This is the current release of the guideline.

This summary updates a previous version: Patel R, Kinsinger L. Childhood immunizations: American College of Preventive Medicine practice policy. Am J Prev Med 1997 Mar-Apr;13(2):74-7.

• Haemophilus influenza b
• Hepatitis B
• Varicella
• Diphtheria
• Tetanus
• Pertussis
• Measles
• Mumps
• Rubella
• Poliomyelitis
• Streptococcus pneumoniae

Prevention

Pediatrics
Preventive Medicine

Physicians

To provide recommendations for childhood immunizations

Infants, children, and adolescents

Childhood and adolescent vaccines, including:

1. Tetanus and diphtheria toxoids (Td)
2. Diphtheria, tetanus toxoids and acellular pertussis (DTaP)
3. Measles, mumps, and rubella (MMR)
4. Haemophilus influenzae type b (Hib) conjugate vaccine
5. Hepatitis B vaccine (HepB)
6. Varicella vaccine
7. Inactivated poliovirus vacicne (IPV)
8. Pneumococcal conjugate vaccine (PCV)
9. Pneumococcal polysaccharide vaccine (PPV)
10. Hepatitis A vaccine
11. Influenza vaccine

• Morbidity and mortality from vaccine-preventable diseases
• Vaccination rates

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases

MEDLINE search, and reference lists from key articles

Not stated

Subjective Review

Not applicable

Review

Not stated

Not stated

Not applicable

The cost effectiveness of routine childhood immunizations has been well documented, with one estimate suggesting that for each dollar spent now on immunization, $10 to $14 will be saved by preventing diseases in the future.

Comparison with Guidelines from Other Groups
Peer Review

Guidelines/recommendations from the following groups were reviewed:

1. American Academy of Pediatrics' (AAP’s) Committee on Infectious Diseases
2. Centers for Disease Control and Prevention's (CDC’s) Advisory Committee on Immunization Practices
3. American Academy of Family Physicians (AAFP)
4. U.S. Preventive Services Task Force (USPSTF)

All children without established contraindications should receive diphtheria and tetanus toxoids and acellular pertussis (DTaP), measles, mumps, and rubella (MMR), haemophilus influenzae type b (Hib), hepatitis B, varicella, inactivated polio vaccine (IPV), and pneumococcal conjugate vaccinations as outlined in the Unified Schedule of Childhood Immunizations and as detailed in the Advisory Committee on Immunization Practices (ACIP’s) General Recommendations on Immunization. Children in selected areas with high rates of hepatitis A should receive hepatitis A vaccination (Wharton et al., 2003). Children with special risk factors, such as compromised immune systems, may require additional immunizations (American Academy of Pediatrics, 2000).

All healthcare providers should adopt the Standards for Child and Adolescent Immunization Practices developed by the National Vaccine Advisory Committee outlined in Table 2 in the original guideline document, and promote the Healthy People 2010 (United States Department of Health and Human Services, 2000) goal of 90% vaccination rate of 2-year-olds in their communities.

None provided

The type of evidence supporting the recommendations is not explicitly stated.

• Decreased morbidity and mortality from vaccine-preventable diseases
• Prevention of lost school and work days
• Community protection by decreasing the spread of infectious agents. The significant public health benefits of these vaccines far outweigh their infrequent harm.

Specific Benefits

Clinical studies of vaccines have shown them to be 85% to 100% effective after appropriate dosing, with the exception of pertussis, which is 62% to 92% effective. The clinical effectiveness of immunizations is best substantiated by the dramatic decline in incidence of disease since their institution. Refer to original guideline document for a discussion of the decline in incidence of specific diseases.

• Most of the adverse effects of immunizations, such as fever, local tenderness at the site of administration, and irritability, are mild and self-limited.
• Of the more serious side effects, the whole cell pertussis vaccine (DTwP) is most likely to cause adverse events with incidence of seizures or hypotonic-hyporesponsive episodes in 1 per 1750 doses. The rates of similar adverse events following immunization with acellular pertussis vaccine have not yet been determined, but because the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine causes high fever less frequently than DTwP, seizures are anticipated to be much less likely following receipt of DTaP.
• The measles, mumps, and rubella (MMR) vaccine is rarely associated with encephalopathy (1 in 1 million doses).
• Eliciting a brief history prior to administration can minimize other risks such as transmission of disease with live-virus vaccines to immunocompromised individuals or the risk of anaphylaxis in egg-allergic individuals (e.g., MMR).
• The full list of adverse effects from immunizations is listed in the AAP’s Red Book Report of the Committee on Infectious Diseases.

Several controversies in the area of childhood immunizations have recently arisen. In response to recent studies showing acellular pertussis vaccine to be equally efficacious to the whole cell vaccine with fewer side effects, it is now the preferred option. Preliminary postlicensure studies suggested an increased risk of intussusception following vaccination with the recently licensed rotavirus vaccine. Although the incidence of intussusception was low (125 per 100,000 infant years), the concern led to a suspension of the recommendation for rotavirus vaccination. Case–control studies conducted subsequently resulted in the withdrawal of rotavirus vaccine. Also recent concerns about mercury-based preservatives in vaccines have led to the development of Thimerosal-free vaccines. Although there has been growing public concern about possible links of the measles, mumps, and rubella (MMR) vaccine to autism and inflammatory bowel disease, several studies have shown a lack of causal association. Similar concerns between hepatitis B vaccine and multiple sclerosis have not been validated. The Institute of Medicine Immunization Safety Review Committee recently found no epidemiologic evidence supporting a causal relationship between multiple immunizations and an increase in the incidence of infections by other pathogens.

In order to address the issues related to suboptimal immunization coverage levels in preschool children, the National Vaccine Advisory Committee (NVAC) developed the Standards for Child and Adolescent Immunization Practices, which includes 17 standards that constitute essential vaccine policies (see Table 2 in the original guideline document). In addition, vaccination registries, follow-up and reminder systems, incentives, and performance measures such as the Health Plan Employer Data and Information Set 3.0 (HEDIS) can enhance compliance, especially for preschool children.

Staying Healthy

Effectiveness
Safety

Not applicable: The guideline was not adapted from another source.

1997 (revised 2003 Aug)

American College of Preventive Medicine - Medical Specialty Society

American College of Preventive Medicine

Practice Guidelines Committee

Authors: Yemisi Adetunji, MD, MPH, Daniel Macklin, MD, MPH, Rita Patel, MD, MPH, Linda Kinsinger, MD, MPH

Not stated

This is the current release of the guideline.

This summary updates a previous version: Patel R, Kinsinger L. Childhood immunizations: American College of Preventive Medicine practice policy. Am J Prev Med 1997 Mar-Apr;13(2):74-7.

None available

None available

This summary was completed by ECRI on September 1, 1998. The information was verified by the guideline developer as of December 1, 1998. This summary was updated by ECRI on January 8, 2004. The updated information was verified by the guideline developer on January 29, 2004.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.