Update on Routine Childhood and Adolescent Immunizations

 


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Am Fam Physician. 2015 Sep 15;92(6):460-468.

  Related editorials: HPV Vaccination: Overcoming Parental and Physician Impediments and Navigating the Changes in Pneumococcal Immunizations for Adults

Author disclosure: No relevant financial affiliations.

Recommendations for routine vaccinations in children and adolescents have changed multiple times in recent years, based on findings in clinical trials, licensure of new vaccines, and evidence of waning immunity. Despite the overwhelming success of vaccinations, vaccine delay and refusal are leading to pockets of vaccine-preventable diseases. Schedules for diphtheria and tetanus toxoids, and acellular pertussis (DTaP); hepatitis A and B; Haemophilus influenzae type b (Hib); inactivated poliovirus; varicella; and measles, mumps, and rubella are unchanged. However, since 2008, 13-valent pneumococcal conjugate vaccine has replaced the 7-valent vaccine; a new two-dose oral rotavirus vaccine has been approved; use of the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been expanded to children seven to 10 years of age who received fewer than five doses of DTaP, as well as during each pregnancy; a booster dose of meningococcal vaccine is recommended in adolescents 16 to 18 years of age (unless the first dose was given after 16 years of age); new meningococcal vaccines have been approved for use in infants at high risk of meningococcal disease; influenza vaccine has been expanded to routine use in all children six months and older; and the human papillomavirus vaccine has been approved for routine immunization of adolescent boys and girls. For the 2015–2016 influenza season, either live attenuated or inactivated vaccine can be administered to healthy children two to eight years of age.

High vaccine coverage is one of the major public health achievements in recent years, particularly with regard to nearly eliminating and dramatically decreasing the 13 vaccine-preventable diseases for which vaccinations were in place before 2005.1,2 For children born in the United States from 1994 to 2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths during their lifetimes.3 Coverage for most vaccines for children 19 to 35 months of age has been stable since 2012, with the exception of a slight increase in rotavirus and birth-dose hepatitis B vaccinations, and a decline in the rates of Haemophilus influenzae type b (Hib) vaccination from 2005 to 2010, possibly related to vaccine shortages.4,5 According to the National Immunization Survey–Teen (2007 to 2013), vaccination coverage for adolescents is improving, although still behind the Healthy People 2020 goals for human papillomavirus (HPV) and meningococcal vaccinations.6,7  Evidence-based findings to improve vaccine access in communities, encourage community demand for vaccinations, and encourage physicians and health care systems to provide vaccines have contributed to many immunization rates reaching the Healthy People 2020 goals (Table 1).4,6  Recommendations from the Community Preventive Services Task Force include many interventions that improve vaccination rates (Table 2).6,8

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Physicians should explain to parents that vaccines—including the measles, mumps, and rubella vaccine—are beneficial, safe, and effective.

C

28, 34

Physicians should reassure parents that there is no evidence that vaccines cause autism or neurologic problems.

C

28, 35

Physicians should inform parents that the risk of intussusception with the rotavirus vaccine is minimal compared with the decrease in morbidity and mortality associated with rotavirus diarrheal disease.

C

3840

Live attenuated influenza vaccine and inactivated influenza vaccine are both appropriate options in healthy children two to eight years of age who have no contraindications. Either vaccine is appropriate in older children and in adults up to 49 years of age.

C

27, 48, 51

The tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine should be administered to pregnant women at 27 to 36 weeks' gestation to provide passive immunity for their infants.

C

57, 58

Human papillomavirus vaccine should be administered to adolescent females and males.

C

64, 68


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Physicians should explain to parents that vaccines—including the measles, mumps, and rubella vaccine—are beneficial, safe, and effective.

C

28, 34

Physicians should reassure parents that there is no evidence that vaccines cause autism or neurologic problems.

C

28, 35

Physicians should inform parents that the risk of intussusception with the rotavirus vaccine is minimal compared with the decrease in morbidity and mortality associated with rotavirus diarrheal disease.

C

3840

Live attenuated influenza vaccine

The Authors

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LANI K. ACKERMAN, MD, is an associate professor of family and community medicine, program director, and associate chair for global and rural health at Texas Tech University Family Medicine Residency at the Permian Basin, Odessa. At the time the article was written, she was an associate professor and academic director at the University of Washington's Alaska Family Medicine Residency Program in Anchorage....

JACQUELYN L. SERRANO, MD, MPH, is a family physician at Samuel Simmonds Memorial Hospital in Barrow, Alaska.

Address correspondence to Lani K. Ackerman, MD, 701 W. 5th St., Odessa, TX 79763 (e-mail: lani.ackerman@ttuhsc.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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