Monthly Archives: February 2017

Healthcare Data Breaches Up 40% Since 2015

Watch out for ‘spear phishing’
• by Alexandria Wilson Pecci
HealthLeaders Media February 26, 2017
When a U.S. Attorney called South Florida “an epicenter of identity theft” last month, it was in the context of announcing federal charges against more than 100 suspected fraudsters.
One of them was a former Jackson Health System employee accused of accessing the health system’s computer databases to steal patient data. The rogue employee, a former secretary, was accused of pilfering the Social Security numbers of more than 24,000 people over the course of five years. She was placed on administrative leave in 2016.
But the Miami-based safety net health system is certainly not alone in experiencing data breaches. According to a report from the Identity Theft Resource Center, the healthcare/medical industry experienced 377 reported data breach incidents in 2016, behind only the business sector in the number of incidents.
The healthcare industry represented 34.5% of the overall total number of breaches among the five industries tracked in the report.
The total number of breaches among the five industries included in the report is now at an all-time high. But ITRC experts said in a statement that it’s hard to tell whether there are actually more breaches each year or simply more reporting of breaches. In total, there were 1,093 reported data breaches in 2016. In 2015 there were 780 — a 40% increase.
More than a decade of ITRC data shows that there were significantly more healthcare data breaches in 2016 than there were in 2005, when the data showed only 16. That number has grown steadily in the years since.
Laws are “always behind,” with the latest techniques used to steal data, said Karen A. Barney, director of research and publications at the Identity Theft Resource Center. “In general, privacy laws typically seem to not necessarily keep pace.”
But some industries are better than others at deterring theft. The banking and financial sectors are better than the medical industry, Barney noted.
The proof is in the numbers. In 2005, the banking/credit/financial industry had more data breaches than the medical/health industry. But by 2016, it had 52 breaches, compared to the health industry’s 377, and accounted for just 4.8% of total breaches.
“There’s a great need for corporate protocols and best practices to be in place,” Barney said.
There have also been changes in how the breaches are occurring. Among the five industries in 2016, hacking/skimming/phishing accounted for 55.5% of total data breaches, compared to 14.1% in 2007.
Hacking, Physical Theft Dominate Healthcare Breaches
Broken down by industry, hacking was the most common data breach source for the healthcare sector, according to data provided to HealthLeaders Media by the Identity Theft Resource Center. Physical theft was the biggest breach category for healthcare in 2015 and 2014.
Insider theft and employee error/negligence tied for the second most common data breach sources in 2016 in the health industry. In addition, insider theft was a bigger problem in the healthcare sector than in other industries, and has been for the past five years.
Insider theft is alleged to have been at play in the Jackson Health System incident. Former employee Evelina Sophia Reid was charged in a fourteen-count indictment with conspiracy to commit access device fraud, possessing fifteen or more unauthorized access devices, aggravated identity theft, and computer fraud, the Department of Justice said. Prosecutors say that her co-conspirators used the stolen information to file fraudulent tax returns in the patients’ names.
What’s the next data breach tactic for the healthcare industry to be aware of? According to Barney, it’s “spear phishing,” a scheme involving email that purports to be from company executives and requests personal information on employees.
The IRS noted a “400% surge in phishing and malware incidents so far this tax season and other reports of scams targeting others in a wider tax community” in a March 2016 warning to payroll and human resource professionals, she said.
“They pretend to be someone in authority,” Barney said, and trick employees into giving things like Social Security numbers and W2 forms. “It’s providing the thief with anything and everything they need to commit tax fraud.”
This report is brought to you by HealthLeaders Media.

