Immunization Strategies and Practices [1 ed.] 9781610022774, 9781610021814

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pediatric collections Immunization Strategies and Practices FEATURES Recommended Childhood and Adolescent Immunization Schedules—United States, 2018 Countering Vaccine Hesitancy Window or Mirror: Social Networks’ Role in Immunization Decisions Strategies for Improving Vaccine Delivery Vaccine Education During Pregnancy and Timeliness of Infant Immunization

Published by the American Academy of Pediatrics 345 Park Blvd Itasca, IL 60143

The American Academy of Pediatrics is not responsible for the content of the resources mentioned in this publication. Web site addresses are as current as possible, but may change at any time. Products are mentioned for information purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics. © 2018 American Academy of Pediatrics. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or otherwise—without prior written permission from the publisher.

Printed in the United States of America APC007 ISBN: 978-1-61002-181-4

pediatric collections Immunization Strategies and Practices

About AAP Pediatric Collections Pediatric Collections is a series of selected pediatric articles that highlight different facets of information across various AAP publications, including AAP Journals, AAP News, Blog Articles, and eBooks. Each series of collections focuses on specific topics in the field of pediatrics so that you can keep up with best practices, and make an informed response to public health matters, trending news, and current events. Each collection includes previously published content focusing on specific topics and articles selected by AAP editors. Visit http://collections.aap.org to view a list of upcoming collections.

The 2018 immunization schedule is available at www.cdc.gov/vaccines/ schedules/hcp/child-adolescent.html.

TABLE OF CONTENTS 1

Introduction

Efficacy

2

Recommended Childhood and Adolescent Immunization Schedules: United States, 2018 From the American Academy of Pediatrics • Original Publication • March-1-2018

4

Physician Response to Parental Requests to Spread Out the Recommended Vaccine Schedule Article • Original Publication • April-1-2015

16

Study Looks at Impact of Different PCV13 Schedules for Preterm Infants AAP News • Original Publication • August-9-2016

17

What’s the Best Pneumococcal Vaccination Schedule for Preterm Infants? A Randomized Controlled Trial Tells All Blog • Original Publication • August-15-2016

18

Schedules for Pneumococcal Vaccination of Preterm Infants: An RCT Article • Original Publication • September-1-2016

go.aap.org/connect

Immunization Strategies and Practices

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TABLE OF CONTENTS 33

Pneumococcal Vaccines in Preterm Infants: Are More Doses Better? Implications for Other Vaccines Commentary • Original Publication • September-1-2016

35

More Evidence Supporting Pertussis Immunization of Pregnant Moms Blog • Original Publication • August-8-2017

36

Tdap Vaccination During Pregnancy Prevents Infant Pertussis Infectious Diseases • Original Publication • August-1-2017

37

Effectiveness of Vaccination During Pregnancy to Prevent Infant Pertussis Article • Original Publication • May-1-2017

45

Study Looks at HPV Prevalence Since Introduction of Vaccine AAP News • Original Publication • February-23-2016

46

Prevalence of HPV After Introduction of the Vaccination Program in the United States Article • Original Publication • March-1-2016

57

Rotavirus Vaccine and Intussusception: A Gut Check Blog • Original Publication • September-8-2016

58

Rotavirus Vaccine and Intussusception Hospitalizations Commentary • Original Publication • September-1-2016

61

Intussusception Rates Before and After the Introduction of Rotavirus Vaccine Article • Original Publication • September-1-2016

Parental Concerns, Hesitancy, and Exemptions

68

The Ethics of Good Intentions Blog • Original Publication • September-22-2016

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AAP PEDIATRIC COLLECTIONS

TABLE OF CONTENTS 70

Should Pediatric Practices Have Policies to Not Care for Children With Vaccine-Hesitant Parents? Ethics Rounds • Original Publication • October-1-2016

76

How to Address Vaccine Hesitancy: New AAP Report Says Dismissal a Last Resort AAP News • Original Publication • August-29-2016

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Facing the Dilemma of Dismissing Vaccine Refusers AAP News • Original Publication • August-29-2016

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Clinical Report: Countering Vaccine Hesitancy From the American Academy of Pediatrics • Original Publication • September-1-2016

93

Eliminate Nonmedical Immunization Exemptions for School Entry, Says AAP AAP News • Original Publication • August-29-2016

95

Policy Statement: Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance From the American Academy of Pediatrics • Original Publication • September-1-2016

Strategies and Education

100 What’s the Best Way to Increase Immunization Levels? Blog • Original Publication • June-1-2016

101 Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial Article • Original Publication • June-1-2016

110 A Message for Your Obstetrical Colleagues: What You Say About Vaccines During Pregnancy Matters Blog • Original Publication • August-21-2017

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Vaccine Education During Pregnancy and Timeliness of Infant Immunization Article • Original Publication • September-1-2017

Immunization Strategies and Practices

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121

Window or Mirror: Social Networks’ Role in Immunization Decisions Commentary • Original Publication • May-1-2013

123 The Impact of Social Networks on Parents’ Vaccination Decisions Article • Original Publication • May-1-2013

134 What’s the Best Way to Improve HPV Vaccination Rates in Your Practice? A Randomized Trial Provides an Answer Blog • Original Publication • December-12-2016

