 | Prep for USMLE |
| Forum | Resources | New Posts | Register | Login | » |
|
| Author | 1 post | |||||||||||||
|
DrVirgo
Forum Junior  Topics: 731 Posts: 3487 |
Guidelines Updated for Varicella Prevention in Children, Teens, Adults CME/CE News Author: Laurie Barclay, MD CME Author: Laurie Barclay, MD Disclosures Release Date: June 26, 2007; Valid for credit through June 26, 2008 Credits Available Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians; Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians; Nurses - 0.25 nursing contact hours (0.25 contact hours are in the area of pharmacology) June 26, 2007 — The Advisory Committee on Immunization Practices (ACIP) has issued updated recommendations for the prevention of varicella in children, adolescents, and adults. The new guidelines appear in the June 22 issue of the Morbidity and Mortality Weekly Report. "Varicella is a highly infectious disease caused by the varicella-zoster virus (VZV)," write Mona Marin, MD, and colleagues from the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention (CDC). "Secondary attack rates for this virus might reach 90% for susceptible household contacts. VZV causes a systemic infection that results typically in lifetime immunity. In otherwise healthy persons, clinical illness after reexposure is rare." This report revises, updates, and replaces earlier ACIP statements regarding use of the varicella vaccine. VARIVAX (Merck & Co, Inc), a single-antigen vaccine to prevent varicella, was licensed in 1995 in the United States for use in healthy children aged 12 months or older, adolescents, and adults. The second live, attenuated VZV-containing vaccine available in the United States is ProQuad (Merck & Co, Inc), a combination measles, mumps, rubella, and varicella (MMRV) vaccine that was licensed in 2005 for use in healthy children aged 12 months to 12 years. The initial ACIP recommendations issued in 1995 for prevention of varicella included routine vaccination of children aged 12 to 18 months, catch-up vaccination of susceptible children aged 19 months to 12 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications, such as healthcare personnel and family contacts of immunocompromised persons. For children aged 12 months to 12 years, 1 dose of vaccine was recommended, whereas 2 doses, given 4 to 8 weeks apart, were recommended for persons aged 13 years or older. In 1999, ACIP updated the recommendations to include establishing childcare and school entry requirements, vaccination following exposure and for outbreak control, vaccination for certain children infected with HIV, and vaccination of adolescents and adults at high risk for exposure or transmission. In June 2005 and June 2006, ACIP adopted new recommendations regarding the use of live, attenuated vaccines to prevent varicella. These new recommendations are as follows: * Implement a routine 2-dose varicella vaccination program for children, with the first dose given at age 12 to 15 months and the second dose at age 4 to 6 years. * Give a second-dose, catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose. * Routinely vaccinate all healthy persons aged 13 years or older without evidence of immunity. * Perform prenatal assessment and postpartum vaccination. * Expand the use of the varicella vaccine to include HIV-infected children with age-specific CD4+T lymphocyte percentages of 15% to 24% and adolescents and adults with CD4+T lymphocyte counts greater than 200 cells/µL. * Establish requirements for middle school, high school, and college entry vaccination. At this time, the ACIP has also approved criteria for evidence of immunity to varicella. In preparing these guidelines, the ACIP workgroup reviewed published and unpublished data on the impact of the 1-dose varicella vaccination program, including data on vaccination coverage, changes in varicella epidemiology, transmission from vaccinated persons with varicella, vaccine effectiveness, immune response to vaccination, evidence of immunity, potential risk factors for vaccine failure; correlates of protection, safety, immunogenicity, and efficacy of the new quadrivalent MMRV vaccine; the immunogenicity and efficacy of a second dose of varicella vaccine; and cost-benefit and cost-effectiveness analyses. Recommendations were developed and discussed by the MMRV workgroup, using definitive research evidence when available and expert opinion of the workgroup members when conclusive data were lacking. Partner organizations, including the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the Council of State and Territorial Epidemiologists, the Association of Immunization Managers and state public healthcare professionals and immunization program directors, also provided input. Specific recommendations for the use of varicella vaccines are as follows: * For