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Appendix E: Immunization Guidelines

INTRODUCTION

For most up to date changes, see https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf (accessed October 24, 2018). This table is approved by the Centers for Disease Control and Prevention, American Academy of Pediatrics (AAP), American Academy of Family Physicians, and American College of Obstetricians and Gynecologists.

IMMUNIZATIONS FOR TERM INFANTS

Term infants follow the recommended immunization schedule for persons aged 0 to 15 months, then 18 months to 18 years (http://www.immunize.org/cdc/schedules/cdc-child-iz-schedule; accessed October 24, 2018).

IMMUNIZATIONS FOR PRETERM INFANTS

Misconceptions about the safety and efficacy of vaccinations for preterm infants have led to delays in immunization for these infants. It is important that preterm infants with prolonged hospital stays begin necessary immunizations prior to neonatal intensive care unit (NICU) discharge to allow development of early protection from infectious agents prevalent in the community, especially pertussis. The AAP current recommendations can be summarized as follows:

  • “Infants born preterm (at less than 37 weeks of gestation) or of low birthweight (less than 2500 g) [who are clinically stable] should, with few exceptions, receive all routinely recommended childhood vaccines at the same chronologic age as term infants,” even if they are still hospitalized.

  • “The same volume of vaccine used for term infants is appropriate for medically stable preterm infants.”

  • “The choice of needle lengths used for IM [intramuscular] vaccine administration is determined by available muscle mass of the preterm or low birth weight infant” (Table E–1).

  • “Medically stable preterm infants who remain in the hospital at 2 months of chronologic age should receive all inactivated vaccines recommended at that age.”

  • All vaccines required at 2 months of age can be given simultaneously to preterm or low birthweight infants, except oral rotavirus vaccine, which should be given at discharge.

  • Limit the number of injections at 2 months of age by giving combination vaccines. If there are limited injection sites, give the vaccines at different times, separated by 2-week intervals.

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Table E–1. SITE AND NEEDLE LENGTH BY AGE FOR INTRAMUSCULAR IMMUNIZATION
Age Group Needle Length, inches (mm)a Suggested Injection Site
Newborns (preterm and term) and infants <1 month of age ⅝–1 (16–25 mm)b Anterolateral thigh muscle
Term infants, 1–12 months of age ⅝–1 (16–25 mm) Anterolateral thigh muscle

aAssumes that needle is inserted fully.

bIf the skin is stretched tightly and subcutaneous tissues are not bunched.

Based on Red Book recommendation (2018–2021).

Refer to Table E–2 for immunizations for preterm infants.

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Table E–2. IMMUNIZATIONS FOR PRETERM INFANTS
Age Infection Prevented Recommended Vaccine
Birth Hepatitis Ba Mother HBsAg positive: Give to all newborns regardless of BW both hepatitis B vaccine and 0.5 mL of HBIG at separate anatomic sites within 12 hours of birth.

Mother HBsAg negative:

BW ...

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