List of Errata/Updates

General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)

May 4, 2021

• PAGE 32 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  MenQuadfi is added in the footnotes as an option for MenACWY within its specific age-approval.
• PAGE 90 pdf icon[26 pages]
  Vaccine Administration
  Added: guidance stating not to combine two or more doses from separate vials to create a single dose or multiple doses.

February 8, 2021

• PAGE 55 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  Preterm birth is a precaution to MenACWY (MenACWY-CRM only). This precaution only applies to infants younger than nine months.
• PAGE 55 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  Latex sensitivity is a precaution to MenB vaccine (MenB-4c only).
• PAGE 138 pdf icon[27 pages]
  Altered Immunocompetence
  Table 8-1
  MenACWY vaccine is recommended in persons with HIV/AIDS
• PAGE 155 pdf icon[25 pages]
  Special Situations
  Persons Vaccinated Outside the U.S.
  A webpage hosted by MedScape is provided to identify vaccine brands given outside the U.S.

November 24, 2020

• PAGE 23 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  References to zoster vaccine have been removed, since the only zoster vaccine available in the U.S. is a non-live vaccine which does not interfere with other live vaccines.
• PAGE 23 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  References to zoster vaccine have been removed, since the only zoster vaccine available in the U.S. is a non-live vaccine and does not belong in the list of live vaccines described in the section on antibody-containing-blood-products.
• PAGE 30 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  Zoster Vaccine Live has been removed from Table 3-1 and the list of abbreviations, since it is no longer available.
• PAGE 30 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  Endnotes related to zoster vaccine live have been removed, since this vaccine is no longer available.
• PAGE 36 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-4
  Zoster vaccine has been removed from the list of live vaccines, since the only zoster vaccine available now is a non-live vaccine.
• PAGE 58 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  Contraindications (Immunosuppression, pregnancy) and precautions (interference with antivirals) have been removed because there is no longer a live zoster vaccine.
• PAGE 59 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-2, footnote “(k)”
  Chronic gastrointestinal disease is a precaution for both brands of rotavirus vaccine. However, spina bifida or bladder exstrophy is a precaution only for RV1 (Rotarix) because latex is a component of RV1. Latex is not a component of RV5.
• PAGE 98 pdf icon[27 pages]
  Vaccine Administration
  Table 6-1, “IIV row”
  A footnote “(b)” has been added because one brand of IIV for persons older than 3 years is NOT 0.5 cc, it is 0.7 cc in volume.
• PAGE 98 pdf icon[27 pages]
  Vaccine Administration
  Table 6-1
  The Zoster Vaccine Live, or ZVL, row, has been removed. ZVL is no longer available in the U.S.
• PAGE 114 pdf icon[6 pages]
  Storage and Handling of Immunobiologics
  Zoster vaccine has been removed as the cardinal example in the admonition against patient transport of vaccine (zoster vaccine is now a refrigerator-stable vaccine since RZV is the only available product).
• PAGE 117 pdf icon[6 pages]
  Storage and Handling of Immunobiologics
  Table 7-1
  Zoster Vaccine Live (ZVL) has been removed, since it is no longer available in the U.S.
• PAGE 124 pdf icon[27 pages]
  Altered Immunocompetence
  Zoster vaccine is no longer discussed along with live vaccines when discussing household contacts of immunocompromised, since the only available zoster vaccine is RZV, a non-live vaccine.
• PAGE 126 pdf icon[27 pages]
  Altered Immunocompetence
  In the discussion of “Live Vaccines in Altered Immunocompetence: Safety” zoster vaccine has been removed from the list of live vaccines, because the only available zoster vaccine is RZV, a non-live vaccine. Now altered immunocompetence no longer considered a contraindication to zoster vaccine; however, zoster vaccine still is “not recommended” in patients with altered immunocompetence.
• PAGE 139 pdf icon[27 pages]
  Altered Immunocompetence
  Table 8-1, footnote “(f)”
  Adenovirus has been removed from the list of live bacterial vaccines, since it is a live viral vaccine.
• PAGE 139 pdf icon[27 pages]
  Altered Immunocompetence
  Table 8-1, footnote “(g)”
  Zoster vaccine has been removed from the list of live viral vaccines, since the only available zoster vaccine is RZV which is non-live.
• PAGE 147 pdf icon[25 pages]
  Special Situations
  In the section on “Concurrent Administration of Antimicrobial Agents and Vaccines” zoster vaccine has been removed from the list of vaccines of concern when antiherpes antiviral medications are administered. The only available zoster vaccine is RZV, which is a non-live vaccine and therefore does not suffer interference from antimicrobial agents.
• PAGE 159 pdf icon[25 pages]
  Special Situations
  In the section on “Concurrent Administration of Antimicrobial Agents and Vaccines” zoster vaccine has been removed from the list of vaccines of concern when antiherpes antiviral medications are administered. The only available zoster vaccine is RZV, which is a non-live vaccine and therefore does not suffer interference from antimicrobial agents.

