2015 Pediatric Immunization Schedule: Changes You Should Know
2015 Pediatric Immunization Schedule: Changes You Should Know
It's that time of year, when pediatric providers begin to look for any vaccine schedule changes recommended by the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention (CDC). The most recent recommendations were released on January 26 but will not be published in Pediatrics as they have been in the past. Instead, the schedules will be provided only online, allowing for real-time updates as any recommendations or products change. For those who are wedded to having a wall chart, however, color PDFs of the recommended schedule and the usual accompanying footnotes can be downloaded, printed, and placed on the office wall.
Compared with last year, there are relatively few changes to the recommendations or footnotes.
For some extensive past footnote revisions that still may be worth reviewing, see my commentary from last year related to changes in hepatitis A vaccine recommendations for infants who will be traveling and important changes in recommendations regarding when and how to sequence pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13). Given the small number of changes to the actual vaccine schedule, I will emphasize some of the new footnote details and some of the specific changes.
One of the advantages of the online schedule is that the footnotes are now links within the chart.
First, both the main and catch-up online charts are broken up into smaller age groups, allowing more detail to be placed on the charts themselves, thereby decreasing the need to always refer to the footnotes.
The first routine chart covers birth to 15 months, with the second covering 18 months to 18 years. The sequential footnotes can be accessed by simply scrolling down after the charts. The catch-up vaccine charts are divided into small age windows, such as 4 months to 6 years, and provide catch-up recommendations for all of the preschool vaccinations. In addition, each of these catch-up vaccine charts is appropriately indexed with hyperlinks to its own footnotes and other resources.
Another advantage of the online chart is that each numerical footnote on the chart is hyperlinked to the corresponding footnote text, allowing quick navigation to the needed information. In addition, the end of each footnote section contains a link to the catch-up vaccination schedule. When clicking on the catch-up vaccination schedule link, the chart appears again and is much easier to follow than were the old footnotes.
As an example of the additional detail displayed on the charts themselves, previously the ages at which some children would "age out" of the need for specific vaccines (eg, only one Haemophilus influenzae B vaccine is recommended after age 15 months) were conveyed in the footnotes. However, these age-out provisions are now shown directly on the charts.
Influenza vaccine. Most of the changes to the influenza vaccine section include additional clarifications and some contraindications. Previously, the guidance had listed asthma, a history of wheezing in the 12 months prior to vaccination, or any underlying medical condition that predisposed to influenza complications as contraindications. Additional contraindications listed this year that are specific to live-attenuated influenza vaccine (LAIV) include:
1. Persons who have experienced severe allergic reactions to LAIV, to any of its components, or to a previous dose of any other influenza vaccine;
2. Children 2 through 17 years receiving aspirin or aspirin-containing products;
3. Persons who are allergic to eggs;
4. Pregnant women;
5. Immunosuppressed persons;
6. Children 2 through 4 years of age with asthma or who had wheezing in the past 12 months; or
7. Persons who have taken influenza antiviral medications in the previous 48 hours.
The updated chart graphically offers additional detail about what vaccines should be given at 6 months to 2 years (inactivated only), the fact that many children 6 months to 9 years will need two vaccines, and the fact that children ≥ 9 years need only one, all providing much more detail than the 2014 chart.
Measles, mumps, rubella (MMR). This chart now displays a purple bar that hyperlinks to a footnote, detailing specific MMR vaccination recommendations for infants < 12 months old. Children < 12 months old who travel internationally should receive one dose before departure. However, note that these children will still require the usual two-dose schedule, beginning at the usual age of 12 months, as they age. In a similar vein, any child who is 12 months or older and travelling internationally should receive two doses of MMR vaccine starting at 12 months, and given at least 4 weeks apart, all prior to departure.
Meningococcal vaccine. There are no changes in the recommendations for which patients should receive the meningococcal vaccine on a routine basis or for the "high-risk" groups who should also receive it. The high-risk groups include children with functional or anatomic asplenia, children with persistent complement component deficiency, and children traveling to endemic areas. The major change here is the change in the footnote display. The new footnote section for meningococcal vaccine is almost chart-like, with clearer distinctions of what each child should receive based on which of the three approved preparations (MenACWY-CRM, MenACWY-D, or Hib-MenCY-TT) the child received.
Overall, the 2015 schedule contains minor alterations to the actual recommendations but some substantial improvements in the "user-friendliness" of the charts. Finally, the online schedule includes links to some great parental vaccine resources, including parent- and child-friendly graphical charts of vaccine recommendations and a tool that one can use to give parents a dated schedule specific to their child about when each of the vaccines should be received. Check it out!
