The Advisory Committee on Immunization Practices (ACIP) holds three meetings each year at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia to review scientific data and vote on vaccine recommendations.
Topics at the ACIP June 2019 meeting, held on June 26 and 27, included:
9vHPV Immunogenicity and Safety Trial in Mid-Adult Females
Overview of Health Economic Models for HPV Vaccination of Mid-Adults
HPV Vaccines Evidence to Recommendations (EtR) Framework
HPV Vaccines Work Group Considerations and Proposed Policy Options
Considerations for PCV13 use among adults 65 years or older and summary of the Evidence to Recommendations (EtR) Framework Proposed policy options
Combination Vaccines – Summary and Relevant Evidence to Recommendation Information
Update: Safety Monitoring and Surveillance for Recombinant Zoster Vaccine (RZV)
Herpes Zoster Work Group Summary
Pertussis Vaccines EtR Framework, Work Group Considerations and Proposed Policy Options
2018-19 U.S. Influenza Activity
2018-19 Influenza Vaccine Effectiveness
2018-19 Influenza Vaccine Safety
Influenza Vaccine Proposed Recommendations for 2019-20
Proposed Recommendations for Use of Hepatitis A
Dengue Epidemiology in the U.S.
Dengvaxia Phase III Clinical Trials and Long Term Follow Up
Dengue Vaccine Work Group Considerations and Next Steps
Specifically, there is a risk for severe infections from the Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.
Fortunately, there are vaccines that protect against many subtypes of these bacteria, including:
Hib – protects against Haemophilus influenzae type B
Meningococcal conjugate vaccines – Menactra or Menveo, which protect against 4 common types of the Neisseria meningitidis bacteria – serogroups ACWY
Serogroup B Meningococcal vaccines – Bexsero or Trunemba, which protect against Neisseria meningitidis serogroup B
Prevnar 13 – protects against 13 subtypes of Streptococcus pneumoniae
Pneumovax 23 – protects against 23 subtypes of Streptococcus pneumoniae
Although Prevnar, Hib, and the meningococcal vaccines (Menactra or Menveo and Bexsero or Trunemba) are part of the routine immunization schedule, there are additional recommendations that can change the timing for when kids get them if they have asplenia.
According to the latest recommendations, in addition to all of the other routine immunizations that they should get according to schedule, children with asplenia should get:
one dose of the Hib vaccine if they are older than age 5 years “who are asplenic or who are scheduled for an elective splenectomy” and have not already vaccinated against Hib. Unvaccinated younger kids should get caught up as soon as possible. In general though, Hib is given according to the standard immunization schedule. This recommendation is about kids who are behind on the shot.
two doses of a meningococcal conjugate vaccine, either Menactra or Menveo, two months apart once a child with asplenia is at least two years old and a booster dose every five years. Infants with asplenia can instead get a primary series of Menveo at 2, 4, 6, and 12 months, with a first booster dose after three years, and a second booster after another five years. Older infants can get Menactra at 9 and 12 months, again, with a first booster dose after three years, and a second booster after another five years. While these vaccines are recommended for all kids, those with asplenia get them much earlier than the standard age.
either a two dose series of Bexsero or a three dose series of Trunemba, once they are at least 10 years old. The Men B vaccines are only formally recommended for high risk kids, others can get it if they want to be protected.
between one to four doses of Prevnar, depending on how old they are when they start and complete the series. Keep in mind that unlike healthy children who do not routinely get Prevnar after they are 5 years old, older children with asplenia can get a single dose of Prevnar up to age 65 years if they have never had it before. Like Hib, this recommendation is about kids who are behind on the shot.
a dose of Pneumovax 23 once they are at least two years old, with a repeat dose five years later and a maximum of two total doses. Kids who are not high risk typically don’t get this vaccine.
Ideally, children would get these vaccines at least two to three weeks before they were going to get a planned splenectomy. Of course, that isn’t always possible in the case of the emergency removal of a child’s spleen, in which case they should get the vaccines as soon as they can.
