PIC Education Committee- Online Educational Modules
Immunization Schedules and Recommendations
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Immunization Schedules are designed to standardize which vaccines are given to different age groups of people and when they are given. There are 2 commonly recommended schedules: a childhood and adolescent schedule and an adult schedule. The childhood and adolescent schedule is divided into the following sections: ages 0 to 6 years, ages 7 to 18 years, and catch-up schedule. These schedules are published annually by the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American Academy of Family Practitioners (AAFP). Updates are published by the CDC and the AAP throughout the year.
The schedules are based on immunization recommendations. Recommendations are official statements regarding who should or should not receive particular vaccines and when. Recommendations from the CDC are made by a special committee of experts called the Advisory Committee on Immunization Practices or ACIP. The ACIP consists of 15 experts in fields associated with immunizations. The committee meets 3 times a year, usually in February, June and October. Since the committee meets multiple times in a year, the schedules are likely to change during the year. You can learn when the ACIP is meeting and what they have recommended by going to their web site at http://www.cdc.gov/vaccines/recs/acip/default.htm. Many healthcare professionals register to receive a weekly publication called Morbidity and Mortality Weekly Report (MMWR) where recommendations are published once they have been approved by the CDC and the Department of Health and Human Services (DHHS). You can check previous issues of the MMWR or subscribe at www.cdc.gov/mmwr. The AAP recommendations result from the AAP Committee on Infectious Diseases, also known as the Red Book Committee. The AAP publishes the recommendations every 2-4 years in the Red Book and updated recommendations are published in their journal, Pediatrics. The AAFP publishes recommendations in the American Family Physician.
Once a vaccine is recommended for children (18 years or younger), each state must decide if it is going to require or mandate the vaccine. A state mandate means that a child must get a certain vaccine at a particular age unless they have a medical contraindication or they claim a religious or philosophical exemption if allowed in their state. (To learn more about exemptions, see Ethical Aspects of Immunizations.) Children who do not receive a vaccine may be kept from school or daycare during an outbreak. When a state government considers mandating a vaccine, they cannot only consider the health significance. Financial considerations are also important because not all families can afford to pay for a vaccine for their child. Usually when a vaccine is recommended, it also qualifies for the Vaccines for Children Program (VFC). VFC coverage is important because it means that the federal government will provide funding to ensure that children who would not be able to afford a vaccine can receive it for free. Any mandated vaccines that are not covered by the VFC program will need to be provided for in the state budget.
Adult vaccines are usually recommended but not required. It is important to realize this difference because it has led to much better vaccine coverage in children as compared to adults. Requirements are not typical for adult vaccines for a couple of reasons. First, whereas children can be required to get vaccines when entering school or childcare, there is not a similar situation in which adults can be mandated to get a vaccine. Second, there is not a national program similar to the VFC program that guarantees payment for vaccines when individuals cannot afford them. That said, Medicare/Medicaid usually covers adult vaccines, however, neither of these programs are specifically focused on immunizations and not all adults qualify for them.
For additional case studies, visit the following:
For training modules from the WHO:
To learn more about ideas covered in this section, visit the following schedules:
Childhood and adolescent schedule:
Catch-up schedules: These are specific schedules designed to get children up-to-date on their immunizations if they have fallen behind. Catch-up recommendations need to take into account which vaccines have been missed, the current age of the child, and amount of time between doses.
Influenza vaccine: The influenza vaccine is unique among vaccines because it must be administered annually to be effective. The primary reason is that the influenza virus readily adapts itself genetically so that infection-causing strains vary from year to year. Each year the influenza vaccine is revised to include the strains of influenza that seem to be circulating in other parts of the world. Because influenza typically infects people between October and April in the US, the vaccine must be administered to all recipients in a relatively short period of time. To accommodate this unique situation, you may hear about or be asked to participate in flu clinics in grocery stores or pharmacies, special hours at healthcare offices, or special programs in schools or at polling places during elections.
Missed opportunities: A missed opportunity occurs when a patient comes in contact with the healthcare system for some other reason (a physical, mild illness, or even some emergency room visits) and they need a vaccine, but it is not offered to them. As a healthcare professional, it is important to be in the habit of checking each patient’s immunization status to minimize the missed opportunities in a healthcare setting.
Minimum age: The youngest age at which a person can receive a particular immunization.
Minimum interval: The shortest amount of time that must pass before an additional dose of the same vaccine can be administered to a person. Minimum intervals are important because if vaccines are given too close together in time, the most protective immune response may not be generated. If vaccines are given in more than two doses, there may also be minimum intervals between the first and last dose.
Contraindications: Reasons why someone should NOT receive a certain vaccine. Contraindications are specific to each vaccine, but generally include things like allergies to vaccine components, previous adverse reactions following that vaccine, and certain pre-existing health conditions or current treatment for a particular condition.
Precautions: Reasons to consider the relative risk versus benefit of giving a vaccine to a particular person. For example, a person with a moderate or severe illness should be evaluated for the relative risk versus benefit of getting a vaccine that they require.
Adverse event: a negative experience or reaction experienced by someone following receipt of a vaccine. Adverse events may or may not be caused by the vaccine, but they are related in time. Adverse events should be recorded in the patient’s medical record and to the national reporting system, VAERS (see below).
Vaccine Adverse Events Reporting System (VAERS): A national reporting system in place to register adverse events that occur after receipt of vaccines. VAERS is co-administered by the FDA and the CDC and is the result of the National Childhood Vaccine Injury Act of 1986. Anyone can report an occurrence to VAERS and the FDA monitors the reports to watch for trends specific to a particular vaccine. If trends are established, studies will be designed to determine whether the relationship between a vaccine and an adverse event are causal or coincidental.
To learn more about ideas covered in this section, visit the following:
Childhood and adolescent schedule:
Vaccine Education Center at The Children’s Hospital of Philadelphia:
National Network for Immunization Information:
Immunization Action Coalition:
Contraindications and Precautions:
UPDATED: July 2009