The CDC has issued its new recommendations for vaccinations for U.S. children.
The 2012 schedule differ a little from the previous schedule. Here is what the CDC says about the changes:
Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the recommended adult immunization schedule to ensure that the schedule reflects current recommendations for licensed vaccines.
Vaccination providers are being advised to use all three schedules (Figure 1, Figure 2, and Figure 3) and their respective footnotes together and not separately.
Changes to the previous schedules include the following:
- Updates to Figure 1 “Recommended immunization schedule for persons aged 0 through 6 years”):
- Quadrivalent meningococcal conjugate vaccine (MCV4) purple bar has been extended to reflect licensure of MCV4-D (Menactra) use in children as young as age 9 months.
- A wording change has been introduced in the hepatitis A (HepA) vaccine yellow bar; wording now states, “Dose 1.” A new yellow and purple bar has been added to reflect HepA vaccine recommendations for children aged 2 years and older.
- Guidance is provided for administration of hepatitis B (HepB) vaccine in infants with birthweights <2,000 grams and ≥2,000 grams. Clarification is provided for doses after administration of the birth dose of HepB vaccine.
- Rotavirus (RV) vaccine footnotes have been condensed.
- Haemophilus influenzae type b (Hib) conjugate vaccine footnotes have been condensed, and use of Hiberix for the booster (final) dose has been clarified. Guidance for use of Hib vaccine in persons aged 5 years and older in the catch-up schedule has been updated.
- Pneumococcal vaccine footnotes have been condensed.
- Guidance is provided for use of measles, mumps, and rubella (MMR) vaccine in infants aged 6 through 11 months. Footnotes in the catch-up schedule have been condensed.
- HepA vaccine footnotes have been updated to clarify that the second dose of HepA vaccine should be administered 6–18 months after dose 1.
- MCV4 footnotes have been updated to reflect recent recommendations published in MMWR.
- Influenza vaccine footnotes have been updated to provide guidance on live, attenuated influenza vaccine (LAIV) contraindications.
- Influenza vaccine footnotes also have been updated to clarify dosing for children aged 6 months through 8 years for the 2011–12 and 2012–13 seasons.
- Figure 2 (“Recommended immunization schedule for persons aged 7 through 18 years”) has been updated to include number of doses for each vaccine. Information regarding the recommended age (16 years) for the booster dose of MCV4 has been added.
- Tdap vaccine recommendations for children aged 7 through 10 years have been updated.
- Human papillomavirus (HPV) vaccine footnotes have been updated to include routine recommendations for vaccination of males.
- Varicella (VAR) vaccine footnotes have been condensed.
- Inactivated poliovirus vaccine (IPV) footnotes have been updated to include upper age limit for routine vaccination. IPV footnotes in the catch-up schedule have been condensed, and relevant wording added to Figure 3 (“Catch-up immunization schedule for persons aged 4 months through 18 years who start late or who are more than 1 month behind”).
- In the catch-up immunization schedule, HepA vaccine and HepB vaccine footnotes have been removed. Relevant wording has been added to Figure 3.
- MCV4 vaccine has been added to Figure 3 along with corresponding footnotes.
A couple of weeks ago I did a little checking on the childhood vaccine schedule. I wanted to see just how many vaccines our children are really being injected with in their first two years of life, if their parents follow the CDC’s schedule.
Here is what I found.
Hepatitis B vaccine: This injection contains 1 vaccine antigen for hepatitis B. Infants receive 3 doses between birth and 2 years. Therefore, HepB gets a score of 3. Manufacturer’s insert for Engerix.
Rotavirus vaccine: This oral solution contains either 4 or 5 vaccine antigens, for different strains of the rotavirus, depending on which manufacturer makes the vaccine. We’ll go with 5, which is what Rotateq contains (see page 3, item number 3). There are 3 doses given. Therefore, Rotavirus gets a score of 15.
DTaP vaccine: This injection contains 3 vaccine antigens: 1 for diptheria, 1 for tetanus, and 1 for acelluar pertussis. Infants get 4 doses of DTaP between birth and age two years, so DTaP gets a score of 12. Manufacturer’s insert for Daptacel.
Hib vaccine: This injection contains 1 vaccine antigen. There are 4 doses, so Hib gets a score of 4. Manufacturer’s insert for ACTHib.
Pneumococcal vaccine: This injection contains 13 vaccine antigens. There are 4 doses given between birth and 2 years, so PCV gets a score of 52. Manufacturer’s insert for Prevnar-13.
Inactivated polio vaccine: This injection contains 3 vaccine antigens. There are 3 doses, so IPV gets a score of 9. Manufacturer’s insert for IPOL.
Influenza vaccine: This injection contains 3 vaccine antigens. There are two doses recommended (6 mos. and 18 mos.) prior to age 2 years. Influenza vaccine gets a score of 6. Manufacturer’s insert for Fluzone.
Measles, mumps, rubella vaccine (MMR): This injection contains 3 vaccine antigens: 1 for measles, 1 for mumps, and 1 for rubella. There is one dose given prior to age two years, so MMR gets a score of 3. Manufacturer’s insert for MMR-II.
Varicella vaccine: This injection contains 1 vaccine antigen. There is one dose given prior to two years. Varicella vaccine gets a score of 1. Manufacturer’s insert for Varivax.
Hepatitis A vaccine: This injection contains 1 vaccine antigen. The first dose is due at 12 months with the second dose anywhere from 6 to 18 months after the first. We’ll count 2 doses prior to age 2 years. Hepatitis A vaccine gets a score of 2. Manufacturer’s insert for Havrix.
Meningococcal Vaccine: This injection contains 4 vaccine antigens. Two doses are given, so Meningococcal vaccine gets a score of 8. Manufacturer’s insert for Menactra is missing from the Institute of Vaccine Safety table. The link is still there but it doesn’t take you anywhere. Here is a link to an abstract from a study of Menactra in adolescents and adults, with mentions that it is a quadravalent vaccine and contains the following strains: A, C, w135, and Y.
Now, for the math:
Hep b = 3
RV = 15
DTaP = 12
Hib = 4
PCV = 52
IPV = 9
Flu = 6
MMR = 3
VZV = 1
HepA = 2
MCV = 8
Total = 115
When your pediatrician tells you your child is “only getting 10 (or another, similarly small number) vaccines between birth and two years of age,” you may want to question which ten he or she is referring to.
NOTE: The criticism has been made that this post is inflammatory and inflates the true number of vaccines. My response is that since each separate vaccine antigen requires a response from the immune system, the totality of those antigens must be considered for their effect on the developing immune system. If they were important enough to include in the vaccine, their presence there is for the specific purpose of provoking a response; therefore, they should be counted. If we are only going to count vaccines for different diseases, regardless of the antigen, then we would have to say that hepatitis B and hepatitis A are one vaccine, even though clearly, this is not the case. The same rationale could be applied for measles and rubella, which are different measles viral strains.
I will concede that the 115 number could be misleading if you do not read this article and understand how the math was done. I have illustrated how I came to that sum, by adding the total number of vaccine antigens for each vaccine, and multiplying that number by the number of doses. This results in the 115 number (from birth to age two years). The true number of separate vaccine antigens is 38 (from birth to 2 years). These individual antigens are combined in different protocols at different stages of the schedule, which raises an entirely different set of issues with regard to vaccine safety and efficacy, due to synergistic effects. This has never been studied and is completely experimental.