Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2018

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

In October 2017, the Advisory Committee on Immunization Practices (ACIP) approved the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2018. The 2018 child and adolescent immunization schedule summarizes ACIP recommendations, including several changes from the 2017 immunization schedules, in three figures and footnotes to the figures. These documents can be found on the CDC immunization schedule website (https://www.cdc.gov/vaccines/schedules/index.html). These immunization schedules are approved by ACIP (https://www.cdc.gov/vaccines/acip/index.html), the American Academy of Pediatrics (https://www.aap.org), the American Academy of Family Physicians (https://www.aafp.org), and the American College of Obstetricians and Gynecologists (https://www.acog.org). Health care providers are advised to use the figures and the footnotes together. The full ACIP recommendations for each vaccine, including contraindications and precautions, can be found at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html. Providers should be aware that changes in recommendations for specific vaccines can occur between annual updates to the childhood/adolescent immunization schedules. If errors or omissions are discovered within the child and adolescent schedule, CDC posts revised versions on the CDC immunization schedule website.* Printable versions of the 2018 immunization schedules for children and adolescents aged 18 years or younger and ordering instructions for laminated versions and easy-to-read versions for parents also are available at the immunization schedule website. For further guidance on the use of each vaccine included in the schedules, including contraindications and precautions, health care providers are referred to the respective ACIP vaccine recommendations. Changes in the 2018 Child and Adolescent Immunization Schedule Changes in the 2018 immunization schedules for children and adolescents aged 18 years or younger include new or revised ACIP recommendations for poliovirus ( 1 ), influenza ( 2 ), and measles, mumps, and rubella vaccines ( 3 ), and clarification of the recommendations for rotavirus and pneumococcal vaccines. Changes Affecting Multiple Portions of the Schedule Mention of MenHiberix (Hib-MenCY) vaccine has been removed from Figure 1 and Figure 2 and the relevant footnotes (Hib and meningococcal A,C,W,Y). Manufacturing of MenHibrix has been discontinued in the United States and all available doses have expired. Cover Page. Changes to the 2018 figure from the 2017 schedule † are as follows: A table was added outlining vaccine type, abbreviation, and brand names for vaccines discussed in the child/adolescent immunization schedule. Figure 2. Changes to the 2018 figure from the 2017 schedule are as follows: The maximum ages for the first and last doses in the rotavirus vaccination series were added to the rotavirus vaccine row. The inactivated poliovirus vaccine rows were edited to clarify the catch-up recommendations for children 4 years of age and older. Figure 3. Changes to the 2018 figure from that in the 2017 schedule are as follows: A reference was added to the HIV column of the figure. The reference provides additional information regarding HIV laboratory parameters and use of live vaccines. Within the pneumococcal conjugate row, stippling was added to heart disease/chronic lung disease, chronic liver disease, and diabetes columns to clarify that, in some situations, an additional dose of vaccine might be recommended for children with these conditions. Footnotes. The footnotes are presented in a new simplified format. The goal was to remove unnecessary text, preserve all pertinent information, and maintain clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes. In addition to this overall simplification, content changes were made as follows: The Hepatitis B vaccine (HepB) footnote was revised to include information regarding vaccination of <2,000-g infants born to hepatitis B virus surface antigen (HBsAg)–negative mothers. The poliovirus vaccine footnote was revised to include updated guidance for persons who received oral poliovirus vaccine as part of their vaccination series. The influenza vaccine footnote has been updated to indicate that live attenuated influenza vaccine (LAIV) should not be used during the 2017–2018 influenza season. A reference link to the 2017–2018 season influenza recommendations has been added. The measles, mumps, and rubella vaccine (MMR) footnote was updated to include guidance regarding the use of a third dose of mumps virus–containing vaccine during a mumps outbreak. The meningococcal vaccine footnote has been edited to create separate footnotes for MenACWY and MenB vaccines.

Related collections

Most cited references 2

Record: found
Abstract: found
Article: found

Is Open Access

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Mona Marin, Mariel Asbury Marlow, Kelly L Moore … (2018)