Update on the 2015 Child and Adolescent Vaccine Schedule Recommendations
It's that time of year, when pediatric providers begin to look for any vaccine schedule changes recommended by the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention (CDC). The most recent recommendations were released on January 26 but will not be published in Pediatrics as they have been in the past. Instead, the schedules will be provided only online, allowing for real-time updates as any recommendations or products change. For those who are wedded to having a wall chart, however, color PDFs of the recommended schedule and the usual accompanying footnotes can be downloaded, printed, and placed on the office wall.
Compared with last year, there are relatively few changes to the recommendations or footnotes.
For some extensive past footnote revisions that still may be worth reviewing, see my commentary from last year related to changes in hepatitis A vaccine recommendations for infants who will be traveling and important changes in recommendations regarding when and how to sequence pneumococcal polysaccharide vaccine (PPSV23) and pneumococcal conjugate vaccine (PCV13). Given the small number of changes to the actual vaccine schedule, I will emphasize some of the new footnote details and some of the specific changes.
Advantages of Online Charts
One of the advantages of the online schedule is that the footnotes are now links within the chart.
First, both the main and catch-up online charts are broken up into smaller age groups, allowing more detail to be placed on the charts themselves, thereby decreasing the need to always refer to the footnotes.
The first routine chart covers birth to 15 months, with the second covering 18 months to 18 years. The sequential footnotes can be accessed by simply scrolling down after the charts. The catch-up vaccine charts are divided into small age windows, such as 4 months to 6 years, and provide catch-up recommendations for all of the preschool vaccinations. In addition, each of these catch-up vaccine charts is appropriately indexed with hyperlinks to its own footnotes and other resources.
Another advantage of the online chart is that each numerical footnote on the chart is hyperlinked to the corresponding footnote text, allowing quick navigation to the needed information. In addition, the end of each footnote section contains a link to the catch-up vaccination schedule. When clicking on the catch-up vaccination schedule link, the chart appears again and is much easier to follow than were the old footnotes.
As an example of the additional detail displayed on the charts themselves, previously the ages at which some children would "age out" of the need for specific vaccines (eg, only one Haemophilus influenzae B vaccine is recommended after age 15 months) were conveyed in the footnotes. However, these age-out provisions are now shown directly on the charts.
Influenza vaccine. Most of the changes to the influenza vaccine section include additional clarifications and some contraindications. Previously, the guidance had listed asthma, a history of wheezing in the 12 months prior to vaccination, or any underlying medical condition that predisposed to influenza complications as contraindications. Additional contraindications listed this year that are specific to live-attenuated influenza vaccine (LAIV) include:
1. Persons who have experienced severe allergic reactions to LAIV, to any of its components, or to a previous dose of any other influenza vaccine;
2. Children 2 through 17 years receiving aspirin or aspirin-containing products;
3. Persons who are allergic to eggs;
4. Pregnant women;
5. Immunosuppressed persons;
6. Children 2 through 4 years of age with asthma or who had wheezing in the past 12 months; or
7. Persons who have taken influenza antiviral medications in the previous 48 hours.
The updated chart graphically offers additional detail about what vaccines should be given at 6 months to 2 years (inactivated only), the fact that many children 6 months to 9 years will need two vaccines, and the fact that children ≥ 9 years need only one, all providing much more detail than the 2014 chart.
Measles, mumps, rubella (MMR). This chart now displays a purple bar that hyperlinks to a footnote, detailing specific MMR vaccination recommendations for infants < 12 months old. Children < 12 months old who travel internationally should receive one dose before departure. However, note that these children will still require the usual two-dose schedule, beginning at the usual age of 12 months, as they age. In a similar vein, any child who is 12 months or older and travelling internationally should receive two doses of MMR vaccine starting at 12 months, and given at least 4 weeks apart, all prior to departure.
Meningococcal vaccine. There are no changes in the recommendations for which patients should receive the meningococcal vaccine on a routine basis or for the "high-risk" groups who should also receive it. The high-risk groups include children with functional or anatomic asplenia, children with persistent complement component deficiency, and children traveling to endemic areas. The major change here is the change in the footnote display. The new footnote section for meningococcal vaccine is almost chart-like, with clearer distinctions of what each child should receive based on which of the three approved preparations (MenACWY-CRM, MenACWY-D, or Hib-MenCY-TT) the child received.
Overall, the 2015 schedule contains minor alterations to the actual recommendations but some substantial improvements in the "user-friendliness" of the charts. Finally, the online schedule includes links to some great parental vaccine resources, including parent- and child-friendly graphical charts of vaccine recommendations and a tool that one can use to give parents a dated schedule specific to their child about when each of the vaccines should be received. Check it out!