Schedule Changes & Guidance

Disruptions to healthcare services during the COVID-19 pandemic resulted in declines in outpatient pediatric visits and fewer vaccine doses being administered, leaving children at risk for vaccine-preventable diseases.

Healthcare providers are encouraged to work with families to keep or bring children up to date with their vaccinations. Healthcare providers should identify children who have missed well-child visits and/or recommended vaccinations and contact them to schedule in person appointments. State-based immunization information systems and electronic health records may be able to support this work.

Primary care practices should continue to use strategies to separate well-child visits from sick visits. Examples could include:

• Scheduling sick visits and well-child visits during different times of the day
• Reducing crowding in waiting rooms or setting up triage booths to screen patients safely
• Collaborating with healthcare providers in the community to identify separate locations for providing well-child visits for children

Visit Let’s RISE to get more actionable strategies, resources, and data to support getting all Americans back on-schedule with their routine immunizations

• Added COVID-19 vaccines, Priorix^®, and 15-valent pneumococcal conjugate vaccine (PCV15) to the child and adolescent schedule
• Added new abbreviations for the COVID-19 vaccine products. These abbreviations contain information on the vaccine’s valency (i.e., monovalent versus bivalent, indicated by “1v” and “2v,” respectively) and vaccine platform (mRNA versus acellular protein subunit, or “aPS”).
• Revised the text for vaccine injury compensation to include the Countermeasures Injury Compensation Program (CICP) for COVID-19 vaccines

The COVID-19 note was added to provide guidance for use of COVID-19 vaccines.

The Dengue note was revised to clarify that the dengue vaccine is recommended for seropositive children living in endemic areas, not for children traveling to or visiting endemic dengue areas.

The hepatitis B note was revised to highlight the recommendations for infants born to mothers who are hepatitis B surface antigen (HBsAg) positive, or whose HBsAg status is unknown. Additionally, Heplisav-B^® and PreHevbrio^® vaccines were added to the catch-up vaccination section for persons aged 18 years.

The influenza note was updated to reflect the recommendations for the 2022-23 influenza season. In the “Special situations” section, language was added to clarify that live attenuated influenza vaccines should not be administered to close contacts of immunosuppressed persons who require a protected environment. The recommendation for persons with egg allergy with symptoms other than hives was moved from the appendix to this section.

The MMR note was updated to include the recommendations for additional MMR doses in a mumps outbreak setting.

The MenACWY note was updated to include language stating the newly licensed Menveo^® one-vial (all liquid) formulation should not be administered before age 10 years.

The “Special situations” section was updated to add guidance stating that if the second dose is administered ≥ 6 months after the first dose, the third dose is not needed. In addition, if the third dose of Trumenba^® is administered earlier than 4 months after the second dose, a fourth dose should be administered at least 4 months after the third dose.

The pneumococcal note was revised to include the recommendations for the use of 15-valent pneumococcal conjugate vaccine (PCV15).

The “Special situations” section was added to include the recommendations for adolescents aged 18 years who are at increased risk of exposure to polioviruses.

The header of the “Contraindications” column was changed to “Contraindicated or not recommended.”

Dengue row: added language stating lack of laboratory confirmation of previous dengue virus infection is a contraindication.

Hepatitis B row: revised to state Heplisav-B^® and PreHevbrio^® are not recommended during pregnancy; other hepatitis B vaccine products should be used. Weblinks to the Heplisav-B^® and PreHevbrio^™ pregnancy registries collecting data on inadvertent administration are provided.

Human papillomavirus vaccine row: added language stating that HPV vaccine is not recommended during pregnancy.

MMR: added MMRV to this row. In addition, precaution was updated to state personal or family history of seizure of any etiology is a precaution for using MMRV.

Varicella vaccine row: added language stating if MMRV is used, the precautions for MMR/MMRV should be reviewed.

• Added COVID-19 vaccines, PreHevbrio™ and Priorix^®to the adult schedule.
• Added new abbreviations for the COVID-19 vaccine products. These abbreviations contain information on the vaccine’s valency (i.e., monovalent versus bivalent, indicated by “1v” and “2v,” respectively) and vaccine platform (mRNA versus acellular protein subunit, or “aPS”).
• Added American Pharmacists Association as an approving partner.
• Revised the text for vaccine injury compensation to include the Countermeasures Injury Compensation Program (CICP) for COVID-19 vaccines.

The COVID-19 note was added to provide guidance for use of COVID-19 vaccines.

The note was updated to add PreHevbrio™ to the description of the 3-dose series, and information on the 4-dose series for persons on hemodialysis was moved to the “Special situations” section. HepB vaccination continues to be universally recommended for all adults 19 through 59 years of age. Language has been added stating that persons aged ≥ 60 years with known risk factors for hepatitis B virus infection should complete a HepB vaccine series, while persons aged ≥ 60 years without known risk factors for hepatitis B virus infection may complete a HepB vaccine series.

The influenza note was updated to reflect the recommendations for the 2022-23 influenza season. In the “Routine vaccination” section, a sub-bullet was added stating that any one of quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine is preferred for adults aged 65 years or older. However, if none of these three vaccines is available, then any other age-appropriate influenza vaccine should be used for this age group. In the “Special situations” section, language was added to clarify that live attenuated influenza vaccines should not be administered to close contacts of immunosuppressed persons who require a protected environment. The recommendation for persons with egg allergy with symptoms other than hives was moved from the appendix to this section.

The MMR note was updated to include the recommendations for additional MMR doses in a mumps outbreak setting.

The meningococcal note was updated to add guidance stating that if the third dose of Trumenba^® is administered earlier than 4 months after the second dose, a fourth dose should be administered at least 4 months after the third dose.

The pneumococcal note was substantially updated to reflect ACIP’s new recommendations for the use of PCV15 and PCV20 in persons who previously received pneumococcal vaccines. Additionally, a hyperlink to the CDC app that can be used to determine a patient’s pneumococcal vaccination needs has been included.

The poliovirus vaccination note was updated to address polio vaccine recommendations for adults who are at increased risk of exposure to poliovirus although routine poliovirus vaccination of adults residing in the United States is not necessary.

The zoster vaccination note was updated to provide guidance for patients with serologic evidence of prior varicella susceptibility, and guidance for persons with immunocompromising conditions who do not have a documented history of prior varicella infection, varicella vaccination, or prior herpes zoster.

The header of the “Contraindications” column was changed to “Contraindicated or not recommended.”

Hepatitis B row: revised to state Heplisav-B^® and PreHevbrio™ are not recommended during pregnancy; other hepatitis B vaccine products should be used. Weblinks to the Heplisav-B^® and PreHevbrio^® pregnancy registries collecting data on inadvertent administration are provided.

Human papillomavirus vaccine row: added language stating that HPV vaccine is not recommended during pregnancy.