Summary of recommendations for childhood and adolescent immunization

Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 1 of 4)
Vaccine name
Schedule for routine vaccination and other guidelines
Schedule for catch-up vaccination
Contraindications and precautions
and route
and related issues
• Vaccinate all children age 0 through 18yrs.
• Do not restart series, no matter how Contraindication
Hepatitis B
• Vaccinate all newborns with monovalent vaccine prior to hospital Previous anaphylaxis to this vaccine or to any of its components.
discharge. Give dose #2 at age 1–2m and the final dose at age • 3-dose series can be started at any age.
Precaution
6–18m (the last dose in the infant series should not be given earlier • Minimum intervals between doses: than age 24wks). After the birth dose, the series may be completed using 2 doses of single-antigen vaccine or up to 3 doses of Com- vax (ages 2m, 4m, 12–15m) or Pediarix (ages 2m, 4m, 6m), which may result in giving a total of 4 doses of hepatitis B vaccine.
• If mother is HBsAg-positive: give the newborn HBIG + dose #1
within 12hrs of birth; complete series at age 6m or, if using Special Notes on Hepatitis B Vaccine (HepB)
Dosing of HepB: Monovalent vaccine brands are interchangeable. For people age 0 through 19yrs, give 0.5 mL
of either Engerix-B or Recombivax HB.
• If mother’s HBsAg status is unknown: give the newborn dose
Alternative dosing schedule for unvaccinated adolescents age 11 through 15yrs: Give 2 doses Recombivax
#1 within 12hrs of birth. If preterm, also give HBIG within 12hrs.
HB 1.0 mL (adult formulation) spaced 4–6m apart. (Engerix-B is not licensed for a 2-dose schedule.) If mother is subsequently found to be HBsAg positive, give infant For preterm infants: Consult ACIP hepatitis B recommendations (MMWR 2005; 54 [RR-16]).*
HBIG within 7d of birth and follow the schedule for infants born • Give to children at ages 2m, 4m, 6m, 15–18m, 4–6yrs.
Contraindications
• May give dose #1 as early as age 6wks.
• Previous anaphylaxis to this vaccine or to any of its components.
• May give #4 as early as age 12m if 6m have elapsed since #3. • For DTaP/Tdap only: encephalopathy within 7d after DTP/DTaP.
• Do not give DTaP/DT to children age 7yrs and older.
• If #4 is given before 4th birthday, wait Precautions
• If possible, use the same DTaP product for all doses.
• Moderate or severe acute illness.
• If #4 is given after 4th birthday, #5 is • History of Arthus reaction following a prior dose of tetanus- and/or diphtheria-toxoid-containing vaccine, including MCV4.
• Guillain-Barré syndrome (GBS) within 6wks after previous dose of • Give 1-time Tdap dose to adolescents age 11–12yrs if 5yrs have elapsed since last dose DTaP; then boost every 10yrs with Td.
• For DTaP only: Any of these events following a previous dose of • Give 1-time dose of Tdap to all adolescents who have not DTP/DTaP: 1) temperature of 105°F (40.5°C) or higher within received previous Tdap. Special efforts should be made to give series (spaced at 0, 1–2m, and 6–12m 48hrs; 2) continuous crying for 3hrs or more within 48hrs; Tdap to people age 11yrs and older who are 1) in contact with intervals); substitute a 1-time Tdap for 3) collapse or shock-like state within 48hrs; 4) convulsion with or infants younger than age 12m and 2) healthcare workers with • For DTaP/Tdap only: Unstable neurologic disorder.
• In pregnancy, when indicated, give Td or Tdap in 2nd or 3rd • For Td in teens: Progressive neurologic disorder.
trimester. If not administered during pregnancy, give Tdap in Note: Tdap may be given to pregnant women at the provider’s
• Tdap can be given regardless of interval since previous Td.
• Give to children at ages 2m, 4m, 6–18m, 4–6yrs.
• The final dose should be given on or Contraindication
• May give dose #1 as early as age 6wks.
Previous anaphylaxis to this vaccine or to any of its components.
