ACIP Issues 2018 Child and Adolescent Vaccine Schedule

Marcia Frellick

The Centers for Disease Control and Prevention's (CDC's) Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) have released the 2018 immunization schedule for children and teens. The updated schedule features guidance on the use of an optional third dose of a mumps-containing vaccine during a mumps outbreak.

It also clarifies the timing for giving newborn infants the hepatitis B vaccine and whether children should get two or three doses of the human papillomavirus (HPV) vaccine.

An updated immunization schedule is approved every year by the AAP, ACIP, American Academy of Family Physicians, and American College of Obstetricians and Gynecologists.

The 2018 schedule was published online today on the CDC website and in Pediatrics.

Mumps Outbreaks Increasing

Mumps outbreaks have been increasing in recent years, particularly on college campuses, in prisons, and in other relatively closed communities. Case numbers in the last 2 years were the highest in a decade, according to the CDC.

To boost antibody titers in an outbreak, the CDC states that in certain circumstances a third dose of the measles, mumps, and rubella (MMR) vaccine may be given to people who have already received two doses.

However, an author of the policy statement on the 2018 recommendations, Cody Meissner, MD, director of pediatric infectious disease at Tufts Medical Center in Boston, Massachusetts, reminds providers that the determination of who should get a third dose  needs to come from public health authorities first and be followed by healthcare providers.

"It's important that people understand that this does not mean a healthcare worker can on his or her own decide to give a third dose of the MMR vaccine," he told Medscape Medical News

Hepatitis B Timing for Newborns

This year's schedule also adds information on the change made last year to administer the first of three doses of the hepatitis B vaccine within the first 24 hours after birth to every nonpremature new born (birthweight of at least 2000 g).

Dr Meissner, a member of the AAP Committee on Infectious Disease, explained that the CDC estimates there are approximately 1000 potentially preventable hepatitis B cases among infants born in the United States each year. Those cases may result from misinterpretation of the mother's screening or miscommunication when a mother tests positive, but that information isn't properly recorded or never makes it to the pediatrician.

When information is misinterpreted or miscommunicated, some pediatricians may not administer the vaccine appropriately.

"This change is designed to serve as a safety net," Dr Meissner said. "Hepatitis B infection in a newborn is a devastating disease. A third of those children will die prematurely from cirrhosis of the liver or liver cancers, and this as a disease that can be prevented."

Children weighing less than 2000 g at birth don't respond very well to the vaccine, he notes, so the recommendation is to wait until they are discharged from the hospital or at least are old enough to develop a protective immune response. 

"Not Too Late" for Flu Vaccine

For the influenza vaccine, the recommendation remains the same: All children age 6 months and older should be vaccinated.

For this year, the vaccine will probably be about 30% to 40% effective against the H3N2 strain, the predominant strain circulating now, he said.

"It's not too late to get the influenza vaccine," Dr Meissner said. "Even though it's not as good as other vaccines that we think of, it's the best intervention available. And for those 60% of those who get the vaccine but still get influenza, it's probably still a milder disease than if they had never been vaccinated."

As for how long providers should continue to give the vaccine, Dr Meissner said the CDC and AAP advise giving it as long as they have it in their offices if the vaccine itself is not out of date. "That's usually until late spring or early summer," he said.

HPV Vaccination Rates Low

One trend Dr Meissner finds particularly troubling is continued low uptake of HPV vaccine — about 50% for males and just more than 60% in females, he noted.

"We would sure like to see them a lot higher because there are about 31,000 cases of HPV-induced cancers each year in the US — mainly cervical cancer for women and oral/pharyngeal cancer for men. The vast majority of these cancers could be prevented by administering the HPV vaccine." Now, only two doses are necessary before a child's 15th birthday. After that birthday, people need three doses, the schedule states.

"At least 80% of the population is going to be infected by at least one strain of HPV in their life, so if you could prevent your son or daughter from getting cancer, it's hard to understand why a parent wouldn't jump at that," Dr Meissner said.

Source: Medscape News