1. Liza Chapman, Pharm.D. GPhA Annual Meeting
Immunization Update 2013
Liza Chapman, Pharm.D.
GPhA Annual Meeting

2. Faculty disclosure
Liza Chapman has no disclosures to declare at this time

3. objectives
Review the changes/developments made to the immunization recommendations during the past year
Discuss cases and provide vaccine recommendations based upon the ACIP/CDC current schedules
Identify new developments in practice that impact immunizing pharmacists’ practices

4. U.S Adult vaccination Rates, 2011
Vaccine (Target Group)
Vaccination Rate (%)
Influenza (50–64 years)
47.2
Influenza (>65 y/o)
64.9
Influenza (health care personnel (HCP))
66.9
Pneumococcal (>65 y/o)
64.5
Pneumococcal (19-64 y/o high risk)
20.1
Tdap in past 6 years (19–49 y/o)
12.5
Tdap (HCP)
26.8
Hepatitis B (> 3 doses y/o
35.9
Hepatitis B (HCP)
63.2
HPV Females (>1 dose)
21.5
Zoster vaccine (>60 y/o)
15.8
APhA IMZ CTP,
National Health Interview Survey –2011 (
National Immunization Survey

5. Recent Disease Outbreaks
Measles Outbreak (2011)1
222 cases reported
Five times the number of cases in 2007
28,000 cases in Europe
Mumps Outbreak (2011)2
29 Mumps cases on University campus in California
Source – unvaccinated student – all cases linked
22 (76%) vaccinated with 2 doses MMR
2 with 3 doses, 2 with 1 dose, and 2 unknown
Pertussis Epidemic3
41,880 cases reported in 2012
18 related deaths
4,783 in Washington State (965 in 2011)
18,719 cases total reported in U.S. in 2011
27,555 in 2010
APhA IMZ CTP,
1. Measles.
2. MMWR Morb Mortal Wkly Rep. 2012;61:
3. CDC Pertussis Report (

6. Recap from 2013 National adult and Influenza Immunizations Summit

7. Hepatitis b

8. New ACIP recommendation
Hepatitis b
Target groups for HBV
Infants
Adolescents who have not been previously vaccinated
High-risk adults
Multiple sex partners
Patients seeking treatment for STDs
HIV patients
IV drug users
Dialysis patients
Patients with chronic liver disease
Health care providers
All diabetics years old
Diabetics >60 years (permissive)
New ACIP recommendation

9. Self-Assessment
How many doses must a patient receive to complete the Hepatitis B series?
1 Dose
2 Doses
3 Doses
4 Doses

10. Self-Assessment
It is October and R.J. is 82 y.o. male patient that is moving into an ALC. His medical conditions include: CHF, COPD, and T2DM. R.J.’s PCP cannot locate his vaccination records. Which vaccines would you recommend R.J. receive?
Influenza
Pneumococcal
Zoster
Hepatitis B
All of the above

11. Influenza

12. Review of 2013-13 Influenza Season

13. HCPs and Influenza vaccinations

14. HCPs and Influenza vaccinations

15. HCPs and Influenza vaccinations

16. HCPs and Influenza vaccinations

17. 2013-14 Influenza Vaccine Strains
Influenza vaccine contains:
A/California/7/2009 (H1N1)–like virus
A/Texas/50/2012 (H3N2)–like virus
B/Massachusetts/2/2012–like virus
Yamagata lineage
Quadrivalent Addition:
B/Brisbane/60/2008-like virus
Victoria lineage

18. 2013-14 Influenza presentations
Vaccine (manufacturer)
Approved Age Indications
Inactivated Influenza Vaccine
Fluzone (sanofi pasteur)
>6 months
Fluvirin (Novartis)
>4 years
Fluarix (GSK)
>3 years
FluLaval (GSK)
>18 years
Afluria (CSL Biotherapies)
>9 years
Agriflu (Novartis)
Fluzone High-Dose (sanofi pasteur)
>65 years
Fluzone Intradermal (sanofi pasteur)
18-64 years
Flucelvax (Novartis) – cell cultured (not eggs)
Flublok (Protein Sciences Corp) -recombinant
18-49 years
Live Attenuated Influenza Vaccine
FluMist (MedImmune)
2 years to 49 years