• Not routinely recommended for U.S. residents age 18yrs and Precautions
• If dose #3 is given after 4th birthday, • Moderate or severe acute illness.
*This document was adapted from the recommendations of the Advisory Committee on Immunization Practices website at www.immunize.org/acip. This table is revised periodically. Visit IAC’s website at www.immunize.
(ACIP). To obtain copies of the recommendations, call the CDC-INFO Contact Center at (800) 232-4636; visit org/childrules to make sure you have the most current version. CDC’s website at www.cdc.gov/vaccines/pubs/ACIP-list.htm; or visit the Immunization Action Coalition (IAC) www.immunize.org/catg.d/p2010.pdf • Item #P2010 (1/11) Technical content reviewed by the Centers for Disease Control and Prevention, January 2011.
Immunization Action Coalition • 1573 Selby Avenue • Saint Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected] Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 2 of 4)
Vaccine name Schedule for routine vaccination and other Schedule for catch-up vaccination
Contraindications and precautions
and route
guidelines
and related issues
Seasonal
• Vaccinate all children and teens age 6m through 18yrs.
Contraindications
Influenza
• LAIV may be given to healthy, non-pregnant people age 2–49yrs.
• Previous anaphylaxis to this vaccine, to any of its components, or to eggs.
• Give 2 doses to first-time vaccinees age 6m through 8yrs, spaced 4wks apart.
• For LAIV only: age younger than 2yrs; pregnancy; chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurological/neuromuscular, hematologic, • For TIV, give 0.25 mL dose to children age 6–35m and 0.5 mL dose if age or metabolic (including diabetes) disorders; immunosuppression (including that caused by medi- cations or HIV); for children and teens ages 6m through 18yrs, current long-term aspirin therapy; • If LAIV and either MMR, Var, and/or yellow fever vaccine are not given on for children age 2 through 4yrs, wheezing or asthma within the past 12m, per healthcare provider the same day, space them at least 28d apart.
Precautions
• Moderate or severe acute illness.
• History of Guillain-Barré syndrome (GBS) within 6wks of a previous influenza vaccination.
- Close contact with an immunosuppressed person when the person requires protective isolation.
- Receipt of specific antivirals (i.e., amantadine, rimantadine, zanamivir, or oseltamivir) 48hrs before vaccination. Avoid use of these antiviral drugs for 14d after vaccination.
Varicella
Contraindications
• Give dose #2 at age 4–6yrs. Dose #2 of • Previous anaphylaxis to this vaccine or to any of its components.
• Pregnancy or possibility of pregnancy within 4wks.
• Children on high-dose immunosuppressive therapy or who are immunocompromised because of • Give a 2nd dose to all older children and • May use as postexposure prophy- malignancy and primary or acquired cellular immunodeficiency, including HIV/AIDS (although adolescents with history of only 1 dose.
vaccination may be considered if CD4+ T-lymphocyte percentages are either 15% or greater in children ages 1 through 8yrs or 200 cells/µL or greater in children age 9yrs and older).
Precautions
• Moderate or severe acute illness.
• If blood, plasma, and/or immune globulin (IG or VZIG) were given in past 11m, see ACIP state- ment General Recommendations on Immunization* regarding time to wait before vaccinating.
• Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24hrs before vaccina- tion, if possible; delay resumption of these antiviral drugs for 14d after vaccination.
• For MMRV only, personal or family (i.e., sibling or parent) history of seizures.
Note: For patients with humoral immunodeficiency or leukemia, see ACIP recommendations*.
Contraindications
• Previous anaphylaxis to this vaccine or to any of its components.
should be given for the first dose in this • Pregnancy or possibility of pregnancy within 4wks.
