ACIP 2020 Child/Teen Immunization Schedule: The Highlights

The Advisory Committee on Immunization Practices (ACIP) has just released its Childhood and Adolescent Immunization Schedule for 2020. The new recommendations include a number of changes important for those of us who care for children.

Here are the highlights:

Table 1. The regular immunization schedule detailed in Table 1 includes several changes:

Hepatitis A has changed and is now a recommended catch-up vaccine for all individuals 2-18 years old. The previous recommendation stated that the vaccine should be considered for older children if desired.
The explanatory language in the notes section for meningococcal serogroup B vaccines now states that the decision to administer the vaccine to adolescents "not at increased risk" should be made by shared decision-making and not solely at the discretion of the provider.

Table 2. The "catch-up" schedule listed in Table 2 now clarifies that the catch-up recommendations for meningococcal vaccines apply only to serogroups "ACWY" vaccines.

Table 3. This table clearly spells out the indications and contraindications for each individual vaccine in certain special populations. This table is always worth reviewing, especially when administering live virus vaccines. For example, live attenuated influenza, MMR, and varicella vaccines are not recommended/contraindicated in pregnant women and selected other patients with potentially immunocompromising conditions.

Table 3 lists all vaccine indications and contraindications for:

Pregnancy;
Immunocompromised patients (including those with HIV);
Patients with kidney failure or end-stage renal disease, heart disease, or chronic lung disease;
Patients with conditions that raise the risk for central nervous system infection such as a cerebrospinal fluid leak or cochlear implant;
Patients with splenectomy or complement deficiencies; and
Patients with chronic liver disease or diabetes.

Notes table. This table contains extensive guidance for each vaccine, including notes on catch-up, contraindications, and administering the vaccine to special populations. A few highlights:

Remember that the final (fifth) dose of DTaP is not needed if the fourth dose was given after the child was 4 years old and with an appropriate booster interval of at least 6 months after dose three.
Children 5 years of age or older do not need catch-up for Haemophilus influenzae type B vaccine unless they have high-risk conditions.
Hepatitis B revaccination may be required in some populations, including infants born to mothers who were positive for hepatitis B surface antigen, patients on hemodialysis, or other patients with immunocompromising conditions.
Any oral polio dose administered after April 1, 2016, should not be counted for any patient.
Finally—and this may be a big relief to pediatric providers—the updated guidance allows more interchangeability between tetanus- and pertussis-containing vaccines. DTaP vaccines inadvertently given to children older than 7 years, instead of appropriate Tdap vaccine, can count toward total vaccine count for catch-up purposes, but these children should still receive a Tdap booster. That said, any adolescent who receives DTaP after age 10 can count it as the adolescent booster as well and does not need to also receive Tdap.

William T. Basco, Jr, MD, MS, is a professor of pediatrics at the Medical University of South Carolina and director of the Division of General Pediatrics. He is an active health services researcher and has published more than 60 manuscripts in the peer-reviewed literature.

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