List of Errata/Updates

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

Updated January 25, 2023

On This Page

2023
2022
2021
2020

2019
2018
2017

2023

PAGE 32
Timing and Spacing of Immunobiologics – Unknown or Uncertain Vaccination Status
Table 3-2
PCV15 and PCV20 have been added to Table 3-2, with an explanatory footnote.
PAGE 101
Vaccine Administration
Table 6-1
PCV15 and PCV20 have been added.
PAGE 120
Storage and Handling of Immunobiologics
Table 7-1
PCV15 and PCV20 have been added
PAGE 133
Altered Immunocompetence
Clarification has been added to guidance involving RZV re-administration to recipients of hematopoietic stem cell transplants (HSCT). More specificity on the timing of vaccination has been provided, on the basis of antiviral timing.

2022

PAGE 59
Contraindications and Precautions
Table 4-1
In the row for PCV13, “PCV15” and “PCV20” have been added to the row margin-header (these three have the same contraindications and precautions).
PAGE 58-59
Contraindications and Precautions
Table 4-1
For the rows for MenACWY and PCV13, 15, 20…….”yeast” has been removed as a call out item. There is nothing special about yeast versus all other components of the vaccine, so there is no need to call it out. Yeast still is a component for these vaccines, so if someone has a severe allergic reaction (e.g., anaphylaxis) to yeast, this is a contraindication to MenACWY, PCV13, PCV15, and PCV20. Gluten sensitivity and history of yeast infection are NEITHER contraindications NOR precautions to MenACWY, PCV13, PCV15, and PCV20.
PAGE 75
Preventing and Managing Adverse Reactions
For management of anaphylaxis, providers should have at least 3 doses of epinephrine on hand (in preparation for one patient).
PAGE 93
Vaccine Administration
Information about the route of administration for ACAM2000 and Jynneos has been added.

PAGE 27
Timing and Spacing of Immunobiologics – Unknown or Uncertain Vaccination Status
A statement is added to emphasize NOT performing serology to ascertain evidence of immunity (with dengue provided as an exception).
PAGE 106
Vaccine Administration
FIGURE 3
The figure has been adapted to align with CDC’s other materials. The previous shaded area to indicate the vaccine site was a hexagon with a pointed vertex that extended superiorly toward the acromion. CDC currently recommends the superior aspect of the vaccine site should be flat or lateral, (and technically [2 fingerbreadths – 2 inches…depending on age] below the acromion, so the shaded area has been altered accordingly with a flat superior surface).
PAGE 132
Altered Immunocompetence
The guideline for recombinant zoster vaccine (RZV) has changed. The re-administration dose of RZV should be administered 6-12 months after hematopoietic stem cell transplant (HSCT) if the transplant was allogeneic, and should be administered 3-12 months after HSCT if the transplant was autologous.

PAGE 29
Timing and Spacing of Immunobiologics
Table 3-1
ACAM2000 was added to the list of live attenuated vaccines.
PAGE 36
Timing and Spacing of Immunobiologics
Table 3-4
Information about the correct spacing between PCV15 and PPSV23 has been added to the footnote.
PAGE 83
Preventing and Managing Adverse Reactions
Table 5-1
A dosing adjustment was made for diphenhydramine in children (the maximum dose is now 50 mg).
PAGE 125
Altered Immunocompetence
ALTERED IMMUNOCOMPETENCE AS AN INDICATION TO RECEIVE A VACCINE OUTSIDE OF ROUTINELY RECOMMENDED AGE GROUPS
HIV has been added as an indication for MenACWY vaccine. Likewise, the caveat to separate MenACWY from PCV by 4 weeks in patients with HIV has been added.
PAGE 139
Altered Immunocompetence
Table 8-1
The table has been revised: complement component deficiency (including use of ravulizumab and/or eculizumab) is NOT an indication for recombinant zoster vaccine.
PAGE 156pdf icon
Special Situations
PERSONS VACCINATED OUTSIDE OF THE UNITED STATES
Additional information added when doses of Twinrix Jr. are invalidated. Only the HepA component is considered invalid. The HepB component is considered valid.