• Severe immunodeficiency (e.g., hematologic and solid tumors; receiving chemotherapy; congeni- tal immunodeficiency; long-term immunosuppressive therapy, or severely symptomatic HIV). • Give dose #2 at age 4–6yrs. Dose #2 Note: HIV infection is NOT a contraindication to MMR for children who are not severely immu- nocompromised (consult ACIP MMR recommendations [MMWR 1998;47 [RR-8] for details*). Precautions
be given earlier if at least 3m since dose MMR is not contraindicated if a TST (tuberculosis • Moderate or severe acute illness.
skin test) was recently applied. If TST and MMR are not • Give a 2nd dose to all older children and given on same day, delay TST for at least 4wks after MMR.
statement General Recommendations on Immunization* regarding time to wait before vaccinating.
• History of thrombocytopenia or thrombocytopenic purpura.
• For MMRV only, personal or family (i.e., sibling or parent) history of seizures.
Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 3 of 4)
Vaccine name
Schedule for routine vaccination and other guidelines
Schedule for catch-up vaccination
Contraindications and precautions
and route
and related issues
• ActHib (PRP-T): give at age 2m, 4m, 6m, 12–15m (booster dose).
All Hib vaccines:
Contraindications
(Haemophilus • PedvaxHIB or Comvax (containing PRP-OMP): give at age 2m, 4m, • If #1 was given at 12–14m, give booster in 8wks.
• Previous anaphylaxis to this vaccine or to any • Give only 1 dose to unvaccinated children ages • Dose #1 of Hib vaccine should not be given earlier than age 6wks.
• The last dose (booster dose) is given no earlier than age 12m and a Precaution
minimum of 8wks after the previous dose.
• #2 and #3 may be given 4wks after previous dose. • Hib vaccines are interchangeable; however, if different brands of • If #1 was given at age 7–11m, only 3 doses are needed; Hib vaccines are administered for dose #1 and dose #2, a total of #2 is given 4–8wks after #1, then boost at age 12–15m 3 doses are necessary to complete the primary series in infants.
• Any Hib vaccine may be used for the booster dose.
PedvaxHIB and Comvax:
• Hib is not routinely given to children age 5yrs and older.
• #2 may be given 4wks after dose #1.
• Hiberix is approved ONLY for the booster dose at age 15m through 4yrs.
As soon as feasible, replace existing stock of PCV7 with PCV13.
• For minimum intervals, see 3rd bullet at left.
Contraindication
Pneumococcal
conjugate
• For age 7–11m: If history of 0 doses, give 2 doses 4wks Previous anaphylaxis to a PCV vaccine, to any • Dose #1 may be given as early as age 6wks.
apart, with a 3rd dose at age 12–15m; if history of 1 or of its components, or to any diphtheria toxoid- 2 doses, give 1 dose with a 2nd dose at age 12–15m.
• When children are behind on PCV schedule, minimum interval for doses given to children younger than age 12m is 4wks; for doses • For age 12–23m: If unvaccinated or history of 1 dose Precaution
before age 12m, give 2 doses 8wks apart; if history of 1 dose at or after age 12m or 2 or 3 doses before age 12m, • Give 1 dose to unvaccinated healthy children age 24–59m.
give 1 dose at least 8wks after most recent dose.
• For high-risk** children ages 24–71m: Give 2 doses at least 8wks • For age 24–59m and healthy: If unvaccinated or any apart if they previously received fewer than 3 doses; give 1 dose incomplete schedule or if 4 doses of PCV7 or any other at least 8wks after the most recent dose if they previously received age-appropriate complete PCV7 schedule, give 1 dose at least 8wks after the most recent dose.
• PCV13 is not routinely given to healthy children age 5yrs and older. • For age 24–71m and at high risk**: If unvaccinated or any incomplete schedule of 1 or 2 doses, give 2 doses, 1 at least 8wks after the most recent dose and another dose at least 8wks later; if any incomplete series of 3 doses, or if 4 doses of PCV7 or any other age-appropriate complete PCV7 schedule, give 1 dose at least 8wks after the most • For children ages 6 through 18yrs with functional or ana- **High-risk: Those with sickle cell disease; anatomic or
tomic asplenia (including sickle cell disease), HIV infec- functional asplenia; chronic cardiac, pulmonary, or renal tion or other immunocompromising condition, cochlear disease; diabetes; cerebrospinal fluid leaks; HIV infection; implant, or CSF leak, consider giving 1 dose of PCV13 immunosuppression; diseases associated with immunosup- regardless of previous history of PCV7 or PPSV.