A substantial increase in the number of mumps outbreaks and outbreak-associated cases has occurred in the United States since late 2015 ( 1 , 2 ). To address this public health problem, the Advisory Committee on Immunization Practices (ACIP) reviewed the available evidence and determined that a third dose of measles, mumps, rubella (MMR) vaccine is safe and effective at preventing mumps. During its October 2017 meeting, ACIP recommended a third dose of a mumps virus–containing vaccine* for persons previously vaccinated with 2 doses who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak. The purpose of the recommendation is to improve protection of persons in outbreak settings against mumps disease and mumps-related complications. This recommendation supplements the existing ACIP recommendations for mumps vaccination ( 3 ). In 1977, ACIP recommended 1 dose of mumps vaccine for all children aged ≥12 months ( 4 ). In response to multiple measles outbreaks in the late 1980s, in 1989 ACIP recommended routine administration of 2 doses of MMR vaccine for children, with the first dose administered at ages 12 through 15 months and the second at ages 4 through 6 years ( 5 ). In addition to improved measles control, this policy led to substantial reduction in the number of mumps cases in the United States during the 1990s, which was sustained through 2005 ( 3 ). However, in 2006, mumps outbreaks primarily affecting populations with high coverage with 2 doses of MMR vaccine in midwestern states and colleges resulted in 6,584 reported mumps cases that year ( 6 ). These outbreaks prompted ACIP to formally recommend a routine 2-dose mumps vaccination policy for school-aged children (i.e., kindergarten–grade 12) and adults at high risk (i.e., students at post-high school educational institutions, health care personnel, and international travelers) in 2006 ( 7 ). In addition, ACIP recommended that a second dose of mumps vaccine should be considered in outbreak settings for children aged 1–4 years and adults who have received 1 dose of vaccine, depending on the epidemiology of the outbreak (e.g., the age groups affected or institutions involved). Despite this recommendation, mumps outbreaks continued to be reported throughout the United States, particularly in settings where persons have close, prolonged contact (e.g., universities and close-knit communities). To assist state and local health departments in responding to mumps outbreaks, CDC issued guidance on use of a third dose of MMR vaccine in the 2012 Manual for the Surveillance of Vaccine-Preventable Diseases. † The guidance was based on limited data and provided criteria for health departments regarding when to consider use of a third dose in specifically identified target populations. Additional evidence on effectiveness and safety of the third dose of MMR vaccine recently became available and was presented to ACIP during 2017. This report summarizes the evidence considered by ACIP regarding use of a third dose of a mumps virus–containing vaccine during outbreaks and provides the recommendation for its use among persons who are at increased risk for acquiring mumps because of an outbreak. Methods During March–October 2017, the ACIP Mumps Work Group held biweekly conference calls to review and discuss relevant scientific evidence. Topics addressed included the epidemiology of mumps in the United States since introduction of a routine second dose of MMR vaccine; effectiveness, duration of protection, immunogenicity, and risk factors for 2-dose vaccine failure; and effectiveness, immunogenicity, and safety of a third dose of MMR vaccine. Also assessed were stakeholders’ values attributed to the perceived benefits and harms of a third dose of MMR vaccine, acceptability, and implementation considerations regarding use of a third dose of MMR vaccine. Where scientific data were lacking, the summary of evidence incorporated the opinions of the Mumps Work Group member experts. Quality of evidence related to the benefits and harms of a third dose of mumps virus–containing vaccine was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework (https://www.cdc.gov/vaccines/acip/recs/grade/about-grade.html). Methods and GRADE tables for the evidence for third dose of mumps virus–containing vaccine can be found at https://www.cdc.gov/vaccines/acip/recs/grade/mumps.html. Summaries of the evidence reviewed were presented to ACIP at the February 2017, June 2017, and October 2017 meetings. At the October 2017 ACIP meeting, the proposed recommendation for a third dose of a mumps virus–containing vaccine (i.e., MMR or measles, mumps, rubella, and varicella [MMRV]) during mumps outbreaks was presented, and after a period for public comment, was approved unanimously by the voting ACIP members. § Summary of Key Findings Public Health Burden of Mumps. Parotitis occurs in >85% of mumps cases; however, severe manifestations with complications such as orchitis (12%–66%), aseptic meningitis (0.2%–10%), or encephalitis (0.02%–0.3%) were recognized during the prevaccine era ( 3 ) and also can occur in vaccinated persons (3%–11%, 5) to student life (median = 6, IQR = 4–7), and 67% indicated outbreaks were more than somewhat disruptive to staff activities (median = 6, IQR = 5–8). Ranking of disruption to student life and staff activities did not differ significantly by the size of the outbreak experienced by the university (p = 0.20 and p = 0.57, respectively). The survey of health departments was distributed through the Council of State and Territorial Epidemiologists to 81 health department jurisdictions, including 58 (72%) state and territorial health departments and 23 (28%) city or large urban health departments. Among the 61 (75%) responding health departments, 46 (75%) reported having one or more mumps outbreaks in their jurisdiction since January 1, 2016 ( 33 ). Nearly half (47%, 20 of 43) of health departments that reported outbreaks indicated recommending an outbreak dose or third dose of MMR