The sentences in bold are very 'interesting'!
ACIP Releases 2014 Pediatric Vaccine Schedule
January 31, 2014
The American Academy of Pediatrics (AAP), in collaboration with the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices, the American Academy of Family Practice, and the American College of Obstetricians and Gynecologists, has published a revision of immunization schedules for infants, children, and teenagers for 2014.
The revised immunization schedule appears in the February 2014 issue of Pediatrics.
"This revision is typically published at the end of January each year," Michael T. Brady, MD, from Nationwide Children's Hospital, Columbus, Ohio, told Medscape Medical News.
Key Change for Tdap
"The purpose of the revised immunization schedules is to ensure that providers have a comprehensive document that updates all changes in available vaccines and any changes in indications or how the vaccines are to be utilized," Dr. Brady said.
"Essentially, this immunization schedule is being published to replace the prior year's immunization schedule because that has become obsolete," he continued. "In some years, there are many changes or significant changes. In other years, there are few changes. This year, most of the changes are minor, with the exception of the provision of information on some new vaccines."
New in 2014 is an AAP recommendation that pregnant adolescents receive tetanus-diphtheria-acellular pertussis (Tdap) vaccine for each pregnancy, preferably during week 27 through week 36 of gestation, regardless of the time since their previous Td or Tdap vaccine.
The 2013 recommendation had called for a Tdap booster for pregnant teenagers but did not specify whether it should be administered for subsequent pregnancies.
Important Updates for Influenza and Meningococcal Vaccines
"There is availability of a number of new influenza vaccines," Dr. Brady said. "Since providers typically order their vaccines for influenza season in January or February, this allows providers to become familiar with the newer vaccines so they can determine which to order."
The 2014 schedules also include information on pneumococcal vaccines for high-risk children and guidance for the use of recently licensed meningococcal vaccines
"There are now 2 additional meningococcal conjugate vaccines available for infants. The schedule provides information for which children these vaccines should be considered and when they should be administered," Dr. Brady said.
Menactra (Sanofi Pasteur) was included in the 2013 immunization schedule. "It was the first 'infant' meningococcal vaccine approved and for which AAP and CDC had recommendations for a 2-dose schedule starting at age 9 months," Dr. Brady said.
The 2014 meningococcal vaccine recommendation now include guidance for the use of 2 new "infant" vaccines, Menveo (Novartis) and MenHibRix (GlaxoSmithKline).
Each vaccine is approved starting at 2 months of age, with a 3-dose primary series and a booster dose at 12 to 15 months of age starting at 2 months of age for high-risk children, such as those with anatomic or functional asplenia, including sickle cell disease, and children with persistent complement component deficiency.
"None of the infant meningococcal vaccines is recommended for routine use in infants," Dr. Brady emphasized. "They are only recommended for infants with an increased risk for meningococcal infection due to an immunodeficiency or those who travel to an area with high rates of meningococcal disease."
Immunization Schedule Format Similar to Last Year
The footnotes in the 2014 schedule show recommendations for routine vaccination, catch-up vaccination, and vaccination of children and adolescents with high-risk conditions or in special circumstances.
The Haemophilus influenza type b footnote clarifies vaccination of children aged 12 through 59 months who are at increased risk because of incomplete vaccination, asplenia, HIV infection, or receipt of a hematopoietic stem cell transplant or who have or are receiving chemotherapy or radiation treatment.
The pneumococcal vaccine footnote lists recommendations for the 13-valent pneumococcal vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) use in children and teenagers at increased risk on the basis of age and degree of risk.
The influenza vaccine footnote describes vaccine dosing for children stratified by age (6 months through 8 years and 9 years and older) for the 2013-2014 season.
The human papillomavirus footnote clarifies the intervals between vaccine doses, calling for a 3-dose series on a schedule of 0, 1 to 2, and 6 months for all adolescents aged 11 through 12 years.
Parents' Fears of Too Many Vaccines Unfounded
"The immunization schedule has gotten larger and looks more complicated every year," Dr. Brady said. "This has caused many parents to feel that their children might be receiving too many vaccines or too many vaccines at one time."
