Over the past two decades, the recommended vaccination schedule in the United States and elsewhere has grown rapidly and become more complicated as many new vaccines have been developed and marketed. 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.

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 2005, the US Centers for Disease Control (CDC) now recommends vaccination against at least eleven diseases. By two years of age, children routinely receive as many as 20 vaccine injections, and might receive up to five shots during one visit to the doctor.

What lies ahead

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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 (such as human papilloma virus or HPV). 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.

Recommended schedules

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Characteristics of illnesses included in most vaccination schedules include:

Characteristics of illnesses in vaccination schedule

Disease	Transmission	Incubation	Mortality	Most serious effects among
Varicella	Airborne	2 weeks	Rare	Adults over 20
Hepatitis B	Exchange of bodily fluids, vertical	N/A	Rare	Chronic infection associated with cirrhosis, hepatocellular carcinoma
Measles	Airborne	10-12 days	Low in healthy patients	Adults
Mumps	Saliva	12-24 days	Rare	Adults
Rubella	Airborne	2-3 weeks	Very rare	Pregnant women
Tetanus	Penetrating injury, through blood contamination	3 day - 15 weeks	Very high	Everyone
Diphtheria	Saliva	1-4 days	High	Children
Pertussis	Airborne	7-21 days	Low in healthy patients	Children
Haemophilus influenzae	By droplet (airborne transmission is possible)	1-4 days	Very rare	Otherwise ill patients
Polio	Fecal contamination	Hours - weeks	High for Bulbar, low otherwise	Children

USA

Childhood vaccinations

The American Academy of Pediatrics recommends the following four vaccines for teenagers and one for college students:

• Varicella (chicken pox) vaccine
• Hepatitis B vaccines
• Measles-Mumps-Rubella (MMR vaccine)
• Tetanus-Diphtheria vaccine
• Meningococcus vaccine (college students)

Adult vaccinations

The 2005 adult immunization schedule recommended by the CDC for adults aged 18 and over is as follows:

• Tetanus-Diphtheria Vaccine (all adults, every 10 years)
• Hepatitis B Vaccine (adults at risk)
• Measles-Mumps-Rubella (MMR) Vaccine (susceptible adults)
• Varicella (chickenpox) Vaccine (susceptible adults)
• 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:

• 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 2005, the United Kingdom childhood vaccination schedule uses combination immunisations where available:

Vaccine	2 months	3 months	4 months	12-15 months	3-5years (Pre-School)	School Leaving (13-18yrs)
Diphtheria, Tetanus, Pertussis, Inactivated Polio Vaccine, Haemophilus influenzae (Hib)	DTaP/IPV/Hib	DTaP/IPV/Hib	DTaP/IPV/Hib	.	DTaP/IPV	Td/IPV
Menningitis C	Men C	Men C	Men C	.	.	.
Measles, Mumps, Rubella	.	.	.	MMR	MMR	.

Notes:

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

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)

References

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1. CDC.gov (pdf) - 'Recommended Childhood and Adolescent Immunization Schedule United States 2005', Centers for Disease Control (CDC)
2. CDC.gov - 'Recommendations: Adult Immunization Schedule (Anyone over 18 years old)', National Immunization Program
3. [http://www.immunisation.nhs.uk/article.php?id=97 Full immunisation schedule

External links

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• InformedChoice.info - 'MMR vaccine and the autism epidemic: In a compulsory inoculation program, it is the responsibility of the developers, promoters and enforcers to prove safety and efficacy'
• VRAN.org - 'Vaccines: Pneumococcal Vaccine - Looking at the Bigger Picture' (adapted from ditorial) Vaccine Risk Awareness Network (Fall 2000)
• When a child should NOT be immunized

Vaccination

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