September 30, 2020

• PAGE 31 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1, footnote (f)
  Clarification is provided when the relative minimum and absolute minimum intervals and ages can be used for the interval between the 3^rd and 4^th dose of DTaP, the minimum age for the 4^th dose of DTaP, and to which intervals the grace period can be applied.
• PAGE 31 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1, footnote (g)
  The minimum interval between the penultimate and ultimate doses of DTaP is defined.
• PAGE 32 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1, footnote (y)
  After a first dose of Tdap, subsequent doses can be Td OR Tdap.
• PAGE 139 pdf icon[27 pages]
  Altered Immunocompetence
  Table 8-1
  Renal disease is a precaution, not a contraindication, to LAIV, so LAIV has been removed from the contraindications column.

July 27, 2020

• PAGE 37 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-5
  The quantity of Immunoglobulin in IG has been revised, and also the interval to MMR- and Var- containing vaccines (from 3 months to 6 months).

• PAGE 54 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  Five new contraindications have been added for LAIV. They are:
  1. Children aged 2 through 4 years who have received a diagnosis of asthma or whose parents or caregivers report that a health care provider has told them during the preceding 12 months that their child had wheezing or asthma or whose medical record indicates a wheezing episode has occurred during the preceding 12 months.
  2. Persons with active cerebrospinal fluid/oropharyngeal communications/leaks.
  3. Persons with cochlear implants (due to the potential for CSF leak, which might exist for some period of time after implantation. Providers might consider consultation with a specialist concerning risk of persistent CSF leak if an age-appropriate inactivated or recombinant vaccine cannot be used).
  4. Altered Immunocompetence
  5. Anatomic or functional asplenia (e.g. sickle cell disease).
• PAGE 54 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  An LAIV contraindication has been revised to reflect various clearance times for antivirals. The contraindication now reads:
  LAIV4 should not be administered to persons who have taken oseltamivir or zanamivir within the previous 48 hours, peramivir within the previous 5 days, or baloxavir within the previous 17 days.

• PAGES 79-80 pdf icon[18 pages]
  Preventing and Managing Adverse Reactions
  Tables 5-1 and 5-2
  For management of anaphylaxis in children and adults, ranitidine has been removed as an H2 blocker.
  Cetirizine is added as an H1 blocker alternative to diphenhydramine.
  Famotidine is added as an H2 agent.

April 23, 2020

• PAGE 13 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Accelerated Twinrix has been added to the list of vaccines for which providers cannot use the grace period.

• PAGE 13 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  When three doses of Hepatitis B vaccine have been administered, if the second dose was administered at least four weeks after the first dose, and the third dose (invalid) was administered less than 8 weeks after the second dose, the repeat third dose (let’s call it a fourth dose) can be administered 8 weeks after the second dose, and this fourth dose will be considered valid (as long as it is administered after 24 weeks of age) even if the fourth dose was not administered a full 8 weeks after the third dose.  In other words, we prospectively allow the minimum interval forecast rule to be violated in this circumstance.

• PAGE 55 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  Yeast is acknowledged to be a component of MenACWY (Menveo only).

