January W. Payne

All health care workers should be vaccinated annually against influenza, and doing so should be a condition of new or continued employment, according to a position paper from the Society for Healthcare Epidemiology of America.

This is the first time the organization has recommended mandatory vaccination of all health care workers; and its position was also endorsed by the Infectious Diseases Society of America.

“I am very hopeful that this guideline will encourage the adoption of more mandatory policies at all health care institutions,” said Dr. Neil Fishman, president of SHEA and director of health care epidemiology and infection control for the University of Pennsylvania Health System, Philadelphia.

A variety of vaccinations already are required at health care facilities, including measles, mumps and rubella, and some facilities also require vaccination against chickenpox, pertussis, and hepatitis B. “So there are precedents for having vaccines as a condition of employment,” Dr. Fishman said.

The hope is that SHEA’s new recommendation – published Aug. 31 in the journal Infection Control and Healthcare Epidemiology – will improve the current influenza vaccination rates for health care workers, which now hover in the 30%-40% range, Dr. Fishman said. The recommendation applies to all workers, students, and volunteers in all health care facilities, regardless of whether they have direct patient contact.

Under the SHEA position paper, the only exceptions to the mandatory vaccination policy would be for medical reasons, such as a severe allergy to eggs, Dr. Fishman said.

The Centers for Disease Control and Prevention currently recommends that all health care professionals get an annual influenza vaccine and that health care facilities provide the vaccine to its workers with a goal of vaccinating 100% of staff.

Some health facilities and systems already require influenza vaccination as a condition of employment. The University of Pennsylvania Health System, where Dr. Fishman works, has required flu vaccination for its workers since 2009.

Researchers at the Virginia Mason Medical Center, Seattle – believed to be the first in the country to institute mandatory influenza vaccination for its health care workers in 2005 – recently studied their institution’s efforts to improve influenza vaccination rates.

They found that in the first year after the mandatory influenza requirement was put in place, 97.6% of the facility’s 4,703 health care workers were vaccinated, followed by adherence rates of more than 98% in the following 4 years. Less than 0.7% of the center’s workers were exempted from vaccination for medical or religious reasons, and less than 0.2% refused vaccination or left employment at the center (Infect. Control Hosp. Epidemiol. 2010;31:881-8).

“Influenza vaccination of health care providers is a professional and ethical obligation ... to prevent the spread of influenza, an infection that can spread rapidly through an institution,” Dr. Fishman said.

Dr. Fishman reported no conflicts of interest. The authors of SHEA’s position paper reported having served as consultants for or having received honoraria from various companies that make vaccines, influenza diagnostics, and pharmaceuticals.

All health care workers should be vaccinated annually against influenza, and doing so should be a condition of new or continued employment, according to a position paper from the Society for Healthcare Epidemiology of America.

This is the first time the organization has recommended mandatory vaccination of all health care workers; and its position was also endorsed by the Infectious Diseases Society of America.

“I am very hopeful that this guideline will encourage the adoption of more mandatory policies at all health care institutions,” said Dr. Neil Fishman, president of SHEA and director of health care epidemiology and infection control for the University of Pennsylvania Health System, Philadelphia.

A variety of vaccinations already are required at health care facilities, including measles, mumps and rubella, and some facilities also require vaccination against chickenpox, pertussis, and hepatitis B. “So there are precedents for having vaccines as a condition of employment,” Dr. Fishman said.

The hope is that SHEA’s new recommendation – published Aug. 31 in the journal Infection Control and Healthcare Epidemiology – will improve the current influenza vaccination rates for health care workers, which now hover in the 30%-40% range, Dr. Fishman said. The recommendation applies to all workers, students, and volunteers in all health care facilities, regardless of whether they have direct patient contact.

Under the SHEA position paper, the only exceptions to the mandatory vaccination policy would be for medical reasons, such as a severe allergy to eggs, Dr. Fishman said.

The Centers for Disease Control and Prevention currently recommends that all health care professionals get an annual influenza vaccine and that health care facilities provide the vaccine to its workers with a goal of vaccinating 100% of staff.

Some health facilities and systems already require influenza vaccination as a condition of employment. The University of Pennsylvania Health System, where Dr. Fishman works, has required flu vaccination for its workers since 2009.

Researchers at the Virginia Mason Medical Center, Seattle – believed to be the first in the country to institute mandatory influenza vaccination for its health care workers in 2005 – recently studied their institution’s efforts to improve influenza vaccination rates.

