Recommended Childhood and Adolescent Immunization Schedule—United States, 2013

The 2013 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians. A change in design of the 2013 schedules has been made because of the increasing complexity of the schedules and the lack of space for new information in the footnotes. The 5-page 2013 format includes a single schedule for people 0 through 18 years of age (Fig 1), which will replace the previous schedules for people 0 to 6 years of age and 7 to 18 years of age. New columns have been added at 4 to 6 years and at 11 to 12 years of age to highlight school entry and adolescent vaccine age group recommendations. The yellow bars on the 2013 schedule contain a notation indicating the recommended dose number by age. The green catch-up bars cover the entire age range of 0 through 18 years of age (previously, the green bars were only in the schedule for 7- to 18-year-olds). The purple bars continue to designate the range of recommended ages for immunization for certain groups at high risk. The white boxes indicate ages when a vaccine is not recommended routinely. In addition, footnotes from the 0 to 6 year, 7 to 18 year, and catch-up schedules have been combined so that each footnote now contains the recommendations for routine vaccination, for catch-up vaccination, and for vaccination of children and adolescents with high-risk conditions or in special circumstances. The catch-up schedule for children and adolescents who start late or are >1 month behind remains unchanged (Fig 2). A parent-friendly vaccine schedule for children and adolescents is available at http://www.cdc.gov/vaccines/schedules/index.html. An adult immunization schedule also is published in February of each year and is available at www.cdc.gov/vaccines. These schedules are revised annually to reflect current recommendations for the use of vaccines licensed by the US Food and Drug Administration and include the following specific changes from last year:

• The rotavirus vaccine footnote contains clarification of the number of doses for RV1 and RV5.

• The Centers for Disease Control and Prevention recommends Tdap for pregnant adolescents and adults during each pregnancy. This approach was in response to increasing cases of pertussis nationally and a recognition that the greatest burden of disease, morbidity, and mortality occurs in infants prior to the time that they can achieve protection from their primary series with DTaP. Data on the safety and efficacy of multiple Tdap doses are limited. The American Academy of Pediatrics agrees that adolescents and young adults who have received Tdap prior to their pregnancy should receive another Tdap during this pregnancy. The American Academy of Pediatrics is reviewing available information before publishing a policy statement concerning whether it is appropriate to provide additional Tdap doses for subsequent pregnancies. This will be addressed in a future AAP policy statement for pertussis vaccine and in the 2014 immunization schedule.

• The Haemophilus influenzae type b footnote clarifies that only 1 dose should be administered to unvaccinated children 15 months of age or older.

Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System (VAERS). Guidance about how to obtain and complete a VAERS form can be obtained at www.vaers.hhs.gov or by calling 800-822-7967. Additional information can be found in the Red Book and at Red Book Online (http://aapredbook.aappublications.org/). Statements from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention that contain details of recommendations for individual vaccines, including recommendations for children with high-risk conditions, are available at www.cdc.gov/vaccines/pubs/ACIP-list.htm. Information on new vaccine releases, vaccine supplies, and interim recommendations resulting from vaccine shortages and statements on specific vaccines can be found at www.aapredbook.org/news/vaccstatus.shtml and www.cdc.gov/vaccines/pubs/ACIP-list.htm.