Article Review:
New recommendations on vaccine schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP), and the American Academy of Family Physicians (AAFP). This update provides three separate vaccination schedules for 0 through 6 years of age, 7 through 18 years of age and a third catch-up schedule for under or unvaccinated children.
Highlights of the new recommendations include:
· Hepatitis B vaccine and HBIG should be given to all newborns 12 hours or less after birth, whose mothers are HBsAg positive. These babies should have serum HBsAg and anti-HBs levels checked after receiving 4 total doses of vaccine. These tests should be done at the 9 month well baby visit.
Infants whose maternal HBsAg status is unknown:
- If infant weighs < 2,000 grams, Hepatitis B vaccine plus HBIG should be given within 12 hours of birth.
- If infant weighs > 2,000 grams, Hepatitis B vaccine alone should be given within 12 hours of birth.
- As soon as it is determined that the mother is HBsAg (+), give infants weighing greater than 2,000 grams should be given HBIG, ideally within the first week of life.
· Tdap vaccine can be given to children as young as age 7 if they have not previously received the complete DTaP series.
· HIB vaccine should be given for unvaccinated children age 5 years and older with a history of Sickle Cell Disease, Leukemia, HIV, or asplenia (functional or anatomic).
Hiberix should only be used as a booster dose for infants 12 months to 4 years of age.
· International travelers between the ages of 6 to 11 months should receive a dose of MMR prior to departure. These infants would then receive their routine MMR vaccine at 12 to 15 months of age (at least 4 weeks after their travel dose) and a third dose prior to Kindergarten entry.
· All children age 11 to 15 should receive the Menactra vaccination. A repeat dose should be given after their 16th birthday and at least 8 weeks after the first dose was given.
· Children ages 9 to 23 months who are present during a local outbreak of meningococcal disease, or with complement deficiency, or traveling to countries where Meningococcal disease is endemic, should receive 2 doses of Menactra, at least 8 weeks apart.
· Children age 24 months and older, who fall under the above criteria and/or have functional or anatomic asplenia, should receive 2 doses of Menactra separated by at least 8 weeks.
· HPV vaccine (Gardasil) is recommended in a 3-dose series for boys and girls after age 11 years. The vaccine can be administered to children as young as age 9.
Editor’s Commentary:
While the current vaccination schedule is complex, these new recommendations represent small changes. Pediatric hospitalists should be aware of the Hepatitis B recommendations for newborns, especially those whose mother’s HBsAg status is unknown at birth. Tdap can now be used in under vaccinated children as young as age 7.
Due to international outbreaks of measles in 2011, infants under 12 months of age are now being vaccinated prior to travel. Thus, they will receive a total of 3 MMR doses in their lifetime. Children over 12 months of age who have received their first dose of MMR and are planning international travel, should receive their second dose of MMR prior to departure, if at least 4 weeks after their first dose. These children would therefore not require the MMR dose at Kindergarten entry.
Menactra can be given as young as 9 months of age under specific circumstances. And children with sickle cell disease and children with asplenia, should receive Menactra after their 2nd birthday.
This review provides 3 distinct tables with footnotes that are worth having for quick reference:
http://pediatrics.aappublications.org/content/129/2/385.full
http://pediatrics.aappublications.org/content/129/2/385.full
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