The recommendations, which were approved by the American Academy of Pediatrics, the CDC's Advisory Committee on Immunization Practices, and the American Academy of Family Physicians, were published in the January issue of Pediatrics.
There were three notable changes this year. The new recommendations are:
- A single dose of pneumococcal conjugate vaccine for all healthy children from 24 months of age to 59 months of age who are not completely immunized.
- Reduced age limit for use of live-attenuated influenza vaccine from five to two. When a second dose is indicated, the new recommendations state that the time interval between doses can be shortened by two weeks -- from six weeks to four.
- A single dose of quadrivalent meningococcal vaccine for 11-to-18-year-olds who haven't already received the vaccine. The committee also added a reminder about the 2006 Red Book recommendation that quadrivalent meningococcal conjugate vaccines are preferred over quadrivalent polysaccharide vaccines for children ages two to 10 at increased risk of infection.
"Children at increased risk for meningococcal disease are those who were born without a spleen, whose spleen doesn't work properly, who have sickle cell disease or who are immunodeficient," said Joseph Bocchini, M.D., of Louisiana State University, who chairs the AAP committee on infectious diseases.
The conjugate meningococcal vaccines convey longer, sustained immunity than polysaccharide vaccines.
Earlier this week researchers from England reported success with an investigational tetravalent meningococcal vaccine for infants. (See: Investigational Vaccine Effective Against Meningitis in Infancy)
Lorry Rubin, M.D., of Albert Einstein College of Medicine in New York, another member of the AAP committee, said the yearly tweaking of the vaccine schedule reflects not only improved understanding of immunogenicity, but also concern that children may serve as a reservoir of infection for at-risk groups, such as the elderly or those with compromised immune systems.
Another prime motivator for the 2008 changes was the ongoing worry about emerging flu strains, including avian influenza.
"A highly immunized population makes it less likely that a person would be simultaneously infected with seasonal influenza and bird (avian) influenza and thereby minimize the chances that the two viruses will exchange genetic material and create a pandemic strain that is well adapted for human-to-human transmission," Dr. Rubin said.
|The committee members did not disclose any financial conflicts. The vaccine recommendations are a joint project of the American Academy of Pediatrics, the CDC's Advisory Committee on Immunization Practices, and the American Academy of Family Physicians.|
Zalman S. Agus, MD Emeritus Professor
University of Pennsylvania School of Medicine
Primary SourceSource Reference:
PediatricsSource Reference: Bocchini, J, et al "Recommended immunization schedules for children and adolescents -- United States, 2008" Pediatrics 2008; 121: 219-220.