From: gazissax@netcom.com Newsgroups: misc.kids.info,misc.answers,news.answers Subject: misc.kids FAQ on Childhood Vaccinations, Part 1/4 Followup-To: misc.kids.health Approved: news-answers-request@MIT.EDU, kids-info-request@ai.mit.edu Reply-To: gazissax@netcom.com Summary: This FAQ contains information on vaccinations, with particular focus on the vaccinations given to children. Section 1 contains general information about vaccinations and vaccination schedules. Archive-name: misc-kids/vaccinations/part1 Posting-Frequency: monthly Last-Modified: October 23, 1999=====================================================================
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Copyright 1994-1999, Lynn Gazis-Sax. All rights reserved. Use and copying of this information are permitted as long as (1) no fees or compensation are charged for use, copies or access to this information, and (2) this copyright notice is included intact.
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[NOTE: this is information collected from many sources and while I
have strived to be accurate and complete, I cannot guarantee that I
have succeeded. This is not medical advice. For that, see your
doctor or other health care provider.]
[This version is updated to reflect the approval of the chicken pox
and hepatitis A vaccines by the FDA, the approval of an acellular
pertussis vaccine for all shots, the approval of IPV for all polio
shots, the rise and fall of the new rotavirus vaccine, new information about adverse events,
and new information about vaccine research. ]
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Contents
Section 1. Introduction and General Information
Q1.1 What is vaccination?
Q1.2 What are active and passive vaccination?
Q1.3 What is herd immunity?
Q1.4 How effective is vaccination at producing immunity?
Q1.5 What are some of the risks of vaccination?
Q1.6 What are some contraindications to vaccinations?
Q1.7 How common are the diseases vaccinated against?
Q1.8 What percentage of children are vaccinated?
Q1.9 What are some sources of further information about
vaccinations?
Section 2. The recommended vaccination schedule and official
organizations
Q2.1 What is the recommended vaccination schedule in the US for
infants?
Q2.2 What is the recommended vaccination schedule in the US for
older children who were not vaccinated in infancy?
Q2.3 What is the recommended vaccination schedule in the US for
adults?
Q2.4 Who determines this schedule?
Q2.5 What other US government organizations are concerned with
vaccinations?
Q2.5.1 What is the National Vaccine Injury Compensation Program
(VICP)?
Q2.5.2 What vaccines are covered?
Q2.5.3 Who may file a claim?
Q2.5.4 Who can I contact to get more information about the Program?
Q2.5.5 What is VAERS?
Q2.5.6 Who can report to VAERS?
Q2.5.7 What events should be reported to VAERS?
Q2.5.8 Are all events reported to VAERS caused by vaccinations?
Q2.5.9 How can I get rapid information on VAERS, such as how to file a
report?
Q2.5.10 Have there been any comprehensive scientific studies on adverse
events following immunization?
Q2.5.11 Are VAERS data available to the public?
Q2.6 What vaccination schedules are used in other countries?
Q2.7 What international bodies are concerned with vaccinations?
Section 3. Specific vaccines
Section 3a. DTP (diptheria, tetanus, and pertussis) and DT
Q3a.1 What is diptheria, and what are the risks of the disease?
Q3a.2 How common was diptheria before routine vaccination, and how
common is it now?
Q3a.3 How effective is the diptheria vaccine?
Q3a.4 How long does the diptheria vaccine last?
Q3a.5 What is pertussis, and what are the risks of the disease?
Q3a.6 How common was pertussis before routine vaccination, and how
common is it now?
Q3a.7 How effective is the whole cell pertussis vaccine?
Q3a.8 How long does the pertussis vaccine last?
Q3a.9 What is tetanus, and what are the risks of the disease?
Q3a.10 How common was tetanus before routine vaccination, and how
common is it now?
Q3a.11 How effective is the tetanus vaccine?
Q3a.12 How long does the tetanus vaccine last?
Q3a.13 What are some of the risks of the DTP vaccine?
Q3a.14 Did SIDS disappear in Japan after the Japanese changed their
pertussis vaccination policy in 1975?
Q3a.15 When is the DTP vaccine contraindicated?
Q3a.16 What are the advantages and disadvantages of the new acellular
pertussis vaccine?
Q3a.17 What are some of the risks of the DT (diptheria and tetanus)
vaccine?
Q3a.18 When is the DT vaccine contraindicated?
Q3a.19 Under what circumstances is tetanus toxoid given to pregnant
women?
Section 3b. Polio
Q3b.1 What is polio, and what are the risks of the disease?
Q3b.2 How common was polio before routine vaccination, and how
common is it now?
Q3b.3 How effective is the polio vaccine?
Q3b.4 How long does the polio vaccine last?
Q3b.5 What is the difference between oral polio vaccine (OPV) and
inactivated polio vaccine (IPV)?
Q3b.6 I've heard that it is possible to contract polio from handling
the diapers of recently immunized infants. How long after receiving
the vaccine does the child's excrement continue to contain the virus?
Q3b.7 What are some other risks of the polio vaccine?
Q3b.8 When is the polio vaccine contraindicated?
Q3b.9 Isn't it true that wild polio has been eliminated in the US?
Q3b.10 Why are we still vaccinating for polio, then?
Section 3c. MMR (measles, mumps, and rubella)
Q3c.1 What is measles, and what are the risks of the disease?
Q3c.2 How common was measles before routine vaccination, and how
common is it now?
Q3c.3 How effective is the measles vaccine?
Q3c.4 How long does the measles vaccine last?
Q3c.5 What are some of the risks of the measles vaccine?
Q3c.6 What is mumps, and what are the risks of the disease?
Q3c.7 How common was mumps before routine vaccination, and how
common is it now?
Q3c.8 How effective is the mumps vaccine?
Q3c.9 How long does the mumps vaccine last?
Q3c.10 What are some of the risks of the mumps vaccine?
Q3c.11 What is rubella, and what are the risks of the disease?
Q3c.12 How common was rubella before routine vaccination, and how
common is it now?
Q3c.13 How effective is the rubella vaccine?
Q3c.14 How long does the rubella vaccine last?
Q3c.15 What are the pros and cons of vaccinating all infants for
rubella versus vaccinating females only at puberty?
