The Centers for Disease Control and Prevention (CDC) and its Advisory Committee on Immunization Practices (ACIP) have approved new adult and childhood vaccine schedules effective February 2019.1 The American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) have all endorsed the new schedules.2
Major Updates to the Childhood Vaccine Schedule
The updated childhood vaccine schedule recommends that children between the ages six to 11 months of age and unvaccinated persons 12 months of age or older receive the hepatitis A vaccine for international travel.2
The second update pertains to the word “all” that has been added to the vaccine recommendation for the birth dose for medically stable infants (more than 2000 grams or 4.4 lbs) born to hepatitis B surface antigen-negative mothers. According to federal health officials, this clarification was added to emphasize the recommendation that all apparently healthy infants, including those with a birth weight as low as 4.4 pounds, should be given a hepatitis B shot at birth.2
According to Cody Meissner, MD who is the director of pediatric infectious disease at Tufts Medical Center in Boston, Massachusetts and a consultant to the AAP, as well as a liaison between the AAP and CDC, there are about 1,000 babies born in the U.S. who are born with hepatitis B because their mothers are infected with hepatitis B when they give birth. He said:
The reason this was added is because there are still about a thousand babies a year who are born with hepatitis B because they contract it from their mother at the time of delivery, primarily. The previous recommendation gave more latitude, so that the first dose could be given up to 2 or 3 or 4 weeks of age in a pediatrician’s office. The problem was some children were slipping through the net and did not get a dose of the vaccine early on if they were born to a mother who is known to be positive. This way, every infant gets the vaccine, even if there is a misinterpretation of the blood result’s serology or the testing done on the mother.3
The third update relates to the live nasal spray influenza vaccine, FluMist (LAIV). FluMist was not recommended by ACIP during the last two flu seasons because the vaccine was found to be ineffective for the preceding three influenza seasons.2 3 Even though the manufacturer has modified the vaccine to include a new H1N1 strain, the AAP still has reservations about its effectiveness.3
Dr. Meissner noted:
The AAP still does not identify FluMist as a first-line vaccine and says it should be reserved for children who refuse to get the shot. The AAP took that position because we don’t know if H1N1 will in fact be protective. We know this new strain does make more antibodies against H1N1 than the older vaccine, but there are no efficacy data. There is no evidence yet available that it will protect as well as IIV [inactivated influenza vaccine].3
The AAP felt that since we have a vaccine that definitely works—it’s not optimal, but it definitely works—we would prefer children to receive IIV rather than LAIV until we know if it works. LAIV is better than nothing.3
The fourth update pertains to the Tdap vaccine. The catch-up vaccination section has been updated to indicate that those children who received a dose of Tdap or DTaP at seven to 10 years of age inadvertently, or as part of the catch-up schedule, should nevertheless receive the routine dose of Tdap at 11 to 12 years of age.2
Major Updates to the Adult Vaccine Schedule
The ACIP has added homelessness as an indication for giving children and adults hepatitis A vaccine.2 Dr. Meissner said that this recommendation was added into the schedule because there were several hepatitis A outbreaks among homeless populations last year.3
The second update is related to information on dosage regarding the use of the new hepatitis B vaccine, Heplisav-B.2
1 Centers for Disease Control and Prevention. Immunization Schedules. CDC.gov 2019.
2 AAP News and Journals. Recommended Childhood and Adolescent Immunization Schedules: United States, 2019. AAPPublications.org February 2019.
3 Frellick M. ACIP Releases 2019 Child and Teen Vaccine Schedule. Medscape Feb. 5, 2019.