More About Asplenia
In addition to these vaccines, preventative antibiotics are typically given once a child’s spleen is removed or is no longer working well. Although there are no definitive guidelines for all children who have had a splenectomy, many experts recommend daily antibiotics (usually penicillin or amoxicillin) until a child is at least 5 years old and for at least 1 year after their splenectomy.
Other less common bacteria that can be a risk for children with asplenia can include Escherichia coli, Staphylococcus aureus, Salmonella species, Klebsiella species, and Pseudomonas aeruginosa. Vaccines aren’t yet available for these bacteria, so you might take other precautions, such as avoiding pet reptiles, which can put kids at risk for Salmonella infections.
Children with asplenia are at increased risk for severe malaria and babesiosis (a tickborne illness) infections. That makes it important to take malaria preventative medications and avoid mosquitoes if traveling to places that have high rates of malaria and to do daily tick checks when camping, etc.
A medical alert type bracelet, indicating that your child has had his spleen removed, can be a good idea in case he ends up in the emergency room with a fever and doctors don’t know his medical history.
Keep in mind that since there are many different causes of asplenia, the specific treatment plan for your child may be a little different than that described here. Talk to your pediatrician and any pediatric specialists that your child sees.
What to Know about Vaccines for Children with Asplenia
Children with asplenia typically need extra vaccines and protection against pneumococcal disease, Hib, and meningococcal disease.
Meningitis is classically defined as an inflammation of the membranes that cover the brain and spinal cord, and it can be caused by:
viruses – also called aseptic meningitis, it can be caused by enteroviruses, measles, mumps, and herpes, etc.
bacteria – Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenzae type b (Hib), Group B strep
a fungus – Cryptococcus, Histoplasma
parasites – uncommon
amebas – Naegleria fowleri
Surprisingly, there are even non-infectious causes of meningitis. These might be include side-effects of a medication or that the child’s meningitis is a part of another systemic illness.
What to Do If Your Child Is Exposed to Meningitis
While meningitis can be contagious, it greatly depends on the type of meningitis to which they are exposed as to whether or not your child is at any risk.
So while the general advice is to “tell your doctor if you think you have been exposed to someone with meningitis,” you should try and gather as much information as you can about the exposure.
This information will hopefully include the type of meningitis they were exposed to, specifically if it was bacterial or viral, the exact organism if it has been identified, and how close of an exposure it was – were they simply in the same school or actually sitting next to each other in the same room.
For example, while the CDC states that “people who are close contacts of a person with meningococcal or Haemophilus influenzae type b (Hib) meningitis are at increased risk of getting infected and may need preventive antibiotics,” they also state that “close contacts of a person with meningitis caused by other bacteria, such as Streptococcus pneumoniae, do not need antibiotics.”
And you often don’t need to take any preventive measures if you are exposed to someone with viral meningitis.
While that might sound scary, it is basically because you typically aren’t at big risk after this kind of exposure. You could get the same virus, but the chances that it would spread and also cause meningitis are very unlikely.
Other types of meningitis, like primary amebic meningoencephalitis (PAM) and fungal and parasitic meningitis aren’t even contagious.
The Histoplasma fungus spreads from bird or bat droppings, for example, not from one person to another.
And parasites typically spread from ingesting raw or undercooked food, or in the case of Baylisascaris procyonis, from ingesting something contaminated with infectious parasite eggs in raccoon feces.
What to Do If Your Unvaccinated Child Is Exposed to Meningitis
Vaccines can prevent a number of different types of meningitis.
You should immediately call your pediatrician or local healthy department, because they might need:
antibiotics (usually rifampin, ciprofloxacin, or ceftriaxone) if the meningitis was caused by Neisseria meningitidis
antibiotics (rifampin) if the meningitis was caused by Haemophilus influenzae type b (Hib)
The availability of these antibiotics isn’t a good reason to skip or delay getting vaccinated though, as you won’t always know when your kids have been exposed to meningitis and not all types of vaccine-preventable meningitis can be prevented with antibiotics.
Of course, getting fully vaccinated on time is the best way to prevent many of these types of meningitis and other life-threatening diseases.
