ACIP approves revisions to 2015 childhood immunization schedules

The CDC’s Advisory Committee on Immunization Practices voted unanimously, 13-0 with two members absent from the meeting, to approve various revisions to the 2015 childhood immunization schedules.

“These edits are intended to improve the readability and utility of the schedule; and hence, to translate the respective ACIP recommendations into a language that is easy to interpret by the busy health care provider,” José R. Romero, MD, a member of ACIP, said during the meeting.

José R. Romero

Raymond A. Strikas, MD, MPH, FACP, of the CDC, presented the proposed changes to the 2015 childhood immunization schedules.

Influenza vaccination schedules were edited to reflect the recent ACIP recommendation for receipt of live attenuated influenza vaccine beginning at age 2 years. New age groups were created for children aged 7 to 8 years and 9 to 10 years to indicate a break at 8 years of age, when children may require two doses of influenza, and after 8 years of age when they require only one dose.

Language was changed from “younger than age 12 months” to “before the first birthday” for all vaccinations.

ACIP determined which Haemophilus influenzae type b (Hib) vaccines should be considered for doses given 4 weeks after the second dose: the schedule now names PRP-T and unknown vaccines.

Children aged 12 to 59 months must receive a second dose of Hib vaccine before age 15 months to allow series completion with one additional dose within 8 weeks.

Language was modified regarding pneumococcal conjugate vaccine to better adhere to the 2010 routine childhood immunization recommendations. The third dose should be given 4 weeks after the second dose if the child is aged younger than 12 months and the previous dose was given before age 7 months. These children should receive a fourth and final dose at age 12 months or older, at least 8 weeks after the third dose.

The third dose of pneumococcal conjugate vaccine should be the final dose in the series in two circumstances: 1) If the child received a second dose between 7 and 11 months of age, the third dose should be given 8 weeks after the second dose once the child is aged 12 months or older; and 2) If the child is aged 12 months or older and has received one of two previous doses before age 12 months, they can complete the series at that time.

In the catch-up schedule, minimum age for initial doses of hepatitis A and B, polio, meningococcal, measles-mumps-rubella and varicella vaccines is not relevant for children aged 7 years, according to the ACIP.

Regarding immunization schedule footnotes, language for DTaP vaccine was changed to indicate children who already received a fourth dose of DTaP at age 12 months may have the dose counted if the fourth dose is administered at least 4 months after the third dose, provided the child was already aged 12 months.

“This change was to facilitate retrospective review of vaccine and being up-to-date, not a recommendation that children should routinely receive the dose 4 months [after], when 6 months [after] is the minimal interval acceptable,” Strikas said.

The pneumococcal conjugate footnote more closely reflects language in the 2010 recommendations for high-risk children aged 2 to 5 years. These children should receive one dose of PCV13 (Prevnar 13, Pfizer) if they have received any incomplete series of three doses of pneumococcal conjugate vaccine, whether 7- or 13-valent, and should receive two doses of PCV13 if they have received fewer than three doses of any conjugate vaccine in the past.

Extensive word changes were made to the meningococcal vaccine footnote, though the meaning remains the same, according to Strikas.

The influenza vaccine footnote was updated to reflect recommendations for the 2014-2015 season.