When should you use HibMenCY for infants?9
Vaccinate infants at increased risk for meningococcal disease with 4 doses of HibMenCY at 2, 4, 6, and 12-15 months. Candidates for vaccination are infants with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia (including sickle cell disease).
HibMenCY can also be used for infants ages 2-18 months in communities with serogroup C and Y meningococcal disease outbreaks for which vaccination is recommended.
ACIP does not recommend routine meningococcal vaccination for infants.
HibMenCY is safe and immunogenic and may be administered to infants to complete the routine Hib vaccination series. If HibMenCY is used to achieve protection against serogroups C and Y, HibMenCY should be used for all 4 doses of Hib vaccine.
Pneumococcal conjugate vaccine recommended for high-risk adults
There are now 2 products that provide protection for adults against pneumococcal disease: a 23-valent polysaccharide product (PPSV23) and a 13-valent conjugate product (PCV13). PPSV23 is recommended for all adults ≥65 years and for those <65 who are at high risk for pneumococcal disease or complications from pneumococcal disease. While PCV13 is approved by the FDA for all adults ≥50 years, ACIP recommends it only for those at higher risk for pneumococcal disease.10
ACIP also recommends that those at risk should receive both PCV13 and PPSV23. Give PCV13 first, followed by PPSV23 2 months later.10 However, if PPSV23 is given first, administer PCV13 12 months later. To complicate matters, for some risk categories it is recommended that patients receive a second dose of PPSV23 5 years after the first one. No more than 2 doses of PPSV23 should be given prior to age 65. This complicated set of recommendations is summarized in TABLE 2.10
TABLE 2
Indications for using pneumococcal vaccines in adults ≥19 years*10
| Risk group | Underlying medical conditions | PCV13 | PPSV23 | |
|---|---|---|---|---|
| Recommended | Recommended | Revaccination 5 years after first dose | ||
| Immunocompetent individuals | Chronic heart disease† | √ | ||
| Chronic lung disease‡ | √ | |||
| Diabetes mellitus | √ | |||
| Cerebrospinal fluid leak | √ | √ | ||
| Cochlear implant | √ | √ | ||
| Alcoholism | √ | |||
| Chronic liver disease, cirrhosis | √ | |||
| Cigarette smoking | √ | |||
| Individuals with functional or anatomic asplenia | Sickle cell disease/other hemoglobinopathy | √ | √ | √ |
| Congenital or acquired asplenia | √ | √ | √ | |
| Immunocompromised individuals | Congenital or acquired immunodeficiency§ | √ | √ | √ |
| Human immunodeficiency virus infection | √ | √ | √ | |
| Chronic renal failure | √ | √ | √ | |
| Nephrotic syndrome | √ | √ | √ | |
| Leukemia | √ | √ | √ | |
| Lymphoma | √ | √ | √ | |
| Hodgkin disease | √ | √ | √ | |
| Generalized malignancy | √ | √ | √ | |
| Iatrogenic immunosuppression|| | √ | √ | √ | |
| Solid organ transplant | √ | √ | √ | |
| Multiple myeloma | √ | √ | √ | |
| PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine. *All adults ≥65 years should receive a dose of PPSV23, regardless of previous history of vaccination with pneumococcal vaccine. †Including congestive heart failure and cardiomyopathies; excluding hypertension. ‡Including chronic obstructive pulmonary disease, emphysema, and asthma. §Including B- (humoral) or T-lymphocyte deficiency, complement deficiencies (particularly C1, C2, C3, and C4 deficiencies), and phagocytic disorders (excluding chronic granulomatous disease). ||Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy. | ||||
MMR for those with HIV and use of IG for measles prevention
The last set of significant changes to the schedules are updated recommendations for the use of MMR vaccine in those who have HIV infection, and the use of immune globulin to prevent measles in those previously unvaccinated who are exposed to the disease. Details of these recommendations can be found at http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-Oct-2012.pdf.