What's New on the Child and

Adolescent Immunization Schedules

William L. Atkinson, MD, MPH
National Center for Immunization and
Respiratory Diseases
2
Childhood Immunization Schedules
Published at least annually since 1995
Child and adolescent schedules
published by AAP, AAFP, and CDC in
January of each year
Schedules for children 0 through 6
years and 7-18 years separated in
2007
2009 2010
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Immunization Schedule for Persons
Aged 0 Through 6 Years - 2010
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Immunization Schedule for Persons
Aged 7 Through 18 Years - 2010
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Catch-up Immunization Schedules
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Changes in the 2010 Schedule
Combination vaccine statement
Age and interval for the last dose in
the IPV series
Meningococcal conjugate
revaccination
Use of HPV2 for females and
permissive use of HPV4 for males
Permissive use of hepatitis A vaccine
for children older than 23 months
9
Immunization Schedule for Persons
Aged 0 Through 6 Years - 2010
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Changes in the 2010 Schedule
Combination vaccine statement
1999-2009
Licensed combination vaccines may be
used whenever any components of the
combination is indicated and other
components of the vaccine are not
contraindicated and if approved by the
Food and Drug Administration for that
dose of the series.

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Changes in the 2010 Schedule
Combination vaccine statement
2010
The use of a combination vaccine generally is
preferred over separate injections of its
equivalent component vaccines.
Considerations should include provider
assessment, patient preference, and the
potential for adverse events.
Wording approved by ACIP in June 2009 and
posted on the ACIP website on August 28
Will be included in the 2010 revision of the
General Recommendations on Immunization

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Changes in the 2010 Schedule
Combination vaccine statement
Age and interval for the last dose in
the IPV series
Meningococcal conjugate
revaccination
Use of HPV2 for females and
permissive use of HPV4 for males
Permissive use of hepatitis A vaccine
for children older than 23 months
13
Polio Vaccine Policy in the U.S.
Recommended schedule of IPV is 4
doses at 2, 4, 6-18 months and 4-6
years
Use of certain combination
vaccines that contain IPV could
result in 4 doses of IPV by 18
months of age
ACIP, AAP, and AAFP were
concerned that this schedule could
lead to suboptimum long-term polio
immunity
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Factors Affecting the
Response to IPV
Age
Maternal antibody level at the time of
the first dose
the lower the maternal antibody level
the higher the seroconversion rate
Longer intervals between doses
an interval of at least 6 months
between the next to last and last dose
provides the best immunologic effect

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New IPV Recommendations
No change in the routine IPV
schedule of four doses at ages 2
months, 4 months, 6 through 18
months, and 4 through 6 years
Minimum interval between the next-
to-last and last doses is now 6
months
Minimum age for the final IPV dose is
now 4 years
MMWR 2009;58(No. 30):829-30
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New IPV Recommendations
When 4 (or more) doses of IPV are
administered before the 4th birthday,
an additional dose of age appropriate
IPV should be given on or after the
4th birthday
Minimum interval from next-to-last to
last dose should always be at least 6
months (even if the series is 3 doses)
MMWR 2009;58(No. 30):829-30
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Changes in the 2010 Schedule
Combination vaccine statement
Age and interval for the last dose in
the IPV series
Meningococcal conjugate
revaccination
Use of HPV2 for females and
permissive use of HPV4 for males
Permissive use of hepatitis A vaccine
for children older than 23 months
19
2005 Meningococcal ACIP Statement:
Revaccination after MCV4
In its 2005 recommendations for
MCV4, ACIP made no recommendation
about revaccination pending the
availability of additional data
Serologic data are now available from
the manufacturer that show significant
decline in antibody 3-5 years after
vaccination although few
breakthrough cases have been
reported
MMWR 2005;54(RR-7)
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MCV4 Revaccination
Recommendations*
Children through age 18 years who
received their first dose of MCV4 or
MPSV4 at ages 2 through 6 years and
remain at increased risk for
meningococcal disease should
receive an additional dose of MCV4
three years after their first dose
MMWR 2009;58(No. 37)
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MCV4 Revaccination
Recommendations
Persons through age 55 years who
received a dose of MCV4 or MPSV4
after age 6 years and remain at
increased risk for meningococcal
disease should receive an additional
dose of MCV4 five years after their
previous dose
MMWR 2009;58(No. 37)
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MCV4 Revaccination
Recommendations
High-risk persons who should be
revaccinated with MCV4:
persistent complement component
deficiency
anatomic or functional asplenia
Microbiologists with prolonged
exposure to Neisseria meningitidis
frequent travelers to or persons
living in areas with high rates of
meningococcal disease
MMWR 2009;58(No. 37)
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MCV4 Revaccination
Recommendations
MCV4 revaccination is NOT
recommended for persons whose
only risk factor is living in on-campus
housing (i.e., college student living in
a dormitory)
MMWR 2009;58(No. 37)
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Changes in the 2010 Schedule
Combination vaccine statement
Age and interval for the last dose in
the IPV series
Meningococcal conjugate
revaccination
Use of HPV2 for females and
permissive use of HPV4 for males
Permissive use of hepatitis A vaccine
for children older than 23 months
26
HPV Vaccines
HPV4 (Gardasil, Merck)
contains HPV types 16, 18, 6 and 11
approved for the prevention of
cervical, vaginal and vulvar cancers
(in females) and genital warts (in
females and males)
HPV2 (Cervarix, GSK)
contains HPV types 16 and 18
approved for the prevention of
cervical cancers in females
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HPV Vaccine Recommendations*
HPV4 or HPV2 is recommended for
the prevention of cervical precancers
and cancers in females
HPV4 is recommended for the
prevention of cervical, vaginal and
vulvar precancers and cancers and
genital warts in females
Administer the first dose to females
at age 11 or 12 years
*ACIP provisional recommendations, October 2009
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HPV Vaccine Recommendations*
Administer the series to females at
age 13 through 18 years if not
previously vaccinated
HPV4 may be administered in a 3-
dose series to males aged 9 through
18 years to reduce their likelihood of
acquiring genital warts
*ACIP provisional recommendations, October 2009
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Changes in the 2010 Schedule
Combination vaccine statement
Age and interval for the last dose in
the IPV series
Meningococcal conjugate
revaccination
Use of HPV2 for females and
permissive use of HPV4 for males
Permissive use of hepatitis A vaccine
for children older than 23 months
30
ACIP Website

www.cdc.gov/vaccines/recs/acip/