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    Major vaccines addressed in updated ACIP guidelines

    There are some notable revisions in 2018 to recommendations concerning hepatitis B vaccination for newborns and a third dose of mumps-containing vaccines, among others.


    Changes for hepatitis B vaccination

    The updated recommendations also make a change to the timing of infant hepatitis B vaccination in an effort to reduce the number of preventable neonatal cases of hepatitis B.

    Despite the fact that properly administered hepatitis B vaccine and hepatitis B immune globulin are extremely effective at preventing neonatal hepatitis B, there are still about 1000 neonatal cases in the United States each year, Meissner says. Babies born to mothers with known hepatitis B infections generally receive appropriate prophylaxis at birth, but in cases in which the mother was not tested properly or testing was falsely interpreted, infected babies might not receive the vaccine until a week or 2 after birth—and that’s too late.

    “We have a pretty effective way of preventing hepatitis B transmission,” Meissner says. “The problem is you have to know the mother is infected in order to provide appropriate prophylaxis."

    Testing can be confusing, Meissner says, or test results from the mother might not be relayed in a timely fashion to the pediatrician. To reduce the chance for error, the new recommendations state that all babies with a birth weight equal to or greater than 2000 grams who are born to a HBsAg-negative mother should receive the first dose of hepatitis B vaccine during the first 24 hours after birth.

    Next: When parents say "no" to newborn nursery protocols

    “It sets up a safety net for cases when results were misread or incorrectly ordered,” Meissner says. "The intention is to reduce the number of hepatitis B-infected babies to as low a number as possible."

    More updates

    Another update included in the guidelines is a recommendation for 2 doses of the human papillomavirus (HPV) vaccine for adolescents and children who receive the first dose before their 15th birthday.

    There were no overall changes to the schedule of vaccinations recommended for children aged 0 to 18 years, although there were 2 changes to the catch-up schedule for children aged 4 months to 18 years who began their immunizations late or are behind on vaccinations by 1 month or more. These changes include a maximum age for the first dose of the rotavirus vaccine (14 weeks, 6 days) and the last dose (8 months, 0 days). The inactivated poliovirus catch-up schedule is also clarified to note that a final dose of inactivated poliovirus vaccine is recommended on or after the 4th birthday and at least 6 months after the previous dose. The schedule indicated for children aged 18 years and younger with medical indications also now includes a reference for administration of live vaccines to children with human immunodeficiency virus (HIV).                                         

    The 2018 catch-up immunization schedule provides minimum intervals between doses for children whose vaccinations have been delayed. Additionally, the Haemophilus influenzae type b (Hib)vaccine MenHibrix (Hib-MenCY) has been removed from the vaccine schedule because the vaccine is no longer available, and all remaining doses have expired, according to the new recommendations.


    1. Centers for Disease Control and Prevention. Recommended immunization schedule for children and adolescents aged 18 years or younger, United States, 2018. Available at: https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. Updated February 6, 2018. Accessed February 16, 2018.

    2. Petrou I. Live attenuated influenza vaccine “shelved” for poor efficacy. Contemporary Pediatrics. Available at: http://contemporarypediatrics.modernmedicine.com/contemporary-pediatrics/news/live-attenuated-influenza-vaccine-shelved-poor-efficacy . Published September 20, 2016. Accessed February 16, 2018.

    3. Rahhal N. Green light for nasal flu spray next season after two-year ban- and experts claim it could have lowered death rate this year. DailyMail.com Available at: http://www.dailymail.co.uk/health/article-5419269/US-panel-say-OK-use-nasal-flu-vaccine-again.html. Published February 21, 2018. Accessed February 22, 2018.

    Rachael Zimlich, RN
    Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and ...


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