Notes from the National Guideline Clearinghouse (NGC) and the Institute for Clinical Systems Improvement (ICSI):
- For a description of what has changed since the previous version of this guidance, refer to "Summary of Changes Report -- October 2007."
- The recommendations for immunizations are presented in the form of immunization schedules and an algorithm with a total of 30 components accompanied by detailed annotations. Clinical highlights and immunization schedules are provided below for: Immunization Schedule for Infants, Children, and Adolescents – Routine and High Risk and Immunization Schedule for Adults -- Routine and High Risk. An algorithm for In-Clinic Immunization is provided in the original guideline document.
- There have been, and will be again in the future, shortages and delays in the distribution of many of the recommended vaccines. The situation varies by location and health care provider. The work group recommends that all practitioners be kept abreast of the latest national information on vaccine shortage by accessing the Centers for Disease Control and Prevention (CDC)'s Web site at http://www.cdc.gov/vaccines/news/default.htm.
- December 2007 Addendum: The Immunization Update is designed to provide current information and recommendations on Immunizations as released by the Centers for Disease Control that come in between the full revision of the guideline. The Immunization Update contains an immunization schedule as well as new or revised annotations to help the reader understand the options recommended for specific immunizations. This update provides revised recommendations for immunization against influenza for infants, children, and adolescents (routine and high-risk). Algorithm Annotation #9 in the original guideline document has been revised to reflect the new information, as well.
Clinical Highlights
- Utilize all clinical encounters as opportunities to assess a patient's immunization status. (Annotation #17 - see the original guideline document)
- Administer at each clinical encounter all immunizations that are due or overdue unless true contraindications exist. (Annotations #20, 21, 26 - see the original guideline document)
- Educate patients and parents regarding the importance of infant, childhood, adolescent, and adult immunizations, the recommended schedule and the need to maintain a personal record of immunizations and childhood diseases. (Annotations #21, 23, 28 - see the original guideline document)
- Document reasons for not administering immunizations that are clinically indicated, and flag the record for a recall appointment. (Annotations #28, 29 - see the original guideline document)
- Document the future plan for administering immunizations. (Annotation #26, 28 - see the original guideline document)
*Immunization Schedule for Infants, Children, and Adolescents – Routine and High Risk
| Vaccine |
Birth |
1 mo |
2 mos |
4 mos |
6 mos |
12 mos |
15 mos |
18 mos |
24 mos |
4-6 yrs |
11-12 yrs |
15-18 yrs |
| DTaP |
|
|
X |
X |
X |
X |
|
X |
Tdap |
|
| IPV |
|
|
X |
X |
X |
|
X |
|
|
| MMR (MMRV) |
Combined measles, mumps, rubella and varicella vaccine (MMRV) is preferred for children 12 months through 12 years of age over separate injection of equivalent component vaccines. |
X |
|
|
X |
|
|
| Varicella |
X |
|
|
X |
|
X
verify second dose completed
|
| Pneumococcal (PCV7) |
|
|
X |
X |
X |
X |
|
|
|
|
|
| Hib |
|
|
X |
X |
X |
X |
|
|
|
|
|
| Rotavirus |
|
|
X |
X |
X |
|
|
|
|
|
|
Hep B
Schedule 1
|
X |
X |
|
X |
|
|
|
|
Hep B
Schedule 2
|
|
X |
X |
X |
|
|
|
|
| Influenza |
|
|
|
X (6 to 59 months, annually) |
X
annually
|
X
annually
|
| Hep A |
|
|
|
|
X |
X |
|
|
|
|
| Meningococcal |
|
|
|
|
|
|
X |
X
if previously not received
|
| Human Papilloma Virus (HPV) |
|
|
|
|
X
(3-dose series)
|
X
(Catch up if appropriate, 3-dose series)
|
Abbreviations: DTaP, diphtheria, tetanus, acellular pertussis; Hep A, hepatitis A; Hep B, hepatitis B; Hib, Haemophilus influenzae type b; IPV, inactivated poliovirus vaccine; MMR, measles, mumps, and rubella; Tdap, tetanus-diphtheria-acellular pertussis; TIV, trivalent influenza vaccine.
*Please check manufacturer specifications for dosing, as all time intervals may not be needed.
For additional information on immunizing high-risk patients, see Annotation #14 in the original guideline document.
*Immunization Schedule for Adults -- Routine and High-Risk
| Vaccine |
19-26 Years |
27-39 Years |
40-64 Years |
65 Years and Older |
| Td/Tdap |
Tdap if previously not immunized, Td booster every 10 years |
Td booster |
| IPV |
Immunize if not previously immunized |
| MMR |
Persons born during or after 1957 should have 1-dose measles; a second dose may be required in special circumstances (see Annotation #3 in the original guideline document). |
|
| Varicella |
X
verify second dose completed
|
For all adults who do not have evidence of immunity to varicella, give two doses of varicella vaccine with at least 28 days between the first and second doses. (See Annotation #4 in the original guideline document.) |
| Pneumococcal (PPV23) |
Immunize high risk groups once. Re-immunize those at risk of losing immunity once after 5 years. |
Immunize at 65 if not done previously. Re-immunize once if 1st received >5 years ago and before age 65 or an appropriate immunocompromising condition is present. |
| Hep B |
Universal immunization |
Immunize those at high risk. |
| Influenza |
Annually during flu season for individuals age 50 and older, those at high risk, and others. |
| Hep A |
Immunize those in risk groups |
| Meningococcal |
X |
Immunize those in risk groups |
| Human Papilloma Virus (HPV) |
X
Catch up, if appropriate,
|
|
|
|
| Herpes Zoster/Shingles |
|
|
Immunize at age 60 and older |
Abbreviations: Hep A, hepatitis A; Hep B, hepatitis B; IPV, inactivated polio vaccine; MMR, measles, mumps, rubella; Td, tetanus, diphtheria; Tdap, tetanus-diphtheria-acellular pertussis
*Please check manufacturer specifications for dosing, as all time intervals may not be needed.
For additional information on immunizing high-risk patients, see Annotation #14 in the original guideline document.
The Centers for Disease Control and Prevention (CDC) updates immunizations recommendations in January, July, and October -- please refer to the CDC website http://www.cdc.gov/vaccines/default.htm for the most current schedule.
