Vaccination schedule

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence.

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.^[1] Many vaccines require multiple doses for maximum effectiveness, either to produce sufficient initial immune response or to boost response that fades over time. For example, tetanus vaccine boosters are often recommended every 10 years.^[2] 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.^[3]

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.^[4] In developing countries, vaccine recommendations also take into account the level of health care access, the cost of vaccines 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.^[5] This difference is due to the lower cost of health care, the lower cost of many vaccines provided to developing nations, and that 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 early 1950s, children routinely received four vaccines, for protection against (diphtheria, pertussis, tetanus, polio, and smallpox), and as many as five shots by two years of age.^[3] Since the mid-1980s, many vaccines have been added to the schedule. As of 2009^[update], the US Centers for Disease Control and Prevention (CDC) now recommends vaccination against at least fourteen 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.^[3] The use of combination vaccine products means that, as of 2009^[update], the United Kingdom's immunization program consists of 10 injections by the age of two, and a further three injections (or four, including the human papillomavirus vaccine) by the time of leaving school.^[6]

Worldwide

The World Health Organization monitors vaccination schedules across the world, noting what vaccines are included in each country's program, the coverage rates achieved and various auditing measures.^[7] The table below shows the types of vaccines given in example countries. Current vaccination schedules for all WHO member states can be accessed here. Additional vaccines are given to individuals that are much more likely to come into contact with certain diseases due to their occupation or travel to regions where the disease is present (including members of the Military), or only after potentially infectious exposure. Examples include Rabies vaccine, Anthrax vaccine, Cholera vaccine and Smallpox vaccine.^[8][9]

1. ^ At risk groups or certain populations only. See reference for more details.
2. ^ Incidence and deaths noted are for cervical cancer. Nearly 100% of cervical cancer is caused by HPV.^[21]

Country Specific Schedules

Australia

The Immunise Australia Program implements the National Immunisation Program (NIP) Schedule. All vaccines available under the Australian immunisation schedule are free of charge under the Pharmaceutical Benefits Scheme.^[22]

United Kingdom

The United Kingdom childhood vaccination schedule is recommended by the Department of Health and National Health Service, and uses combination immunisations where available (NB recent change as of December 2010: 13 month vaccination now at 12 months):^[24]

Non-routine vaccinations

Some children may receive vaccines in addition to those listed in the table:

• BCG vaccine is given at birth "to babies who are more likely to come into contact with Tuberculosis than the general population."
• Hepatitis B vaccine is given at birth "to babies whose mothers are hepatitis B positive."

Adult 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.^[25]

Pneumococcal vaccinations (pneumococcal polysaccharide vaccine/PPV) are recommended for those over 65 and for people without a functional spleen (asplenia), either because the spleen has been removed or does not work properly.^[26]

Flu vaccine is recommended for anyone who is aged 65 years and over, people with certain long-term medical conditions, health and social care professionals and poultry workers.^[27]

United States

The Recommended Childhood and Adolescent Immunization Schedule and the Recommended Adult Immunization Schedule are revised annually. The most up-to-date schedules are available from CDC's National Center for Immunization and Respiratory Diseases. 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.^[28]

See also

• Influenza vaccine
• H5N1 clinical trials
• 2009 flu pandemic vaccine

References

External links

• National Center for Immunization and Respiratory Diseases. "CDC National Immunization Program". (U.S.) Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/. Retrieved 2008-06-14. 
• UK National Health Service. "The UK immunisation schedule". National Health Service. http://www.immunisation.nhs.uk. Retrieved 2006-11-03. 
• UN World Health Organisation. "Reported immunization schedule by regions/countries/antigens" (CFM). World Health Organisation. http://www.who.int/vaccines/globalsummary/immunization/scheduleselect.cfm. Retrieved 2010-05-07.