In the Journals

AAP updates policy statement on immunization schedule

AAP has issued an updated policy statement about changes to this year’s childhood and adolescent immunization schedule made by the CDC, which includes the removal of references to the live-attenuated influenza vaccine.

ACIP approved an update in June 2016 for the 2016-2017 season that stated that live-attenuated influenza vaccine (LAIV) should not be used in any setting. The vote passed 13 to 1, with one abstention.

 “The 2017 recommended childhood and adolescent immunization schedules have been approved by the AAP, the Advisory Committee on Immunization Practices of the CDC, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists,” Carrie L. Byington, MD, FAAP, chairperson of the Committee on Infectious Disease for 2016-2017, and colleagues wrote. “The schedules are revised annually to reflect current recommendations for the use of vaccines licensed by the U.S. FDA.”

The greatest number of changes were made to Figure 1 of the immunization schedule, which outlines the recommended immunization schedule for children and adolescents aged 18 years and younger, and the footnotes included in the schedule.

Specific changes to Figure 1 for the 2017 include:

  • A column has been added for adolescents at 16 years of age. This age group has been separated from children aged 17 to 18 years to emphasize the need for a meningococcal conjugate vaccine booster dose at age 16.
  • Reference to LAIV has been removed from the influenza vaccine row.
  • A blue bar has been added to the human papillomavirus (HPV) vaccine row at 9 to 10 years to indicate that, even in the absence of a high-risk condition, children may receive HPV vaccine series at this age.

Updates to footnotes in the report include:

  • Hepatitis B: Updated recommendations reflect that a monovalent birth dose should be administered to all newborns within 24 hours of birth. Revised wording indicates that infants born to hepatitis B surface antigen-positive mothers should be tested for HBsAg and antibody to HBsAg at 9 through 12 months (rather than 9 through 18 months).
  • Haemophilus influenzae type b: Comvax vaccine (Merck, Whitehouse Station, NJ) has been removed because the vaccine is no longer commercially available and all available doses have expired. Hiberix [Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate); GlaxoSmithKline Biologicals] has been added to the list of vaccines that may be used for a primary vaccination series.
  • Pneumococcal conjugate: References to Prevnar 7 (7-valent pneumococcal conjugate vaccine; Pfizer) have been removed because all children who may have received PCV7 as part of a primary series have now aged out of the recommendation for pneumococcal vaccine.
  • Influenza: Wording has been added to indicate that LAIV is not recommended for the 2016-2017 influenza season.
  • Meningitis ACWY conjugate vaccine: Recommendations now include vaccination of children with HIV infection.
  • Meningococcal B: Wording has been modified to note that persons aged 16 through 23 years may be vaccinated on the basis of clinical discretion. Updated recommendations regarding a 2-dose Trumenba (MenB-FHbp, Wyeth Pharmaceuticals) schedule have been added.
  • Tdap: Revised wording indicates a preference for administration of one dose for pregnant adolescents; this dose should be administered as early as possible in the 27- to 36-week gestational period. Wording is changed to indicate that for children aged 7 through 10 years who receive Tdap as part of a catch-up series, either Tdap or a booster vaccine for tetanus and diphtheria may be administered for the adolescent dose at 11 through 12 years.
  • HPV: Wording reflects that the number of recommended doses is based on age at administration of the first dose. Two doses are recommended for persons starting the series before their 15th birthday, whereas three doses are recommended for those who start the series on or after their 15th birthday and for persons with certain immunocompromising conditions. The bivalent HPV vaccine, 2vHPV (Cervarix; GlaxoSmithKline), has been removed from the schedule because this vaccine is no longer available and all available doses expired before January 1, 2017.

The updated immunization schedule also includes a new table, Figure 3, discussing which vaccines may be designated for persons aged 0 to 18 years who have a particular medical indication. This figure, which appears in the child and adolescent immunization schedule, is similar to Figure 2 in the schedule for adult immunizations.

Clinically significant adverse events following an immunization should continue to be reported to the Vaccine Adverse Event Reporting System, according to the report. – by Julia Ernst, MS

Disclosures: The researchers report no relevant financial disclosures.