February 21, 2020

• PAGE 23 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  The recommendation was changed to allow providers to administer a dose of live, injectable vaccine even if the interval after an antibody-containing blood product is not complete. The dose should be invalidated and repeated. Serology is no longer recommended to ascertain whether the dose provided protection.
• PAGE 39 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-5 Footnotes
  The specific source material for understanding antibody quantities in antibody products is now listed. Also listed is the process for determining how to calculate the interval between antibody product and live, injectable vaccine, based on the quantity of antibody in the product.
• PAGE 55 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  A footnote is placed after HPV vaccine to clarify that HPV vaccine is not recommended during pregnancy.
• PAGE 115 pdf icon[6 pages]
  Storage and Handling of Immunobiologics
  For response to out-of-range temperature readings, if a non-live vaccine is administered and then found out to have been stored at a deviated temperature, the dose should be repeated and does not need to wait an interval from the invalid dose. Shingrix is a non-live vaccine, this dose needs to be repeated and does need to wait 4 weeks after the invalid dose.

December 26, 2019

• PAGE 49-51 pdf icon[19 pages]
  Contraindications and Precautions
  General principles of “contraindications”, “precautions” and “neither contraindications nor precautions”, are organized into sub-headers.
• PAGE 114 pdf icon[6 pages]
  Storage and Handling of Immunobiologics
  The section on expiration dates, which had been removed in 2014, is restored, with exceptions to the general rule for non-live vaccines added for recombinant zoster vaccine.

August 29, 2019

• PAGE 53 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  Pregnancy is no longer a precaution to HPV vaccine. Note that HPV vaccine should not be administered during pregnancy. Pregnancy is now a contraindication to LAIV.

July 8, 2019

• PAGE 86 pdf icon[27 pages]
  Vaccine Administration
  Smallpox vaccine is listed as an exception to the best practice that vaccine must be prepared far away (at a distance) from the patient.

May 14, 2019

• New CE package approved
  New Frontmatterpdf icon
  New ACIP Membership Listpdf icon
  List of ACIP members, Liaisons, Ex Officios, and General Best Practices Work Group members based on the date of the recent General Best Practices Work Group presentation to the Advisory Committee on Immunization Practice (ACIP) on October 25, 2018.
• PAGE 7 pdf icon[6 pages]
  Methods
  Vaccine Administration section has been revised to reflect ACIP presentation on October 25, 2018.
• PAGE 15 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Subheading “Simultaneous Administration”
  The guideline to administer PCV13 before MenACWY-D was expanded to include patients with HIV infection.
• PAGE 27 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  A description of the four day grace period has been added under the table header.
• PAGE 27 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  The ages/interval information for HPV vaccine has been separated into the two dose series and the three dose series.
• PAGE 52 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  As it is for Hepatitis B vaccine, yeast is called out as a vaccine component for HPV vaccine.
• PAGE 54 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  As it is for Hepatitis B vaccine, yeast is called out as a vaccine component for PCV13 vaccine.
• PAGE 57 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  As a precaution, the interval between zoster vaccine (first) and antiviral drugs (second) is called out specifically for the live zoster vaccine only.

January 16, 2019

• PAGE 29 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  Serogroup B meningococcal vaccine has been added to the table.
• PAGE 36 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-5
  International Travel rows
  The cutoff for the higher dose of IG has been corrected to a duration of ONE month.

September 20, 2018

• PAGE 29 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  Serogroup B meningococcal vaccine now appears on the table.
• PAGE 52 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-1
  DTaP ROW / PRECAUTIONS COLUMN
  “Fever within 48 hours after vaccination with a previous dose of DTP or DTaP” is no longer a precaution to DTaP vaccine.
• PAGE 59 pdf icon[19 pages]
  Contraindications and Precautions
  Table 4-2
  DTaP ROW
  “Fever within 48 hours after vaccination with a previous dose of DTP or DTaP” is no longer a precaution to DTaP vaccine.

