Children's Vaccines Health Center

New Childhood Vaccine Recommendations for a New Year

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The new recommendation for hepatitis A vaccination calls for the addition of two doses of the HAV vaccine to the routine schedule beginning at age 2 in states where risk of HAV infection is twice the national average. These states are Arizona, Alaska, Oregon, New Mexico, Utah, Washington, Oklahoma, South Dakota, Idaho, Nevada, and California.

The hepatitis B vaccine should not be confused with the hepatitis A vaccine. Hepatitis A is often acquired through contaminated water or food or from person-to-person contact; hepatitis B is acquired from exposure to blood and body fluids. The hepatitis B vaccine series begins at birth in all children throughout the U.S.

Continued suspension of the rotavirus vaccine is another change since the January 1999 recommendations were issued. The FDA in 1999 suspended approval of the vaccine after the CDC confirmed a link between receiving the vaccine and a rare form of bowel obstruction. Rotavirus causes a severe diarrheal disease in children, especially infants. An improved vaccine is needed to prevent this serious illness.

"It is possible that if we had continued with the rotavirus vaccine the benefits would have been more apparent," Modlin says. "But the risk of a serious complication, which we now know is very real, is estimated to occur in 1 in 5,000 recipients. It wasn't tenable to continue to take on that risk, even if in the very, very long run you might eventually prevent more cases of disease and death. We know what the risk is, but we can only estimate the benefits."

Another big change may come before the next annual recommendations: A pneumococcal vaccine is very close to FDA approval. "We are anticipating the availability of a new pneumococcal vaccine," Modlin tells WebMD. "We think there is a strong possibility that the FDA will license it very early in the new year." Burr, however, is skeptical that approval will come so soon. "Because of the way things work, I don't think the pneumococcal vaccine will come along real quickly," he says.

The following list represents an overview of the Y2K recommendations:

• Hepatitis B virus (HBV) vaccine: should be given from birth to age 2 months, a second dose at least 1 month after the first dose, and a third dose administered at least 4 months after the first dose and at least 2 months after the second dose. Unimmunized children may begin the series at any visit.
• Diphtheria/tetanus/acellular pertussis (DTaP) combination vaccine: should be given at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. Tetanus and diphtheria toxoids (Td) is recommended at 11-12 years of age. Td boosters are recommended every 10 years.
• Haemophilus influenzae type b (Hib) conjugate vaccine: combined vaccines should not be used for primary immunization in infants at 2, 4, or 6 months of age pending FDA approval. Hib vaccination is recommended at ages 2, 4, 6, and 12-15 months.
• Polio vaccine: oral polio vaccine no longer is recommended for routine use in the U.S. IPV should be given at 2 months, 4 months, 6-18 months, and 4-6 years of age.
• Measles/mumps/rubella (MMR) vaccine: should be given at ages 12-15 months and 4-6 years. Children not given the second dose should get it by age 11-12 years.
• Varicella vaccine: on or after the first birthday for children lacking a reliable history of chickenpox. Susceptible people 13 years of age or older should receive two doses at least 4 weeks apart.
• Hepatitis A vaccine: should be given to children 2 years of age or older in Arizona, Alaska, Oregon, New Mexico, Utah, Washington, Oklahoma, South Dakota, Idaho, Nevada, and California.