Key changes to Adult and Child Immunization schedule for 2020

Key changes to Adult and Child Immunization schedule for 2020

Study findings have implications for meningococcal B vaccine programs globally Adults who are at increased risk, such as those with complement deficiency, who are on complement inhibitor therapy, without a spleen, and for clinical microbiologists with risk of laboratory exposure, should now receive a meningococcal B booster at 1 year after the vaccination is complete. If still at risk the dose should be repeated every 2-3 years. The schedule states that the same product should be used each time. Pneumococcal conjugate vaccine PCV13 With the pneumococcal conjugate vaccine PCV13, people above 65 years who have normal immunity should be told about the vaccine and asked if they want to take it. It is not routinely recommended in the schedule, because the strains that the vaccine protects against are no longer widespread. It is still recommended for those with weakened immunity, cochlear implants, and cerebrospinal leaks. In certain groups, it may be regularly offered even now because of the potentially increased risk for exposure to the vaccine strains and the above-average benefit expected. These include: Residents of long-term nursing or care facilities Residents in areas where few children have received PCV13 Travelers visiting places where childhood vaccination does not include PCV13 It may also be considered, though without evidence of much benefit, in people with chronic heart, lung and liver disease, diabetes or alcoholism, smokers and people with multiple health issues, who have a higher-than-average burden of pneumonia and sepsis with PCV13-type strains. Meanwhile, older adults (65 years and above) should still receive the pneumococcal polysaccharide vaccine PPSV23. Human papilloma virus (HPV) vaccine Human papilloma virus (HPV) vaccine can now be advised up to the age of 45 in some patients. Also, adult males and females are recommended to have catch-up HPV immunization up to the age of 26 years, up from the previous upper limit of 21 years for males and 26 years for females. In most cases sexually active adults between 27 and 45 years who have had multiple partners are already infected with the strains found in the vaccine, which makes it not useful. However, new infections are more likely in any individual who has a new sex partner, especially if the previous partnership was monogamous on both sides. Doctors should discuss the vaccine and allow the patient to help decide whether to take it or not. The most effective preventive measure is to be in a monogamous relationship with another partner who is also monogamous. Hepatitis A vaccine Individuals with HIV above the age of 1 year should be vaccinated against Hepatitis A because infection with the latter in an HIV-infected patient stimulates HIV replication. Moreover, the hepatitis A virus lingers much longer in an HIV patient, encouraging higher rates of transmission. Hepatitis A vaccine is no longer required for patients receiving clotting factor disorders because of the safe and effective sterilization methods now used for recombinant clotting factor concentrates. This means their risk is no higher than that of other people. Influenza vaccine Routine influenza vaccination is recommended for all individuals 6 months or above lacking contraindications for the 2019-2020 season. Hepatitis B vaccine In addition to previous indications, Hepatitis B may now be considered in pregnant women who are at risk for this infection, or who may have a related pregnancy complication. Td, Tdap vaccines Tdap vaccine may now be substituted freely for Td booster vaccine. Journal reference: Freedman M, Kroger A, Hunter P, et al, for the Advisory Committee on Immunization Practices. Recommended Adult Immunization Schedule, United States, 2020*. Ann Intern Med. 2020; [Epub ahead of print 4 February 2020]. doi: https://doi.org/10.7326/M20-0046



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