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Vaccine Update: Catch-Up Immunization Recommendations in Preparation for Vaccine Interest

Column Author: Yvonne M Carter, MSN, APRN II, FNP-C
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Column Editor: Angela L. Myers, MD, MPH | Chief Wellbeing Officer, Center for Wellbeing, Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Clinical Assistant Professor of Pediatrics, University of Kansas School of Medicine

It is often in times of crisis that the pendulum will swing. While recent 2025 measles outbreaks have led to increased media coverage of vaccine hesitancy or vaccine refusal movements, other sources have indicated that providers may witness an uptick in “vaccine enthusiasm.” As of April 4, the Centers for Disease Control and Prevention (CDC) reported 607 confirmed cases of measles in over 20 states, with most cases identified in Texas where the initial outbreak began. However, some physicians claim that parents are now expressing increased interest in having their children vaccinated with the measles, mumps and rubella (MMR) vaccine amid concerns for their child’s safety as cases continue to rise.1,2 In some cases, requests have even been made to vaccinate early (prior to the recommended 12-15 month window), particularly if families have upcoming travel planned.  

Those of us in health care during the 2019 measles outbreak may recall an increase in phone calls from parents inquiring whether titers for immunization should be drawn or requesting repeat vaccines be administered out of an abundance of caution. As measles cases now spread in Kansas (32 cases across eight counties as of April 9, 2025),3 health care professionals may anticipate a resurgence of similar questions from concerned parents interested in vaccination, even if they had previously expressed hesitation. As we near the end of the school year and enter spring and summer vacation season, questions and concerns may arise if families are planning to travel to (or through) states where outbreaks have been particularly problematic. It is also possible that if interest in vaccinating against measles rises, facilities may see an increased interest in other routine or seasonal childhood vaccinations as well. Now is an opportune time to review catch-up immunization schedules and resources in preparation for these conversations with parents.

Per the CDC, six steps should be taken to properly make vaccine recommendations if a parent or caregiver is interested in “catching up” on their child’s routine immunizations if for any reason they have been delayed.4

1.      Determine recommended vaccine by age. How old is the patient? What vaccines would be due at this appointment if they were up to date? It is recommended to use this schedule as a baseline, paying special attention to each section’s notes.4

2.      Determine recommended window for catch-up vaccination. How long has it been since the ideal timeframe for vaccination in this patient? What is the minimum interval between doses for this child’s age? How many other vaccines are they planning to receive today? When should they come back to continue the series? For catch-up immunizations, it is recommended to use this catch-up schedule in addition to the schedule above, taking into account each section’s notes. Also note that an entire vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Note finally that clinicians should use the section appropriate for the child’s current age at time of request for vaccination.5

3.      Assess need for additional recommended vaccines by medical condition or other indication. Is the patient immunocompromised, or do they have a history of HIV? Are there chronic conditions to consider — diabetes, heart disease, chronic lung disease, liver disease, chronic kidney disease or dialysis? Is there a cerebrospinal fluid leak or cochlear implant? Does the patient still have their spleen? These are the most common conditions to take into account when assessing the need for additional recommended vaccines outside of the “normal” window, and CDC recommendations can be found here. Note that depending on the condition, some immunizations are recommended for all age-eligible children missing documentation of a complete series of vaccination, while others are only recommended based on increased risk for severe outcomes from disease. In each case, clinicians should ensure that the benefits of protection outweigh the risk of adverse reaction.6

4.      Review vaccine types, frequencies, intervals and considerations for special situations. Note that when calculating the minimum interval between doses, four weeks should equal a minimum of 28 days. For intervals of four months or more, calendar months may be used. For a dose to be considered “valid,” it must be administered four days or less before the minimum interval or age range. Doses administered five days or more before the minimum interval are considered “invalid” and should be repeated as age appropriate — with the repeat dose spaced after the invalid dose by the minimum recommended interval. This timing would be especially important to consider if parents are requesting “early” vaccination for MMR in outbreak areas, or due to travel plans. Also recall that as discussed in March’s issue of The Link, infants as young as 6-12 months may receive the MMR vaccine if they are at high risk for exposure. This may be considered if the family is planning to travel abroad, or if they are in an outbreak area. When it comes to travel, a thoughtful conversation may be beneficial as well — what are the risks versus benefits? Can the travel be delayed until the child is at the ideal recommended age for vaccination? More guidance on timing and spacing doses can be found here, and additional immunization schedule notes and special considerations can be found on the CDC website.7,8