They found that in the first year after the mandatory influenza requirement was put in place, 97.6% of the facility’s 4,703 health care workers were vaccinated, followed by adherence rates of more than 98% in the following 4 years. Less than 0.7% of the center’s workers were exempted from vaccination for medical or religious reasons, and less than 0.2% refused vaccination or left employment at the center (Infect. Control Hosp. Epidemiol. 2010;31:881-8).

“Influenza vaccination of health care providers is a professional and ethical obligation ... to prevent the spread of influenza, an infection that can spread rapidly through an institution,” Dr. Fishman said.

Dr. Fishman reported no conflicts of interest. The authors of SHEA’s position paper reported having served as consultants for or having received honoraria from various companies that make vaccines, influenza diagnostics, and pharmaceuticals.

All health care workers should be vaccinated annually against influenza, and doing so should be a condition of new or continued employment, according to a position paper from the Society for Healthcare Epidemiology of America.

This is the first time the organization has recommended mandatory vaccination of all health care workers; and its position was also endorsed by the Infectious Diseases Society of America.

“I am very hopeful that this guideline will encourage the adoption of more mandatory policies at all health care institutions,” said Dr. Neil Fishman, president of SHEA and director of health care epidemiology and infection control for the University of Pennsylvania Health System, Philadelphia.

A variety of vaccinations already are required at health care facilities, including measles, mumps and rubella, and some facilities also require vaccination against chickenpox, pertussis, and hepatitis B. “So there are precedents for having vaccines as a condition of employment,” Dr. Fishman said.

The hope is that SHEA’s new recommendation – published Aug. 31 in the journal Infection Control and Healthcare Epidemiology – will improve the current influenza vaccination rates for health care workers, which now hover in the 30%-40% range, Dr. Fishman said. The recommendation applies to all workers, students, and volunteers in all health care facilities, regardless of whether they have direct patient contact.

Under the SHEA position paper, the only exceptions to the mandatory vaccination policy would be for medical reasons, such as a severe allergy to eggs, Dr. Fishman said.

The Centers for Disease Control and Prevention currently recommends that all health care professionals get an annual influenza vaccine and that health care facilities provide the vaccine to its workers with a goal of vaccinating 100% of staff.

Some health facilities and systems already require influenza vaccination as a condition of employment. The University of Pennsylvania Health System, where Dr. Fishman works, has required flu vaccination for its workers since 2009.

Researchers at the Virginia Mason Medical Center, Seattle – believed to be the first in the country to institute mandatory influenza vaccination for its health care workers in 2005 – recently studied their institution’s efforts to improve influenza vaccination rates.

They found that in the first year after the mandatory influenza requirement was put in place, 97.6% of the facility’s 4,703 health care workers were vaccinated, followed by adherence rates of more than 98% in the following 4 years. Less than 0.7% of the center’s workers were exempted from vaccination for medical or religious reasons, and less than 0.2% refused vaccination or left employment at the center (Infect. Control Hosp. Epidemiol. 2010;31:881-8).

“Influenza vaccination of health care providers is a professional and ethical obligation ... to prevent the spread of influenza, an infection that can spread rapidly through an institution,” Dr. Fishman said.

Dr. Fishman reported no conflicts of interest. The authors of SHEA’s position paper reported having served as consultants for or having received honoraria from various companies that make vaccines, influenza diagnostics, and pharmaceuticals.

The Food and Drug Administration has approved influenza vaccines for the 2010-2011 flu season that protect against three influenza strains, including the 2009 H1N1 virus, the agency announced July 30.

Last year, two separate vaccines were needed to protect against seasonal influenza and H1N1, respectively, because H1N1 emerged after the season’s supply of flu vaccine had already been produced. But the upcoming flu season’s supply of vaccines will incorporate protection against H1N1, as well as two other influenza strains.

The vaccine will contain these strains:

–A/California/7/09 (H1N1)-like virus (pandemic [H1N1] 2009 influenza virus)

–A/Perth/16/2009 (H3N2)-like virus

–B/Brisbane/60/2008-like virus.

In a written statement, the FDA said that one vaccine, Afluria (manufactured by CSL Ltd.), recently had its label changed to warn of an increased incidence of febrile seizure and fever. The symptoms were observed mostly in children younger than age 5 years after it was administered in the Southern Hemisphere this year. Because of this, Afluria will be distributed only in 0.5-mL single-dose, prefilled syringes, and via 5-mL multidose vials; the 0.25-mL dose used in very young children will not be administered in the United States. The FDA is requiring CSL to conduct further studies to gather more information on the febrile problems observed in the Southern Hemisphere.

