Vaccination schedule
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A '''vaccination schedule''' is a recommended series of [[vaccination]]s including the suggested timing of all doses. A [[vaccine]] is an [[antigen]]ic 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]]. Many vaccines require multiple doses for maximum effectiveness, either to produce sufficient initial immune response or to boost response that fades over time. 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.
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.<ref>Update on Yellow Fever in the Americas, http://www.paho.org/english/SHA/be_v21n2-yellowfever.htm, the Epidemiological Bulletin, Vol. 21 No. 2, June 2000, Pan American Health Organization, accessed July 18, 2007</ref> In developing countries, vaccine recommendations also have to consider poor health care access, high vaccine cost 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.<ref name="WHO2"> [http://www.who.int/vaccines-documents/DocsPDF04/wwwSOWV_E.pdf State of the World's Vaccines and Immunizations (pdf)] from the [[World Health Organization]] (2003 edition)</ref> This difference incorporates the facts that health care costs are much lower, many vaccines are provided at lower costs to developing nations and 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 1960s, children routinely received five vaccines, for protection against ([[diphtheria]], [[pertussis]], [[tetanus]], [[polio]], and [[smallpox]]), and as many as eight shots by two years of age. [[As of 2007]], the US [[Centers for Disease Control]] (CDC) now recommends [[vaccination]] against at least sixteen 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. The use of combination vaccine products means that, [[as of 2006]], the [[United Kingdom]] immunisation programme consists of just 11 injections by the age of two years and a further three injections by the time of leaving school.
==Diseases and vaccines==
{| class="wikitable" style="margin: 1em auto 1em auto"
|+'''Characteristics of diseases vaccinated against in most vaccine schedules'''
|-
|rowspan="2" |
!colspan="2" | Disease<ref name= "WHO">[http://www.who.int/immunization/topics/en/ '''Estimated''' Incidence/deaths] World Health Organization ''Immunization, Vaccines and Biologicals'' Year 2000 data (unless noted) (Note: Please choose appropriate disease)</ref>
!colspan="2" | Worldwide<ref name= "WHO"/>
!colspan="2" | U.S.<ref name= "CDC1">[http://www.cdc.gov/nip/publications/pink/Appendices/appdx-full-g.pdf '''Reported''' cases/deaths (pdf)] CDC "Pink Pages", Year 2002 data </ref>
!colspan="2" | U.K.<ref name=UK1>[http://www.immunisation.nhs.uk/article.php?id=91 '''Reported''' cases/deaths] NHS Immunisation Information, Year 2000 data (unless noted)</ref>
|-
!Transmission
!Incubation
!Incidence
!Deaths
!Incidence
!Deaths
!Incidence
!Deaths
|-
|[[Diphtheria]]
| Saliva
| 1-4 days
| 30,000
| 3,000
| 1
| 0
| 0
| 0
|-
|[[Haemophilus influenzae|Haemophilus <br>influenzae]]
|By airborne droplet
|1-4 days
|2-3,000,000
|450,000<br/><small>(mostly children)</small>
| 1,743
| 7
| 30
| 0
|-
|[[Hepatitis B]]
| Exchange of bodily fluids
| 6 weeks - 6 months
| 5,700,00 <small>(acute)</small>
