Knowledge and Attitudes Regarding Category B ACIP Recommendations Among Primary Care Providers for Children

Kempe, Allison; Allison, Mandy A.; MacNeil, Jessica R.; O’Leary, Sean T.; Crane, Lori A.; Beaty, Brenda; Hurley, Laura P.; Brtnikova, Michaela; Lindley, Megan C.; Liang, Jennifer L.; Albert, Alison P.; SMITH, JEAN C.

doi:10.1016/j.acap.2018.04.005

Cited by 22 publications

(30 citation statements)

References 9 publications

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“…In another study, Kempe and colleagues reported that 56% and 38% of pediatricians and family physicians surveyed, respectively, were able to correctly define the category B recommendation. 26 One reason that these percentages were higher than those reported here may be the difference in how the survey questions were worded. The Kempe study asked respondents to define the recommendation, whereas our study asked HCPs to indicate how they decide whether to prescribe the MenB vaccine in their practice based on ACIP recommendations.…”

Section: Almost Always U S U a L L Ycontrasting

confidence: 62%

Disparities in healthcare providers’ interpretations and implementations of ACIP’s meningococcal vaccine recommendations

Huang

Goren

Lee

et al. 2019

Human Vaccines & Immunotherapeutics

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Invasive meningococcal disease (IMD) caused by the bacteria Neisseria meningitidis is rare but potentially fatal. For healthy adolescents, the US Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with MenACWY and recommends MenB vaccination under shared clinical decision-making (previously "Category B"). The recommendation for MenB vaccination was the first category B recommendation in adolescents, and it is unclear how healthcare providers (HCPs) implement these guidelines. This 2017 web-based survey of US HCPs explored characteristics associated with prescribing or receiving MenB and MenACWY vaccines, HCP knowledge of vaccine recommendations, and real-world practice patterns. Of 529 respondents, 436 prescribed MenB vaccines to their eligible adolescent/young adult patients and 93 prescribed MenACWY vaccines only. MenB vaccine prescribers were more likely to be pediatricians compared with MenACWY vaccine only prescribers, and patients who received MenB vaccines were more likely to be non-Hispanic whites living in shared spaces (eg, college dormitories) than those not receiving the vaccine. Seventy-seven percent of HCPs indicated that they prescribe MenACWY vaccines consistently with ACIP recommendations (to all members of an age group), whereas only 7% indicated that they prescribe MenB vaccines consistently with ACIP recommendations (individual clinical decision making). Patientrelated factors, disease-related factors, and guidelines all influenced HCP decisions to prescribe meningococcal vaccines. Providing HCPs with clear guidance on how to initiate discussion of MenB vaccines with patients and their caregivers may aid in fully protecting US adolescents against meningococcal disease caused by 5 of the disease-causing serogroups. ARTICLE HISTORY

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Section: Almost Always U S U a L L Ycontrasting

confidence: 62%

Disparities in healthcare providers’ interpretations and implementations of ACIP’s meningococcal vaccine recommendations

Huang

Goren

Lee

et al. 2019

Human Vaccines & Immunotherapeutics

View full text Add to dashboard Cite

show abstract

“…GRADE Category B is a recommendation for vaccination based on individual clinical decision‐making between the clinician and patient . Many physicians may misinterpret the individual decision‐making (previously Category B) recommendation to imply that they should decide whether or not to raise the topic with patients, while in reality the goal is for healthcare providers and patients to jointly discuss the benefits and risks of possible vaccination together to reach a clinical decision . In some cases, such as a lack of available information, ACIP may not make any recommendation…”

Section: Resultsmentioning

confidence: 99%

“…75 Many physicians may misinterpret the individual decision-making (previously Category B 76,77 ) recommendation to imply that they should decide whether or not to raise the topic with patients, while in reality the goal is for healthcare providers and patients to jointly discuss the benefits and risks of possible vaccination together to reach a clinical decision. 63,[78][79][80] In some cases, such as a lack of available information, ACIP may not make any recommendation. 75 In early 2015, ACIP issued a Category A recommendation for MenB vaccination of individuals ≥10 years of age at increased risk for IMD (Table 4 5 18 years.…”

Section: Grade Category a Indicates A Recommendationmentioning

confidence: 99%

A review of the immunogenicity, safety and current recommendations for the meningococcal serogroup B vaccine, MenB‐FHbp

