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2019 CDC Vaccine Schedule Changes

14 Nov 2019 1:08 PM | MSHP Office (Administrator)

Authors: Colton Frazer, PharmD Candidate 2022 and Paul Juang, Pharm.D, BCPS, BCCCP, FASHP, FCCM

2019 CDC Vaccine Schedule Changes

Vaccines are an imperative part of the success of the modern health system. However, vaccines are only effective when utilized correctly. Due to the intricacies of the vaccination schedule, and the continually evolving contraindications, reviewing the Center for Disease Control’s vaccination schedule can be a valuable method of staying up to date from year to year. In this review of the CDC’s 2019 vaccination schedule, a few recent changes will be highlighted, Shingrix and Pneumococcal guidelines will be refreshed, and the new hexavalent vaccine, VaxelisTM, will be discussed. 

Notable Changes as of February 2019:

Influenza Vaccine:

As of 2019 the Live Attenuated Influenza Vaccine (LAIV) has been listed separately from the Inactive Influenza Vaccine (IIV) and Recombinant Influenza Vaccine (RIV). Moreover, LAIV is suitable for ages 2 years through 49 years old. Absolute contraindications in adult and children patients for LAIV include immunocompromising conditions (including HIV infection), anatomical or functional asplenia, pregnancy, close contact with severely immunocompromised persons, received influenza antiviral medications in the previous 48 hours, cerebrospinal fluid leak, cochlear implant, asthma (5 years or older). Other problematic underlying medical conditions (e.g., chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])


If any of the above LAIV contraindications apply to the patient, then the CDC recommends the IIV or RIV as a safe alternative.

Hepatitis A Vaccine:

A new indication for HepA vaccine has been added, homelessness. This is because being homeless has been linked with a two to three times higher chance of contracting hepatitis A, as well as displaying more severe outcomes from the disease when compared to non-homeless. For this new indication there are 2 options: get a 2-dose series of single-antigen hepatitis A vaccine or a 3-dose series of hepatitis A and hepatitis B vaccine. Moreover, there is a new pediatric international travel recommendation for vaccination of patients age 6 - 11 months and for all travelers greater than 12 months of age.

Hepatitis B Vaccine:

The hepatitis B have been updated to a 2-dose Heplisav-B® given at least 4 weeks apart. As needed, it can be switched to 3-dose series of Engerix-B vaccine. The seroprotection of the two vaccine sets shows that the newer Heplisav-B® is the preferred method when possible. (65%-81% for Engerix-B vs. 90%-95% for Heplisav-B®)


Common Vaccination Review

Shingrix:

The Shingrix vaccine is recommended by the CDC for immunocompetent people older than 50 years, and is to be given in a two shot series separated by 2 - 6 months. This is regardless of previous herpes zoster episodes, taking low-dose immunosuppressives/are anticipating immunosuppression, or have recovered from an immunocompromising disease.

For patients who have had previous episodes of herpes zoster, there is no set time to wait to receive the Shingrix vaccine. However, Shingrix is not to be administered to patients with active herpes zoster infections. If the patient has recently received Zostavax®, it is recommended to wait at least 8 weeks before administering Shingrix.

Contraindications include allergies to any component of Shingrix, seronegative to varicella, acute episode of herpes zoster, or women who are pregnant or breastfeeding

 

PCV13 and PPSV23 in Children and Adults

All infants should receive the PCV13 immunization at 2, 4, and 6 months old. Then, a booster should be administered at age 12 - 15 months. Furthermore, all adults 65 years and older are recommended to receive the pneumococcal vaccine. If the adult has never received a dose of PCV13 before, administer this first. One year later, the PPSV23 should be administered. If the adult has received their dose of PPSV23 already, then administer the PCV13 at least one year after. 


Vaxelis

In December 2018, the FDA approved VaxelisTM to vaccinate children between 6 weeks old and 4 years old. VaxelisTM is indicated to prevent diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type b, and poliomyelitis. VaxelisTM is administered as a 3-shot series starting at the age of 6 weeks old, and ending before the child is 5 years old. This vaccine is a combo product, combining antigens for diphtheria, tetanus, pertussis, and poliomyelitis from drug company Sanofi, and antigens for H. influenzae type b and hepatitis B from drug company Merck. After receiving the 3-dose series of VaxelisTM, the child will still need to receive one additional pertussis shot to complete their immunizations to the agent. By using this combo-vaccine a child can receive their Hepatitis B series in 4 or 5 shots, compared to the normal 6 to 8 using conventional Hep. B vaccination series. Below is a chart illustrating the advantage of using the VaxelisTM vaccination series compared to alternative options.

VaxelisTM is expected to be available for use by 2020.


References:

All information and pictures sourced from www.cdc.gov/vaccines.

For any further information, or to check the most recent vaccination guidelines, please visit


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