vaccine** during one or more of these outbreaks. Compared with other mumps outbreak control measures, on a scale from not effective (0), to somewhat effective (5), to most effective (10), 42% (8 of 19) of health departments rated the intervention with an effectiveness score >5 (more than somewhat effective) (median = 5, IQR = 3–7). On a scale from least cost beneficial (0), to somewhat cost beneficial (5), to most cost beneficial (10), 53% (8 of 15) of health departments rated the intervention with a cost benefit score >5 (more than somewhat cost beneficial) (median = 7, IQR = 4–7). GRADE Quality of Evidence Summary. The GRADE evidence type †† for critical outcomes was determined to be 4 for benefits (effectiveness for prevention of mumps) and 2 for harms (serious adverse events) (https://www.cdc.gov/vaccines/acip/recs/grade/mumps.html). Summary of Rationale for Recommendation for a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Acquiring Mumps During an Outbreak Mumps outbreaks have occurred primarily in populations in institutional settings with close contact or in close-knit communities. The current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, but insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high. Waning of vaccine-induced immunity with time after receipt of the second vaccine dose in high intensity exposure settings typical of outbreaks contributes to this higher risk for mumps disease in these settings. Protection against severe disease, however, is maintained. Considering the evidence regarding the public health burden of disease and the known risk factors, persons who are at increased risk for acquiring mumps because of an outbreak were identified as a public health priority for receiving a third dose of mumps virus–containing vaccine. A third dose of MMR vaccine has at least a short-term benefit for persons in outbreak settings. No serious adverse events were reported, and rates of nonserious adverse events were low. Because mumps is prevented in persons who receive a third dose, complications will also be prevented. Together, the benefit of added protection through administration of a third dose of MMR vaccine outweighs the low risk for vaccine-associated adverse events. Universities and health departments value the prevention of mumps disease and mumps complications and recognize that there is a potential loss of productivity because of mumps disease. A third dose of MMR vaccine was considered acceptable to students, parents, universities/schools, and health departments. Regarding implementation, an ACIP recommendation would allow health departments to make more rapid decisions regarding use of a third dose of MMR vaccine and increase access to vaccine for persons identified by public health authorities as being at increased risk for mumps because of an outbreak. MMRV vaccine, which is the other vaccine licensed in the United States for the prevention of mumps ( 34 ), §§ may also be used when a third dose mumps vaccination is indicated among children aged ≤12 years. Available evidence indicates that a third dose of MMR vaccine improves protection for persons at increased risk for mumps because of an outbreak. Because of the complexity of mumps outbreaks, including the setting, the group or population affected, and risk factors for transmission, public health authorities are uniquely positioned to advise parents, students, clinicians, and universities regarding when and for which groups a third dose of MMR vaccine is appropriate. At this time, evidence is limited and is not sufficient to fully characterize the effect of a third dose of MMR vaccine on reducing the size or duration of an outbreak, nor are any data available to demonstrate the duration of additional protection conferred by a third dose. In addition, limited immunologic evidence suggests antibody titers decline within 1 year after the third dose. As more data on duration of protection after receipt of the third dose become available, evidence for use of a routine third dose will be considered. No evidence is available regarding the benefit of an additional dose of a mumps virus–containing vaccine to persons with documentation of receipt of 3 previous doses; therefore, no additional dose is recommended for persons in outbreak settings who have already received ≥3 doses of a mumps virus–containing vaccine. Recommendation Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications. Implementation Considerations and Future Research In the setting of an identified mumps outbreak, public health authorities should define target groups at increased risk for mumps during the outbreak, determine whether vaccination of at-risk persons is indicated, and provide recommendations for vaccination to health care providers. Persons at increased risk for acquiring mumps are those who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, such as through close contact or sharing of drinks or utensils. During an outbreak, persons identified as being at increased risk and who have received ≤2 doses of mumps virus–containing vaccine or have unknown vaccination status should receive 1 dose. Additional guidance can be found in the Manual for the Surveillance of Vaccine-Preventable Diseases ( 9 ). Contraindications and precautions for administration of a third dose of a mumps virus–containing vaccine are the same as those for routine use of the vaccine (1 or 2 doses) ( 3 ). CDC will monitor the burden of mumps among persons who have received 2 and 3 doses of mumps virus–containing vaccine and the duration of protection conferred by the third dose, as well as adverse events after the receipt of a third dose of a mumps virus–containing vaccine. Adverse events occurring after administration of any vaccine should be reported to the Vaccine Adverse Event Reporting System (VAERS; https://vaers.hhs.gov/). In addition, CDC will continue to collect data to assess the impact of receipt of a third dose of mumps virus–containing vaccine on mumps outbreaks.