children aged 12 months or older, adolescents, and adults without evidence of immunity, two 0.5-mL doses of varicella vaccine should be given subcutaneously. The recommended minimum interval between the 2 doses is 3 months for children aged 12 months to 12 years. However, if the second dose was given more than 28 days after the first dose, the second dose does not have to be repeated. For persons aged 13 years and older, 4 weeks is the recommended minimum interval. * Single-antigen varicella vaccine is approved for use in healthy persons aged 12 months or older, whereas combination MMRV vaccine for simultaneous vaccination against MMRV is approved for use in healthy children aged 12 months to 12 years. Whenever any components of the combination vaccine are indicated and the other components are not contraindicated, the MMRV vaccine or other licensed combination vaccines is preferred over separate injection of equivalent component vaccines. * Routine vaccination schedules for young children are as follows: all healthy children should receive their first dose of varicella-containing vaccine at age 12 to 15 months. A second dose of varicella vaccine is recommended for all children aged 4 to 6 years before entering school, but it may be given earlier as long as the interval between the first and second dose is more than 3 months. Because of the risk for VZV transmission in schools, all children entering school should have received 2 doses of varicella-containing vaccine or have other evidence of immunity to varicella. * Routine vaccination schedules for adolescents and students are as follows: persons aged 13 years or older without evidence of varicella immunity should be given two 0.5-mL doses of single-antigen varicella vaccine subcutaneously, 4 to 8 weeks apart. If more than 8 weeks elapse after the first dose, the second dose may be given without restarting the schedule. The MMRV vaccine is not licensed for use in anyone aged 13 years or older. All students should be evaluated for varicella immunity, and those without such evidence should routinely receive 2 doses of single-antigen varicella vaccine 4 to 8 weeks apart. * All healthy adults should be evaluated for varicella immunity, and those without such evidence should be given 2 doses of single-antigen varicella vaccine 4 to 8 weeks apart. Special consideration for vaccination should be given to adults without evidence of immunity who might be at increased risk for exposure or transmission. * Second-dose, catch-up varicella vaccination is recommended for children, adolescents, and adults previously given 1 dose to improve individual protection against varicella and to more rapidly control school outbreaks. Catch-up vaccination may be given during routine healthcare provider visits, such as the recommended health maintenance visit at age 11 to 12 years, and through school and college entry requirements. Although the recommended minimum interval between the first dose and the catch-up second dose is 3 months for children aged 12 years or younger and 4 weeks for persons aged 13 years or older, the catch-up second dose may be given at any interval longer than the minimum recommended interval. * Pregnant women should undergo prenatal evaluation for evidence of varicella immunity. Because of the potentially devastating sequelae of varicella infection during pregnancy, birth before 1980 is not considered evidence of immunity for pregnant women. After delivery or pregnancy termination, women without evidence of varicella immunity should be given the first dose of vaccine before hospital discharge and the second dose 4 to 8 weeks later at the postpartum visit. "Women should be counseled to avoid conception for 1 month after each dose of varicella vaccine," the authors conclude. "Health-care settings in which completion or termination of pregnancy occurs should use standing orders to ensure the administration of varicella vaccine to women without evidence of immunity." MMWR Morb Mortal Wkly Rep. 2007;56:1-40. Clinical Context Varicella, a highly infectious disease caused by the VZV, causes a systemic infection that typically results in lifetime immunity. The 2 varicella vaccines licensed for use in the United States are VARIVAX, a single-antigen vaccine approved for use in healthy children aged 12 months or older, adolescents, and adults, and ProQuad, a combination MMRV vaccine for use in healthy children aged 12 months to 12 years. Previous ACIP recommendations for prevention of varicella have included routine vaccination of children aged 12 to 18 months, catch-up vaccination of susceptible children aged 19 months to 12 years, and vaccination of susceptible persons who have close contact with persons at high risk for serious complications. In 1999, ACIP updated their recommendations to include establishing