Q3c.16 What are some of the risks of the rubella vaccine?
Q3c.17 When is the MMR vaccine contraindicated?
Section 3d. HiB (Hemophilus influenze B)
Q3d.1 What is hemophilus influenze B, and what are the risks of the
disease?
Q3d.2 How common was HiB before routine vaccination, and how
common is it now?
Q3d.3 How effective is the HiB vaccine?
Q3d.4 How long does the HiB vaccine last?
Q3d.5 What are some of the risks of the HiB vaccine?
Q3d.6 When is the HiB vaccine contraindicated?
Q3d.7 What about rifampin prophylaxis?
Section 3e. Hepatitis B gamma globulin and hepatitis B vaccine
Q3e.1 What is hepatitis B, and what are the risks of the disease?
Q3e.2 How common is hepatitis B?
Q3e.3 What is hepatitis B gamma globulin, and when is it given?
Q3e.4 How long does the immunity provided by hepatitis B gamma
globulin last?
Q3e.5 What are the risks and contraindications of hepatitis B gamma
globulin?
Q3e.6 How effective is the hepatitis B vaccine?
Q3e.7 How long does the hepatitis B vaccine last?
Q3e.8 What are some of the risks of the hepatitis B vaccine?
Q3e.9 When is the hepatitis B vaccine contraindicated?
Q3e.10 Why did the ACIP and AAP change their recommendation about the
hepatitis B vaccine?
Q3e.11 Does vaccination for hepatitis B affect one's ability to
donate blood?
Q3e.12 Do people who have showed up positive on the blood banks' tests
for hepatitis B exposure still need to be vaccinated?
Q3e.13 I will be travelling to an area where hepatitis B shots are
recommended, but I have less than six months before I leave. Is there
an accelerated schedule for hepatitis B vaccination?
Section 3f. Influenza
Q3f.1 What is influenza, and what are the risks of the disease?
Q3f.2 How common is influenza?
Q3f.3 How effective is the influenza vaccine?
Q3f.4 How long does the influenza vaccine last?
Q3f.5 What are some of the risks of the influenza vaccine?
Q3f.6 When is the influenza vaccine recommended?
Q3f.7 When is the influenza vaccine contraindicated?
Q3f.8 Is it OK to be vaccinated for influenza during pregnancy?
Section 3g. Pneumococcal vaccine
Q3g.1 What is pneumococcal disease, and what are the risks of the
disease?
Q3g.2 How common is pneumococcal disease?
Q3g.3 How effective is the pneumococcal vaccine?
Q3g.4 How long does the pneumococcal vaccine last?
Q3g.5 What are some of the risks of the pneumococcal vaccine?
Q3g.6 When is the pneumococcal vaccine recommended?
Q3g.7 When is the pneumococcal vaccine contraindicated?
Section 3h. Meningococcal vaccine
Q3h.1 What is meningococcal disease, and what are the risks of the
disease?
Q3h.2 How common is meningococcal disease?
Q3h.3 How effective is the meningococcal vaccine?
Q3h.4 How long does the meningococcal vaccine last?
Q3h.5 What are some of the risks of the meningococcal vaccine?
Q3h.6 When is the meningococcal vaccine recommended?
Q3h.7 When is the meningococcal vaccine contraindicated?
Section 3i. Varicella (chicken pox) vaccine
Q3i.1 What is chicken pox, and what are the risks of the disease?
Q3i.2 How common is chicken pox?
Q3i.3 What is Herpes Zoster?
Q3i.4 What is the current recommendation for the chicken pox
vaccine be part for children?
Q3i.5 What is the current recommendation for adults?
Q3i.6 How effective is the chicken pox vaccine?
Q3i.7 How long does the chicken pox vaccine last?
Q3i.8 What reactions have been reported following the chickenpox
vaccine?
Q3i.9 Will a second dose be necessary in younger children?
Q3i.10 For which groups is the chicken pox vaccine especially
recommended?
Q3i.11 When is the chicken pox vaccine contraindicated?
Q3i.12 Is there a gamma globulin for chicken pox?
Section 3j. BCG (tuberculosis) vaccine
Q3j.1 What is tuberculosis, and what are the risks of the disease?
Q3j.2 How common is tuberculosis?
Q3j.3 How effective is the BCG vaccine?
Q3j.4 How long does the BCG vaccine last?
Q3j.5 What are some of the risks of the BCG vaccine?
Q3j.6 When is the BCG vaccine recommended?
Q3j.7 When is the BCG vaccine contraindicated?
Q3j.8 What are some other methods of controlling tuberculosis?
Section 3k. Hepatitis A vaccine
Q3k.1 What is hepatitis A and what are the risks of the disease?
Q3k.2 How common is hepatitis A?
Q3k.3 Who is at risk for acquiring hepatitis A?
Q3k.4 Is there a vaccine to protect against hepatitis A?
Q3k.5 How is it to be administered?
Q3k.6 How effective is the vaccine?
Q3k.7 How long does immunity last?
Q3k.8 What are some of the risks of the vaccine?
Q3k.9 When is hepatitis A vaccine contraindicated?
Q3k.10 What groups at risk may be included in a recommendation to receive
hepatitis A vaccination?
Q3k.11 Is it possible that hepatitis A vaccine (like hepatitis B vaccine)
might eventually be recommended for routine administration to
children and adults?
Section 3l. Rotavirus vaccine
Q3l.1 What is rotavirus, and what are the risks of the disease?
Q3l.2 How common is rotavirus?
Q3l.3 What is the current status of the rotavirus vaccine?
Q3l.4 How effective is the rotavirus vaccine?
Q3l.5 Is the rotavirus vaccine effective for breastfeeding infants?
Q3l.6 How long does the rotavirus vaccine last?
Q3l.7 What is intussusception?
Q3l.8 What is the relationship between the rotavirus vaccine and
intussusception?
Q3l.9 Why was a connection between the rotavirus vaccine and
intussusception not observed prior to FDA approval of
the vaccine?
Q3l.10 What other reactions have been reported following the
rotavirus vaccine?
Q3l.11 Can the rotavirus vaccine be effectively used in developing
countries?
Q3l.12 When is the rotavirus vaccine contraindicated?
