Every winter, the Centers for Disease Control and Prevention (CDC) promulgate the newest immunization schedules for children and adults. These schedules, along with the catch-up immunization schedule, are approved by the Advisory Committee on Immunization Practice (ACIP) as well as the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the American College of Obstetrician and Gynecologists.

This article provides a synopsis of the most important changes since last year.

The Recommended Immunization Schedules for Persons Aged 0 through 18 years and Adults 19 Years and Older are available on the CDC website: www.cdc.gov/vaccines/schedules/hcp. Please note: when reviewing the schedules, the footnotes contain important information such as vaccine intervals, exceptions to the vaccine schedule and information regarding vaccination of special populations.

New Immunization Schedule for Children with Certain Medical Conditions

A new figure has been added to the schedule for children and adolescents aged 18 or younger entitled “Figure 3. Vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications”. Per the CDC, the purpose of this new figure is to do the following¹:

• Demonstrate that most children with medical conditions can (and should) be vaccinated according to the routine child and adolescent immunization schedule
• Indicate when a medical condition is a precaution or contraindication to vaccination
• Indicate when additional doses of vaccines may be necessary because of a child’s or adolescent’s medical condition.
   

Significant Changes in Vaccine Recommendations

• Hepatitis B for Newborns – ACIP now recommends vaccination of all newborns within 24 hours of birth. The previous recommendation called for infants to receive a dose of hepatitis B vaccine prior to discharge.
  
  ACIP also revised recommendations for post–vaccination serology (PVS) testing of infants born to hepatitis B surface antigen (HBsAg) positive mothers. PVS testing is now recommended at 9–12 months of age, instead of 9–18 months. This shortened interval facilitates testing at either the 9 month or 12 month well-child visit and shortens the time period during which non-responders are at risk for transmission from close contacts with hepatitis B. Earlier testing also enables prompt revaccination with a second series of hepatitis B of these infant non-responders.
   
• HPV - see expanded section "Human Papillomavirus Vaccine - ACIP Approves 2 Dose Schedule" below.

   

• Meningococcal B (MenB) – In December 2016, the Food and Drug Administration approved a 2-dose schedule (0, 6 months) for MenB – FHbp (Trumenba). The ACIP now recommends the choice of MenB vaccine be based on the patient’s risk of exposure and the patient’s susceptibility to meningococcal serogroup B disease. The new dosing schedule calls for persons ages 16–23 years who are not at increased risk for meningococcal disease to be vaccinated using the 2–dose schedule for either Trumenba or Bexsero (MenB – 4C). Bexsero should be administered at 0 and 1 months. Persons at increased risk for meningococcal disease should receive three doses of Trumenba at 0, 1–2, and 6 months or Bexsero (0, 1 month).

   

• Meningococcal Conjugate Vaccine - see expanded section "Meningococcal Conjugate Vaccine – New Recommendations for Patients with HIV" below.
   
• Polio – Children age 4 or older who have received only four doses of oral polio vaccine (OPV) are not considered adequately vaccinated and should have an additional dose of inactivated polio vaccine (IPV).  It is now recommended that this additional IPV dose be administered at least 6 months (not 1 month) from the last OPV dose. This interval was changed so that the vaccination schedules for both IPV and OPV are the same. Children who have received a combination of four doses of OPV and IPV at 2, 4, 6 months, and 4–6 years  are considered adequately vaccinated if the last dose was on or after the 4th birthday.

   

• Tdap in Pregnancy – The recommendation for Tdap vaccination during pregnancy changed slightly to encourage providers to administer the vaccine during the early part of gestational weeks 27 through 36, instead of anytime during the same period. The CDC recommends providing Tdap vaccine earlier in the pregnancy because it increases antibody produced by the mother and subsequently transferred to the infant.

   

Expanded Immunization-Related Information

Human Papillomavirus Vaccine - ACIP Approves 2–Dose Schedule

In 2016, ACIP published a new 2–dose HPV vaccine recommendation for pre–teens and adolescents less than 15 years of age. The new recommendation allows for a 2–dose (0, 6–12 months) HPV vaccine series for girls and boys who begin the vaccination series between the ages of 9-14 years. The new dosing schedule is based on new immunogenicity data which showed that two doses administered to adolescents was just as effective as three doses.²

The dosing schedule for adolescents and young adults who begin the vaccination series on or after their 15^th birthday remains unchanged. This population should continue to receive three doses of HPV vaccine at 0, 1–2, and 6 months.  In addition, persons who are immunocompromised, including those with human immunodeficiency virus (HIV), should receive a three dose series at the same intervals (Table 1).

Review the CDC catch–up immunization schedule to determine if patients have completed the HPV series or require additional doses. Additional information regarding the two–dose schedule, including safety and efficacy data, is available on the CDC website.

Table 1. HPV Vaccination Schedule

Meningococcal Conjugate Vaccine – New Recommendations for Patients with HIV

New recommendations for routine meningococcal vaccination of human immunodeficiency virus (HIV) infected persons 2 months of age and older (Table 2) were recently published by ACIP. The following are details regarding the new recommendation³:

• Children < 2 years require multiple doses of meningococcal conjugate vaccine to complete the series. Review footnote 11 of the pediatric schedule for specific details. 
• Persons ≥ 2 years with HIV infection who have not been previously vaccinated should receive a 2–dose primary series (at least 8 weeks apart) of meningococcal conjugate vaccine.
• The number of booster doses and recommended intervals is dependent on the patient’s age.
• Persons who have been previously vaccinated with meningococcal conjugate vaccine should receive a booster dose at the earliest opportunity (at least 8 weeks after the previous dose) and then continue to receive booster doses at the appropriate intervals.

Table 2. Meningococcal Conjugate Vaccinations Schedule for HIV – Positive Patients

Conclusion

Vaccines protect infants, children, and adults against serious communicable diseases, if administered per the CDC guidelines. Please share the updated schedules with all health care personnel in your facility, especially those staff who provide immunization services. Also, replace any copies of the 2016 schedule posted in your facility with the new 2017 version. For more information on the immunization schedule, including recommended routine intervals, and contraindications and precautions to vaccine, visit the Immunization Program website. 

References

1. Robinson CL, Romero JR, Kempe A, Pellegrini C. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:134–135. DOI: http://dx.doi.org/10.15585/mmwr.mm6605e1
2. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2016; 65:1405–1408. DOI: http://dx.doi.org/10.15585/mmwr.mm6549a5
3. MacNeil JR, Rubin LG, Patton M, Ortega-Sanchez IR, Martin SW. Recommendations for Use of Meningococcal Conjugate Vaccines in HIV-Infected Persons — Advisory Committee on Immunization Practices, 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1189–1194. DOI: http://dx.doi.org/10.15585/mmwr.mm6543a3