General Best Practice Guidelines for Immunization

ACIP General Best Practice Guidelines for Immunization | Recommendations | CDC

General Best Practice Guidelines for Immunization

Kroger AT, Duchin J, Vázquez M

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https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf

July 18, 2018

• PAGE 36[38 pages]Timing and Spacing of Immunobiologics
  Table 3-4
  The dosages for Hepatitis A IG have changed.

  

• PAGE 52[18 pages]Contraindications and Precautions
  Table 4-1
  Three precautions have been removed from the DTaP row.
  Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
  Seizure ≤3 days after receiving a previous dose of DTP/DTaP
  Persistent, inconsolable crying lasting ≥3 hours within 48 hours after receiving a previous dose of DTP/DTaP

• PAGE 56[18 pages]Contraindications and Precautions
  Table 4-1
  VARICELLA ROW / PRECAUTIONS COLUMN
  “Use of aspirin or aspirin-containing products(j)”.  Harmonized with the Adult Schedule. With accompanying footnote that explains the circumstances behind waiting for 6 weeks after varicella vaccine to receive aspirin or aspirin-containing products.

• PAGE 59[18 pages]Contraindications and Precautions
  Table 4-2
  HEADER
  Changed to: “Conditions incorrectly perceived as contraindications or precautions to vaccination” – because none of the conditions listed are contraindications, and none of the conditions listed are precautions.

• PAGE 94[26 pages]
  Vaccine Administration
  Subheading “Multiple Vaccinations”
  HepA vaccine and IG – this couplet added to the pairs which should NOT be administered in the same limb.

• PAGE 99[26 pages]Vaccine Administration
  Table 6-1
  RZV ROW / DOSE COLUMN
  New volume 0.5 cc, along with a footnote that states that only 0.5 cc should be withdraw even if more vaccine remains in the vial.

May 14, 2018

• PAGE 29[38 pages]Timing and Spacing of Immunobiologics
  Table 3-1
  A row has been added for LAIV

• PAGE 29[38 pages]Timing and Spacing of Immunobiologics
  Table 3-1
  The rows for meningococcal polysaccharide vaccine have been removed. This vaccine is no longer available.

October 23, 2017

• PAGE 30[38 pages]Timing and Spacing of Immunobiologics
  Table 3-1, Footnote (f)
  “The minimum recommended interval between DTaP-3 and DTaP-4 is 6 months. However, DTaP-4 need not be repeated if administered at least 4 months after DTaP-3. This is a special grace period of 2 months which can be used if evaluating records retrospectively. An additional 4 days cannot be added to this grace period prospectively, but can be added retrospectively.” This is to accommodate recent SME email that allows double dipping of the grace period (adding 4 days to the 2 months) for retrospective validation of series WHOSE 4th DOSE WAS ADMINISTERED AT 12 months of age. But this double dipping cannot be applied prospectively, meaning we will only allow a 4 day grace period added to a prospective 6 month interval, and we will only allow a four month interval prospectively (not four months plus four days) if the fourth dose would be  administered after 12 months of age.  CDSi has been updated to accommodate this.

  

• PAGE 54[18 pages]Contraindications and Precautions
  Table 4-1
  LAIV ROW / CONTRAINDICATIONS COLUMN
  “LAIV4 should not be administered to persons who have taken influenza antivirals medications within the previous 48 hours.” To harmonize with the adult schedule.

  

• PAGE 54[18 pages]Contraindications and Precautions
  Table 4-1
  Serogroup B meningococcal vaccine has been added to the Contraindications and Precautions table.

• PAGE 54[18 pages]Contraindications and Precautions
  Table 4-1
  MMR ROW / CONTRAINDICATIONS COLUMN
  “Family history of altered immunocompetence”. To harmonize AND REFERENCED with the vaccine-specific statements to accommodate infants and toddlers with occult heritable congenital immunodeficiencies.

• PAGE 56[18 pages]Contraindications and Precautions
  TABLE 4-1
  VARICELLA ROW / CONTRAINDICATIONS COLUMN
  “Family history of altered immunocompetence”. To harmonize AND REFERENCED with the vaccine-specific statements to accommodate infants and toddlers with occult heritable congenital immunodeficiencies.

• PAGE 56[18 pages]Contraindications and Precautions
  Table 4-1
  VARICELLA ROW / PRECAUTIONS COLUMN
  “Receipt of specific antiviral drugs (acyclovir, famiciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination).”

• PAGE 57[18 pages]Contraindications and Precautions
  Table 4-1
  ZOSTER ROW / PRECAUTIONS COLUMN
  “Receipt of specific antiviral drugs (acyclovir, famiciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination).”

  

• PAGE 81[18 pages]Preventing and Managing Adverse Reactions
  Table 5-2
  “TREATMENT OF REFRACTORY SYMPTOMS” ROW
  Up to Date Table was incorrectly formatted so that two footnotes re: rate of epinephrine infusion were misplaced. This has been corrected.