FDA Clears ‘Painless’ Blood Draw

Push-button device collects 100 μL of blood from upper arm
• by Kristen Monaco
Contributing Writer, MedPage Today February 27, 2017
• This article is a collaboration between MedPage Today® and:
WASHINGTON — A push-button blood collection device billed as “virtually painless” received initial FDA 510(k) clearance late last week.
The device, called TAP and sold by Seventh Sense Biosystems, is cleared for use by healthcare workers for testing HbA1c levels in patients with diabetes and prediabetes. However, a company official said that, in practice, it could be used for other types of tests.
“It’s fairly common industry practice for labs to use products under CLIA guidelines as long as they do their own validation testing, i.e., for different tests. But that’s up to them,” said Stuart Blitz, Seventh Sense’s chief business officer, in an email to MedPage Today.
A notable feature of the device is that it collects only 100 μL of capillary blood, whereas 3-7 mL are typical of standard blood tubes.
Joana Velasquez, MS, RN, CNOR, of the Phillips School of Nursing at Mount Sinai in New York City, suggested that the TAP device would not be appropriate for at least some applications. “On the usual blood collection devices, we use multiple tubes for various tests. How will that work for this device?”
Donald R. Von Hagen, vice president of corporate communications for the giant diagnostic testing firm LabCorp told MedPage Today in an email, “Various testing platforms have different specimen volume requirements that can be explored for potential applications using TAP. We see promise for TAP in the appropriate setting and for certain tests.”
Attached to the upper arm through vacuum pressure, the single-use device draws blood through an array of fine needles concealed from the patient. The drawn blood is held internally within the device until laboratory analysis. The device uses lithium heparin as its anticoagulant, which may also limit the range of potential diagnostic testing.
The company hopes to widen the usage and clinical applicability of technology in the near future, looking to expand into the space of at-home collection and ability for other diagnostic testing.
“Now that we are cleared, we’re working on new versions which will expand the test menu, as well as add-on accessories to increase stability and transport. We also intend to go back and get an ‘at home’ claim to enable patients to use TAP on their own,” Blitz explained via email.
Although many technical questions regarding TAP remain, such as how to safeguard against spillage or contamination of the specimen, Velasquez did see the new device filling an unmet gap in the market.
“We do numerous phlebotomies in both inpatient and outpatient settings. I believe that it will be widely applicable. An in-service [training] to all endpoint users will be beneficial,” she told MedPage Today.

Should Dentists Screen for Diabetes?

Link to gum disease suggests that it would flag patients otherwise undiagnosed
• by Jeff Minerd
Contributing Writer, MedPage Today February 22, 2017
• This article is a collaboration between MedPage Today® and:
Action Points

