p2010
TRANSCRIPT
•Vaccinateallchildrenage0through18yrs.•Vaccinateallnewbornswithmonovalentvaccinepriortohospital
discharge.Givedose#2atage1–2mandthefinaldoseatage6–18m(thelastdoseintheinfantseriesshouldnotbegivenearlierthanage24wks).Afterthebirthdose,theseriesmaybecompletedusing2dosesofsingle-antigenvaccineorupto3dosesofCom-vax(ages2m,4m,12–15m)orPediarix(ages2m,4m,6m),whichmayresultingivingatotalof4dosesofhepatitisBvaccine.
•If mother is HBsAg-positive:givethenewbornHBIG+dose#1within12hrsofbirth;completeseriesatage6mor,ifusingComvax,atage12–15m.
•If mother’s HBsAg status is unknown:givethenewborndose#1within12hrsofbirth.Iflowbirthweight(lessthan2000grams),alsogiveHBIGwithin12hrs.IfthemotherissubsequentlyfoundtobeHBsAgpositive,givetheinfantHBIGASAPandwithin7dofbirthandfollowHepBimmunizationscheduleforinfantsborntoHBsAg-positivemothers.
•Givetochildrenatages2m,4m,6m,15–18m,4–6yrs.•Maygivedose#1asearlyasage6wks.•Maygive#4asearlyasage12mif6mhaveelapsedsince#3.•DonotgiveDTaP/DTtochildrenage7yrsandolder.•Ifpossible,usethesameDTaPproductforalldoses.
•GiveTdaptoallchildrenandteensage11–18yrs(startingatage11–12yrs)whohavenotreceivedpreviousTdap;thenboostevery10yrswithTd.
•TdapshouldbegivenregardlessofintervalsincepreviousTd.•MakespecialeffortstogiveTdaptochildrenandteenswhoare
1)incontactwithinfantsyoungerthanage12mand2)healthcareworkerswithdirectpatientcontact.
•Inpregnancy,whenindicated,giveTdorTdapin2ndor3rdtrimester.Ifnotadministeredduringpregnancy,giveTdapinimmediatepostpartumperiod(ifnotpreviouslyvaccinated).
•Givetochildrenatages2m,4m,6–18m,4–6yrs.•Maygivedose#1asearlyasage6wks.•NotroutinelyrecommendedforU.S.residentsage18yrsand
older(exceptcertaintravelers).
Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 1 of 4)
Schedule for routine vaccination and other guidelines (anyvaccinecanbegivenwithanother)
•Donotrestartseries,nomatterhowlongsincepreviousdose.
•3-doseseriescanbestartedatanyage.•Minimumintervalsbetweendoses:
4wksbetween#1and#2,8wksbetween#2and#3,andatleast16wksbetween#1and#3(e.g.,0-,2-,4m;0-,1-,4m).
•#2and#3maybegiven4wksafterpreviousdose.
•#4maybegiven6mafter#3.•If#4isgivenbefore4thbirthday,wait
atleast6mfor#5(age4–6yrs).•If#4isgivenafter4thbirthday,#5is
notneeded.
•Childrenasyoungasage7yrsandteenswhoareunvaccinatedorbehindscheduleshouldcompleteaprimaryTdseries(spacedat0,1–2m,and6–12mintervals);substitutea1-timeTdapforanydoseintheseries,preferablyasdose#1.
•Thefinaldoseshouldbegivenonorafterthe4thbirthdayandatleast6mfromthepreviousdose.
•Ifdose#3isgivenafter4thbirthday,dose#4isnotneededifdose#3isgivenatleast6mafterdose#2.
Contraindication Previousanaphylaxistothisvaccineortoanyofitscomponents.Precaution Moderateorsevereacuteillness.
