Press Release

2000 Childhood Immunization Schedule

The Centers for Disease Control and Prevention (CDC) today announced the 2000 childhood immunization schedule, which includes changes made during the last year that ensure vaccinations for the Nation's children remain safe and effective. The new schedule appears in the January 21, 2000, issue of CDC's Morbidity and Mortality Weekly Report.

The changes in the schedule, proposed by CDC's Advisory Committee on Immunization Practices (ACIP), recommend the use of inactivated poliovirus vaccine (IPV) alone for routine childhood polio vaccination, remove rotavirus vaccine from the schedule, and recommend exclusive use of acellular pertussis (whooping cough) vaccines for all doses of the pertussis vaccine series. In addition, hepatitis A (Hep A) vaccination is now recommended for use in selected areas of the United States with high rates of hepatitis A. The American Academy of Pediatrics and the American Academy of Family Physicians have made the same recommendations regarding the childhood immunization schedule.

"Vaccines are among the safest and most successful public health tools available for preventing diseases and death," said Walter A. Orenstein, M.D., Director of the CDC's National Immunization Program. "The changes in the recommendations for polio and pertussis vaccinations and the removal of rotavirus vaccine from the schedule reflect our ongoing commitment to protecting our children's health with safe and effective vaccines.

Childhood vaccination levels in the United States are at an all-time high, and disease and death from diphtheria, pertussis, tetanus, measles, mumps, rubella and Haemophilus influenzae type b are at or near record lows. For instance, provisional data indicate there was only one reported case of diphtheria, 86 reported cases of measles, and no reported cases of wild poliovirus for 1999. Nonetheless, about 20 percent of American toddlers remain vulnerable to disease because they are not fully immunized.

Under the updated schedule, IPV is now the only polio vaccine recommended for routine use in the United States. The recommendation to use an all-IPV schedule for routine childhood polio vaccination will eliminate the rare occurrence of vaccine-associated paralytic poliomyelitis (VAPP) in the United States. All children should receive four doses of IPV at 2 months, 4 months, between 6-18 months, and 4-6 years. Since 1979, the only cases of polio in the United States have been caused by the oral poliovirus vaccine. The risk of VAPP from the oral polio vaccine is about one case in every 2.4 million doses. There have been no reported cases of vaccine-associated paralytic poliomyelitis from IPV.

The decision to remove rotavirus vaccine from the schedule was based on results of an expedited review by CDC of scientific data that indicated an association between the rotavirus vaccine and intussusception, a form of bowel obstruction, among some infants during the first one to two weeks following vaccination. Use of the rotavirus vaccine was suspended in July, and on October 22, 1999, the ACIP recommended that the vaccine no longer be used in the United States. Children who received rotavirus vaccine before July are no longer at risk for intussusception from the vaccine.

"We are committed to ongoing monitoring and to ensuring vaccine safety," said Dr. Orenstein. "While no drug, and no vaccine, is 100 percent safe, the serious adverse events that do occur following vaccination are extremely rare. The public is entitled to and should expect safe and effective vaccines. We are constantly striving to ensure vaccines are safe and effective so our children will have a healthy start to life."

A third change makes acellular pertussis vaccines the only recommended pertussis vaccine for all doses. Whole-cell pertussis vaccines are no longer recommended for use. Acellular pertussis vaccines are recommended because they are less likely to cause the adverse reactions that have been associated with the whole-cell pertussis vaccines. All children should receive diphtheria, tetanus, and acellular pertussis (DTaP) vaccine at 2 months, 4 months, 6 months, between 15 and 18 months, and between 4 and 6 years. Subsequent routine tetanus-diphtheria boosters are recommended every ten year.

The fourth change in the recommended childhood schedule will protect more children from hepatitis A, an infectious disease of the liver. The new schedule recommends vaccination of children living in States with consistently high rates of hepatitis A. Since hepatitis A vaccination is not recommended throughout the United States, parents should talk with their healthcare provider or local public health authority to find out about current recommendations for their community.

As part of ongoing efforts to continually improve vaccine safety, the CDC and other Department of Health and Human Services agencies will also be directing additional resources to vaccine safety initiatives in the coming year. These initiatives include enhancements to the Vaccine Adverse Event Reporting System, improvements in educational materials, and enhanced efforts to determine whether adverse reactions reported after vaccination are causally related or coincidental through independent expert reviews of available information. The NIP and others will also continue expansion of research designed to identify uncommon vaccine side effects.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES