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Notice to Readers Recommended Childhood Immunization Schedule -- United States, January 1995

Since the 1960s, the two groups that historically have developed vaccine guidelines for the United States have been the Advisory Committee on Immunization Practices (ACIP) and the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP). During 1994, these organizations participated in a working group that included representatives from the American Academy of Family Physicians to develop one vaccination schedule that would accommodate the current ACIP and AAP recommendations and ensure the earliest administration of vaccines. The recommended childhood immunization schedule Table_1 has been endorsed by these groups and becomes effective January 1995.

In the first year of life, three doses each of diphtheria and tetanus toxoids and pertussis vaccine (DTP), Haemophilus influenzae type b (Hib) vaccine, and oral poliovirus vaccine (OPV) are recommended to be administered at ages 2, 4, and 6 months; however, the third dose of OPV may be administered through age 18 months, and for children who receive Haemophilus b conjugate vaccine (Meningococcal Protein Conjugate) (PRP-OMP) at ages 2 and 4 months, a dose at age 6 months is not required. For hepatitis B vaccine, the first dose is recommended at birth (but can be given up to age 2 months), the second at age 2 months (age 1-4 months is acceptable, provided at least 1 month has elapsed since receipt of the first dose), and the third at age 6- 18 months. Vaccines recommended at age 12-15 months can be administered simultaneously during one visit or during two separate visits. The second dose of measles, mumps, and rubella vaccine (MMR) may be given at entry to kindergarten or middle school. Diphtheria and tetanus toxoids (Td) is recommended at age 11-12 years but may be given through age 14- 16 years. When this vaccine is given at age 11-12 years, health-care providers can ensure that the child has received a second dose of MMR. Reported by: Advisory Committee on Immunization Practices. American Academy of Pediatrics. American Academy of Family Physicians. National Immunization Program, CDC.

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TABLE 1. Recommended childhood immunization schedule * --United States, January
                                     2          4          6          12 +       15         18       4 - 6     11-12     14-16
Vaccine                  Birth     Months     Months     Months     Months     Months     Months     Years     Years     Years

                         - HB-1 --------
Hepatitis B &                      - HB-2 ---------   - HB-3 --------------------------------

Diphtheria, Tetanus,                DTP        DTP        DTP      ----------- DTP ------------    DTP or   - Td ---------
  Pertussis @                                                      - or DTaP at >= 15 months --     DTaP

H. influenzae                       Hib        Hib        Hib      ------ Hib ------
  type b **

Poliovirus                          OPV        OPV      - OPV ---------------------------------     OPV

Measles, Mumps,                                                    ------ MMR ------                MMR  or   MMR
  Rubella ++


 * Recommended vaccines are listed under the routinely recommended ages. Shaded bars
   indicate range of acceptable ages for vaccination.
 + Vaccines recommended in the second year of life (i.e., 12-15 months of age) may be given
   at either one or two visits.
 & Infants born to hepatitis B surface antigen (HBsAg)-negative mothers should receive the
   second dose of hepatitis B vaccine between 1 and 4 months of age, provided at least
   1 month has elapsed since receipt of the first dose. The third dose is recommended between
   6 and 18 months of age. Infants born to HBsAg-positive mothers should receive
   immunoprophylaxis for hepatitis B with 0.5 ml Hepatitis B Immune Globulin (HBIG) within
   12 hours of birth, and 0.5 ml of either Merck Sharpe & Dohme (West Point, Pennsylvania)
   vaccine (Recombivax HB (R)) or of SmithKline  Beecham (Philadelphia) vaccine (Engerix-B (R))
   at a separate site. In these infants, the second dose of vaccine is recommended at 1 month
   of age and the third dose at 6 months of age. All pregnant women should be screened for
   HBsAg during an early prenatal visit.
 @ The fourth dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP) may be
   administered as early as 12 months of age, provided at least 6 months have elapsed since
   the third dose of DTP. Combined DTP-Hib products may be used when these two vaccines
   are administered simultaneously. Diphtheria and tetanus toxoids and acellular pertussis
   vaccine (DTaP) is licensed for use for the fourth and/or fifth dose of DTP in children aged
   >=15 months and may be preferred for these doses in children in this age group.
** Three H. influenzae type b conjugate vaccines are available for use in infants:
   1) oligosaccharide conjugate Hib vaccine (HbOC) (HibTITER (R), manufactured by Praxis
   Biologics, Inc. {West Henrietta, New York}, and distributed by Lederle-Praxis Biologicals,
   {Wayne, New Jersey}); 2) polyribosylribitol phosphate-tetanus toxoid conjugate (PRP-T)
   (ActHIB (TM), manufactured by Pasteur Merieux Serums & Vaccins, S.A. (Lyon, France), and
   distributed by Connaught Laboratories, Inc. {Swiftwater, Pennsylvania}, and OmniHIB (TM),
   manufactured by Pasteur Merieux Serums & Vaccins, S.A., and distributed by SmithKline
   Beecham); and 3) Haemophilus b conjugate vaccine (Meningococcal Protein Conjugate)
   (PRP-OMP) (PedvaxHIB (R), manufactured by Merck Sharp & Dohme). Children who have
   received PRP-OMP at 2 and 4 months of age do not require a dose at 6 months of age.
   After the primary infant Hib conjugate vaccine series is completed, any licensed Hib
   conjugate vaccine may be used as a booster dose at age 12-15 months.
++ The second dose of measles-mumps-rubella vaccine should be administered EITHER at
   4-6 years of age OR at 11-12 years of age.

Source: Advisory Committee on Immunization Practices, American Academy of Pediatrics,
and American Academy of Family Physicians.

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