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What's new in the 1999 immunization schedule
Every January, the Advisory Committee on Immunization Practices (ACIP)of the CDC, the American Academy of Pediatrics, and the American Academyof Family Physicians release their collective wisdom on the subject of recommendedchildhood immunizations. This year, the new schedule includes two significantchanges:
The schedule is reproduced on the facing page. Bars indicate the rangeof recommended ages for each dose. Any dose not given at the recommendedage should be given at a subsequent visit. Ovals indicate vaccines to begiven if recommended doses were missed or were given earlier than the recommendedminimum age. Combination vaccines may be used whenever any of the componentsare indicated and other components are not contraindicated. The followingqualifications apply:
Hepatitis B. Infants born to HBsAgnegative mothers shouldreceive the second dose at least one month after the first dose, and thethird dose at least four months after the first and two months after thesecond, but not before 6 monthsof age. Infants born to HBsAg positivemothers should receive vaccine and 0.5 mL of hepatitis B immune globulin(HBIG) within 12 hours of birth at separate sites, a second dose of vaccineat 1 to 2 months of age, and a third dose at 6 months. Infants born to mothersof unknown status should receive vaccine within 12 hours of birth, and maternalblood should be tested. If the test is positive, infants should receiveHBIG as soon as possible. Unimmunized children under 18 years of age maybegin the series at any age.
DTaP. Acellular vaccine is preferred for all doses, includingcompletion in children who have received earlier doses of whole-cell vaccine.Whole-cell DTP is an acceptable alternative. The fourth dose may be administeredas early as 12 months of age if the child is unlikely to return at 15 to18 months, provided six months have elapsed since the last dose.
Haemophilus influenzae type b(Hib) conjugate vaccines. If PRPOMPis used at 2 and 4 months, a 6-month dose is not required. DTaP/Hib combinationsshould not be used at 2, 4, or 6 months unless FDA approved for these ages.
Polio. ACIP, AAP, and AAFP now recommend that the first two dosesof polio vaccine be IPV. ACIP continues to recommend two IPV followed bytwo OPV. An allIPV schedule is also acceptable and is recommended forthe immunocompromised. OPV is acceptable for the first two doses only inspecial circumstances; it remains the vaccine of choice for mass immunizationcampaigns.
Rotavirus. The darker shading of the bar indicates that this vaccineis new and providers may need time to incorporate it into their practice.The AAFP feels the decision for use should be made in consultation betweenparents and provider. The series should begin when an infant is between6 weeks and 7 months of age. The minimum interval between doses is 3 weeks,and the series should be completed by the first birthday.
MMR. The second dose may be administered at any visit, providedat least four weeks have elapsed since the first dose and both doses areadministered after 12 months of age.
Varicella. Recommended at any visit after the first birthday forchildren who lack a reliable history of chickenpox. Susceptible persons13 years of age or older should receive two doses at least four weeks apart.
Special report. Contemporary Pediatrics 1999;0:030.