The Advisory Committee on Immunization Practices (ACIP) has issued updated immunization schedules for children, adolescents and adults.
The 2017 child and adolescent immunization schedule includes several updates regarding influenza, human papillomavirus (HPV), hepatitis B, Haemophilus influenzae type B (Hib), pneumococcal, meningococcal, and diphtheria and tetanus toxoids and acellular pertussis vaccines (DTap).
Some key changes to the schedule include:
- The 16-year age column has been separated from the 17–18-year age column to highlight the need for a meningococcal conjugate vaccine booster dose at age 16 years.
- Live attenuated influenza vaccine (LAIV) has been removed from the influenza row.
- A blue bar was added for HPV for children aged 9–10 years, indicating that persons in this age group may be vaccinated (even in the absence of a high-risk condition).
A new figure called “Vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications” has been added. This figure serves to show that most children with medical conditions can (and should) be vaccinated according to the routine child/adolescent immunization schedule. The figure also indicates when a condition is a precaution or a contraindication to vaccination, and indicates when additional vaccine doses may be needed due to a specific medical condition.
In addition, changes to the footnotes have been made:
- Hepatitis B vaccine: birth dose should be administered within 24 hours of birth
- DTap: recommendations following inadvertently early administered 4th dose of DTaP
- Hib: Comvax removed from the market; Hiberix added for use in primary vaccination series
- Pneumococcal vaccine: references to PCV7 removed
- Influenza vaccine: LAIV should not be used for 2016–2017 season
- Meningococcal vaccines: recommendations for vaccination of children with HIV and for the use of 2-dose Trumenba (Pfizer) schedule
- Tetanus and diphtheria toxoids and acellular pertussis (TdaP): preference for earlier vaccination in pregnant adolescents between gestational weeks 27–36
- HPV: new 2-dose schedule for persons initiating HPV vaccination series before age 15 years; also, bivalent HPV vaccine removed from schedule
The 2017 adult immunization schedule includes several updates regarding influenza, HPV, hepatitis B, and meningococcal vaccines.
Some key changes to the schedule include:
- LAIV should not be used during the 2016–17 influenza season
- Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV)
- Adults with a history of egg allergy with symptoms other than hives (eg, angioedema, respiratory distress, lightheadedness, or recurrent emesis, or who required epinephrine or another emergency medical intervention) may receive age-appropriate IIV or RIV (vaccine should be administered in an inpatient or outpatient medical setting and supervised by a clinician who is able to recognize and manage severe allergic conditions)
- Healthy adolescents who start their HPV vaccination series before age 15 years are recommended to receive 2 doses of HPV vaccine
- Adults and adolescents who did not start their HPV vaccination series before age 15 years should receive 3 doses of HPV vaccine
- Adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an ALT or AST level >2XULN should receive a HepB series
- Adults with HIV infection should receive a 2-dose primary series of serogroups A, C, W, and Y meningococcal conjugate vaccine (MenACWY)
- Dosing guidance for one of the serogroup B meningococcal vaccines (MenB) (MenB-FHbp [Trumenba, Pfizer]) has been updated
The footnotes are now organized by vaccine-specific information and considerations for special populations such as pregnant women or adults with HIV infection. Vaccine-specific information on immunocompromising conditions has also been added to appropriate footnotes. In addition, the table of contraindications and precautions has been incorporated into the adult immunization schedule and is no longer a stand-alone table.
For additional guidance on the use of each vaccine appearing in the schedules, including precautions and contraindications, clinicians can view the respective ACIP vaccine recommendations at CDC.gov. Immunization schedules for birth to 18 years, catch-up, and adult versions can be found on the CDC website.
For more information visit CDC.gov.