135 Announcements Versus Conversations to Improve HPV Vaccination Coverage: A Randomized Trial Article • Original Publication • January-1-2017

146 Clinical Report: Practical Approaches to Optimize Adolescent Immunization From the American Academy of Pediatrics • Original Publication • March-1-2017

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Introduction I

mmunizations are a cornerstone of pediatric healthcare. The introduction of immunizations for the prevention of life-threatening infections was an important driver of improvements in infant and

childhood morbidity and mortality in the 20th century. Modeling of vaccine impact demonstrates that routine childhood immunizations in the 2009 US birth cohort would prevent approximately 42,000 deaths, 20 million cases of disease, and save $13.5 billion in direct health care costs and $68.8 billion in societal costs. Paradoxically, the reduction or elimination of vaccine preventable infections in the United States has been postulated to be a factor associated with an increase in vaccine hesitancy in the 21st century. Parents who have not experienced vaccine-preventable infection may not be able to accurately assess the risk of these infections pose to the health of their children. The vision of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases (COID) is to support the optimal health of all children by diminishing the adverse health effects of infectious diseases. Naturally, access to vaccines and vaccine uptake in the United States play large roles in achieving this vision. The COID works in partnership with many organizations to ensure vaccine policies support the health of all children. For example, the COID works closely with the Centers for Disease Control and Prevention (CDC) and has members on all CDC immunization work groups to represent the interests of infants, children, and the pediatric providers who care for them as vaccine policies are developed. This work involves weighing the risks and benefits of vaccines and ensuring that the best data are communicated to providers, parents, and others who care for children. Transparency, especially in the age of social media is vital to increasing confidence in vaccines. The COID is grateful to the AAP for developing this collection of policies and AAP articles addressing vaccine schedules, the safety of vaccines, and methods for addressing vaccine hesitancy. Vaccine delivery is a substantive portion of pediatric practice and addressing vaccine hesitancy is time-consuming. This collection of articles will assist providers by providing vaccine information and policy statements in a single, easily accessible platform. Combined with other AAP COID resources, such as the Red Book and Red Book Online, we hope to support vaccine confidence and increase immunization of infants and children.

Carrie Byington, MD, Chairperson Yvonne Maldonado, MD, Vice Chairperson AAP Committee on Infectious Diseases

Immunization Strategies and Practices

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POLICY STATEMENT

Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children

Recommended Childhood and Adolescent Immunization Schedules: United States, 2018 COMMITTEE ON INFECTIOUS DISEASES

The recommended childhood and adolescent immunization schedules for 2018 have been approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of 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 title page of the 2018 immunization schedule has been modified to include a table showing the common abbreviations and brand names for vaccines recommended for children and adolescents. Figure 1 provides vaccine recommendations in a single table for people from birth through 18 years of age. No changes have been made to the schedule shown in Figure 1. As in previous years, the yellow bars indicate the recommended age range for all children and contain a notation indicating the recommended dose number by age. The green bars indicate the recommended catch-up age. The purple bars designate the range for immunization for certain groups at high risk. The blue bars indicate the range of recommended doses for people in nonhigh-risk groups who may receive a vaccine, subject to individual decision-making. The white boxes show the ages when a vaccine is not recommended to be given routinely. The columns that begin with a gray-shaded box indicate vaccine recommendations for school entry and at adolescent visits. Figure 2 is the catch-up immunization schedule offering recommendations for children and adolescents who start late or are >1 month behind. As in previous years, the catch-up schedule is divided into sections for children 4 months through 6 years of age and children and adolescents 7 years through 18 years of age. Two changes have been made to Figure 2. First, the rotavirus vaccine row has been modified to include the maximum ages for the first and last doses of the series. Second, the polio vaccine rows clarify the catch-up schedule for people 4 years of age or older. Tables (job aids) clarify the recommended use of Haemophilus influenzae type b, pneumococcal, and pertussis-containing vaccines as a function of age, the number of doses previously administered, and the time

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AAP PEDIATRIC COLLECTIONS

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. DOI: https://doi.org/10.1542/peds.2018-0083 PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2018 by the American Academy of Pediatrics

To cite: AAP COMMITTEE ON INFECTIOUS DISEASES. Recommended Childhood and Adolescent Immunization Schedules: United States, 2018. Pediatrics. 2018;141(3): e20180083

FROM THE AMERICAN ACADEMY OF PEDIATRICS

interval since the last dose. Minor wording changes have been made for clarity, but there are no new recommendations. Figure 3 addresses vaccines that may be indicated for people 0 through 18 years of age who have a specific medical indication. This figure now includes a reference for use of live vaccines in people with HIV. Footnotes contain recommendations for routine vaccination, for catch-up vaccination, and for the vaccination of children and adolescents with high-risk conditions or in special circumstances. For 2018, the footnotes are presented in a new, simplified format to increase ease of use and clarity but still provide all pertinent information. Complete sentences have been replaced by bullets and redundant or unnecessary language has been removed. Recommendations in the figures should be read with the corresponding footnotes. Changes have been made to the following footnotes:

• Hepatitis B: Additional information regarding the timing of the birth dose for infants with a birth weight of