ACIP Releases 2014 Pediatric Vaccine Schedule - January 31, 2014
The American Academy of Pediatrics (AAP), in collaboration with the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices, the American Academy of Family Practice, and the American College of Obstetricians and Gynecologists, has published a revision of immunization schedules for infants, children, and teenagers for 2014.
Key Change for Tdap
"The purpose of the revised immunization schedules is to ensure that providers have a comprehensive document that updates all changes in available vaccines and any changes in indications or how the vaccines are to be utilized," Dr. Brady said.
"Essentially, this immunization schedule is being published to replace the prior year's immunization schedule because that has become obsolete," he continued. "In some years, there are many changes or significant changes. In other years, there are few changes. This year, most of the changes are minor, with the exception of the provision of information on some new vaccines."
New in 2014 is an AAP recommendation that pregnant adolescents receive tetanus-diphtheria-acellular pertussis (Tdap) vaccine for each pregnancy, preferably during week 27 through week 36 of gestation, regardless of the time since their previous Td or Tdap vaccine.
The 2013 recommendation had called for a Tdap booster for pregnant teenagers but did not specify whether it should be administered for subsequent pregnancies.
Important Updates for Influenza and Meningococcal Vaccines
"There is availability of a number of new influenza vaccines," Dr. Brady said. "Since providers typically order their vaccines for influenza season in January or February, this allows providers to become familiar with the newer vaccines so they can determine which to order."
The 2014 schedules also include information on pneumococcal vaccines for high-risk children and guidance for the use of recently licensed meningococcal vaccines
"There are now 2 additional meningococcal conjugate vaccines available for infants. The schedule provides information for which children these vaccines should be considered and when they should be administered," Dr. Brady said.
Menactra (Sanofi Pasteur) was included in the 2013 immunization schedule. "It was the first 'infant' meningococcal vaccine approved and for which AAP and CDC had recommendations for a 2-dose schedule starting at age 9 months," Dr. Brady said.
The 2014 meningococcal vaccine recommendation now include guidance for the use of 2 new "infant" vaccines, Menveo (Novartis) and MenHibRix (GlaxoSmithKline).
Each vaccine is approved starting at 2 months of age, with a 3-dose primary series and a booster dose at 12 to 15 months of age starting at 2 months of age for high-risk children, such as those with anatomic or functional asplenia, including sickle cell disease, and children with persistent complement component deficiency.
"None of the infant meningococcal vaccines is recommended for routine use in infants," Dr. Brady emphasized. "They are only recommended for infants with an increased risk for meningococcal infection due to an immunodeficiency or those who travel to an area with high rates of meningococcal disease."
Immunization Schedule Format Similar to Last Year
The footnotes in the 2014 schedule show recommendations for routine vaccination, catch-up vaccination, and vaccination of children and adolescents with high-risk conditions or in special circumstances.
The Haemophilus influenza type b footnote clarifies vaccination of children aged 12 through 59 months who are at increased risk because of incomplete vaccination, asplenia, HIV infection, or receipt of a hematopoietic stem cell transplant or who have or are receiving chemotherapy or radiation treatment.
The pneumococcal vaccine footnote lists recommendations for the 13-valent pneumococcal vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) use in children and teenagers at increased risk on the basis of age and degree of risk.
The influenza vaccine footnote describes vaccine dosing for children stratified by age (6 months through 8 years and 9 years and older) for the 2013-2014 season.
The human papillomavirus footnote clarifies the intervals between vaccine doses, calling for a 3-dose series on a schedule of 0, 1 to 2, and 6 months for all adolescents aged 11 through 12 years.
Parents' Fears of Too Many Vaccines Unfounded
"The immunization schedule has gotten larger and looks more complicated every year," Dr. Brady said. "This has caused many parents to feel that their children might be receiving too many vaccines or too many vaccines at one time."
The Institute of Medicine has investigated this issue to see whether there was any potential harm, and the findings were "very supportive of the immunization schedule as currently laid out," Dr. Brady said.
"They found no evidence that...the immunization schedule [or] the number of immunizations given at one time caused harm. There is no evidence that the number of vaccines in the schedule overwhelms the immune system. There is actually good evidence that the vaccines recommended to be given together result in the same immune response as when they are given separately," he said.
The schedule also separates the giving of vaccines in the "rare" instance where one will interfere with the immune response of the other, Dr. Brady said.
"This is done because as vaccines come to the market, the companies making the vaccines need to do studies to show that the new vaccine can be safely given with the other vaccines recommended at the same age," he said.
The Institute of Medicine has in fact stated that any study that attempted to study administration of vaccines on a schedule that delayed any of the vaccines from the current schedule would be unethical, Dr. Brady added.
"The rationale for this statement was that the current immunization schedule is safe, and any delay in giving a vaccine according to the schedule would place the child at risk of the vaccine-preventable disease for a longer period of time."