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New Recommendations for Old Vaccines

Author: David G. McAlpine, M.D.
Clinic: Woodbury Clinic

View more Articles by this Physician

Every year, there are multiple changes in vaccine recommendations.  This includes initiation of new vaccines such as Rotovirus, HPV and Shingles, which have occurred in the last year, as well as changes in recommendations for vaccines which are already established. This article will outline changes that have been recommended for two vaccines that have been available for some time.

Meningococcus:

Meningococcal meningitis is a serious and often fatal type of bacterial meningitis. It is most common in adolescents and young adults. A number of years ago, college students living in dorms were found to be an especially high risk group. It was found that it was easy to give vaccines to this group of patients at the time of entrance to college and this has been a recommendation for some time.

Unfortunately, the first vaccine for meningococcal meningitis only worked for approximately two years. Approximately three years ago, this vaccine was improved. The new vaccine (Menactra) has a duration of action of at least six years. Some studies indicate that it works as long as eight years.

Last year, the CDC changed its recommendation for the time that this vaccine was given from the previous entrance to college recommendation, to the new recommendation of entrance to junior high school at age 12. Based on strength of scientific information, some vaccines are required for school and others only recommended. At this point, Menactra is in the eecommended category. There is still some controversy about the best time to give this vaccine because of fear that giving it at age 12 will leave a patient with reduced immunity at the time of highest risk (age -18-20). New studies indicate that the length of immunity coverage for this vaccine is longer than previously reported, and these fears are becoming less. Despite this, many providers have felt that age 15 is the ideal time to give this vaccine.

This is because there are an extremely low number of meningitis cases between the age of 12 and 15, but quite a few between the ages of 18 and 21. Giving it at 15 gives the peak immunity at the time that the patient is at the highest risk for developing this potentially catastrophic disease. I would recommend discussing recommendation and timing of giving this vaccine with your provider during visits in the age 12 to 18 time frame.

Hepatitis A:

Hepatitis A is an extremely common disease world wide. Commonly, the infection is very mild and sometimes not even recognized as being hepatitis. During it's peak incidence in the United States, it was estimated that there were approximately 250,000 new cases yearly during the 1980's and 1990's. A Hepatitis A vaccine was introduced in the mid 1990's. In 2005, the estimated new cases of this disease dropped to 42,000. Prior vaccine recommendations were to give this vaccine to patients who are at risk. This would include travelers to third world nations or in areas where this disease has a very high prevalence.

Since 2006, the CDC has recommended that Hepatitis A vaccines be given universally to children between the ages of 12 and 23 months. In addition, children at older ages can be vaccinated on a "catch up schedule". This is a vaccine series of two shots given six months apart. As with Meningococcal vaccine, this is a recommended but not required vaccine.

Over the past decade, there have been multiple strategies for reducing the effect of Hepatitis A outbreaks. Universal immunization is the newest one. There is some disagreement as to
whether this is the best option. Other options, such as immunizing at first sign of a Hepatitis A outbreak, immunizing those patients who are at risk for more serious effect from mild liver disease, or becoming vaccinated before travel to endemic areas have all been encouraged.  However, both the Center for Disease Control, as well as the American Academy of Family  physicians, approved the recommendations for universal immunization for children. Further evaluations of these and multiple other vaccines will certainly lead to new recommendations for timing of the vaccine as well as who should receive it. Hopefully, this report has shed some light on the rational behind current recommendations for vaccines for meningococcus and
Hepatitis A.