| 521,000
| 7,996
| 7
| 600<ref>[http://news.bbc.co.uk/2/hi/health/2664171.stm ''Call for hepatitis B vaccination''] BBC News, 16 January, 2003.</ref>
| <small>Not reported<small/>
|-
|[[Measles]]
|Airborne
|10-12 days
|30-40,000,000
|610,000<ref>[http://www.who.int/mediacentre/factsheets/fs286/en/ See also: Estimated regional measles deaths (with uncertainty bounds)] Fact sheet N°286 (2004). The World Health Organization (WHO) and UNICEF. Revised March 2006.</ref>
| 44
| 0
| 77 <ref name="BBC">[http://news.bbc.co.uk/1/hi/england/5081286.stm ''UK 'in grip of measles outbreak'''] BBC News. Statistics: 2005. First measles related death in the UK in 14 years</ref>
| 1 <ref name="BBC"/>
|-
|[[Mumps]]
|Airborne droplets
|14-21 days
|477,079 <small>(reported)<small/>
| N/A
| 270
| 1
| 16,436 <ref>[http://news.bbc.co.uk/1/hi/health/4543343.stm ''Mumps''] BBC News, Friday, 13 May, 2005. Statistics: 2004</ref>
| 0
|-
|[[Pertussis]]
|Airborne droplets
|5-10 days
|39,000,000
|297,000
| 9,771
| 18
| 2 <ref>1999</ref>
| 2
|-
|[[Polio]]
|Fecal contamination
|Hours
| 1,951 <ref name= "WHO2005">(2005 data) Polio is endemic in only four countries; Nigeria, India, Afghanistan and Pakistan</ref>
|<1,000 <ref name= "WHO2005"/>
| 0
| 0
| 0
| 0
|-
|[[Rubella]]
|Airborne droplets
|5-7 days
|<small>Not reported<small/>
|631,571 <br>(most [[Congenital rubella syndrome|CRS]])
| 18
| (1 CRS)
| 0
| 0
|-
|[[Tetanus]]
|Penetrating injury, <br>blood contamination, <br>
|3-10 days
|18,781
|200,000 <ref>(year 2000: due to [[neonatal tetanus]] from non-sterile delivery and/or umbilical severing tools)</ref>
| 25
| 5
| 6
| 0
|-
|[[Tuberculosis]]
|Airborne
|3 day - 15 weeks
|8,000,000
|1,600,000
| 15,056<ref>[http://www.cdc.gov/nchstp/tb/surv/surv2005/PDF/table1.pdf ''Reported Tuberculosis in the United States''] The National Center for HIV, STD, and TB Prevention Statistics: 2002</ref>
| 784
| 6,572
| 373
|-
|[[Varicella]]
|Airborne
|2 weeks
|<small>Not reported<small/>
|<small>Not reported<small/>
| 22,841
| 32
|<small>Not reported<small/>
|<small>Not reported<small/>
|-
|}
==Recommended schedules==
[[Image:CDC immunization schedule.png|right|thumb|400px|US childhood vaccination schedule<ref name=US-childhood>{{cite journal |journal= MMWR Morb Mortal Wkly Rep |date=2008 |volume=57 |issue=1 |pages= Q–1–Q–4 |title= Recommended immunization schedules for persons Aged 0–18 Years — United States, 2008 |author= Centers for Disease Control and Prevention |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm}}</ref>]]
The [[World Health Organization]] monitors vaccination schedules across the world, noting what vaccines are included in each country's programme, the coverage rates achieved and various auditing measures.<ref>{{cite web | title=WHO Vaccine Preventable Diseases Monitoring System | url=http://www.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm
| date=22 December 2006 | publisher=[[World Health Organization]] | accessdate=2007-01-02}}</ref>
A comprehensive list of vaccination schedules including the European Union, Africa, and Asia is available <ref>[http://www.charakclinics.com/charak_child/blog/?p=35 International Vaccination Schedule for Children]</ref>.
