RN

2018 Update on Immunizations

  By Jennifer Turney MSN, RN, CNS, CPN
Opioid Prescriptions

Each year, the Advisory Committee on Immunization Practices (ACIP) develops recommendations and updates for routine use of vaccines in children, adolescents, and adults. The ACIP team consists of medical and public health experts that develop vaccine use recommendations in the United States (Advisory Committee on Immunization Practices (ACIP), 2013). When developing vaccine recommendations, ACIP considers many factors, including disease epidemiology, vaccine safety and effectiveness, feasibility of program implementation, and economics of immunization policy (ACIP, 2013). Once the recommendations have been made by ACIP, the CDC along with the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Obstetricians and Gynecologists (ACOG) approve the recommendations and age specific schedules are created (ACIP, 2013).

In February 2018, the approved immunization schedule updates were released (Centers for Disease Control and Prevention (CDC), 2018).

Key Changes for Child and Adolescent Schedules:
  •   General Schedule.
         o   Infant Meningococcal vaccine - has been removed from the schedule as it is no longer available          (CDC, 2018a).
  •   Hepatitis B vaccine (HepB) - was revised to include information regarding vaccination of infants weighing   less than 2000 grams born to Hepatitis B surface antigen (HBsAg) negative mothers (CDC, 2018). Infants less   than 2,000 grams should receive their first dose at chronological age 1 month or hospital discharge
  (CDC, 2018a).
  •   Influenza vaccine - has been updated to indicate that live attenuated influenza vaccine (LAIV) should not   be used during the 2017–2018 influenza season (CDC, 2018a). A reference link to the 2017-2018 season   influenza recommendations has been added (CDC, 2018a). www.cdc.gov/mmwr/volumes/66/rr/pdfs/rr6602.pdf
  •   Measles, mumps, and rubella vaccine (MMR) - was updated to include the use of a third dose of
  mumps-containing vaccine during a mumps outbreak (CDC, 2018a). Persons 12 months of age or older who   previously received two or less doses of mumps-containing vaccine and are identified by public health   authorities to be at increased risk during a mumps outbreak should receive a dose of mumps virus–containing   vaccine (CDC, 2018a).
  •   Meningococcal vaccine - has been modified to create separate call-outs for Meningitis serotypes A,C,W,   Y and Meningitis B vaccines (CDC, 2018a).
  •   Polio vaccine - The inactivated poliovirus schedule has been modified to clarify the catch-up   recommendations for children 4 years of age and older. Additionally, the poliovirus vaccine was revised to   include updated guidance for persons who received oral polio vaccine as part of their vaccination series
  (CDC, 2018a).
  •   Rotavirus vaccine - The maximum ages for administration of the first dose (14 weeks, 6 days) and last   dose (8 months, 0 days) of the rotavirus series have been added to the rotavirus vaccine row of the catch-up
  schedule (CDC, 2018a).

Key Changes to Adult Immunization Schedule Changes:
  •   Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) or tetanus and   diphtheria toxoids (Td) vaccines - Td/Tdap has been replaced by Tdap or Td   and the administration   schedule has been revised to 1 dose Tdap, then Td booster every 10 years (CDC, 2018b).
  •   MMR - Administer one dose of MMR to adults who previously received two or less doses of mumps-
  containing vaccine and are identified by a public health authority to be at increased risk during a mumps   outbreak (CDC, 2018b).
         o   The recommendation has been changed to 1 to 2 doses depending on indication, if born in 1957 or           later (CDC, 2018b).
  •   Zoster vaccines - Administer two doses of recombinant zoster vaccine (RZV; Shingrix®) 2-6 months apart   to adults age 50 years or older, regardless of past episode of herpes zoster or history of receiving zoster   vaccine live (ZVL; Zostavax®) (CDC, 2018b). Note: ZVL has replaced the term HZV (herpes zoster vaccine)   that was used in past adult immunization   schedules to refer to the live zoster vaccine (CDC, 2018b).
         o   For adults who previously received ZVL, administer two doses of RZV 6 months apart, and at least 2           months after the dose of ZVL (CDC, 2018b).
         o   For adults age 60 years or older, administer either RZV or ZVL;RZV is preferred(CDC, 2018b).
  •   Human Papilloma Virus (HPV) vaccine - for females and males has been revised to 2 or 3 doses depending on age at series initiation (CDC, 2018b).
  •   Meningococcal vaccine - MPSV4 (4-valent meningococcal polysaccharide vaccine) is no longer available   and has been removed from the adult immunization schedule (CDC, 2018b).
         o   MenACWY (serogroups A, C, W, and Y meningococcal vaccine) has been revised to 1 or 2 doses           depending on indication, then booster every 5 years if risk remains (CDC, 2018b).

For more information regarding ACIP recommended changes and the current immunization schedule by age; review the following website
  •   Children and Adolescents 18 years or younger:
  https://www.cdc.gov/mmwr/volumes/67/wr/mm6705e2.htm
  •   Adults aged 19 years and older:
  https://www.cdc.gov/mmwr/volumes/67/wr/mm6705e3.htm
  •   Immunization Schedule by age:
  https://www.cdc.gov/vaccines/schedules/



References
Center for Disease Control and Prevention (CDC). (2016). Adult vaccination information for healthcare and public health professionals. Retrieved from: https://www.cdc.gov/vaccines/hcp/adults/index.html

CDC. (2018a). Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. Retrieved from: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

CDC. (2018b). Recommended immunization schedule for adults aged 19 years or older, United States 2018. Retrieved from: https://www.cdc.gov/vaccines/schedules/hcp/adult.html

The Advisory Committee on Immunization Practices (ACIP) (2013), Retrieved from: https://www.cdc.gov/vaccines/hcp/conversations/downloads/vacsafe-acip-color-office.pdf



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