Use of Measles-Mumps-Rubella (MMR) Vaccine for the Management of Mumps Outbreaks in Canada
Back To School Means Updating Childhood Vaccines
The lazy, crazy days of summer are drawing to a close and it is time to start thinking about back to school and all that entails to prepare students to optimize their health. Vaccines can be number one on the list. We need to take a serious look at how the number of children who receive all necessary vaccines for school has dropped since the COVID-19 pandemic began its devastating march around the world.1 The immunization rates are even lower in children who are eligible for the Vaccines for Children (VFC) program.2 This federal program provides no-cost vaccines to children who are uninsured or are Medicaid eligible.3 In some states VFC also covers children whose insurance does not cover vaccines. It is time to review what vaccines are indicated to keep all students healthy and practice some infection prevention.
Back to School VaccinesReminder/recall is one of the best ways to get parents/caregivers to bring children into providers' offices for that all important review of vaccines.4 Many state immunization registries have functions that can easily generate reminders for parents. States such as New York follow the Advisory Committee for Immunization Practice (ACIP) guidelines for children and adolescents vaccine schedules for school attendance. All providers need to be familiar with the immunization requirements for school attendance in the states in which they practice. This information is easy to access by contacting the state health departments who will have the requirements posted online.
Pre-KindergartenChildren entering Pre-K programs vaccination schedules:
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Back to school offers an opportunity to have these all-important immunization conversations with parents and students, and get all children immunized.
KindergartenKindergarten requirements include:
Intervals between doses of the Hep B and VAR vaccines are of utmost importance for the vaccines to be effective and intervals should follow the schedules noted for Pre-K children. If the intervals are less than recommended, then additional doses are indicated. Many of the children we will be seeing in preparation for returning to school may be behind schedule. Please consult the CDC's catch-up schedule for further guidance to ensure that children receive the appropriate vaccines on an accelerated schedule.
Grades 1 to 6Children entering grades 1 through 5 are required to have the same vaccines as indicated for kindergarten except for Hib and PCV, which are not required. Only 3 doses of DTaP/Tdap are indicated for grade 6. Sixth-grade children should have a Tdap booster at ages 11 to 12 years, however, a dose given at age 10 years is acceptable in addition to the other required vaccines. Hib and PCV are also not required for grade 5.5
Grades 7 to 12For grades 7 through 11, the vaccine series required is the same as for grade 6 with the addition of a dose of Meningococcal conjugate vaccine (MenACWY) if they did not receive a dose at age 11 to 12 years.
In addition to the vaccines required for grades 6 through 11, students in grade 12 need an additional dose of MenACWY vaccine administered at age 16 years or older.5
College Bound StudentsLet's not forget about the students headed for college. They too should have all of the vaccines recommended for adolescents in grade 12. But college-bound students need to be made aware of the risk of Meningitis B (MenB), including a discussion of the vaccine using shared decision making.5 Meningitis B, while relatively rare, is the only strain of meningitis seen on college campuses in over 10 years.6 There are 2 MenB vaccines, which are NOT interchangeable. If one brand is started, then the series must be completed with the same brand. If the same brand is not available, then the series must be restarted with the other brand.
Bexsero® is a 2-dose series given at 0 and 1 month. Trumenba® is a 2-dose series given at 0 and 6 months. If the second dose is administered earlier than 6 months a third dose must be given at least 4 months after the second dose. CDC has a fact sheet on shared clinical decision making that is very helpful.
Recently a 5-valent Meningitis vaccine was licensed. If a student is receiving MenACWY and MenB vaccines at the same visit, MenABCWY vaccine (Penbraya™) may be given. This vaccine is limited to students aged 16 years and older and it contains Trumenba®. Since there is no interchanging of vaccines all subsequent doses of MenB vaccine must be Trumenba®.
Influenza VaccineDo not forget the influenza vaccine. The CDC recommends that everyone age 6 months and older receive an influenza vaccine as long as there are no contraindications. It is sobering to note that there were 102 pediatric deaths nationwide as of March 2024. These tragic losses of life were most likely preventable since nearly 90% of cases occurred in unvaccinated children.7 Remember persons with a history of egg allergy of any severity can be vaccinated with any influenza vaccine indicated for the recipient's age and health status with no additional safety considerations.5
New and improved influenza vaccines are coming according to CDC. One study examining people's immune response to various influenza vaccines suggests that vaccination with non-egg-based flu vaccines might improve the antibody response to circulating influenza viruses over traditional egg-based vaccines. The findings indicate that repeated vaccination with non-egg-based vaccines could redirect antibody responses from immune memory, offering possible insights for improving vaccination strategy. Cell-based vaccines will reduce the impact of the seasonal virus at a lesser production and distribution cost.8
New COVID-19 VaccineThe FDA approved KP.2-adapted COVID-19 vaccines for the 2024-2025 season. The vaccines will include a monovalent component that corresponds to the KP.2 strain of the SARS-CoV-2 Omicrom JN.1 lineage, according to the FDA.9
The updated formulation pertains to both approved (Comirnaty and Spikevax) and authorized (Moderna COVID-19 Vaccine and Pfizer-BioNTech COVID-19 Vaccine) mRNA vaccines. Targeting the KP.2 strain is expected to provide better protection against COVID-19 based on current data indicating that KP.2-adapted vaccines generate a substantially improved neutralizing response against currently circulating Omicron JN.1 sublineages compared with Omicron XBB.1.5-adapted COVID-19 vaccines.
Children and young adults will be part of the new vaccine strategy.
