ACIP updates recommendations on HPV, HepB, MenB vaccines
MelissaJenco, News Content Editor
Adolescents under age 15 years need only two doses of human papillomavirus (HPV) vaccine
instead of three under a new recommendation from a Centers for Disease Control and
Prevention (CDC) committee.
The CDC’s Advisory Committee on Immunization Practices (ACIP) said a two-dose schedule
could improve lagging completion rates, while still providing protection against the
The group also made changes to hepatitis B and meningococcal B (MenB) vaccine recommendations
during Wednesday’s meeting.
ACIP’s recommendations will be reviewed by the CDC director. Those that are approved
will be published as official recommendations in the Morbidity and Mortality Weekly Report (MMWR). The Academy will review the CDC’s changes and make official policy recommendations
of its own. Yvonne A. Maldonado, M.D., FAAP, vice chair of the AAP Committee on Infectious
Diseases who represented the Academy at the meeting, recommends pediatricians follow
existing AAP guidance for now but prepare for the potential changes.
To protect against HPV-related cancers, the Academy and CDC recommend HPV vaccine as part of routine immunization for males and females at age 11 or 12 years, although
it can be started as early as 9 years.
The vaccine, now available as the 9-valent Gardasil 9, traditionally has been given
in a three-dose series, but the Food and Drug Administration (FDA) recently approved
a two-dose series for children ages 9-14.
After reviewing the data, ACIP members followed suit. They recommended a two-dose
schedule for children younger than 15 years of age who are starting vaccination, with
the second dose administered six to 12 months after the first dose. Those starting
vaccination at age 15-26 should receive three doses. ACIP continues to recommend routine
vaccination at age 11-12, though the vaccine can be given as early as 9 years of age.
Dr. Maldonado applauded the change.
“We want to make sure children are up to date on their vaccines and ... the two-dose
HPV schedule is certainly much easier and should hopefully lead to more compliance,”
Only about 42% of teen girls and 28% of teen boys receive all three doses, according
to the CDC.
Adolescents under 15 who have received two doses that were less than six months apart
will need a third dose.
The 9-valent vaccine may be used to complete a series started with a quadrivalent
or bivalent vaccine, and a schedule that has been interrupted does not need to be
restarted. ACIP currently does not have a recommendation as to whether those who were
fully vaccinated with one of those two types should receive additional vaccination
with the 9-valent vaccine, and the Academy will work closely with the CDC to determine
if such guidance can be forthcoming.
CDC Director Tom Frieden, M.D., M.P.H., quickly approved ACIP’s HPV recommendations.
“Safe, effective, and long-lasting protection against HPV cancers with two visits
instead of three means more Americans will be protected from cancer,” Dr. Frieden
said in a news release. “This recommendation will make it simpler for parents to get
their children protected in time.”
ACIP also took steps Wednesday to stress the importance of vaccinating infants against
hepatitis B as soon as possible after birth.
Hepatitis B is a liver infection transmitted through blood or body fluids and can
be passed from a mother to her infant. The CDC estimates 90% of infected infants develop
ACIP recommended Wednesday that infants be immunized within 24 hours of birth and
removed policy language allowing a delay in some circumstances.
“The earlier the better,” Dr. Maldonado said. “Once infants are discharged home after
birth, there is a risk they might miss their first well-child appointment and their
first hepatitis B vaccine dose. If the infant’s mother is infected with hepatitis
B, there would be a very high risk of becoming infected themselves.”
Pediatricians should continue to be vigilant about vaccinating infants who did not
receive a dose at birth.
The Academy and CDC currently recommend routine MenB vaccination for those 10 and older who are at increased risk of MenB, including those with persistent
complement component deficiencies, anatomic or functional asplenia, and people living
in an outbreak area. They do not express a preference for the two licensed vaccines
— MenB-4C (Bexsero) and MenB-FHbp (Trumenba) — but the same product must be used for
the entire series.
In April, the FDA approved a label change giving MenB-FHbp a flexible three-dose schedule
of zero, one to two months and six months and a two-dose schedule of zero and six
months. ACIP members on Wednesday recommended when using MenB-FHbp to vaccinate people
at increased risk of MenB, the three-dose schedule should be used.
That schedule will “provide early protection and maximize immune response,” said Jessica
MacNeil, M.P.H., a CDC epidemiologist.
For healthy people ages 16-23 years who are not at increased risk of MenB disease,
ACIP has a permissive recommendation that allows use of one of the MenB vaccines should
the patient desire to be immunized. If an adolescent so chooses and MenB-FHbp is selected,
ACIP recommended a two-dose schedule.
If a patient receives a second dose of MenB-FHbp less than six months after the first
dose, a third dose should be given at least six months after the first.
CDC epidemiologist Jennifer Liang, D.V.M.,M.P.V.M., said data “continue to be reassuring.”
“Studies of over 50,000 women receiving Tdap during pregnancy … show no increased
risk of adverse maternal or infant health outcomes,” she said.
In 2012, ACIP began recommending Tdap during every pregnancy. While it can be given
at any time, the CDC considers 27-36 weeks’ gestation to be optimal. The CDC now is
working on new language to emphasize vaccination in the early part of that window
when it is believed to be most beneficial.
AAP News will continue to update members when recommendations have been approved by the CDC
director and published in the MMWR, as well as when the Academy makes official policy recommendations on these vaccinations.