===USA===
====Childhood vaccinations====
The CDC recommends the following vaccines for children aged 0-6:<ref name=US-childhood/>
* [[Tetanus]]-[[Diphtheria]]-[[Pertussis]] (TDP) vaccine
* [[Hepatitis A]] vaccine
* [[Hepatitis B]] vaccine
* [[Haemophilus influenzae type b|HiB]] vaccine
* [[Influenza]] vaccine
* Measles-Mumps-Rubella ([[MMR vaccine]])
* [[Polio]] (inactivated vaccine)
* [[Pneumococcal vaccine]]
* [[Rotavirus]] vaccine
* [[Varicella]] (chicken pox) vaccine
for children aged 11-12:
* [[DPT vaccine|TDP vaccine]]
* [[HPV vaccine|Human papillomavirus vaccine]] (for girls)
* [[Meningococcus]] vaccine
[[Image:CDC adult immunization 2007.png|right|thumb|400px|The 2007 adult immunization schedule recommended by the CDC <ref>{{cite web | title=Recommendations: Adult Immunization Schedule (Anyone over 18 years old | url=http://www.cdc.gov/vaccines/recs/schedules/downloads/adult/06-07/adult-schedule.pdf| format=PDF | publisher=[[Centers for Disease Control]] (CDC)}}</ref>]]
====Adult vaccinations====
The 2007 adult immunization schedule recommended by the CDC for adults aged 18 and over adds to the 2005 schedule Human Papilloma Virus vaccination, and is clearer in specifying guidance for at risk groups:
* [[Tetanus]]-[[Diphtheria]] [[Pertussis]] Vaccine (all adults, every 10 years)
* Human Papillomavirus Vaccine (for women)
* [[Hepatitis B]] Vaccine (adults at risk)
* [[Measles]]-Mumps-Rubella (MMR) Vaccine (all those under 50, above this age if susceptible)
* Varicella (chickenpox) Vaccine (all those under 50, for 50 - 65 years of age if susceptible, not routinely for those above 65)
* Vaccines for travelers
Vaccines recommended for those age 50 and older:
* Influenza (flu) Vaccine
Vaccines needed for those age 65 and older
* Pneumococcal Vaccine
Vaccines recommended for healthcare workers:
* Tetanus-Diphtheria Pertussis Vaccine
* Human Papillomavirus Vaccine (for women)
* Hepatitis B Vaccine
* Influenza Vaccine (annually)
* Measles-Mumps-Rubella (MMR) Vaccine
* Varicella (chickenpox) Vaccine
====Vaccine Information Statements====
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.
<br clear="right">
===UK===
====Childhood vaccinations====
As of September 2006, the United Kingdom childhood vaccination schedule uses combination immunisations where available:
{| border=2
!Vaccine||2 months||3 months||4 months||12 months||13 months||3-5 years<br>(Pre-School)||School Leaving<br>(13-18yrs)
|-
|[[Diphtheria]], [[Tetanus]], [[Pertussis]],<br>Inactivated [[Polio Vaccine]],<br>[[Haemophilus influenzae]] ('''Hib''') || DTaP/IPV/Hib|| DTaP/IPV/Hib || DTaP/IPV/Hib|| align="center"|Hib || align="center"|. || align="center"|DTaP/IPV || align="center"|Td/IPV
|-
|[[Pneumococcal polysaccharide vaccine|Pneumococcal conjugate vaccine]] || align="center"|PCV || align="center"|. || align="center"|PCV || align="center"|. ||align="center"|PCV || align="center"|. || align="center"|.
|-
|[[Neisseria meningitidis|Meningitis C]] || align="center"|. || align="center"|Men C || align="center"|Men C || align="center"|MenC || align="center"|. || align="center"|. || align="center"|.
|-
|[[Measles]], [[Mumps]], [[Rubella]]|| align="center"|. || align="center"|. || align="center"|. || align="center"|. || align="center"|MMR || align="center"|MMR || align="center"|.
|}
Notes:
This schedule was amended on [[4 September]] [[2006]] with the introduction of pneumococcal vaccine for babies, adjustment of the spacing of the MenC immunisations and an additional Hib booster at 12 months of age. A limited catch-up programme is now in place for pneumococcal vaccination.
<ref>{{cite web | title=Full immunisation schedule | url=http://www.immunisation.nhs.uk/article.php?id=97 | date=September 4, 2006 | publisher=[[National Health Service|NHS]]}}</ref>
* [[Tuberculosis]] [[Bacillus Calmette-Guérin|BCG]] vaccination is no longer part of a universal programme delivered through schools, but is targeted for those who are at greatest risk.
* Hepatitis B vaccination is sometimes offered to high risk cases.
=====2006 release of childhood vaccination records=====
According to a 2006 report, there have been "50 to 60 per cent more vaccines recorded as being administered as would be expected." The report acknowledges that entries may have been duplicated, although speculation has raised that some NHS doctors may have deliberately overstated the number of shots given to youngsters in order to claim bonuses.<ref>{{cite news | author=Jane Symons | title=National jabs scandal exposed | url=http://www.thesun.co.uk/article/0,,2-2006510771,00.html | date=November8, 2006 | publisher=[[The Sun (newspaper)|The Sun]] | accessdate=2006-11-14}}</ref>
====Adult & High-Risk 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.
