Immunization Update
APhA staff
Both the adult and the child and adolescent 2020 immunization schedules are now available on CDC’s website following the release of the new recommendations from CDC’s Advisory Committee on Immunization Practices.
Adult schedule
The adult schedule for 2020 (Table 1) includes some changes and additions. The columns for ages 19 to 21 years and for ages 22 to 26 years have been combined because of the change made to recommended catch-up HPV vaccination for all adults through age 26 years.
Adults up to age 26 years who aren’t fully vaccinated should receive catch-up HPV vaccination. For adults ages 27 through 45 years who aren’t fully vaccinated, CDC recommends shared decision making for the HPV vaccine.
Shared clinical decision making is also recommended for meningococcal B vaccinations in persons 19 through 23 years and for pneumococcal conjugate vaccine (PCV13) consideration in persons ages 65 years and older who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13.
Child and adolescent schedule
For children and adolescents, changes include recommendations for Haemophilius influenza type b, hepatitis A and B, meningococcal ACWY, meningococcal B, oral poliovirus, and Tdap vaccines (Table 2).
H. influenza type b. Catch-up vaccination is not recommended for previously unvaccinated children ages 5 years (60 mo) or older who are not at high risk.
Hepatitis A. All children and adolescents ages 2 through 18 years who have not previously received hepatitis A vaccine should receive catch-up vaccination and complete a two-dose series.
Hepatitis B. Revaccination may be recommended for some populations in special situations.
Meningococcal ACWY. Guidance regarding adolescent vaccination for children who received MenACWY prior to age 10 years has been added.
Meningococcal B. Booster doses are now recommended for persons who are 10 years and older with complement deficiency, those who use complement inhibitors, persons with asplenia, persons who are microbiologists, and persons determined by public health officials to be at increased risk during an outbreak.
Oral poliovirus. Detailed information has been added on which doses may be counted toward U.S. vaccination requirements.
Td/Tdap/DTaP. Either Td or Tdap may be used for decennial tetanus booster doses and catch-up series doses in persons who have previously received Tdap. In addition, a dose of Tdap or DTaP administered at age 10 years may now be counted as the adolescent Tdap booster. A Tdap or DTaP dose administered at age 7 years through 9 years should not be counted as the adolescent dose, and Tdap should be administered at age 11 to 12 years. The DTaP note has been updated to state that dose five is not necessary if dose four was administered at age 4 years or older AND at least 6 months after dose three.
Using the schedules: Three steps
CDC recommends three steps for using the immunization schedules:
- Determine the recommended vaccinations by age.
- Assess the need for additional recommended vaccinations by medical conditions and other indications.
- Review vaccine types, frequencies, intervals, and considerations for special situations.
For children and adolescents, take the additional step of determining recommended intervals for catch-up vaccination.
For more information, see www.cdc.gov/vaccines/schedules/index.html.
