H1N1 added to new immunization schedules

The CDC advisory panel's recommendations also include a new HPV vaccine for females and the hepatitis A vaccine for adults adopting children from other countries.

By — Posted Jan. 19, 2010

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The Centers for Disease Controls and Prevention Advisory Committee on Immunization Practices has released new immunization schedules for adults, adolescents and children, recommending a new human papillomavirus vaccine for females and the hepatitis A vaccine for people in close contact with international adoptees. The schedules also note CDC recommendations about vaccines for influenza A(H1N1).

The new vaccine schedule for adults was published in the Jan. 5 Annals of Internal Medicine (link). The schedule for children and adolescents appeared in the January Pediatrics (link).

The annual revisions come as health experts work to bolster vaccine rates among adults and encourage physicians to continue immunizing patients for H1N1, even with cases of the virus declining nationwide. Experts say vaccination will help prevent a third wave of the epidemic, following waves in the spring and the fall.

The latest adolescent and adult immunization schedules recommend the vaccination of females age 11 to 26 with either Merck's quadrivalent HPV vaccine Gardasil or GlaxoSmithKline's recently approved bivalent HPV vaccine Cervarix. Both have been approved for use in females age 9 to 26.

The bivalent protects against virus strains 16 and 18, which are associated with more than 70% of the cases of cervical cancer in women, ACIP said.

The quadrivalent offers protection against the additional two strains, 6 and 11, to reduce the incidence of genital warts, said Carol Friedman, DO, an internist and associate director for adult immunization at the CDC. "There should be a discussion or conversation between a physician and his or her patient regarding which vaccine would be the most beneficial," she said.

ACIP includes in the adolescent and adult schedules the permissive recommendation it gave Merck's recently licensed quadrivalent HPV vaccine for males age 9 to 26 during an October 2009 meeting. That means the panel believes Gardasil is effective, but it is waiting for data on cost effectiveness and efficacy in preventing precancer in males.

The new guidelines for adults also recommend the hepatitis A vaccine for unvaccinated people who anticipate close contact with children adopted from outside the United States.

Among the revisions in the immunization schedule for children and adolescents is the addition of a footnote on the H1N1 vaccine, which advises physicians to follow the guidelines issued by the CDC in its Aug. 28, 2009, Morbidity and Mortality Weekly Report.

The guidelines identify five initial target groups for vaccination, including health care and emergency medical services personnel, pregnant women, youths age 6 months to 24 years, and people 25 to 64 who are at high risk for influenza-related complications (link).

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