Contraindications•Previousanaphylaxistothisvaccineortoanyofitscomponents.•ForDTaP/Tdaponly:encephalopathynotattributabletoanidentifi-
ablecause,within7dafterDTP/DTaP.Precautions •Moderateorsevereacuteillness.•Historyofarthusreactionfollowingapriordoseoftetanus-toxoid-
containingvaccine.•Guillain-Barrésyndrome(GBS)within6wksafterpreviousdoseof
tetanus-toxoid-containingvaccine.•ForDTaPonly:Anyoftheseeventsfollowingapreviousdoseof
DTP/DTaP:1)temperatureof105°F(40.5°C)orhigherwithin48hrs;2)continuouscryingfor3hrsormorewithin48hrs;3)collapseorshock-likestatewithin48hrs;4)seizurewithin3d.
•ForDTaP/Tdaponly:Progressiveorunstableneurologicdisorder,uncontrolledseizures,orprogressiveencephalopathy.
Note:Tdapmaybegiventopregnantwomenattheprovider’sdiscretion.
ContraindicationPreviousanaphylaxistothisvaccineortoanyofitscomponents.Precautions•Moderateorsevereacuteillness.•Pregnancy.
Schedule for catch-up vaccination and related issues
Contraindications and precautions (mildillnessisnotacontraindication)
www.immunize.org/catg.d/p2010.pdf•Item #P2010 (5/11)
*ThisdocumentwasadaptedfromtherecommendationsoftheAdvisoryCommitteeonImmunizationPractices(ACIP).Toobtaincopiesoftherecommendations,calltheCDC-INFOContactCenterat(800)232-4636;visitCDC’swebsiteatwww.cdc.gov/vaccines/pubs/ACIP-list.htm;orvisitthe
ImmunizationActionCoalition (IAC)website atwww.immunize.org/acip. This table is revisedperiodically.VisitIAC’swebsiteatwww.immunize.org/childrulestomakesureyouhavethemostcurrentversion.
Technical content reviewed by the Centers for Disease Control and Prevention, May 2011.
Immunization Action Coalition • 1573 Selby Avenue • Saint Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
Special Notes on Hepatitis B Vaccine (HepB)Dosing of HepB: Monovalentvaccinebrandsareinterchangeable.Forpeopleage0through19yrs,give0.5mL
ofeitherEngerix-BorRecombivaxHB.Alternative dosing schedule for unvaccinated adolescents age 11 through 15yrs: Give2dosesRecombivax
HB1.0mL(adultformulation)spaced4–6mapart.(Engerix-Bisnotlicensedfora2-doseschedule.)For preterm infants:ConsultACIPhepatitisBrecommendations(MMWR2005;54[RR-16]).*
Hepatitis B(HepB)
Give IM
DTaP, DT(Diphtheria,
tetanus,acellularpertussis)
Give IM
Td, Tdap(Tetanus,
diphtheria,acellularpertussis)
Give IM
Polio(IPV)
Give SC or IM
Vaccine nameand route
•Ifyoungerthanage13yrs,spacedose#1and#2atleast3mapart.Ifage13yrsorolder,spaceatleast4wksapart.
•Mayuseaspostexposurepro-phylaxisifgivenwithin5d.
•IfVarandeitherMMR,LAIV,and/oryellowfevervaccinearenotgivenonthesameday,spacethematleast28dapart.
•IfMMRandeitherVar,LAIV,and/oryellowfevervaccinearenotgivenonthesameday,spacethematleast28dapart.
•WhenusingMMRforbothdoses,minimumintervalis4wks.
•WhenusingMMRVforbothdoses,minimumintervalis3m.
•Within72hrsofmeaslesexpo-sure,give1doseofMMRaspostexposureprophylaxistosusceptiblehealthychildrenage12mandolder.
Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 2 of 4)
Contraindications•Previousanaphylaxistothisvaccine,toanyofitscomponents,ortoeggs.•ForLAIVonly:ageyoungerthan2yrs;pregnancy;chronicpulmonary(includingasthma),
cardiovascular(excepthypertension),renal,hepatic,neurological/neuromuscular,hematologic,ormetabolic(includingdiabetes)disorders;immunosuppression(includingthatcausedbymedicationsorHIV);forchildrenandteensages6mthrough18yrs,currentlong-termaspirintherapy;forchildrenage2through4yrs,wheezingorasthmawithinthepast12m,perhealthcareproviderstatement.
