Immunizations are recommended for individuals of all ages, from birth to the elderly. Each year the Advisory Committee on Immunization Practices (ACIP) issues annual updates to the child/adolescent and adult immunization schedules based on the best available evidence.1 The ACIP offers the guidelines necessary to ensure nurse practitioners (NPs) and physician assistants (PAs) use the best available evidence every year to offer the best protection against preventable diseases to their patients.
In 2020, there has been an increased effort to streamline the information presented and make it more user-friendly. The cover sheet of the pediatric/adolescent schedule now includes information for reporting vaccine-preventable diseases and a link to the Vaccine Adverse Event Reporting System (VAERS).2 VAERS is now online, and it is easy to report an adverse event following an immunization. If an individual or provider believes that an injury has occurred due to a vaccine, a report to VAERS should be submitted. VAERS is a passive system but has always been very successful in detecting adverse events. For example, the increased risk for intussusception following the first rotavirus vaccine was detected by VAERS.3
The cover sheet also has a link to the complete ACIP recommendations and their General Best Practice Guidelines for Immunizations. The US Centers for Disease Control Prevention (CDC) provides vaccine schedules in the form of a user-friendly app that can be downloaded; this tool provides easy access to schedules for the various age groups, as well as footnotes related to the individual vaccines.4
Catch-up vaccination for Haemophilus influenzae type b (Hib) is not recommended for previously unvaccinated children aged ≥5 years (60 months) unless the children are at high risk.
Catch-up vaccination for hepatitis A (Hep A) is recommend for all children and adolescents aged 2 to 18 years who have not previously been vaccinated. The children should complete a 2-dose series, with a minimum interval between doses of 6 months.5
The “special situations” of the hepatitis B (Hep B) vaccine section contain information regarding populations for whom revaccination may be recommended. Those recommendations include infants born to mothers who test positive for hepatitis B virus infection, as well as patients undergoing hemodialysis and other immunocompromised patients.6
Guidance regarding vaccination for children who received the meningococcal conjugate (MenACWY)vaccineprior to age 10 has been added to the MenACWY note. Booster doses of the vaccine should be administered to children with the following conditions: complement component deficiencies (C3, C5-C9, properdin, factor D, and factor H), HIV, and functional or anatomic asplenia (including sickle cell disease), as well as patients taking complement inhibitors (ie, eculizumab, ravulizumab). Booster doses should be administered as follows:
- If most recent dose before age 7 years, administer the booster dose 3 years later
- If most recent dose at age ≥7 years, administer the booster dose 5 years later
- Administer booster doses every 5 years thereafter throughout life or as long as the person remains at increased risk for meningococcal disease7
The recommendations for adolescents has also been amended. For children in whom boosters are not recommended, administer MenACWY according to the recommended adolescent schedule with 1 primary dose at 11 to 12 years of age and 1 booster dose at age 16 years.7
For children who are at high risk for meningococcal disease, the CDC recommends booster doses after completion of the primary series, but the dosing schedules are different for Menveo® and Menactra®. Menveo® can be used for children with anatomic or functional asplenia, HIV infection, and persistent complement component deficiency, as well as those who are taking complement inhibitor. Menactra® can be used for selected conditions, but the dosing schedules are different (Table).7