1. Practical Challenges to Adolescent Immunization Society for Adolescent Health and Medicine Conference, Los Angeles 2015

2. Presenters/Facilitators  Nneka Holder, MD, MPH  Akron Children’s Hospital  Avril Melissa Houston, MD, MPH, FAAP  Dept. of Health and Human Services Health Resources and Services Administration  Jessica Kahn, MD, MPH  Cincinnati Children’s Hospital Medical Center  Lea Widdice, MD  Cincinnati Children’s Hospital Medical Center

3. Educational Objectives  Describe the latest recommendations for utilizing adolescent vaccines in special populations  Identify common legal issues that impact an adolescent’s right to provide self-consent for vaccination  Discuss at least three strategies for managing challenges in vaccinating adolescents, including vaccine refusal, vaccine hesitancy, and parental or adolescent lack of understanding of vaccine safety and efficacy  Describe two evidence-based strategies for enhancing vaccine administration among adolescent patients

4. Adolescent Immunization Schedule 2015

5. ACIP Adolescent Immunization Schedule Vaccines11-12 yrs.13-15 yrs. 16-18 yrs. HPV Tdap MCV4 Influenza Tdap: tetanus, diphtheria, and acellular pertussis vaccine MCV4: meningococcal conjugate vaccine ACIP: Advisory Committee on Immunization Practices booster 3-dose series 1 st dose Annual immunization 1 dose Range of recommended ages for all children Range of recommended ages for catch-up immunization

6. Immunizations and Pregnancy  Adapted from Centers for Disease Control and Prevention: National Center for Immunization and Respiratory Diseases, Immunization Services Division VaccineBeforeDuringAfterType Hep AYes Inactivated Hep AYes Inactivated HPVYes No YesInactivated Influenza IIV Yes Inactivated Influenza LAIV Yes, avoid conception for 4 wks. No Yes, avoid conception for 4 wks. Live MMRYes, avoid conception for 4 weeks No Yes, immediately postpartum if susceptible to Rubella Live MCVYes Inactivated PSVYes Inactivated TdapYesYes (27-36 wks. gestation) Yes, immediately postpartum, if not received previously Inactivated/tox oid TdYesYes, Tdap preferred YesToxoid VaricellaYes, avoid conception for 4 wks. No Yes, immediately postpartum if susceptible Live

7. Immunizations and Primary Immune Deficiencies CategorySpecific Immunodeficiency ContraindicatedRisk-Specific Recommended Vaccines Effectiveness & Comments B-lymphocyte (Humoral) Severe (X-linked agammaglobuline mia) Less severe (IgA deficiency) LAIVPneumococcal MMR Varicella Efficacy uncertain (in severe forms) as it depends on the humoral response; IVIG interferes with immune response Immune response may be attenuated T-lymphocyte (cell- mediated and humoral) Complete (SCID, complete DiGeorge) Partial (Wiscott- Aldrich, most DiGeorge) LAIV MMR Varicella LAIV MMR Varicella Pneumococcal Meningococcal Efficacy uncertain Efficacy depends on immune response ComplementComplement or Factor B NonePneumococcal Meningococcal Likely effective Phagocytic functionChronic Granulomatous Dz, Leukocyte adhesion defect Live bacterial vaccines (such as BCG, S. typhi vaccine) PneumococcalLikely safe and effective

8. Immunizations and Secondary Immune Deficiencies Specific Immunodeficiency Contraindicated vaccinesRisk-specific recommendations Effectiveness and Comments HIV/AIDSOPV MMR, Varicella (if severe) LAIV Pneumococcal Hib Meningococcal Vaccines might be effective IG should be given after exposure to measles Malignant neoplasm, s/p transplant, XRT Live and bacterial vaccines PneumococcalEfficacy depends of degree of immune suppression AspleniaNonePneumococcal Meningococcal Hib Routine vaccines likely effective Chronic Renal DiseaseLAIVPneumococcal Hepatitis Routine vaccines likely effective Adapted ACIP, Jan 2011