• Patients with mild-to-severe periodontitis had significantly higher mean HbA1c values than a control group without periodontitis; using the American Diabetes Association (ADA) cutoff of 6.5%, diabetes was identified in 23% of patients with severe periodontitis, 14% with moderate/mild periodontitis, and 10% of control patients without gum disease.
• Note that the data suggest that a dental office treating patients with severe periodontitis is suitable for screening for (pre)diabetes and diabetes, and a considerable number of suspected new cases can be identified, indicating that periodontitis can be an early sign of diabetes mellitus.
Screening periodontitis patients in the dentist’s office with a glycated hemoglobin (HbA1c) test may help identify undiagnosed cases of diabetes and prediabetes, according to a Dutch study.
Patients with severe periodontitis had significantly higher mean HbA1c values compared with a control group without periodontitis (6.3% ± 1.3% versus 5.7% + 0.7%; P=0.003). The mean HbA1c of patients with moderate/mild periodontitis was also significantly higher (6.1% ± 1.4%; P=0.003), reported Bruno Loos, MSc, of the University of Amsterdam in the Netherlands, and colleagues.
Using the American Diabetes Association (ADA) cutoff of 6.5%, the researchers identified diabetes in 23% of the patients with severe periodontitis, 14% of those with moderate/mild periodontitis, and 10% of control patients without gum disease (P=0.01 for comparison), according to the study in BMJ Open Diabetes Research and Care.
After adjusting for patients with a diagnosis of diabetes, the team found undiagnosed diabetes in 18.1% of the severe periodontitis group, 9.9% of the moderate/mild group, and 8.5% of the control group (P=0.024 for comparison).
When the ADA definition of prediabetes was used (HbA1c of 5.7%-6.4%), prediabetes was identified in 47% of the severe periodontitis group, 46% of the moderate/mild group, and 37% of the control group (P=0.01).
“The early identification of subjects at high risk for (pre)diabetes mellitus or with undiagnosed diabetes mellitus is crucial to implement measures that may prevent or delay progression from pre-diabetes to overt diabetes mellitus and reduce the incidence of chronic complications,” Loos and colleagues wrote. “Here, we show that periodontitis is an early sign of diabetes mellitus and may therefore serve as a valuable risk indicator.
“A dental office that treats patients with periodontitis is a suitable location for screening for diabetes by a simple finger stick and validated HbA1c dry spot analysis.”
However, one expert not involved with the study was not entirely convinced by the findings: “This method of screening has never been validated, and this method of measuring HbA1c is not standardized in the way blood tests are rigorously validated,” Vivian Fonseca, MD, chief of the Section of Endocrinology at Tulane University in New Orleans, said in an email to MedPage Today, when asked for his opinion.
“Screening of the whole population may not be cost effective, so targeted screening of high-risk populations is recommended. Patients with periodontitis do not necessarily fall into that category unless they have other features that make them high risk,” said Fonseca, acting as a spokesperson for the American Association of Clinical Endocrinologists (AACE).
The study included 313 adult participants seen at a university dental clinic. Of these, 78 had severe periodontitis, 126 had moderate/mild periodontitis, and 109 did not have periodontitis and served as the control group. The investigators measured HbA1c values by laboratory analysis of dry blood spots. Blood was collected by finger stick and spotted on Whatman 903 paper collection cards. The cards were mailed to a laboratory, where HbA1c was measured on an Abbott ci8200 clinical chemistry analyzer.
The main outcome measures of the study were differences in HbA1c values and the prevalence of diabetes and prediabetes in the periodontitis groups versus the control group.
The investigators also measured the height and weight of the participants. The mean body-mass index was significantly higher in patients with periodontitis versus controls (27 versus 24.9; P=0.008).
When the higher cutoff HbA1c of 7% was used to identify cases of diabetes, the team found a trend that bordered on significance: 12.8% in the severe periodontitis group, 7.1% in the moderate/mild group, and 3.7% in the control group (P=0.061).
“The early diagnosis and intervention of (pre)diabetes prevent the common microvascular and macrovascular complications and are cost-effective. In addition, it can be suggested that the early diagnosis and treatment of (pre)diabetes may also benefit the treatment of periodontitis,” Loos and colleagues concluded.
“A dental office that treats patients with severe periodontitis is a suitable location for screening for (pre)diabetes; a considerable number of suspected new diabetes cases were identified and indicated that periodontitis is an early sign of diabetes mellitus.”

iMedical Apps: CoherentRx for Asthma Patient Education

• by Douglas Maurer DO, MPH
February 21, 2017
Asthma is one of the most common chronic conditions in children and adults with a prevalence of over 8% in U.S. children and 7% in adults. This translates to over 7 million children in the U.S. who have asthma and over 26 million people total. In 2007, the National Heart, Lung and Blood Institute (NHLBI) released an Expert Panel Report-3 for the management of asthma. These guidelines are still in effect with minor updates over the years. More recent guidelines are available from the Global Initiative for Asthma (GINA). Both guidelines have similar recommendations including use of asthma action plans, for example.
Many providers struggle to get patients to adhere to asthma guidelines. In a busy practice, taking the time to educate patients on proper inhaler use and the importance of compliance with daily maintenance therapy can be challenging. Previously, we reviewed the American Academy of Pediatrics (AAP) Asthma Care App and found it potentially useful for improving compliance with asthma guidelines. However, like many other AAP apps, Asthma Care had its shortcomings.
CoherentRx has launched their latest patient education app focused on asthma. The company has numerous patient education apps from physical therapy to breast health. Their new Asthma Patient Education app combines patient education materials from reputable groups including the Asthma and Allergy Foundation of America, the CDC, and the Environmental Protection Agency, among others. The medical app also includes a unique 3D anatomy feature that providers can make notes on and share with patients.
Let’s take a look at the CoherentRx Asthma Patient Education app via a patient scenario. You are seeing John, a 10-year-old male with moderate persistent asthma, in clinic with his mother. John recently had an asthma exacerbation, and it is clear to you that the family lacked an asthma action plan and John is unclear on how to use his inhaler. His mother also has many questions on how to decrease asthma triggers at home.
Evidence-based medicine
The medical app includes resources from reputable national and international groups such as the NHLBI and CDC. The resources are available in multiple languages and various media and cover evidence-based topics including proper inhaler use, allergen reduction, and asthma action plans.
What providers would benefit from this Medical App?
Students, residents, mid-levels, family medicine, internal medicine, emergency medicine, pulmonary — any provider who prescribes or manages patients with asthma.
• High-quality patient education materials from reputable sources
• Easy share function via email and text to patients
• Zygote 3D anatomy feature has lots of potential
• Available for Android
• Interface lacking in some ease-of-use functions
• Some concerns about patient privacy/data protection
• Requires membership to the CoherentRx system which is free but unclear how provider information may be used/shared
The CoherentRx medical app is onto something with their lineup of patient education apps. The quality of the education materials is outstanding and easy to share with patients. The resources in their asthma education app may very well keep patients out of the ER and hospital.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government.

