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Recommendation of the Immunization Practices Advisory Committee New Recommended Schedule for Active Immunization of Normal Infants and Children

Until now, the recommended schedule for active immunization of normal infants and children called for administering combined measles-mumps-rubella (MMR) vaccine at 15 months and giving the fourth dose of Diphtheria and Tetanus Toxoids and Pertussis Vaccine (DTP) and the third dose of oral poliovirus vaccine (OPV) at 18 months (1). Two visits have been needed to receive these vaccines in the second year of life because the safety and efficacy of administering all three simultaneously had not been proven.* A large, randomized, double-blind trial has recently been completed (2), and sufficient data are now available to recommend the simultaneous administration of MMR, DTP, and OPV to all children 15 months old or older who are eligible to receive these vaccines (Table 1).

In this trial, serologic response and clinical reaction rates following primary immunization with MMR were compared in a test group of 405 children given MMR simultaneously with DTP and OPV and a control group of 410 children given MMR followed by doses of DTP and OPV vaccine 2 months later. Seroconversion rates to each MMR component exceeded 96% in both groups, and the geometric mean titers achieved against the other six antigens were also similar in both groups. Rates of most of the common vaccine-associated clinical reactions to DTP and MMR were not augmented by simultaneous administration of these two vaccines. Some minor side effects were reported more frequently in the simultaneous-administration group; however, these differences were judged to be related to artifacts of the study design rather than to differences in the safety of the two vaccine schedules.

Data from CDC's Monitoring System for Adverse Events Following Immunization (MSAEFI) have been reviewed, particularly the information from Idaho, Louisiana, and Tennessee, where policies to administer MMR, DTP, and OPV simultaneously have been in effect for periods ranging from several months to years. Although there are limitations to the use of the MSAEFI data set for this purpose, the evidence suggests no increased risk of reactions associated with the simultaneous administration of these antigens.

Although the overall implications of simultaneous administration have not been fully defined, it is anticipated that implementation of this new schedule will result in at least three benefits: (1) a decrease in the number of health-care-provider visits required for immunization during the second year of life, (2) an accompanying decrease in costs, and (3) an increase in the percentage of children who will be fully or partially immunized by 24 months of age.

Some health-care providers may continue to prefer administering MMR at 15 months followed by DTP and OPV at 18 months, especially for patients who are known to be compliant with health-care recommendations or if other purposes are served by the additional visit. Such a schedule remains an acceptable alternative to the newly proposed schedule involving simultaneous administration of DTP, MMR, and OPV in a single visit.

References

  1. ACIP: General recommendations on immunization. MMWR 1983;32:1-17.

  2. Deforest A, Long FF, Lischner HW, et al. Simultaneous administration of measles-mumps-rubella (MMR) with booster doses of diphtheria-tetanus-pertussis (DTP) and poliovirus (OPV) vaccines (unpublished data). *It should be noted that simultaneous administration of MMR, DTP, and OPV was previously recommended for children who were behind schedule in receiving their immunizations. This recommendation was based on the demonstrated safety and efficacy of other vaccine combinations (e.g., DTP and measles, or MMR and OPV).

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