by H. Cody Meissner, M.D., FAAP
The 2016 immunization schedules for children and adolescents from birth through 18 years of age include several changes from last year, including updated recommendations for the human papillomavirus (HPV) and meningococcal B vaccines.
The schedules are approved annually by the Academy, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists to reflect current recommendations for use of vaccines licensed by the Food and Drug Administration.
The 2016 format is similar to last year and includes a single schedule for people from birth through 18 years of age. A catch-up schedule provides recommendations for children and adolescents who start late or are more than one month behind.
Footnotes contain recommendations for routine and catch-up vaccination as well as for vaccination of children and adolescents with high-risk conditions or in special circumstances. Providers are encouraged to use figures, tables and footnotes together.
The schedules are available at www.cdc.gov/vaccines/schedules/index.html and will be published in the March issue of AAP News. The AAP policy statement Recommended Childhood and Adolescent Immunization Schedule — United States, 2016 is available at www.pediatrics.org/cgi/doi/10.1542/peds.2015-4531 and will be published in the March issue of Pediatrics.
Providers should be aware that changes in recommendations for a specific vaccine may occur between annual updates to the immunization schedule and will be posted on Red Book Online, http://redbook.solutions.aap.org/SS/Immunization_Schedules.aspx, and the CDC website, www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html.
In addition, the CDC website includes tables (job-aids) to clarify recommended use of Haemophilus influenzae type b, pneumococcal and pertussis-containing vaccines as a function of age, the number of doses previously administered and the time interval since the last dose.
Here is a closer look at the changes to the 2016 immunization schedule:
- The order of vaccines has been changed to group vaccines by recommended age of administration. The order of footnotes also has been changed.
- A purple bar was added for Haemophilus influenzae type b vaccine for children ages 5 through 18 years to denote the recommendation to vaccinate certain unimmunized high-risk children in this age group.
- A purple bar has been added for HPV vaccine for children starting at 9 years of age with a history of sexual abuse.
- A new row has been added for meningococcal B vaccine. A purple bar indicates the recommendation to vaccinate certain high-risk people ages 10 years and older. A blue bar indicates the recommendation for permissive administration to non-high risk groups subject to individual decision-making for those 16 through 18 years.
- In the catch-up schedule, Tdap/Td was added to the list of possible previous vaccines in the Tdap line for children ages 7 years and older, dose 2 to dose 3 column.
Changes to the 2016 footnotes include:
- The hepatitis B vaccine footnote was revised to present the timing for post vaccination serologic testing for infants born to hepatitis B surface antigen positive mothers.
- The DTaP footnote was clarified to present recommendations following an inadvertent early fourth dose of DTaP vaccine.
- The inactivated polio vaccine footnote was updated to provide guidance for vaccination of people who received only oral polio vaccine and received all doses before 4 years of age.
- The footnotes for the meningococcal vaccines were updated to include recommendations for administration of the meningococcal B vaccine.
- The HPV footnote has been updated to reflect the 9-valent nomenclature (9vHPV). Guidance has been added for vaccination beginning at 9 years of age for children with a history of sexual abuse, recognizing their increased risk of HPV infection.
Reporting adverse events
Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance on how to obtain and complete a VAERS form is available at www.vaers.hhs.gov or by calling 800-822-7967. Additional information can be found in the 2015 Red Book and at Red Book Online, http://bit.ly/1KA2YjK.
Dr. Meissner is professor of pediatrics at Floating Hospital for Children, Tufts Medical Center. He also is an ex officio member of the AAP Committee on Infectious Diseases and associate editor of the AAP Visual Red Book.