The Institute of Medicine has investigated this issue to see whether there was any potential harm, and the findings were "very supportive of the immunization schedule as currently laid out," Dr. Brady said.
"They found no evidence that...the immunization schedule [or] the number of immunizations given at one time caused harm. There is no evidence that the number of vaccines in the schedule overwhelms the immune system. There is actually good evidence that the vaccines recommended to be given together result in the same immune response as when they are given separately," he said.
The schedule also separates the giving of vaccines in the "rare" instance where one will interfere with the immune response of the other, Dr. Brady said.
"This is done because as vaccines come to the market, the companies making the vaccines need to do studies to show that the new vaccine can be safely given with the other vaccines recommended at the same age," he said.
The Institute of Medicine has in fact stated that any study that attempted to study administration of vaccines on a schedule that delayed any of the vaccines from the current schedule would be unethical, Dr. Brady added.
"The rationale for this statement was that the current immunization schedule is safe, and any delay in giving a vaccine according to the schedule would place the child at risk of the vaccine-preventable disease for a longer period of time."
Dr. Brady has disclosed no relevant financial relationships.
Pediatrics. 2014;133:357-358. Full text
ACIP Issues 2014 Immunization Schedule for Adults
February 03, 2014
Updated vaccination recommendations for adults aged 19 years and older for 2014 have been released by the Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization.
The committee approved the Adult Immunization Schedule for 2014 in October 2013; the schedule was also reviewed and approved by the American Academy of Family Physicians, American College of Physicians, American College of Obstetricians and Gynecologists, and American College of Nurse-Midwives.
The immunization schedule is being simultaneously published in the February 4 issue of the Annals of Internal Medicine and on the CDC's Web site.
Additional guidance for the use of the vaccines and updates is also provided on the CDC's Web site.
A press release from the journal highlights key changes in the recommendations, including:
Haemophilus influenza type b (Hib): The Hib "vaccine recommendations were updated. The vaccine is recommended for certain adults at increased risk for Hib who have not received the vaccine before, except for those with HIV because their risk for Hib infection is low. Adults who have had a successful hematopoietic stem cell transplant are recommended to receive a 3-dose series of Hib vaccine 6 to 12 months after the transplant regardless of Hib vaccination status."
Influenza vaccine: The update adds "[i]nformation on the use of the recombinant influenza (RIV) and inactivated influenza (IIV) vaccines among egg-allergic patients was added to the footnote and indicates that RIV or IIV can be used among persons with hives-only allergy to eggs, as it contains no egg protein."
"Td/Tdap: The tetanus, diphtheria, acellular pertussis (Tdap) and tetanus, diphtheria (Td) vaccines footnote was edited to harmonize with the language used in the pediatric immunization schedule. A single dose of Tdap vaccine is recommended for previously unvaccinated persons aged 11 years or older, and Td booster should be administered every 10 years thereafter."
Human papillomavirus: "Information was added to the humanpapillomavirus...vaccine footnote to clarify the timing between the second and third doses and to harmonize language between the pediatric and adult immunization schedules. No changes in recommendations were made."
Zoster: "Being a healthcare worker is no longer an indication for vaccination."
Pneumococcal vaccines: "PCV13 [the 13-valent pneumococcal vaccine] is recommended to be administered before PPSV23 [the 23-valent pneumococcal vaccine] among persons for whom both vaccines are recommended. The PCV13 footnote now precedes the PPSV23 footnote and includes wording to remind providers of the appropriate order of these vaccines when both are indicated."
Meningococcal vaccine: The footnote "was edited to clarify which persons need either one or two doses of vaccine and to provide greater clarity regarding which patients should receive meningococcal conjugate (MeanACWY-D) versus the meningococcal polysaccharide (MenACWY-CRM)."
One member of the Advisory Committee on Immunization Practices reports relevant financial relationships with Sanofi Pasteur, GlaxoSmithKline, Merck, Novartis, and Pfizer but declares that all relationships with industry were terminated before he became a voting member, and one member who reports receiving a grant from Merck.
Ann Intern Med. 2014;160:190-197.