Vaccination schedule

A vaccination schedule is a recommended series of vaccinations including the suggested timing of all doses. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or 'wild' pathogen. Many vaccines require multiple doses for maximum effectiveness, either to produce sufficient initial immune response or to boost response that fades over time. Vaccine schedules are developed by governmental agencies or physicians groups to achieve maximum effectiveness using required and recommended vaccines for a locality while minimizing the number of health care system interactions. Over the past two decades, the recommended vaccination schedule has grown rapidly and become more complicated as many new vaccines have been developed.

Some vaccines are recommended only in certain areas (countries, subnational areas or at-risk populations) where a disease is common. For instance, yellow fever vaccination is on the routine vaccine schedule of French Guiana, is recommended in certain regions of Brazil but in the United States is only given to travelers heading to countries with a history of the disease.^[1] In developing countries, vaccine recommendations also have to consider poor health care access, high vaccine cost and issues with vaccine availability and storage. Sample vaccinations schedules discussed by the World Health Organization show a developed country using a schedule which extends over the first five years of a child's life and uses vaccines which cost over $700 including administration costs while a developing country uses a schedule providing vaccines in the first 9 months of life and costing only $25.^[2] This difference incorporates the facts that health care costs are much lower, many vaccines are provided at lower costs to developing nations and more expensive vaccines, often for less common diseases, are not utilized.

In 1900, the smallpox vaccine was the only one administered to children. By the 1960s, children routinely received five vaccines, for protection against (diphtheria, pertussis, tetanus, polio, and smallpox), and as many as eight shots by two years of age. As of 2007, the US Centers for Disease Control (CDC) now recommends vaccination against at least sixteen diseases. By two years of age, U.S. children receive as many as 24 vaccine injections, and might receive up to five shots during one visit to the doctor. The use of combination vaccine products means that, as of 2006, the United Kingdom immunisation programme consists of just 11 injections by the age of two years and a further three injections by the time of leaving school.

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Diseases and vaccines

Recommended schedules

  The World Health Organization monitors vaccination schedules across the world, noting what vaccines are included in each country's programme, the coverage rates achieved and various auditing measures.^[15]

USA

Childhood vaccinations

The CDC recommends the following vaccines for children aged 0-6:

• Diphtheria-Tetanus-Pertussis vaccine
• Hepatitis A vaccine
• Hepatitis B vaccine
• HiB vaccine
• Influenza vaccine
• Measles-Mumps-Rubella (MMR vaccine)
• Polio (inactivated vaccine)
• Pneumococcal vaccine
• Rotavirus vaccine
• Varicella (chicken pox) vaccine

for children aged 11-12:

• HPV vaccine
• Meningococcus vaccine

Adult vaccinations

The 2007 adult immunization schedule recommended by the CDC for adults aged 18 and over adds to the 2005 schedule Human Papilloma Virus vaccination, and is clearer in specifying guidance for at risk groups:

• Tetanus-Diphtheria Pertussis Vaccine (all adults, every 10 years)
• Human Papilloma Virus Vaccine (for women)
• Hepatitis B Vaccine (adults at risk)
• Measles-Mumps-Rubella (MMR) Vaccine (all those under 50, above this age if susceptible)
• Varicella (chickenpox) Vaccine (all those under 50, for 50 - 65 years of age if susceptible, not routinely for those above 65)
• Vaccines for travelers

Vaccines recommended for those age 50 and older:

• Influenza (flu) Vaccine

Vaccines needed for those age 65 and older

• Pneumococcal Vaccine

Vaccines recommended for healthcare workers:

• Tetanus-Diphtheria Pertussis Vaccine
• Human Papilloma Virus Vaccine (for women)
• Hepatitis B Vaccine
• Influenza Vaccine (annually)
• Measles-Mumps-Rubella (MMR) Vaccine
• Varicella (chickenpox) Vaccine

Vaccine Information Statements

In the US, the National Childhood Vaccine Injury Act requires all health-care providers to provide parents or patients with copies of Vaccine Information Statements before administering vaccines.

UK

Childhood vaccinations

As of September 2006, the United Kingdom childhood vaccination schedule uses combination immunisations where available:

Notes: This schedule was amended on 4 September 2006 with the introduction of pneumococcal vaccine for babies, adjustment of the spacing of the MenC immunisations and an additional Hib booster at 12 months of age. A limited catch-up programme is now in place for pneumococcal vaccination. ^[17]

• Tuberculosis BCG vaccination is no longer part of a universal programme delivered through schools, but is targeted for those who are at greatest risk.
• Hepatitis B vaccination is sometimes offered to high risk cases.

2006 release of childhood vaccination records

According to a 2006 report, there have been "50 to 60 per cent more vaccines recorded as being administered as would be expected." The report acknowledges that entries may have been duplicated, although speculation has raised that some NHS doctors may have deliberately overstated the number of shots given to youngsters in order to claim bonuses.^[18]

Adult & High-Risk vaccinations

• The five scheduled childhood tetanus vaccinations are thought to generally confer lifelong immunity; thus, no routine booster doses are given in adulthood. Those adults at risk of contaminated cuts (e.g., gardeners) may have booster tetanus vaccination every ten years.
• Pneumococcal and Flu vaccinations are recommended routinely for those over 65 and also for both children and adults in special risk categories:
  • Serious breathing problems
  • Serious heart conditions
  • Severe kidney problems
  • Long term liver disease
  • Diabetes requiring medication
  • Immunosuppression due to disease or treatment (e.g., chemotherapy or radiation therapy, long-term steroid use, and problems with the spleen (asplenia), either because the spleen has been removed or does not work properly, for example, sickle cell anemia)

Developing countries

What lies ahead

See also: Flu research and Vaccine controversy

Many vaccinations are currently being evaluated for inclusion into the recommended vaccination schedule. Some of these combine up to five vaccinations into a single preparation, thus decreasing the number of individual vaccinations necessary. Others attempt to prevent diseases which currently do not have available vaccines. In addition, attempts to shield pharmaceutical companies which manufacture vaccines from liability are currently ongoing in the US and elsewhere, including numerous legislative initiatives in the United States Congress. Senator Richard Burr (R-North Carolina) has introduced the most far reaching legislation, known as Biodefense and Pandemic Vaccine and Drug Development Act of 2005, that would further shield drug makers from vaccine injury liability, while streamlining vaccine approval processes to allow new vaccines to reach markets sooner, particularly in the event of a serious public health threat.

According to Dr. Thomas Saari, spokesperson for the American Academy of Pediatrics, "We project over the next ten years that we'll add one to two new vaccines a year." Dr. Andrew Wakefield has said, "The next few years are likely to see the introduction of ever greater numbers of vaccines and the possibility of using combination vaccines containing up to 16 different infectious diseases, is already being discussed in the US."

Often, immunity conferred by vaccination is life-long. However, immunity to some illnesses, such as pertussis fades over time and aging naturally increases susceptibility to disease.

Although the benefits far out way the consequences, many parents are choosing to not immunize their children.

See also

• Influenza vaccine
• H5N1 clinical trials

Sources and notes