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Vaccine update 2010: Keeping up with the changes

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ABSTRACTA number of new vaccines have been approved in recent years, and existing vaccines have been extended to new groups. We summarize the additions and changes over the past 3 years.

KEY POINTS

  • New recommendations for infants and children:
    • Rotavirus vaccination for infants
    • Seasonal influenza vaccine yearly at ages 5–18
    • Hepatitis A vaccine at age 12–23 months
    • Varicella vaccine at 12–15 months and again at 4–6 years, with catch-up for others.
  • New recommendations for adolescents:
    • Meningococcus quadrivalent conjugate vaccine for all at age 11 or 12 and catch-up through age 18
    • A shot of tetanus toxoid, reduced-dose diphtheria toxoid, and acellular pertussis vaccine (Tdap) at age 11 or 12 and catch-up through age 18
    • Human papillomavirus vaccine (three doses) for girls at age 11 or 12 and catch-up through age 26.
  • New recommendations for adults:
    • One dose of Tdap instead of the next tetanus-diphtheria booster
    • Herpes zoster vaccine at age 60 or older
    • Pneumococcal vaccination extended to smokers and people with asthma, with a second dose 5 years after the first for people who have immune suppression, sickle cell disease, or asplenia.


 

References

The past 10 years have seen marked advances in vaccine research, resulting in more products being available. In 1983 the childhood vaccination schedule included protection against seven diseases: polio, tetanus, diphtheria, pertussis, measles, mumps, and rubella. The schedule in 2010 includes protection against organisms that cause seven more: Haemophilus influenzae, hepatitis A, hepatitis B, influenza, meningococcus, pneumococcus, and varicella.1 In addition, new vaccine products are available for adolescents, offering protection against meningococcus, seasonal influenza, and human papillomavirus (HPV) and extending the length of protection against pertussis. For adults, a vaccine now protects against shingles, and several products offer boosting of pertussis immunity.

This rapid growth in the number of recommended vaccine products has made it challenging for practicing physicians to stay current on and to implement the ever-changing recommendations. The purpose of this article is to summarize the additions and changes over the past 3 years to the schedules of recommended vaccines for children, adolescents, and adults.

VACCINE UPDATE FOR CHILDREN

The recent changes to the childhood immunization schedule have added protection against rotavirus and seasonal influenza and have expanded the protection against hepatitis A and varicella.

Rotavirus vaccination for infants

Rotavirus is the leading cause of infectious gastroenteritis in infants. It causes significant morbidity and expense, accounting for 2.7 million episodes per year in the United States, 410,000 outpatient or office visits, 201,000 to 272,000 emergency department visits, 55,000 to 70,000 hospitalizations, and 20 to 60 deaths.2 Although the number of deaths in the United States is not large, rotavirus is a leading cause of infant deaths around the world.

A rotavirus vaccine was first introduced in the United States in 1998 but was withdrawn from the market in less than a year due to risk of intussusception, which occurred in 1 per 10,000 infants vaccinated.2 Two different rotavirus vaccines have recently been approved by the US Food and Drug Administration: a five-antigen vaccine (RV5; RotaTeq) in 2006 and a single-antigen vaccine (RV1; Rotarix) in 2008. Both are modified live-virus vaccines, given orally. They contain different antigens and have different schedules of administration— RV5 requires three doses, while RV1 requires two doses. Table 1 summarizes the characteristics of each product.

Rotavirus vaccination is challenging because of the time frame in which the series needs to be given. The first dose has to be given after 6 weeks of age but before 15 weeks of age, and the last dose should be given before 8 months of age, with a minimum of 4 weeks between doses. It is preferable to use the same product to finish the series. They can be used interchangeably, but this then requires three total doses.

The effectiveness of the vaccine in preventing rotavirus gastroenteritis in the first year after vaccination was greater than 80% in most studies and approached 100% in preventing serious gastroenteritis.2

Those vaccinated appear to have a slightly higher rate of diarrhea and vomiting in the first 42 days after vaccination. Safety monitoring after the products were licensed has not shown an increased rate of intussusception with either product.

The only contraindication to the vaccines is a serious allergic reaction to them or to one of their components. They should be used with caution in patients who have suppressed immunity, acute gastroenteritis, preexisting gastrointestinal disease, or previous intussusception.

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