Morbidity and Mortality Weekly Report Recommendations and Reports / Vol. 60 / No. 2 January 28, 2011 General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP) Continuing Education Examination available at http://www.cdc.gov/mmwr/cme/conted.html U.S. Department of Health and Human Services Centers for Disease Control and Prevention CONTENTS Disclosure of Relationship CDC, our planners, and our content experts wish to disclose that they have no financial Introduction ............................................................................................................3 interests or other relationships with the manufacturers of commercial products, sup- Methods ....................................................................................................................4 pliers of commercial services, or commercial supporters. This report will not include any discussion of the unlabeled use of a product or a product under investigational Timing and Spacing of Immunobiologics ....................................................4 use with the exception of the following situations: 1. The nonsimultaneous administration of yellow fever (YF) vaccine and inactivated Contraindications and Precautions.............................................................. 10 vaccines. Preventing and Managing Adverse Reactions ......................................... 11 2. Simultaneous administration of an inactivated and live vaccine (e.g., pneumococcal polysaccharide vaccine [PPSV] and zoster [Zos] vaccine). Vaccine Administration .................................................................................... 13 3. Interchangeability of combination vaccines and single-component vaccines (e.g., using single-component Haemophilus influenzae type b [Hib], diphtheria and Storage and Handling of Immunobiologics ............................................. 17 tetanus toxoids and acellular pertussis (DTaP), and inactivated poliovirus [IPV] Altered Immunocompetence ........................................................................ 19 for later doses in series, after a series has begun with DTaP-IPV/Hib). 4. Interchangeability of brands of combination vaccines and single-component Special Situations ............................................................................................... 23 vaccines (e.g., using DTaP-IPV/Hib and single-component hepatitis B [Hep B] vaccine for later doses in series that might have previously included DTaP-IPV- Vaccination Records .......................................................................................... 30 HepB and Hib). Vaccination Programs ....................................................................................... 31 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 Vaccine Information Sources ......................................................................... 34 of quadrivalent meningococcal conjugate vaccine (MCV4) in the absence of an anaphylactic allergy. Acknowledgments ............................................................................................. 35 7. No need to repeat a dose of MCV4 vaccine given subcutaneously. References ............................................................................................................. 52 8. Revaccination with MCV4. 9. Appropriate storage and handling for the following vaccines at 35°F–46°F: Abbreviations ...................................................................................................... 59 • DTaP • Measles, mumps, and rubella (MMR) • Hib • Pneumococcal conjugate vaccine (PCV) Glossary.................................................................................................................. 60 • Hepatitis A • Rotavirus (RV) • Hepatitis B • Tetanus toxoid, reduced diphtheria toxoid, • Human papillomavirus (HPV) and acellular pertussis (Tdap) vaccine • PPSV • 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. 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 age. There is no commercial support for this activity. Credit: Constant Joseph Desbordes (1761–1827), Baron Jean Louis Alibert (1768–1837) performing the vaccination against smallpox in the Château of Liancourt (detail), c. 1820, French. Oil on canvas. Courtesy: Musée de l’Assistance Publique — Hôpitaux de Paris, Paris, France / Archives Charmet / The Bridgeman Art Library. The MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30333. Suggested Citation: Centers for Disease Control and Prevention. [Title]. MMWR 2011;60(No. RR-#):[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science James W. Stephens, PhD, Office of the Associate Director for Science Stephen B. Thacker, MD, MSc, Deputy Director for Surveillance, Epidemiology, and Laboratory Services Stephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program Office MMWR Editorial and Production Staff Ronald L. Moolenaar, MD, MPH, Editor, MMWR Series Martha F. Boyd, Lead Visual Information Specialist Christine G. Casey, MD, Deputy Editor, MMWR Series Malbea A. LaPete, Julia C. Martinroe, Stephen R. Spriggs, Terraye M. Starr Teresa F. Rutledge, Managing Editor, MMWR Series Visual Information Specialists David C. Johnson, Lead Technical Writer-Editor Quang M. Doan, MBA, Phyllis H. King Catherine B. Lansdowne, MS, Project Editor Information Technology Specialists MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Virginia A. Caine, MD, Indianapolis, IN Patricia Quinlisk, MD, MPH, Des Moines, IA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Patrick L. Remington, MD, MPH, Madison, WI David W. Fleming, MD, Seattle, WA Barbara K. Rimer, DrPH, Chapel Hill, NC William E. Halperin, MD, DrPH, MPH, Newark, NJ John V. Rullan, MD, MPH, San Juan, PR King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN Deborah Holtzman, PhD, Atlanta, GA Anne Schuchat, MD, Atlanta, GA John K. Iglehart, Bethesda, MD Dixie E. Snider, MD, MPH, Atlanta, GA Dennis G. Maki, MD, Madison, WI John W. Ward, MD, Atlanta, GA Recommendations and Reports General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP) Prepared by Andrew T. Kroger, MD1 Ciro V. Sumaya, MD2 Larry K. Pickering, MD1 William L. Atkinson, MD1 1National Center for Immunization and Respiratory Diseases 2Texas A&M Health Science Center, College Station, Texas Summary This 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. Update on adult immunization recommendations of the immunization practices Advisory Committee [ACIP]. MMWR 1991;40[No. RR-12]); the assessment and feedback strategy to increase vaccination rates (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination rates—assessment and feedback of provider-based vaccination coverage information. MMWR 1996;45:219–20); linkage of vaccination services and those of the Supplemental Nutrition Program for Women, Infants, and Children (WIC program) (CDC. Recommendations of the Advisory Committee on Immunization Practices: programmatic strategies to increase vaccination coverage by age 2 years—linkage of vaccination and WIC services. MMWR 1996;45:217–8); adolescent immunization (CDC. Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR 1996;45[No. RR-13]); and combination vaccines (CDC. Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP], the American Academy of Pediatrics [AAP], and the American Academy of Family Physicians [AAFP]. MMWR 1999;48[No. RR-5]). Notable revisions to the 2006 recommendations include 1) revisions to the tables of contraindications and precautions to vaccination, as well as a separate table of conditions that are commonly misperceived as contraindications and precautions; 2) reordering of the report content, with vaccine risk-benefit screening, managing adverse reactions, reporting of adverse events, and the vaccine injury compensation program presented immediately after the discussion of contraindications and precautions; 3) stricter criteria for selecting an appropriate storage unit for vaccines; 4) additional guidance for maintaining