Changes to meningococcal B, DTaP, polio, and human papillomavirus (HPV) vaccination recommendations were among those unanimously approved at a meeting of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) for child and adolescent immunization schedules.
Meningococcal B vaccine has now been added to the 2016 immunization schedule, and is recommended for high-risk children beginning at age 10 years. The schedule also includes recommendations for adolescents age 16 years and older in “not high-risk groups that may receive this vaccine subject to individual clinical decision-making,” according to Dr. Candice Robinson of the CDC’s National Center for Immunization and Respiratory Diseases, Atlanta. Relevant information for administration of meningococcal B vaccination has been added to the footnotes and routine vaccination sections as well.
In the footnotes section, DTaP recommendations have been revised to add Quadracel to the minimum age exception line, and administration instructions of inadvertent doses have been clarified. The new instructions will now read: “If the fourth dose of DTaP was administered at least 4 months, but less than 6 months, after the third dose of DTaP, it need not be repeated [and] the 4-day grace period may not be used for the fourth dose given less than 6 months after the third dose of DTaP.”
“We use the description of ‘inadvertent dose’ to indicate that this shortened interval between doses should not be used prospectively; however, the dose could be counted as valid after the fact,” Dr. Robinson explained.
Footnotes for inactivated polio vaccine (IPV) will now include guidance for IPV use in patients who have previously received only oral polio vaccine (OPV) and did not receive any doses after their fourth birthday. This addition, which was added after repeated inquiries from providers, will read: “If only OPV were administered, and all doses were given prior to 4 years of age, one dose of IPV should be given at 4 years or older at least 4 weeks after the last dose of [OPV].”
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For HPV, children aged 9-10 years will now be recommended for vaccination if they are “high risk” – indicated by a purple bar on Figure 1 of the 2016 immunization schedule – due to a history of sexual abuse in their youth. Furthermore, all HPV nomenclature in the 2016 recommendations will be updated to reflect currently accepted naming formats; for example, HPV4 will now be called 4-valent or 4V HPV. In the footnotes, the 9-valent HPV vaccine is now included along with the 5-valent and 4-valent variants, along with restructured language to clarify administration instructions.
Other changes to Figure 1 of next year’s immunization schedules include moving the Tdap recommendations to a lower section of the table, and moving the pneumococcal polysaccharide vaccination schedule toward the bottom of the chart because it is “not routinely recommended for any population.” Haemophilus influenzae type b (Hib) vaccinations are now recommended for certain high-risk groups in patients aged 5-18 years, in accordance with text in the recommendations’ footnotes that suggested vaccination in this age group for those who had previously been vaccinated or have other high-risk conditions.
The catch-up schedule will have one minor change – “in the Tdap line’s Dose 2-3 column, we added Tdap and Td to the list of possible previous vaccines,” Dr. Robinson said.
Revisions will be made to be submitted for approval by Dr. Tom Frieden, CDC director. The edited copy of these updated recommendations will be submitted to the American Academy of Pediatrics, American Academy of Family Physicians, and American Congress of Obstetricians and Gynecologists by Jan. 1, 2016, with publication by the CDC and partner publications following in January and February.