5.      Review contraindications and precautions for vaccine types. Has this child had a severe allergic reaction such as anaphylaxis to a vaccine previously? Is there medical history or immunodeficiency to consider, such as in #3? A thorough list of contraindications and precautions for each recommended vaccine, as well as additional guidance, can be found in the CDC’s Child Immunization Schedule Appendix.9

6.      Review new or updated Advisory Committee on Immunization Practices (ACIP) guidance. Per the CDC website, there has been no new ACIP guidance on vaccines or vaccine recommendations to report since Oct. 24, 2024. The CDC’s Child Immunization Schedule Addendum can be visited at any time for updated information. In addition, as questions regarding vaccine schedules and recommendations may soon increase, it is recommended to review the ACIP’s Shared Clinical Decision-Making Recommendations. In recent years, five vaccination recommendations have been identified as especially important to consider on an individual and case-by-case basis with patients. Two of these apply to the pediatric population, including meningitis B vaccinations for adolescents aged 16-23 years and additional COVID-19 vaccinations for the moderately or severely immunocompromised patient. Shared clinical decision-making vaccinations differ from routine, risk-based or catch-up recommendations in that they may not be suggested for everyone in a certain age group or even risk group. These recommendations should be individualized to each patient and involve a mutual decision-making process between the health care provider and caregiver.10

While it can be easy as a health care worker to get dismayed while watching media coverage of vaccine hesitancy or reading about outbreak case numbers rising, it is important to remember the amount of trust that parents and caregivers are placing in providers. Just by arriving at the clinic for an appointment or making a phone call to the nurses’ line to ask a question, they are demonstrating that there is already value in the relationship between you and their child’s health — a great privilege indeed. Although attitudes toward vaccines in the past 10 years may indicate low trust in the health care system, each clinician is in a unique position to move the needle in restoring this trust. Every interaction with a patient or caregiver can be viewed as an opportunity for repair, whether in person, virtually or on the phone. With this approach, and the tools and resources listed above, health care professionals can work with parents and caregivers to mitigate disease risk now and in the future.

 

References:

  1. Measles cases and outbreaks. Centers for Disease Control and Prevention. April 11, 2025. Accessed April 10, 2025. https://www.cdc.gov/measles/data-research/index.html
  2. Godoy M. As measles cases rise, some parents become vaccine enthusiasts. National Public Radio. March 30, 2025. https://www.npr.org/sections/shots-health-news/2025/03/30/nx-s1-5343997/measles-vaccine-hesitancy-enthusiasm-outbreaks
  3. Kansas 2025 measles outbreak dashboard. Kansas Department of Health and Environment. Accessed April 9, 2025. https://www.kdhe.ks.gov/2314/Measles-Data
  4. Child and adolescent immunization schedule by age. Centers for Disease Control and Prevention. November 21, 2024. Accessed April 10, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
  5. Catch-up immunization schedule for children and adolescents. Centers for Disease Control and Prevention. Accessed April 10, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-catch-up.html#table-2
  6. Child and adolescent immunization schedule by medical indication. Centers for Disease Control and Prevention. November 21, 2024. Accessed April 10, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-medical-indication.html
  7. Timing and spacing of immunobiologics. Centers for Disease Control and Prevention. July 24, 2024. Accessed April 10, 2025. https://www.cdc.gov/vaccines/hcp/imz-best-practices/timing-spacing-immunobiologics.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html
  8. Child immunization schedule notes. Centers for Disease Control and Prevention. November 21, 2024. Accessed April 10, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-notes.html
  9. Child immunization schedule appendix. Centers for Disease Control and Prevention. November 21, 2024. Accessed April 10, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-appendix.html
  10. ACIP shared clinical decision-making recommendations. Centers for Disease Control and Prevention. January 7, 2025. Accessed April 10, 2025. https://www.cdc.gov/acip/vaccine-recommendations/shared-clinical-decision-making.html?CDC_AAref_Val=https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html
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Vaccine Update: Catch-Up Immunization Recommendations in Preparation for Vaccine Interest