Precautions•Moderateorsevereacuteillness.•HistoryofGuillain-Barrésyndrome(GBS)within6wksofapreviousinfluenzavaccination.•ForLAIVonly:Receiptofspecificantivirals(i.e.,amantadine,rimantadine,zanamivir,oroseltamivir)48hrsbeforevaccination.Avoiduseoftheseantiviraldrugsfor14daftervaccination.
Contraindications•Previousanaphylaxistothisvaccineortoanyofitscomponents.•Pregnancyorpossibilityofpregnancywithin4wks.•Childrenonhigh-doseimmunosuppressivetherapyorwhoareimmunocompromisedbecauseof
malignancyandprimaryoracquiredcellularimmunodeficiency,includingHIV/AIDS(althoughvaccinationmaybeconsideredifCD4+T-lymphocytepercentagesareeither15%orgreaterinchildrenages1through8yrsor200cells/µLorgreaterinchildrenage9yrsandolder).
Precautions•Moderateorsevereacuteillness.•Ifblood,plasma,and/orimmuneglobulin(IGorVZIG)weregiveninpast11m,seeACIPstatement
General Recommendations on Immunization*regardingtimetowaitbeforevaccinating.•Receiptofspecificantivirals(i.e.,acyclovir,famciclovir,orvalacyclovir)24hrsbeforevaccination,if
possible;delayresumptionoftheseantiviraldrugsfor14daftervaccination.•ForMMRVonly,personalorfamily(i.e.,siblingorparent)historyofseizures.Note:Forpatientswithhumoralimmunodeficiencyorleukemia,seeACIPrecommendations*.
Contraindications•Previousanaphylaxistothisvaccineortoanyofitscomponents.•Pregnancyorpossibilityofpregnancywithin4wks.•Severeimmunodeficiency(e.g.,hematologicandsolidtumors;receivingchemotherapy;congenital
immunodeficiency;long-termimmunosuppressivetherapy,orseverelysymptomaticHIV).Note:HIVinfectionisNOTacontraindicationtoMMRforchildrenwhoarenotseverelyimmunocompromised(consultACIPMMRrecommendations[MMWR1998;47[RR-8]fordetails*).
Precautions•Moderateorsevereacuteillness.•Ifblood,plasma,orimmuneglobulingiveninpast11m,seeACIPstatementGeneral Recommendations
on Immunization*regardingtimetowaitbeforevaccinating.•Historyofthrombocytopeniaorthrombocytopenicpurpura.•ForMMRVonly,personalorfamily(i.e.,siblingorparent)historyofseizures.•Needfortuberculinskintesting(TST).IfTSTneeded,giveTSTbeforeoronsamedayasMMR,or
giveTST4wksfollowingMMR.
Contraindications and precautions(mildillnessisnotacontraindication)
Schedule for catch-up vaccination and related issues
•Givedose#1atage12–15m.•Givedose#2atage4–6yrs.Dose#2
ofVarorMMRVmaybegivenearlierifatleast3msincedose#1.
•Givea2nddosetoallolderchildrenandadolescentswithhistoryofonly1dose.
•MMRVmaybeusedinchildrenage12mthrough12yrs(seenotebelow).
•Givedose#1atage12–15m.•Givedose#2atage4–6yrs.Dose#2
maybegivenearlierifatleast4wkssincedose#1.ForMMRV:dose#2maybegivenearlierifatleast3msincedose#1.
•Givea2nddosetoallolderchildrenandteenswithhistoryofonly1dose.
•MMRVmaybeusedinchildrenage12mthrough12yrs(seenoteabove).