Other vaccine brand names and manufacturers of influenza vaccines for the 2010-2011 season listed in the agency statement are Agriflu by Novartis Vaccines and Diagnostics, Fluarix by GlaxoSmithKline Biologicals, FluLaval by ID Biomedical Corp., FluMist by MedImmune Vaccines Inc., Fluvirin by Novartis Vaccines and Diagnostics Limited, and Fluzone and Fluzone High-Dose by Sanofi Pasteur Inc.

Issuing guidelines that are effective during the 2010-2011 influenza season, the Centers for Disease Control and Prevention recommends that everyone aged 6 months of age and older get an annual influenza vaccine. Until now, vaccination was mainly recommended for people at higher risk of influenza complications, children aged 6 months to 18 years old, and those who had close contact with people at high risk for complications of the illness.

“The best way to protect yourself and your family against influenza is to get vaccinated every year,” said Dr. Karen Midthun, acting director of the FDA’s Center for Biologics Evaluation and Research. “The availability of a new seasonal influenza vaccine each year is an important tool in the prevention of influenza related illnesses and death.”

The Food and Drug Administration has approved influenza vaccines for the 2010-2011 flu season that protect against three influenza strains, including the 2009 H1N1 virus, the agency announced July 30.

Last year, two separate vaccines were needed to protect against seasonal influenza and H1N1, respectively, because H1N1 emerged after the season’s supply of flu vaccine had already been produced. But the upcoming flu season’s supply of vaccines will incorporate protection against H1N1, as well as two other influenza strains.

The vaccine will contain these strains:

–A/California/7/09 (H1N1)-like virus (pandemic [H1N1] 2009 influenza virus)

–A/Perth/16/2009 (H3N2)-like virus

–B/Brisbane/60/2008-like virus.

In a written statement, the FDA said that one vaccine, Afluria (manufactured by CSL Ltd.), recently had its label changed to warn of an increased incidence of febrile seizure and fever. The symptoms were observed mostly in children younger than age 5 years after it was administered in the Southern Hemisphere this year. Because of this, Afluria will be distributed only in 0.5-mL single-dose, prefilled syringes, and via 5-mL multidose vials; the 0.25-mL dose used in very young children will not be administered in the United States. The FDA is requiring CSL to conduct further studies to gather more information on the febrile problems observed in the Southern Hemisphere.

Other vaccine brand names and manufacturers of influenza vaccines for the 2010-2011 season listed in the agency statement are Agriflu by Novartis Vaccines and Diagnostics, Fluarix by GlaxoSmithKline Biologicals, FluLaval by ID Biomedical Corp., FluMist by MedImmune Vaccines Inc., Fluvirin by Novartis Vaccines and Diagnostics Limited, and Fluzone and Fluzone High-Dose by Sanofi Pasteur Inc.

Issuing guidelines that are effective during the 2010-2011 influenza season, the Centers for Disease Control and Prevention recommends that everyone aged 6 months of age and older get an annual influenza vaccine. Until now, vaccination was mainly recommended for people at higher risk of influenza complications, children aged 6 months to 18 years old, and those who had close contact with people at high risk for complications of the illness.

“The best way to protect yourself and your family against influenza is to get vaccinated every year,” said Dr. Karen Midthun, acting director of the FDA’s Center for Biologics Evaluation and Research. “The availability of a new seasonal influenza vaccine each year is an important tool in the prevention of influenza related illnesses and death.”

The Food and Drug Administration has approved influenza vaccines for the 2010-2011 flu season that protect against three influenza strains, including the 2009 H1N1 virus, the agency announced July 30.

Last year, two separate vaccines were needed to protect against seasonal influenza and H1N1, respectively, because H1N1 emerged after the season’s supply of flu vaccine had already been produced. But the upcoming flu season’s supply of vaccines will incorporate protection against H1N1, as well as two other influenza strains.

The vaccine will contain these strains:

–A/California/7/09 (H1N1)-like virus (pandemic [H1N1] 2009 influenza virus)

–A/Perth/16/2009 (H3N2)-like virus

–B/Brisbane/60/2008-like virus.

In a written statement, the FDA said that one vaccine, Afluria (manufactured by CSL Ltd.), recently had its label changed to warn of an increased incidence of febrile seizure and fever. The symptoms were observed mostly in children younger than age 5 years after it was administered in the Southern Hemisphere this year. Because of this, Afluria will be distributed only in 0.5-mL single-dose, prefilled syringes, and via 5-mL multidose vials; the 0.25-mL dose used in very young children will not be administered in the United States. The FDA is requiring CSL to conduct further studies to gather more information on the febrile problems observed in the Southern Hemisphere.

