What's New in the Pediatric Vaccination Schedule?

The US Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has provided updates on vaccination schedules for both adult Immunization Schedule for ages 19 years or older and children and young adults.

In a recent issue of the CDC’s Morbidity and Mortality Weekly Report, authors provide details on the new ACIP recommendations for children and adolescents aged 18 years and younger. The recommendations were determined at ACIP’s October 2019 meeting.

Changes in the 2020 immunization schedule for children and adolescents include new and updated recommendations for the influenza vaccine, meningococcal B vaccine, hepatitis A vaccine, and more.

Updates also reflect new recommendations for tetanus and diphtheria toxoids (Td) and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines.

For decennial tetanus booster doses and catch up series in people who have previously received Tdap, Td and Tdap are now permitted to be used interchangeably in some cases.

Hemophilus influenzae type b vaccine notes were updated to reflect that catch-up vaccination is not recommended for unvaccinated children 5 years or older who do not have high risk.

Additional information has been added to the notes on oral polio vaccine to clarify that only trivalent vaccines count toward vaccination requirements.

The authors wrote that for catch-up vaccination, doses of oral polio vaccine administered before April 1, 2016, should be counted. On the other hand, doses administered on or after April 1, 2016 should not be counted towards catch-up vaccination.

Hepatitis A notes were revised to reflect the recommendation that adolescents and children between 2 and 18 years of age who have not previously received a hepatitis A vaccine should receive catch-up vaccination and complete a 2-dose series.

The “special situations” section of the hepatitis B vaccine notes were updated to explain which populations revaccination should be considered for. Revaccination is not recommended for people with standard immune status who have already been vaccinated.

On the other hand, the new notes indicate that revaccination may be recommended for infants born to hepatitis B positive mothers, immunocompromised persons, and hemodialysis patients.

Guidance related to the meningococcal A, C, W and Y (MenACWY) vaccine for children who received the vaccine prior to age 10 years has been added to the MenACWY section.

For children who are at increased risk of meningococcal disease, including reasons such as asplenia or HIV, the booster schedule for persons at increased risk applies.

For children for whom boosters are not recommended—for example those who received a single dose of vaccine for travel to an endemic country—MenACWY should be administered with 1 dose at age 11-12 years of age and a second dose at 16 years of age.

Meningococcal B vaccine (MenB) booster doses are now recommended for children and adolescents aged 10 years or older who have a complement deficiency, use complement inhibitors, persons with asplenia, and people determined by public health officials to be at greater risk during an outbreak.

As a rising number of children have parents who take advantage of non-medical vaccine exemptions, it will be important for clinicians to communicate the value and safety of vaccination for any vaccine recommendations to have a real world impact.

It has been demonstrated that increases in vaccine-preventable disease shape political responses which limit the ability to use non-medical vaccine exemptions. But hopefully, improved communication between providers and parents can prevent the problem before it occurs.