Adolescent-Webinar (Humiston) 11-13-18 FINAL

1 immunization action coalition (651) 647 9009 Item#S8005 (8/19)1 Adolescent immunization Updateand the 16-year-old PlatformSharon G. Humiston, MD, MPHA ssociate Director for ResearchImmunization action CoalitionDeborah L. Wexler, MDExecutive DirectorImmunization action CoalitionAugust 2019 Item #S8005 Overview 16-year-old adolescent immunization platform Adolescent immunization rates Vaccination recommendations & updates Wrap upImmunizationPlatformsBenefits of immunization Platforms Ensure we give our patients all their recommended vaccines, and if not done earlier, catch them up on any vaccines they may have missed Using the 16-year-old platform Helps ensure that vaccines recommended at age 16 are given while the patients are still covered by public or private insurance Benefit of creating the opportunity to provide Developmentally targeted care and Anticipatory guidance5 AuslanderB et al.

2 J Adolescent Health 2017;60:475-6. Dear Colleague or Call to action LetterSigned by: AAFP AAP ACHA ACOG APhA IAC SAHM123456 immunization action coalition (651) 647 9009 Item#S8005 (8/19) action coalition (651) 647 9009 Item#S8005 (8/19) has a lot of handouts on these s how to find has a lot of handouts on these s how to find action coalition (651) 647 9009 Item#S8005 (8/19)4192021222324 immunization action coalition (651) 647 9009 Item#S8005 (8/19)5 Adolescent immunization topic/ immunization -and-infectious-diseas es/objectivesEstimated coverage with selected vaccines and doses among adolescentsage 13 17 years, by survey year and ACIP recommendation National immunization Survey-Teen, United States, 2006 201726 Estimated coverage with selected vaccines and doses among adolescentsage 13 17 years, by survey year and ACIP recommendation National immunization Survey-Teen, United States, 2006 201727 TdapEstimated coverage with selected vaccines and doses among adolescentsage 13 17 years, by survey year and ACIP recommendation National immunization Survey-Teen, United States.

3 2006 201728 TdapHPV dose 1 Estimated coverage with selected vaccines and doses among adolescentsage 13 17 years, by survey year and ACIP recommendation National immunization Survey-Teen, United States, 2006 201729 TdapHPV dose 2 HPV dose 1 Estimated coverage with selected vaccines and doses among adolescentsage 13 17 years, by survey year and ACIP recommendation National immunization Survey-Teen, United States, 2006 201730 MenACWY dose 1252627282930 immunization action coalition (651) 647 9009 Item#S8005 (8/19)6 Estimated coverage with selected vaccines and doses among adolescentsage 13 17 years, by survey year and ACIP recommendation National immunization Survey-Teen, United States, 2006 201731 MenACWY dose 1 MenACWY dose 2 MeningococcalDisease and VaccinesMeningococcal DiseaseRelatively rare In 2017, there were ~350 cases of meningococcal disease reported (all serogroups)Large toll Invasive meningococcal disease: 10% 15% patients die, even with antibiotic treatment Meningococcemia: up to 40% die Among survivors: Up to _____ sustain lifelong disability such as arm or leg amputation, hearing loss, or neurologic damage33 MMWR2013;62(RR-2):15; MMWR2015.

4 64:608-12 Meningococcal DiseaseRelatively rare In 2017, there were ~350 cases of meningococcal disease reported (all serogroups)Large toll Invasive meningococcal disease: 10% 15% patients die, even with antibiotic treatment Meningococcemia: up to 40% die Among survivors: Up to _____ sustain lifelong disability such as arm or leg amputation, hearing loss, or neurologic damage3420%MMWR2013;62(RR-2):15; MMWR2015;64:608-12 Two Types of Meningococcal Vaccines Meningococcal Serogroup ACWY Vaccines (MenACWY) Available since 2005 ACIP routine recommendations In 2005 Routinely recommended at age 11 12 In 2010 Booster dose recommended at age 1635 MMWR2013;62(RR-2):15; MMWR2015;64:608-12 Two Types of Meningococcal Vaccines Meningococcal Serogroup ACWY Vaccines (MenACWY) Available since 2005 ACIP routine recommendations In 2005 Routinely recommended at age 11 12 In 2010 Booster dose recommended at age 1636 Meningococcal Serogroup B Vaccines (MenB) Available since late 2014 ACIP routine recommendations In 2015 Routinely recommended for people at increased riskage >10 years Later in 2015 May be given to healthy persons 16 to 23 years of age, preferred at 16 18 MMWR2013;62(RR-2):15; MMWR2015.