Other vaccine brand names and manufacturers of influenza vaccines for the 2010-2011 season listed in the agency statement are Agriflu by Novartis Vaccines and Diagnostics, Fluarix by GlaxoSmithKline Biologicals, FluLaval by ID Biomedical Corp., FluMist by MedImmune Vaccines Inc., Fluvirin by Novartis Vaccines and Diagnostics Limited, and Fluzone and Fluzone High-Dose by Sanofi Pasteur Inc.

Issuing guidelines that are effective during the 2010-2011 influenza season, the Centers for Disease Control and Prevention recommends that everyone aged 6 months of age and older get an annual influenza vaccine. Until now, vaccination was mainly recommended for people at higher risk of influenza complications, children aged 6 months to 18 years old, and those who had close contact with people at high risk for complications of the illness.

“The best way to protect yourself and your family against influenza is to get vaccinated every year,” said Dr. Karen Midthun, acting director of the FDA’s Center for Biologics Evaluation and Research. “The availability of a new seasonal influenza vaccine each year is an important tool in the prevention of influenza related illnesses and death.”

Screening young women before the age of 21 doesn't reduce cervical cancer rates, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care.

Because of this, the committee recommended for the first time that cervical cancer screening start at age 21, except in situations that warrant earlier testing.

“The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test,” Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice, said in a statement.

“Our guidelines now specify the exceptions to this recommendation,” which include adolescents whose immune systems are compromised by HIV, prior organ transplants, or long-term steroid treatment.

Young women with HIV should get Pap tests twice in the year following their diagnosis with the virus and annually after that. Those with a history of an organ transplant or long-term steroid treatment should be tested every 6 months in the year after they start having sex, followed by annual screening.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Washington Hospital Center and Children's National Medical Center, also in Washington, said she appreciates that the committee paid particular attention to how to handle adolescents with compromised immune systems—her area of specialty.

“I think it makes it very clear for us as clinicians as to what we should be doing,” she said in an interview.

Dr. Gomez-Lobo said that waiting until age 21 to screen young women makes sense, given how rare cervical cancer is in that age group.

“When we did screen a lot of teenagers, we were not preventing the few cancers that do happen in adolescents,” Dr. Gomez-Lobo said.

“Ultimately, many were having excisional procedures that put them at risk for preterm labor in the future,” she said.

The guidelines also specify how physicians should manage women younger than age 21 years who have already had Pap tests and who were found to have dysplasia. Periodic observation is generally safe for those with low- to high-grade precancerous lesions (Obstet. Gynecol. 2010;116:469-72).

For those women whose Pap smear results showed improvement in dysplasia, it's acceptable to wait to rescreen until age 21, although annual screening is also okay.

In those younger women who were found to have cervical intraepithelial neoplasia 3 (CIN 3), however, treatment with cryotherapy, laser therapy, or loop electrosurgical excision is warranted as the natural history of CIN 3 has not been determined.

Adolescents should not be tested for human papillomavirus because the infection tends to resolve on is own most of the time, according to the new ACOG guidelines.

Pregnancy in young women does not alter the recommendations, nor does a diagnosis of a sexually transmitted infection other than HIV.

Disclosures: Dr. Gomez-Lobo reported that she has received an investigator-initiated grant from Merck and is studying the use of Gardasil in transplant patients.

Screening young women before the age of 21 doesn't reduce cervical cancer rates, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care.

Because of this, the committee recommended for the first time that cervical cancer screening start at age 21, except in situations that warrant earlier testing.

“The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test,” Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice, said in a statement.

“Our guidelines now specify the exceptions to this recommendation,” which include adolescents whose immune systems are compromised by HIV, prior organ transplants, or long-term steroid treatment.

Young women with HIV should get Pap tests twice in the year following their diagnosis with the virus and annually after that. Those with a history of an organ transplant or long-term steroid treatment should be tested every 6 months in the year after they start having sex, followed by annual screening.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Washington Hospital Center and Children's National Medical Center, also in Washington, said she appreciates that the committee paid particular attention to how to handle adolescents with compromised immune systems—her area of specialty.

“I think it makes it very clear for us as clinicians as to what we should be doing,” she said in an interview.

Dr. Gomez-Lobo said that waiting until age 21 to screen young women makes sense, given how rare cervical cancer is in that age group.