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Everyday Exposure to EM Fields Can Disrupt Pacemakers

Lower sensitivity and bipolar sensing recommended
• by Nicole Lou
Reporter, MedPage Today/ February 27, 2017
Like implantable cardioverter-defibrillators (ICDs) before them, pacemakers were found to be susceptible to interference from electromagnetic fields emitted from personal electronics, household appliances, and power lines, German researchers reported.
In the study by Andreas Napp, MD, of RWTH Aachen University in Germany, and colleagues, 119 individuals with pacemakers were subjected to stepwise increases in electromagnetic exposure. Exposure was tested under worst-case scenario conditions: whole-body exposure, maximal inspiration, and sustained pacing. Interference was defined as sensing failure (over- or under-sensing) by the pacemaker.
Emissions from an electric drill would have interfered with 61% and 16% of pacemakers at maximal and nominal sensitivity, respectively, according to the research letter in the Feb. 28 issue of Circulation.
Additionally, American limits for daily exposure to electromagnetic radiation would have interfered with 34% and 4.4% of pacemakers at maximal and nominal sensitivity, respectively.
“To protect patients from electromagnetic interference, adjusting pacemaker settings to a lower sensitivity, bipolar sensing, and keeping at a distance from electromagnetic field sources are effective measures. The field strength decreases at least by half if the distance is doubled. Further actions to reduce susceptibility (e.g., programming to VVI mode and improved lead placement) might be necessary in selected patients exposed to strong electromagnetic fields in occupational environments,” the authors suggested.
Among the majority of participants that had bipolar leads with bipolar sensing (n=114), 71.9% and 36.0% had sensing failures within the study limits of electromagnetic exposure when devices were programmed at maximum and nominal sensitivity, respectively. All 5 unipolar leads showed signs of interference over the study.

Time to Stand Against the No-Sitting Hysteria? (CNN)

After adjusting for other risk factors, sitting per se appears benign
• by MedPage Today Staff
February 21, 2017
Chances are good you’ve heard, “Sitting is the new smoking.” The catchy phrase has spurred many office workers to stand at their desks. However, the evidence for it looks increasingly shaky, a report on CNN indicated.
In one recent study published in The BMJ , researchers analyzed data from 4,811 British government workers over 13 years to investigate whether jobs involving sitting made a difference in diabetes risk. After adjusting for obesity, physical activity, and other risk factors for diabetes, sitting was not connected with development of diabetes.
Along with other studies, the research suggests that sitting, in and of itself, is not particularly unhealthy. “One possible explanation for the weak links between sitting and diabetes we observed is that participants were protected by their high levels of [overall] physical activity,” said lead researcher Emmanuel Stamatakis.

ACP: Non-Drug Tx Preferred for Low Back Pain – Try exercise, mindfulness, acupuncture or yoga before NSAIDs

