2/15/12
2/14/12
Adult Immunization Schedule for 2012 Issued
Clinical Context
The Advisory Committee on Immunization Practices (ACIP) has adopted an evidence-based process modeled after GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines to evaluate the quality of evidence, harms, benefits and values, and preferences of affected populations in its recommendations for adult and pediatric immunization schedules. The preliminary recommendations are considered provisional until published in the Morbidity and Mortality Weekly Report Recommendations and Reports. Vaccine coverage mandated through the Affordable Healthcare Act should increase access to vaccines, but budget issues could delay incorporation of recommendations, especially in the private sector.
This is a summary of changes in the ACIP immunization recommendations for 2012.
Study Synopsis and Perspective
The US Centers for Disease Control (CDC)'s ACIP has issued the 2012 adult immunization schedule, published onlineJanuary 31 in the Annals of Internal Medicine. The schedule was also published simultaneously in the CDC'sMorbidity and Mortality Weekly Report Recommendations and Reports.
The new recommendations include broader recommendations for human papillomavirus (HPV) and hepatitis B virus (HBV) vaccination. In addition, the adult schedule and the child and adolescent schedules are now designed to be combined and used together.
Since October 2010, the annual ACIP review of the CDC's Recommended Adult Immunization Schedule has used an evidence-based process considering the quality of evidence, the benefits and harms, the values and preferences of affected populations, and the economic effects of the immunizations. The ACIP intends the updated schedule to reflect current clinical recommendations for licensed vaccines, and to offer guidance to healthcare practitioners regarding the appropriate vaccines for their adult patients.
Specific changes from the 2011 recommendations include the following:
- Boys aged 11 to 12 years should receive routine vaccination with quadrivalent human papillomavirus (HPV4), with catch-up vaccination for boys and men aged 13 to 21 years.
- Adults younger than 60 years who have diabetes should receive HBV vaccination as soon as possible after the diagnosis of diabetes.
- Adults aged at least 60 years who have diabetes should receive HBV vaccination based on their need for assisted blood glucose monitoring, risk for acquiring hepatitis B infection, and likelihood of immune response to HBV vaccination.
- Pregnant women should receive the tetanus, diphtheria, and acellular pertussis (Tdap) booster, preferably after 20 weeks of gestation, to protect infants from pertussis by transfer of protective maternal antibodies.
- Adults should continue to receive influenza vaccination, even if they are allergic to eggs. However, adults with egg allergy should receive inactivated influenza vaccination, because safety data are available for this vaccination in this population.
- A new footnote adds links for the full ACIP vaccine recommendations and the specific vaccine recommendations for travelers.
- A new table summarizes precautions and contraindications for vaccines.
- The influenza vaccination footnote now states that all persons at least 6 months of age can receive trivalent inactivated influenza vaccine (TIV), and that healthcare personnel (HCP) who care for persons requiring a protected environment should receive TIV. HCP younger than 50 years who have no contraindications may receive either the live attenuated influenza vaccine or TIV. This footnote also includes age indications for 2 recently licensed formulations of TIV.
- The HPV vaccination footnote now explains that HPV vaccination is not specifically recommended for HCP, but that they should receive the vaccine if they are in the recommended age group. Men aged 22 to 26 years also may be vaccinated with HPV4 vaccine.
- The zoster vaccination footnote now indicates that zoster vaccination is not specifically recommended for HCP, but that they should receive the vaccine if they are in the recommended age group. Although the FDA has approved this vaccine for use in persons at least 50 years of age, ACIP continues to recommend that vaccination begin at 60 years of age.
- The measles, mumps, rubella (MMR) vaccination footnote refers readers to the ACIP MMR recommendations, as well as to the ACIP recommendations for the immunization of HCP regarding the use of MMR vaccine in outbreak settings.
- The pneumococcal polysaccharide vaccine (PPSV) vaccination footnote now includes additional examples of functional and anatomic asplenia.
- A footnote regarding revaccination with PPSV clarifies recommendations for persons at least 65 years of age who had been vaccinated with PPSV23 at least 5 years previously.
- The meningococcal vaccination footnote now includes military recruits in the group recommended to receive a single dose of meningococcal vaccine. It also indicates that first-year college students through 21 years of age who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.
An accompanying editorial by Sandra Adamson Fryhofer, MD, from Emory University in Atlanta, Georgia, describes the rationale behind the 2012 changes and notes that the American College of Physicians has established its first Adult Immunization Technical Advisory Committee.
"The College has representation at all ACIP meetings and on many ACIP vaccine working groups," Dr. Fryhofer writes. "Vaccines are vital to ensuring our nation's health. The newly released fourth edition of the ACP Guide to Adult Immunization can help physicians incorporate and improve vaccination strategies in their own practices."
Relevant financial relationships of the ACIP and Dr. Fryhofer can be viewed on the ACP Web site.
Ann Intern Med. 2012;156:211-217, 243-245. Article full text, Editorial full text
regards, taniafdi ^_^
1/25/12
Differences in Estrogen Metabolism May Influence Breast Cancer Risk
The way a woman’s body processes, or metabolizes, the hormone estrogen may influence her risk ofpostmenopausal breast cancer, according to new data from NCI’s Division of Cancer Epidemiology and Genetics(DCEG) published online January 9 in the Journal of the National Cancer Institute.