“When we did screen a lot of teenagers, we were not preventing the few cancers that do happen in adolescents,” Dr. Gomez-Lobo said.

“Ultimately, many were having excisional procedures that put them at risk for preterm labor in the future,” she said.

The guidelines also specify how physicians should manage women younger than age 21 years who have already had Pap tests and who were found to have dysplasia. Periodic observation is generally safe for those with low- to high-grade precancerous lesions (Obstet. Gynecol. 2010;116:469-72).

For those women whose Pap smear results showed improvement in dysplasia, it's acceptable to wait to rescreen until age 21, although annual screening is also okay.

In those younger women who were found to have cervical intraepithelial neoplasia 3 (CIN 3), however, treatment with cryotherapy, laser therapy, or loop electrosurgical excision is warranted as the natural history of CIN 3 has not been determined.

Adolescents should not be tested for human papillomavirus because the infection tends to resolve on is own most of the time, according to the new ACOG guidelines.

Pregnancy in young women does not alter the recommendations, nor does a diagnosis of a sexually transmitted infection other than HIV.

Disclosures: Dr. Gomez-Lobo reported that she has received an investigator-initiated grant from Merck and is studying the use of Gardasil in transplant patients.

Screening young women before the age of 21 doesn't reduce cervical cancer rates, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care.

Because of this, the committee recommended for the first time that cervical cancer screening start at age 21, except in situations that warrant earlier testing.

“The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test,” Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice, said in a statement.

“Our guidelines now specify the exceptions to this recommendation,” which include adolescents whose immune systems are compromised by HIV, prior organ transplants, or long-term steroid treatment.

Young women with HIV should get Pap tests twice in the year following their diagnosis with the virus and annually after that. Those with a history of an organ transplant or long-term steroid treatment should be tested every 6 months in the year after they start having sex, followed by annual screening.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Washington Hospital Center and Children's National Medical Center, also in Washington, said she appreciates that the committee paid particular attention to how to handle adolescents with compromised immune systems—her area of specialty.

“I think it makes it very clear for us as clinicians as to what we should be doing,” she said in an interview.

Dr. Gomez-Lobo said that waiting until age 21 to screen young women makes sense, given how rare cervical cancer is in that age group.

“When we did screen a lot of teenagers, we were not preventing the few cancers that do happen in adolescents,” Dr. Gomez-Lobo said.

“Ultimately, many were having excisional procedures that put them at risk for preterm labor in the future,” she said.

The guidelines also specify how physicians should manage women younger than age 21 years who have already had Pap tests and who were found to have dysplasia. Periodic observation is generally safe for those with low- to high-grade precancerous lesions (Obstet. Gynecol. 2010;116:469-72).

For those women whose Pap smear results showed improvement in dysplasia, it's acceptable to wait to rescreen until age 21, although annual screening is also okay.

In those younger women who were found to have cervical intraepithelial neoplasia 3 (CIN 3), however, treatment with cryotherapy, laser therapy, or loop electrosurgical excision is warranted as the natural history of CIN 3 has not been determined.

Adolescents should not be tested for human papillomavirus because the infection tends to resolve on is own most of the time, according to the new ACOG guidelines.

Pregnancy in young women does not alter the recommendations, nor does a diagnosis of a sexually transmitted infection other than HIV.

Disclosures: Dr. Gomez-Lobo reported that she has received an investigator-initiated grant from Merck and is studying the use of Gardasil in transplant patients.

Screening young women before the age of 21 doesn't reduce cervical cancer rates, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care. Because of this, the committee recommended for the first time that cervical cancer screening start at age 21, except in situations that warrant earlier testing.

“The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test,” Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice, said in a statement. “Our guidelines now specify the exceptions to this recommendation,” which include adolescents whose immune systems are compromised by HIV, prior organ transplants, or long-term steroid treatment.

Young women with HIV should get Pap tests twice in the year following their diagnosis with the virus and annually after that. Those with a history of an organ transplant or long-term steroid treatment should be tested every 6 months in the year after they start having sex, followed by annual screening.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Washington Hospital Center and Children's National Medical Center, also in Washington, said she appreciates that the committee paid particular attention to how to handle adolescents with compromised immune systems—her area of specialty. “I think it makes it very clear for us as clinicians as to what we should be doing,” she said.

Dr. Gomez-Lobo said that waiting until age 21 to screen young women makes sense, given how rare cervical cancer is in that age group. “When we did screen a lot of teenagers, we were not preventing the few cancers that do happen in adolescents,” she said. “Ultimately, many were having excisional procedures that put them at risk for preterm labor in the future.”

