Wednesday, February 15, 2017

Vaccines in the news: controversies & updated recommendations

- Jennifer Middleton, MD, MPH

Vaccine safety concerns continue to make headlines, with another physician garnering attention for voicing his opinions in the last few weeks. Although his healthcare system has vehemently disavowed his statements, some physicians may fear that his claims will complicate the discussions we have with patients about vaccination. It's within this context that AFP's current issue reviews the Advisory Committee on Immunization Practices' (ACIP) updated recommendations for 2017, with articles focusing on children and adults. There are several changes for physicians to be aware of - and having strategies at the ready to respond to concerns evoked by current events may prove useful when discussing them with patients.

Some highlights from the ACIP recommendations:

* Live attenuated influenza vaccine is no longer recommended following studies showing its relative ineffectiveness. This change unfortunately eliminates what was an attractive influenza vaccine option for our needle-phobic patients.

* Only 2 doses of human papillomavirus (HPV) vaccine are now needed for healthy adolescents as long as the series is started before age 15; if started at or after age 15, then 3 doses are still required.

* Pregnant adolescents and women should receive a tetanus toxoid, reduced diptheria toxoid, and acelluar pertussis (Tdap) vaccine between 27 and 36 weeks gestation, regardless of when they last received Tdap vaccination.

* Speaking of infants, ACIP changed their language regarding the first hepatitis B vaccination to emphasize that it should be given "within 24 hours of birth."

* The new vaccine for serotype B meningococcal disease is available for adolescents between ages 16-23.

* Everyone with chronic liver disease - including non-alcoholic fatty liver disease - should receive the hepatitis B vaccine series.

It's likely that, in the course of discussing these changes with patients, that some patients will share their hesitancy to receive a vaccination themselves and/or vaccinate their children. Several techniques may be useful in overcoming vaccine hesitancy. I've written on the blog before about how eliciting our patients' specific concerns and then tailoring our message accordingly can be successful. Dr. Lin has previously provided recommendations about discussing HPV vaccination with parents. A recent editorial in AFP shared "Strategies for Addressing and Overcoming Vaccine Hesitancy," and this excellent article provides useful information about vaccinations and common concerns to share with patients as well. There are AFP By Topics on Immunizations (excluding influenza) and another on Influenza with editorials, patient information, and review articles at your fingertips. If you have concerns about reimbursement related to providing vaccines in your office, check out this 2015 article from Family Practice Management.

Recent outbreaks in the United States of measles and pertussis serve as vivid reminders of how dangerous these diseases can be. Countering anti-vaccine messages can feel challenging, but the best predictor of being vaccinated is still hearing a physician's recommendation to vaccinate. Arming ourselves with information and strategies can help our patients make informed choices about vaccination.

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