PAGE 24 and PAGE 41
Timing and Spacing of Immunobiologics
Table 3-6
Information about the spacing of dengue vaccine after receipt of an antibody-containing blood product has been added. Antibody-containing blood products may generate a false-positive serology test for dengue. This effect wears off in 12 months. Because vaccination must occur after testing, this means an automatic interval between antibody-containing blood products and dengue vaccine.
PAGE 29
Timing and Spacing of Immunobiologics
Table 3-1
PCV15 has been added to the list of vaccines.
PAGE 30 and PAGE 33
Timing and Spacing of Immunobiologics
Table 3-2
Dengue vaccine (DEN4CYD) has been added to Table 3-2: Recommended and Minimum Ages and Intervals Between Vaccine Doses.
PAGE 100
Vaccine Administration
TABLE 6-1
Dengue vaccine (DEN4CYD) has been added to Table 6-1: Dose and route of administration for selected vaccines.
PAGE 117 and PAGE 118
Storage and Handling of Immunobiologics
When rotavirus vaccine undergoes a temperature excursion or exceeds an expiration date, the repeat dose should be administered after a minimum interval from the invalid dose or prior to the maximum age for that dose, whichever is earlier.
PAGE 119 and PAGE 120
Storage and Handling of Immunobiologics
TABLE 7-1
Dengue vaccine (DEN4CYD) has been added to Table 7-1: Vaccine storage temperature recommendations.
PAGE 132
Altered Immunocompetence
Meningococcal conjugate vaccine and serogroup B meningococcal vaccine continue to be recommended for repeat dosing when a hematopoietic stem cell transplant (HSCT) follows previous dosing of vaccine. However, these vaccines are recommended for repeat dosing only if the potential recipient falls within the recommended age for the vaccine or has a traditional risk-based recommendation for the dose.
PAGE 138-140
Altered Immunocompetence
Table 8-1
Dengue vaccine (DEN4CYD) has been added to Table 8-1: Vaccination of persons with primary and secondary immunodeficiencies.
PAGE 140
Altered Immunocompetence
Table 8-1
Oral typhoid vaccine has been added to the list of vaccines for which HIV/AIDS is a contraindication.
PAGE 156
Special Situations
A list of vaccines for which providers cannot count as valid has been added. Two vaccines are on this list currently: Aimmungen and Twinrix Jr.

PAGE 29 [40 pages]
Timing and Spacing of Immunobiologics
Table 3-1 (callout from PAGE 12)
A new table has been added (check renumbering if you’ve exported stand-alone documents). The new table highlights categories of vaccines (with callout from text on page 12). There are four categories: live; live-attenuated; non-live; and non-replicating.
PAGE 54 [21 pages]
Contraindications and Precautions
Table 4-1
In the row for dengue vaccine, information has been added specifying that dengue vaccine should be used only in persons in endemic areas who have evidence of prior infection with dengue virus. Additionally, “Lack of laboratory evidence of previous dengue infection” has been added as a contraindication to dengue vaccine.

PAGE 125 [25 pages]
Altered Immunocompetence
Zoster vaccine has been added to the list of vaccines for which altered immunocompetence is an indicated (specifically a “risk-based indicated”) recommendation for vaccination, in persons 19 years old and older.
PAGE 135 [25 pages]
Altered Immunocompetence
The term “anti-B-cell antibodies” has been replaced with “anti-B-cell agents” because the term “anti-B-cell antibodies” is not sufficiently broad to encompass the scope of drugs directed against B cells which compromise the immunity of the recipient. In other words, many are composed of factors that are not antibodies but other components of the immune system.
PAGE 136 [25 pages]
Altered Immunocompetence
Zoster vaccine has been added to the list of vaccines for which altered immunocompetence is an indicated (specifically a “risk-based indicated”) recommendation for vaccination, in persons 19 years old and older.

PAGE 52 [21 pages]
Contraindications and Precautions
Table 4-1
Contraindications and precautions for dengue vaccine have been added.
PAGE 54 [21 pages]
Contraindications and Precautions
Table 4-1
A footnote is added to inactivated influenza vaccine and live attenuated influenza vaccine to describe the change in allergy-related contraindications and precautions. A history of severe allergic reaction (e.g., anaphylaxis) is now tied to the history of specific influenza vaccine brands.
PAGE 119 [6 pages]
Storage and Handling of Immunobiologics
Table 7-1
The correct storage temperature range is applied to MMR vaccine. The vaccine portion (but not the diluent) can be stored at freezer or refrigerator temperature. Hence the storage range is -50° C – 8° C (5° F – 46° F).

2021

PAGE 99-102 [26 pages]
Vaccine Administration
TABLE 6-2
In Table 6-2, a new row has been added (with footnote) to clarify the needle length that should be used for adults for intramuscular administration in the anterolateral thigh. Accompanying language has been added to the text on page 92.

