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Adolescent Immunization Update: New Recommendations 

Introduction

 

Over the past few months, the recommended vaccine schedule for adolescents has been updated. The changes include giving the HPV vaccine (Gardasil) to males, "catching up" teenagers with the Hepatitis A vaccine, and providing a pre-college booster for the meningitis vaccine (Menactra).

 

Before we take this opportunity to provide some of the information behind these changes, we would like to have a word about the cost of these immunizations.

                                            

While these are all recommended vaccines, they are not being paid for by the Massachusetts government. Therefore, in order to provide our patients with the best care possible, Westwood-Mansfield Pediatrics routinely purchases these vaccines.  

 

Fortunately, most of the insurance companies (including Tufts, Harvard-Pilgrim Health Care and MassHealth) represented in our practice recognize the importance of these vaccines and cover their cost.   Over the past few years, however, insurance companies have been slowly but steadily shifting the costs of healthcare to the patients. One way this has been accomplished is through high deductible plans. It is possible that any of these immunizations may be applied to any deductible you may have. If your plan does not cover the vaccine (or if it comes out of your deductible), you will be billed for the cost of the vaccine. If this is a concern, we recommend you contact your insurer before your visit.

 

  

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Gardasil (HPV Vaccine)

 

Gardasil is a vaccine that protects against the four most aggressive types of HPV (human papillomavirus). This virus is most known for causing cervical cancer in women. In addition, it is a common cause of genital warts, anal cancer, penis cancer and throat cancer.

 

It is recommended that children receive the HPV vaccine between ages 9-12 for maximum effect (the developing immune system is very responsive in these years). For individuals who do not receive the vaccine in that time period, they may be given this immunization at any time up to age 26.

 

At Westwood-Mansfield Pediatrics we have been successfully vaccinating our teenage girls for over six years. Recently the Center for Disease Control and the American Academy of Pediatrics stated that boys may receive this vaccine as well.  From both an individual and public health perspective, we strongly advise that all teens receive protection from this vaccine.  

 

We typically discuss the vaccine at the 11 year old visit and start the three-shot series at the 12 year visit.

 

Questions/Concerns include:

 

1) Is this a 'new' vaccine? The vaccine has had safety studies now going back over 10 years. The vaccine was derived from the hepatitis B vaccine. The majority of the vaccine components is from the hepatitis B vaccine with the hepatitis B viral proteins removed and the HPV viral proteins inserted. Hepatitis B is a vaccine that has been safely given to newborns and infants for many years. The Gardasil vaccine is basically the same.

 

2) Can I wait and give it when my child is older? The HPV virus is transmitted sexually. Thus, it is very important to have completed the vaccine series long before any type of sexual activity takes place. It can be hard to convince a teenager to get shots. A well-known and well-studied public health strategy is to vaccinate for sexually transmitted diseases when parents have more control over their child's immunization schedule. The hepatitis B virus is also sexually transmitted and most Americans complete their vaccine series before age 1. Furthermore, we know that kids in the 9-12 age groups produce more antibodies than young adults so we think the protection is probably better when given in this age range.

 

3) Is it covered by insurance? Most insurers (including Tufts, HPHC and MassHealth) are covering Gardasil for boys (they all cover it for girls). Blue Cross is expected to approve coverage in October 2011. If you are interested in starting the series for your son, we suggest you contact your insurer first and then call us to book the shot visit (no copay will be charged).  

 

 

4) I recently heard a politician state that the HPV vaccine causes "mental retardation" and is not safe. Should I be concerned? No.  For more information, please view these links from the American Academy of Pediatrics, the New York Times, USA Today, and the Minneapolis Star Tribune.   

 

 

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Hepatitis A Vaccine

 

The Hepatitis A vaccine is a vaccine that has been a 'traveler's vaccine' for almost 20 years. It provides protection against the hepatitis A virus which is transmitted through contaminated water, most often in fresh fruits and vegetables. 10% of people infected with hepatitis A develop a severe liver infection that is fatal without a transplant.

 

This virus was very rare in the US until an outbreak occurred about 6-7 years ago (strawberries from Mexico). At that time, the Center for Disease Control recommended that the hepatitis A vaccine be added to the vaccine schedule for young children. Many states started to require hepatitis A vaccination for preschool.

 

When this initial recommendation was made, we at Westwood-Mansfield Pediatrics started immunizing our toddlers with this vaccine. As such, almost all of our patients ages 6 years and younger have completed their hepatitis A series. Some other patients may have received it prior to travel or before starting college.

 

In keeping with the recommendations, we have recently decided to "catch-up" all of our patients who may not have received this vaccine. The hepatitis A vaccine series includes two immunizations at least six months apart.

 

All insurance plans cover the cost of this vaccine (which is much less than the HPV vaccine). It is possible that it will come out of your deductible, however, and we recommend you check with your insurer first.

 

We will be recommending this vaccine at routine checkups for all kids who have not previously been immunized.

 

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Menactra
 

The Menactra vaccine protects against the bacteria Neisseria meningitidis (commonly referred to as meningococcus) one of the leading causes of bacterial meningitis (a life threatening infection around the brain and spinal cord). Meningococcal disease is fatal in approximately 10% of cases and survivors often have complications including seizures, developmental delay, deafness, and amputation of limbs.

Menactra has been routinely been given to 11 and 12 year olds since 2005. Recently, a pre-college booster was recommended for all adolescents 16-18 years old who received a first Menactra dose prior to 15 years of age. The reason for this booster dose is that meningitis caused by meningococcus has a peak occurrence rate anytime a large number of people live in close quarters with college dormitories a prime example.

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