“A-maze-ing” Immunization

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Immunizations are amazing for 2 reasons: (1) their use saves lives (see the recent report by Marin and colleagues1 about the decline in deaths after varicella vaccine implementation), and (2) their use constantly changes, which makes it difficult to keep up with their schedules. Even though I lecture about this topic regularly, write about it frequently, and discuss it in clinic on a weekly basis, the immunization schedule still seems like a maze to me.

The catch-up immunization schedule is particularly maze-like. When updating my vaccine lecture that I deliver to each new crop of medical students I see on their pediatrics rotation every 8 weeks or so, I always have to look this up. No matter how often I have to order vaccines for the vaccine-delayed child, I just cannot remember the catch-up schedules for certain vaccines, such as the Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugate vaccine (PCV). Specifically, I have trouble remembering the catch-up recommendations for children just older than one year who have not received any vaccines.

For instance, I would have to look up how many doses to give a child aged 12 to 14 months who has received no doses of Hib vaccine. It is 2 doses, 8 weeks apart; however, if the child is aged 15 months or older, then only one dose is recommended.2 For the PCV, previously unvaccinated children in the 12 to 23-month age range should receive 2 doses, 8 weeks apart; however, if the child is 24 months or older, only one dose is required.3 Do you have that straight? Also, don’t forget the new 2011 recommendations that a booster dose of the meningococcal conjugate vaccine is required at age 16 years if the first dose was given at age 11 years; however, be sure to give just one dose to the college freshman who has received no doses.

I am a fan of vaccines, but not so much a fan of the frequent scheduling changes—even though I certainly appreciate why the changes occur. Pediatricians have to be vigilant with keeping on top of the latest vaccine recommendations and vaccine controversies, so our patients’ parents trust our care. I teach students and residents that learning the vaccine schedule occurs by using it, over and over and over again in real life with patients. I find it tough to memorize the schedules. For readers who have mastered this maze, any tips you can pass along to the rest of us—and that I could pass along to trainees—to help keep these vaccine schedules straight would be greatly appreciated.