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.

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 A comprehensive list of vaccination schedules including the European Union, Africa, and Asia is available ¹⁶.

USA

Childhood vaccinations

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:

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.

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. ¹⁸

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.¹⁹

Adult & High-Risk vaccinations

Developing countries

References

^ Update on Yellow Fever in the Americas, http://www.paho.org/english/SHA/be_v21n2-yellowfever.htm, the Epidemiological Bulletin, Vol. 21 No. 2, June 2000, Pan American Health Organization, accessed July 18, 2007
^ ^a ^b State of the World's Vaccines and Immunizations (pdf) from the World Health Organization (2003 edition)
^ ^a ^b Estimated Incidence/deaths World Health Organization Immunization, Vaccines and Biologicals Year 2000 data (unless noted) (Note: Please choose appropriate disease)
^ Reported cases/deaths (pdf) CDC "Pink Pages", Year 2002 data
^ Reported cases/deaths NHS Immunisation Information, Year 2000 data (unless noted)
^ Call for hepatitis B vaccination BBC News, 16 January, 2003.
^ See also: Estimated regional measles deaths (with uncertainty bounds) Fact sheet N°286 (2004). The World Health Organization (WHO) and UNICEF. Revised March 2006.
^ ^a ^b UK 'in grip of measles outbreak' BBC News. Statistics: 2005. First measles related death in the UK in 14 years
^ Mumps BBC News, Friday, 13 May, 2005. Statistics: 2004
^ 1999
^ ^a ^b (2005 data) Polio is endemic in only four countries; Nigeria, India, Afghanistan and Pakistan
^ (year 2000: due to neonatal tetanus from non-sterile delivery and/or umbilical severing tools)
^ Reported Tuberculosis in the United States The National Center for HIV, STD, and TB Prevention Statistics: 2002
^ ^a ^b Centers for Disease Control and Prevention (2008). "Recommended immunization schedules for persons Aged 0–18 Years — United States, 2008". MMWR Morb Mortal Wkly Rep 57 (1): Q–1–Q–4. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm.
^ "WHO Vaccine Preventable Diseases Monitoring System". World Health Organization. 22 December 2006. http://www.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm. Retrieved on 2007-01-02.
^ International Vaccination Schedule for Children
^ "Recommendations: Adult Immunization Schedule (Anyone over 18 years old" (PDF). Centers for Disease Control (CDC). http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/06-07/adult-schedule.pdf.
^ "Full immunisation schedule". NHS. September 4, 2006. http://www.immunisation.nhs.uk/article.php?id=97.
^ Jane Symons (November8, 2006). "National jabs scandal exposed", The Sun. Retrieved on 14 November 2006.

What lies ahead

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.^{citation needed} Others attempt to prevent diseases which currently do not have available vaccines.^{citation needed} 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.^{citation needed}

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."^{cite this quote} 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."^{cite this quote}

Contents

Diseases and vaccines

Recommended schedules

USA

Childhood vaccinations

Adult vaccinations

Vaccine Information Statements

UK

Childhood vaccinations

2006 release of childhood vaccination records

Adult & High-Risk vaccinations

Developing countries

References

What lies ahead

See also

Sources and notes

External links