Why the childhood vaccine schedule is republished every single year

At its October 2018 meeting, the Advisory Committee on Immunization
Practices voted to recommend the **2019 Recommended Immunization Schedule for
Children and Adolescents Aged 18 Years or Younger.**

It is a cover page, three tables and a set of notes — and the first
instruction about it is easy to skip past:

**Health care providers are advised to use the tables and the notes
together.**

The tables say when. The notes say for whom, with which exceptions, and what to
do when a child arrives late or with a condition. A schedule read as a grid of
ages is being read wrong.

What changed for 2019

New or revised recommendations for:

• Hepatitis A vaccine
• Hepatitis B vaccine
• Influenza vaccine
• Tdap — tetanus, reduced diphtheria, acellular pertussis

plus **clarification of the recommendations for inactivated poliovirus
vaccine.**

Why it is annual, and why annual is not enough

The schedule exists to consolidate and summarise updates so that a provider
has one current document instead of a stack of individual recommendations.

And then the sentence that explains why the document cannot be the last word:

**Changes in recommended use of vaccines can occur between annual updates to
the child and adolescent immunization schedule.**

Those changes are published separately, as they happen. A printed schedule is
a snapshot of a moving set of recommendations — which is why the report also
points providers at **the individual ACIP vaccine recommendations for
contraindications and precautions**, the detail no summary table can hold.

Who agrees to it

The schedule is recommended by ACIP and approved by **the CDC Director, the
American Academy of Pediatrics, the American Academy of Family Physicians, and
the American College of Obstetricians and Gynecologists** — paediatrics, family
medicine and obstetrics all signing the same document, which is what stops a
parent getting different answers from different specialties.

ACIP's recommendations are developed after in-depth reviews of disease
epidemiology and burden, vaccine efficacy and effectiveness, vaccine safety,
quality of evidence, feasibility of programme implementation, and
economic analyses of immunisation policy.

The last two are worth noticing. A recommendation is not only a judgement about
whether a vaccine works; it is a judgement about whether a country can actually
deliver it.

*(Trade names appear in the schedule for identification only, and do not imply
endorsement.)*

Source: Centers for Disease Control and Prevention, MMWR.