Updated Recommendations for Pediatric Immunization Schedules in the United States

In conjunction with its release of the adult guidelines earlier this year, the United States Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) earlier this year issued its annual update on pediatric immunization schedules, published in the Morbidity and Mortality Weekly Report.¹

Updates in the 2019 immunization schedule for children and adolescents aged ≤18 years include new or revised ACIP recommendations for hepatitis A vaccine, hepatitis B vaccine, influenza vaccine, and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, as well as clarification of the recommendations for inactivated poliovirus vaccines. The additional recommendations are as follows:²

1. The live attenuated influenza vaccine is now again recommended for children aged ≥24 months. The ACIP notes there are several contraindications for the administration of the live vaccine: children aged <2 years, the routine use of aspirin or other salicylates, immunosuppression (including HIV and functional or anatomic asplenia), children aged 2 years to 4 years who experienced asthma or wheezing in the 12 months before vaccination, the administration of influenza antiviral medications <48 hours before vaccination, and allergy to any component of the vaccine or a previous allergic reaction to the vaccine. Several other lower-grade precautions can be found in the full pamphlet.
2. Homelessness has been added to the list of indications for the hepatitis A vaccine. In addition, adolescents aged ≥18 years may receive a combination vaccine for prophylaxis of hepatitis A and hepatitis B, as a 3-dose series (0, 1, and 6 months) or a 4-dose series (0, 7, and 21-30 days, followed by a dose at 12 months). Further, the ACIP recommends travel prophylaxis. For infants aged 6 months to 11 months: 1 dose before departure and a 2-dose revaccination between ages 12 months and 23 months, separated by 6 to 18 months. For unvaccinated infants aged ≥12 months: the first dose as soon as travel is considered.
3. The new CpG-adjuvanted hepatitis B vaccine is recommended for adolescents aged ≥18 years by the administration of a 2-dose series of the vaccine at least 4 weeks apart.
4. For vaccine series containing oral polio vaccine (either mixed oral polio/inactivated polio or oral only), the total number of doses needed to complete the series is the same as that recommended for the inactivated polio vaccine schedule. Broadly, this requires 4 doses of the inactivated polio vaccine by age 4 years, with the last dose occurring on or after the fourth birthday; for the detailed inactivated polio vaccine schedule, see this guidance.
5. With regard to tetanus prophylaxis, the ACIP updated recommendations to indicate that children aged 7 years to 10 years who, inadvertently or as part of a catch-up schedule, received a dose of the Tdap vaccine or the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine should still receive the routine dose of Tdap between the ages of 11 years and 12 years.

In addition to the inclusion of these updates, the ACIP has also removed all recommendations for the management of outbreaks such as measles, mumps, rubella, and meningitis in favor of directing clinicians to state and/or local health departments for vaccination procedures during outbreaks.

The ACIP also added color-specific banners, highlights, and tables to indicate and categorize vaccine indications, precautions, and contraindications, based on comorbid medical condition. Overall, the CDC hopes that the pediatric immunization schedule has been simplified in language, instruction, and indications for administration to facilitate ease of use in counseling parents and encourage the widespread vaccination of pediatric patients against preventable diseases.

References

1. Robinson CL, Bernstein H, Romero JR, Szilagyi P. Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger — United States, 2019. MMWR. 2019;68(5):112-114.

2. United States Centers for Disease Control and Prevention. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2019. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html. Accessed August 6, 2019.

This article originally appeared on Infectious Disease Advisor