Section 3m. Other vaccines which are available
Q3m.1 What other vaccines are available and when are they given?
Section 3n. Vaccines under development
Q3n.1 What vaccines are currently under development?
Q3n.2 What other research is being done to improve vaccines?
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Section 1. Introduction and General Information
The basic principle of vaccination is that a disease-causing agent is
given to a person in a killed or weakened form (or in the form of
proteins genetically engineered to look like a disease-causing agent),
in order to stimulate the production of antibodies to fight off the
disease.
Q1.2 What are active and passive vaccination?
Active immunization involves trying to stimulate antibodies by giving a
person a killed or weakened form of a disease-causing agent. Passive
immunization involves giving a person antibodies from someone who was
infected with the disease (these are called gamma globulins). Passive
immunization doesn't last very long, but can be useful for someone who
expects to be exposed to a disease (e.g. someone travelling to another
country who takes hepatitis A gamma globulin right before leaving), or to
someone who has just been exposed to a disease. Most of the vaccinations
discussed in this FAQ fall under the active vaccination category.
Q1.3 What is herd immunity?
If a large enough percentage of a population is immune to a disease,
their immunity protects the rest of the "herd."
Some discussion of this concept from misc.kids follows:
Vaccination does not always work. For one thing, vaccines can lose
effectiveness when they aren't stored properly. And even if they are
stored effectively, they will fail to stimulate immunity a certain
percentage of the time. The effectiveness of vaccines varies,
depending on the vaccine. Effectiveness can also vary depending on
the age, sex, and health of the recipient. Sometimes different
strains of a vaccine can have different effectiveness.
Vaccine effectiveness is measured in two ways. First, antibody levels
are measured after a vaccine is given. Second, people are vaccinated
and then followed to see whether they get the disease when they are
exposed to it. Estimates of effectiveness can vary in some cases
depending on the level of antibodies which is considered as passing,
and the criteria for measuring whether someone has the disease (for
instance, pertussis vaccine is more effective at preventing full-blown
pertussis than at preventing a mild cough). Also, some sources give
estimates of field effectiveness which take into account difficulties in
storing vaccines in some areas; these estimates tend to be lower than
estimates based on studies of vaccination in the US or other developed
countries.
Estimates of effectiveness of individual vaccines are given in the
section for each vaccine (and, where I have found variations in estimates
of effectiveness, I have noted that as well).
*************************************************************************
In addition to all of the factors you mentioned which determine the
variability of response to a vaccine, another very important factor is the
genetic inheritance of every individual. To give an example I feel sure of,
I'll use the Hepatitis B vaccine. A certain small percentage of the
population has no response at all to the recombinant Hep B vaccine. This
occurs because these people lack the particular forms of major
histocompatibility complex (MHC) proteins which are necessary to "present"
the _single_ protein in the vaccine to the immune system. These people can
make a good response to the whole virus, but they have a problem with the
protein in the vaccine.
This also highlights the need for "herd immunity," since people who
cannot make an immune response to a vaccine component will _never_ have a
good response to the vaccine, regardless of how often it is given.
Q1.5 What are some of the risks of vaccination?
Again, these risks vary with the vaccine. However, there are some
risks which are common to several vaccines. People may be allergic to
a component of the vaccine, such as eggs or neomycin. Occasionally,
these allergies can lead to anaphylactic shock (doctors keep
epinephrine on hand when giving vaccinations to guard against this
risk). Vaccines can produce the same symptoms as the disease
(in a milder form, and with less frequent incidence of the risks
associated with the disease). Live vaccines in particular can be
risky for people with weakened immune systems, who have less ability
to resist even the weakened form of the disease. Common minor adverse
reactions include soreness or swelling at the injection site and
fever. Because of the latter, vaccinations are often postponed if the
recipient already has a fever.
Another risk is the risk that the vaccination will wear off, and the
recipient will get the disease later. Depending on the illness, the
disease could be either less or more harmful to adults. While this
risk can be dealt with by giving boosters, it is worth bearing in mind
in setting vaccination policies and making vaccination dscisions,
because in some case getting the vaccine and then *not* getting the
booster might lead to increased risk.
Further information related to vaccination risks follows:
Contraindications vary with the vaccine, so contraindications for each
specific vaccine are given in the appropriate sections. Some common ones
are: allergy to some substance contained in the vaccine (such as eggs or
thimerosal, a preservative used in some vaccines), a weakened immune
system (which may make attenuated live vaccines more risky), and
pregnancy.
The allergies to worry about, in particular, are those with an
anaphylactic or anaphylactoid reaction, e.g. hives, swelling of
mouth and throat, difficulty breathing, hypotension, or shock.
Breastfeeding is not a contraindication to vaccination. From Harrison's
Internal Medicine, "Breastfed infants can be immunized on a normal
schedule. Breast feeding does not adversely affect the immunce response
and is not a contraindication for any vaccine. Breast-feeding mothers
also may be vaccinated without any problem." (British Medical Journal
1994; 309:1073-5 contains an article which confirms that breastfeeding
will not interfere with vaccination, and provides references to a couple
of relevant studies.)
Q1.7 How common are the diseases vaccinated against?
I have extracted from table number 190, in _Statistical Abstracts of
the United States_, the following table, showing the frequency, in the
US, of some diseases for which vaccinations are either available and
diseases for which I knew a vaccine was being developed or researched
(obviously with more success in some cases than in others). Table
information extracted from:
Polio: 16,435 cases reported by 46 countries to the Expanded Programme
on Immunization in 1990, a 39% decrease from 1989 when 26,916 cases
were reported. (Hull and Ward)
"Neonatal tetanus claimed the lives of over 433,000 infants in 1991.
It is endemic in over 90 countries throughout the world." (Whitman,
Belgharbi, Gasse, Torel, Mattei, and Zoffman)
Pertussis (whooping cough): 659,973 cases reported in 1987. (Galazka)
The incidence of some of these diseases has changed significantly
since the tables in this section. More up to date information on
worldwide incidence of vaccine preventable diseases can be found
at http://www.who.org.
Q1.8 What percentage of children are vaccinated?
