The 2019 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention (CDC), the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. The schedules are revised annually to reflect current recommendations for the use of vaccines licensed by the US Food and Drug Administration.
The 2019 childhood and adolescent immunization schedule has been updated to ensure consistency between the format of the childhood and adolescent and adult immunization schedules. Changes have been made to the cover page, including guidance for use of the schedule as well as a list of links to “Helpful information.” Similar to last year, the cover page includes a table with alphabetical listing of vaccines, approved abbreviations for each vaccine, and vaccine trade names.
Table 1 contains the recommended immunization schedule from birth through 18 years of age. The influenza row has been modified to reflect current CDC recommendations for use of LAIV in age-appropriate and health status–appropriate children 24 months of age and older. A purple bar has been added to the hepatitis A vaccine row, indicating a recommendation for use of this vaccine among infants 6 through 11 months of age before departure to an international destination. A purple bar has been added to the Tdap row, indicating vaccine use for pregnant adolescents 13 through 18 years of age.
Table 2 is the catch-up immunization schedule for persons 4 months through 18 years of age who start late or who are more than 1 month behind the recommended age for vaccine administration. A change is noted in relation to administration of Haemophilus influenzae type b and pneumococcal conjugate vaccines. The criteria under which no further doses are needed are presented, followed by recommendations for those in whom additional doses are indicated.
Table 3 lists the vaccines that may be indicated for children and adolescents 18 years of age or younger on the basis of medical conditions. A pink color has been added to the pregnancy column in the HPV row, indicating the need for a delay in vaccination for pregnant adolescents. The influenza vaccine row has been modified to separate LAIV from IIV and to include contraindications and precautions for LAIV.
A bullet directing providers to their state or local health departments for information regarding vaccination in the setting of a vaccine-preventable disease outbreak has been added to the "Additional Information" section of the notes.
This year, the notes are presented in alphabetical order. The following changes to individual footnotes have been made:
Hepatitis A vaccine
Information regarding the use of combined HepA-HepB (Twinrix) vaccine in persons 18 years of age or older has been added.
A section for international travel has been added with recommendation for vaccination of those 6 through 11 months of age and unvaccinated persons 12 months of age or older.
Homelessness has been added as an indication for vaccination.
Hepatitis B vaccine
The word “all” has been added to the vaccine recommendation for the birth dose for medically stable infants (≥2000 g) born to hepatitis B surface antigen-negative mothers. This was added to emphasize the recommendation for this population.
Information regarding the use of CPG–adjuvanted HepB (Heplisav-B) vaccine and combination Twinrix vaccine in persons 18 years or older has been added.
A bullet has been added regarding the use of combination vaccines that contain IPV. This bullet mirrors similar information presented in the hepatitis B vaccine note.
LAIV has been added where appropriate.
A “special situations” section has been added with information regarding vaccination of persons with a history of egg allergy and information regarding when not to use LAIV.
MMR and meningococcal vaccines
Language regarding use of the MMR vaccine in the setting of a mumps outbreak and MenACWY and MenB vaccine use in the setting of meningococcal outbreaks has been removed, and providers are now directed to local health departments for information regarding vaccination during an outbreak (see “Additional Information” section).
The catch-up vaccination section has been updated to indicate that those who received a dose of Tdap or DTaP at 7 through 10 years of age inadvertently or as part of the catch-up schedule should receive the routine dose of Tdap at 11 through 12 years of age.
A link to information regarding the use of Tdap/Td for wound prophylaxis has been added.
The 2019 version of tables 1 through 3 and the notes are available on the American Academy of Pediatrics Web site (https://redbook.solutions.aap.org/SS/Immunization_Schedules.aspx) and the CDC Web site (www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html). A parent-friendly vaccine schedule for children and adolescents is available at www.cdc.gov/vaccines/schedules/index.html. An adult immunization schedule is published in February of each year and is available at www.cdc.gov/vaccines/schedules/hcp/adult.html.
Clinically significant adverse events that follow immunization should be reported to the Vaccine Adverse Event Reporting System. Guidance about how to obtain and complete a Vaccine Adverse Event Reporting System 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 and the CDC that contain detailed recommendations for individual vaccines, including recommendations for children with high-risk conditions, are available at www.cdc.gov/vaccines/hcp/acip-recs/index.html. 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.
This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.
Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.
The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.
Committee on Infectious Diseases, 2018–2019
Yvonne A. Maldonado, MD, FAAP, Chairperson
Theoklis E. Zaoutis, MD, MSCE, FAAP, Vice Chairperson
Ritu Banerjee, MD, PhD, FAAP
Elizabeth D. Barnett, MD, FAAP
James D. Campbell, MD, MS, FAAP
Jeffrey S. Gerber, MD, PhD, FAAP
Athena P. Kourtis, MD, PhD, MPH, FAAP
Ruth Lynfield, MD, FAAP
Flor M. Munoz, MD, MSc, FAAP
Dawn Nolt, MD, MPH, FAAP
Ann-Christine Nyquist, MD, MSPH, FAAP
Sean T. O’Leary, MD, MPH, FAAP
Mark H. Sawyer, MD, FAAP
William J. Steinbach, MD, FAAP
Tina Q. Tan, MD, FAAP
David W. Kimberlin, MD, FAAP – Red Book Editor
Henry H. Bernstein, DO, MHCM, FAAP – Red Book Online Associate Editor
H. Cody Meissner, MD, FAAP – Visual Red Book Associate Editor
Amanda C. Cohn, MD, FAAP – Centers for Disease Control and Prevention
Jamie Deseda-Tous, MD – Sociedad Latinoamericana de Infectologia Pediatrica
Karen M. Farizo, MD – US Food and Drug Administration
Marc Fischer, MD, FAAP – Centers for Disease Control and Prevention
Natasha B. Halasa, MD, MPH, FAAP – Pediatric Infectious Diseases Society
Nicole Le Saux, MD, FRCP(C) – Canadian Paediatric Society
Scot B. Moore, MD, FAAP – Committee on Practice Ambulatory Medicine
Neil S. Silverman, MD – American College of Obstetricians and Gynecologists
Jeffrey R. Starke, MD, FAAP – American Thoracic Society
James J. Stevermer, MD, MSPH, FAAFP – American Academy of Family Physicians
Kay M. Tomashek, MD, MPH, DTM – National Institutes of Health
Jennifer M. Frantz, MPH