ACIP Releases 2020 Child and Adolescent
Vaccine Schedule

Marcia Frellick

February 04, 2020

Changes reflected in this year's child and adolescent vaccine schedule include guidance that a hepatitis A catch-up vaccination is now recommended for anyone who was not vaccinated as a child.

The 2020 Childhood and Adolescent Immunization Schedules were published online today in Pediatrics and on the Centers for Disease Control and Prevention (CDC) website.

Sean O'Leary, MD, MPH, a member of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases, told Medscape Medical News that, in the past, if a child presented at a doctor's office without any record of the hepatitis A vaccine as an infant, there was no recommendation to give the vaccine. Now that guidance is there.

The 2020 schedule was approved by the AAP, CDC's Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.

Which Oral Poliovaccine Doses Count

Information was also added regarding which doses of trivalent oral poliovaccine (OPV) count as valid. This pertains to children coming from countries that still use oral poliovirus vaccine.

Doses of OPV administered before April 1, 2016 should be counted (unless specifically noted as administered during a campaign). Doses of the oral vaccine given on or after April 1, 2016 should not be counted. Parts of the world where the oral vaccine was still in use switched on April 1, 2016 from trivalent to bivalent vaccine.

In the United States, the trivalent inactivated poliovirus vaccine is recommended for routine vaccination.

Clarification for Meningococcal B

A terminology change was made that mainly pertains to the meningococcal serogroup B vaccines, O'Leary pointed out. Instead of deciding use of the vaccine by "clinical discretion," the recommendation is now for "shared clinical decision-making."

"Guidance is being developed for what that means," he said. "The idea is that the provider is supposed to have a conversation with the parent or patient about the pros and cons of getting the vaccine in a given situation."

Clarifications Regarding the DTaP Vaccine

Regarding the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, authors of the report clarified in the catch-up recommendation that the fifth dose is not necessary if the fourth dose was given when the child was at least 4 years old and it was given at least 6 months after the third dose.

New advice was also given on DTaP given inadvertently after the child's seventh birthday. That is not recommended because it tends to cause local reactions, O'Leary said.

If DTaP was given from age 7 to 9 years, it may count in the catch-up series. Routine tetanus toxoid-reduced diphtheria toxoid-acellular pertussis adsorbed (Tdap vaccine) should then be given at age 11 to 12 years.

If it was given from ages 10 to 18 years, "count the dose of DTaP as the adolescent Tdap booster," the new guidance advises.

Tdap Clarification

The Tdap vaccine may now be used for booster doses and remaining doses of the catch-up series.

Authors also added guidance for Tdap given at age 7 to 10 years. Children aged 7 to 9 years who get the Tdap vaccine should get the routine Tdap dose at ages 11 to 12, but 10-year-olds do not need to get the routine Tdap dose at age 11 to 12 years.

"Prior guidance had made it look like if you got a dose at 10 years you still needed another at 11 to 12 years and now that's been made clear that you don't," O'Leary said. "A lot of states require Tdap upon entrance to 6th grade when a lot of kids are still only 10. Those kids sometimes would get a second dose of Tdap but that was not the official recommendation, and this clarified they don't need the additional dose."

Nothing has changed this year regarding the live attenuated influenza vaccine (LAIV), O'Leary noted. Both the AAP and ACIP recommended the mist last season as an alternative to inactivated influenza vaccine (IIV), with the same list of exceptions.

The vaccine schedules are revised every year to reflect current recommendations for using vaccines licensed by the US Food and Drug Administration.

The recommendation authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 4, 2020. Full text

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