CDC: Notable Changes Made to Immunization Schedules

The CDC has released the 2020 immunization schedules for adults, adolescents, and children, following approval by the Advisory Committee on Immunization Practices in October 2019. The schedule includes several changes, including new recommendations for the HPV and PCV13 vaccines.

The updates incorporate language changes in the adult vaccination schedule, including a change in the definition of “contraindication.” Instead of solely using the word “contraindicated,” the new definitions substitutes “not recommended or contraindicated.”

Child Immunization Changes

Several immunization recommendations were updated for pediatric patients, including haemophilus influenza type b (Hib) vaccination, and Tdap vaccinations.

The recommendations for Hib were revised to include that catch-up vaccination is not recommended for previous unvaccinated children ages 5 years and older who are not at high risk.

The note for hepatitis A vaccination was updated to include the recommendation that all children between age 2 years and 18 years that have not previously received the vaccine should receive catch-up vaccination, and complete a 2-dose series.

In a notable change, meningococcal B vaccine booster doses are now recommended for patients aged 10 years and older with complement deficiency, patients who use complement inhibitors, patients with asplenia, patients who are microbiologists, and anyone determined by public health officials to be at increased risk during an outbreak.

Finally, the Tdap note was updated to allow either Td or Tdap as an option for decennial tetanus booster doses and catch-up series doses in patients who have previously received Tdap. It has also been edited to reflect clinical guidance updates for children ages 7 years to 18 years that received doses of Tdap or DTaP between ages 7 years and 10 years. A dose of either administered at age 10 years may not be counted as the adolescent Tdap booster. Doses administered between ages 7 years and 9 years, however, should not be counted as the adolescent Tdap booster and Tdap should be administered at ages 11 years to 12 years.

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Adult Immunization Changes

The HPV footnote was revised to indicate that the HPV vaccination is recommended for everyone through age 26 years. The series depends on the patient’s age at the initial vaccination. For patients age 15 years or older at the initial vaccination, a 3-dose series at ages 0 months, 1-2 months, and 6 months is recommended. For patients between ages 9 years and 14 years that received 1 or 2 doses less than 5 months apart, 1 dose is recommended. Finally, for patients between ages 9 years and 14 years that received 2 doses at least 5 months apart, no additional dose is needed.

The adult recommendations for influenza vaccines were updated to include a list of situations in which the live attenuated influenza vaccine (LAIV) should not be used, including in patients with a history of severe allergic reaction to any vaccine component, immunocompromised patients, those with anatomic or functional asplenia, those with a cochlear implant, patients with cerebrospinal fluid-oropharyngeal communication, anyone with close contacts who are several immunosuppressed, pregnant patients, or those who received influenza antiviral medications within the previous 48 hours.

Recommendations for meningococcal vaccination were updated to include the use of the complement inhibitor ravulizumab as a special situation for meningitis B. A shared clinical decision-making subsection was also added, specifying that adolescents and young adults between ages 16 years and 23 years are not at increased risk for meningococcal disease.

Several minor changes to definitions were also included for various vaccinations, including hepatitis A and B, Tdap vaccinations, and the varicella vaccination.

REFERENCE

Immunization Schedules: Schedule Changes & Guidance. Centers for Disease Control and Prevention website, https://www.cdc.gov/vaccines/schedules/hcp/schedule-changes.html#adult. Accessed February 18, 2020.