Posted on the Pediatric SuperSite on November 20, 2010
NEW YORK CITY – The American Academy of Pediatrics Committee on Infectious Diseases and CDC Advisory Committee on Immunization Practices have altered slightly their preference to combination vaccines for most children.
“There has been a combination vaccine statement for a long time that gave preference to combination vaccines over the individual component vaccines. In the 2010 revision of this statement, the use of a combination vaccine series is now considered generally preferred over separate injections of the equivalent component vaccines,” Dennehy said during a presentation.
Penelope H. Dennehy, MD, presented a review of these recommendations at the 23rd Annual Infectious Diseases in Children Symposium. Dennehy is director of the division of pediatric infectious disease at Hasbro Children’s Hospital, and professor and vice chair for academic affairs in the department of pediatrics at Alpert Medical School, at Brown University, in Providence, RI.
The main immunization changes included measles, mumps, rubella (MMR, MMR II, Merck) and measles, mumps, rubella and varicella (MMR-V, Proquad, Merck) vaccine recommendations; age and interval for the last dose in the inactivated polio vaccine (IPV) series; meningococcal conjugate revaccination; use of HPV2 (Cervarix, GlaxoSmithKline) for girls/women and permissive use of HPV4 (Gardasil, Merck) for boys/men; 2010/2011 influenza vaccine recommendations; and recommendations for 13-valent pneumococcal conjugate vaccine (PCV-13, Prevnar13, Wyeth).
Reasons for change
Considerations for making the changes, according to Dennehy, included provider assessment, the number of injections, vaccine availability, likelihood of improved coverage and patient return, and storage and cost consideration. Patient preference and the potential for adverse events were also considered.
The potential for adverse events has driven this change in the combination statement, particularly, the increased risk for febrile seizures with MMR-V, according to Dennehy. Among children aged 12 to 23 months, fever and seizure increased 7 to 10 days after all measles-containing vaccines; MMRV increased fever and seizure about two times as much as MMR plus varicella; and one additional febrile seizure will occur 7 to 10 days after vaccination as compared with MMR plus varicella, for every 2,300 MMR-V doses given.
New ACIP recommendations included that for the first dose of MMR and varicella given during ages 12 to 47 months, either MMR-V or separate MMR and varicella could be used. For the first dose of MMR and varicella given in children aged older than 4 years, the use of MMRV is preferred. MMR-V is preferred for the second dose given at any age. In addition, personal or family history of seizures is a new precaution for use of MMR-V vaccine.