COMMENTARY

2017 Child Vaccine Schedule: Goodbyes and Hellos

William T. Basco, Jr., MD, MS

Disclosures

February 06, 2017

The 2017 child and adolescent immunization schedule, a joint statement by the Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, was published on February 6, 2017. As usual, there are some new things in the schedule this year ("hellos"), things leaving the schedule this year ("goodbyes"), and things that fall somewhere in between.

The Biggest Changes: Goodbyes

LAIV. Say goodbye to live attenuated influenza vaccine (LAIV). Most pediatric providers have already heard of this recommendation and all of the hubbub that went along with it, but the updated recommendations formally remove LAIV from the recommended schedule. This was actually announced in June 2016, so practitioners have heard about this.

Three-dose HPV vaccine. Say goodbye to a three-dose human papillomavirus (HPV) series. Again, most pediatric providers have likely heard that new recommendations are for a two-dose series for any individual who begins the series before turning 15 years old. This recommendation came about on the basis of a comparison of antibody responses among patients who received two- versus three-dose regimens and the field data on infections after two- versus three-dose regimens.[1] The two doses of vaccine should be given 6-12 months apart. Current recommendations are to vaccinate any female under 26 years of age and any male under 21 years. Any individual who starts the series after turning 15 should continue with the previous three-dose series, as should individuals who might be considered immunocompromised.

Products off the market. Say goodbye to products that are now off the market. All 7-valent pneumococcal conjugate vaccine (PCV-7) vaccines have expired and are no longer part of any recommended schedule. All subjects should now receive PCV-13 vaccines.

Goodbye also to divalent and quadrivalent HPV vaccines. Beginning in May 2017, when the last doses of quadrivalent HPV vaccine have expired, the only HPV vaccine available in the United States will be the 9-valent formulation.

The Biggest Changes: Hellos

Two-dose HPV vaccine. Say hello to a recommendation that one may begin the two-dose HPV series at age 9 years. The recommendation is to begin the series at that age in any child who is a victim of sexual abuse or assault. In fact, those who receive it at age 9 appear to have a more robust immune response. In the same vein, giving the two-dose series 12 months apart appears to provoke a better immune response than giving it at 6 months apart, but any time 6-12 months after the initial vaccine is acceptable.

Hepatitis B vaccine. Say hello to a new recommendation that the hepatitis B vaccine should be administered to newborns during the first 24 hours after birth. This represents a more stringent recommendation to get the vaccine in early.

Tdap in pregnancy. Say hello to a clear recommendation that every pregnant adolescent should receive one dose of tetanus-diphtheria-acellular pertussis vaccine (Tdap), ideally administered between 27 and 36 weeks of gestation. This should really be repeated for each pregnancy, consistent with recommendations for older mothers.

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