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Harmonized 1999 immunization schedule being finalized by ACIP

While most schedule changes were clear during the ACIP meeting, the three groups will concurrently release the official schedule in January 1999.

[Polio] [Rotavirus] [Additional changes]

[Your turn]

December 1998

ATLANTA - While most of the schedule will remain basically the same, two major changes are expected with the release of the 1999 harmonized childhood immunization schedule next month, based on panel votes at the recent Advisory Committee on Immunization Practices (ACIP) meeting.

The advisory committee unanimously voted to incorporate rotavirus vaccine into the schedule and also agreed that an all-OPV (oral poliovirus vaccine) schedule is no longer acceptable.

While the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) are expected to follow with similar recommendations, those have not been released. The immunization schedule will not be official until the ACIP, AAP and AAFP concurrently publish the harmonized schedule next month.

Polio

The ACIP also voted to change its policy on poliovirus immunization from a preference for the sequential schedule, to a recommendation for the sequential schedule.

"Therefore, the all-OPV schedule will not be accepted, [except] in special circumstances like when a child is behind on immunizations - starting the immunization schedule after 6 months - or whose parents refuse the number of injections needed," explained Neal A. Halsey, MD, an AAP liaison representative to the ACIP.

The December issue of AAP News included a brief summary of the academy's policies, which follow the ACIP's recommendation regarding poliovirus immunization. The AAP supports the move toward increased use of IPV and decreased use of OPV, Halsey said.

"Based on the vote at the ACIP meeting, it appears the groups are moving another step in the direction toward an all-IPV schedule," said Halsey, director of the Institute for Vaccine Safety and professor in the department of internal health at Johns Hopkins University School of Public Health, Baltimore. "The discussion focused on the first two doses being IPV. The groups are moving away from the all-OPV being an acceptable choice for poliovirus immunization."

The ACIP also established a working group to review the issue and eventually determine the appropriate time to move to an all-IPV schedule.

"The previous statements from the AAP stated that around the anticipated time of the global eradication of polio, we should be at an all-IPV schedule," said Halsey. "The safe conclusion to make is that within the next few years an all-IPV schedule could be in place."

With the increasing use of IPV since the switch to the sequential schedule in 1995, there has not been any increased reporting of significant adverse events associated with IPV (see story on page 44). However, cases of vaccine-associated paralytic polio (VAPP) have occurred only in children who have received the all-OPV schedule. There are four confirmed VAPP cases and three under investigation, he said.

"That's one of the factors that has led to the movement toward increased IPV use," he said.

Rotavirus

The ACIP in June recommended rotavirus vaccine be added to the routine childhood immunization schedule upon approval by the Food and Drug Administration. At the recent meeting, the committee again unanimously voted for the vaccine's addition to the schedule.

The AAP also released a statement regarding the routine use of rotavirus vaccine. This decision was based on several findings, including that the rate of the disease is comparable in both industrialized and developing countries, which indicates the improved public sanitation is unlikely to decrease the incidence of the disease. Second, while implementation of oral rehydration programs to prevent dehydration has improved in the United States, widespread use is inadequate to prevent significant morbidity. Third, recent drug trials in the United States, Finland and Venezuela have shown an 80% prevention of severe illness associated with rotavirus infection and 48% to 68% efficacy against any rotavirus-induced diarrheal episode, according to a statement from the AAP.

Studies have shown that each year rotavirus infects 2.7 million U.S. children, 500,000 of those are seen by a physician and 50,000 are hospitalized, for a total cost to society reaching $1.4 billion. Expert estimate that an immunization program may prevent 1.08 million cases of diarrhea, avoiding 34,000 hospitalizations, 95,000 emergency department visits and 227,000 physician visits among children 5 years and younger.

Rotavirus is responsible for 30% to 50% of all diarrheal hospitalizations for children younger than 5 years, according to rotavirus researcher Joseph Bresee, MD, Viral Gastroenteritis Section of the Centers for Disease Control and Prevention (CDC).

Additional changes

Aside from the two major changes regarding rotavirus and polio immunizations, the updated immunization schedule will be basically unchanged. The ACIP did unanimously vote on various minor changes - affecting either the appearance of the printed immunization schedule or footnotes regarding each vaccine-preventable disease.

Minor changes were made regarding hepatitis B, diphtheria-tetanus-acellular pertussis, measles-mumps-rubella, Haemophilus influenzae type b and varicella vaccinations; no policy changes occurred.

Infectious Diseases in Children will publish the new harmonized schedule in the January issue.

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Copyright 2000, SLACK Incorporated. Revised 15 September 2000.