19. New Manufacturing Technologies
Cell cultured vaccine
Recombinant HA vaccine

20. Selecting the best product for your patient
It is up to the health care provider to determine the best influenza vaccine product for the patient based on patients’ needs
Patient Age
Preservative vs. preservative free
Administration ID IM IN
IIV3 or IIV4

21. Influenza Vaccine and Egg Allergies
According to ACIP, individuals who have only reported hives as a result of vaccination with influenza vaccine should be vaccinated by following these safety measures:
Use IIV rather than LAIV
Vaccine should be administered by a health care professional familiar with egg allergies
Observation after vaccination should be at lease 30 minutes

22. Influenza Vaccine and Egg Allergies
APhA IMZ CTP,

23. Self-assessment Which influenza vaccine would you recommend for R.J.?
LAIV
IIV3
IIV4
Fluzone HD
Fluzone ID

24. Meningitis

25. Meningococcal Vaccine
As of March, 2013, now an recommended vaccine for high-risk infants
Complement deficiencies
Asplenia
Travel to certain countries
Community outbreaks
Not recommended for routine use
FDA approved vaccines for infant use
Menactra (sanofi-pasteur) – high risk infants only
2 dose series 8 weeks apart (9-23 months of age)
Dose 0.5mL IM
Menhibrix (GSK)
4 dose series (2,4,6,12-15 months of age)
Dose: 0.5 mL IM
Used if Hib vaccine needed
Not for travel (only 2 serotypes)
Community outbreaks only if serotypes C and Y
If used, must complete all 4 doses

26. Pneumococcal

27. Pneumococcal Vaccine PCV 13 (Prevnar)
Indicated for the active immunization of children ages 6 weeks to 5 years old
For the prevention of invasive disease caused by 13 Streptococcus pneumoniae serotypes
For the prevention of otitis media caused by 7 Streptococcus pneumoniae serotypes
FDA approved for adults aged 50 years and older (Not ACIP recommended for routine use)
Dose and route: 0.5 mL IM

28. PCV 13 Target groups for vaccination Infants and children
Routine schedule: 2, 4, 6, 12–15 months
Any PCV series begun with PCV7 should be completed with PCV13
Administer a single supplemental dose of PCV13 for:
Children aged 14–59 months who have received an age-appropriate series of PCV7
Children aged 60–71 months with underlying medical conditions who have received an age-appropriate series of PCV7
APhA IMZ CTP,

29. PCV 13 and Adults FDA Approved adults >50 years
Approval based upon serology
ACIP
No recommendations for routine use in all adults at this time
Not enough data to evaluate
Studies currently ongoing
Recommended for:
Immunocompromising conditions
Functional or anatomical asplenia
CSF leaks
Cochlear implants
APhA IMZ CTP,

30. PCV 13 and Immunocompromised Adults
It is possible that these patients could receive three doses of PPSV23 in their lifetime.
APhA IMZ CTP,

31. Self-Assessment
If a patient has already had PPSV23 for a high-risk condition and also needs PCV13 for the same condition, how long should you wait before administering PCV13?
No wait
4 weeks
8 weeks
12 weeks

32. Tdap

33. Pertussis Surveillance

34. Pertussis Outbreaks

35. Tdap Age of Patient Recommendation 6 weeks to 6 years old
Use DTaP to complete the primary series
7 years to 10 years old who are not fully vaccinated against pertussis
Give a single dose of Tdap
11 to 64 years old
If there is no record of a Tdap dose, give a single dose of Tdap followed by one dose of Td every 10 years
>65 years old
If there is no record of a Tdap dose, give a single dose of Tdap followed by one dose of Td every 10 years
Health Care Providers
If there is no record of a Tdap dose, give a single dose of Tdap.
Pregnant women (every pregnancy)
Give a dose of Tdap after 20 weeks of gestation. (27-36 weeks optimal)

36. Self-assessment
Some women have closely spaced pregnancies. Should Tdap be given during each pregnancy, even if it means such women would get 2 doses within 12 months?
Yes No

37. Travel vaccines Japanese Encephalitis (Ixiaro)
Approved age now includes children 2 months and over
2 Dose vaccine series
0 and 28 days
2 months to 35 months
0.25 ml
36 months and older
0.5 ml
Yellow Fever (YF-VAX)
WHO has determined there is no need for booster vaccination

38. Make sure you are up to date
MMWR
Epidemiology and Prevention of Vaccine-Preventable Diseases
2012 Yellow Book
IAC Express
Current VISs

39. Questions
Liza Chapman