0 comments Cited 45 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Guidance for Assessment of Poliovirus Vaccination Status and Vaccination of Children Who Have Received Poliovirus Vaccine Outside the United States

Mona Marin, Manisha S. Patel, Steve Oberste … (2017)

In 1988, the World Health Assembly resolved to eradicate poliomyelitis (polio). Since then, wild poliovirus (WPV) cases have declined by >99.9%, from an estimated 350,000 cases of polio each year to 74 cases in two countries in 2015 ( 1 ). This decrease was achieved primarily through the use of trivalent oral poliovirus vaccine (tOPV), which contains types 1, 2, and 3 live, attenuated polioviruses. Since 2000, the United States has exclusively used inactivated polio vaccine (IPV), which contains all three poliovirus types ( 2 , 3 ). In 2013, the World Health Organization (WHO) set a target of a polio-free world by 2018 ( 4 ). Of the three WPV types, type 2 was declared eradicated in September 2015. To remove the risk for infection with circulating type 2 vaccine-derived polioviruses (cVDPV), which can lead to paralysis similar to that caused by WPV, all OPV-using countries simultaneously switched in April 2016 from tOPV to bivalent OPV (bOPV), which contains only types 1 and 3 polioviruses ( 5 ). This report summarizes current Advisory Committee on Immunization Practices (ACIP) recommendations for poliovirus vaccination and provides CDC guidance, in the context of the switch from tOPV to bOPV, regarding assessment of vaccination status and vaccination of children who might have received poliovirus vaccine outside the United States, to ensure that children living in the United States (including immigrants and refugees) are protected against all three poliovirus types. This guidance is not new policy and does not change the recommendations of ACIP for poliovirus vaccination in the United States. Children living in the United States who might have received poliovirus vaccination outside the United States should meet ACIP recommendations for poliovirus vaccination, which require protection against all three poliovirus types by age-appropriate vaccination with IPV or tOPV. In the absence of vaccination records indicating receipt of these vaccines, only vaccination or revaccination in accordance with the age-appropriate U.S. IPV schedule is recommended. Serology to assess immunity for children with no or questionable documentation of poliovirus vaccination will no longer be an available option and therefore is no longer recommended, because of increasingly limited availability of antibody testing against type 2 poliovirus. The widespread use of OPV, most commonly tOPV, has been critical for polio eradication efforts. However, OPV use, particularly in areas with low vaccination coverage, is associated with a low risk for reemergence of cVDPVs, which can lead to outbreaks of poliomyelitis similar to those caused by WPV ( 6 ). Type 2 cVDPVs in particular have accounted for >94% of all cVDPVs and have caused more than 650 polio cases since 2006, including several outbreaks in 2015 ( 7 ). Furthermore, type 2 cVPDVs have been detected in environmental (sewage) samples in recent years (in 2015 in Pakistan and in 2015 and 2016 in Nigeria) ( 7 , 8 ). To remove the risk for infection with type 2 cVDPVs, all OPV-using countries simultaneously switched from tOPV to bOPV in April 2016 ( 5 ). To further reduce the risk for reintroduction of type 2 polioviruses, laboratory containment activities limiting the handling of potentially infectious materials to certified poliovirus-essential facilities were initiated in 2015 ( 9 ). Although circulation of indigenous WPV in the United States ceased decades ago, the risk for importation of either WPV types 1 or 3 as well as cVDPVs remains ( 10 ). The following guidance is provided to highlight recent changes in global polio eradication program strategies and to ensure adequate vaccination according to ACIP recommendations of children who might have received poliovirus vaccination outside the United States. Current ACIP Recommendations for Routine Poliovirus Vaccination in the United States In the United States, all infants and children should receive 4 doses of IPV at ages 2 months, 4 months, 6 through 18 months, and at 4 through 6 years ( 2 , 3 ). The final dose in the series should be administered on or after the fourth birthday, regardless of the number of previous doses, and should be given ≥6 months after the previous dose. A fourth dose in the routine IPV series is not necessary if the third dose was administered at age ≥4 years and ≥6 months after the previous dose. Vaccines administered outside the United States generally can be accepted as valid doses if the schedule (i.e., minimum age for vaccination and intervals between doses) is similar to that recommended in the United States.* Vaccination against polio is also valid for children from countries that use an accelerated schedule, with the first dose given as early as 6 weeks and the second and third doses administered at least 4 weeks after the previous doses. The minimum interval between the third and fourth doses should be 6 months. Only written, dated records are acceptable as evidence of previous vaccination. Documentation of vaccination with OPV outside the United States should specify vaccination against all three poliovirus types. If both tOPV and IPV were administered as part of a series, the total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule. A minimum interval of 4 weeks should separate doses in the series, with the final dose administered on or after the fourth birthday and at least 6 months after the previous dose. If only tOPV was administered, and all doses were given before age 4 years, 1 dose of IPV should be given at age ≥4 years, at least 6 months after the last tOPV dose. Guidance for Assessment of Poliovirus Vaccination Status and for Vaccination of Children Who Might Have Been Vaccinated Outside the United States Children without adequate documentation of poliovirus vaccination. Persons aged <18 years should be vaccinated or revaccinated in accordance with the age-appropriate U.S. IPV schedule. † Adverse events after administration of IPV are rare ( 2 ). The 2011 ACIP General Recommendations on Immunization included the option to perform serologic testing for neutralizing antibodies to poliovirus types 1, 2, and 3 to assess immunity in children without adequate documentation of vaccination against polio. Persons with protective titers against all three poliovirus types did not need to receive repeat doses, but were recommended to complete the schedule as age appropriate. In the United States, availability of serologic testing for neutralizing antibodies has been limited in certain commercial and state health department laboratories. Serologic testing for antibodies against poliovirus type 2, an assay that uses live virus, is becoming increasingly unavailable as U.S. laboratories conform to WHO’s laboratory containment strategy to destroy type 2 poliovirus in their facilities; these activities were begun in late 2015. Demonstrating antibodies to poliovirus types 1 and 3 does not reliably indicate protection against poliovirus type 2, because countries might have used a combination of monovalent oral poliovirus vaccine (mOPV), bOPV, or tOPV for routine programs and immunization campaigns. In the absence of the availability of testing for antibodies to all 3 serotypes, serologic testing is no longer recommended to assess immunity. Children with documentation of poliovirus vaccination. Previous poliovirus vaccination is valid if documentation indicates receipt of IPV or tOPV. Although tOPV was used for routine poliovirus vaccination in all OPV-using countries, mOPV or bOPV often were used in vaccination campaigns. Therefore, only documentation specifying receipt of tOPV constitutes proof of vaccination according to the U.S. polio vaccination recommendations. If such documentation cannot be validated, persons aged <18 years should be revaccinated with IPV according to the U.S. IPV schedule. Consistent with the polio eradication strategy, doses of OPV administered after April 2016 would either be bOPV (used in routine immunization and campaigns), or mOPV (used in a type-specific outbreak response). ACIP and CDC provide public health recommendations based on the best available epidemiologic and scientific data. The global switch from tOPV to bOPV will markedly reduce the risk for type 2 cVDPV reemergence and possible importation into the United States. However, until this risk is estimated by WHO to approach zero, public health authorities in the United States should continue to follow ACIP recommendations regarding poliovirus vaccination to ensure that all children living in the United States are protected against all three poliovirus types ( 2 , 3 ).