Schedule for routine vaccination and other guidelines
(anyvaccinecanbegivenwithanother)
Influenza
Trivalentinactivatedinfluenzavaccine(TIV)
Give IM
Liveattenuatedinfluenzavaccine(LAIV)
Give intranasally
Varicella(Var)
(Chickenpox)
Give SC
MMR(Measles,mumps,rubella)
Give SC
Vaccine nameand route
•Vaccinateallchildrenandteensage6mthrough18yrs.•LAIVmaybegiventohealthy,non-pregnantpeopleage2–49yrs.•Give2dosestofirst-timevaccineesage6mthrough8yrs,spaced4wks
apart.•ForTIV,give0.25mLdosetochildrenage6–35mand0.5mLdoseif
age3yrsandolder.•IfLAIVandeitherMMR,Var,and/oryellowfevervaccinearenotgiven
onthesameday,spacethematleast28dapart.
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Note:ForthefirstdoseofMMRandvaricellagivenatage12–47mos,eitherMMRandVarorMMRVmaybeused.UnlesstheparentorcaregiverexpressesapreferenceforMMRV,CDCrecommendsthatMMRandVarshouldbegivenforthefirstdoseinthisagegroup.
All Hib vaccines:•If#1wasgivenat12–14m,giveboosterin8wks.•Giveonly1dosetounvaccinatedchildrenages15through59m.ActHib:•#2and#3maybegiven4wksafterpreviousdose.•If#1wasgivenatage7–11m,only3dosesareneeded;#2is
given4–8wksafter#1,thenboostatage12–15m(waitatleast8wksafterdose#2).
PedvaxHIB and Comvax:•#2maybegiven4wksafterdose#1.
•Forminimumintervals,see3rdbulletatleft.•Forage7–11m:Ifhistoryof0doses,give2dosesofPCV13,
8wksapart,witha3rddoseatage12–15m;ifhistoryof1or2doses,give1doseofPCV13witha2nddoseatage12–15m,atleast8wkslater.
•Forage12–23m:Ifunvaccinatedorhistoryof1dosebeforeage12m,give2dosesofPCV138wksapart;ifhistoryof1doseatorafterage12mor2or3dosesbeforeage12m,give1doseofPCV13atleast8wksaftermostrecentdose;ifhistoryof4dosesofPCV7orotherage-appropriatecompletePCV7schedule,give1supplementaldoseofPCV13atleast8wksafterthemostrecentdose.
•Forage24–59mandhealthy:Ifunvaccinatedoranyincompletescheduleorif4dosesofPCV7oranyotherage-appropriatecom-pletePCV7schedule,give1supplementaldoseofPCV13atleast8wksafterthemostrecentdose.
•Forage24–71mandathighrisk**:Ifunvaccinatedoranyincom-pletescheduleof1or2doses,give2dosesofPCV13,1atleast8wksafterthemostrecentdoseandanotherdoseatleast8wkslater;ifanyincompleteseriesof3doses,orif4dosesofPCV7oranyotherage-appropriatecompletePCV7schedule,give1supple-mentaldoseofPCV13atleast8wksafterthemostrecentPCV7dose.
•Forchildrenages6through18yrswithfunctionaloranatomicasplenia(includingsicklecelldisease),HIVinfectionorotherimmunocompromisingcondition,cochlearimplant,orCSFleak,considergiving1doseofPCV13regardlessofprevioushistoryofPCV7orPPSV.
•ActHib(PRP-T):giveatage2m,4m,6m,12–15m(boosterdose).•PedvaxHIBorComvax(containingPRP-OMP):giveatage2m,4m,
12–15m(boosterdose).•Dose#1ofHibvaccineshouldnotbegivenearlierthanage6wks.•Thelastdose(boosterdose)isgivennoearlierthanage12manda
minimumof8wksafterthepreviousdose.•Hibvaccinesareinterchangeable;however,ifdifferentbrandsof
Hibvaccinesareadministeredfordose#1anddose#2,atotalof3dosesarenecessarytocompletetheprimaryseriesininfants.
