P&T News: March 1997: The Recommended Childhood Vaccination Schedule: Update on Recent Changes

Table 1
The Recommended Childhood Immunization Schedule: United States, January-December 1997

Joan M. Murhammer, R.Ph., Clinical Pharmacist
Peer Review Status: Internally Peer Reviewed by Ellen A. Link, M.D., Clinical Assistant Professor, Department of Pediatrics and Jody R. Murph, M.D., Associate Professor, Department of Pediatrics

Vaccines1 are listed under the routinely recommended ages.
* indicate range of acceptable ages for vaccination.
** indicate catch-up vaccination: at 11-12 years of age, hepatitis B vaccine should be administered to children not previously vaccinated, and Varicella vaccine should be administered to children not previously vaccinated who lack a reliable history of chickenpox.

Age-
Vaccine|

Birth

1
mo

2
mos

4
mos

6
mos

12
mos

15
mos

18
mos

4-6
yrs

11-12
yrs

14-16
yrs

Hepatitis B2,3

*Hep B-1

*Hep B-2

*Hep B-3

**Hep B-3

Diphtheria, Tetanus, Pertussis4

DTaP or DTP

DTaP or DTP

DTaP or DTP

*DTaP or DTP4

DTaP or DTP

*Td

H. influenzae type b5

Hib

Hib

Hib5

*Hib5

Polio6

Polio6

Polio

*Polio6

Polio

Measles, Mumps, Rubella7

*MMR

MMR7

OR

MMR7

Varicella8

*Var

**Var8

Approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).

1 This schedule indicates the recommended age for routine administration of currently licensed childhood vaccines. Some combination vaccines are available and may be used whenever administration of all components of the vaccine is indicated. Providers should consult the manufacturers' package inserts for detailed recommendations.

2 Infants born to HBsAg-negative mothers should receive 2.5 ug of Merck vaccine (Recombivax HB) or 10 ug of SmithKline Beecham (SB) vaccine (Engerix-B). The 2nd dose should be administered 1 or more mo after the 1st dose.

Infants born to HBsAg-positive mothers should receive 0.5 mL hepatitis B immune globulin (HBIG) within 12 hrs of birth, and either 5 ug of Merck vaccine (Recombivax HB) or 10 ug of SB vaccine (Engerix-B) at a separate site. The 2nd dose is recommended at 1-2 mos of age and the 3rd dose at 6 mos of age.

Infants born to mothers whose HBsAg status ia unknown should receive either 5 ug of Merck vaccine (Recombivax HB) or 10 ug Of SB vaccine (Engerix-B) within 12 hrs of birth. The 2nd dose of vaccine is recommended at 1 mo of age and the 3rd dose at 6 mos of age. Blood should be drawn at the time of delivery to determine the mother's HBsAg status, if it is positive, the infant should receive HBIG as soon as possible (no later than 1 wk of age). The dosage and timing of subsequent vaccine doses should be based upon the mother's HBsAg status.

3 Children and adolescents who have not been vaccinated against hepatitis B in infancy may begin the series during any childhood visit. Those who have not previously received 3 doses of hepatitis B vaccine should initiate or complete the series during the 11-12 year-old visit. The 2nd dose should be administered at least 1 mo after the 1 st dose and the 3rd dose should be administered at least 4 mos after the 1st dose and at least 2 mos after the 2nd dose.

4 DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) is the preferred vaccine for all doses in the vaccination series, including completion of the series in children who have received 1 or more dose of whole-cell DTP vaccine. Whole cell DTP is an acceptable alternative to DTaP The 4th dose of DTaP) may be administered as early as 12 months of age, provided 6 months have elapsed since the 3rd dose, and ff the child is considered unlikely to return at 15-18 mos of age. Td (tetanus and diphtheria toxoids, absorbed, for adult use) is recommended at 11-12 years of age of at least 5 years have elapsed since the last dose of DTP, DTaP, or DT. Subsequent routine Td boosters are recommended every 10 years.

5 Three H. influenzae type b (Hib) conjugate vaccines are licensed for infant use. If PRPOMP (PedvaxHIB [Merck]) is administered at 2 and 4 mos of age, a dose at 6 mos is not required. After completing the primary series, any Hib conjugate vaccine may be used as a booster.

6 Two poliovirus vaccines are currently licensed in the US: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). The following schedules are all acceptable by the ACIR the AAP, and the AAFP, and parents and providers may choose among them:

1. IPV at 2 and 4 mos; OPV at 12-18 mos and 4-6 yr
2. IPV at 2, 4,12-18 mos, and 4-6 yr
3. OPV at 2, 4, 6-18 mos, and 4-6 yr

The ACIP routinely recommends schedule 1. IPV is the only poliovirus vaccine recommended for immunocompromised persons and their household contacts.

7 The 2nd dose of MMR is routinely recommended at 4-6 yrs of age or at 11-12 yrs of age, but may be administered during any visit, provided at least 1 month has elapsed since receipt of the 1st dose and that both doses are administered at or after 12 months of age.

Susceptible children may receive Varicella vaccine (Var) at any visit after the first birthday, and those who lack a reliable history of chickenpox should be immunized during the 11-12 year-old visit. Children 13 or more years of age should receive 2 doses, at least 1 mos apart.

Reprinted from Pediatrics. 1997;99:136-7.

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