At the Montgomery County Pediatric Society's first meeting of the year this past week, Dr. Kirsten Hawkins, chief of adolescent medicine and residency program director at Georgetown University, presented a very engaging discussion on hot topics in adolescent health. Of course I was particularly drawn to her mention of adolescent immunization and thought I'd expand a bit on some of the points she mentioned.
First, a bit of encouragement about successes with human papillomavirus (HPV) vaccine down under. A recent computer modeling study estimated dramatic decreases in cervical cancer rates in Australia related to high vaccine uptake and screening programs in that country. In 2016 it was estimated that just over 78% of 15 year-old girls and 72% of boys had received the full course of 3 doses of quadrivalent vaccine. (Subsequently recommendations changed to a 2-dose regimen with the nonavalent vaccine.) Mathematical modeling presented in the article predicts that fewer than 4 per 100,000 Australian women will be diagnosed with cervical cancer annually by the year 2028, a threshold below what is generally accepted as a "rare" cancer. Contrast that with rates for US teenagers, where a little under 50% were fully immunized against HPV.
Dr. Hawkins also mentioned the meningococcal B vaccine, including a key point that meningococcal epidemiology differs significantly by country. In particular, group B meningococcal disease is much more common in the United Kingdom compared to the US, so meningococcal B vaccine is more cost effective in that country compared to the US. (Keep that in mind if any of your adolescent patients attend college in the UK.)
Certainly adolescents attending college in the US are at somewhat higher risk for group B meningococcal disease than are US adolescents not attending college, but the risk is still so low that universal meningococcal B immunization is not cost-effective. Also weighing into this equation is that not all meningococcal B strains are the same, and meningococcal B vaccines have varying abilities to protect against infection with different bacterial strains. So, meningococcal B vaccines are an option for healthy adolescents, but universal meningococcal B immunization is unlikely to significantly alter the epidemiology of this disease. Remember that the 2 meningococcal vaccines are not interchangeable, once a child has been immunized with 1 product you must use the same product to complete the full vaccine series. Take this opportunity to review the CDC's resources on the topic.