•AnyHibvaccinemaybeusedfortheboosterdose.•Hibisnotroutinelygiventochildrenage5yrsandolder.•HiberixisapprovedONLYfortheboosterdoseatage15mthrough4yrs.
Assoonasfeasible,replaceexistingstockofPCV7withPCV13.•Giveatages2m,4m,6m,12–15m.•Dose#1maybegivenasearlyasage6wks.•WhenchildrenarebehindonPCVschedule,minimumintervalfor
dosesgiventochildrenyoungerthanage12mis4wks;fordosesgivenat12mandolder,itis8wks.
•Give1dosetounvaccinatedhealthychildrenage24–59m.•Forhigh-risk**childrenages24–71m:Give2dosesatleast8wks
apartiftheypreviouslyreceivedfewerthan3doses;give1doseatleast8wksafterthemostrecentdoseiftheypreviouslyreceived3doses.
•PCV13isnotroutinelygiventohealthychildrenage5yrsandolder.
•Give1doseatleast8wksafterfinaldoseofPCVtohigh-riskchil-drenage2yrsandolder.
•Forchildrenwhohaveanimmunocompromisingconditionorhavesicklecelldiseaseorfunctionaloranatomicasplenia,givea2nddoseofPPSV5yrsafterpreviousPPSV(consultACIPPPSVrec-ommendationsatwww.cdc.gov/vaccines/pubs/ACIP-list.htm*).
Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 3 of 4)
Vaccine nameand route
Schedule for catch-up vaccination and related issues
Schedule for routine vaccination and other guidelines (anyvaccinecanbegivenwithanother)
Contraindications and precautions(mildillnessisnotacontraindication)
Contraindications•Previousanaphylaxistothisvaccine
ortoanyofitscomponents.•Ageyoungerthan6wks.Precaution Moderateorsevereacuteillness.
ContraindicationPreviousanaphylaxistoaPCVvaccine,toanyofitscomponents,ortoanydiphtheriatoxoid-containingvaccine.PrecautionModerateorsevereacuteillness.
ContraindicationPreviousanaphylaxistothisvaccineortoanyofitscomponents.Precaution Moderateorsevereacuteillness.
Hib(Haemophilus
influenzaetypeb)
Give IM
Pneumococcal conjugate(PCV13)
Give IM
Pneumococcal polysaccharide
(PPSV)
Give IM or SC
**High-risk: Thosewithsicklecelldisease;anatomicorfunctionalasplenia;chroniccardiac,pulmonary,orrenaldisease;diabetes;cerebrospinalfluidleaks;HIVinfection;immunosuppression;diseasesassociatedwithimmunosup-pressiveand/orradiationtherapy;orwhohaveorwillhaveacochlearimplant.
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Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Page 4 of 4)
Rotavirus(RV)
Give orally
Hepatitis A(HepA)
Give IM
Meningococcal conjugate,
quadrivalent(MCV4)Give IM
Meningococcal polysaccharide
(MPSV4)Give SC
Human papillomavirus
(HPV)(HPV2,Cervarix)(HPV4,Gardasil)
Give IM
•Rotarix(RV1):giveatage2m,4m.•RotaTeq(RV5):giveatage2m,4m,6m.•Maygivedose#1asearlyasage6wks.•Givefinaldosenolaterthanage8m0days.
•Give2dosesspaced6maparttoallchildrenatage1yr(12–23m).•Vaccinateallpreviouslyunvaccinatedchildrenandadolescentsage2yrs
andolderwho-WanttobeprotectedfromHAVinfection.-Liveinareaswherevaccinationprogramstargetolderchildren.-TravelanywhereexceptU.S.,W.Europe,N.Zealand,Australia,Canada,
orJapan.-Havechronicliverdisease,clottingfactordisorder,orareadolescent
maleswhohavesexwithothermales.-Areusersofillicitdrugs(injectableornon-injectable).-Anticipateclosepersonalcontactwithaninternationaladopteefroma
countryofhighorintermediateendemicityduringthefirst60daysfol-lowingtheadoptee’sarrivalintheU.S.
