NAPNAP 2012: US Immunizations… Looking Back and Looking Ahead

Back by popular demand, William Atkinson, MD, MPH, presented his eleventh straight pediatric immunization update to the National Association of Pediatric Nurse Practitioners at its 33^rd Annual Conference. The general session started with an announcement of Dr. Atkinson’s impending retirement this summer and a formal recognition of appreciation by NAPNAP.

During his lively and often humorous presentation, which was initially planned as a straightforward update of the most pertinent issues in pediatric and adolescent immunizations, Atkinson instead presented a critical retrospective summary of his last 11 NAPNAP talks. Yes, he did keep all of his original slide sets!

Dr. Atkinson discussed key events and milestones in immunization research and policy that occurred during the last decade, including the anthrax scare, the failed smallpox vaccination campaign (in the planning phase during his first presentation in 2002), the H1N1 scare and subsequent vaccine shortage, the swine flu pandemic, introduction of combination vaccines and live attenuated influenza vaccine, expansion of routine influenza immunization recommendations, the approval of Gardasil® (HPV4) vaccine, pertussis problems, and vaccine safety concerns, particularly those related to an unfounded link between the vaccines and autism.

Attendees also learned about several new developments for 2012. Atkinson noted that the meningococcal conjugate vaccine Menactra® has been approved for use in children as young as nine months of age. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends a two-dose series for high risk children as young as nine months (high-risk patients include those with persistent complement component deficiency, patients who will travel to a part of the world where meningococcal disease is epidemic). Asplenic kids are exempted from this recommendation because of concerns about interference with the pneumococcal vaccination.

In October 2011, ACIP published a recommendation for routine HPV4 vaccination of healthy boys, 11 through 21 years of age. Routine vaccination of males with immunosuppression or HIV may be carried through 26 years of age. These recommendations are for HPV4 only; HPV2 should not be given to male patients and if it is, that dose should not be counted.

“Ever since the very beginning, I have attempted to predict what was going to happen in the near future...,” quipped Dr. Atkinson. This year, his predictions included the introduction of more combination vaccines, the first quadrivalent influenza vaccine (which would include H3N2, H1N1, and two types of influenza B), and tissue culture influenza vaccine (egg free); meningococcal vaccinations for infants; more than a single dose of Tdap, expansions of pneumococcal conjugate vaccine (PCV13) recommendations; and more vaccine safety concerns.

When asked if there was one message he wanted attendees to walk away with, he replied, “Keep vaccinating. Do not miss an opportunity.”

Atkinson’s presentation slides are available here. http://www.napnap.org/Files/204_Atkinson.pdf