childcare and school entry requirements, vaccination following exposure and for outbreak control, vaccination for certain children infected with HIV, and vaccination of adolescents and adults at high risk for exposure or transmission. The current ACIP revision is intended to replace and update earlier guidelines. Study Highlights * For children aged 12 months or older, adolescents, and adults without evidence of immunity, give 2 subcutaneous 0.5-mL doses of varicella vaccine, at a recommended minimum interval of 3 months (although 28 days or more is acceptable) for children aged 12 months to 12 years or 4 weeks for persons aged 13 years or older. * Single-antigen varicella vaccine is approved for healthy persons aged 12 months or older, and combination MMRV vaccine is approved only for healthy children aged 12 months to 12 years. * All healthy children should routinely receive their first dose of varicella-containing vaccine at age 12 to 15 months and a second dose at age 4 to 6 years, or earlier as long as the interval between the first and second dose is more than 3 months. * All children entering school should have received 2 doses of varicella-containing vaccine or have other evidence of immunity to varicella. * Persons aged 13 years or older without evidence of varicella immunity should routinely be given two 0.5-mL doses of single-antigen varicella vaccine subcutaneously, 4 to 8 weeks apart. If more than 8 weeks elapse after the first dose, the second dose may be given without restarting the schedule. * All students should be evaluated for varicella immunity, and those without such evidence should routinely receive 2 doses of single-antigen varicella vaccine 4 to 8 weeks apart. * Special consideration for vaccination should be given to adults without evidence of immunity who might be at increased risk for exposure or transmission. * Second-dose, catch-up varicella vaccination is recommended for children, adolescents, and adults previously given 1 dose. Catch-up vaccination may be given during routine healthcare provider visits and through school and college entry requirements. * The recommended minimum interval between the first dose and the catch-up second dose is 3 months for children aged 12 years or younger and 4 weeks for persons aged 13 years or older, but the catch-up second dose may be given at any interval longer than the minimum recommended interval. * Pregnant women should undergo prenatal evaluation for evidence of varicella immunity. After delivery or pregnancy termination, women without evidence of varicella immunity should receive the first dose of vaccine before hospital discharge and the second dose 4 to 8 weeks later at the postpartum visit. * Women should be counseled to avoid conception for 1 month after each dose of varicella vaccine. * New ACIP recommendations for varicella vaccination are as follows: routine 2-dose program for children (first dose, age 12 - 15 months; second dose, age 4 - 6 years); second-dose, catch-up vaccination for children, adolescents, and adults who previously received 1 dose; routine vaccination of all healthy persons aged 13 years or older without evidence of immunity; prenatal evaluation and postpartum vaccination; vaccination of HIV-infected children with age-specific CD4+T lymphocyte percentages of 15% to 24% and adolescents and adults with CD4+T lymphocyte counts greater than 200 cells/µL; and requirements for middle school, high school, and college entry vaccination. Pearls for Practice * All persons aged 12 months or older without evidence of immunity should receive 2 subcutaneous 0.5-mL doses of varicella vaccine, at a recommended minimum interval of 3 months (28 days or more is acceptable) for children aged 12 months to 12 years or 4 weeks for persons aged 13 years or older. Single-antigen varicella vaccine is approved for healthy persons aged 12 months or older, and combination MMRV vaccine is approved only for those aged 12 months to 12 years. * New ACIP recommendations for varicella vaccination include a routine 2-dose program for children; second-dose, catch-up vaccination for children, adolescents, and adults; routine vaccination of all healthy persons aged 13 years or older without evidence of immunity; prenatal evaluation and postpartum vaccination; vaccination of HIV-infected children with age-specific CD4+T lymphocyte percentages of 15% to 24% and adolescents and adults with CD4+T lymphocyte counts greater than 200 cells/µL; and requirements for middle school, high school, and college entry vaccination.
|
Prep4USMLE.com
|
Advertisement
|
|
|
| | |||||||
|
This thread is closed, so you cannot post a reply.
 Similar forum topicsmost effective way to prevent PPH # of pts to treat to prevent 1 case Germ inspector helps prevent hosp | Related resources |
Advertise | Support | Premium | Contact |