinated. Males aged 22 through 26 years may be vaccinated, Kim says.

The CDC offers several versions of the immunization schedule-including one for patients by age, and another by medical condition.