0 comments Cited 5 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): MMWR Morb Mortal Wkly Rep

Journal ID (iso-abbrev): MMWR Morb. Mortal. Wkly. Rep

Journal ID (publisher-id): WR

Title: Morbidity and Mortality Weekly Report

Publisher: Centers for Disease Control and Prevention

ISSN (Print): 0149-2195

ISSN (Electronic): 1545-861X

Publication date (Electronic): 09 February 2018

Publication date Collection: 09 February 2018

Volume: 67

Issue: 5

Pages: 156-157

Affiliations

Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC; University of Arkansas for Medical Sciences, Little Rock; Arkansas Children's Hospital, Little Rock; Department of Pediatrics, University of Colorado Anschutz Medical Campus, Denver; March of Dimes, Washington, D.C.; Department of Pediatrics, University of California Los Angeles.

Author notes

Corresponding author: Candice L. Robinson, crobinson4@ 123456cdc.gov , 404-718-1400.

Article

Publisher ID: mm6705e2

DOI: 10.15585/mmwr.mm6705e2

PMC ID: 5812475

PubMed ID: 29420458

SO-VID: f6898b73-0cfb-4136-8c3f-096b0e2a8938

License:

All material in the MMWR Series is in the public domain and may be used and reprinted without permission; citation as to source, however, is appreciated.

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2018

Read this article at

Abstract

Related collections

50 years of ROAPE

Most cited references 2

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

Guidance for Assessment of Poliovirus Vaccination Status and Vaccination of Children Who Have Received Poliovirus Vaccine Outside the United States

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 39

Cited by 11

Most referenced authors 28