by Nicole Lou
Reporter, MedPage Today/ February 13, 2017

For patients with low back pain, providers should consider alternatives to drugs as first-line therapy, according to an updated clinical practice guideline from the American College of Physicians (ACP).
Moderate-quality evidence in the literature shows that chronic pain can be eased with exercise, multidisciplinary rehabilitation, acupuncture, and mindful stress reduction, according to Amir Qaseem, MD, PhD, MHA, and colleagues on the ACP’s Clinical Guidelines Committee, writing online in the Annals of Internal Medicine..
Similar results have been observed in lower-quality studies with tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, laser therapy, operant therapy, cognitive behavioral therapy, and spinal manipulation, the panel determined.
If these fail to ease chronic pain, nonsteroidal anti-inflammatory drugs (NSAIDs) may then be a reasonable choice.
Qaseem and colleagues reviewed 114 studies of non-pharmacologic treatments as well as 46 studies on pharmacologic therapies.
In a change from the ACP’s previous recommendations from 2007, acetaminophen (Tylenol) was no longer deemed effective for acute pain due to new evidence.
Duloxetine (Cymbalta) had modest effects for chronic pain and could be considered in the case of an inadequate response to NSAIDs; the opioid tramadol (Ultram) was yet another option.
However, “clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients,” according to the guideline.
Acute or subacute low back pain is expected to improve over time regardless of treatment, Qaseem’s group wrote, again strongly recommending non-pharmacologic treatments such as acupuncture, heat packs, and massage. When it comes to drugs, the ACP committee added, NSAIDs and skeletal muscle relaxants should be the go-to therapies.
The updated guideline was welcomed by Natalia E. Morone, MD, MS, of University of Pittsburgh School of Medicine, who was not involved in the review.
“It is practice-changing in that clinicians do not routinely refer to complementary and integrative therapies such as mindfulness because up to now there were no studies to base their recommendations on,” she told MedPage Today in an email.
“With these updated guidelines, clinicians now have a menu of evidence-based non-pharmacologic treatments to offer their patients. Hopefully, insurance providers will now pay for effective therapies such as acupuncture and mindfulness-based therapies.”
In line with that sentiment, an editorial accompanying the updated ACP guideline highlighted two problems with prioritizing alternative treatments for low back pain: their limited availability and affordability.
“Moreover, these updated reviews and recommendations do not focus on diagnostic tests, such as magnetic resonance imaging, and invasive therapies, such as injections and surgery, which are major drivers of healthcare spending for low back pain,” wrote Steven J. Atlas, MD, MPH, of Boston’s Massachusetts General Hospital.
In fact, despite the large number of studies included in the reviews, Atlas argued that the evidence base for all treatments remains shaky.
“Likely what is needed is an ‘all of the above’ approach,” he wrote. He called for “more pragmatic trials to evaluate proven therapies and their combinations in real-world settings; efforts to reduce the use of low-value services, such as payer coverage policies based on guideline recommendations; patient engagement through shared decision making; and pressure on insurers to cover non-pharmacologic, non-invasive therapies that have shown benefit.”

David Shulkin wins bipartisan approval, confirmed as VA secretary

by Ilene MacDonald | FierceHealth
Feb 14, 2017 11:16am
The Senate Monday night unanimously voted to confirm David Shulkin, M.D., as secretary of Veterans Affairs.
In a rare display of bipartisan support for one of President Donald Trump’s cabinet members, the Senate voted 100-0 in favor of his confirmation.
Shulkin served as the Department of Veterans Affairs Undersecretary for Health prior to his confirmation. An internist, Shulkin previously held many chief executive roles, including president of Morristown Medical Center, Goryeb Children’s Hospital, Atlantic Rehabilitation Institute and the Atlantic Health System Accountable Care Organization. He was also the president and CEO of Beth Israel Medical Center in New York City.
He faces a big challenge in his new role. The VA is still reeling from a nationwide scandal involving secret lists that covered up long wait times for veterans seeking care. During his confirmation hearing, Shulkin said that “the Department of Veterans Affairs will not be privatized under my watch,” and he supported an integrated system of care that takes the best of the VA and the best of the community.
Shulkin is the first nonveteran to head the agency. In his new role, he will oversee approximately 370,000 employees and an annual budget of nearly $167 billion, according to the Associated Press.
Despite his nonmilitary background, The American Legion and Veterans of Foreign Wars were among the national veterans organizations that supported his nomination, according to Military Times. The publication reports that in a letter to the Senate, the organizations wrote that Shulkin “has led the Veterans Health Administration through a difficult transition period by installing new leadership and implementing new reform plans to improve access and quality of care. Once confirmed as secretary, we are confident (Shulkin) will continue moving VA forward so that it can better meet the needs of America’s veterans, their families and survivors.”

