2020 immunization schedule includes changes to hepA, Tdap vaccines

Sean T. O’Leary, M.D., M.P.H., FAAP

The 2020 child and adolescent immunization schedule released today includes changes to recommendations for hepatitis A and tetanus, diphtheria and acellular pertussis (Tdap) vaccines. In addition, the terms “individual clinical decision-making” and “clinical discretion” have been replaced with “shared clinical decision-making.”

The schedule for the use of routinely recommended vaccines is updated annually to reflect the most current guidance. The 2020 schedule has been approved by the Academy, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists. It is available at https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.

Similar to last year, the cover page includes a table with an alphabetical listing of vaccines, approved abbreviations for each vaccine and vaccine trade names. The American College of Nurse-Midwives has been added to the list of approving organizations.

The following changes have been made to Table 1 in the schedule:

  • The row for hepatitis A vaccine has been changed to a solid green bar from ages 2 through 18 to reflect routine catch-up vaccination for children in this age range.
  • In the label legend, the blue box was changed from “Range of recommended ages for non-high-risk groups that may receive vaccine, subject to individual clinical decision-making” to “Recommended based on shared clinical decision-making.”
  • An asterisk was added to HPV vaccine at ages 9 and 10 years (*can be used in this age group). This represents a difference between ACIP and AAP policy regarding HPV vaccine. AAP policy states: “The AAP recommends starting the series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series.”

The only change to Table 2 (the catch-up immunization schedule) is that “ACWY” was added to “Meningococcal” in relevant rows to clarify that these recommendations apply to MenACWY only and not MenB vaccine.

Table 3 lists the vaccines that may be indicated for children and adolescents 18 years of age or younger based on medical conditions. All boxes in the hepatitis A vaccine row were changed to yellow to denote that it is a routine vaccination for all children, including those with medical indications. The pregnancy box in the MenACWY row has been changed to yellow, as pregnancy is not considered an indication to withhold routine adolescent vaccination.

Similar to the 2019 schedule, the notes are presented in alphabetical order. The following changes to individual footnotes have been made to the 2020 schedule:

  • Diphtheria, tetanus and acellular pertussis (DTaP) vaccine: A clarification was added to the catch-up recommendation that dose 5 is not necessary if dose 4 was administered at age 4 years or older AND it was given at least six months after dose 3.
  • Haemophilus influenzae type b vaccine: A bullet was added to clarify that catch-up vaccination is not recommended for children 5 years and older who are not at high risk.
  • Hepatitis A vaccine: A note was added to reflect the recommendation for routine catch-up vaccination through 18 years of age.
  • Hepatitis B vaccine: A “Special Situations” section was added with recommendations for revaccination and a link to the ACIP hepatitis B recommendations.
  • Influenza vaccines: The routine recommendations section was reformatted to more clearly outline circumstances under which one or two doses of influenza vaccine are recommended.
  • Poliovirus vaccine: Information was added regarding which doses of trivalent oral poliovirus vaccine (OPV) may be counted as valid. It now reads, “Only trivalent OPV (tOPV) counts toward the US vaccination requirements. Doses of OPV administered before April 1, 2016, should be counted (unless specifically noted as administered during a campaign). Doses of OPV administered on or after April 1, 2016, should not be counted.”
  • Meningococcal serogroup ACWY vaccine: Guidance was added regarding adolescent revaccination for children who received the vaccine prior to age 10 years.
  • Meningococcal serogroup B vaccines: The heading that said, “Clinical Discretion” was changed to “Shared Clinical Decision-Making.”
  • Tdap vaccine: Tdap was added as an option for booster doses and remaining doses of the catch-up series. Guidance also was added for DTaP and Tdap doses received at 7-10 years of age, including that children age 10 years who receive Tdap do not need to receive the routine Tdap dose at age 11-12 years.

Adverse events that follow vaccination should be reported to the Vaccine Adverse Event Reporting system at www.vaers.hhs.gov or by calling 800-822-7967.

Dr. O’Leary is a member of the AAP Committee on Infectious Diseases.

Read here.