News & Views: Grab Your 2020 Immunization Schedules for a Scavenger Hunt!

Have you had a chance to review the changes to the 2020 immunization schedules published by the Centers for Disease Control and Prevention (CDC)? If yes, see how well you remember them, and if not, find out about some of the changes with this scavenger hunt.

Get started

Have you printed the 2020 versions of the immunization schedule? Posted them on your websites? Written them on your hand? If you don’t have the schedules handy, you can quickly grab them from here:

• 2020 immunization schedule for children and adolescents (Birth to 18 years)
• 2020 immunization schedule for adults (19 years or older)

Clues

Childhood and adolescent schedule

1. What cut-off date is important for counting doses of OPV as valid?
2. Your patient is 11 years old and has no pre-existing conditions; however, they previously received meningococcal conjugate ACWY vaccine (before the age of 10) for travel. Should they be vaccinated with the adolescent dose of meningococcal conjugate ACWY?
3. Your 11-year-old patient, immunized as an infant, received a dose of Tdap at 10 years of age. Do they need the Tdap booster recommended at 11 to 12 years of age?
4. What if that same 11-year-old had received DTaP at 10 years of age (instead of Tdap)? Do they need the Tdap booster recommended at 11 to 12 years of age?
5. If a child comes in for an appointment and they have not received two doses of hepatitis A, what is the recommendation?

Adult schedule

1. What does the newly added blue box on table 1 indicate?
2. Which patients should not receive LAIV (FluMist^®)?
3. What seven conditions are considered in the category of chronic liver disease?
4. What three groups are now listed to get hepatitis A vaccine, and which one group is no longer listed?
5. Which of these patients would be recommended to get HPV vaccine according to the 2020 schedule: a 24-year-old male not previously immunized, a 40-year-old female who has asked about being vaccinated, or a pregnant 20-year-old female?
6. A 30-year-old male is injured on the job and brought in with a puncture wound. He does not remember when he last had a tetanus booster. What version of tetanus-containing vaccine should he be given?

Find out more about the changes and see the answers by reading more below. Note: Scavenger hunt items do not cover all changes. For a complete list of changes to the schedules, visit the CDC’s schedule changes webpage.

More information about the changes

Childhood and adolescent schedule

Changes to the childhood and adolescent immunization schedule included:

• Updates related to the use of Tdap or Td for decennial booster doses and catch-up recommendations. In addition, updated guidance related to children who received Tdap or DTaP between 7 and 10 years of age was also added.
• Guidance related to adolescent vaccination of children who received meningococcal conjugate ACWY before 10 years of age.
• An updated list of which children ages 10 years or older should get booster doses of meningococcal B vaccine.
• More specific guidance related to validity of oral polio vaccine (OPV) doses.
• Clarifications were also made to notes related to Hib, hepatitis A, and hepatitis B vaccination.

Adult schedule

Changes to the adult immunization schedule included:

• Changes to the number of columns on table 1 (age group consolidations) and the addition of a separate color to indicate shared clinical decision-making recommendations.
• Updates related to recommendation changes for HPV, pneumococcal, Tdap.
• Clarifications related to the use of MMR, LAIV, meningococcal B and varicella vaccines for certain sub-populations.
• Updates to hepatitis A and hepatitis B related to the definition of chronic liver disease and use of these vaccines in some sub-populations.

To view the complete list of changes with more detailed information, visit the CDC’s “Schedule changes” webpage.

Answers

Childhood and adolescent schedule

1. April 1, 2016 — See fourth bullet under “Catch-up vaccination” in poliovirus vaccination notes.
2. Yes — See the last section of notes under “Special situations” in the “Meningococcal serogroup A,C,W,Y vaccination” notes.
3. No — See the third bullet under “Catch-up vaccination” in “Tetanus, diphtheria, and pertussis (Tdap) vaccination” notes. However, note that if this child had received Tdap between 7 and 9 years of age, they would be recommended to get the routine booster between 11 and 12 years of age.
4. No — See the fourth bullet under “Catch-up vaccination” in “Tetanus, diphtheria, and pertussis (Tdap) vaccination” notes. However, note that if this child had received DTaP between 7 and 9 years of age, they would be recommended to get the routine booster between 11 and 12 years of age.
5. The series should be started or completed — See the first and second bullet points under “Catch-up vaccination” in the “Hepatitis A vaccination” notes section. The text related to “if desired” has been removed as hepatitis A vaccine is routinely recommended for all children.

Adult schedule

1. The blue boxes represent “shared clinical decision-making” recommendations.
2. Several groups of patients should not get LAIV — See the list in the third bullet point under “Special situations” in the notes section of “Influenza vaccination.”
3. Patients with hepatitis B, hepatitis C, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, or levels of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) that are greater than twice the upper limit of normal — See this list in the “Special situations” notes for either “Hepatitis A vaccination” or “Hepatitis B vaccination.”
4. The three groups added include pregnant women, individuals who have HIV, and those in settings with higher risk of exposure. People with clotting factor disorders are no longer listed — See the “Special situations” section of the “Hepatitis A vaccination” notes for more details.
5. The 20-year-old male is recommended to be vaccinated. The 40-year-old female would be part of the “shared clinical decision-making” group, so the fact that she is inquiring suggests that she would be a candidate for vaccination. However, the 20-year-old pregnant female would be recommended to delay vaccination until after delivery — The “Human papillomavirus vaccination” notes have been updated to address the recommendations related to these scenarios.
6. The patient can receive either Tdap or Td — As per the recently updated recommendations, the “Tetanus, diphtheria, pertussis” line on table 1 has been updated to include the use of either Tdap or Td; likewise, the notes have also been updated to reflect the change.