Volume 33 • Number 2 • February 2012
by Walter A. Orenstein, M.D., FAAP, and Yvonne A. Maldonado, M.D., FAAP
We’re 99% there
Now is the time for final push to end polio forever
Polio once inspired fear and dread among
Americans. Now, we’re 99% of the way to
achieving polio eradication. But the last 1% is
the hardest to overcome.
During the first half of the 1950s, more than
15,000 people annually, generally children, were
paralyzed, most for life. The development of
inactivated polio vaccine (IPV) by Jonas Salk
followed by development of live attenuated oral
polio vaccine by Albert Sabin offered the poten-
tial to prevent poliomyelitis. The last polio out-
break in the United States occurred in 1979.
U.S. pediatricians tempted to defer the inactivated
polio vaccine when parents desire alternative
immunization schedules should be aware that
undervaccinated children could sustain transmission if polioviruses are introduced.
2012 immunization schedules
reflect updates on use of 9 vaccines
by H. Cody Meissner, M.D., FAAP
The immunization schedules for 2012 include
updated and clarified recommendations for the
hepatitis B, influenza, Haemophilus influenzae
type b (Hib), measles-mumps-rubella (MMR),
hepatitis A, meningococcal, human papillomavirus
(HPV), inactivated poliovirus (IPV), and tetanus
toxoid, reduced diphtheria toxoid and acellular
pertussis adsorbed (Tdap) vaccines.
At the beginning of each year, updated schedules
are published that include current recommendations for use of vaccines licensed by the Food and
Drug Administration and approved by the Academy, the Advisory Committee on Immunization
Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and the American
Academy of Family Physicians (AAFP). As in previous years, three schedules provide advice on
administration of immunizations for children 0
through 6 years, 7 through 18 years and a “
catch-up” schedule (See pages 17-19).
Because of the increasing complexity of the vaccine schedules and the limited amount of space
for footnotes, repetition between footnotes has
been eliminated. Providers are advised to use all
three schedules and their respective footnotes
together and not as stand-alone schedules. An
adult immunization schedule also is updated and
published each year ( www.cdc.gov/vaccines).
Here is a closer look at this year’s changes:
• Updated influenza vaccine footnotes describe
• Clarification is provided for administration
of hepatitis B vaccine and hepatitis B immune
globulin to infants weighing less than 2,000
grams and for infants weighing 2,000 or more
grams who are born to HBsAg positive moth-
ers. Clarification is provided for timing of
doses after administration of the birth dose
of hepatitis B vaccine.
vaccine dosing for children ages 6 months
through 8 years of age. For the 2011-’ 12 sea-
NHLBI guidelines on cholesterol in
kids: What’s new and how does this
by Sarah de Ferranti, M.D., M.P.H., FAAP,
and Reginald L. Washington, M.D., FAAP
New guidelines from the National Heart, Lung and
Blood Institute (NHLBI) on reducing cardiovascular disease (CVD) in children and adolescents provide many
recommendations that are consistent with previous AAP
and American Heart Association (AHA) statements. A
few provisions, however, are new and/or controversial,
including the following:
• All children should undergo cholesterol screening
once between ages 9-11 years and once between ages
• Non-fasting total cholesterol and high-density lipoprotein
(HDL) can be used for the initial lipid screening test.
• Clinicians may recommend low-fat or no-fat dairy
at age 1 year for high-risk patients.
• For patients who fail lifestyle changes and require
lipid-lowering medications, pharmacologic treatment
should be considered at age 10 years.
• Once low-density lipoprotein (LDL) is optimized,
high non-HDL cholesterol may be targeted for residual CVD risk reduction.
Guidelines based on extensive review
The NHLBI released Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (
cvd_ped/) in November 2011. The report was endorsed
by the Academy, and a summary was published in a supplement to Pediatrics, http://pediatrics.aappublications.
The guidelines present the results of an expert committee review of more than 1,000 published documents
on CVD as it relates to children and adolescents. The
guidelines cover a range of CVD risk domains; they grade
the quality of evidence in pediatrics for the first time; and
they can be integrated into the Bright Futures guidelines
on pediatric health maintenance.
Data are presented that clearly support a relationship
between early exposure to CVD risk factors and athero-
See Cholesterol, page 13
In this issue
Immunization schedules inside
They’re here: the newly revised immunization schedules for children
ages 0-6 years old and 7-18 years, and the catch-up schedule
for 2012. Pages 17-19
No code? No problem
When a code cannot be located for a common pediatric service,
how do you bill? Page 27