The Centers for Disease Control and Prevention (CDC)1 and the American Academy of Pediatrics (AAP)2 have released updated pediatric immunization schedules for 2017.
Among the most notable changes in the AAP’s Recommended Childhood and Adolescent Immunization Schedule—United States, 2017 is the removal of the live attenuated influenza vaccine as an option for vaccination against influenza, according to Theoklis Zaoutis, MD, MSCE, a member of the AAP committee that authored the immunization schedule report.
Zaoutis says this is a big deal for pediatricians.
“The vaccine has been shown to have decreased effectiveness,3” says Zaoutis, professor of pediatrics and of epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and chief of the infectious diseases’ division at the Children’s Hospital of Philadelphia.
The CDC’s Advisory Committee on Immunization Practices (ACIP) and the AAP are on the same page with this the recommendation, he says.
Another change to highlight and one that’s also in the CDC’s latest document, according to Zaoutis: Human papillomavirus (HPV) vaccine can now be given to children aged 9 and 10 years. “This is to try to improve vaccination rates against HPV, which are low because it is often hard to capture teenagers and vaccinate them,” Zaoutis says.
A third change of note is that a meningococcal booster is needed at age 16 years—another recommendation that both groups endorse, according to Zaoutis.
The CDC sets the US childhood and adult immunization schedules and updates them annually based on recommendations from the ACIP, which is a group of medical and public health experts that make immunization recommendations based on the latest science available for each vaccine, according to Candice Robinson, MD, MPH, a pediatrician in the CDC's Immunization Services Division and the lead author on the childhood immunization schedule, published February 10, 2017, in the Morbidity and Mortality Weekly Report (MMWR).
The AAP, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists also approve the resulting CDC immunization schedules, along with the ACIP.
This year’s update to the pediatric immunization schedule includes changes to influenza; HPV; Haemophilus influenzae type b (Hib); pneumococcal; hepatitis B (HepB); diphtheria, tetanus, and acellular pertussis (DTaP); tetanus, diphtheria, and acellular pertussis (Tdap); and meningococcal vaccines.
Like in the AAP’s updated recommendations, the CDC has removed the live attenuated influenza vaccine and is not recommending it for the 2016 and 2017 seasons.3
In addition, the CDC recommends the HPV vaccine for children aged 9 and 10 years, even in the absence of a high-risk condition. Whereas the vaccination may be started at age 9, the recommended age for routine vaccination is still age 11 to 12 years.4 The CDC also updated the HPV vaccine recommendation to include the new 2-dose schedule for children starting the HPV vaccination series before age 15 years. The 2vHPV has been removed from the schedule because the vaccine is no longer available in the US market and all vaccine doses have expired, Robinson says.
“Within the [Haemophilus influenzae type b] footnote, Comvax [Merck] was removed from the routine vaccination portion of the footnote. This vaccine has been removed from the market and all available doses have expired,” Robinson says. “Additionally, Hiberix has been added to the list of vaccines that may be used for the primary vaccination series.”5
The CDC recommendations no longer reference the 7-valent pneumococcal conjugate vaccine (PCV7). “All healthy children who may have received PCV7 as part of a primary series have now aged out of the recommendation for pneumococcal vaccine,” Robinson says.
The government revised its recommendation for the HepB vaccine to reflect that the birth dose of hepatitis B vaccine should be administered within 24 hours of birth for medically stable infants weighing 2000 grams or more, born to hepatitis B surface antigen (HBsAg)-negative mothers, according to Robinson.6
“The recommendations for vaccination of infants [greater than] 2000 grams (as well as infants born to HBsAg-positive mothers or a mother whose hepatitis B status is unknown) remain unchanged,” Robinson says.
Changes to the DTaP vaccine recommendation more clearly present recommendations following an inadvertently early administered fourth dose of DTaP vaccine, according to Robinson.
The recommendation for Tdap vaccination of pregnant adolescents between gestational weeks 27 to 36 was updated to reflect a preference for vaccination earlier during this period, Robinson says. “Currently available data suggest that vaccinating earlier in the 27th through 36th week period will maximize passive antibody transfer to the infant,” she notes.7
Like the AAP, the CDC recommends a meningococcal conjugate (MenACWY) vaccine booster dose at age 16 years. The revised document highlights the recommendation in a separate age 16 column in Figure 1, according to Robinson.
“The meningococcal vaccines footnote has been updated to include recommendations for meningococcal vaccination of children with human immunodeficiency virus (HIV) infection and to reflect recommendations for the use of a 2-dose Trumenba (meningococcal B vaccine) schedule,” Robinson says.8,9
1. Robinson CL, Romero JR, Kempe A Pellegrini C: Advisory Committee on Immunization Practices (ACIP) Child/Adolescent Immunization Work Group. 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(5):134-135.
2. Committee on Infectious Diseases. Policy statement: Recommended Childhood and Adolescent Immunization Schedule—United States, 2017. Pediatrics. 2017;139(3):e20164007.
3. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines. MMWR Rep Recomm Rep. 2016;65(5):1-54.
4. Meites E, Kempe A, Markowitz LE. Use of 2-dose schedule for human papillomavirus vaccination—updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65(49):1405-1408.
5. Briere EC. Food and Drug Administration approval for use of Hiberix as a 3-dose primary Haemophilus influenzae type b (Hib) vaccination series. MMWR Morb Mortal Wkly Rep. 2016;65(16):418-419.
6. Advisory Committee on Immunization Practices (ACIP). Updated 2016 ACIP statement on October 2016 hepatitis B vaccination recommendations (publication pending). Relevant ACIP presentation slides available at https://www.cdc.gov/vaccines/acip/meetings/slides-2016-10.html.
7. Advisory Committee on Immunization Practices (ACIP). Updated ACIP statement on October 2016 tetanus and diphtheria toxoids and acellular pertussis vaccination recommendations (publication pending). Relevant ACIP presentation slides available at: https://www.cdc.gov/vaccines/acip/meetings/slides-2016-10.html
8. 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(43(:1189-1194.
9. Advisory Committee on Immunization Practices (ACIP). Updated ACIP statement on October 2016 meningococcal vaccination recommendations (publication pending). Relevant ACIP presentation slides available at: https://www.cdc.gov/vaccines/acip/meetings/slides-2016-10.html.