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New, and Some Not-So-New, Vaccines for Adolescents and Diseases They Prevent

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New, and Some Not-So-New, Vaccines for Adolescents and Diseases They Prevent SUPPLEMENT ARTICLE New, and Some Not-so-New, Vaccines for Adolescents and Diseases They Prevent Daniel B. Fishbein, MDa, Karen R. Broder, MD, FAAPa, Lauri Markowitz, MDb, Nancy Messonnier, MDa aNational Center for Immunization and Respiratory Diseases and bNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia ABSTRACT Adolescents in the United States now have the opportunity to receive new vaccines that prevent invasive meningococcal infections, pertussis (whooping cough), and cervical cancer. Except for their potential to cause serious illness, these infections www.pediatrics.org/cgi/doi/10.1542/ could not be more different. Their incidence ranges from extremely low to quite peds.2007-1115B high. Early clinical manifestations of infection range from none to life-threatening doi:10.1542/peds.2007-1115B illness. Two of the vaccines are similar to those already in use, whereas 1 is The findings and conclusions in this report are those of the authors and do not completely new. In conjunction with the 4 vaccines previously recommended for necessarily represent the views of the adolescents (the tetanus and diphtheria booster, hepatitis B, measles-mumps-ru- funding agency. bella, and varicella), the 3 new vaccines (meningococcal, human papillomavirus, and Key Words the tetanus-diphtheria-pertussis booster [which replaced the tetanus-diphtheria adolescent vaccination, new vaccines booster]) bring the number recommended for adolescents to 6. In this article, we Abbreviations describe key characteristics of the 3 new vaccines and infections they were designed Td—tetanus and diphtheria toxoids to prevent. We also briefly discuss other vaccines recommended for all adolescents MMR—measles-mumps-rubella AAP—American Academy of Pediatrics who have not already received them and new vaccines that are still under ACIP—Advisory Committee on development. Immunization Practices HPV—human papillomavirus MPSV4—meningococcal polysaccharide vaccine MCV4—meningococcal polysaccharide- EFORE 2005, THE only vaccine routinely recommended for healthy adolescents protein conjugate vaccine Bwho had received all recommended childhood vaccinations was the tetanus and GBS—Guillain-Barre´syndrome diphtheria toxoids (Td) booster.1 Three other vaccines (measles-mumps-rubella TdaP—tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine [MMR], hepatitis B, and varicella) were used as “catch-up vaccinations” for adoles- HbsAG—hepatitis B surface antigen cents who did not receive these vaccines as children (and, in the case of varicella, had Accepted for publication Aug 22, 2007 not had chickenpox). The second dose of MMR vaccine was first recommended for Address correspondence to Daniel B. Fishbein, adolescents by the American Academy of Pediatrics (AAP) in 1989,2 whereas hepa- MD, National Center for Preparedness, titis B and varicella vaccines were first recommended for this age group in 1995 and Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 3,4 1996, respectively. These recommendations were consolidated in 1996, when the 1600 Clifton Rd NE, Mail Stop E-03, Atlanta, Advisory Committee on Immunization Practices (ACIP), AAP, American Academy of GA 30333. E-mail: dfi[email protected] Family Physicians, and American Medical Association harmonized their recommen- PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2008 by the dations. These organizations suggested that the recommended immunizations and American Academy of Pediatrics other preventive services be delivered at a routine preventive visit at 11 to 12 years of age.1 Three new vaccines intended primarily for adolescents are now available. The first of these, a new vaccine effective for the prevention of disease caused by Neisseria meningitidis, was licensed in the United States in 2005 and officially recommended for use when the ACIP recommendations were published in May of that year.5,6 Two vaccines for adolescents, both of which prevent infections with Bordetella pertussis, tetanus, and diphtheria, were licensed in May and June of 2005, respectively, and recommendations were published in early 2006.7 A vaccine that prevents human papillomavirus (HPV), the cause of cervical cancer, was licensed in May 2006, and recommendations for its use were published in March 2007.8 All the diseases against which these new vaccines offer protection are potentially serious, but the clinical course for each could hardly be more different. A fulminant life-threatening course is common with disease caused by N meningitidis but extremely rare among adolescents and adults infected with B pertussis and does not occur with HPV infection. Pertussis rarely causes serious complications in adolescents but does cause substantial morbidity. Moreover, adolescents may transmit pertussis to infants who are at risk for death if they develop pertussis. HPV infections can cause genital warts and abnormal Papanicolaou test results in adolescents and adults, and persistent HPV infection