In postmenopausal women, higher levels of estrogen are known to be associated with an increased risk of breast cancer. Laboratory work, however, has suggested that how estrogen is metabolized may also be important for risk. Two major hypotheses for the role of estrogen metabolites have dominated the field: one, that specific metabolites stimulate tumor growth and progression; and two, that specific metabolites function as mutagensand initiate DNA damage that can turn a normal cell into a cancerous one. This study confirms that estrogen metabolism is important and lends credence to both hypotheses.
“Those are the results we’re most excited about and also the most cautious about, because it’s the first time that we’ve been able to measure the relevant metabolites in blood in an epidemiologic setting,” said Dr. Barbara Fuhrman, a postdoctoral fellow with DCEG and lead author of the study. She and her colleagues used a novel liquid chromatography/mass spectrometry assay that allowed them to measure 15 different parent estrogens and estrogen metabolites accurately at the very low concentrations present in postmenopausal women.
They performed their analyses on blood samples taken from women enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Researchers compared the blood samples of 277 postmenopausal women who later developed breast cancer and 423 matched women without the disease. None of the women were taking menopausal hormone therapy at the time of blood collection.
Apart from the expected strong relationship with estradiol, the researchers found no clear relationships between individual hormone and metabolite concentrations and cancer risk. When they considered relationships among the three major estrogen metabolic pathways and their components, the clearest patterns emerged when they compared the pathways to one another and to the total pool of parent estrogens available for metabolism. Two metabolic patterns seemed to influence breast cancer risk in a statistically significant manner independent of circulating estradiol. One pattern was associated with an increased risk of breast cancer, whereas the other was associated with a decreased risk. When the researchers included a measure of each of these patterns in an established risk prediction model for breast cancer, the calculated risk for a considerable number of the women changed substantially.
“Although these findings are of great research interest, they need to be replicated and there are no immediate clinical implications,” said Dr. Regina Ziegler, also of DCEG and the senior author on the study. “We are still at the beginning of our understanding of the complex role of estrogen in the etiology of breast cancer. By improving our knowledge of the role of estrogen metabolism, we may uncover novel strategies for chemoprevention and treatment and be better able to predict an individual’s risk of breast cancer.”
http://www.cancer.gov/ncicancerbulletin/012412/page3#c
regards, taniafdi ^_^
Subscribe to:
Posts (Atom)
2/15/12
2/14/12
Adult Immunization Schedule for 2012 Issued
Clinical Context
The Advisory Committee on Immunization Practices (ACIP) has adopted an evidence-based process modeled after GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines to evaluate the quality of evidence, harms, benefits and values, and preferences of affected populations in its recommendations for adult and pediatric immunization schedules. The preliminary recommendations are considered provisional until published in the Morbidity and Mortality Weekly Report Recommendations and Reports. Vaccine coverage mandated through the Affordable Healthcare Act should increase access to vaccines, but budget issues could delay incorporation of recommendations, especially in the private sector.
This is a summary of changes in the ACIP immunization recommendations for 2012.
Study Synopsis and Perspective
The US Centers for Disease Control (CDC)'s ACIP has issued the 2012 adult immunization schedule, published onlineJanuary 31 in the Annals of Internal Medicine. The schedule was also published simultaneously in the CDC'sMorbidity and Mortality Weekly Report Recommendations and Reports.
The new recommendations include broader recommendations for human papillomavirus (HPV) and hepatitis B virus (HBV) vaccination. In addition, the adult schedule and the child and adolescent schedules are now designed to be combined and used together.
Since October 2010, the annual ACIP review of the CDC's Recommended Adult Immunization Schedule has used an evidence-based process considering the quality of evidence, the benefits and harms, the values and preferences of affected populations, and the economic effects of the immunizations. The ACIP intends the updated schedule to reflect current clinical recommendations for licensed vaccines, and to offer guidance to healthcare practitioners regarding the appropriate vaccines for their adult patients.
Specific changes from the 2011 recommendations include the following:
- Boys aged 11 to 12 years should receive routine vaccination with quadrivalent human papillomavirus (HPV4), with catch-up vaccination for boys and men aged 13 to 21 years.
- Adults younger than 60 years who have diabetes should receive HBV vaccination as soon as possible after the diagnosis of diabetes.
- Adults aged at least 60 years who have diabetes should receive HBV vaccination based on their need for assisted blood glucose monitoring, risk for acquiring hepatitis B infection, and likelihood of immune response to HBV vaccination.
- Pregnant women should receive the tetanus, diphtheria, and acellular pertussis (Tdap) booster, preferably after 20 weeks of gestation, to protect infants from pertussis by transfer of protective maternal antibodies.
- Adults should continue to receive influenza vaccination, even if they are allergic to eggs. However, adults with egg allergy should receive inactivated influenza vaccination, because safety data are available for this vaccination in this population.
- A new footnote adds links for the full ACIP vaccine recommendations and the specific vaccine recommendations for travelers.
