Pediatric Vaccine Update

With Immunization Awareness Month approaching, the CDC and other groups are offering guidance on how to initiate the vaccination conversation. A pediatric vaccine schedule is also offered here.

As the fall season approaches and children prepare for a return to the classroom, the National Public Health Information Coalition (NPHIC) is encouraging healthcare providers to piggyback on the “back to school” theme when initiating conversations about immunization scheduling with parents. As part of its agenda for National Immunization Awareness Month, the NPHIC, an independent organization of professionals sought after to improve America’s health through public communications, is also asking providers to remember that an honest, yet strategic, approach to explaining the importance of vaccinations — particularly among those parents who may be fearful or skeptical of them.

According to NPHIC officials, when having the conversation about immunizations it is best to assume that parents are planning to vaccinate. Research has shown that parents are more likely to express concern about vaccines when providers use language that “asks” parents about their vaccination plans as opposed to explicitly saying “your child needs [these] shots today.”

Beyond the first round of hepatitis B administered at birth, current guidelines for administration of vaccines up to age 18 that have been established by the Centers for Disease Control and Prevention (CDC) are as follows:

  • Hepatitis B – subsequent rounds (by 1-2 months of age and 9-12 months old);
  • Rotavirus (2 months and 4 months, plus a third dose at 6 months if RotaTeq is used);
  • Diphtheria, tetanus and acellular pertussis (2 months, 4 months, 6 months, 15-18 months and 4-6 years)
  • Haemophilus influenzae type B (2 months, 4 months, 6 months and 12-15 months; note that PedvaxHIB requires only three doses at 2, 4 and 12-15 months)
  • Pneumococcal conjugate (2 months, 4 months, 6 months and 12-15 months)
  • Inactivated poliovirus (2 months, 4 months, 6-18 months and 4-6 years)
  • Influenza (annual dose beginning at 6 months)
  • Measles, mumps, rubella (12-15 months and 4-6 years; note that the 2nd dose may be given as early as 4 weeks after 1st dose)
  • Varicella (12-15 months and 4-6 years; note that the 2nd dose may be given as early as 3 months after the 1st dose)
  • Hepatitis A (two doses separated by 6-18 months between the 1st and 2nd birthdays; note that a series begun before the 2nd birthday should be completed even if the child turns 2 before the 2nd dose is given
  • Meningococcal (11-12 years and 16 years)
  • Tetanus, diphtheria and acellular pertussis (11-12 years)
  • Human papillomavirus (9 years and 6-12 months later; note that if 1st dose is administered after 15th birthday there is a 3-dose protocol)
  • Meningococcal B (Bexsero given in 2 doses at least 1 month apart at 16-18 years
  • Trumenba given in 2 doses at least 6 months apart at 16-18 years)
  • Pneumococcal polysaccharide (2 months, 4 months, 6 months and 12-15 months).

Healthcare providers are also being urged to remain cognizant of vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications, such as diabetes, HIV, chronic lung disease and chronic liver disease. (For more specific protocol for these patient populations, contact the CDC directly.)

CDC officials have also distributed some literature related to the potential of vaccine shortages that could affect pediatric populations as follows:

During 2017, large outbreaks of hepatitis A among adults in several U.S. cities resulted in increased demand for the vaccine, which resulted in constrained supplies. In response, the CDC has worked with public officials in affected jurisdictions to provide guidance about targeting vaccine in response to local epidemiology. As available vaccine supplies have increased, the public supply strategy has evolved and additional vaccine has been made available for unaffected jurisdictions to facilitate routine vaccinations. Manufacturers reportedly have supply to meet current demand, and the CDC continues to monitor the problem. These constraints do not apply to pediatric hepatitis A vaccine supply in the U.S.
Updated Mar 2018 Pediatric hepatitis B vaccine has been impacted, however.

Merck has not been distributing its vaccine since mid-2017 and has informed the CDC that it will continue to have a limited supply during 2018, according to CDC officials. GlaxoSmithKline (GSK) has reportedly confirmed to the CDC that it can continue to support full demand for pediatric hepatitis B vaccine throughout 2018, using a combination of monovalent pediatric hepatitis B vaccine and its Pediarix combination vaccine. CDC officials said they anticipate there will be approximately 10% less monovalent pediatric vaccine than normal during the remainder of 2018.

The expected monovalent supply will provide sufficient vaccine to cover the birth dose for all children as well as additional pediatric vaccine for 2nd and 3rd doses, officials said. However, providers are being warned that some adjustments will be needed because of the decrease in monovalent vaccine. To ensure an equitable distribution of monovalent vaccine and direct vaccine doses according to the CDC’s clinical guidance, CDC officials have implemented controlled vaccine ordering in the public sector using both Merck’s and GSK’s monovalent pediatric vaccines.

GSK has also provided monovalent doses to the private sector directly and through channels using a plan to help control ordering and to target monovalent vaccine consistent with the CDC’s clinical guidance, according to officials. Pediarix is expected to be available ongoing.

Also of note, the manufacturing of MenHibrix vaccine for meningococcal groups C and Y, and haemophilus influenzae type B, has been discontinued in the U.S. and all available doses have expired, according to the CDC.

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