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Appendix 1: Schedule for Routine Immunizations 1

Approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).

  1. This schedule indicates the recommended age for routine administration of currently licensed childhood vaccines. Some combination vaccines are available and may be used whenever administration of all components of the vaccine is indicated. Providers should consult the manufacturers' package inserts for detailed recommendations.

  2. Infants born to HBsAg-negative mothers should receive 2.5 g of Merck vaccine (Recombivax HB ) or 10 g of SmithKlineBeecham (SB) vaccine (Engerix-B ). The 2nd dose should be administered greater than or equal to one month after the 1st dose.

    Infants born to HBsAg-positive mothers should receive 0.5 mL hepatitis B immune globulin (HBIG) within 12 hrs of birth and either 5g of Merck vaccine (Recombivax HB ) or 10 g of SB vaccine (Engerix-B ) at a separate site. The 2nd dose is recommended at 1-2 months of age and the 3rd dose at 6 months of age.

    Infants born to mothers whose HBsAg status is unknown should receive either 5 g of Merck vaccine (Recombivax HB ) or 10 g of SB vaccine (Engerix-B ) within 12 hours of birth. The 2nd dose of vaccine is recommended at 1 month of age and the 3rd dose at 6 months of age. Blood should be drawn at the time of delivery to determine the mother's HBsAg status - if it is positive, the infant should receive HBIG as soon as possible (no later than 1 week of age). The dosage and timing of subsequent vaccine doses should be based upon the mother's HBsAg status.

  3. Children and adolescents who have not been vaccinated against hepatitis B in infancy may begin the series during any childhood visit. Those who have not previously received 3 doses of hepatitis B vaccine should initiate or complete the series during the 11-12 year-old visit. The 2nd dose should be administered at least 1 month after the 1st dose, and the 3rd dose should be administered at least 4 months after the 1st dose, and at least 2 months after the 2nd dose.

  4. DTaP (diphtheria and tetanus toxoids and acellular pertussis vaccine) is the preferred vaccine for all doses in the vaccination series, including completion of the series in children who have received greater than or equal to 1 dose of whole-cell DTP vaccine. Whole-cell DTP is an acceptable alternative to DTaP. The 4th dose of DTaP may be administered as early as 12 months of age, provided 6 months have elapsed since the 3rd dose, and if the child is considered unlikely to return at 15-18 months of age. Td (tetanus and diphtheria toxoids, adsorbed, for adult use) is recommended at 11-12 yrs of age if at least 5 years have elapsed since the last dose of DTP, DTaP, or DT.

    Subsequent routine Td boosters are recommended every 10 years.

  5. Three H. influenzae type b (Hib) conjugate vaccines are licensed for infant use. If PRP-OMP (PedavaxHIB [Merck]) is administered at 2 and 4 months of age, a dose at 6 months is not required. After completing the primary series, any Hib conjugate vaccine may be used as a booster.

  6. Two poliovirus vaccines are currently licensed in the US: inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV). The following schedules are all acceptable by the ACIP, the AAP, abd AAFP, and parents and providers may choose among them:

    1. IPV at 2 and 4 mos; OPV at 12-18 months and 4-6 years

    2. IPV at 2, 4, 12-18 months, and 4-6 years

    3. OPV at 2, 4, 6-18 months, and 4-6 years

    The ACIP routinely recommends schedule "1". IPV is the only poliovirus vaccine recommended for immunocompromised persons and their household contacts.

  7. The 2nd dose of MMR is routinely recommended at 4-6 years of age or at 11-12 years of age, but may be administered during any visit, provided at least 1 month has elapsed since receipt of the 1st dose, and that both doses are administered at or after 12 months of age.

  8. Susceptible children may receive Varicella vaccine (Var) during any visit after the 1st birthday, and unvaccinated persons who lack a reliable history of chickenpox should be vaccinated during the 11-12 year-old visit. Susceptible persons 13 years of age or older should receive 2 doses at least 1 month apart.

From the Preventive Medicine Residency Program, University of North Carolina, Chapel Hill, North Carolina

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References

  1. Kinsinger D. Schedule for Routine Immunizaitons. American Journal of Preventive Medicine March/April 1997;13(2):74-77.

Written and overseen by Lewis Mehl-Madrona, M.D., Ph.D.

Program Director, Continuum Center for Health and Healing,
Beth Israel Hospital / Albert Einstein School of Medicine

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