Updated Vaccine Schedule for Children, Teens

Annual Revision Addresses Whooping Cough, Influenza, Pneumococcal Vaccines

From the WebMD Archives

Feb. 1, 2011 -- An updated vaccine schedule for children and teens is out from the American Academy of Pediatrics.

"Parents should be aware that the vaccine schedule is updated every year," Cody Meissner, MD, a consultant to the AAP's Committee on Infectious Disease who helped update the new schedule, tells WebMD.

"It's updated as we acquire new vaccines that are licensed by the FDA, and it's updated as we gain new information about the optimal times to administer different vaccines,'' says Meissner, a professor of pediatrics at Tufts University School of Medicine and chief of pediatric infectious diseases, Tufts Medical Center, Boston.

This year's schedule addresses all the recommended vaccines during childhood and adolescence, with changes involving these vaccines:

The updated schedule has been approved by the AAP, the CDC's Advisory Committee on Immunization Practices, and the American Academy of Family Physicians. The pediatricians have also issued a catch-up schedule for children and teens ages 4 months through 18 years who started immunizations late or who are behind by more than a month.

The new information on immunizations is published online in the journal Pediatrics.

Recommended Vaccines: What Parents Need to Know

WebMD asked for input from two doctors involved in developing the updated schedules -- Meissner and Henry Bernstein, DO, a member of the AAP Committee on Infectious Diseases and chief of general pediatrics at the Cohen Children's Medical Center of New York.

Among the vaccine news they say parents need to know:

Pertussis vaccine. Children ages 7 through 10 who aren't fully vaccinated against pertussis (whooping cough), including children never vaccinated or with an unknown vaccination status, should get a single dose of the Tdap vaccine, Meissner says. Parents may mistakenly think whooping cough is a disease of the past, he says, but that's not so, as last year's outbreaks of whooping cough suggest.

Teens 13 through 18 who haven't gotten the Tdap vaccine yet should get a dose, followed by a booster of tetanus and diphtheria (Td) every decade.

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Meningococcal vaccine. Meningococcal disease, a serious bacterial illness, is a cause of bacterial meningitis (an infection of the membranes around the brain and spinal cord) in children 2-18. Under previous schedules, this vaccine was routinely given at age 11 or 12, Meissner says. "It was expected immunity would last through age 21," he tells WebMD. But, he says, ''it turns out immunity does not last even five years for most vaccine recipients."

So the new recommendation is to give the first dose at age 11 or 12, as before, then to give the second dose, the booster, at age 16 to 18.

Hepatitis B vaccine. The new schedule gives guidance for when to give this vaccine (which protects against serious liver disease from a form of viral hepatitis) to children who did not receive the recommended dose at birth. Some children are given the first dose of this at birth, some get the first dose at 6-8 weeks, Meissner says. The new schedule sets the minimum age for dose three for the children who did not get the first dose at birth at no earlier than 24 weeks of age.

Influenza vaccine. The new schedule gives guidance for whether a child needs one or two doses of this vaccine for seasonal flu, says Bernstein. The decision is based on the child's history of getting the monovalent 2009 H1N1 vaccine. If a child is between 6 months and 8 years and is being vaccinated against flu for the first time (or was vaccinated for the first time during the previous flu season but only got one dose) he or she should get two doses, separated by at least four weeks.

A 6-month to 8-year-old child who received no doses of the 2009 H1N1 vaccine or if the dosing schedule is unknown should receive two doses of the 2010-2011 seasonal influenza vaccine.

Bernstein says parents are often unaware that pediatricians have been recommending flu vaccine for everyone 6 months old and older.

HPV vaccine. Human papillomavirus or HPV, is the most common sexually transmitted virus and is linked to cervical cancers and genital warts. Under the new schedule, the HPV4 vaccine (the type recommended for prevention of genital warts in girls) may be given in three dosesto boys aged 9 to 18.

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Haemophilus influenzae type b. The vaccine is already recommended for children under age 5 to prevent serious disease caused by bacteria. Under the updated schedule, it should be considered in previously unvaccinated children aged 5 and older if they have sickle cell disease, leukemia, or HIV, or if their spleen was removed.

Pneumococcal conjugate vaccine 13. "We have moved from PCV 7, the pneumococcal conjugate vaccine that protects against 7 serotypes or stains, to PCV 13," Bernstein says. It protects against more strains of bacteria that cause infections such as serious bacterial pneumonia and meningitis, he says. Under the new schedule, a single supplemental dose of PCV13 is advised for all children aged 14 through 59 months who have gotten their PCV7 shots on schedule previously. A single dose of the PCV13 is advised for kids 60 through 71 months with underlying medical condition who already got PCV7 on schedule, among other recommendations about the new vaccine.

Other Recommended Vaccines

Besides these vaccines, the AAP schedule covers recommendations on other childhood vaccines, including rotavirus vaccine, polio virus, MMR (measles, mumps, and rubella), and varicella. Parents can ask their pediatrician if their child is up to date on these and other immunizations.

Monitoring of vaccine safety is continuous, Bernstein says. "Even though a vaccine is licensed, we don't stop monitoring its safety and effectiveness," he says.

WebMD Health News Reviewed by Laura J. Martin, MD on January 31, 2011

Sources

SOURCES:

Pediatrics, published online Feb. 1, 2011.

Henry Bernstein, DO, chief of general pediatrics, Cohen Children's Medical Center of New York; member, American Academy of Pediatrics' Committee on Infectious Diseases.

Cody Meissner, MD, professor of pediatrics, Tufts University School of Medicine; chief of pediatric infectious diseases, Tufts Medical Center; consultant, American Academy of Pediatrics' Committee on Infectious Diseases.

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