Don’t Throw Away Your Shot: A Great Resource For Vaccine Updates

In a recently released article in Pediatrics, practitioners can find the AAP Policy Statement, “Recommended Childhood and Adolescent Immunization Schedule: United States, 2023,” highlighting the harmonized changes made to 3 key tables (10.1542/peds.2022-061029):

• Table 1 is the recommended immunization schedule for ages birth to 18 years
• Table 2 is the catch-up immunization schedule for ages 4 months to 18 years of age for those who start late or are more than one month behind
• Table 3 lists indicated vaccines for those 18 years of age or younger on the basis of medical conditions.

Notable changes include the addition of a “box” for COVID-19 vaccines, the addition of a new 15 valent pneumococcal conjugate vaccine (which at this time will be considered interchangeable with the older 13 valent vaccine), and a new brand of measles mumps rubella (MMR) combined vaccine. Key updates include clarification regarding additional doses of MMR in mumps outbreaks and specific indications for polio vaccination in those at risk who are 18 years or older. Updates that will likely impact fewer physicians include clarity that dengue vaccine should not be given to children travelling to and from endemic areas, while updates about influenza (flu) vaccine are more broadly impactful. Live flu vaccine should NOT be given to close contacts of immunocompromised persons, and inactivated flu vaccine may be given to those with severe egg allergy (angioedema, requiring epinephrine, respiratory distress) but under medical supervision in a setting with ready ability to treat anaphylaxis or other reactions.

Learning vaccines, i.e., knowing not just which to give during scheduled timely well care visits, but knowing minimum intervals, combination vaccine indications and other nuances that permit one to “catch up” children and youth who delayed on vaccines, is harder than it looks. Trainees sometimes express frustration about vaccine “rules”, which seem nonintuitive and unnecessarily restrictive but are a function of how the vaccine was tested in clinical trials and approved—for example, it seems KINRIX™ would be perfect for “catching-up” a 3-year-old who has completed their Hepatitis B series but needs a 3^rd inactivated polio and diphtheria-, tetanus- and pertussis-containing vaccine, but the package insert is clear that this vaccine is not approved for those younger than 4 years (or older than 6 years). Multiple excellent resources are free to practitioners, and many trainees rely on the free “CDC Vaccine Schedules” app. I love the job aids that CDC has created for each vaccine and age group. With columns for the child’s current age and then for the number of, ages at, and time since prior doses, the table tells you what to do today and when to have the child return – perfecto!

Finally and  unfortunately, no discussion about vaccines would be complete without an acknowledgement of increasing vaccine hesitancy and the need for management strategies, with many excellent review articles available.^1,2 Both the CDC and Immunize.org (formerly the Immunization Action Coalition) have informative, parent- and practitioner-friendly websites with ready-to-use resources on this topic.^3,4 Most office practitioners likely have well-honed motivational interviewing approaches and curated resources, but it’s good to know that additional help is here. The AAP has just released a report with tools and resources called “Reframing the Conversation about Child and Adolescent Vaccinations,” that offers a new approach aiming to shift and “reframe” our approach to vaccine uptake, with the help of metaphors that liken vaccination to both a “computer update,” or performance improvement of the immune system, and to literacy, i.e., how the immune system learns to respond to viruses through vaccination. To learn more here, and stay tuned for webinars and other supporting information from the AAP. 

References:

1. Lafnitzegger A, Gaviria-Agudelo C. Vaccine Hesitancy in Pediatrics. Adv Pediatr. 2022 Aug;69(1):163-176. doi: 10.1016/j.yapd.2022.03.011. Epub 2022 Jun 20. PMID: 35985708.
2. Garett R, Young SD. Online misinformation and vaccine hesitancy. Transl Behav Med. 2021 Dec 14;11(12):2194-2199. doi: 10.1093/tbm/ibab128. PMID: 34529080; PMCID: PMC8515268.
3. Provider Resources for Vaccine Conversations with Parents. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/conversations/index.html Accessed 1/25/2023.
4. org Talking about Vaccines. https://www.immunize.org/talking-about-vaccines/ Accessed 1/25/2023.