The guidelines also specify how physicians should manage women younger than age 21 years who have already had Pap tests and who were found to have dysplasia. Periodic observation is generally safe for those with low- to high-grade precancerous lesions (Obstet. Gynecol. 2010;116:469-72).

For those women whose Pap smear results showed improvement in dysplasia, it's acceptable to wait to rescreen until age 21, although annual screening is also okay.

In those younger women who were found to have cervical intraepithelial neoplasia 3 (CIN 3), however, treatment with cryotherapy, laser therapy, or loop electrosurgical excision is warranted as the natural history of CIN 3 has not been determined.

Adolescents should not be tested for human papillomavirus because the infection tends to resolve on is own most of the time, according to the guidelines. Pregnancy in young women does not alter the recommendations, nor does a diagnosis of a sexually transmitted infection other than HIV.

“While some clinicians will prefer to wait for updated guidelines produced by the U.S. Preventive Services Task Force or the American Cancer Society before changing their practices, it is clear that the momentum of the evolutionary changes will continue in the direction that ACOG has taken,” said Dr. Michael S. Policar, clinical professor of obstetrics and gynecology and reproductive sciences at the University of California, San Francisco.

“The bottom line is that by continuing to screen adolescents for cervical cancer, including those who are pregnant, we risk harming our patients rather than helping them. It's time to abandon this unnecessary practice,” he said.

Disclosures: Dr. Gomez-Lobo reported that she has received an investigator-initiated grant from Merck and is studying the use of Gardasil in transplant patients. Dr. Policar reported having no conflicts of interest.

Screening young women before the age of 21 doesn't reduce cervical cancer rates, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care. Because of this, the committee recommended for the first time that cervical cancer screening start at age 21, except in situations that warrant earlier testing.

“The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test,” Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice, said in a statement. “Our guidelines now specify the exceptions to this recommendation,” which include adolescents whose immune systems are compromised by HIV, prior organ transplants, or long-term steroid treatment.

Young women with HIV should get Pap tests twice in the year following their diagnosis with the virus and annually after that. Those with a history of an organ transplant or long-term steroid treatment should be tested every 6 months in the year after they start having sex, followed by annual screening.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Washington Hospital Center and Children's National Medical Center, also in Washington, said she appreciates that the committee paid particular attention to how to handle adolescents with compromised immune systems—her area of specialty. “I think it makes it very clear for us as clinicians as to what we should be doing,” she said.

Dr. Gomez-Lobo said that waiting until age 21 to screen young women makes sense, given how rare cervical cancer is in that age group. “When we did screen a lot of teenagers, we were not preventing the few cancers that do happen in adolescents,” she said. “Ultimately, many were having excisional procedures that put them at risk for preterm labor in the future.”

The guidelines also specify how physicians should manage women younger than age 21 years who have already had Pap tests and who were found to have dysplasia. Periodic observation is generally safe for those with low- to high-grade precancerous lesions (Obstet. Gynecol. 2010;116:469-72).

For those women whose Pap smear results showed improvement in dysplasia, it's acceptable to wait to rescreen until age 21, although annual screening is also okay.

In those younger women who were found to have cervical intraepithelial neoplasia 3 (CIN 3), however, treatment with cryotherapy, laser therapy, or loop electrosurgical excision is warranted as the natural history of CIN 3 has not been determined.

Adolescents should not be tested for human papillomavirus because the infection tends to resolve on is own most of the time, according to the guidelines. Pregnancy in young women does not alter the recommendations, nor does a diagnosis of a sexually transmitted infection other than HIV.

“While some clinicians will prefer to wait for updated guidelines produced by the U.S. Preventive Services Task Force or the American Cancer Society before changing their practices, it is clear that the momentum of the evolutionary changes will continue in the direction that ACOG has taken,” said Dr. Michael S. Policar, clinical professor of obstetrics and gynecology and reproductive sciences at the University of California, San Francisco.

“The bottom line is that by continuing to screen adolescents for cervical cancer, including those who are pregnant, we risk harming our patients rather than helping them. It's time to abandon this unnecessary practice,” he said.

Disclosures: Dr. Gomez-Lobo reported that she has received an investigator-initiated grant from Merck and is studying the use of Gardasil in transplant patients. Dr. Policar reported having no conflicts of interest.

Screening young women before the age of 21 doesn't reduce cervical cancer rates, according to an opinion from the American College of Obstetricians and Gynecologists' Committee on Adolescent Health Care. Because of this, the committee recommended for the first time that cervical cancer screening start at age 21, except in situations that warrant earlier testing.

