Vaccine Update 2016 Kathryn Moffett, MD

Serogroup B Meningococcal Vaccine (Men B)

Men B (10 years or older) s Complement component deficiency s Person taking Soliris® (eculizumab)-a monoclonal antibody –Treats paroxysmal nocturnal hemoglobinuria (PNH) s Functional or anatomic asplenia s A microbiologist who is routinely exposed to Neisseria meningitidis s Part of a serogroup B meningococcal disease outbreak

Men B s Teens and young adults (16 through 23 year olds) may also be vaccinated with a serogroup B meningococcal vaccine (Bexsero® or Trumenba®), preferably at 16 through 18 years old. Two or three doses are needed depending on the brand.

Cancer Prevention

US Cancer Attributed to HPV SITEAvr #/yr% HPV% 16 or 18 Anus 4, Cervix 11, Oropharynx 11, Penis 1, Vagina Vulva 3, TOTAL 33,371 MMWR 2012 Apr 20; Gillison Cancer 2008; 113 President’s CPAR

Cervical Cancer 2010 WV 11.2 US 7.5 South 8.2 HPV associated cancers among females: -the highest in WV at 16.3/100,000 -the lowest in Utah at 8.5 ( )

MMWR, National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2014 West Virginia 58.0 (+ 5.6) 48.3 (+ 9.3) 40.0 (+ 9.0) 42.7 (+ 8.9) 28.8 (+ 8.0) 23.5 (+ 7.7)

ACIP Recommendation: Routine HPV Vaccination 1,a s Males and females: Vaccination series can be started at age 9 years ACIP=Advisory Committee on Immunization Practices; HPV=human papillomavirus; HPV2=bivalent HPV vaccine; HPV4=quadrivalent vaccine; HPV9=9-valent HPV vaccine. a For complete ACIP recommendations on HPV vaccination, please see the MMWR. 1. Centers for Disease Control and Prevention (CDC). MMWR Recomm Rep. 2015;64(11):300–304. Routine: 11- or 12-year-olds Males: HPV Vaccination with HPV4 or HPV9 Routine: 11- or 12-year-olds Females: HPV Vaccination with HPV2, HPV4, or HPV9

s Any teenage boy/ girl who did not start or finish the HPV vaccine series –should get it now s Young women can get HPV vaccine through age 26 s Young men can get vaccinated through age 21 –recommended for any MSM through age 26 –men with compromised immune systems (including HIV) through age 26younger

Actual and Achievable Vaccination Coverage if Missed Opportunities were Eliminated: Adolescents Years, NIS-Teen 2012 Missed opportunity: Encounter when some, but not all ACIP-recommended vaccines are given. HPV-1: Receipt of at least one dose of HPV. Among girls unvaccinated for HPV, 84% had a missed opportunity

Complications related to current methods of cervical cancer prevention s Infertility due to treatment of cervical cancer by hysterectomy s Cervical conization and loop electrosurgical excision procedure (LEEP) procedures associated with adverse obstetric morbidity s Subsequent pregnancies are at risk of –Perinatal mortality –Severe and extreme preterm delivery (<32/34 or <28/30 weeks) –Severe and extreme low birth weight (< 2000g or 1500g) These outcomes have a considerable impact—not only on the mothers and infants concerned—but also on the cost of neonatal intensive care

Why We Need to Do Better in HPV Vaccination of 12 year olds For each year we stay at 30% coverage instead of achieving 80%, 4,400 future cervical cancer cases and 1400 cervical cancer deaths will occur.  Currently 26 million girls <13 yo in the US; If none of these girls are vaccinated then:  168,400 will develop cervical cancer and  54,100 will die from it  Vaccinating 30% would prevent 45,500 of these cases and 14,600 deaths  Vaccinating 80% would prevent 98,800 cases and 31,700 deaths

What are you waiting for? Why not vaccinate?

QUESTIONS?