Some estimates of vaccination rates, from articles in World Health
Statistics Quarterly, 45, 1992:
Measles: About 80% of the world's children aged less than 1 were reported to
have received measles vaccine (a dramatic increase from 1983, when the
figure was less than 20%). (Clements, Strassburg, Cutts, and Torel)
Polio: Estimated vaccination rate of 85% worldwide in 1990. This rate
isn't equally distributed, though. The Western Pacific Region had a
coverage rate of 95%, and the South-East Asia Region 91%, but the
Africa Region had a coverage rate of only 56%. (Hull and Ward)
DTP: Varies widely from country to country. The US, Canada, France,
Norway, Poland, Australia, China were among the countries with
coverage rates over 80% in 1987-1989. (The article gives Yugoslavia
as also being in this category, but in view of the breakup of the
country and the civil war there, I would suspect that level hasn't
been maintained.) England, Spain, Mexico, Turkey, and most of the
countries in South America, as well as the Soviet Union (now defunct)
were in the 50-80% category. Sweden and many African countries had
coverage rates of under 50%. Coverage rates in the WHO regions were
as follows: Africa 57%, Americas 75%, Eastern Mediterranean 80%,
South-East Asia 89%, Western Pacific 94%. (Galazka)
From _Statistical Abstracts of the United States, tables no. 189,
Percent of Children Immunized Against Specific Diseases, by Age Group:
1980 to 1985 (I am including the totals only, but the table also
includes a breakdown by race)
The May 1, 1994 HICNet Medical News, citing MMWR, reports on vaccination
coverage of 2 year old children in the US from 1992-1993,
"Vaccination coverage increased for three vaccines from 1992 to 1993:
for three or more doses of Hib, from 28.0% to 49.9% (p less than 0.05); for three or
more doses of poliomyelitis vaccine, from 72.4% to 78.4% (p less than 0.05); and for
three or more doses of DTP/ diphtheria and tetanus toxoids (DT), from 83.0%
to 87.2% (p greater than 0.05). Coverage with measles-containing vaccine
decreased from 82.5% to 80.8% (p greater than 0.05). Among
19-35-month-olds, 12.7% had received three or more doses of Hep B.
From 1992 to 1993, the proportion of children who had received a
combined series of four or more doses of DTP/DT, three or more doses of
polio vaccine, and one dose of MMR increased from 55.3% to 64.8% (p less than 0.05),
primarily because of increased coverage with the fourth DTP/DT dose (from
59.0% to 71.1% [p less than 0.05])."
More details on these statistics in that issue of HICNet Medical News.
For those who are interested, MMWR gives quarterly updates of vaccination
coverage in the US, evaluating progress toward the national goal of 90%
coverage. These updates are included in HICNet Medical News when they
come out, and MMWR itself can also be retrieved over the net. See the
reference section in section 3 of this FAQ for information on retrieving
MMWR over the net. HiB and hepatitis B vaccination coverage has been
increasing (as is to be expected, since those are the most recently
instituted vaccines). The March 5, 1995 HICNet includes an MMWR report
which shows HiB coverage rising to a record high of 70.6% and Hep B
coverage rising to 25.5% during the first quarter of 1994. However,
a report in JAMA, cited in a summary in Journal Watch for Jan 15, 1995
(paper) or Feb 7, 1995 (electronic), "found that only 46 percent of white
children and only 34 percent of black children had received adequate
immunization by eight months of age (JAMA Oct 12, pp. 1105 and 1111)."
Q1.9 What are some sources of further information about
vaccinations?
I don't have any addresses for information outside the US (except for the
WHO book on travel vaccinations); if people contribute them I'll add them.
Information on vaccinations is available from: The Academy of
Pediatrics, Committee on Infectious Diseases, Evanston, Illinois
60204; Centers for Disease Control, Atlanta, Georgia 30333; Council on
Environmental Health, American Medical Association, Chicago, Illinois
60610. The CDC also has a Voice/Fax Information Service. To access the
CDC Voice Information System, telephone (404) 332-4555; to access the CDC
Fax Information System, telephone (404) 332-4565. Their Web site is
http://www.aap.org.
Not specific to vaccinations, but useful in general for the effects
of drugs, illnesses, etc., during pregnancy is the UCSD Teratogen
Registry (1-800-532-3749). Another general source of information on
illnesses is the National Foundation for Infectious Diseases, 4733
Bethesda Ave., Suite 750, Bethesda, Maryland 20814 (USA).
Critics of routine vaccination have set up their own information
center; it is called the National Center for Information on Vaccination
and is based in Virginia. Their telephone number is 1-800-909-SHOT
(for orders only) or 703-938-DPT3 and their address is 512 W. Maple
Ave. #206, Vienna VA 22180. Their web site can be found at
http://www.909shot.com/default.htm.
Information on travel vaccinations is available from _Health Information
for International Travel_, published annually by the Centers for Disease
Control, and available from: Superintendent of Documents, US Government
Printing Office, Washington, DC 20402. This publication also has a lot of
other information on health-related travel issues, and some information on
the regular childhood vaccinations as well (it also includes a table, for
all vaccinations, of which are contraindicated during pregnancy). It is
also available in some public libraries. The CDC informs all state and many
city and county health departments twice monthly about changing risks and
requirements. Another source is _INTERNATIONAL TRAVEL AND HEALTH:
Vaccination Requirements and Health Advice_, copies of which may be ordered
from WHO Distribution and Sales, CH-1211, Geneva 27, telephone
(41 22) 791 2476; fax (41 22) 788 0401. (More sources of information
about travel vaccinations can be found in the section of this FAQ which
covers them.)
The reference section of this FAQ lists the sources I used in putting
together the FAQ. Some of the ones I used most heavily include Harrison's
Principles of Internal Medicine, The Merck Manual, _Taking Care of Your
Child: A Parents' Guide to Medical Care_, by Pantell, Fries, and Vickery,
The Physician's Desk Reference, The American Hospital Formulary Service
Drug Information, and _The Wellness Encyclopedia_ From the editors of the
UC Berkeley Wellness Letter, and, more recently, http://www.medscape.com.