- A new table summarizes precautions and contraindications for vaccines.
- The influenza vaccination footnote now states that all persons at least 6 months of age can receive trivalent inactivated influenza vaccine (TIV), and that healthcare personnel (HCP) who care for persons requiring a protected environment should receive TIV. HCP younger than 50 years who have no contraindications may receive either the live attenuated influenza vaccine or TIV. This footnote also includes age indications for 2 recently licensed formulations of TIV.
- The HPV vaccination footnote now explains that HPV vaccination is not specifically recommended for HCP, but that they should receive the vaccine if they are in the recommended age group. Men aged 22 to 26 years also may be vaccinated with HPV4 vaccine.
- The zoster vaccination footnote now indicates that zoster vaccination is not specifically recommended for HCP, but that they should receive the vaccine if they are in the recommended age group. Although the FDA has approved this vaccine for use in persons at least 50 years of age, ACIP continues to recommend that vaccination begin at 60 years of age.
- The measles, mumps, rubella (MMR) vaccination footnote refers readers to the ACIP MMR recommendations, as well as to the ACIP recommendations for the immunization of HCP regarding the use of MMR vaccine in outbreak settings.
- The pneumococcal polysaccharide vaccine (PPSV) vaccination footnote now includes additional examples of functional and anatomic asplenia.
- A footnote regarding revaccination with PPSV clarifies recommendations for persons at least 65 years of age who had been vaccinated with PPSV23 at least 5 years previously.
- The meningococcal vaccination footnote now includes military recruits in the group recommended to receive a single dose of meningococcal vaccine. It also indicates that first-year college students through 21 years of age who are living in residence halls should be vaccinated if they have not received a dose on or after their 16th birthday.
An accompanying editorial by Sandra Adamson Fryhofer, MD, from Emory University in Atlanta, Georgia, describes the rationale behind the 2012 changes and notes that the American College of Physicians has established its first Adult Immunization Technical Advisory Committee.
"The College has representation at all ACIP meetings and on many ACIP vaccine working groups," Dr. Fryhofer writes. "Vaccines are vital to ensuring our nation's health. The newly released fourth edition of the ACP Guide to Adult Immunization can help physicians incorporate and improve vaccination strategies in their own practices."
Relevant financial relationships of the ACIP and Dr. Fryhofer can be viewed on the ACP Web site.
Ann Intern Med. 2012;156:211-217, 243-245. Article full text, Editorial full text
regards, taniafdi ^_^
1/25/12
Differences in Estrogen Metabolism May Influence Breast Cancer Risk
The way a woman’s body processes, or metabolizes, the hormone estrogen may influence her risk ofpostmenopausal breast cancer, according to new data from NCI’s Division of Cancer Epidemiology and Genetics(DCEG) published online January 9 in the Journal of the National Cancer Institute.
In postmenopausal women, higher levels of estrogen are known to be associated with an increased risk of breast cancer. Laboratory work, however, has suggested that how estrogen is metabolized may also be important for risk. Two major hypotheses for the role of estrogen metabolites have dominated the field: one, that specific metabolites stimulate tumor growth and progression; and two, that specific metabolites function as mutagensand initiate DNA damage that can turn a normal cell into a cancerous one. This study confirms that estrogen metabolism is important and lends credence to both hypotheses.
“Those are the results we’re most excited about and also the most cautious about, because it’s the first time that we’ve been able to measure the relevant metabolites in blood in an epidemiologic setting,” said Dr. Barbara Fuhrman, a postdoctoral fellow with DCEG and lead author of the study. She and her colleagues used a novel liquid chromatography/mass spectrometry assay that allowed them to measure 15 different parent estrogens and estrogen metabolites accurately at the very low concentrations present in postmenopausal women.
They performed their analyses on blood samples taken from women enrolled in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Researchers compared the blood samples of 277 postmenopausal women who later developed breast cancer and 423 matched women without the disease. None of the women were taking menopausal hormone therapy at the time of blood collection.
Apart from the expected strong relationship with estradiol, the researchers found no clear relationships between individual hormone and metabolite concentrations and cancer risk. When they considered relationships among the three major estrogen metabolic pathways and their components, the clearest patterns emerged when they compared the pathways to one another and to the total pool of parent estrogens available for metabolism. Two metabolic patterns seemed to influence breast cancer risk in a statistically significant manner independent of circulating estradiol. One pattern was associated with an increased risk of breast cancer, whereas the other was associated with a decreased risk. When the researchers included a measure of each of these patterns in an established risk prediction model for breast cancer, the calculated risk for a considerable number of the women changed substantially.
“Although these findings are of great research interest, they need to be replicated and there are no immediate clinical implications,” said Dr. Regina Ziegler, also of DCEG and the senior author on the study. “We are still at the beginning of our understanding of the complex role of estrogen in the etiology of breast cancer. By improving our knowledge of the role of estrogen metabolism, we may uncover novel strategies for chemoprevention and treatment and be better able to predict an individual’s risk of breast cancer.”
http://www.cancer.gov/ncicancerbulletin/012412/page3#c
regards, taniafdi ^_^
Subscribe to:
Posts (Atom)