2013 Childhood Immunization Schedule 0-18 Yrs.

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Vaccines, responsible for controlling and eliminating several conditions that were once commonplace, have been one of the most successful methods of disease prevention in history. Despite the reductions in morbidity and mortality attributable to vaccines, not enough children are being immunized.

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Although more teens and preteens are getting the recommended vaccines than in previous years, there is still significant room for improvement. According to data from the CDC’s 2011 National Immunization Survey, only 78.2% of eligible children have received the tetanus, diphtheria, acellular pertussis (Tdap) vaccine, and 70.5% have received the meningococcal vaccines.

Even more disturbing is the fact that only 53.0% of eligible females had received one dose of the human papillomavirus (HPV) vaccine, and only 34.8% of eligible females had received all three doses of the HPV vaccine.1

Do you recommend the HPV vaccine for 11 and 12 year olds during well-child visits?

More children and young adults need to be immunized, not only for their own well-being, but also for the well-being of others in their communities. Providers must be aware of current vaccine recommendations and relay this important information to patients and caretakers to ensure that the number of children who receive these potentially life-saving medications increases.

Which vaccine-preventable diseases are preteens and teenagers most at risk of contracting?

Children in their preteen and teenage years are most at risk for contracting, and then spreading, meningococcal disease, pertussis (whooping cough) and HPV. Other vaccine-preventable diseases include varicella, measles, mumps, rubella, and hepatitis A and B.

Adolescents are in close contact with one another through school, living, and social situations, which facilitate disease transmission. Vaccination remains the most effective method of disease prevention.

Why aren’t more preteens and teenagers being immunized against these vaccine-preventable diseases?

Children older than age 10 years visit a health-care provider less often than younger children. The latest data show that only about 16% of teenagers receive an annual well-child visit.2 Clinicians need to do a better job of getting these children into the office.

Children and their caretakers are also often unaware of the current vaccine recommendations and the reasons for immunizing. It is up to clinicians to inform patients and their caregivers of the CDC vaccine recommendations and to become strong advocates for vaccination. A provider’s advice is the most influential factor in determining whether a child receives a particular vaccine.

What is the prevalence of HPV?

HPV is the most common sexually transmitted infection (STI). The latest estimate is that 20 million people in the United States are currently infected with HPV.3 Up to half of these infections occur in adolescents and young adults between age 15 and 24 years.

Estimates place the lifetime prevalence of genital HPV for people living in the United States at greater than 50%. More than 40 HPV types can infect mucosal surfaces, especially genital, anal, and oropharyngeal areas. The body’s immune system will clear most HPV infections, but certain types, notably 16, 18, 31, 33, 45, 52, and 58, are oncogenic. 

What is the connection between HPV and cancer?

Most people who contract HPV are unaware of the infection, and it is possible to contract more than one type of HPV. Certain HPV types have been linked as causative agents for various cancers. Annually, HPV types 16 and 18 are responsible for approximately 15,000 cases of cancer in females and 7,000 cases of cancer in males.4 Cervical cancer represents the majority of these cases in females. In males, oropharyngeal cancer caused by HPV 16 and 18 is the most common, followed by anal and penile cancers.

Why immunize children aged 11 to 12 years against an STI like HPV?

Immunizations are most effective when given prior to exposure to a particular pathogen. Immunizing children routinely at age 11 to 12 years against HPV ensures an HPV-naïve patient population. Knowing there is an established link between certain HPV types and cancers, immunizing against a pathogen that is potentially carcinogenic makes sense from a public health and preventive medicine standpoint.

The Advisory Committee on Immunization Practices (ACIP), an expert committee that provides vaccine-use recommendations to the CDC, weighs all of these issues. The ACIP also considers cost per quality-adjusted life year, a statistical measure of whether a vaccine’s cost warrants routine or permissive recommendation.

What is the difference between the two licensed vaccines for HPV?

The quadrivalent HPV vaccine (HPV4, Gardasil, Merck & Co.) and the bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) were created using technology developed by scientists at the National Cancer Institute.

HPV4 protects against HPV types 6, 11, 16 and 18, and was approved for use in 2006. HPV2 protects against HPV types 16 and 18 and was approved for use in 2009. Both vaccines are licensed for females (aged 9 to 26 years for HPV4 and ages 9 to 25 years for HPV2).

HPV4 is also licensed for use in males aged 9 to 26 years. Both HPV4 and HPV2 are extremely effective against HPV types 16 and 18. The CDC makes no brand preference for females; however, HPV4 is the only licensed HPV vaccine for males.

Parents say their child does not need the HPV vaccine because he or she is not sexually active. What reasons do I give for immunizing against a STI at such an early age?

To re-emphasize, vaccination is most effective before exposure to the pathogen. The HPV vaccine is not active against HPV subtypes previously contracted. Many parents do not realize that HPV can be spread in ways other than direct sexual intercourse. Adolescence is a common time for sexual experimentation, and HPV can be passed through manual and oral sex. According to a 2012 study, more than half of all individuals aged 13 to 21 years already have HPV, more than 11% of whom have never had sexual intercourse.5

Inform parents that studies have shown that administering the HPV vaccine does not encourage sexual promiscuity.6 Encourage parents to have frank talks with their children about sexual matters. The better the communication at an earlier age, the healthier the parent-child relationship will be throughout the adolescent years. Tell parents that even if their child never came in contact with HPV prior to marriage, there is no assurance his or her eventual partner will have been equally chaste.