Childhood and Adolescent Immunization Schedules Approved for 2010

From Medscape Medical News
Laurie Barclay, MD

January 4, 2010 — The 2010 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians, according to a report posted online January 4 and to be published in the January 2010 issue of Pediatrics.

There are 3 revised schedules describing current guidelines for use of US Food and Drug Administration (FDA)–licensed vaccines: one for children from birth through age 6 years, one for children and adolescents aged 7 through 18 years, and a catch-up immunization schedule for children and adolescents who start late or fall behind with scheduled vaccinations.

Noteworthy changes in the 2010 schedule are a new recommendation for influenza A (H1N1) 2009 monovalent vaccine, a recommendation to revaccinate children who remain at increased risk for meningococcal disease with meningococcal conjugate vaccine (MCV4), recommendations on combination vaccines, and recommendations for the recently licensed bivalent human papillomavirus (HPV) vaccine in girls and the quadrivalent HPV vaccine in boys.

Specific changes from last year's recommendations for vaccination with FDA-approved vaccines include the following:

A footnote refers to ACIP recommendations regarding use of influenza A (H1N1) 2009 monovalent vaccine.
Only children 6 months or older should receive trivalent inactivated influenza vaccine (TIV), and only those 2 years or older should receive the live attenuated influenza vaccine (LAIV).
Healthy children aged 2 to 6 years may receive either TIV or LAIV.
However, children aged 2 to 4 years who have a history of wheezing in the preceding 12 months should not receive LAIV.
The dose of TIV is 0.25 mL for children aged 6 to 35 months and 0.5 mL for those at least 3 years old. For children younger than 9 years given the influenza vaccine for the first time, 2 doses should be given 4 weeks apart. Children who received a single dose of influenza vaccine the previous season should be given 2 doses, separated by 4 weeks or more.

Children who remain at increased risk for meningococcal disease because of persistent complement deficiency, asplenia, or other conditions should be revaccinated with MCV4.
Children who received the initial MCV4 dose at ages 2 through 6 years should receive a dose of MCV4 after 3 years.
If the first dose was given at age 7 years or older, children should be revaccinated after 5 years. These children should then be revaccinated with MCV4 every 5 years.

Children not previously vaccinated with MCV4 should be given this vaccine at age 11 or 12 years or between ages 13 and 18 years.
College freshmen living in a dormitory who have not previously received MCV4 should be given this vaccine.

Combination vaccines are usually preferred to separate injections of the equivalent component vaccines. Updated recommendations regarding the inactivated poliovirus vaccine series are that the final dose should be given on or after the fourth birthday and at least 6 months after the previous dose.
Children receiving 4 doses before age 4 years should receive an additional (fifth) dose at ages 4 through 6 years.

Updated recommendations describe use of the recently licensed bivalent HPV vaccine in girls and the quadrivalent HPV vaccine in boys. Girls not previously vaccinated against HPV should receive the bivalent HPV series at ages 13 through 18 years.
For catch-up, the second and third HPV dose should be given at 1 to 2 months and at 6 months after the first dose. The minimal interval for vaccination is 4 weeks between the first and second doses, 12 weeks between the second and third doses, and 24 weeks or more between the first dose and third dose.

Revisions to most of the footnotes for the individual vaccines offer additional information and explain recommendations provided in the schedules.

The guidelines note that clinically significant adverse events after vaccination should be reported to the Vaccine Adverse Event Reporting System or at 1-800-822-7967. Details of ACIP recommendations for individual vaccines, including recommendations for children with high-risk conditions, are available on the Centers for Disease Control and Prevention Web site.

All of the guidelines authors filed conflict-of-interest statements with the AAP, and any conflicts were resolved through a process approved by the Board of Directors. The AAP neither solicited nor accepted any commercial involvement in the development of the content of this publication.

Pediatrics. Published online January 4, 2010.