Here is a list of other people's suggestions (to which people are welcome
to add):
Suggested by Heather Madrone:
Robert Mendelsohn _How to Raise a Healthy Child_
George Wootan _Take Charge of Your Child's Health_
Suggested by Roger Barr:
recommend books by Harris Coulter among others:
Shot in the Dark (about DPT vaccinations)
and another about violence in society due to neurological damage caused by
vaccinations (autoimmune responses leading to meningitis)
Suggested by John:
http://www.whale.to/vaccines.html
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Q2.1 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.
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.
Q2.2 What is the recommended vaccination schedule in the US for
older children who were not vaccinated in infancy?
Schedules for people not vaccinated in infancy can be found, among
other places, in the Merck Manual and in AMA Drug Evaluations Annual.
There are two schedules, one for children under 7, and one for people
(children or adults) over 7. The reason is that pertussis vaccine
should not be given to anyone over 7. Pertussis is a mild disease
over the age of 7, but a serious one for the very young. For that
reason, the risks of the vaccine outweigh the risks of the disease
after the age of 7. It is possible that, with the availability
of a less reactogenic acellular vaccine, this recommendation may
change, and pertussis vaccine be give to older people as well, but
such a change will not occur without further study.
Q2.3 What is the recommended vaccination schedule in the US for
adults?
If they haven't been vaccinated at all, see the answer to question
2.22.2. If they have been vaccinated, then a tetanus and diptheria
booster is recommended every ten years (or five years in case of a
very dirty wound). People in certain high risk groups are advised to
get flu shots annually (see the section on the flu vaccine).
Q2.4 Who determines this schedule?
Two bodies set these schedules. They are the Immunization Practices
Advisory Committee (ACIP) of the Public Health Service, and the
American Academy of Pediatrics Committee on Infectious Diseases.
During 1994, these organizations were part of a working group which
included representatives from the American Academy of Family Physicians
which developed one schedule to incorporate ACIP and AAP recommendations.
A new schedule was been endorsed by these groups and became effective
January 1995. In modifications of the schedule since then, sometimes
one group has differed slightly from the other, but in time they
reconcile their schedules.
Q2.5 What other US government organizations are concerned with
vaccinations?
Q2.5.1 What is the National Vaccine Injury Compensation Program
(VICP)?
[Note: Answers to this and the following several questions are
extracted from a longer list of questions and answers put out
by the National Vaccine Injury Compensation Program (1-800-338-2382).]
The National Childhood Vaccine Injury Act of 1986 (the Act)
established the VICP. This Program went into effect in
October 1988 and is a Federal "no-fault" system designed to
compensate those individuals, or families of individuals,
who have been injured by childhood vaccines, whether
administered in the private or public sector. The Program is
administered jointly by the Court, the
Department of Health and Human Services (HHS), and the
Department of Justice (DOJ).
Q2.5.2 What vaccines are covered?
Diphtheria, tetanus, pertussis (DTP, DT, TT, or Td),
measles, mumps, rubella (MMR or any components), and polio
(OPV or IPV).
Q2.5.3 Who may file a claim?
A claim may be made for any injury or death thought to be a
result of a covered vaccine. These injuries may include,
but are not limited to: anaphylaxis, paralytic polio,
seizure disorders, and encephalopathy. The injured
individual may file; or a parent, legal guardian, or trustee
may file on behalf of a child or an incapacitated person.
Claims need to be filed within 36 months after the first
symptoms appeared and show that effects have continued for
at least 6 months (in the case of vaccine related injuried)
or be filed within 24 months of the death and within 48 months
after the onset of the vaccine-related injury from which the death
occurred. The time for filing claims for injuries resulting from
vaccines administered prior to October 1, 1988, has expired.
The petitioner must either prove that the vaccine caused the
injury or significantly aggravated a preexisting condition, or
the petitioner must show that an injury on the Vaccine Injury
Table occurred (most claims involve "Table Injuries" because it
is easier to demonstrate a Table Injury than to prove that the
vaccine caused the condition). A modified Vaccine Injury Table
is effective for claims filed on or after March 10, 1995.
Q2.5.4 Who can I contact to get more information about the Program?
1. The toll-free number for the National Vaccine Injury
Compensation Program is 1-800-338-2382 to obtain an
information packet detailing how to file a claim, criteria
for eligibility, and the documentation required. For
further information write to: National Vaccine Injury
Compensation Program, Parklawn Building, Room 8A-35, 5600
Fishers Lane, Rockville, Maryland 20857.
2. For information on the rules of the U.S. Court of
Federal Claims, including requirements for filing a
petition, call 1-202-219-9657 or write to: U.S. Court of
Federal Claims, 717 Madison Place, N.W., Washington, DC
20005.
Q2.5.5 What is VAERS?
[LG: Information about VAERS excerpted and summarized from material
from VAERS. This section last updated in 1994.]
The National Childhood Vaccine Injury Act (NCVIA) of 1986 mandated
the reporting of certain adverse events following vaccination.
This Act led to the establishment of the Vaccine Adverse
Event Reporting System (VAERS) in November 1990 by the Department
of Health and Human Services. VAERS provides a database management
system for the collection and analysis of data from reports of
adverse events following vaccination. VAERS is operated jointly by
the Centers for Disease Control and Prevention (CDC) and the Food
and Drug Administration (FDA). Both the CDC and the FDA review
data reported to VAERS.
Between January 1, 1991 and December 31, 1994, VAERS has received
approximately 45,000 reports. VAERS currently receives
approximately 800-1000 reports each month.
Q2.5.6 Who can report to VAERS?
Any one can report to VAERS. VAERS reports are usually submitted
by health care providers, vaccine manufacturers, and vaccine
recipients (or their parents/guardians). Patients, parents, and
guardians are encouraged to seek the help of a health-care
professional in reporting to VAERS.
Q2.5.7 What events should be reported to VAERS?
The NCVIA requires the reporting of any events in the Reportable Events
Table which occur within the time period specified and any event listed
in the manufacturer's package insert as a contraindication to subsequent
doses of the vaccine. A copy of the Table can be obtained by calling
1-800-822-7967.
Although NCVIA only requires reporting of the events mentioned in the
Table, VAERS encourages all reporting of any clinically significant adverse
event occurring after the administration of any vaccine licensed in
the United States.
