2.1 What is the recommended vaccination schedule in the US for infants?
Description
This article is from the Childhood Vaccinations FAQ, by Lynn Gazis-Sax lynng@alsirat.com with numerous contributions by others.
2.1 What is the recommended vaccination schedule in the US for infants?
The following schedule is based on the schedule published on January
15, 1999, published in MMWR 48(01);8-16 and the schedule on the AAP
website as of August 1999.
Vaccine Recommended Age (or Range) Hepatitis B Birth to 2 mos, 2-4 mos, 6-18 mos DTaP 2 mos, 4 mos, 6 mos, 15-18 mos, 4-6 yrs DT 11-12 yrs or 14-16 yrs, every ten years thereafter HiB 2 mos, 4 mos, 6 mos, 12-15 mos Polio (IPV) 2 mos, 4 mos, 6-18 mos, 4-6 yrs MMR 12-15 mos, 4-6 yrs Varicella 12-18 mos
Notes: (1) At 11-12 years, hepatitis B, MMR, and Varicella vaccines to
be assessed and administered if necessary. (2) Hepatitis B vaccine
schedule in infants depends on the mother's hepatitis B surface
antigen status; where this status is positive or unknown, hepatitis B
vaccination is recommended within 12 hours of birth, but where this
status is negative, the vaccine may be given at any time between birth
and 2 months. (3) Three different Hib conjugate vaccines are
licensed. Depending on which is used, the dose at 6 months may or may
not be required. (4) As of July, 1999, the AAP recommended a temporary
delay (until thimerosal-free Hepatitis B vaccine is available), for
children of Hepatitis B surface antigen negative mothers, in the first
shot, to six months. The CDC continues to recommend that the shot be
given at from 2-6 months. As of September, 1999, a hepatitis B vaccine
without thimerosal has become available, so, as supplies of this
vaccine are distributed, the temporary delay should come to an
end. (5) In 1999, ACIP recommended hepatitis A vaccine for all
children aged 2 years and older in the 11 Western states where
incidence is especially high (at least 20 cases per 100,000 people,
twice the national average). These states are: Arizona, Alaska,
California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota,
Utah and Washington.
There has been a difference of opinion about when the second dose of
MMR should be given. ACIP recommended 4-6 years, but the AAP
recommended at entry to middle or junior high school. Health
authorities in different states in the US have adopted one or the
other of these requirements. The advantage of giving the second dose
at 4-6 years is that compliance may be higher if it is made a
requirement of entrance to public schools. The advantage of giving the
second dose later is that it will be closer in time to the age at
which measles outbreaks have been occuring, and may increase immunity
at that time. The AAP and ACIP have since coordinated their
recommendations and agreed on 4-6 years.
This schedule is subject to change, and so, if you look at different
medical and childcare books, you may see slightly different
schedules. Recent changes include the addition of a new vaccine for
haemophilus influenzae B, the addition of the hepatitis B vaccine to
the schedule, and the addition of a second dose of MMR at entry to
primary or middle school, in response to an increased incidence in
measles among teenagers, and the addition of the chicken pox vaccine
to the schedule. The FDA approved a couple of new vaccines in 1993: a
combination of Haemophilus influenzae B vaccine and DTP vaccine, and a
new dosage for the hepatitis B vaccine. In 1992, a new acellular
pertussis vaccine was approved. In 1995, the varicella zoster (chicken
pox) vaccine was approved. On July 12, 1996, ACIP recommended that
this vaccine be added to the schedule. The newly approved hepatitis A
vaccine was *not* added to the schedule; this vaccine was recommended
only for people at particular risk, such as travellers to countries
where hepatitis A is more prevalent (more recently, it has been
recommended in states where hepatitis A is particularly prevalent). In
1996, an acellular pertussis vaccine was approved for the earlier
shots in the pertussis series (previously it had only been approved
for the fourth and fifth shots), so that it is now the preferred
vaccine for all shots. As a result of progress in the global
eradication of polio, in 1997, ACIP recommended that the first doses
of polio vaccine use the inactivated polio vaccine (IPV) rather than
the oral polio vaccine (OPV). In January, 1999, the AAP recommended
that all doses use IPV, and on June 17, 1999, the ACIP followed suit
(this new ACIP recommendation will become effective on January 1,
2000).
Rotavirus vaccine was added to the schedule at 2, 4, and 6 months,
after its approval on August 31, 1998, but on July 7, 1999, this
recommendation was suspended, pending collection of further data,
based on early surveillance reports of intussusception (a type of
bowel obstruction), and on October 15, 1999, the vaccine was withdrawn
from the market.
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