5 64:608-12313233343536 immunization action coalition (651) 647 9009 Item#S8005 (8/19)737 WCAYT here is currently no vaccine that contains all 5 serogroupsBBMeningococcal ACWY Vaccine (MenACWY) Two brands Menactra(Sanofi Pasteur) Menveo(GlaxoSmithKline) Routine schedule 1stdose: Recommended at age 11 12 years 2nddose (booster): Recommended at age 16 years3941 Routine RecommendationsRisk-based of vaccine series completion373839404142 immunization action coalition (651) 647 9009 Item#S8005 (8/19)843 How can we make a change for the better?GoodvaccinesBaddiseaseUglyrates of vaccine series completionJust updated! New website design Highlights importance of: Booster dose ofMenACWY vaccine ALL recommendedvaccines for 16-year-olds4445464748434445464748 immunization action coalition (651) 647 9009 Item#S8005 (8/19)9495051525354495051525354 immunization action coalition (651) 647 9009 Item#S8005 (8/19)10555657585960555657585960 immunization action coalition (651) 647 9009 Item#S8005 (8/19) Serogroup BVaccine(MenB) Two brands Bexsero(GlaxoSmithKline) Trumenba(Pfizer) Schedule for the primary series For healthy people 2-dose schedule Bexsero: >1 month apart Trumenba: 6 months apart For high-risk people Bexsero: 2 doses>1 month apart Trumenba.

6 3-dose schedule (0, 2, 6 months)64 MenBprimary series More on scheduling Minimum intervals between doses have not been defined; use only the routine schedule MenBvaccines can be given at the same time as other vaccines, including MenACWYand all other vaccines that are indicated the 16-year-old visit65 MenBvaccines are NOT interchangeable The same vaccine must be used for all doses in the series If a person got a dose of both vaccines, pick one and complete the routine series with that brand The dose of the other brand of vaccine will NOT count as part of the series66 MMWR2015;64( ):1171-76616263646566 immunization action coalition (651) 647 9009 Item#S8005 (8/19)12 For whom is MenBrecommended?

7 67 Routine (formerly Category A)for persons age 10 or older at high risk: Functional or anatomic asplenia Persistent complement component deficiency, including people taking eculizumab (Soliris) At risk during an outbreak caused by a vaccine serogroup, such as on college campuses Microbiologists who work with meningococcus bacteria in a laboratory Shared Clinical Decision-Making (formerly Category B) ACIP recommends a MenBprimary series for individuals aged 16 23 years based on shared clinical decision-making Preferred age of vaccination of 16 through 18 yearsCDC will publish an updated statement68 Will include new shared clinical decision-making language Will incorporate all existing ACIP recommendations for MenACWYand MenBvaccines into a single document Will include the new booster recommendations for high risk individualsWatch for an announcement in IAC Express69 Routine RecommendationsRisk-based ARE Covered by VFC & ACA70 Vaccines are included in the Vaccines For Children (VFC) program and the Affordable Care Act (ACA) if there is either kind of ACIP recommendation for them.

8 Routine (for MenBhigh-risk groups) Shared Clinical Decision-Making (for healthy persons)Both MenBvaccine formulations are covered for both high-risk persons (routine) and healthy persons (shared clinical decision-making) Vaccines Tdap vaccines recommended by ACIP for persons >10 Adacel(Sanofi Pasteur) for ages 10 through 64 years, can be used off-label for older individuals according to ACIP Boostrix(GlaxoSmithKline) for ages 10 years and older Everyone ages >11 should receive their first Tdap at the next visit if not done already Neither FDA-approved for persons <10, but ACIP recommends use as young as age 7 in some cases Both approved for a single dose 2018 Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines676869707172 immunization action coalition (651) 647 9009 Item#S8005 (8/19)

9 13 Tdap in Pregnancy Administer a dose of Tdap vaccine during each pregnancy, regardless of the woman s prior history of receiving Tdap Optimal timing of Tdap is between 27 and 36 weeks gestation preferably earlier in the interval Tdap may be administered earlier in pregnancy if necessary ( , wound management) Not needed to give another dose during that pregnancy73 MMWR 2013:62( ):131 135 PapillomavirusVaccineAverage numbers of HPV-related cancers per year by location, &VaginaAnus &RectumOropharynxPenisFemalesMalesNot Causedby numbers of HPV-related cancers per year by location, &VaginaAnus &RectumOropharynxPenisFemalesMalesNot Causedby HPV10,751 caused by HPV(females) numbers of HPV-related cancers per year by location, &VaginaAnus &RectumOropharynxPenisFemalesMalesNot Causedby HPV10,751 caused by HPV(females)10,725 caused by HPV(males) Vaccine Recommendations Ages Recommended age: 11 12 years Earliest age: 9 years Catch-up: 13 26 years.

10 ACIP recommends that people who begin the HPV series at or before age 26 years may complete it at age 27 years or older Adults:Shared clinical decision-making for persons 27 through 45 years of age78 MMWR. 2016;65(49);1405 8 MMWR. 2019;68(32);698 702 737475767778 immunization action coalition (651) 647 9009 Item#S8005 (8/19)14 HPV Vaccination Schedule79 2-dose series suffices if started before the 15thbirthday (6 12 months between doses) 3-dose series if started on/after 15th birthday or immunocompromised in relevant way (1 2 months between doses #1 6 months doses #1 & #3) If there is a long delay between doses #1 2 or #2 3, you do nothave to restart the series. For more details, see the schedule HPV Vaccination Rates80 Low coverage has been a persistent problem In clinical settings, communication is key Same way, on the same day as the other vaccines Announcement style For an 11-year old it might sound like this:Today, Cole is due for 3 vaccines: Tdap, HPV vaccine, and a meningitis Vaccine: Same Way, Same Day App Brief, interactive role-play simulation Designed to enhance healthcare professionals ability to introduce HPV vaccine and address hesitant parents concerns Developed by Academic Pediatric A