Recommended Childhood Immunization Schedule—United States, January–December 1999

Abstract

The annual Recommended Childhood Immunization Schedule of the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP) is issued in January of each year. Several significant changes for the 1999 Schedule have been made since publication of the 1998 Schedule.1This report provides the 1999 Schedule and delineates the changes, including those in the footnotes, as follows:1. Rotavirus vaccine (Rv) at 2, 4, and 6 months of age is recommended. Details of the AAP recommendations for rotavirus vaccination were published in the December 1998 issue ofPediatrics.2 Rv is shaded in theSchedule to indicate that implementation of the recommendation for routine use will require reconciliation of related economic issues, as noted in the AAP statement.2. Inactivated poliovirus vaccine (IPV) is recommended at 2 and 4 months of age. For the third and fourth doses of poliovirus vaccine, either IPV or oral poliovirus vaccine (OPV) can be administered. Details of the AAP recommendations regarding this change are given in the statement in this issue of Pediatrics.33. The manufacturer of Recombivax HB (Merck and Co, Inc, West Point, PA) has standardized the dose of this hepatitis vaccine to 5 μg for children from birth through 19 years of age regardless of maternal hepatitis B surface antigen carrier status. The change was made to avoid the confusion that occasionally occurred due to the availability of multiple dose formulations of this vaccine product. Children who have received a 2.5-μg dose of Recombivax for any or all the recommended doses are considered adequately immunized and no additional doses need to be administered. The other available hepatitis B vaccine, Engerix B (SmithKline Beecham, Pittsburgh, PA), also has a standard dose (10 μg) for all children from birth through 19 years of age. The vaccines are interchangeable when given in the doses recommended by the manufacturers.4. Acellular pertussis vaccines combined with diphtheria and tetanus toxoids (DTaP) are listed on the Schedule as the recommended product for pertussis vaccination. Whole-cell pertussis-containing vaccines (DTP) remain acceptable, as noted in the footnote.A fourth acellular pertussis-containing vaccine (Certiva [North American Vaccines, Beltsville, MD]) has been approved by the Food and Drug Administration (FDA) for immunization of infants and children. Clinical data to support the superiority of one DTaP product in comparison to the others are not available, and therefore the four approved DTaP products are considered equally acceptable. Additional questions regarding acellular pertussis vaccines have been addressed in a recent article in AAP News.45. The footnote in the Schedule pertaining toHaemophilus influenzae type b (Hib) vaccine has been modified to indicate that currently available DTaP/Hib combination products should not be used for the primary immunization series of infants unless approved by the FDA for the specific ages. The use of one such product in infants has resulted in suboptimal antibody responses.56. Minor changes to clarify recommendations have been made in the measles–mumps–rubella vaccine (MMR) and varicella footnotes, and the numbers (1, 2, and 3) for the respective doses of hepatitis B vaccine in the Schedule have been omitted to make the information consistent with that for other vaccines.Detailed recommendations for the use of the vaccines routinely indicated during infancy, childhood, and adolescence are given in the1997 Red Book,6 AAP statements (www.aap.org), and ACIP statements (www.cdc.gov/nip) on specific vaccines, and the respective manufacturers' package inserts.