Updated Immunization Schedules for Children and Adults

Recent Morbidity and Mortality Weekly Report announcements from the Centers for Disease Control and Prevention (CDC) have outlined changes to the 2017 immunization schedules approved by the Advisory Committee on Immunization Practices for children and adolescents aged 18 years or younger, and for adults aged 19 years or older, in the United States.

Some of the key changes include:

Influenza vaccination: For the 2016-2017 season, clinicians should not use the quadrivalent, live attenuated, intranasal vaccine (LAIV4) for patients of any age, because studies have highlighted its low effectiveness. Also, individuals with a history of hives-only egg allergy can receive any age-appropriate inactivated influenza vaccine or recombinant influenza vaccine.

Human papillomavirus (HPV) vaccination: According to the updated guidelines, healthy individuals who start the HPV vaccination series before age 15 only need two doses of the vaccine, given at least 6 months apart. However, individuals who started the HPV vaccine series at 15 years or older still need to receive three doses of the vaccine. The guidelines recommend that clinicians should vaccinate any female under 26 years of age and any male under 21 years of age. Clinicians can also now begin the vaccination series in children as young as 9 years of age, even in the absence of a high-risk condition.

Both the bivalent and quadrivalent HPV vaccines have been removed from the immunization schedules. In addition, come May 2017, when the last doses of quadrivalent HPV vaccine will have expired, only the 9-valent HPV vaccine will be available in the United States.

Hepatitis B (HepB) vaccination: Clinicians are now advised to administer the HepB vaccine to newborns within 24 hours after birth. The new schedule also lists the types of liver disease that require patients to receive a HepB series. These include, but are not limited to, patients with hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, or autoimmune hepatitis, as well as patients with an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the normal upper limit.

Meningococcal vaccination: Two key changes have been made to the adult meningococcal vaccination schedule. First, adults with HIV infection should receive two doses of meningococcal conjugate vaccine (MenACWY). Second, the guideline also provides updated dosing guidance for one of the serogroup B meningococcal (MenB) vaccines (MenB-FHbp): Clinicians should give three doses of MenB-FHbp at 0, 1 to 2, and 6 months to adults who have an increased risk of meningococcal disease, and to those who receive vaccination during MenB disease outbreaks.

However, two doses of the vaccine at 0 and 6 months are sufficient for routine vaccination of healthy adolescents and young adults. The guidelines also now include recommendations for children with HIV infection to receive meningococcal vaccination. Although individuals aged 16 to 23 years of age can receive the vaccine, this requires a discretionary agreement between the clinician and the patient.

Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine: The schedule now recommends that pregnant adolescents receive one dose of the Tdap vaccine between weeks 27 and 36 of gestation.

The updated guidelines also include a table that outlines what vaccines might be required for children and adolescents aged 18 years or younger, based on their specific medical indications. It highlights that most children with medical conditions can, and should, be vaccinated according to the routine immunization schedule. It also provides guidance on whether a medical condition might either be a precaution or contraindication to vaccination, or might require an individual to receive additional doses of vaccines.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.