University of Iowa Family Practice Handbook, Fourth Edition, Chapter 23

Reference Materials: Figure 23-10

Mark A. Graber, MD
Departments of Family Medicine and Emergency Medicine
University of Iowa College of Medicine
Peer Review Status: Externally Peer Reviewed by Mosby

*This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines as of November 1, 2000, for children through age 18 years. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and the vaccine's other components are not contraindicated. Providers should consult the manufacturer's package inserts for detailed recommendations.

ÝInfants born to hepatitis B surface antigen (HBsAg)-negative mothers should receive the first dose of hepatitis B vaccine (Hep B) by age 2 months. The second dose should be administered at least 1 month after the first dose. The third dose should be administered at least 4 months after the first dose and at least 2 months after the second dose, but not before age 6 months. Infants born to HBsAg-positive mothers should receive Hep B and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1&emdash;2 months and the third dose at age 6 months. Infants born to mothers whose HBsAg status is unknown should receive Hep B within 12 hours of birth. Maternal blood should be drawn at delivery to determine the mother's HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week). All children and adolescents (through age 18 years) who have not been immunized against hepatitis B should begin the series during any visit. Providers should make special efforts to immunize children who were born in or whose parents were born in areas of the world where hepatitis B virus infection is moderately or highly endemic.

§The fourth dose of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) may be administered as early as age 12 months, provided 6 months have elapsed since the third dose and the child is unlikely to return at age 15&emdash;18 months. Tetanus and diphtheria toxoids (Td) is recommended at age 11&emdash;12 years if at least 5 years have elapsed since the last dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP), DTaP, or diphtheria and tetanus toxoids (DT). Subsequent routine Td boosters are recommended every 10 years.

¶Three Haemophilus influenzae type b (Hib) conjugate vaccines are licensed for infant use. If Hib conjugate vaccine (PRP-OMP) (PedvaxHIB or ComVax [Merck]) is administered at ages 2 and 4 months, a dose at age 6 months is not required. Because clinical studies in infants have demonstrated that using some combination products may induce a lower immune response to the Hib vaccine component, DTaP/Hib combination products should not be used for primary immunization in infants at ages 2, 4 or 6 months unless approved by the Food and Drug Administration for these ages.

**An all-activated poliovirus vaccine (IPV) schedule is recommended for routine childhood polio vaccination in the United States. All children should receive four doses of IPV at age 2 months, age 4 months, between ages 6 and 18 months, and between ages 4 and 6 years. Oral poliovirus vaccine should be used only in selected circumstances (1).

ýýThe heptavalent pneumococcal conjugate vaccine (PCV) is recommended for all children age 2&emdash;23 months. It is also recommended for certain children age 24&emdash;59 months (2).

§§The second dose of measles, mumps, and rubella vaccine (MMR) is recommended routinely at age 4&emdash;6 years but may be administered during any visit, provided at least 4 weeks have elapsed since receipt of the first dose and that both doses are administered beginning at or after age 12 months. Those who previously have not received the second dose should complete the schedule no later than the routine visit to a health-care provider at age 11&emdash;12 years.

¶¶Varicella vaccine (Var) is recommended at any visit on or after the first birthday for susceptible children, i.e., those who lack a reliable history of chickenpox (as judged by a health-care provider) and who have not been immunized). Susceptible persons aged$13 years should receive two doses given at least 4 weeks apart.

***Hepatitis A vaccine (Hep A) is recommended for use in selected states and/or regions, and for certain high-risk groups. Information is available from local public health authorities (3). Additional information about the immunization schedule is available on the National Immunization Program World-Wide Web site, http://www.cdc.gov/nip, or by telephone, (800)232-2522 (English) or (800)232-0233 (Spanish).

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See related Provider Topics Immune System/AIDS, Immunization/Vaccination, Infections, Preventing Disease and Staying Healthy or Wellness and Lifestyle.

See related Patient Topics Immune System/AIDS, Immunization/Vaccination, Infections, Preventing Disease and Staying Healthy or Wellness and Lifestyle.

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