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Letters to the Editor  |   September 2012
Update on Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations, June 2012
Author Affiliations
  • Stanley E. Grogg, DO
    American Osteopathic Association liaison to the ACIP; Oklahoma State University Center for Health Sciences, Tulsa
Article Information
Pediatrics / Preventive Medicine
Letters to the Editor   |   September 2012
Update on Advisory Committee on Immunization Practices (ACIP) Vaccine Recommendations, June 2012
The Journal of the American Osteopathic Association, September 2012, Vol. 112, 585-586. doi:10.7556/jaoa.2012.112.9.585
The Journal of the American Osteopathic Association, September 2012, Vol. 112, 585-586. doi:10.7556/jaoa.2012.112.9.585
To the Editor: 
At its June 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) approved 2 recommendations: (1) a dose of PCV13 (pneumococcal conjugate vaccine-13 serotypes; Prevnar13, Pfizer Inc, New York, New York), in combination with PPSV23 (pneumococcal polysaccharide vaccine-23 serotypes; Pneumovax, Merck & Co Inc, Whitehouse Station, New Jersey) for individuals aged 19 years or older who are immunocompromised1 and (2) the 2012-2013 influenza recommendations for children aged 6 months to 8 years.2 What do these recommendations mean for health care providers? 
Recommendation 1 (PCV13)
Patients aged 19 years or older who have functional or anatomic asplenia, immunocompromising conditions, congenital or acquired immunodeficiency, human immunodeficiency virus infection, chronic renal failure or nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, diseases requiring treatment with immunosuppressive drugs such as long-term corticosteroids or radiotherapy, solid organ transplantation, multiple myeloma, cerebrospinal fluid leaks, or cochlear implants are candidates for both PPSV23 and PCV13. Although the US Food and Drug Administration approved PCV13 for children aged 6 weeks through 5 years in 20103 and for adults aged 50 years or older in 2011,4 the ACIP—after review of the research—believed the evidence supported the use of PCV13 for individuals listed above aged 19 years or older. 
There are 2 categories of patients: (1) patients who have not received PPSV23 and (2) patients who have received PPSV23. For those who have not previously received PPSV23, PCV13 should be given first, at least 8 weeks before PPSV23 is administered. Individuals who have previously received PPSV23 should be given PCV13 one year after last dose of PPSV23. For persons with functional or anatomic asplenia and for persons with immunocompromising conditions, a second dose of PPSV23 is recommended 1 or more years after PCV13 and 5 or more years after the first dose of PPSV23. 
Recommendation 2 (young children and the 2012-2013 influenza vaccine)
The 2012-2013 influenza vaccine will contain the 2009 pandemic H1N1 strain, but the H3N2 and B strains will be replaced. The H3N2 component is changing from A/Perth/16/2009 to A/Victoria/361/2011, and the B component is changing from the Victoria-lineage B/Brisbane/60/2008 to the Yamagata-lineage B/Wisconsin/1/2010. Because 2 doses of influenza vaccine are required to adequately stimulate a young child's immune system, the ACIP approved the following algorithm for children aged 6 months to 8 years: 
Ask the following: “Has the child ever received the influenza vaccine?”
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    If yes, ask “Did the child receive 2 or more doses of seasonal vaccine since July 2010?”
     
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      If yes, administer 1 dose.
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      If no or if answer is unknown, administer 2 doses.
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    If no or if answer is unknown, administer 2 doses.
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    When administering 2 doses, the doses should be given at least 4 weeks apart.
Trivalent influenza vaccine injectable is a killed virus and has been approved starting at age 6 months. Live attenuated influenza virus in nasal spray formula has been approved starting at age 2 years. Osteopathic physicians should consider these new ACIP recommendations as the influenza season arrives. 
   Financial Disclosure: Dr Grogg is a primary investigator for vaccine research and has received grants from GlaxoSmithKline plc; Merck & Co, Inc; MedImmune LLC; Novartis Pharmaceuticals; Pfizer Inc; and sanofi-aventis US LLC. He serves on the speakers' bureaus for MedImmune LLC; Merck & Co, Inc, Novartis Pharmaceuticals; and sanofi-aventis US LLC. He is also a consultant for Merck & Co, Inc (for the human papillomavirus), and Novartis Pharmaceuticals (for meningitis).
 
References
Centers for Disease Control and Prevention. Recommended Immunization Schedules for Persons Aged 0 Through 18 Years—United States, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(5):1-4. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6105a5.htm. Accessed August 2, 2012.
Centers for Disease Control and Prevention. Licensure of 13-valent pneumococcal conjugate vaccine for adults aged 50 years and older. MMWR Morb Mortal Wkly Rep. 2012;61(21):394-395. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a2.htm. Accessed August 2, 2012.
FDA expands use of Prevnar 13 vaccine for people ages 50 and older [news release]. Silver Spring, MD: US Food and Drug Administration; December 30 , 2011. http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm285431.htm?source=govdelivery. Accessed August 2, 2012.