* [[Pneumococcal]] and [[Flu]] vaccinations are recommended routinely for those over 65 and also for both children and adults in special risk categories:
** Serious breathing problems
** Serious heart conditions
** Severe kidney problems
** Long term liver disease
** Diabetes requiring medication
** Immunosuppression due to disease or treatment (e.g., [[chemotherapy]] or radiation therapy, long-term [[steroid]] use, and problems with the spleen ([[asplenia]]), either because the spleen has been removed or does not work properly, for example, [[sickle cell anemia]])
===Developing countries===
{| class="wikitable"
|+'''A typical childhood vaccination schedule for infants in developing countries with Yellow Fever'''<ref name="WHO2"/>
|-
!Vaccine
!Age at immunization
!Notes
|-
|[[Bacillus Calmette-Guérin|BCG]]
|Birth
|
|-
|[[Polio Vaccine|Polio]]
|6, 10 and 14 weeks
|At birth, in [[endemic (epidemiology)|endemic]] countries
|-
|[[Diphtheria]], [[Tetanus]], [[Pertussis]]
|6, 10 and 14 weeks
|
|-
|[[Hepatitis B]]
|6, 10 and 14 weeks
|Vaccine not widely available.
|-
|[[Haemophilus influenzae]]
|6, 10 and 14 weeks
|Vaccine not widely available.
|-
|[[Yellow Fever]]
| 9 months
| In countries where Yellow <br>Fever poses a risk.
|-
|[[Measles]]
| 9 months
| A second vaccination should <br>be provided.
|-
|}
== References ==
{{reflist}}
==What lies ahead==
{{seealso|Flu research}}
Many vaccinations are currently being evaluated for inclusion into the recommended vaccination schedule. Some of these combine up to five vaccinations into a single preparation, thus decreasing the number of individual vaccinations necessary.{{Fact|date=January 2008}} Others attempt to prevent diseases which currently do not have available vaccines.{{Fact|date=January 2008}} In addition, attempts to shield [[pharmaceutical]] companies which manufacture vaccines from liability are currently ongoing in the US and elsewhere, including numerous legislative initiatives in the [[United States Congress]].{{Fact|date=January 2008}}
According to Dr. Thomas Saari, spokesperson for the [[American Academy of Pediatrics]], "We project over the next ten years that we'll add one to two new vaccines a year."{{citequote}} Dr. [[Andrew Wakefield]] has said, "The next few years are likely to see the introduction of ever greater numbers of vaccines and the possibility of using combination vaccines containing up to 16 different infectious diseases, is already being discussed in the US."{{citequote}}
==See also==
*[[Influenza vaccine]]
*[[H5N1 clinical trials]]
==Sources and notes==
{{reflist}}
==External links==
* {{cite web | author=[[National Center for Immunization and Respiratory Diseases]] | title=CDC National Immunization Program | url=http://www.cdc.gov/vaccines/ | publisher=[[Centers for Disease Control and Prevention|CDC]] | accessdate=2008-06-14}}
* {{cite web | author= | title=MMR vaccine and the autism epidemic: In a compulsory inoculation program, it is the responsibility of the developers, promoters and enforcers to prove safety and efficacy | url=http://www.informedchoice.info/MMR.html | work=MMR vaccine and the autism epidemic | publisher=InformedChoice.info | accessdate=2006-09-18}}
* {{cite web | author=[[National Health Service]] of UK | title=UK Immunisation Schedule and Information| url=http://www.immunisation.nhs.uk| publisher=[[National Health Service|NHS]] | accessdate=2006-11-03}}
* {{cite web | author=[[World Health Organisation]] of UN | title=WHO Immunisation Schedule and Information| url=http://www.who.int/vaccines/globalsummary/immunization/scheduleselect.cfm| publisher=[[World Health Organisation|WHO]] | accessdate=2008-07-13}}
* {{cite web | author=EUVAC.NET | title=EU National Childhood Vaccination Schedules| url=http://www.euvac.net/graphics/euvac/vaccination/vaccination.html| publisher=[[EU|EU]] | accessdate=2008-07-13}}
{{Vaccines}}
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