CDC, AAFP, AAP Issue Updated Children's, Adolescent Immunizations Schedules

It's that time again -- the CDC's Advisory Committee on Immunization Practices, or ACIP, in conjunction with the AAFP and the American Academy of Pediatrics, has released the newly revised recommended immunizations schedules for children and adolescents, as well as the 2008 version of the catch-up schedule for these age groups. Although no vaccines have been added to the 2008 schedules, they do include a couple of changes from last year's schedules that are worth noting.

The new schedules

were posted this week on the AAFP Web site.

In September 2007, the FDA approved expanding the use of the live, attenuated influenza vaccine, or LAIV, to include children ages 2 years to 5 years. Previously, use of this nasal spray vaccine, which is manufactured by MedImmune Vaccines Inc. of Gaithersburg, Md., and marketed as FluMist, had been limited to healthy children ages 5 years and older and to adults as old as 49.

At its Oct. 24-25 meeting, the ACIP agreed that either LAIV or trivalent inactivated influenza vaccine, or TIV, could be used in healthy patients ages 2 years to 49 years. The minimum age for administration of TIV remains 6 months.

Both types of vaccine products are used to immunize patients against seasonal influenza, a process that should continue well into January and beyond, say CDC officials.

According to an article in the Jan. 1 American Family Physician that accompanies the new schedules, a number of conditions constitute contraindications to or precautions for giving LAIV to young children. In that article, the Academy's ACIP liaisons -- Jonathan Temte, M.D., Ph.D., of Madison, Wis., and Doug Campos-Outcalt, M.D., M.P.A., of Phoenix --list those conditions as

The revised immunization schedules also note that children younger than 9 years who are receiving influenza vaccine for the first time, or who were vaccinated for the first time last season but only received a single vaccine dose, should receive two doses of vaccine, given at least four weeks apart.

The other schedule change FPs may want to incorporate into their immunization plans and protocols involves the quadrivalent meningococcal conjugate vaccine, or MCV4, which is manufactured by sanofi pasteur of Swiftwater, Pa., and sold as Menactra.

This change also entails an expansion of the approved age range for vaccine administration, with the FDA in mid-October approving use of MCV4 among children ages 2 years to 10 years. That approval was followed a week later by an ACIP recommendation that administration of MCV4 is preferred among children in this age range who are at increased risk for meningococcal disease rather than the quadrivalent meningococcal polysaccharide vaccine, or MPSV4, previously recommended for use in this population.

Children at increased risk are considered those who reside in or travel to countries in which meningococcal disease is hyperendemic or epidemic, children who have terminal complement component deficiencies, and those with anatomic or functional asplenia.

In addition, MCV4 is preferred to MPSV4 among children ages 2-10 for control of meningococcal disease outbreaks. Furthermore, among children in this age group who were previously immunized with MPSV4 and who remain at increased risk for meningococcal disease, ACIP recommends administration of MCV4 three years after receipt of MPSV4. If MPSV4 was given more than three years prior to a child who remains at increased risk for meningococcal disease, physicians should administer MCV4 at the earliest opportunity.

Finally, physicians should note that the 2008 immunization schedules do not take into account recently released interim guidelines for administration of Haemophilus influenzae type b, or Hib, vaccine. Those guidelines, developed in response to a looming shortage of Hib vaccine, recommend, in part, that physicians and other vaccine providers temporarily defer the routine Hib vaccine booster dose typically administered at age 12-15 months except among children in specific high-risk groups. The interim guidelines for Hib vaccine administration should be followed until the current vaccine supply disruption improves.

More information about the 2008 schedules, including background on the ACIP recommendations they reflect, is available at the CDC's Morbidity and Mortality Weekly Report Web site.