pressive and/or radiation therapy; or who have or will have Contraindication
Pneumococcal
polysaccharide
• Give 1 dose at least 8wks after final dose of PCV to high-risk chil- Previous anaphylaxis to this vaccine or to any • For children who have an immunocompromising condition or have Precaution
sickle cell disease or functional or anatomic asplenia, give a 2nd dose of PPSV 5yrs after previous PPSV (consult ACIP PPSV rec- ommendations at www.cdc.gov/vaccines/pubs/ACIP-list.htm*).
Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 4 of 4)
Vaccine name
Schedule for routine vaccination and other guidelines
Schedule for catch-up vaccination and
Contraindications and precautions
and route
related issues
Rotavirus
• Rotarix (RV1): give at age 2m, 4m.
• Do not begin series in infants older Contraindications
• RotaTeq (RV5): give at age 2m, 4m, 6m.
• Previous anaphylaxis to this vaccine or to any of its components. If • May give dose #1 as early as age 6wks.
• Diagnosis of severe combined immunodeficiency (SCID).
• Give final dose no later than age 8m 0 days.
• If prior vaccination included use of Precautions
• Moderate or severe acute illness.
• Altered immunocompetence.
• Moderate to severe acute gastroenteritis or chronic pre-existing gas- Hepatitis A
• Give 2 doses spaced 6m apart to all children at age 1yr (12–23m).
• Minimum interval between doses is 6m.
Contraindication
• Vaccinate all previously unvaccinated children and adolescents age • Children who are not fully vaccinated Previous anaphylaxis to this vaccine or to any of its components.
Precautions
- Want to be protected from HAV infection.
• Moderate or severe acute illness.
- Live in areas where vaccination programs target older children.
- Travel anywhere except U.S., W. Europe, N. Zealand, Australia, - Have chronic liver disease, clotting factor disorder, or are adoles- • Give 1 dose as postexposure cent males who have sex with other males.
- Are users of illicit drugs (injectable or non-injectable).
- Anticipate close personal contact with an international adoptee from a country of high or intermediate endemicity during the first been exposed to hepatitis A virus.
60 days following the adoptee’s arrival in the U.S.
Meningococcal • Give MCV4 #1 routinely at age 11 through 12yrs and a booster
Contraindication
conjugate,
Previous anaphylaxis to any meningococcal vaccine or to any of its quadrivalent
• Give MCV4 to all unvaccinated teens ages 13 through 18yrs; if disease persists, revaccinate with Men- components, including diphtheria toxoid (for MCV4).
vaccinated at age 13–15yrs, give booster dose at age 16–18yrs.
actra in 3yrs (if first dose given at age Precautions
Menactra (ages • Vaccinate all college freshmen living in dorms who have not been • Moderate or severe acute illness.
• In pregnancy, studies of vaccination with MPSV4 have not docu- • Vaccinate all children age 2yrs and older who have any of the mented adverse effects so may use MPSV4 if indicated. No data are available on the safety of MCV4 during pregnancy.
- Anatomic or functional asplenia, or persistent complement component deficiency; give 2 doses, separated by 8wks.
• For children with HIV infection, give Meningococcal
- Travel to or reside in countries in which meningococcal polysaccharide
disease is hyperendemic or epidemic (e.g., the “meningitis Note: Use MPSV4 ONLY if there is a permanent contraindication • Give 3-dose series to girls at age 11–12yrs on a 0, 1–2, 6m sched- Contraindication
papillomavirus
ule. (May be given as early as age 9yrs.) Previous anaphylaxis to this vaccine or to any of its components. • Vaccinate all older girls and women (through age 26yrs) who were between #2 and #3. Overall, there must Precautions
(HPV2, Cervarix) not previously vaccinated.
be at least 24wks between doses #1 and • Moderate or severe acute illness.
(HPV4, Gardasil) • Consider giving HPV4 to males age 9 through 26yrs to reduce their likelihood of acquiring genital warts.

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