What to Do If Your Vaccinated Child Is Exposed to Meningitis
Even if your child is vaccinated, they might still need preventative antibiotics if they are exposed to someone with Hib or meningococcal meningitis, as vaccines are not 100% effective.
“Regardless of immunization status, close contacts of all people with invasive meningococcal disease , whether endemic or in an outbreak situation, are at high risk of infection and should receive chemoprophylaxis.”
AAP Red Book on Meningococcal Infections
This is especially true if they are not fully vaccinated.
Remember, to be fully vaccinated against Haemophilus influenzae type b, kids get a 2 or 3 dose primary series of the Hib vaccine when they are infants and a booster dose once they are 12 months old.
In the case of exposure to Hib meningitis, antibiotic prophylaxis would be recommended if:
the child is fully vaccinated, but there is a young child, under age 4 years, in the house who is unvaccinated or only partially vaccinated
the child is fully vaccinated, but there is another child in the house who is immunocompromised
the child is only partially vaccinated and under age 4 years
there is an outbreak in a preschool or daycare, with 2 or more cases within 60 days
And anyone exposed to someone with meningococcal meningitis should likely get antibiotics (chemoprophylaxis), even if they are fully vaccinated.
Talk to your pediatrician or local health department if your child is exposed to meningitis and you aren’t sure what to do, whether or not your child has been vaccinated.
What to Know About Getting Exposed to Meningitis
Learn what to do if your child is exposed to someone with meningitis, especially if they are unvaccinated, or have been exposed to someone with Hib meningitis or meningococcal disease.
And even after a vaccine is added to the immunization schedule and it is given together with other vaccines, our post-licensure vaccine safety monitoring systems, from VAERS to the Vaccine Safety Datalink, kick in to make sure that they are indeed safe and effective.
The Myth That Vaccines Aren’t Tested Together
If it is clear that vaccines are in fact tested together, then why do some folks still believe that they aren’t?
Hopefully everyone sees the irony in Dr. Bob saying something about vaccines being untested, as he is infamous for pushing his own made up and completely untested alternative vaccine schedule.
“Babies get as many as 6 or 7 vaccines altogether…and the CDC is admitting that they don’t always research them that way.”
Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?
When did they admit that???
“We’ve researched the flu vaccine in great detail and it seems safe when it’s given alone, but the CDC has never researched the flu vaccine when you give it in conjunction with all the other infant shots…and that’s what we’re worried about. ”
Dr. Bob Sears on Fox & Friends Vaccines: A Bad Combination?
So, what about the flu vaccine?
While most kids get their flu vaccine by itself, just before the beginning of flu season, some might get it when they see their pediatrician for a regular checkup, at the same time they are due for other vaccines.
Not surprisingly, Dr. Bob was wrong, and several studies have shown that the flu vaccine can be safely given with other vaccines.
And don’t forget, any problems with co-administration of vaccines would show up in post-licensure vaccine safety testing.
That’s how a very small increased risk of febrile seizures was found during the 2010-11 flu season in toddlers who received either DTaP or Prevnar and a flu shot at the same time.
The very small extra risk doesn’t mean that you still can’t get the vaccines at the same time if your child needs them all though. Remember that febrile seizures “are temporary and do not cause any lasting damage.”
It will be even more reassuring to some parents that another study “examined risk of febrile seizures (FS) after trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) during the 2010-2011 influenza season, adjusted for concomitant diphtheria tetanus acellular pertussis-containing vaccines (DTaP)” and found no extra risk for febrile seizures.
“Vaccines can generally be co-administered (i.e. more than one vaccine given at different sites during the same visit). Recommendations that explicitly endorse co-administration are indicated in the table, however, lack of an explicit co-administration recommendation does not imply that the vaccine cannot be co-administered; further, there are no recommendations against co-administration.”
Summary of WHO Position Papers – Recommendations for Routine Immunization
Also remember that “there are no recommendations against co-administration of vaccines,” unless of course, you are getting your advice from Bob Sears…
What To Know About Vaccines Being Tested Together
Vaccines are thoroughly tested for both safety and efficacy and they are also tested in many of the different combinations on the routine childhood immunization schedule.