ACIP Releases 2013 Immunization Schedules
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Am Fam Physician. 2013 Feb 1;87(3):204.
Guideline source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices
Evidence rating system used? No
Literature search described? No
Guideline developed by participants without relevant financial ties to industry? Not reported
Published source: Morbidity and Mortality Weekly Report. In press.
There are several significant changes to the 2013 immunization schedules, printed in this issue of American Family Physician. First, the format of the routine child and adolescent schedules has changed. The two previous age-based schedules (0 to six years and seven to 18 years of age) have been merged into one 0- to 18-year schedule. The catch-up vaccination schedule has not changed and is still on a separate page. However, the footnotes for both schedules have been combined.
There are two new tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine recommendations. In response to the 2012 pertussis epidemic, the Advisory Committee on Immunization Practices (ACIP) recommended in June that the Tdap vaccine be offered to adults older than 65 years (http://www.aafp.org/adult-immunizations). The ACIP noted that only Boostrix, not Adacel, has U.S. Food and Drug Administration approval for use in adults older than 65 years. If Boostrix is unavailable, the use of Adacel is a valid option.
The ACIP also recommended that the Tdap vaccine be given to all women in the late second or early third trimester of pregnancy, regardless of whether they have received a previous dose of Tdap. This recommendation was based on data showing that maternal antibodies wane over time and that the highest risk of morbidity and mortality from pertussis is in the first few months of life, before an infant receives three diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines. This recommendation engendered much discussion about the potential risks for Tdap vaccinations given at short intervals (some less than 12 months apart), as well as for more than two Tdap vaccinations. However, current data on repeat Tdap vaccination have not shown any significant difference in adverse effects between the first and second administration.
The recommendation for the use of 13-valent pneumococcal conjugate (PCV13) and 23-valent pneumococcal polysaccharide vaccines (PPSV23) in adults with high-risk conditions is more complicated. Specifically, adults 19 years and older with specific immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants should receive PCV13 in addition to the current PPSV23. If an individual has not received either vaccine, PCV13 should be given first with PPSV23 two months later. If a patient has had PPSV23 in the past, PCV13 should be given at least one year after the most recent dose of PPSV23.
Quadrivalent inactivated and live virus influenza vaccines will be available for the 2013–2014 influenza season. These vaccines will include two influenza A strains and two influenza B strains. In the past, only one influenza B strain was included, and if it did not match the dominant circulating B strain, then it was much less effective.
Finally, family physicians should be aware that the measles, mumps, and rubella vaccine is recommended for all infants six to 11 months of age traveling internationally. This includes travel to Europe, Australia, and other first-world locations.
EDITOR's NOTE: The author serves as liaison to the ACIP for the AAFP.
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
A collection of Practice Guidelines published in AFP is available at http://www.aafp.org/afp/practguide.
Copyright © 2013 by the American Academy of Family Physicians.
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