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Recommended Childhood and Adolescent Immunization Schedule
Please note:
An
erratum has been published for this article. To view the erratum, please click
here.
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.
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.
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