February 11, 2011
By Claire McCarthy, M.D.
Boston Children's Hospital
Every January, the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) announce changes to the childhood and adolescent immunization schedules. Many people think of the immunization schedules as set-in-stone, but they're not.
Immunization is an evolving science. New vaccines are being developed all the time. Since I've been a practicing pediatrician, I've seen six vaccines added to the schedule. I've also seen one taken off a previous version of the rotavirus vaccine, which turned out to have worrisome side effects.
As we get experience with new vaccines, it's not uncommon for there to be changes to the dosing schedule as well. So when parents (or children) ask me if there will be a shot at the next checkup, the answer is very often "I don't know."
Here are the changes for 2011:
- The recommendations for catching up on late doses of the hepatitis B vaccine have been clarified: The third dose shouldn't be given before 24 weeks of age.
- The new vaccine against pneumococcus, PCV13, offers more protection than the previous PCV 7 vaccine. So, it's recommended that:
All children over the age of 2 years who have an underlying medical condition should also get another pneumococcal vaccine, PPSV. The recommendations for the flu vaccine have been clarified. This year's flu shot protects against H1N1 as well as other strains of influenza. Two doses of the flu vaccine should be given to any child between 6 months and 8 years of age who:
- All children between 14 months and 59 months who got the full PCV7 series get a dose of PCV 13 as well.
- Children between 60 months and 71 months who have an underlying medical condition, and older children with certain medical conditions that put them at particularly high risk of infection, should get a dose of PCV 13.
A booster dose of Menactra is now recommended to protect against a dangerous kind of meningitis. If the first dose is given at the recommended age of 11 to 12 years, the booster would be given at age 16;. If the first dose is given at age 13 to 15 years, the booster would be at age 18. There is a change in the catch-up schedule for children who get behind on their immunizations. This is to ensure that they are fully immunized against pertussis. The exact schedule depends on the age of the child and how much catching up they need to do. The Haemophilus influenzae type B vaccine (HIB) used to be given only to children ages 5 years and younger. It is now recommended for older children with sickle cell disease, HIV, leukemia or who have problems with their spleen. The HPV vaccine is now officially recommended for the prevention of genital warts as well as cervical cancer. (Before, it was only "officially" recommended for the prevention of cervical cancer.) There is also a reminder that the HPV4 vaccine, or Gardasil, can be given to boys ages 9 years to 18 years to prevent genital warts. (Many insurance companies, however, will not pay for it to be given to boys, and it is expensive.)
- Is getting the flu shot for the first time
- Only got one dose of the regular flu shot last year
- Got less than 2 doses of the H1N1 vaccine last year
Some of these changes may apply to your child; others may not. Check with your doctor.
For more information, visit the CDC's immunization schedule webpage. There is also a specific page for preteen and adolescent immunizations. The AAP's website also has information about the new schedule.
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Claire McCarthy, M.D., is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.