New Schedules for Immunizations before College

New Schedules for Immunizations before College

An increasing number of American colleges and universities have sharply increased the formality of their requirements for students attending college.

As a result, students are increasingly finding that as they prepare to go to school, these requirements must be met before they can begin attending college.

In response to these more formal requirements, Advanced Pediatrics is making the following recommendations regarding three required, and one recommended vaccine.

The Tetanus Shot (TDaP)
Actually this immunization protects against 3 diseases: tetanus, diphtheria, pertussis (or whooping cough).   In the past, the accepted practice was to give this immunization every ten years starting at 7th grade.  But now colleges are requiring many to have a recent TDaP the year of entry to college.
So our new recommendation is that a TDaP be given to every senior at their senior year health supervision visit (check-up).

The Chickenpox Vaccine (Varicella)
The universal use of varicella immunization across the US has essentially eliminated naturally occurring chickenpox in America.  As a result, it is very unlikely a child will emerge into adulthood protected from getting chickenpox as an adult by having chickenpox as a child.  It turns out that one dose of the varicella vaccine gives very good protection from the serious danger of getting a full case of chickenpox as an adult.   Getting two varicella immunizations goes further and nearly eliminates the 10% chance those with one dose have of getting a very mild bout of chickenpox (a handful of red dots, no serious illness.
With these facts in mind, elementary schools have been requiring everyone who enters kindergarten to have two varicella immunizations, for many years.
In the fall of 2015, colleges began to also require two doses of varicella be received to attend class.
So our new recommendation is that everyone have two doses of the varicella immunization by their senior year health supervision visit (check-up)

The Meningitis Vaccines
Bacterial meningitis is a very serious infection of the brain and spinal cord.  There are a number of bacteria that can cause such an infection, but most of these bacteria cause meningitis in the very young and the elderly.   The Hib and pneumococcal immunizations of infancy protect against these bacteria.  But there is one bacteria that causes bacterial meningitis in young adults, and that is the meningococcus.

Although a devastating disease, meningococcal meningitis is thankfully very, very rare, happening in about 1 in 100,000 young people a year.  There is a slight rise in the risk in crowded living conditions, so the risk goes to 4 in 100,000 for the first year of college dorm living, and much higher in military barracks.

The meningococcal germ comes in at least 5 types, referred to as A, B, C, Y, and W-135.  The currently used meningococcal immunization, Menactra, has been proven to be safe and effective in reducing the risk of meningococcal infections for the 4 types A, C, Y, and W-135.   This immunization only lasts 5 or so years, and since the risk of this infection begins to increase in high school, the standard practice is to give a dose in 7th grade, then again in 12th.
So our new recommendation is that everyone have the Menactra immunization going into 7th and then again going into 12 grade.

A note on the Meningococcal B immunization
You may notice the Menactra immunization does not protect against the B-type of the meningococcal germ.  A new vaccine is now available to protect against Meningococcal B infections.  However, the nation's review board for immunization practice, the ACIP of the CDC, met in the summer of 2015 and concluded that they do not recommend routine use of this immunization at this time.  The experts found that the actual incidence of meningococcal infections from Group B is already decreasing even without immunization, that we do not yet know how long it lasts, and that some people have had serious reactions to this immunization.
Our recommendation is that unless there is reason to take the risk of an immunization not yet approved for universal use, we would not recommend your young adult receive the new Meningococcal B immunization at this time.

HPV Immunization
The human papilloma viruses cause all the warts on all the parts of our bodies.   There are many hundreds of types of these HPV's.  Nearly every human alive has had an HPV infection from at least one of these wart viruses.
But a small subset of these HPV's cause warts only in the genital area of the body.  These genital HPV's are transmitted by sexual contact, but still are very widespread- about 2/3-3/4 of all adults have genital HPV's.
The real danger from these genital HPV's is that they, on rare occassion, can cause cancer- throat cancer in males, cervical cancer in females.
The HPV vaccines available protect against 4-9 of these genital HPV types, and are recommended
for use prior to onset of sexual activity.
Colleges are not requiring HPV immunization, but Advanced Pediatrics recommends that this three shot series be started near the end of middle school or the start of high school.

We are all familiar with the fact that infants need their baby shots.
Now there are four vaccines that becoming a routine part of the high school aged child's routine.
In summary, here is there timing of recommended immunization:

  • 11-12 years old, going into 7th grade:  TDaP, Menactra
  • 14-15 years old, going into 9th grade:  Begin HPV series (three shot series)
  • 17-18 years old, going into 12th grade:  Menactra, 2nd Varicella if needed

Having these immunizations up to date will protect your adolescent from tetanus, diphtheria, whooping cough, meningococcal meningitis, HPV caused cancers, and chickenpox.  

Having them done in this timely fashion will also prevent rushes to vaccinate before the first day of college, and avoids having to give too many shots at one time.

To your health,
Dr. Arthur Lavin

Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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