PEDIATRICS Volume 121, Supplement 1, January 2008 S5 Downloaded from www.aappublications.org/news by guest on September 29, 2021 TABLE 1 Annual Reported Cases of Disease Occurrences in the United States in the 20th and 21st Centuries Disease Maximum Reported Most Recently a Cases, 20th Century Reported Cases, 21st (All Ages)a Centuryb All Ages Ages Ages 5–14 15–24 Varicella 4 000 000 NAc NAc NAc Measles 503 282 65 21 12 Hepatitis B 287 000 5119 11 514 Diphtheria 175 885 0 0 0 Mumps 152 209 314 75 67 FIGURE 1 Pertussis 147 271 25 616 7028 3944 Rates of meningococcal disease: United States, 1991–2002. a Per 100 000 population. Rubella 47 745 11 4 1 Source: Active Bacterial Core surveillance data (adapted from Bilukha OO, Rosenstein N; Cervical cancer NAd 12 085e NA 115e National Center for Infectious Diseases, Centers for Disease Control and Prevention. MMWR Recomm Rep. 2005;54[RR-7]:1–21). Invasive meningococcal infection 3525 1245 140 261 Tetanus 1314 27 1 3 NA indicates not applicable. a Adapted from Centers for Disease Control and Prevention. MMWR Morb Mortal Wkly Rep. fewer than 1% of carriers develop disease. Transmission 1999;48:243–248. occurs when close, mouth-to-mouth contact permits the b Unless otherwise noted, data are from Centers for Disease Control and Prevention. MMWR exchange of salivary secretions. Although close contacts Recomm Rep. 2007;54:1–92. c National surveillance for varicella cases remains incomplete, although active surveillance in of people who are ill with meningococcal disease are at limited geographic areas demonstrated that varicella cases decreased from 71% to 84% be- much higher risk, most people contract the bacteria from tween 1995 and 2000. asymptomatic carriers. When N meningitidis invades the d No historical data are available. bloodstream, it can cause a serious, rapidly progressing, e Data are for 2002 from the US Cancer Statistics Working Group. Available at: www.cdc.gov/ cancer/npcr/uscstes. Data from selected statewide and metropolitan area cancer registries that and sometimes fatal disease. N meningitidis can be iso- met the data quality criteria for all invasive cancer sites combined were used. Adolescent data lated from the bloodstream in up to three fourths of are for people who are 15 to 24 years old. Incidence counts cover ϳ95% of the US population, patients, but meningococcal sepsis, which is also called and death counts cover 100% of the US population. meningococcemia, occurs in only 5% to 20% of patients. Meningeal infection results from hematogenous spread and occurs in approximately one half of patients. Pneu- can result in cervical cancer, usually many years after monia is the third most common presentation, occurring the initial infection. Similarly distinct is the past and in 5% to 15% of patients.10 The onset of disease is often present incidence of the diseases that are prevented by abrupt, and its course is rapid. The death rate is 10% to these vaccines (Table 1). 14%, and an additional 11% to 19% of survivors suffer In this article, we focus primarily on these new vac- serious sequelae, including deafness, neurologic deficit, cines and discuss the diseases the vaccines prevent and or limb loss.5 the similarities and differences among the vaccines themselves. We also briefly discuss and compare these Epidemiology vaccines with the 3 other vaccines (MMR, hepatitis B, Annually, 1400 to 2800 cases of invasive meningococcal and varicella) recommended for adolescents who have disease occur in the United States. In the past 5 years, not previously received them and future vaccines that serogroups B, C, and Y each caused approximately one are still under development. A summary of vaccines in third of disease cases.9 Disease is seasonal, with cases later stages of development as well as those recently peaking in December and January. Most cases (97%) are licensed in the United States can be found at http:// sporadic; only a minority (3%) are associated with out- aapredbook.aappublications.org/news/vaccstatus.shtml. breaks.11 In 1990–2002, the incidence of invasive me- ningococcal disease in the United States ranged from 0.5 THE DISEASES AND THE VACCINES THAT PREVENT THEM to 1.1 cases per 100 000 population.5,9 During these years, rates of meningococcal disease were highest Invasive Meningococcal Infections among infants Ͻ1 year old (9.2 per 100 000); the rate for Etiology, Pathogenesis, and Clinical Manifestations youth 11 to 19 years old (1.2 per 100 000) was also N meningitidis is a Gram-negative diplococci that is clas- higher than that for the general population (Fig 1).1 sified antigenically into 13 distinct serogroups on the College freshmen living in dormitories are at a higher basis of their capsular polysaccharides. Worldwide, sero- risk than college students in general. Although the dis- groups A, B, C, Y, and W-135 account for the majority of ease is quite rare, every case triggers a costly public cases, although serogroup A disease is rare in the United heath response.9 States.9 Risk factors for infection include household ex- posure, crowding, concurrent upper respiratory tract in- Vaccines fections, and active and passive smoking.
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