News & Views: Updated Immunization Schedules

In the Feb. 9, 2017, issue of MMWR Weekly, the Centers for Disease Control and Prevention (CDC) released the 2017 immunization schedules for children and adolescents 18 years or younger and for adults 19 years and older. Find a summary of the changes to both schedules:

Child and adolescent schedule (18 years or younger)

Two major changes to the format of the schedule were implemented:

• A new figure 3 was added — This new table, titled “Vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications,” is meant to assist providers with determining when young patients with certain conditions can get vaccines according to the recommended schedule, should not get vaccinated according to the schedule, or may need extra doses of certain vaccines. Conditions in the table include pregnancy, immunocompromised status (exclusive of HIV), kidney-related conditions, heart disease, chronic lung disease, CSF leaks/cochlear implants, asplenia and persistent complement component deficiencies, chronic liver disease and diabetes. A CD4 status subdivided column for HIV-positive patients is also included on the table.
• A new column on the schedule (figure 1) now exists for 16-year-olds to emphasize the importance of seeing patients for a 16-year immunization visit. Read the accompanying “Technically Speaking” by Dr. Wexler for a detailed description of why this change was made, its importance, and the implications and opportunities for providers in practice.

Vaccine-specific and footnote updates, most of which you are likely aware of and have already implemented in practice, include:

• DTaP — Change to footnote related to recommendations following inadvertent early administration of the fourth dose of DTaP.
• Tdap — Change to footnote related to preference for earlier administration during the pregnancy window of 27 – 36 weeks.
• Hep B — Change to footnote indicating first dose should be administered within 24 hours of birth.
• Hib — Removal of Comvax® and addition of Hiberix® to footnotes.
• HPV — A new blue bar has been added to this row to show that 9- to 10-year-olds can receive this vaccine without being part of a high-risk group. In addition the footnote was updated to include the revised two-dose recommendations for those younger than 15 years of age. Cervarix® was removed from the footnotes.
• Influenza — The row related to live attenuated influenza vaccine (LAIV) was removed from the schedule, and a footnote was added indicating that this version should not be used for the 2016-17 influenza season.
• Meningococcus — The new 16-year-old column was added to emphasize the importance of the recommended booster at 16 years of age, and the footnote was updated to reflect the two-dose recommendation for Trumenba® and recommendations for children with HIV.
• Pneumococcus — The references to PCV7 have been removed.

Read the full article.

Print the revised child and adolescent schedule — eight-page PDF.

Adult schedule (19 years and older)

The most noticeable change to the adult schedule may be the revised cover page which now includes:

• Select general principles relevant to adult immunizations
• Additional CDC resources
• Instructions for reporting adverse events and suspected cases of reportable vaccine-preventable diseases
• A list of ACIP-approved acronyms

Vaccine-specific and footnote updates include:

• Influenza — Removal of recommendation related to the use of LAIV for the 2016-17 season, and clarification of recommendations related to adults with history of egg allergies.
• Hepatitis B — Updates related to adults with chronic liver disease.
• HPV — Clarifications to dosing recommendations for unvaccinated or partially vaccinated young adults.
• Meningococcus (ACWY and B) — Clarification of recommendations for high-risk groups including those with anatomical or functional asplenia, persistent complement deficiencies and HIV; those at increased risk because of occupation or travel, and young adults not considered to be high risk, but who wish to be protected.

Read the full article.

Print the revised adult schedule — six-page PDF.