On average, about 17% of the reports reflect adverse events
resulting in life-threatening illness, hospitalization, permanent
disability, extended hospital stay or death. The remaining 83% of
the reports primarily describe events such as fever, local
reactions transient crying or mild irritability, and other less
serious experiences.
Q2.5.8 Are all events reported to VAERS caused by vaccinations?
Again, VAERS accepts all reports of adverse events following
vaccination, so not all events reported to VAERS are caused by
vaccines. In fact, limitations such as differential reporting
rates, simultaneous administration of different vaccine antigens,
temporal reporting bias and lack of background vaccination
rate data generally prevent the determination of vaccine-event
causal associations using VAERS data.
Q2.5.9 How can I get rapid information on VAERS, such as how to file a
report?
There is a toll-free VAERS information line that is currently
receiving over 650 calls per month.
A VAERS report form has been designed to facilitate and standardize
the process of reporting adverse events following vaccination to
VAERS. For a sample copy of
the VAERS report form, see the last page of the 1995 Physician˙s
Desk Reference (PDR) or page 34 of the 1994 Redbook.
Report forms can be obtained by calling VAERS at 1-800-822-7967.
Xerox copies of the PDR or Redbook forms may also be used.
Q2.5.10 Have there been any comprehensive scientific studies on adverse
events following immunization?
Yes. In 1986, the US Congress mandated the Institute of Medicine
to conduct a scientific review of the possible adverse events
following commonly used childhood vaccines. The Institute convened
an expert panel to implement this mandate and has published two
reports on its findings. Both reports concluded that adverse
events caused by vaccines are rare.
Yes. Once any identifying information is removed,
VAERS data are made available to the public, for a fee, through the
National Technical Information Service (NTIS) at:
Routine vaccination is practiced in many countries, but specific schedules
vary from country to country. The vaccine for tuberculosis is given in
some countries where tuberculosis is common, but is not given in the US.
Tetanus toxoid is given to pregnant women in countries where neonatal
tetanus is common. Some countries, like the US, vaccinate all infants
against rubella, while others choose instead to vaccinate adolescent
girls (as of 1992 - I am not sure whether this is still true, as I
know that the UK, at least, has switched to infant vaccination since
then). (Galazka). When this FAQ was first written, there were
significant differences between countries in requirements and
coverage for the pertussis vaccine, but, with the introduction of
the new acellular pertussis vaccine, countries which had increased
the age of pertussis vaccination or made it optional have returned
it to their schedules.
There is also some variation in the schedules at which vaccines are
given. For example, schedules for DTP vaccine include 2, 3, and 4
months, or 3, 4, and 5 months, or 3, 5-6, and 7-15 months, and booster
doses are given in some countries at 12-14 months, and in some countries
at 3-6 years (Galazka - two charts in this article give DTP schedules for
various countries in Europe and percentages of countries following
different schedules in different regions of the world).
People outside the US are advised to consult their doctors about the
specifics of vaccination schedules in their countries (keeping
vaccination schedules for all the countries represented in misc.kids
current is probably too big a job for one FAQ maintainer).
http://www.who.org is also a good source for vaccination schedules
in various countries.
Q2.7 What international bodies are concerned with vaccinations?
The World Health Service Expanded Programme on Immunization works to
increase the percentage of the world's children vaccinated against certain
target diseases: poliomyelitis, measles, tuberculosis, diptheria, and
tetanus. The WHO/UNDP (United Nations Development Programme) Programme
for Vaccine Development promoted research into new and improved vaccines.
The Children's Vaccine Initiative, founded in 1990 by UNICEF, UNDP, the
Rockefeller Institute, the World Bank, and WHO, promoted new and better
vaccines for the world's children, cooperating with the Programme for
Vaccine Development and the EPI. (Hartveldt) WHO also has three centers
which cooperate with organizations in 79 countries to formulate the annual
flu vaccine. (Ghendon)
[This section last updated on September 25, 1999.]
*************************************************************************
From: pburch@cmb.bcm.tmc.edu (Paula Burch)
|> >Paula Burch (pburch@cmb.bcm.tmc.edu) wrote:
|> >: If one child remains unvaccinated, but all other children are
|> >: vaccinated, the one child who does not get vaccinated is pretty safe
|> >: from getting the disease. If many children remain unvaccinated,
|> >: epidemics occur, and children die needlessly.
|> dolson@ucsd.edu (Mark Dolson) writes:
|> >This is exactly what occured with measles in the 80's, BTW. Fewer
|> >vaccinated, and the incidence skyrocketed, with resulting complications
|> >of eye problems, etc, and even some deaths. I agree that people who
|> >let their children remain unvaccinated are riding on the backs of
|> >everyone that does vaccinate, and I resent it.
mblum@world.std.com (Cerebus) writes:
|> To be fair, most of the major outbreaks (as well as most of the
|> serious complications) were and are on college campuses, and occurred *not*
|> because of failure to vaccinate, but because the vaccine that was given
|> to kids between '69-'76 turned out not to give total immunity. Many kids
|> who were vaccinated were victims of measles, before people became conscious
|> that it was necessary for many teens and young adults to be re-vaccinated.
|>
|> I had measles my first year in college, after vaccination at the appropriate
|> age. After that outbreak my college began requiring re-vaccination. But it
|> is not technically correct to blame the measles outbreak on the failure of
|> parents to vaccinate.
It's true that that's what happended in that case, but it's not true for
other cases, in which failure to vaccinate has been a major factor:
"The nation [U.S.] has experienced a marked increase in measles cases
during 1989 and 1990. Almost one half of all cases have occurred in
*unvaccinated* preschool children." (JAMA. 1991 Sep 18. 266(11).
P 1547-52.)
"Beginning in October, 1990, a large measles outbreak involving
predominantly *unvaccinated* preschool age children occurred in
Philadelphia. By June, 1991, 938 measles cases had been reported to
the Philadelphia Health Department. In addition to these cases, 486
cases and 6 measles-associated *deaths* occurred between November 4,
1990, and March 24, 1991, among members of 2 Philadelphia church
groups that do not accept vaccination." (Pediatr-Infect-Dis-J. 1993 Apr.
12(4). P 288-92.)
