Key Changes Reflected in 2011 Immunization Schedule

More than a dozen changes are reflected in the 2011 child, adolescent, and adult immunization schedules developed by the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians, including a recommendation for off-label use of tetanus, diphtheria and acellular pertussis (Tdap) vaccine in two specific patient groups.

The new schedules include guidance on administering hepatitis B vaccine to children who do not receive the recommended birth dose, as well as new information on the use of 13-valent pneumococcal conjugate vaccine, which replaced the 7-valent pneumococcal conjugate vaccine.

In response to recent pertussis outbreaks nationally, guidance has been provided for a dose of Tdap in 7- to 10-year-old children who are not adequately immunized against pertussis. During a meeting last October, the Advisory Committee on Immunization Practices (ACIP) of the CDC voted to recommend that children ages seven through 10 years who did not complete the recommended childhood series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine receive a catch-up dose of Tdap. ACIP members also recommended at that time that adults ages 65 and older who have close contact with infants receive a dose of Tdap. A dose also may be given to anyone else in this age group who desires the vaccine and has not previously received Tdap.

The purpose of the new recommendations, according to AAFP News Now, is to protect infants, in whom pertussis can cause particularly severe illness.

Several states had pertussis outbreaks last year, at least one of which still is ongoing. As of Jan. 7, California had more than 8,300 reported cases in its lingering outbreak, which has resulted in hundreds of hospitalizations and 10 infant deaths. The updated Tdap recommendations also state that the vaccine can be used regardless of the interval since previous immunization with a vaccine that contains tetanus or diphtheria toxoid.

In addition to the Tdap revisions, the ACIP recommended changes for meningococcal vaccination at its October meeting, including that a second dose of quadrivalent meningococcal conjugate vaccine, or MCV4, be added to the primary series for high-risk children. That recommendation also is reflected in the 2011 childhood schedule.

Another change in the 2011 adolescent schedule also was driven by the ACIP's actions during its October meeting. Previously, all adolescents were recommended to receive one dose of MCV4 at age 11 or 12 years (or at 13-18 years if not previously vaccinated). The committee voted in October to recommend a booster dose at age 16 for adolescents who received their first dose at the preteen (age 11 or 12) visit. Those who received their initial dose at ages 13-15 should get a booster dose three to five years after that first dose but prior to age 18, the committee said.

Two more significant changes included in the 2011 immunization schedules include:

• Expanding the recommendation for annual influenza vaccination to include all people ages 6 months and older in whom the vaccine is not contraindicated; and
• Replacing the seven-valent pneumococcal conjugate vaccine Prevnar with the 13-valent Prevnar 13, which contains six additional antigens to protect against Streptococcus pneumoniae. The new vaccine is administered in a four-dose series at ages 2, 4, 6 and 12-15 months.

Other changes to the adult immunization schedule include reordering to keep all universally recommended vaccines together and the addition of a statement clarifying that a vaccine series does not need to be restarted, regardless of the time that has elapsed between doses.

Additional changes to the child and adolescent schedules include the addition of guidance for the hepatitis B vaccine schedule for children who did not receive a birth dose, as well as revised guidance for catch-up doses of Haemophilus influenzae type b vaccine in people ages 5 years and older.

For more:

• Recommended Childhood and Adolescent Immunization Schedules—United States, 2011 (Pediatrics)
• Childhood schedule (birth to 6 years)
• Adolescent schedule (7-18 years)
• Catch-up schedule (4 months-18 years)