By Deepi Brar, M.S.
Every year the American Academy of Pediatrics, the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians revise their schedule of childhood immunizations.
In 1995, they added a vaccine that protects against the varicella virus which causes chicken pox; in 2000, they added one that fights pneumococcal bacteria, which cause pneumonia; and in 2005, another was added to help prevent meningococcal disease, which causes meningitis.
In June 2006, the U.S. Food and Drug Administration approved the human papillomavirus (HPV) vaccine. Shortly thereafter, the CDC's Advisory Committee on Immunization Practices (ACIP) recommended the vaccine for females aged 9 to 26 years old. The CDC then adopted the ACIP recommendation in its immunization schedule. The vaccine protects against certain types of HPV that are responsible for 70 percent of cervical cancers and 90 percent of genital warts.
Another vaccine added to the schedule in the late '90s was designed to protect against rotavirus, a common cause of severe diarrhea. The government suspended the rotavirus vaccine in mid-July 1999, because of possible risks. However, in February 2006, the ACIP recommended a newly designed rotavirus vaccine for infants. The ACIP made its recommendation after reviewing a study that involved 70,000 children in which the new vaccine showed no association with the previous one's risks. The CDC accepted the new rotavirus vaccine in its immunization schedule in February 2007.
A new version of the pertussis (whooping cough) vaccine (DTaP), which causes fewer side effects, was also made available to children in 1991 and, more recently, to infants. All these immunizations are age-specific; it's important to stick to the recommended timetable, since some vaccines are not safe or effective before or after a particular age.
For a PDF version of the CDC's 2010 immunization schedule, go to the website at: http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm.
Detailed information on timing these immunizations:
Hep B: All babies should receive the first dose of Hep B vaccine soon after birth, before they are discharged from the hospital, though babies born to hepatitis B surface antigen (HBsAg)-negative mothers may delay the first dose in rare circumstances. If combination vaccine containing Hep B is used for the rest of the vaccination series, four doses may be administered: The second dose at least 4 weeks after the first dose, and the third dose 8 weeks later (and at least 16 weeks after the first dose.) The last dose should not be administered before the baby is 6 months old. Babies born to HBsAg-positive mothers should receive the Hep B vaccine and hepatitis B immune globulin within 12 hours of birth at separate sites. The second dose is recommended at 1 to 2 months, and the final dose (the third or fourth) at 6 months. Children and teens through age 18 who haven't been vaccinated against hepatitis B can begin the series at any time. Babies born to mothers whose HBsAg status is unknown should receive their first dose of HepB within 12 hours of birth. The mother's blood should be tested for HBsAg status as soon as possible; if the test is positive, her baby should receive HBIG right away, and before the baby is one week old. The second dose should be given at 1-2 months. The last dose should not be given before the baby is 6 months old.
DTaP: The CDC recommends a series of five shots of the DTaP vaccine that protects against diptheria, tetanus, and pertussis. Children usually get their first shot at age 2 months, followed by shots at 4 months, 6 months, 15-18 months, and 4-6 years. In the wake of a 2010 pertussis outbreak in California, CDC's Advisory Committee on Immunization Practices, or ACIP, voted to recommend that children ages 7-9 years who did not complete the recommended childhood series of DtaP receive a catch-up dose of Tdap. Kids should also get a booster of tetanus and diphtheria toxoids (Td) at age 11 to 12 if it's been at least 5 years since their last DTP or DTaP shot. In 2005, the FDA approved a new tetanus and acellular pertussis vaccine for adolescents (Tdap adolescent preparation), given in one dose to children who miss their 11-12-year Td/Tdap booster. Everyone should get a Td booster every 10 years.
Hib: If a baby gets Hib conjugate vaccines at 2 and 4 months, she doesn't need a third dose at 6 months. The final dose in the series should not be given before the child is 12 months old. Avoid DTaP/Hib combination products for the first three doses because they may not provide the same level of immunity as the separate vaccines.
Polio: The oral vaccine (OPV) containing live bacteria is no longer recommended for children in the United States and as of 2000, the CDC recommends using the inactivated form (IPV) for all four doses. Children should receive four doses of IPV at 2 months, 4 months, 6-18 months, and on or after the 4th birthday.
Pneumococcal (PCV): Recommended for all children 2 to 23 months of age and children age 2 to 5 who are at high risk for pneumococcal infection or with weak immune systems. Children under 24 months get four doses of PCV at 2, 4, 6, and 12 to 15 months of age, and children over 24 months of age get one dose of PCV if they have been partially immunized.
Rota: The Rotavirus vaccine should be administered in three doses, at ages 2, 4, and 6 months. (If Rotarix vaccine is used, the third dose at 6 months is not needed.) The first dose should be given at 6 to 12 weeks, with subsequent doses at four to 10-week intervals. The vaccine should not be started when the child is older than 15 weeks or continued after 32 weeks.
MMR: The first dose should be administered at 12 to 15 months of age. Experts recommend the second dose of MMR at 4-6 years, but kids can receive it anytime at least 4 weeks after the first dose (as long as they get both after 12 months of age). If they miss the second dose, they can get it anytime up to age 18.
Var: Susceptible babies (those who lack a reliable history of chickenpox) should get this vaccine at 12 to 15 months and a second dose at 4 to 6 years of age. Susceptible children over age 13 should get two doses at least 4 weeks apart.
Hep A: This vaccine is now recommended for all children at the age of 1 year. There are two doses, given 6 months apart. Children older than 1 year can have the vaccine if they missed it earlier and immunity is desired.
Influenza vaccine: A yearly flu shot is recommended for all children aged 6 months to 18 years. Children under 9 who are getting vaccinated for the first time should receive two doses separated by at least a month. Healthy people between the ages 5 and 49 can opt for the nasal spray vaccine instead of the injected version.
MCV4: The FDA approved Meningococcal conjugate vaccine in January 2005. All children 11 to 12 years old, previously unvaccinated adolescents and college freshmen living in dormitories should also receive MCV4.
HPV: The new human papillomavirus vaccine comes in three doses, with the second and third dose following at two and six months after the first dose. The CDC recommends routine immunization for girls who are 11 to 12 years old, though vaccination can start as young as 9. The CDC also recommends a catch-up vaccination for females between 13 and 26 who haven't been immunized or completed the full vaccine series.
Centers for Disease Control. Meningococcal Conjugate Vaccine. March 2005.
Centers for Disease Control. CDC's Advisory Committee Recommends New Vaccine to Prevent Rotavirus. February 2006.
Centers for Disease Control. HPV and HPV vaccine -- Information for Healthcare Providers. August 2006.
Centers for Disease Control. 2008 Child and Adolescent Immunization Schedules. March 2010.
Last Updated: March 11, 2013
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