“The vast majority of adolescent girls should wait until they turn 21 before they have their first Pap test,” Dr. Cheryl B. Iglesia, chair of ACOG's Committee on Gynecologic Practice, said in a statement. “Our guidelines now specify the exceptions to this recommendation,” which include adolescents whose immune systems are compromised by HIV, prior organ transplants, or long-term steroid treatment.

Young women with HIV should get Pap tests twice in the year following their diagnosis with the virus and annually after that. Those with a history of an organ transplant or long-term steroid treatment should be tested every 6 months in the year after they start having sex, followed by annual screening.

Dr. Veronica Gomez-Lobo, director of pediatric and adolescent gynecology at Washington Hospital Center and Children's National Medical Center, also in Washington, said she appreciates that the committee paid particular attention to how to handle adolescents with compromised immune systems—her area of specialty. “I think it makes it very clear for us as clinicians as to what we should be doing,” she said.

Dr. Gomez-Lobo said that waiting until age 21 to screen young women makes sense, given how rare cervical cancer is in that age group. “When we did screen a lot of teenagers, we were not preventing the few cancers that do happen in adolescents,” she said. “Ultimately, many were having excisional procedures that put them at risk for preterm labor in the future.”

The guidelines also specify how physicians should manage women younger than age 21 years who have already had Pap tests and who were found to have dysplasia. Periodic observation is generally safe for those with low- to high-grade precancerous lesions (Obstet. Gynecol. 2010;116:469-72).

For those women whose Pap smear results showed improvement in dysplasia, it's acceptable to wait to rescreen until age 21, although annual screening is also okay.

In those younger women who were found to have cervical intraepithelial neoplasia 3 (CIN 3), however, treatment with cryotherapy, laser therapy, or loop electrosurgical excision is warranted as the natural history of CIN 3 has not been determined.

Adolescents should not be tested for human papillomavirus because the infection tends to resolve on is own most of the time, according to the guidelines. Pregnancy in young women does not alter the recommendations, nor does a diagnosis of a sexually transmitted infection other than HIV.

“While some clinicians will prefer to wait for updated guidelines produced by the U.S. Preventive Services Task Force or the American Cancer Society before changing their practices, it is clear that the momentum of the evolutionary changes will continue in the direction that ACOG has taken,” said Dr. Michael S. Policar, clinical professor of obstetrics and gynecology and reproductive sciences at the University of California, San Francisco.

“The bottom line is that by continuing to screen adolescents for cervical cancer, including those who are pregnant, we risk harming our patients rather than helping them. It's time to abandon this unnecessary practice,” he said.

Disclosures: Dr. Gomez-Lobo reported that she has received an investigator-initiated grant from Merck and is studying the use of Gardasil in transplant patients. Dr. Policar reported having no conflicts of interest.

The Food and Drug Administration has approved influenza vaccines for the 2010-2011 flu season that protect against three influenza strains, including the 2009 H1N1 virus, the agency announced July 30.

Last year, two separate vaccines were needed to protect against seasonal influenza and H1N1, respectively, because H1N1 emerged after the season's supply of flu vaccine had already been produced. But the upcoming flu season's supply of vaccines will incorporate protection against H1N1, as well as two other influenza strains.

The vaccine will contain these strains:

▸ A/California/7/09 (H1N1)-like virus (pandemic [H1N1] 2009 influenza virus)

▸ A/Perth/16/2009 (H3N2)-like virus

▸ B/Brisbane/60/2008-like virus.

Just days after the FDA's announcement last month, however, the Advisory Committee on Immunization Practices voted Aug. 5 not to use Afluria, a seasonal influenza vaccine manufactured by CSL Biotherapies, in children between the ages of 6 months and 8 years because of an increased incidence of fever and febrile seizures.

Other vaccine brand names and manufacturers of influenza vaccines for the 2010-2011 season listed in the agency statement are Agriflu by Novartis Vaccines and Diagnostics, Fluarix by GlaxoSmithKline Biologicals, FluLaval by ID Biomedical Corp., FluMist by MedImmune Vaccines Inc., Fluvirin by Novartis Vaccines and Diagnostics Limited, and Fluzone and Fluzone High-Dose by Sanofi Pasteur Inc.