July 18, 2018

• PAGE 36 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-4
  The dosages for Hepatitis A IG have changed.
• PAGE 52 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  Three precautions have been removed from the DTaP row.
  Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
  Seizure ≤3 days after receiving a previous dose of DTP/DTaP
  Persistent, inconsolable crying lasting ≥3 hours within 48 hours after receiving a previous dose of DTP/DTaP
• PAGE 56 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  VARICELLA ROW / PRECAUTIONS COLUMN
  “Use of aspirin or aspirin-containing products(j)”.  Harmonized with the Adult Schedule. With accompanying footnote that explains the circumstances behind waiting for 6 weeks after varicella vaccine to receive aspirin or aspirin-containing products.
• PAGE 59 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-2
  HEADER
  Changed to: “Conditions incorrectly perceived as contraindications or precautions to vaccination” – because none of the conditions listed are contraindications, and none of the conditions listed are precautions.
• PAGE 94 pdf icon[26 pages]
  Vaccine Administration
  Subheading “Multiple Vaccinations”
  HepA vaccine and IG – this couplet added to the pairs which should NOT be administered in the same limb.
• PAGE 99 pdf icon[26 pages]
  Vaccine Administration
  Table 6-1
  RZV ROW / DOSE COLUMN
  New volume 0.5 cc, along with a footnote that states that only 0.5 cc should be withdraw even if more vaccine remains in the vial.

May 14, 2018

• PAGE 29 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  A row has been added for LAIV
• PAGE 29 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1
  The rows for meningococcal polysaccharide vaccine have been removed. This vaccine is no longer available.

October 23, 2017

• PAGE 30 pdf icon[38 pages]
  Timing and Spacing of Immunobiologics
  Table 3-1, Footnote (f)
  “The minimum recommended interval between DTaP-3 and DTaP-4 is 6 months. However, DTaP-4 need not be repeated if administered at least 4 months after DTaP-3. This is a special grace period of 2 months which can be used if evaluating records retrospectively. An additional 4 days cannot be added to this grace period prospectively, but can be added retrospectively.” This is to accommodate recent SME email that allows double dipping of the grace period (adding 4 days to the 2 months) for retrospective validation of series WHOSE 4^th DOSE WAS ADMINISTERED AT 12 months of age. But this double dipping cannot be applied prospectively, meaning we will only allow a 4 day grace period added to a prospective 6 month interval, and we will only allow a four month interval prospectively (not four months plus four days) if the fourth dose would be  administered after 12 months of age.  CDSi has been updated to accommodate this.
• PAGE 54 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  LAIV ROW / CONTRAINDICATIONS COLUMN
  “LAIV4 should not be administered to persons who have taken influenza antivirals medications within the previous 48 hours.” To harmonize with the adult schedule.
• PAGE 54 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  Serogroup B meningococcal vaccine has been added to the Contraindications and Precautions table.
• PAGE 54 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  MMR ROW / CONTRAINDICATIONS COLUMN
  “Family history of altered immunocompetence”. To harmonize AND REFERENCED with the vaccine-specific statements to accommodate infants and toddlers with occult heritable congenital immunodeficiencies.
• PAGE 56 pdf icon[18 pages]
  Contraindications and Precautions
  TABLE 4-1
  VARICELLA ROW / CONTRAINDICATIONS COLUMN
  “Family history of altered immunocompetence”. To harmonize AND REFERENCED with the vaccine-specific statements to accommodate infants and toddlers with occult heritable congenital immunodeficiencies.
• PAGE 56 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  VARICELLA ROW / PRECAUTIONS COLUMN
  “Receipt of specific antiviral drugs (acyclovir, famiciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination).”
• PAGE 57 pdf icon[18 pages]
  Contraindications and Precautions
  Table 4-1
  ZOSTER ROW / PRECAUTIONS COLUMN
  “Receipt of specific antiviral drugs (acyclovir, famiciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination).”
• PAGE 81 pdf icon[18 pages]
  Preventing and Managing Adverse Reactions
  Table 5-2
  “TREATMENT OF REFRACTORY SYMPTOMS” ROW
  Up to Date Table was incorrectly formatted so that two footnotes re: rate of epinephrine infusion were misplaced. This has been corrected.