The importance of shared decision-making in the ER

by Ilene MacDonald | FierceHealthcare
Feb 7, 2017 12:05pm
Shared decision-making, the cornerstone of patient-centered care, often takes place in non-emergency care settings where patients have the luxury of more time to talk to their clinicians and consider all their options. But these discussions should also take place in busy, chaotic emergency departments, wrote two clinicians in a blog post for Health Affairs.
“There is tremendous potential for driving value-based care in the emergency setting through shared decision-making, wrote Edward Melnick, M.D., assistant professor of emergency medicine at the Yale School of Medicine and Erik Hess, associate professor of emergency medicine and research chair for the Department of Emergency Medicine at the Mayo Clinic. “As we continue to build incentives for value-based care into our healthcare system, we should not leave the ED out.”
The value of decision-aids to encourage shared decision-making was made clear during a randomized control trial at six EDs across the U.S., according to the blog post. The pilot program used a decision aid, “Chest Pain Choice,” developed by Hess and his research team. Chest pain, a common reason for patient visits to the ER, often leads to unnecessary admissions. So Hess’ team wanted to see what would happen if clinicians took the time to inform patients of their options.
The results: Increased patient engagement and a reduction in unnecessary hospital admissions for cardiac testing. Hess and Melnick saw it as a “multi-billion dollar opportunity” to reduce waste in the healthcare system. The findings were so promising that the research team began working on the development of decision aids to discuss CAT scans for adults and children with minor head trauma.

New Year, New Vaccination Guidelines – CDC and AAP committees offer updates for flu shots, HPV, and others

