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CDC Merges Child, Teen Immunization Schedules for 2013
Tdap, PCV13 Changes Highlighted in New Recommendations
By Matt Brown
"While the catch-up schedule has not been merged (with the child/adolescent recommendations), the footnotes for what used to be all three schedules are now combined," Loehr said. "There is a lot of overlap, and the ACIP felt that it was better to have all of the routine vaccines on one page rather than on different, separate pages. They tested that theory and found that the catch-up schedule is different enough that it should be on its own separate page, but the visual advantage of being able to see the whole 18 years at once outweighed the benefits of having two separate (child and adolescent) schedules."
Each of the new schedules, which were developed in conjunction with the AAFP and other groups, contain changes that are especially pertinent to family physicians, said Loehr.
- The CDC has released its 2013 childhood and adult immunization schedules, combining the previously separate child and adolescent schedules into a single 0- to 18-year schedule.
- One change for this year's 0- to 18-year schedule is that infants ages 6 months through 11 months who are traveling anywhere outside the United States, including to other industrialized countries, should receive measles, mumps and rubella vaccine.
- Two new tetanus, diphtheria and acellular pertussis vaccine recommendations -- specifically concerning adults 65 and older and pregnant women -- are contained in the 2013 adult schedule.
- Two quadrivalent influenza vaccines will be available for the 2013-14 flu season.
"Based on new data of waning immunity to pertussis, the new recommendation is to give Tdap during every pregnancy between 28 and 32 weeks," Loehr said.
"For people over 65, the ACIP recommends (GlaxoSmithKline's) Boostrix, because it has that indication on the label. However, if Boostrix is unavailable, off-label use of (Sanofi Pasteur's) Adacel is valid, because we do not want people walking out without the vaccination simply because an office doesn't have the right one."
"For the subset of high-risk people who get both (PCV13 and PPSV23) -- including those with chronic renal failure and nephrotic syndrome, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants -- there are very specific rules," Loehr said. "If they've had the Pneumovax already, then you give PCV13 a year later. If they haven't had the PPSV23, you give Prevnar 13 first and then the Pneumovax two months later."
Loehr pointed out that, although rare, PCV13 also can cause issues when administered to children who require the Haemophilus influenzae type b-Neisseria meningitidis serogroups C and Y-tetanus toxoid (HibMenCY) vaccine, which is marketed by Sanofi Pasteur as Menactra.
"One specialized footnote that applies to Prevnar 13 is a fairly esoteric one that I have never run into," said Loehr. "You usually don't give Menactra to kids, but if a child has sickle cell disease or anatomic or functional asplenia, you would give (both Menactra) and Prevnar 13. The important thing is that you don't want to give both of them at the same time; you have to separate them by one month."
Quadrivalent Influenza Vaccines
"It is going to be a transition year, so what we used to call 'TIV' (trivalent influenza vaccine) is now called 'IIV' (injectable influenza vaccine), versus the acronym for live attenuated influenza vaccine (LAIV), which remains unchanged," he said. "With the new quadrivalent vaccines in the system, we are now going to say 'trivalent IIV' or 'quadrivalent IIV' to differentiate between the two."
2013 Immunization Schedules Include Several Changes