ACIP Approves 2014 Child/Adolescent Immunization Schedule

Troy Brown, RN

October 23, 2013

The Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP) unanimously approved the 2014 Child/Adolescent Immunization Schedule today, which includes some changes to the current schedule. The committee works closely with the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists to develop the guidelines, which are updated annually.

The 2014 guidelines include the following changes:

• Pneumococcal vaccine: A section in the footnotes separates various risk groups by age (ages 24 - 71 months and 6 - 18 years) and provides recommendations regarding 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine. There are separate guidelines for children aged 6 to 18 years who are immunocompromised and for those with chronic conditions who are not immunocompromised. A vaccine catch-up table is also included.
• Hepatitis A vaccine: The guidelines now include individuals who travel to or work in countries with high or intermediate endemicity of infection, men who have sex with men, those who use injection or noninjection illicit drugs, those who work with hepatitis A virus (HAV)-infected primates or with HAV in a research laboratory, those with clotting-factor disorders, and those with chronic liver disease.
• Human papillomavirus vaccine: The guidelines have been changed to add that the third dose should be administered "at least 12 weeks after the second dose AND at least 24 weeks after the first dose," according to information provided at the meeting.
• Meningococcal vaccines: The guidelines now recommend that the MenACWY-CRM (Menveo, Novartis Vaccines) vaccine may be given as early as 2 months of age for those with high risk for meningococcal disease. The guidelines include detailed instructions for use of the vaccines, as well as catch-up recommendations.
• Tdap vaccine: Those aged 11 years and older who have received no Tdap vaccine should have a Tdap followed by tetanus and diphtheria toxoids booster doses every 10 years after that. The committee does not recommend repeat doses of Tdap, except for pregnant adolescents, during each pregnancy. The guidelines also advise that in adolescents (aged 11 - 18 years) who inadvertently receive a pediatric DTaP, that dose should be considered the adolescent Tdap booster.

Sometimes the language in the child and adolescent guidelines overlaps with that in the adult guidelines and should be clearer, said voting member and committee chair Jonathan L. Temte, MD, PhD, a professor of family medicine at the University of Wisconsin School of Medicine and Public Health in Madison. Regarding the pneumococcal vaccines "for the asplenics and the sickle cell, it might be worthwhile to provide guidance as to what happens after they turn 19," Dr. Temte noted.

The ACIP and CDC will revise these guidelines based on today's meeting and will submit finalized guidelines to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by January 1, 2014. The CDC will publish the guidelines on its Web site in January 2014, and Pediatrics and American Family Physician will publish them in February 2014.

One of the voting members reported that her institution receives grant money from pharmaceutical companies for research. The other voting members have disclosed no relevant financial relationships.