"In 1989 and 1990 the United States experienced a measles epidemic with
more than 18,000 and 27,000 reported cases. Nearly half of all persons
with measles were *unvaccinated* preschool children under 5 years of age."
(Am-J-Public-Health. 1993 Jun. 83(6). P 862-7.)
Measles is bad, but I'm more concerned myself about pertussis (whooping cough):
"From 1980 through 1989, 27,826 cases of pertussis were reported to
the Centers for Disease Control....Infants less than 2 months of age
had the highest reported rates of pertussis-associated hospitalization
(82%), pneumonia (25%), seizures (4%), encephalopathy (1%), and *death*
(1%)." (Clin-Infect-Dis. 1992 Mar. 14(3). P 708-19.) [Many of these
infants would not have caught the disease if enough older children were
appropriately vaccinated.]
"Two large *epidemics* of pertussis occurred in Britain during 1977-79
and 1981-83." (Commun-Dis-Rep-CDR-Rev. 1992 Dec 4. 2(13). P R155-6.)
This explains the herd immunity concept rather well:
"The epidemiology of whooping cough [pertussis] in Denmark is described
on the basis of the notified cases of the disease. The frequency of
whooping cough has decreased to approximately one sixteenth of the
previous level in children following the introduction of vaccination
for whooping cough in 1961....deaths from whooping cough still
occurred in the eighties, all of these among *unvaccinated* infants.
The risk of whooping cough in an *unvaccinated* child is approximately
one sixth of the risk prior to introduction of vaccination. In a
vaccinated child, the risk, as judged from the notified cases, is one
twentieth of the risk during the time prior to introduction of
vaccination. In all age groups "herd immunity" is considered to have
contributed considerably to the reduced incidence. The incidence in
Denmark is, however, high compared with the incidence in some other
industrialized countries. A vaccination programme with more numerous
whooping cough vaccinations...may be recommended on the basis of the
strategy aimed at keeping the incidence of whooping cough, and thus the
risk of exposure, as low as possible." (Ugeskr-Laeger. 1990 Feb 26.
152(9). P 597-604.)
Paula Burch
pburch@bcm.tmc.edu
not speaking for Baylor College of Medicine
*************************************************************************
Q1.4 How effective is vaccination at producing immunity?
From J Thompson (jet14@columbia.edu):
*************************************************************************
From Cyndy Brunken:
I posted this for Kathleen over on sci.med then I realized that
misc.kidders might also benefit from the info contained herein.
*****************************************************************
DISCLAIMER: THIS MESSAGE IS BEING POSTED FOR KATHLEEN STRATTON BY
SOMEONE NOT AFFILIATED WITH THE MESSAGE. I have read-only access to
USENET and have followed the immunization discussions in the last few
weeks. I think some of the participants will have an interest in the
following information.
An Institute of Medicine (IOM) committee has concluded in a new report
that a causal relation exists between certain common childhood vaccines
and specific, but rare, health problems. The committee also determined
that there appears to be no causal relation between some of those same
vaccines and other specific health problems. The vaccines studied
include those used against tetanus, diphtheria, measles, mumps, polio,
hepatitis B, and Haemophilus influenzae type b (Hib).
The IOM is a private, non-profit organization that provides health
policy advice under a congressional charter granted to the National
Academy of Sciences. The IOM committee was NOT asked to assess risk-
benefit or cost-benefit relations. Rather, the task was to evaluate all
medical and scientific evidence bearing on the causal relation between
childhood vaccines and specific, serious health outcomes.
The report is entitled "Adverse Events Associated with Childhood
Vaccines: Evidence Bearing on Causality". A previous IOM committee
submitted a report in 1991 entitled "Adverse Effects of Pertussis and
Rubella Vaccines". Both reports were mandated by the U.S. Congress in
the 1986 National Childhood Vaccine Injury Act (P.L. 99-660). This law
addressed many aspects of childhood immunization. Notably, it
established a federal compensation program for those who have been
injured by mandated childhood vaccines.
The IOM committee reported that the evidence established a causal
relation between diphtheria, tetanus, measles-mumps-and-rubella, and
hepatitis B vaccines and anaphylaxis. The evidence established a causal
relation between measles-mumps-and rubella vaccine and thrombocytopenia;
between measles vaccine and death from measles infection (primarily in
immunocompromised individuals); between oral polio vaccine and death
from poliovirus infection (primarily in immunocompromised individuals);
and between the oral polio vaccine and poliomyelitis disease.
On the other hand, the committee found that the evidence favored
rejection of a causal relation between diphtheria and tetanus vaccines
and encephalopathy, infantile spasms, and SIDS. The committee found
similarly regarding certain Hib vaccines and increased susceptibility to
Hib disease. The committee investigated other serious health problems
and classified their relation to vaccines in three other categories: no
evidence, inadequate evidence to accept or reject a causal relation, and
evidence favors acceptance of a causal relation. The specific relations
are too numerous to list here.
The committee noted that in most cases it was impossible to calculate an
incidence rate or relative risk for these reactions, but that they were,
on the whole, extremely rare.
The final report will be available in late October or early November
from National Academy Press, 1-800-624-6242. It will cost approximately
$60.00. (The report on pertussis and rubella is still available) A few
prepublication copies of the Executive Summary of the new, 1993 report
are available from the project director at no cost on a first come-first
served basis. Anyone wishing specific information about this report can
email me, Kathleen Stratton, directly. I am the study director for this
project. My internet address is kstratto@nas.edu
*************************************************************************
More information on the findings of the expert committee of the
Institute of Medicine, along with a table showing in which categories
they have placed various adverse events, and modified ACIP recommendations
based on these findings, can be found in (MMWR 1996;45[No. RR-12]),
or
http://www.medscape.com/govmt/CDC/MMWR/1996/sep/rr4512/rr4512.html.
Between the publication of the 1993 report, and the publication
of the 1996 update, two other IOM committees had met, and published
findings concerning "concerning both the diphtheria and tetanus toxoids
and pertussis vaccine (DTP) and chronic nervous system dysfunction
... and research strategies for vaccine-associated adverse
events" (MMWR 1996;45[No. RR-12]).
From Mike Dedek:
*************************************************************************
New England Journal of Medicine 1987; 316: 1283-1288, May 14, 1987,
"Compensating Children with Vaccine-Related Injuries", Iglehart, John K.
