The Advisory Committee on Immunization Practices (ACIP), a committee of the Centers for Disease Control and Prevention (CDC), each year reviews the recommendations of its vaccine review work group for changes to the child and adolescent, adult, and catch-up vaccine schedules. This analysis occurred at the October 2013 ACIP Meeting. Comments are suggested by the ACIP committee, the liaisons representing the different stakeholders, such as the American Osteopathic Association (AOA), and public comments. The present article provides language from the ACIP as well as a rationale for the 2014 vaccine updated schedules. (The actual footnote changes are in boldface and italics. The rationale follows the footnote changes.)
Highlights of the Children and Adolescent 2014 Vaccination Schedule Recommended Footnote Changes
PCV13 [pneumococcal conjugate vaccine] and PPSV23 [pneumococcal polysaccharide vaccine] (Minimum age: 2 years): All recommended PCV13 doses should be administered prior to 23-valent Pneumococcal if possible.1
Rationale: In this footnote, PCV13 (Prevar13 by Pfizer Inc) was placed before PPSV23 (Pneumovax by Merck & Co, Inc) to stress that because of efficacy and the interactions of the 2 types of pneumococcal vaccines, PCV13 should be administered before PPSV23, if at all possible.
For children aged 24 through 71 months with any of the following conditions: chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy); diabetes mellitus; cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; HIV infection, chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas and Hodgkin disease; solid organ transplantation; or congenital immunodeficiency:
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Administer 1 dose of PCV13 if 3 doses of PCV (PCV7 and/or PCV13) were received previously.
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Administer 2 doses of PCV13 at least 8 weeks apart if fewer than 3 doses of PCV (PCV7 and/or PCV13) were received previously.
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Administer 1 supplemental dose of PCV13 if 4 doses of PCV7 or other age-appropriate complete PCV7 schedule were received previously. (from 2010 [recommendations], table 11).
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The minimum interval between doses of PCV (PCV7 or PCV13) is 8 weeks.
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For children previously unvaccinated with PPSV23, administer PPSV23 at least 8 weeks after the most recent dose of PCV13.
For children aged 6 through 18 years who have cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiences [sic]; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma.
For children aged 6 through 18 years who have chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma if treated with high-dose oral corticosteroid therapy); diabetes mellitus; alcoholism, chronic liver disease; or who have not received PPSV23, administer 1 dose of PPSV23. If PCV13 has been received previously, administer PPSV23 at least 8 weeks after the most recent dose of PCV13.
A single revaccination with PPSV23 should be administered after 5 years to children with sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiences [sic]; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma.1
Rationale: These additions allow health care practitioners to differentiate between the use of pneumococcal vaccines for high-risk children aged 24 through 71 months and those aged 6 through 18 years. The paragraphs also differentiate the use of the pneumococcal vaccines in high-risk children and adolescents from those with immunodeficiencies.
Vaccination of Persons With High-Risk Conditions and of Other Persons at Increased Risk of Disease
Persons aged 7 years and older who are not fully immunized with the childhood DTaP [diphtheria, tetanus, pertussis] vaccine series, should receive Tdap vaccine as one (preferably the first) dose in the catch-up series; if additional doses are needed at this age or older, use Td [diphtheria toxoids] vaccine instead of Tdap. For children 7 through 10 years who receive a dose of Tdap as part of the catch-up series, an adolescent Tdap vaccine dose at age 11 through 12 years should not be administered. Td should be administered instead 10 years after the Tdap dose.
Persons aged 11 years and older who have not received Tdap vaccine should receive a dose followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter. Repeat doses of Tdap are not recommended except for the pregnant adolescent, during every pregnancy.1
Rationale: The ACIP did not feel that it is cost effective to administer more than 1 dose of Tdap after age 7 years. The exception is that a dose of Tdap should be administered during each pregnancy to protect the fetus and mother.
An inadvertent dose of DTaP vaccine administered to children aged 7 through 10 years may count as part of the catch-up series. This dose may count as the adolescent Tdap dose, or the child can later receive a Tdap booster dose at age 11 through 12 years. If pediatric DTaP is inadvertently administered to an adolescent aged 11 through 18 years, the dose should be counted as the adolescent Tdap booster.1
Rationale: This language helps to clarify that if an inadvertent dose of DTaP is given instead of a Tdap, there is no need to repeat the Tdap dose because the amount of diphtheria and pertussis is greater in the DTaP than the Tdap. Note that the reactions, especially local, may be greater with the DTaP than the Tdap if the DTaP is administered after age 6 years.
Rationale: By adding the URL to the footnotes, vaccine administerers can directly access the website for the contraindications for LAIV.
For the 2014-2015 season, follow dosing guidelines in the 2014 ACIP influenza vaccine recommendations.1
Rationale: Because of the different types of influenza vaccines (eg, intradermal, intramuscular, high dose, nasal) and the development of additional new vaccines, follow the ACIP guidelines for administration of the particular vaccination.