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CDC publishes updates to immunization schedules for children and adults


Vaccines are known as one of the greatest achievements in public health over the last century. And each year, it seems more vaccines are introduced, or their uses expanded, to protect more people from dangerous and deadly diseases. It can be a lot to keep up with!

That is why each year, the Centers for Disease Control and Prevention (CDC) publishes clinical “schedules” for vaccines that indicate which vaccines to give, at what intervals, to which age groups, and for which conditions. The immunization schedules are a tremendous resource for practitioners in the field to make vaccinating children, adolescents, and adults a little easier. All vaccine recommendations on the schedule represent the opinion of the Advisory Committee on Immunization Practices (ACIP), which is an expert panel of clinicians and scientists (including nurses) that makes evidence-based recommendations for vaccine policy.

The 2013 immunization schedule publication represents an exciting first for ANA. This is the first time that the CDC has published the schedules in a nursing journal, whereas they are routinely published in three medical journals. Nurses have an impact on immunization rates and attitudes, and publication of immunization in nursing journals alongside medical journals is a testament to the importance of that impact.

2013 revisions to schedules for children

For 2013, the schedules for children ages 0-18 years, and adults ages 19-65+ years, had several changes to reflect ACIP recommendations and other suggested modifications. In the children’s schedule, a significant change was combining the schedules for children ages 0-6 years and adolescents 7-18 years, for ease of use. This was particularly important since there is greater emphasis on adolescent vaccination. Color-coded bars indicate the type of recommendation (i.e., routine vs. high risk patients only), and new arrows were added to certain bars to reflect the need to vaccinate across that age span. Other changes in individual vaccines are for meningococcal conjugate vaccine, which was recently licensed for infants as young as 6 weeks, and Hepatitis A.

There were revisions to the footnotes in the childhood schedule as well. Footnotes in the schedules are an important clinical guide to the details of a vaccination recommendation, including interval spacing, revaccination, and guidance for vaccinating patients with high-risk conditions. For the childhood schedule, changes included a revised, standardized formatting for each vaccine. For specific vaccines, there was a change in the Tetanus-diptheria-acellular pertussis (Tdap) vaccine recommendation for pregnant women/adolescents, in that pregnant women are recommended to receive a dose of vaccine with every pregnancy. There were also changes to the influenza dosing recommendation for children under 9 years of age, and changes to the recommendations for meningococcal vaccine to reflect the licensure of that vaccine for infants.

2013 revisions to schedules for adults

On the adult immunization schedule, there were quite a few changes, reflecting the increased attention to adult immunization. There were many changes in the recommendations for Tdap, reflecting the emphasis on use of the vaccine to curb the current national epidemic. The routine recommendation bar on the table reflects the fact that now, all adults 65 years and older are recommended to receive one dose of Tdap vaccine, and that pregnant women should receive a dose of Tdap with all pregnancies, regardless of prior vaccination. There were also changes to the acceptable immunity against measles, mumps and rubella based on birth year, and changes to the recommendations for pneumococcal vaccine for men who have sex with men.

The footnotes for the adult schedule were revised. Like the childhood/adolescent footnotes, the footnotes were changed to reflect the recommendation changes for Tdap vaccine use in pregnant women. Also related to pregnancy, additional information was added to the HPV footnote regarding HPV vaccination and pregnancy. For the zoster vaccine, the footnote was changed to clarify that ACIP recommends vaccination of all persons beginning at age 60 years. For the pneumococcal vaccines, changes were also made in the pneumococcal polysaccharide (PPSV23) vaccination footnote and the PPSV23 revaccination footnote, and there was a new pneumococcal conjugate vaccine (PCV13) footnote added. These changes reflect the introduction of PCV13 as a recommendation for older adults and patients with high-risk conditions. There were also changes in the hepatitis A vaccine recommendation to remove pregnancy as a precaution for hepatitis A vaccine (the vaccine is inactivated and has been deemed safe for women at risk for exposure to the disease).

To read the immunization schedules, visit www.anaimmunize.org/schedules/

Katie Brewer is a senior policy analyst at ANA.

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