Physician Resources

2014 childhood and adolescent immunization schedule now available



The 2014 childhood and adolescent immunization schedule has been approved, with additions that include the use of one of the meningococcal conjugate vaccines (Menveo) in certain groups of high-risk infants and a list specifying the groups of people at increased risk of hepatitis A.

The schedule will be published in the February 2014 issue of Pediatrics, and is being made available online on Jan. 31 (Pediatrics 2014 [doi: 10.1542/peds.2013-3965]).

Guidance on the use of Menveo (Meningococcal Groups A, C, W-135, and Y Oligosaccharide Diphtheria CRM197 conjugate vaccine) for certain groups of infants at increased risk of disease starting at age 2 months has been added to the meningococcal vaccine footnote. This is based on the Food and Drug Administration licensure of Menveo for use starting at age 2 months in August 2013. Some of the high-risk categories include anatomic or functional asplenia, including sickle cell disease; children with persistent complement component deficiency; and those who travel to or live in an area hyperendemic area for meningococcal disease.

This is the first time that a meningococcal vaccine has been available for use starting at age 2 months, Dr. H. Cody Meissner, professor of pediatrics at Tufts University, Boston, pointed out in an interview.

The hepatitis A vaccine footnote now provides a list of groups at increased risk for hepatitis A. While these groups are well recognized, "it was useful to itemize these groups in the footnote," noted Dr. Meissner, who is a member of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices work group on the harmonized immunization schedule.

The list includes people traveling to or working in countries where there is a high or intermediate endemicity of infection; men having sex with men; people with clotting factor disorders; people with chronic liver disease; users of injection and noninjection illicit drugs; and personal contacts – such as household contacts or regular babysitters – of international adoptees during the first 2 months of arrival in the United States "from a country with high or intermediate endemicity."

The footnote on the tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine now states that a dose of the vaccine is recommended for pregnant adolescents every time they get pregnant – preferably during week 27 through week 36 of gestation. Last year, the American Academy of Pediatrics agreed that this vaccine should be given to a pregnant woman, but it withheld the recommendation to vaccinate during every pregnancy until more data became available, Dr. Meissner said. "Additional data now indicate the safety and efficacy of administration of Tdap each time a woman becomes pregnant." This will protect most infants during the first 2 months of life when pertussis can be most severe and until they receive their first DTaP dose at 2 months, he noted.

Other changes include clarification of the intervals between doses in the human papillomavirus (HPV) vaccines footnote, to avoid any misunderstanding of the schedule, said Dr. Meissner, who is also chief of pediatric infectious disease at the Floating Hospital for Children at Tufts Medical Center.

The recommendation for pneumococcal vaccines has not changed from last year, but the footnote provides clarification about the recommendations for PCV13 (Prevnar 13) and PPSV23 in children and adolescents, "which have been stratified according to age and according to degree of risk," he added.

The footnote on Haemophilus influenzae type b (Hib) conjugate vaccine now includes clarification of who should receive the vaccine if immunocompromised.

This is the second year that recommendations and footnotes for ages 0-18 years are included in one schedule, as opposed to previous years, when there were separate schedules and footnotes for 0-7 years and 8-18 years.

The 2014 schedules have been approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Dr. Meissner said he has no relevant financial disclosures.

You can view the 2014 schedule at our Resources section here.

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