Alderfer

Snow

2019

J Clin Pharm Ther

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What is known and objective This review describes invasive meningococcal disease (IMD) epidemiology in the United States, provides a brief overview of available meningococcal vaccines and discusses meningococcal serogroup B (MenB) vaccine development. Particular focus is given to the recombinant protein MenB vaccine, MenB‐FHbp (Trumenba®, bivalent rLP2086) in light of recent publication of phase 3 data; the other MenB vaccine (Bexsero®, MenB‐4C) has been recently reviewed. Current recommendations of the US Advisory Committee on Immunization Practices (ACIP) for MenB vaccination and potential barriers to immunization are also discussed. Methods Using the published literature, this article reviews the development and use of MenB‐FHbp to date, with a focus on the United States. Results and discussion Despite the availability of medical treatment, IMD is associated with significant mortality and frequently occurring serious permanent sequelae in surviving individuals. Worldwide, most IMD is caused by six serogroups (A, B, C, W, X and Y). MenB is the most common disease‐causing meningococcal serogroup in the United States and has caused several recent university‐based IMD outbreaks. MenB vaccines, including MenB‐FHbp, are available in the United States. ACIP recommends that all individuals ≥10 years of age at increased risk for meningococcal disease receive MenB vaccination; healthy individuals 16‐23 years of age are recommended MenB vaccines based on individual clinical decision‐making. MenB‐FHbp is used on a 2‐dose schedule (0, 6 months) when vaccinating healthy individuals and on a tailored 3‐dose schedule (0, 1‒2, 6 months) in cases of increased risk. What is new and conclusion Because vaccination provides the most effective protection against IMD, pharmacists are in an excellent position to offer evidence‐based vaccine information, as well as to encourage and provide meningococcal immunizations to adolescents and young adults.

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“…57 Parents expect their children's physicians to provide guidance on adolescent vaccinations, 58 but studies have shown that these physicians struggle to understand the reasons for different types of meningococcal vaccines and the ACIP meningococcal vaccine recommendations. 59 For MenB vaccines, the ACIP Category B recommendation requires individual clinical decision-making in the context of a patientprovider discussion, 60 and several studies have shown that this recommendation is especially confusing for health-care providers to implement. 59,[61][62][63] However, it is noteworthy that the American Academy of Pediatrics states that not discussing MenB disease and the available licensed vaccines with families is not an option.…”

Section: Mo 1-2 Momentioning

confidence: 99%

“…59 For MenB vaccines, the ACIP Category B recommendation requires individual clinical decision-making in the context of a patientprovider discussion, 60 and several studies have shown that this recommendation is especially confusing for health-care providers to implement. 59,[61][62][63] However, it is noteworthy that the American Academy of Pediatrics states that not discussing MenB disease and the available licensed vaccines with families is not an option. 60 Taken together, these factors likely contribute to the disparate immunization rates for adolescent vaccines.…”

Section: Mo 1-2 Momentioning

confidence: 99%

A physician’s guide to the 2-dose schedule of MenB-FHbp vaccine

McDaniel

Srivastava

2019

Human Vaccines & Immunotherapeutics

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Meningococcal serogroup B (MenB) is the predominant cause of invasive meningococcal disease in the United States, with older adolescents and young adults attending college at increased risk. Notably, MenB caused all meningococcal disease outbreaks at US colleges between 2011 and 2018. MenB disease is vaccine-preventable. The MenB-FHbp vaccine can be administered on a 2-dose (0 and 6 months) schedule to healthy adolescents and young adults or as a tailored 3-dose (0, 1–2, and 6 months) schedule for individuals at increased risk. This review focuses on the 2-dose schedule (0 and 6 months) of MenB-FHbp. Clinical evidence demonstrating strong and broadly protective immunogenicity in adolescents after primary vaccination, immune persistence up to 48 months post-primary vaccination (18–61% of subjects across schedules), and immune memory evidenced by robust response to a single booster dose are described. Implementation approaches to ensure adolescents and young adults are fully vaccinated against meningococcal disease are discussed.

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Knowledge and Attitudes Regarding Category B ACIP Recommendations Among Primary Care Providers for Children

Abstract: For category B recommendations to be useful in guiding practice, primary care clinicians will need to have a better understanding of their meaning, their implications for insurance payment, and guidance on how to discuss them with parents and patients.

Cited by 22 publications

References 9 publications

Disparities in healthcare providers’ interpretations and implementations of ACIP’s meningococcal vaccine recommendations

Disparities in healthcare providers’ interpretations and implementations of ACIP’s meningococcal vaccine recommendations

A review of the immunogenicity, safety and current recommendations for the meningococcal serogroup B vaccine, MenB‐FHbp

A physician’s guide to the 2-dose schedule of MenB-FHbp vaccine

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