Issuing guidelines that are effective during the 2010-2011 influenza season, the Centers for Disease Control and Prevention recommends that everyone aged 6 months of age and older get an annual influenza vaccine. Until now, vaccination was mainly recommended for people at higher risk of influenza complications, children aged 6 months to 18 years old, and those who had close contact with people at high risk for complications of the illness. “The best way to protect yourself and your family against influenza is to get vaccinated every year,” said Dr. Karen Midthun, acting director of the FDA's Center for Biologics Evaluation and Research. “The availability of a new seasonal influenza vaccine each year is an important tool in the prevention of influenza-related illnesses and death.”

The Food and Drug Administration has approved influenza vaccines for the 2010-2011 flu season that protect against three influenza strains, including the 2009 H1N1 virus, the agency announced July 30.

Last year, two separate vaccines were needed to protect against seasonal influenza and H1N1, respectively, because H1N1 emerged after the season's supply of flu vaccine had already been produced. But the upcoming flu season's supply of vaccines will incorporate protection against H1N1, as well as two other influenza strains.

The vaccine will contain these strains:

▸ A/California/7/09 (H1N1)-like virus (pandemic [H1N1] 2009 influenza virus)

▸ A/Perth/16/2009 (H3N2)-like virus

▸ B/Brisbane/60/2008-like virus.

Just days after the FDA's announcement last month, however, the Advisory Committee on Immunization Practices voted Aug. 5 not to use Afluria, a seasonal influenza vaccine manufactured by CSL Biotherapies, in children between the ages of 6 months and 8 years because of an increased incidence of fever and febrile seizures.

Other vaccine brand names and manufacturers of influenza vaccines for the 2010-2011 season listed in the agency statement are Agriflu by Novartis Vaccines and Diagnostics, Fluarix by GlaxoSmithKline Biologicals, FluLaval by ID Biomedical Corp., FluMist by MedImmune Vaccines Inc., Fluvirin by Novartis Vaccines and Diagnostics Limited, and Fluzone and Fluzone High-Dose by Sanofi Pasteur Inc.

Issuing guidelines that are effective during the 2010-2011 influenza season, the Centers for Disease Control and Prevention recommends that everyone aged 6 months of age and older get an annual influenza vaccine. Until now, vaccination was mainly recommended for people at higher risk of influenza complications, children aged 6 months to 18 years old, and those who had close contact with people at high risk for complications of the illness. “The best way to protect yourself and your family against influenza is to get vaccinated every year,” said Dr. Karen Midthun, acting director of the FDA's Center for Biologics Evaluation and Research. “The availability of a new seasonal influenza vaccine each year is an important tool in the prevention of influenza-related illnesses and death.”

The Food and Drug Administration has approved influenza vaccines for the 2010-2011 flu season that protect against three influenza strains, including the 2009 H1N1 virus, the agency announced July 30.

Last year, two separate vaccines were needed to protect against seasonal influenza and H1N1, respectively, because H1N1 emerged after the season's supply of flu vaccine had already been produced. But the upcoming flu season's supply of vaccines will incorporate protection against H1N1, as well as two other influenza strains.

The vaccine will contain these strains:

▸ A/California/7/09 (H1N1)-like virus (pandemic [H1N1] 2009 influenza virus)

▸ A/Perth/16/2009 (H3N2)-like virus

▸ B/Brisbane/60/2008-like virus.

Just days after the FDA's announcement last month, however, the Advisory Committee on Immunization Practices voted Aug. 5 not to use Afluria, a seasonal influenza vaccine manufactured by CSL Biotherapies, in children between the ages of 6 months and 8 years because of an increased incidence of fever and febrile seizures.

Other vaccine brand names and manufacturers of influenza vaccines for the 2010-2011 season listed in the agency statement are Agriflu by Novartis Vaccines and Diagnostics, Fluarix by GlaxoSmithKline Biologicals, FluLaval by ID Biomedical Corp., FluMist by MedImmune Vaccines Inc., Fluvirin by Novartis Vaccines and Diagnostics Limited, and Fluzone and Fluzone High-Dose by Sanofi Pasteur Inc.

Issuing guidelines that are effective during the 2010-2011 influenza season, the Centers for Disease Control and Prevention recommends that everyone aged 6 months of age and older get an annual influenza vaccine. Until now, vaccination was mainly recommended for people at higher risk of influenza complications, children aged 6 months to 18 years old, and those who had close contact with people at high risk for complications of the illness. “The best way to protect yourself and your family against influenza is to get vaccinated every year,” said Dr. Karen Midthun, acting director of the FDA's Center for Biologics Evaluation and Research. “The availability of a new seasonal influenza vaccine each year is an important tool in the prevention of influenza-related illnesses and death.”