Countering DisinformationSome final thoughts about immunizations. The problem for the health of the American people is not a virus, it is disinformation! 10 Clinicians need to listen and acknowledge patient and parent concerns, and always be kind. Patients and parents are afraid of what they hear and read, and they need nurse practitioners and physician associates to be their trusted sources of information.11 While progress has been made to get back to the immunization levels seen before the COVID-19 pandemic, we have a way to go. Nurse practitioners are already instrumental in getting patients back on track with vaccines. Back to school offers an opportunity to have these all-important immunization conversations with parents and students, and get all children immunized.
Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, a pediatric nurse practitioner and owner of Pediatric Nurse Practitioner House Calls. Dr. Koslap-Petraco is also a nurse consultant for the Immunization Action Coalition and a clinical assistant professor at Stony Brook University in New York.
Wisconsin Has Updated Immunization Requirements For Schools, Child Care. Here's What To Know
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Updated COVID Vaccines For 2024–2025 Get FDA Approval
The U.S. Food and Drug Administration (FDA) on Thursday approved updated COVID-19 vaccines for the 2024–25 season from Pfizer and Moderna.[1]
The new shots are expected to be available to the public no later than the end of next week, following an official sign-off by the Centers for Disease Control and Prevention (CDC).
An updated Novavax vaccine, which uses a more traditional protein-based technology than the Pfizer and Moderna mRNA (messenger RNA) shots, is still under review by the FDA but is expected to be green-lighted soon.[2]
"Vaccination continues to be the cornerstone of COVID-19 prevention," said Peter Marks, MD, PhD, the director of the FDA's Center for Biologics Evaluation and Research, in a statement.[1] "Given waning immunity of the population from previous exposure to the virus and from prior vaccination, we strongly encourage those who are eligible to consider receiving an updated COVID-19 vaccine to provide better protection against currently circulating variants."
Many Americans have been eager for the arrival of the new vaccines because of a summer wave of illness, with rates of test positivity running moderate to high throughout most of the country.[3]
What's Different About the New COVID-19 Shots? The updated COVID-19 vaccines were designed to target JN.1 and KP.2, omicron virus variants that were dominant in the spring. Since then, KP3.1.1 and KP.3 have come to account for more than half of all infections.[4]
KP3.1.1. And KP.3 are closely related to KP.2 — they all belong to a family of variants known as FLiRT, marked by similar mutations. Experts say the updated COVID shots should still be effective, especially compared with the current vaccines.
"The new vaccines are expected to provide much better protection than the ones that are out right now, based on the study that has been done to date," says Robert Hopkins Jr., MD, the medical director of the National Foundation for Infectious Diseases (NFID). "We believe the shots are going to give us better defense as we go into this next year."
Even if the virus keeps mutating to evade vaccination-induced immunity, the CDC suggests that the shots will continue to protect against severe disease, hospitalization, and death. The vaccines also may reduce a person's chances of developing long COVID, a collection of symptoms that can last for months or even years after initial infection.[5]
"The vaccine's superpowers are in preventing serious disease and death," says Peter Chin-Hong, MD, an infectious disease specialist and a professor of medicine at the University of California San Francisco School of Medicine. "But there is some impact on reducing the risk of infections as well, depending on how closely matched the vaccine is to what is circulating in the community. Because the new vaccines are similar to what is in the community, you might expect to decrease the risk of infection by several weeks. Protection from serious disease may last up to a year or longer, depending on who you are."
Who Should Get the New Vaccines? The CDC advises that everyone age 6 months and older should get a 2024–2025 COVID-19 vaccine.[6]
The federal agency especially urges vaccination for those who have a higher risk of becoming very sick from the virus. This includes adults age 65 and up, who account for more than 8 in 10 COVID-related deaths, and those who have weakened immune systems from conditions such as cancer, heart conditions, diabetes, chronic lung disease, or chronic kidney disease.[7]
When it comes to serious illness, Dr. Hopkins stresses that no age group is free of risk. Federal data indicate that the group with the second highest rate of hospitalization is 50- to 64-year-olds, and children have the third highest rate.[8]
"Children didn't have as many deaths as other age groups, but they still had far more deaths from COVID than from flu, so I think it's important that everyone 6 months of age and older get vaccinated," says Hopkins.
When Should You Get Your COVID Shot?While many people may want to get immunized as soon as possible to protect against the summer COVID wave, others may prefer to get their COVID shot along with their fall flu shot for convenience. Hopkins notes that some adults may opt to wait on their flu shot until later September or early October to be more assured that protection lasts for the entire flu season, which can extend well into spring.
For people who are at higher risk of severe illness, he advises not to wait, and to get the COVID shots as soon as they become available.
Fewer Than a Quarter of U.S. Adults Got Last Year's Vaccine Recent uptake of COVID vaccines has been slow. CDC numbers show that less than a quarter of adults age 18 and older received last year's updated vaccine, and the percentage of children being inoculated was far less.[9]
Hopkins warns that these dropping vaccination rates pose a public health threat. "As long as you have the virus infecting people, you're going to continue to get mutations," he says. "Less circulation of the virus is going to reduce the development of new variants. If we have a higher vaccinated population, well, then we would at least slow the virus from mutating."
How Much Will the Vaccine Cost?Although the out-of-pocket price for a vaccine is about $130, according to Dr. Chin-Hong, the vaccine should be free for most people — covered by private insurance, Medicaid, or Medicare.
Children under the age of 18 have all vaccines covered by a federal program regardless of their ability to pay.[10]
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