The federal immunization program, by virtually all economic, medical, and
political measures, is a stunning success story because of its record of
protecting millions of children against the common infectious diseases of the
young. But in recent years the program has come under a legal cloud that is
threatening its stability, slowing the development of new vaccines, and
sending vaccine prices sharply upward. To address these problems, Congress has
created a new federal program to compensate children who suffer vaccine-related
injuries, but how it will be funded and whether it will achieve its goals remain
open questions.
The legal cloud has formed because, even when the best vaccine products are
properly administered and used, vaccines pose minute risks to those who receive
them, and an increasing number of lawsuits are seeking damages on behalf of
injured persons. Dr. Louis Z. Cooper, representing the American Academy of
Pediatrics, testified before Congress on March 5 about the nature of these
risks. Cooper stated:
One case of polio-like disease will result from each 2.6 million doses of
oral polio vaccine OPV , and a serious, permanent neurological injury will
result from every 310,000 doses of DTP diphtheria, tetanus, and pertussis
vaccine . In extremely rare cases, an encephalitis or nerve deafness will
develop from MMR measles, mumps, and rubella vaccine . Approximately 75
vaccine-related injuries per year are the price we pay to protect the more than
3.8 million children born each year in this country.
For five years, Congress has struggled to fashion legislation that addresses
he complex issues related to the compensation of children injured by vaccines;
in the process, it has explored virtually every conceivable policy option.
Q1.6 What are some contraindications to vaccinations?
No. 190. Specific Reportable Diseases - Cases Reported: 1970 to 1990
Disease 1970 1980 1983 1984 1985
AIDS (N/A) (N/A) 2,117 4,445 8,249
Chickenpox (1000) (N/A) 190.9 177.5 222.0 178.2
Diptheria 435 3 5 1 3
Hepatitis B (serum) (1000) 8.3 19.0 24.3 26.1 26.6
A (infectious) (1000) 56.8 29.1 21.5 22.0 23.2
Measles (1000) 47.4 13.5 1.5 2.6 2.8
Meningococcal infections 2,505 2,840 2,736 2,746 2,479
Mumps (1000) 105.0 8.6 3.4 3.0 3.0
Pertussis (1000) 4.2 1.7 2.5 2.3 3.6
Plague 13 18 40 31 17
Poliomyelitis, acute 33 9 15 8 7
Rabies, animal 3,224 6,421 5,878 5,567 5,565
Rabies, human 3 _ 2 3 1
Rubella (1000) 56.6 3.9 1.0 1.0 0.6
Tetanus 148 95 91 74 83
Tuberculosis (1000) 37.1 27.7 23.8 22.3 22.2
Typhoid fever 346 510 507 390 402
Disease 1986 1987 1988 1989 1990
AIDS 13,166 21,070 31,001 33,722 41,595
Chickenpox (1000) 183.2 213.2 192.9 185.4 173.1
Diptheria _ 3 2 3 4
Hepatitis B (serum) (1000) 26.1 25.9 23.2 23.4 21.1
A (infectious) (1000) 23.4 25.3 28.5 35.8 31.4
Measles (1000) 6.3 3.7 3.4 18.2 27.8
Meningococcal infections 2,594 2,930 2,964 2,727 2,451
Mumps (1000) 7.8 12.8 4.9 5.7 5.3
Pertussis (1000) 4.2 2.8 3.5 4.2 4.6
Plague 10 12 15 4 2
Poliomyelitis, acute 8 6 9 5 7
Rabies, animal 5,504 4,658 4,651 4,724 4,826
Rabies, human _ 1 _ 1 1
Rubella (1000) 0.6 0.3 0.2 0.4 1.1
Tetanus 64 48 53 53 64
Tuberculosis (1000) 22.8 22.5 22.4 23.5 25.7
Typhoid fever 362 400 436 460 552
Measles: 45 million cases and around 1 million deaths estimated in
developing countries in 1990. (Clements, Strassburg, Cutts, and Torel)
Disease All Respondents
1 to 4 years old
1980 1984 1985
Diptheria-tetanus-pertussis 66.3 65.7 64.9
Polio 58.8 54.8 55.3
Measles 63.5 62.8 60.8
Rubella 63.5 60.9 58.9
Mumps 56.6 58.7 58.9
Disease All Respondents
5 to 14 years old
1980 1984 1985
Diptheria-tetanus-pertussis 74.0 73.8 73.7
Polio 70.0 70.2 69.7
Measles 71.0 73.5 71.5
Rubella 74.0 72.4 70.2
Mumps 63.2 70.9 71.6
Respondents consulting records, 1985 (29 percent of white and 15
percent of black or other respondents who consulted records for some
or all vaccination questions)
Disease 1 to 4 years 5 to 14 years
Diptheria-tetanus-pertussis 87.0 93.0
Polio 75.7 88.4
Measles 76.9 87.4
Rubella 73.8 85.3
Mumps 75.5 87.1
According to the California Morbidity for May 21, 1993, about one third
of infants were found not to be vaccinated, and more than half of all
toddlers were behind schedule at their second birthday. Vaccination
rates were lower among black and Hispanic children. Only at school entry
age did vaccination levels really rise, the result of school
requirements. By 1990, more than 90% of school age children were
vaccinated. Immigration was cited as one factor keeping vaccination
rates low.
Section 2. The recommended vaccination schedule
[This section last updated on October 23, 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.
1. Howson, et al., Adverse Effects of Pertussis and Rubella
Vaccines.
Washington, DC: National Academy Press, 1991.
2. Stratton, et al., Adverse Events Associated with Childhood
Vaccines,
Evidence Bearing on Causality. Washington, DC: National Academy
Press, 1993.
Q2.5.11 Are VAERS data available to the public?
National Technical Information Service
5285 Port Royal Road
Springfield, VA 22161
(703-487-4650).
Q2.6 What vaccination schedules are used in other countries?
Section 2 of the misc.kids Childhood Vaccinations FAQ
Section 3 of the misc.kids Childhood Vaccinations FAQ
Section 4 of the misc.kids Childhood Vaccinations FAQ
Back to the Childhood Vaccinations page of the Children's Health page