PAGE 33 [38 pages]
Timing and Spacing of Immunobiologics
Table 3-2
Combination vaccine Vaxelis (DTaP-IPV-Hib-HepB) has been added to “Table 3-2: FDA-licensed combination vaccines”.
PAGE 37 [38 pages]
Timing and Spacing of Immunobiologics
Table 3-5
The word “live” has been added to the column header of the interval column, in “Table 3-5: Recommended intervals between administration of antibody-containing products and measles- or varicella-containing vaccine, by product and indication for vaccination” to indicate that intervals following passive immunobiologics is NOT applicable to Shingrix, because this is the only licensed and U.S. available varicella-containing vaccine that is not live.
PAGE 59 [21 pages]
Contraindications and Precautions
Table 4-1, Footnote (e)
Footnote “e” for “Table 4-1: Contraindications and Precautions” has been revised to clarify the reason use of influenza antivirals are contraindications to LAIV. Unlike most contraindications, this designation is not because of an increased concern of adverse reactions, but because of a concern about the effectiveness of the vaccine.
PAGE 127 [25 pages]
Altered Immunocompetence
The sentence “Doses separated by less than three months are invalid for persons with HIV infection” has been deleted from the paragraph “Children with HIV infection are at increased…….” While the minimum interval prospectively for two doses of varicella vaccine in HIV infected children is three months, the minimum interval retrospectively for two doses of varicella vaccine in HIV infected children is four weeks. That is to say, when catching up on lapsed doses prospective, forecast/schedule a three-month interval, but when retrospectively reviewing records to determine whether a dose counts and does not need to be repeated, use four weeks.
PAGE 136 [25 pages]
Altered Immunocompetence
Table 8-1
In “Table 8-1: Vaccination of persons with primary and secondary immunodeficiency”, in the row on complement inhibition, the drug ravulizumab (Ultomiris) was added as an agent that mimics complement deficiency.
PAGE 137 [25 pages]
Altered Immunocompetence
Table 8-1
In Table 8-1, in the row on HIV infection, the column on contraindicated vaccines, zoster was removed, since moderate or severe immunodeficiency from HIV is not a contraindication to Shingrix.

PAGE 129 [25 pages]
Altered Immunocompetence
Page 129, with endnote on page 134
Added: language allowing vaccination with HPV vaccine to persons 27 through 45 years old based on shared clinical decision-making (SCDM), regardless of previous vaccination with HPV vaccine prior to a hematopoietic cell transplant (HCT).

PAGE 32 [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 [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.

PAGE 55 [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 [19 pages]
Contraindications and Precautions
Table 4-1
Latex sensitivity is a precaution to MenB vaccine (MenB-4c only).
PAGE 138 [27 pages]
Altered Immunocompetence
Table 8-1
MenACWY vaccine is recommended in persons with HIV/AIDS
PAGE 155 [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.

2020

PAGE 23 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 [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 31 [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 [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 [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 [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.

PAGE 37 [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 [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 [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 [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.

PAGE 13 [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 [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 [19 pages]
Contraindications and Precautions
Table 4-1
Yeast is acknowledged to be a component of MenACWY (Menveo only).

PAGE 23 [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 [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 [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 [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.

2019

PAGE 49-51 [19 pages]
Contraindications and Precautions
General principles of “contraindications”, “precautions” and “neither contraindications nor precautions”, are organized into sub-headers.
PAGE 114 [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.

PAGE 53 [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.

PAGE 86 [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.

New CE package approved
New Frontmatter
New ACIP Membership List
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 [6 pages]
Methods
Vaccine Administration section has been revised to reflect ACIP presentation on October 25, 2018.
PAGE 15 [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 [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 [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 [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 [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 [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.

PAGE 29 [38 pages]
Timing and Spacing of Immunobiologics
Table 3-1
Serogroup B meningococcal vaccine has been added to the table.
PAGE 36 [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.

2018

PAGE 29 [38 pages]
Timing and Spacing of Immunobiologics
Table 3-1
Serogroup B meningococcal vaccine now appears on the table.
PAGE 52 [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 [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.

PAGE 36 [38 pages]
Timing and Spacing of Immunobiologics
Table 3-4
The dosages for Hepatitis A IG have changed.
PAGE 52 [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 [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 [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 [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 [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.

PAGE 29 [38 pages]
Timing and Spacing of Immunobiologics
Table 3-1
A row has been added for LAIV
PAGE 29 [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.

2017

PAGE 30 [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 [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 [18 pages]
Contraindications and Precautions
Table 4-1
Serogroup B meningococcal vaccine has been added to the Contraindications and Precautions table.
PAGE 54 [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 [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 [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 [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 [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.