Immunization Schedule Changes

Child Immunization Schedule Changes for 2019

  • Any licensed influenza vaccine that is appropriate for age and health status of the patient may be used.
  • LAIV has been listed separately from inactivated influenza vaccine (IIV) on the immunization schedule.
  • Live, attenuated influenza vaccine (LAIV) is an option for children and adolescents beginning at age 2 years, except those who:
    • Have immunocompromising conditions, including HIV infection
    • Have anatomical or functional asplenia
    • Are pregnant
    • Have close contact with or are caregivers of severely immunocompromised persons in a protected environment
    • Have received influenza antiviral medications in the previous 48 hours
    • Have a cerebrospinal fluid leak or a cochlear implant
    • Are age 2-4 years and who have received a diagnosis of asthma or wheezing within the preceding 12 months
    • Are receiving aspirin- or salicylate-containing medications
    • Have a history of severe allergic reaction to any component of the vaccine (except egg) or after a previous dose of any influenza vaccine
  • The following conditions are precautions for LAIV:
    • Asthma in persons age 5 years or older
    • Other underlying medical conditions (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])

Homelessness has been added as an indication for HepA vaccination. A section for international travel has also been added with recommendations for vaccination of travelers 6-11 months and unvaccinated travelers age ≥12 months (a purple bar has been added to Table 1 on the schedule to reflect this change). The HepA note was revised to include information regarding the use of combined HepA-HepB vaccine in persons age ≥18 years.

The HepB note was revised to include information regarding the use of CpG-adjuvanted HepB vaccine and combination HepA-HepB vaccine in persons 18 years or older.

The pregnancy box in the meningococcal B vaccine row in Table 3 has been changed to the orange “precaution” color.

Within the IPV note, a bullet has been added regarding the use of combination vaccines that contain IPV.

  • The Tdap note has been updated to indicate those who receive a dose of Tdap or diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) at age 7-10 years inadvertently or as part of the catch-up series should still receive the routine dose of Tdap at age 11-12 years.
  • On the Tdap row in Table 1 of the schedule, the bar for persons age 13-18 years has been split into a half green and half purple bar to represent catch-up vaccinations and use in pregnant adolescents, respectively.

Related to mumps and meningococcal outbreaks, the “Additional information” section at the beginning of the vaccine notes directs providers to their state or local health department for information regarding vaccinations during an outbreak. Therefore, language regarding the use of measles, mumps, and rubella (MMR) vaccine in the setting of an outbreak or the use of Meningococcal (groups A, C, W-135, and Y) conjugate (MenACWY) and Meningococcal group B (MenB) vaccines in the setting of meningococcal disease outbreaks has been removed from the MMR and meningococcal vaccine notes.

  • The schedule cover page has been simplified, providing a shortened title and basic instructions on how to use the schedule.  The cover page also lists routinely recommended vaccines and their standardized abbreviations and trade names.
  • Web links are provided for downloading the CDC Vaccine Schedules App, reference materials on vaccine-preventable disease surveillance, reporting postvaccination adverse events to the Vaccine Adverse Event Reporting System, travelers’ vaccines, and vaccine information statements (VISs).
  • The table providing recommended immunizations by medical condition and other indications distinguishes between precautions, delay, and contraindications:
    • Precaution – vaccine might be indicated if benefit of protection outweighs risk of adverse reaction is highlighted in orange
    • Delay in vaccination – vaccine that should not be given during pregnancy is highlighted in pink
    • Contraindicated or use not recommended – vaccine should not be administered because of risk factors for serious adverse reaction is highlighted in red
  • The notes in the schedule have been reordered alphabetically by vaccine, providing concise information describing vaccine indications, dosing frequencies and intervals, and other published ACIP recommendations.

The comprehensive summary of the ACIP recommended changes to the child and adolescent schedule can be found in the February 8, 2019 MMWR.

Adult Immunization Schedule Changes for 2019

  • Any licensed influenza vaccine that is appropriate for age and health status of the patient may be used.
  • LAIV has been listed separately from inactivated influenza vaccine (IIV) on the immunization schedule.
  • Live, attenuated influenza vaccine (LAIV) is an option for adults through age 49 years, except those who:
    • Have immunocompromising conditions, including HIV infection
    • Have anatomical or functional asplenia
    • Are pregnant
    • Have close contact with or are caregivers of severely immunocompromised persons in a protected environment
    • Have received influenza antiviral medications in the previous 48 hours
    • Have a cerebrospinal fluid leak or a cochlear implant

Heplisav-B is routinely administered in 2 doses given at least 4 weeks apart. It can be used as a substitute in a 3-dose series with a different hepatitis B vaccine, but a valid 2-dose series requires 2 doses of Heplisav-B with at least 4 weeks between doses.

Homelessness is an indication for routine hepatitis A vaccination with a 2-dose series of single-antigen hepatitis A vaccine or a 3-dose series of combination hepatitis A and hepatitis B vaccine.

  • The schedule cover page has been simplified, providing a shortened title basic instructions on how to use the schedule.  The cover page also lists routinely recommended vaccines and their standardized abbreviations and trade names.
  • Web links are provided for downloading the CDC Vaccine Schedules App, reference materials on vaccine-preventable disease surveillance, reporting postvaccination adverse events to the Vaccine Adverse Event Reporting System, travelers’ vaccines, and vaccine information statements (VISs).
  • The table providing recommended immunizations by medical condition and other indications distinguishes between precautions, delay, and contraindications:
    • Precaution – vaccine might be indicated if benefit of protection outweighs risk of adverse reaction is highlighted in orange
    • Delay in vaccination – vaccine that should not be given to pregnant women is highlighted in pink
    • Contraindicated or use not recommended – vaccine should not be administered because of risk factors for serious adverse reaction is highlighted in red
  • The notes in the schedule have been reordered alphabetically by vaccine, providing concise information describing vaccine indications, dosing frequencies and intervals, and other published ACIP recommendations.

The comprehensive summary of the ACIP recommended changes to the adult schedule can be found in the February 8, 2019 MMWR.

Page last reviewed: February 5, 2019