November 2000
ATLANTA - The Advisory Committee on Immunization Practices (ACIP) approved the recommended childhood immunization schedule for January through December 2001.
Changes to the childhood immunization schedule include the addition of the seven-valent pneumococcal conjugate vaccine (Prevnar, Wyeth Lederle), the numbering of the three doses of hepatitis B vaccine (HepB) in the schedule to avoid confusion, adding the word "inactivated" before polio vaccine and extending the age box of 14 to 16 years to 14 to 18 years.
The ACIP also voted to add a general Web site address for any providers who seek more information, as well as an 800-number for those who aren't as computer literate as others.
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Approval closely followed data released in a July Morbidity and Mortality Weekly Report (MMWR) on vaccination coverage among U.S. children ages 19 to 35 months for 1999. National vaccination coverage for three doses of any diphtheria and tetanus toxoids and pertussis vaccine was 95.9%; three doses of poliovirus vaccine was 89.6%; three doses of Haemophilus influenzae type B was 93.5%; one dose of measles-mumps-rubella vaccine (M-M-R II, Merck) was 91.5%; three doses of HepB was 88.1%; and one dose of varicella vaccine (Varivax, Merck) was 59.4%.
The 1999 data represent 33,548 household interviews and 34,442 children, with a 66.3% response rate.
According to Walter Orenstein, MD, director of the National Immunization Program, Centers for Disease Control and Prevention, coverage levels for 1999 among children ages 19 to 35 months, or those born between February 1996 and May 1998, were virtually identical to those seen in 1998.
Findings indicate that while national vaccination coverage levels have reached the highest levels to date, there is still a substantial variation in coverage between state and urban areas.
In 1999, the mean national vaccination coverage level was 78%, with Vermont achieving the highest rates and Idaho achieving the lowest. Interestingly, both states are universal purchase states.
The pneumococcal vaccine has been ordered by 43 states for a total of 1.6 million doses as of mid-October 2000. According to Orenstein, three states ordered more than 100,000 doses and 24 states ordered less than 25,000 doses; or, in other terms, the number of orders for the pneumococcal vaccine is approximately 65% of those orders for the DTP vaccine.
"My prediction is substantially more will be needed (to reach optimal coverage)," said Orenstein. "Less vaccine than needs to be ordered has been ordered."
Barriers facing the use of conjugate pneumococcal vaccine include a lack of 317 funding, a lack of state funds to ensure maintenance of existing policies for vaccine distribution and health insurers not covering Prevnar-eligible children or those children who are referred to public providers.
For more information:
- CDC. National, state and urban area vaccination coverage levels among children aged 19-35 months - United States. MMWR. 2000;49(26):585-89.
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