CDC's ACIP Fine-Tunes Vaccine Schedule for Children and Teens

Diana Swift

October 20, 2016

Several updates to the vaccination schedule for children and adolescents were approved this week by the Advisory Committee on Immunization Practices (ACIP), an expert panel that counsels the Centers for Disease Control and Prevention (CDC).

In addition to giving the nod to a new two-dose regimen for the human papillomavirus (HPV) vaccine in young people 9 to 15 years of age, ACIP also voted in some changes for other vaccines in the 2017 schedule. After approval by the CDC director, the updates from ACIP's October meeting will be published early in 2017 in the CDC's Morbidity and Mortality Weekly Report.

The fine-tuning of the 2017 schedule does not represent shifts in policy but rather translates policies previously approved by different work groups, explained ACIP member José Romero, MD, a pediatric infectious diseases specialist based in Little Rock, Arkansas, at an ACIP session on Thursday. "The intent of the edits are to improve the readability of the document and put the recommendations in language easy to interpret for use by busy practitioners."

Among the many changes presented by Candice Robinson, MD, MPH, an officer with the CDC's Epidemic Intelligence Service in Atlanta, Georgia, were the following:

  • The age-16 category has been separated out from ages 17 and 18 and placed in a shaded column. The work group felt this would highlight the need for meningococcal conjugate booster vaccines at this age and perhaps provide an opportunity to give catch-up vaccines when other adolescent vaccines have not yet been administered or the series has not yet been completed. No changes were made to catch-up schedules.

  • For influenza, reference to the live activated influenza vaccine (LAIV) has been removed in light of ACIP's recommendation against using LAIV in the 2016–2017 flu season.

  • The HPV vaccine may be given to all 9- and 10-year-olds, regardless of whether they have a history of sexual assault or abuse, as was the previous stipulation.

  • A "high-risk" graphic has been added to stress that most young people with medical conditions can and should be vaccinated according to routine schedules. It indicates conditions that are contraindications to vaccination or require caution, as well as conditions that may require additional doses. Children with HIV infection have been added to this list.

  • Hepatitis B information has been updated to reflect that the vaccine should be administered within 24 hours of birth and that infants of hepatitis B surface antigen–positive mothers should be tested at 9 and 12 months of age.

  • The Haemophilus B (Hib) influenza vaccine Hiberix (GlaxoSmithKline) is now recommended for use in primary series and not just booster doses. Comvax (Merck) has been deleted from recommendations as it is no longer produced and all doses have expired.

  • Children aged 9 to 59 months need only one catch-up dose for Hib.

  • For pneumococcal series, the PCV 7 vaccine has been removed because all doses expired in 2010 and patients who received it in primary series have aged out.

  • In the meningococcal B category, young adults aged 16 to 23 years (optimal, 16 to 18 years) may be vaccinated with a two-dose series of Bexsero (GlaxoSmithKline) at 0 months and at least 1 month or Trumenba (Pfizer) at 0 and 6 months. If the second dose of Trumenba is given sooner than 6 months after the first, then a third dose should be given at least 6 months after the first.

  • Pregnant adolescents should have one dose of tetanus-diphtheria-pertussis (Tdap) vaccine at 27 to 36 weeks' gestation in each pregnancy regardless of time since previous immunization.

  • Children who receive Tdap at ages 7 to 10 years as part of a catch-up series may receive Tdap at ages 11 to 12 years.

  • HPV vaccine should be routinely given on a two-dose schedule to all children aged 11 to 12 years and even as young as age 9 years. Adolescents through age 18 years not adequately vaccinated previously should receive the HPV vaccine, with the number of doses based on age at first vaccination. The immunocompromised require three doses at 0, 1 to 2, and 6 months.

  • HPV vaccination is not recommend during pregnancy. An adolescent who becomes pregnant during the immunization series requires no intervention but should delay further doses until after delivery.

Attendees commented that the information on high-risk patients would be very helpful in practice, especially if it could be integrated in a practical way into prompts or alerts in electronic medical records or codes to flag high-risk patients.

Another observer noted that the minimum intervals for the two-dose vaccines might need reexamination. The commentator offered the example that if a second dose of Trumenba is given too early and a third is required, this should be given no sooner than at 6 months, a later time than that for a regular three-dose schedule.

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