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Recommended Childhood and Adolescent Immunization Schedule
Each year, CDC's Advisory Committee on Immunization Practices (ACIP)
reviews the recommended childhood and adolescent immunization schedule to
ensure that it is current with changes in manufacturers' vaccine
formulations and contains revised recommendations for the use of licensed
vaccines, including those newly licensed. The recommended childhood
immunization schedule for 2003 has remained the same in content and format
since January 2002 (Figure 1) (1). The
recommendations and format have been approved by ACIP, the American Academy
of Family Physicians, and the American Academy of Pediatrics.
Catch-Up Childhood and Adolescent Immunization Schedule
A new catch-up immunization schedule for children and adolescents who
start late or who are >1 month behind is presented for the first time in
2003 (Tables 1 and 2). Minimum ages
and minimum intervals between doses are provided for each of the routinely
recommended childhood and adolescent vaccines. The schedule is divided into
two age groups, children aged 4 months--6 years and children/adolescents
aged 7--18 years.
Hepatitis B Vaccine
The schedule indicates a preference for administering the first dose of
hepatitis B vaccine to all newborns soon after birth and before hospital
discharge. Administering the first dose of hepatitis B vaccine soon after
birth should minimize the risk for infection caused by errors or delays in
maternal hepatitis B surface antigen (HBsAg) testing or reporting, or by
exposure to persons with chronic hepatitis B virus (HBV) infection in the
household, and can increase the child's likelihood of completing the vaccine
series. Only monovalent hepatitis B vaccine can be used for the birth dose.
Either monovalent or combination vaccine can be used to complete the series.
Four doses of hepatitis B vaccine can be administered to complete the series
when a birth dose is given. In addition to receiving hepatitis B immune
globulin (HBIG) and the hepatitis B vaccine series, infants born to HBsAg-positive
mothers should be tested for HBsAg and antibody to HBsAg (anti-HBs) at age
9--15 months to identify those with chronic HBV infection or those who might
require revaccination (2).
Influenza Vaccine
In addition to the recommendation to administer annual influenza vaccine
to children at high risk, healthy children aged 6--23 months are encouraged
to receive influenza vaccine when feasible. Children in this age group are
at substantially increased risk for influenza-related hospitalizations (3).
Inactivated Poliovirus Vaccine
The inactivated poliovirus (IPV) vaccine footnote has been removed from
the Recommended Childhood and Adolescent Immunization Schedule, reflecting
the cessation of the use of oral poliovirus (OPV) vaccine in the United
States. An all-IPV schedule for routine childhood poliovirus vaccination has
been recommended in the United States since January 1, 2000 (4). All
children should receive 4 doses of IPV at age 2, 4, and 6--18 months, and at
age 4--6 years. For children who received an all-IPV or all-OPV series, a
fourth dose is not necessary if the third dose was administered at age >4
years. If both OPV and IPV were administered as part of a series, a total of
4 doses should be administered regardless of the child's current age. These
statements clarify the "Dose Three to Booster Dose" column in
Table 2 of the catch-up schedule. Routine poliovirus
vaccination is not generally recommended for persons aged >18 years
residing in the United States (5).
Vaccine Supply Recommendations
As a result of the vaccine supply shortage, deferral of some doses of
pneumococcal conjugate vaccine (PCV) has been recommended (6);
health-care providers should record patients for whom vaccination has been
deferred and should contact them once the supply has been restored. Supplies
of tetanus and diphtheria toxoids (Td) vaccine; diphtheria and tetanus
toxoids and acellular pertussis (DTaP) vaccine; measles, mumps, and rubella
(MMR) vaccine; and varicella vaccine in the United States have become
sufficient to permit the resumption of the routine schedule for use as
recommended by ACIP (7--9). The range of recommended ages for the Td
vaccine has been extended to 18 years to emphasize that the vaccine can be
administered during any visit if at least 5 years have elapsed since the
last dose of tetanus and diphtheria toxoid--containing vaccine. Information
about vaccine shortages is available from CDC's National Immunization
Program at
http://www.cdc.gov/nip/news/shortages/default.htm.
Vaccine Information Statements
The National Childhood Vaccine Injury Act requires that all health-care
providers give parents or patients copies of Vaccine Information Statements
before administering each dose of the vaccines listed in the schedule.
Additional information is available from state health departments and at
http://www.cdc.gov/nip/publications/vis. Detailed recommendations for
using vaccines are available from the manufacturers' package inserts, ACIP
statements on specific vaccines, and the 2000 Red Book (10).
ACIP statements for each recommended childhood vaccine can be viewed,
downloaded, and printed from CDC's National Immunization Program at
http://www.cdc.gov/nip/publications/acip-list.htm; instructions on the
use of the Vaccine Information Statements are available at
http://www.cdc.gov/nip/publications/vis/vis-instructions.pdf.
References
- CDC. Recommended childhood immunization schedule---United States,
2002. MMWR 2002;51:31--3.
- CDC. Hepatitis B virus: a comprehensive strategy for eliminating
transmission in the United States through universal childhood vaccination:
recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 1991;40(No. RR-13).
- CDC. Prevention and control of influenza: recommendations of the
Advisory Committee on Immunization Practices (ACIP). MMWR 2002;51(No.
RR-3).
- CDC. Updated recommendations on the use of pneumococcal conjugate
vaccine in a setting of vaccine shortage---Advisory Committee on
Immunization Practices. MMWR 2001;50:1140--2.
- CDC. Recommendations of the Advisory Committee on Immunization
Practices: revised recommendations for routine poliomyelitis vaccination.
MMWR 1999;48:590.
- CDC. Poliovirus prevention in the United States: updated
recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 2000;49(No. RR-5).
- CDC. Resumption of routine schedule for tetanus and diphtheria toxoids.
MMWR 2002;51:529--30.
- CDC. Resumption of routine schedule for diphtheria and tetanus toxoids
and acellular pertussis vaccine and for measles, mumps, and rubella
vaccine. MMWR 2002;51:598--9.
- CDC. Resumption of routine schedule for varicella vaccine. MMWR
2002;51:679.
- American Academy of Pediatrics. Active and passive immunization. In:
Pickering LK, ed. 2000 Red Book: Report of the Committee on Infectious
Diseases; 25th ed. Elk Grove Village, Illinois: American Academy of
Pediatrics, 2000.
Figure 1
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Table 1
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Table 2
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