geoffrey modest medical blogs

the CDC just published their updated, 2020 immunization schedule for adults. there are a few changes from last year: influenza for 2019-2020 season: no preferential recommendation for one vaccine over another. the live attenuated intranasal vaccine is okay up to age 49, for most people without imunocompromising conditions including HIV or functional asplenia, but also those pregnant, are caregivers of severely immunocompromised people, have taken antiviral influenza meds in prior 48 hours, or have cochlear implants. hepatitis A: now includes all with HIV. HPV: should do catch-up vaccines in all adults (ie, including males) til age 26, and shared clinical decision-making through age 45 MMR: new language that health care workers born after 1957 without evidence of immunity should get 2 MMR doses, 4 weeks apart; those born before 1957 and no evidence of immunity "consider" 2-dose schedule Meningococcal ...

From: Rebecca Perkins [mailto: Rbperkin@bu.edu ] Sent: Tuesday, August 20, 2019 8:43 AM To: Geoff A. Modest, M.D. Subject: Re: CDC recommends HPV vaccine to age 26, and more Thanks for highlighting HPV and your great work! And thank you for largely focusing your article on the benefits for the pediatric population.  I did want to add that the risk benefit vaccination ratio for adults is very different from kids. The estimated reduction is 193 HPV-related cancer cases per year if the entire adult population is vaccinated, compared to 25,000 cases averted per year if the entire pediatric and adolescent population is vaccinated. Vaccination of adults in the US will also cause a worldwide shortage of HPV vaccine, delaying cervical cancer reduction efforts in low resource countries which have the majority of cervical cancer burden. So thanks for helping to keep the focus where it will make the most difference--vaccinating kids! These comments are from Rebecca Perkins...

The Advisory Committee on Immunization Practices (ACIP) of the CDC voted last week on 2 new vaccine recommendations: extending the age indication for the HPV vaccine and making the PCV-13 vaccine less clearly recommended. (There was no direct ACIP statement on these, just as reported by others. my info comes from STAT:  https://www.statnews.com/2019/06/26/u-s-advisory-panel-stops-short-of-broad-recommendations-for-two-common-vaccines/  ). In general the ACIP recommendations are followed by the CDC. HPV vaccine (human papillomavirus): --unanimous vote to equalize the recommended age for vaccination for women and men to age 26 (prior recommendation for men was til age 21) --they did not recommend extending the age to 45, but left that to the patients and providers to decide.  This goes against the strong FDA recommendation to extend the age for all to 45 (of course, the patient still can decide….). see  http://gmodestmedblogs.blogspo...