New immunization schedules more user-friendly

The 2008 immunization schedules will be published in January.

Issue: September 2007

In anticipation of drafting the 2008 immunization schedule, the Advisory Committee on Immunization Practices surveyed immunization providers to find out their thoughts on the format and suggestions for how to make the new schedules more user-friendly.

According to Angela Calugar, MD, MPH, who presented the findings at the ACIP meeting in Atlanta, providers said that the new format is easier to read and is convenient to print and use for separate age groups. Pediatricians also noted that the colors are harmonized with the adult schedule. However, the providers said that the catch-up bars in the routine schedule are confusing, and that the catch-up schedule is complex.

When asked about the content, physicians said that it had become clearer, and that the references in the footnotes were useful.

“We finally achieved a more or less correct level of details,” Calugar said.

The physicians also offered suggestions for improving the schedule.

“These suggestions have to do with the hepatitis B vaccine birth dose, clarifications for pneumococcal conjugate vaccine indication, providing more details for children with special medical conditions, and options for a black-and-white copy machine. Many immunization providers suggested we use brand names; however, we try to avoid this as much as possible,” Calugar added.

Collaborating

In an attempt to finalize the accumulated information, the work group conducted joint meetings with the adult immunization schedule work group. The two groups discussed the best approach for dealing with people with special medical conditions because the adult work group has experience with this, and the topic is complex, according to Calugar.

“Another question we discussed with the adult work group was the timing of the publication of the immunization schedules. We thought that it might be an option to synchronize the vote for the adult schedule and the child schedule and then synchronize the publication. However, after discussing all the pros and cons, we decided to adhere to the existing timelines,” she said. “The adult schedule will be published in October, and we will present our final draft in October for the vote and publish our schedule in January of next year.”

The pediatric schedule work group also shared with the adult schedule work group its past experience with the Focus Group Survey and how this experience helped in the development of more user-friendly schedules.

“Discussing the provided feedback for a draft immunization schedule for HIV–infected children aged 0 to 6 years was another exciting activity,” Calugar said.

When updating the current schedule, the work group must take into consideration the new vaccines being considered by the FDA and any new indications for existing vaccines. For example, the FluMist vaccine (MedImmune) may be recommended for those 2 years of age and older for the 2007-2008 season.

This recommendation is currently awaiting FDA approval.

“We are always looking to improve the schedule’s content, format and appearance,” Calugar said.

New schedule

In previous years, the immunization schedule had yellow, green and purple bars: yellow for recommended ages, green for catch-up immunization and purple for certain high-risk groups.

“The green bars are confusing. They are redundant with the catch-up schedule, and this year, we are planning to take away the hepatitis B series green bar and the green bar for the Haemophilus influenzae type b vaccine. Consequently, we will have no need for green in the color legend on the side.” Calugar said.

The current catch-up schedule is divided for children aged 4 months to 6 years at the top of the schedule and children aged 7 to 18 years at the bottom.

“We have to correct an error related to tetanus-diphtheria-pertussis vaccine for ages 7 to 18 years. Doses two and three will now be four weeks apart instead of eight weeks, as it was previously,” she said.

Footnotes

In all of the current schedules, the footnotes are bulleted. The age for administration is on the first line for each vaccine, and updated references are included.

The following are proposed changes to the footnotes for newborns to 6-years-old:

Add the statement, “For additional details, see the catch-up immunization schedule.”
Change the hepatitis B dose wording to read, “If the mother is hepatitis B surface antigen-negative, the birth dose can be delayed, in rare cases, with physician’s order and a copy of the mother’s negative HBsAG laboratory report in the infant’s medical record.”
Change the PCV7 (Prevnar, Wyeth) wording to read, “Administer PCV7 at ages 24 to 59 months in certain high-risk groups; consider catch-up for other children aged 24 to 59 months.”

The following is the proposed change to the footnotes for children aged 7 to 18 years:

Add the statement, “The catch-up bars highlight the importance of the adolescent platform; for additional details, see the catch-up immunization schedule.”

The following is the proposed change to the footnotes for the catch-up schedule:

Change the PCV7 wording to read, “Administer PCV7 at ages 24 to 59 months in certain high-risk groups; consider catch-up for other children aged 24 to 59 months. Vaccine is not generally recommended for children aged 5 years or older.”

“In summary, updating immunization schedules requires multiple activities. Our work group recognizes the importance of feedback from immunization providers, collaboration with different ACIP work groups and subject matter experts, and harmonization with the stakeholders of the child and adolescent immunization schedule,” Calugar said. – by Michelle Stephenson

For more information:

Calugar A. Developing the 2008 immunization schedules for children and adolescents. Presented at: Advisory Committee on Immunization Practices Meeting; June 27-28, 2007; Atlanta.