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CDC Releases 2003 Pediatric Vaccination Schedule

Kate Traynor

This year’s childhood and adolescent vaccinations schedule (PDF) from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) is virtually identical to the 2002 schedule except for details on the administration of influenza and hepatitis vaccines.

ACIP continues to recommend that children at high risk of influenza-related complications receive an annual flu shot, and notes this year that household contacts of these children should receive the vaccine, too. In addition, ACIP now encourages influenza vaccination of children ages 6–23 months because they are at increased risk of hospitalization from complications of influenza.

This year’s schedule, like last year’s, recommends the hepatitis A virus vaccine inactivated for children and adolescents who live in areas where the disease is common or who are at high risk for contracting the viral infection. The 2003 schedule reminds clinicians and parents that the two-dose regimen of hepatitis A vaccine can begin during any health care visit, with the second shot administered six months after the first.

Several clarifications have been made to ACIP’s recommendations for the use of hepatitis B vaccines. Last year’s schedule stated that four doses of a hepatitis B vaccine could be administered if a combination vaccine were used to complete the regimen. This year, ACIP emphasizes that four doses of vaccine may be given if the first is administered at birth and if a monovalent vaccine is used for that dose.

ACIP continues to remind health care practitioners that a combination vaccine including hepatitis B surface antigen (HBsAg) cannot be used in infants less than six weeks of age. This means that, if hepatitis B vaccination begins at birth, a combination vaccine cannot be used for the first two doses.

An expanded section of the recommendations discusses hepatitis B vaccination of infants whose mother tests positive for HBsAg or whose mother’s immune status to hepatitis B virus is unknown. ACIP continues to recommend that infants born to HBsAg-seropositive mothers receive a dose of monovalent hepatitis B vaccine and a dose of hepatitis B immune globulin within 12 hours of birth. A second dose of vaccine should be administered at one to two months of age; last year’s schedule called for this dose to be given at age six months. [Correction: According to the 2003 schedule, the third and final dose of vaccine should not be administered before the infant is six months of age; last year's schedule called for this dose to be given at age six months.]

When the mother’s hepatitis B immune status is unknown before she gives birth, ACIP recommends determining her status as soon as possible so that the infant can receive appropriate treatment if needed.

New this year to ACIP’s recommendations is a catch-up schedule (PDF) that addresses the timing of vaccinations among children and adolescents whose doses have been delayed. A vaccination regimen that has been interrupted, ACIP notes, does not need to be restarted from scratch but may continue where the series stopped.