The recent COVID pandemic put vaccine development on the national stage as we all watched the “Operation Warp Speed” creation of new vaccines to prevent SARS-CoV2 infection. As of the time that I am writing this, we do not yet know whether these vaccines will be recommended for use in children, but the discussion around these new vaccines reminded me of the many talks that I have had with patients and parents about some of our newer pediatric vaccines.
Children typically receive vaccines against many diseases prior to kindergarten entry, including diphtheria, tetanus, pertussis, Hemophilus influenza type B, hepatitis A and B, Streptococcus pneumoniae, polio, rotavirus, measles, mumps, rubella, and varicella—most of these vaccines have been given for decades and are very familiar to parents. In the past 15 years, however, our older school-age children have been given the opportunity for protection against two potentially deadly pathogens: Neisseria meningitidis and Human papillomavirus.
Meningococcal Vaccines
Both types of meningococcal vaccines work to prevent infection by Neisseria meningitidis, a bacterium that is transmitted by oral or respiratory secretions—typically spread by sharing food or drinks, kissing or having close contact with an infected person. Outbreaks can happen in areas where many people share the same living space, such as classrooms, college dormitories and military barracks. The bacteria can cause inflammation of the lining of the brain and spinal cord (this inflammation is known as meningitis) or can spread into the bloodstream and cause widespread infection. Approximately 20% of people infected with meningococcus will have long-term serious side effects and about 10% will die. Vaccination is an important tool in preventing this severe disease.
There are 5 types of Neisseria meningitidis that cause most meningococcal infections—these types are named A, C, W-135, Y and B. Menactra and Menveo are two vaccines that protect against types A, C, W-135, and Y, and are abbreviated MenACWY. Menactra was licensed in 2005 and Menveo in 2010. Kids should be vaccinated with one of these at age 11 and receive a booster dose at age 16. Children who have specific immune deficiencies may need to receive the vaccine at an earlier age.
Two new vaccines that protect against type B were recently licensed in 2015, Trumenba and Bexsero. Both are licensed for all children ages 16-18 and in other age groups depending upon risk factors.
The state of Florida does not require meningococcal vaccination for school entry, but universities and colleges are increasingly requiring that incoming students vaccinate against these infections (or sign a waiver that they understand the risks of not vaccinating). Currently over 30 states have or are in the process of implementing the MenACWY vaccine as a public-school requirement and it will hopefully approach similar vaccination rates as the routine tetanus booster given at the same age.
HPV Vaccine
Human papillomavirus is a common virus with multiple variants that affect the skin, mouth and throat, genitals, and lining of the cervix. The HPV vaccine (brand name Gardasil) protects against 9 variants of the virus, including those most commonly associated with cervical cancer. HPV is transmitted by sexual contact, including skin-to-skin contact, and is the most common sexually transmitted disease in the world. Approximately 14 million Americans are infected with HPV currently. Most HPV infections are asymptomatic and resolve on their own, but occasionally the virus will persist and lead to cancer. Over 30,000 cases of HPV-related cancers are diagnosed in the US each year, the majority being cervical and head and neck cancers; two-thirds of infections are in women. HPV infection can be prevented by abstinence from sexual contact, but risk of infection is high with sexual activity. Infection typically occurs within 2-3 years of initiating sexual activity, but it takes several years after infection for cancer to develop, therefore the cancer incidence is highest in ages 40-60.
The HPV vaccine was first licensed in 2006 and is currently licensed for use in ages 9-45. It is part of the routine vaccination schedule for the 11-12-year-old well visit and is administered as a 2-dose series for children who begin the series prior to age 15, or a 3-dose series for children 15 or older. Children who are immunocompromised should receive 3 doses. This vaccine and other adolescent vaccines have an increased risk of fainting shortly after vaccination; therefore a 15-minute waiting period is recommended before leaving the physician’s office.
I hope this helps to answer some questions about our newer routine pediatric vaccinations. If you would like further reading, I highly recommend both the AAP Healthy Children website (http://www.healthychildren.org ) and the Vaccine Education Center at the Children’s Hospital of Philadelphia site ( http://www.chop.edu/centers-programs/vaccine-education-center ).