AAP has issued an updated policy statement about changes to this year’s childhood and adolescent immunization schedule made by the CDC, which includes the removal of references to the live-attenuated influenza vaccine.

ACIP approved an update in June 2016 for the 2016-2017 season that stated that live-attenuated influenza vaccine (LAIV) should not be used in any setting. The vote passed 13 to 1, with one abstention.

 “The 2017 recommended childhood and adolescent immunization schedules have been approved by the AAP, the Advisory Committee on Immunization Practices of the CDC, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists,” Carrie L. Byington, MD, FAAP, chairperson of the Committee on Infectious Disease for 2016-2017, and colleagues wrote. “The schedules are revised annually to reflect current recommendations for the use of vaccines licensed by the U.S. FDA.”

The greatest number of changes were made to Figure 1 of the immunization schedule, which outlines the recommended immunization schedule for children and adolescents aged 18 years and younger, and the footnotes included in the schedule.

Specific changes to Figure 1 for the 2017 include:

  • A column has been added for adolescents at 16 years of age. This age group has been separated from children aged 17 to 18 years to emphasize the need for a meningococcal conjugate vaccine booster dose at age 16.
  • Reference to LAIV has been removed from the influenza vaccine row.
  • A blue bar has been added to the human papillomavirus (HPV) vaccine row at 9 to 10 years to indicate that, even in the absence of a high-risk condition, children may receive HPV vaccine series at this age.

Updates to footnotes in the report include:

  • Hepatitis B: Updated recommendations reflect that a monovalent birth dose should be administered to all newborns within 24 hours of birth. Revised wording indicates that infants born to hepatitis B surface antigen-positive mothers should be tested for HBsAg and antibody to HBsAg at 9 through 12 months (rather than 9 through 18 months).
  • Haemophilus influenzae type b: Comvax vaccine (Merck, Whitehouse Station, NJ) has been removed because the vaccine is no longer commercially available and all available doses have expired. Hiberix [Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate); GlaxoSmithKline Biologicals] has been added to the list of vaccines that may be used for a primary vaccination series.
  • Pneumococcal conjugate: References to Prevnar 7 (7-valent pneumococcal conjugate vaccine; Pfizer) have been removed because all children who may have received PCV7 as part of a primary series have now aged out of the recommendation for pneumococcal vaccine.
  • Influenza: Wording has been added to indicate that LAIV is not recommended for the 2016-2017 influenza season.
  • Meningitis ACWY conjugate vaccine: Recommendations now include vaccination of children with HIV infection.
  • Meningococcal B: Wording has been modified to note that persons aged 16 through 23 years may be vaccinated on the basis of clinical discretion. Updated recommendations regarding a 2-dose Trumenba (MenB-FHbp, Wyeth Pharmaceuticals) schedule have been added.
  • Tdap: Revised wording indicates a preference for administration of one dose for pregnant adolescents; this dose should be administered as early as possible in the 27- to 36-week gestational period. Wording is changed to indicate that for children aged 7 through 10 years who receive Tdap as part of a catch-up series, either Tdap or a booster vaccine for tetanus and diphtheria may be administered for the adolescent dose at 11 through 12 years.
  • HPV: Wording reflects that the number of recommended doses is based on age at administration of the first dose. Two doses are recommended for persons starting the series before their 15th birthday, whereas three doses are recommended for those who start the series on or after their 15th birthday and for persons with certain immunocompromising conditions. The bivalent HPV vaccine, 2vHPV (Cervarix; GlaxoSmithKline), has been removed from the schedule because this vaccine is no longer available and all available doses expired before January 1, 2017.

The updated immunization schedule also includes a new table, Figure 3, discussing which vaccines may be designated for persons aged 0 to 18 years who have a particular medical indication. This figure, which appears in the child and adolescent immunization schedule, is similar to Figure 2 in the schedule for adult immunizations.

Clinically significant adverse events following an immunization should continue to be reported to the Vaccine Adverse Event Reporting System, according to the report. – by Julia Ernst, MS

Disclosures: The researchers report no relevant financial disclosures.