by Molly Walker
Staff Writer, MedPage Today February 06, 2017

• The live attenuated influenza vaccine (FluMist) is not recommended for either adults or children during the 2016-2017 flu season.
• Note that regarding potential HPV vaccine hesitancy and to improve vaccine uptake among adolescents, one strategy for pediatricians would be to emphasize that HPV immunization prevents cancer.
FluMist is out and amended requirements for the HPV vaccine in certain populations are in, according to 2017 changes to the vaccination schedule.
The CDC’s Advisory Committee on Immunization Practices (ACIP) has reiterated its recommendation against using the live attenuated influenza vaccine (FluMist) for either adults or children.
But two doses of the HPV vaccine are now recommended for children and adolescents under the age of 15 years, although three doses are still recommended for adults and adolescents who did not start their vaccination series prior to age 15, they noted.
Also, changes to vaccinations against meningococcal disease were made.
All of these updates were approved at ACIP meetings, and are now published in the Annals of Internal Medicine.
In addition, the American Academy of Pediatrics’ (AAP) Committee on Infectious Diseases released its 2017 recommendations for children and adolescents simultaneously in Pediatrics.
Meningococcal Vaccine
The ACIP recommended changes to the schedule for MenB-FHbp vaccine (Trumenba), which protects against serogroup B among people, including adolescents and young adults, at increased risk of contracting the disease.
Among adults at increased risk or during outbreaks of serogroup B meningococcal disease, the three-dose vaccine should be administered at 0, 1-2 and 6 months. “Healthy” adolescents and adults may receive a two-dose series of MenB-FHbp at 0 and 6 months.
However, the ACIP noted that there was no change to the vaccination interval for the MenB-4C vaccine (Bexsero).
The ACIP also recommended immunizing people with HIV infection with the 2-dose MenACWY vaccine. Adults should receive these vaccines 2 months apart, and should be revaccinated every 5 years.
Other populations that should receive vaccination against meningococcal disease include:
• Adults with anatomical or functional asplenia or persistent complement component deficiencies (2-dose MenACWY and either 2-dose MenB-4C or three-dose MenB-FHbp)
• Microbiologists routinely exposed to Neisseria meningitidis isolates (1 dose MenACWY and 2-dose MenB-4C or three-dose MenB-FHbp)
• Adults at risk of an outbreak of meningococcal disease (one dose MenACWY or 2-dose MenB-4C or three-dose MenB-FHbp, depending on the outbreak strain)
• Healthy young adults ages 16 to 23 years, “on the basis of clinical discretion” (two-dose MenB-4C or two-dose MenB-Fhbp)
HPV Vaccine
Few changes were made to the HPV vaccination series in adults. The ACIP recommended a three-dose vaccination series for women from ages 19 to 26 years, and men through age 21 years (at 0, 1-2 and 6 month intervals), though men ages 22 to 26 years may also receive the three-dose series at the same intervals.
But women and men who initiated HPV vaccination prior to age 15 only need two doses total for a complete series. This means that adults with one dose of HPV vaccine prior to age 15 only need one more dose, and adults who initiated the HPV series prior to age 15 and received two doses at least 5 months apart are now considered fully protected against the disease.
Influenza Vaccine
The ACIP stated that “changes are related to concerns regarding low effectiveness of the live attenuated influenza vaccine … against influenza A(H1N1)pdm09 in the U.S. during the 2013–2014 and 2015–2016 influenza seasons.” Last June, it issued an interim recommendation against using the product.
The committee also noted that people with an egg allergy receiving the influenza vaccine should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV). Those people with more severe allergic symptoms other than hives should receive the vaccine at “an inpatient or outpatient medical setting and supervised by a healthcare provider” who can recognize severe allergic reactions.
Hepatitis Vaccine
Finally, adults with various chronic liver conditions, including hepatitis C, cirrhosis, fatty liver disease and alcoholic liver disease, should receive the hepatitis B (HepB) vaccination.
AAP Advice
The AAP committee recommended that children receive two doses of HPV vaccine prior to age 15, or three doses of the HPV vaccine if the series starts after age 15, or if the child has certain immunocompromising conditions. They also reiterated the ACIP’s recommendations for the MenACWY vaccine in HIV-infected children, as well as the MenB vaccine for adolescents and young adults ages 16 to 23 if deemed necessary by the clinician.
Other recommendations included:
• All newborns should receive a monovalent dose of hepatitis B vaccine within 24 hours of birth, and infants born to mothers who test positive for hepatitis B surface antigen should be tested for hepatitis B surface antigen and its associated antibodies at 9 to 12 months after birth.
• Pregnant adolescents should receive one dose of tetanus, diphtheria, and pertussis (Tdap) vaccine, as early as possible in the 27 to 34 week gestation period, and children receiving Tdap as a catch-up series at ages 7 to 10 years may either receive Tdap or Td for their adolescent dose at age 11 or 12 years.
• Haemophilus b conjugate vaccine (Hiberix) may be used for the primary vaccination series for haemophilus influenzae type B (Hib) as Comvax is no longer commercially available, committee members noted.
Improving HPV Vax Uptake
Along with the AAP recommendations, two clinical reports, by Henry H. Bernstein, DO, and Joseph A. Bocchini Jr., MD, addressed potential vaccine hesitancy and improve vaccine uptake among adolescents.
Although the AAP has addressed these issues in a recent clinical report, and offered strategies for pediatricians to communicate with vaccine-hesitant parents, the first report also highlighted the need to advocate for HPV immunization in adolescents.
The authors argued that because HPV vaccination rates lag behind other vaccines, clinicians should emphasize that HPV immunization prevents cancer — “a major reason that parents accept the vaccine,” they stated. They also said that clinicians should discuss both the vaccine schedule and the age of administration with parents.
Moreover, they wrote that the vaccination should not be delayed, because “attempting to predict when the adolescent will become sexually active is difficult and impractical,” and recommended a “now or never” mentality when trying to argue for the immunization of adolescents.
Other strategies include co-administering the HPV vaccine with other vaccines, as well as stating that the HPV vaccine is “part of the routine immunization schedule,” the authors stated.
The second report touched on barriers that may prevent HPV vaccination efforts, such as “Internet and media sources that give false information about vaccines,” racial and economic disparities, and financial difficulties, Bernstein and Bocchini explained.
They cited a 2015 study that found HPV vaccination coverage was higher among non-Hispanic and Hispanic males compared with non-Hispanic white males, and cited increased education about the benefits of the vaccine as a way to combat this.
The HPV vaccine is also currently the most expensive of the vaccines included in the Vaccines for Children program, the authors noted, which may mean “limited availability of in-network healthcare providers in some rural jurisdictions” and some grandfathered plans not required to follow the Affordable Care Act preventive care provisions.
They recommended collaboration with the AAP, which can provide resources for clinicians facing either financial issues or issues with vaccine supply.