Childhood Immunization Schedule
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| Childhood Immunization Schedule |
In January 1995, the recommended childhood immunization schedule was published in MMWR following issuance by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) (ACIP. Recommended childhood immunization schedule — United States, 1998. MMWR 1998;47:8–12). This schedule was the first unified schedule developed through a collaborative process among the recommending groups, the pharmaceutical manufacturing industry, and the Food and Drug Administration. This collaborative process should assist in maintaining a common childhood vaccination schedule and enabling further simplification of the schedule.
The ACIP, AAP, and AAFP published and revised the recommended childhood immunization schedule in the January-December 2000 issue of Pediatrics (ACIP. Recommended childhood immunization schedule — United States, January-December 2000. Pediatrics 2000;105:148–51). The revisions are listed in the following table.
| Recommended Childhood Vaccination Schedule1-United States, 2000 |
| Vaccine |
Age |
| Birth |
1
Mo. |
2
Mos. |
4
Mos. |
6
Mos. |
12
Mos. |
15
Mos. |
18
Mos. |
24
Mos. |
4–6 Yrs. |
11–12Yrs. |
14–16 Yrs. |
| Hepatitis B2 |
Hep B-1 |
|
|
|
|
|
|
|
|
|
| |
Hep B-2 |
|
Hep B-3 |
|
Hep B |
|
| Diphtheria, Tetanus, Pertussis3 |
|
|
DTaP |
DTaP |
DTaP |
|
DTaP3 |
|
DTaP |
Td |
| Haemophilus influenzae type b4 |
|
|
Hib |
Hib |
Hib |
Hib |
|
|
|
|
|
| Polio5 |
|
|
IPV |
IPV |
IPV5 |
|
IPV5 |
|
|
| Measles, Mumps, Rubella6 |
|
|
|
|
|
MMR |
|
|
MMR6 |
MMR6 |
|
| Varicella7 |
|
|
|
|
|
Var |
|
|
Var7 |
|
| Hepatitis A8 |
|
|
|
|
|
|
|
|
Hep A8 (in selected areas) |
|
* Range of acceptable ages for vaccination
* Vaccines to be assessed and administered, if necessary
* On October 22, 1999, the Advisory Committee on Immunization Practices (ACIP) recommended that Wyeth-Lederle Vaccines’ RotaShield (RRV-TV), the only US-licensed rotavirus vaccine, no longer be used in the (MMWR Weekly Report, Volume 48, Number 43, Nov. 5, 1999). Children who received rotavirus vaccine before July are not at increased risk for intussusception.
1 This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines as of November 1, 1999. Additional vaccines may be licensed and recommended during the year. Combination vaccines may be used whenever any components of the combination are indicated and its other components are not contraindicated. Providers should consult the manufacturers’ package inserts for detailed recommendations.
2 Infants born to HBsAg-negative mothers should receive the first dose of hepatitis B (Hep B) vaccine by 2 months of age. The second dose should be ³ 1 month after the first dose. The third dose should be administered at ³ 4 months after the dose and ³ 2 months after the second dose, but not before 6 months of age.
Infants born to HBsAg-positive mothers should receive hepatitis B vaccine and 0.5 ml hepatitis B immune globulin (HBIG) at separate sites within 12 hours of birth. The second dose is recommended at 1 month of age and the third dose at 6 months of age.
Infants born to mothers whose HBsAg status is unknown and should receive hepatitis B vaccine within 12 hours of birth. Maternal blood should be drawn at the time of delivery to determine the mother’s HBs-Ag status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than 1 week of age).
All children and adolescents (through 18 years of age) who have not been immunized against hepatitis B may begin the series during any visit. Special efforts should be made to immunize children who were born in or whose parents were born in areas of the world with moderate or high endemicity of hepatitis B virus infection.
3 The fourth dose of DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) may be administered as early as 12 months of age, provided 6 months have elapsed since the third dose and if the child is unlikely to return at age 15 to 18 months. Td (tetanus and diphtheria toxoids) is recommended at 11 to 12 years of age if ³ 5 years have elapsed since the last dose of DTP, DtaP, or DT. Subsequent routine Td boosters are recommended every 10 years.
4 Three Haemophilus inluenza type b (Hib) conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB, ComVax [Merck]) is administered at 2 to 4 months of age, a dose at 6 months is not required. Because clinical studies in infants have demonstrated that the use of some combination products should not be used for primary immunization in infants at 2, 4, or 6 months of age, unless FDA-approved for these ages.
5 To eliminate the risk of vaccine-associated paralytic polio (VAPP), an all-IPV schedule is now recommended for routine childhood polio vaccination in the US. All children should receive 4 doses of IPV at 2, 4, and 6 to 18 months, and 4 to 6 years. OPV (if available) may be used only for the following special circumstances:
- Mass vaccination campaigns to control outbreaks of paralytic polio.
- Unvaccinated children who will be traveling in < 4 weeks to areas where polio is endemic or epidemic.
- Children of parents who do not accept the recommended number of vaccine injections. These children may receive OPV only for the third or fourth dose or both; in this situation, health care providers should administer OPV only after discussing the risk for VAPP with parents or caregivers.
- During the transition to an all-IPV schedule, recommendations for the use of remaining OPV supplies in physicians’ offices and clinics have been issued by the American Academy of Pediatrics (see Pediatrics, December 1999 and the American Academy of Family Physicians.
6 The second dose of the measles, mumps, and rubella (MMR) vaccine is recommended routinely at 4 to 6 years of age but may be administered during any visit, provided ³ 4 weeks have elapsed since receipt of the first dose and that both doses are administered beginning at or after 12 months of age. Those who have not previously received the second dose should complete the schedule by 11 to 12 years of age.
7 Varicella (Var) vaccine is recommended at any visit on or after the first birthday for susceptible children (ie, those who lack a reliable history of chickenpox [as judged by a health care provider] and who have not been immunized). Susceptible people ³ 13 years of age should receive 2 doses, given ³ 4 weeks apart.
8 Hepatitis A (Hep A) is shaded to indicate its recommended use in selected states or regions; consult the local public health authority. (Also see MMRW Oct. 1, 1999/48[RR12];1–37.)
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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts