General Recommendations on Immunization

1 Continuing Education Examination available at and Reports / Vol. 60 / No. 2 January 28, 2011 General Recommendations on ImmunizationRecommendations of the Advisory Committee on Immunization Practices (ACIP) Department of Health and Human ServicesCenters for Disease Control and PreventionMorbidity and Mortality Weekly ReportThe MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, Atlanta, GA Citation: Centers for Disease Control and Prevention.

2 [Title]. MMWR 2011;60(No. RR-#):[inclusive page numbers].Centers for Disease Control and PreventionThomas R. Frieden, MD, MPH, DirectorHarold W. Jaffe, MD, MA, Associate Director for ScienceJames W. Stephens, PhD, Office of the Associate Director for ScienceStephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory ServicesStephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program OfficeMMWR Editorial and Production StaffRonald L. Moolenaar, MD, MPH, Editor, MMWR SeriesChristine G. Casey, MD, Deputy Editor, MMWR SeriesTeresa F.

3 Rutledge, Managing Editor, MMWR SeriesDavid C. Johnson, Lead Technical Writer-EditorCatherine B. Lansdowne, MS, Project EditorMartha F. Boyd, Lead Visual Information SpecialistMalbea A. LaPete, Julia C. Martinroe,Stephen R. Spriggs, Terraye M. StarrVisual Information SpecialistsQuang M. Doan, MBA, Phyllis H. KingInformation Technology SpecialistsMMWR Editorial BoardWilliam L. Roper, MD, MPH, Chapel Hill, NC, ChairmanVirginia A. Caine, MD, Indianapolis, INJonathan E. Fielding, MD, MPH, MBA, Los Angeles, CADavid W. Fleming, MD, Seattle, WAWilliam E.

4 Halperin, MD, DrPH, MPH, Newark, NJKing K. Holmes, MD, PhD, Seattle, WADeborah Holtzman, PhD, Atlanta, GAJohn K. Iglehart, Bethesda, MDDennis G. Maki, MD, Madison, WIPatricia Quinlisk, MD, MPH, Des Moines, IAPatrick L. Remington, MD, MPH, Madison, WIBarbara K. Rimer, DrPH, Chapel Hill, NCJohn V. Rullan, MD, MPH, San Juan, PRWilliam Schaffner, MD, Nashville, TNAnne Schuchat, MD, Atlanta, GADixie E. Snider, MD, MPH, Atlanta, GAJohn W. Ward, MD, Atlanta, GADisclosure of RelationshipCDC, our planners, and our content experts wish to disclose that they have no financial interests or other relationships with the manufacturers of commercial products, sup-pliers of commercial services, or commercial supporters.

5 This report will not include any discussion of the unlabeled use of a product or a product under investigational use with the exception of the following situations: 1. The nonsimultaneous administration of yellow fever (YF) vaccine and inactivated vaccines. 2. Simultaneous administration of an inactivated and live vaccine ( , pneumococcal polysaccharide vaccine [PPSV] and zoster [Zos] vaccine). 3. Interchangeability of combination vaccines and single-component vaccines ( , using single-component Haemophilus influenzae type b [Hib], diphtheria and tetanus toxoids and acellular pertussis (DTaP), and inactivated poliovirus [IPV] for later doses in series, after a series has begun with DTaP-IPV/Hib).

6 4. Interchangeability of brands of combination vaccines and single-component vaccines ( , using DTaP-IPV/Hib and single-component hepatitis B [Hep B]vaccine for later doses in series that might have previously included DTaP-IPV-HepB and Hib). 5. Rotarix and RotaTeq need not be repeated if an infant spits up or regurgitates a dose. 6. Contact allergy to latex is neither a contraindication nor a precaution to the use of quadrivalent meningococcal conjugate vaccine (MCV4) in the absence of an anaphylactic allergy. 7. No need to repeat a dose of MCV4 vaccine given subcutaneously.

7 8. Revaccination with MCV4. 9. Appropriate storage and handling for the following vaccines at 35 F 46 F: DTaP Hib Hepatitis A Hepatitis B Human papillomavirus (HPV) PPSV Measles, mumps, and rubella (MMR) Pneumococcal conjugate vaccine (PCV) Rotavirus (RV) Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine Trivalent inactivated influenza vaccine (TIV) 10. Initiation of live Zos vaccine in immunocompetent patients 3 months after remission from chemotherapy. 11. Avoiding conception for 1 month after vaccination with MMR or varicella (Var) vaccine.

8 12. A minimum age of 12 months for the fourth dose of DTaP. 13. Use of pneumococcal conjugate vaccine and Haemophilus influenzae b vaccine in persons receiving hematopoietic cell transplant or who are infected with human immunodeficiency virus, regardless of is no commercial support for this : Constant Joseph Desbordes (1761 1827), Baron Jean Louis Alibert (1768 1837) performing the vaccination against smallpox in the Ch teau of Liancourt (detail), c. 1820, French. Oil on canvas. Courtesy: Mus e de l Assistance Publique H pitaux de Paris, Paris, France / Archives Charmet / The Bridgeman Art.

9 3 Methods ..4 Timing and Spacing of Immunobiologics ..4 Contraindications and and Managing Adverse Reactions ..11 Vaccine Administration ..13 Storage and Handling of Immunobiologics ..17 Altered Immunocompetence ..19 Special Situations ..23 Vaccination Records ..30 Vaccination Programs ..31 Vaccine Information Sources ..34 Acknowledgments ..35 References ..52 Abbreviations .. and ReportsMMWR / January 28, 2011 / Vol. 60 / No. 2 3 General Recommendations on ImmunizationRecommendations of the Advisory Committee on Immunization Practices (ACIP)Prepared byAndrew T.

10 Kroger, MD1 Ciro V. Sumaya, MD2 Larry K. Pickering, MD1 William L. Atkinson, MD11 National Center for Immunization and Respiratory Diseases2 Texas A&M Health Science Center, College Station, TexasSummaryThis report is a revision of the General Recommendations on Immunization and updates the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General Recommendations on Immunization : Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55[No. RR-15]). The report also includes revised content from previ-ous ACIP Recommendations on the following topics: adult vaccination (CDC.)