Revised Childhood and Adolescent Immunization Schedule for 2013

Vaccination season: It's a time filled with hand clutching, some tears, little pinches, neat Dora the Explorer Band-Aids, shiny stickers and – if you're lucky – free lollipops. Despite having to endure your little ones' whimpering, these injected forms of disease prevention can be crucial and, sometimes, even life saving.

Every February, the Recommended Childhood and Adolescent Immunization Schedule – United States is updated to ensure parents know when to get their kids vaccinated – and which one are needed. It's released annually by the American Academy of Pediatrics, Advisory Committee on Immunization Practices of the Centers for Disease Control, and Prevention and the American Academy of Family Physicians.

The 2013 revision, however, is a bit more ambitious than usual: It introduces changes in format, footnote improvements and added recommendations. The goal is to make the schedule more informative – and readable – for parents.

Here's what you need to know about changes made to this year's schedule.

What's New

Changes in age group

Information in colors

  • The yellow bars on the schedule indicate the recommended dose number by age.
  • The green bars, which only represented ages 7-18 last year, currently depict catch-up immunization for the entire age range: 0-18.
  • The purple bars continue to designate the range for immunization for certain groups at high risk.
  • White boxes indicate the ages at which a vaccine is not recommended routinely.

Footnote changes

The important fine print has seen a few changes, too – again, with the goal of streamlining and making information easier to digest.

  • Footnotes for ages 0-6, 7-18 and catch-up immunizations are now combined. So, each footnote includes recommendations for routine vaccination, catch-up vaccination and vaccination for children and adolescents with high-risk conditions or in special circumstances – all in one spot.
  • The footnote regarding the rotavirus has been modified. It now includes clarifications about the number of doses for RV1 and RV5.
  • Pay close attention to the footnote pertaining to the Haemophilus influenza Type B vaccination. It now clarifies that only one dose should be administered to children 15 months or older.

For expecting mothers

This year's newly published schedule also includes a new recommendation for pregnant women and adolescents. It's suggesting they receive the tetanus, diphtheria and acellular pertussis – aka Tdap – vaccine. Why?

Last year, the CDC reported an increase in whopping cough cases. In fact, an article on CNN's The Chart blog notes, whopping cough cases have risen to a 50-year high.

Getting the Tdap vaccine, however, will effectively provide newborns with immunity against whopping cough until they can build their own resistance.

"The (rationing) behind this recommendation is to vaccinate women near their time of delivery to boost immunity," The Chart notes, "which then passes through the placenta and gets into the baby – so the baby will have its mother's immunity until it can develop its own."

Michigan's registry helps

Although the tweaks aim to make the schedules easier to understand, the many different components can still be confusing for parents, says Dr. Charles Barone, chair of pediatrics at the Henry Ford Hospital and Medical Center in Detroit.

Barone does note, however, that the Michigan Care Improvement Registry, or MCIR, is helping parents keep track. Required by state regulation, all immunization providers to kids ages 0-18 must register each patient's name, birth date, address, vaccine given and manufacturer of that vaccine.

Therefore, Barone explains, each physician knows exactly which vaccines their patients have received, need to receive and when they're due for their next shots.

MCIR also gives physicians the ability to refer to documented proof of a patient's immunization history, Barone says. So, despite how confusing the annual schedule may seem, parents can always refer to their physicians for the most accurate account of their child's vaccination history and needs.

When physicians encounter out-of-state patients, he adds, they attempt to compile immunization records for the patient and add them to the MCIR database, so that the patient has traceable immunization information on record.

MCIR also serves as a way for physicians to quickly track immunized patients in case of a vaccination recall or epidemic, Barone says.

Trend takeaways

The growing trend of parents choosing to not vaccinate their kids is also a hot topic in the pediatric realm. According to Barone, a parent has every right not to vaccinate his or her child. However, he adds, the mother must sign the child's chart and acknowledge that she approves the non-immunization of her child.

"The baby is my patient, not the mom; I have to work with the mom to treat the baby," Barone says. "If the mom does not want to vaccinate the child, I will try to build relationships with the mom and give the parent a better understanding of immunization."

Barone emphasizes the importance of the newly recommended Tdap vaccine for pregnant mothers. However, he also suggests that all individuals in the family – and near the newborn child – get vaccinated for whopping cough, as well.

"We try to cocoon the newborn," he said. "We want to make sure that everyone that's going to be around the new
born is immune to whopping cough. We try to give it (the Tdap vaccine) to the mom – but as well as the dad, grandparents and siblings that may not have gotten the Tdap vaccine."


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