•GiveMCV4#1routinelyatage11through12yrsandaboosterdoseatage16yrs.
•GiveMCV4toallunvaccinatedteensages13through18yrs;ifvaccinatedatage13–15yrs,giveboosterdoseatage16–18yrs.
•Give1initialdosetounvaccinatedincomingcollegestudentsages19–21yrs;giveboosterdosetoincomingstudentswhoreceivedthemostrecentdosewhenyoungerthanage16yrs.Considersamevaccinationstrategyforexistingcollegestudentsages19–21yrs.
•Vaccinateallchildrenage2yrsandolderwhohaveanyofthefollowingriskfactors:-Anatomicorfunctionalasplenia,orpersistentcomplementcomponent
deficiency;give2doses,separatedby8wks.-Traveltoorresideincountriesinwhichmeningococcaldiseaseishyper-
endemicorepidemic(e.g.,the“meningitisbelt”ofSub-SaharanAfrica).Note:UseMPSV4ONLYifthereisapermanentcontraindicationorprecautiontoMCV4.
•Give3-doseseriestogirlsatage11–12yrsona0,1–2,6mschedule.(Maybegivenasearlyasage9yrs.)
•Givea3-doseseriestoalloldergirlsandwomen(throughage26yrs)whowerenotpreviouslyvaccinated.
•ConsidergivingHPV4tomalesage9through26yrstoreducetheirlikeli-hoodofacquiringgenitalwarts.
•Donotbeginseriesininfantsolderthanage14wks6days.
•Intervalsbetweendosesmaybeasshortas4wks.
•Ifpriorvaccinationincludeduseofdifferentorunknownbrand(s),atotalof3dosesshouldbegiven.
•Minimumintervalbetweendosesis6m.•Childrenwhoarenotfullyvaccinated
byage2yrscanbevaccinatedatsubse-quentvisits.
•Considerroutinevaccinationofchildrenage2yrsandolderinareaswithnoexistingprogram.
•Give1doseaspostexposureprophylaxistoincompletelyvaccinatedchildrenage12mandolderwhohaverecently(duringthepast2wks)beenexposedtohepatitisAvirus.
•IfpreviouslyvaccinatedwithMPSV4orMCV4andriskofmeningococ-caldiseasepersists,revaccinatewithMCV4in3yrs(iffirstdosegivenatage2through6yrs)orin5yrs(ifpreviousdosegivenatage7yrsorolder).Then,giveadditionalboosterdosesevery5yrsifriskcontinues.
•WhenadministeringMCV4tochildrenwithHIVinfection,give2initialdoses,separatedby8wks.
Minimumintervalsbetweendoses:4wksbetween#1and#2;12wksbetween#2and#3.Overall,theremustbeatleast24wksbetweendoses#1and#3.Ifpos-sible,usethesamevaccineproductforalldoses.
Contraindications•Previousanaphylaxistothisvaccineortoanyofitscom-ponents.Ifallergytolatex,useRV5.•Diagnosisofseverecombinedimmunodeficiency(SCID).Precautions•Moderateorsevereacuteillness.•AlteredimmunocompetenceotherthanSCID.•Chronicgastrointestinaldisease.•Historyofintussusception.•Spinabifidaorbladderexstrophy.
ContraindicationPreviousanaphylaxistothisvaccineortoanyofitscompo-nents.Precautions•Moderateorsevereacuteillness.•Pregnancy.
ContraindicationPreviousanaphylaxistothisvaccineortoanyofitscompo-nents.Precautions•Moderateorsevereacuteillness.
ContraindicationPreviousanaphylaxistothisvaccineortoanyofitscompo-nents.Precautions•Moderateorsevereacuteillness.•Pregnancy.
Schedule for catch-up vaccination and related issues
Schedule for routine vaccination and other guidelines (anyvaccinecanbegivenwithanother)
Vaccine nameand route
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Contraindications and precautions(mildillnessisnotacontraindication)