“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.