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Immunization Schedules and Statistics

Vaxopedia

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Updated March 19, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Immunization Schedules

With the latest immunization schedule that was recommended for kids by the Centers for Disease Control, American Academy of Pediatrics, and Advisory Committee on Immunization Practices, kids in the United States, by the time they start kindergarten, will get:

  • 3 doses of the hepatitis B vaccine
  • 2 or 3 doses of the oral rotavirus vaccine (Rotarix or Rotateq)
  • 5 doses of the DTaP vaccine
  • 3 or 4 doses of the Hib vaccine
  • 4 doses of the Prevnar 13 vaccine
  • 4 doses of the polio vaccine
  • 2 doses of the MMR vaccine
  • 2 doses of the chicken pox vaccine (Varivax)
  • 2 doses of the hepatitis A vaccine
  • yearly flu vaccines, available as a nasal spray once kids are at least 2 years old

The number of doses required for the rotavirus and Hib vaccines depend on which brand of vaccine is used. Fewer doses are needed for Rotarix (rotavirus) and PedvaxHIB and Comvax (Hib) vaccines.

Kids can also get fewer shots if combination vaccines are used, such as:

  • Pediarix, a combination of DTaP, IPV, and the hepatitis B vaccine
  • ProQuad, a combination of MMR and Varivax
  • Pentacel, a combination of DTaP, IPV, and Hib
  • Kinrix, a combination of DTaP and IPV

Once they start school, kids need booster shots when they are 11 to 12 years old:

  • 1 dose of Tdap
  • 1 dose of Menactra or Menveo, with a booster dose at age 16
  • 3 doses of HPV vaccine (girls only)

Immunization Statistics

Another way to think about the immunization schedule is that by the time they start kindergarten, most kids will get multiple doses of 10 vaccines to protect them against 14 vaccine-preventable infections.

Why is that better than the immunization schedules from the 1980s when kids only got 10 doses of 3 vaccines (1983) or 11 doses of 4 vaccines (1989)?

Sure, they got fewer shots back then, but the more important statistic is the much higher numbers of many now vaccine-preventable infections people (mainly kids) got each year in the years before a routine vaccine was given for protection, such as:

  • Pneumonia, meningitis, and blood infections from the Streptococcus pneumoniae bacteria -- 63,067 cases and 6,500 deaths
  • Meningitis, epiglottitis, and other serious infections from the Haemophilus influenzae type b (Hib) bacteria -- 20,000 cases and 1,000 deaths
  • Hepatitis A -- 117,333 cases, 6,863 hospitalizations, and 137 deaths
  • Hepatitis B -- 66,232 cases, 7,348 hospitalizations, and 237 deaths
  • Rotavirus gastroenteritis -- 3 million cases, 70 hospitalizations, and 20 to 60 deaths
  • Chicken pox -- just over 4 million cases, 10,000 hospitalizations, and 100 deaths

Immunization Schedules in Europe

Aren't there alternatives to the CDC immunization schedule?

Of course, not everyone in the world follows the CDC immunization schedule. Some people like to point out that some other countries have immunization schedules with fewer vaccines, such as Denmark, Sweden, Finland, and Iceland.

Are their immunization schedules that different, though?

According to the National Board of Health and Welfare in Sweden, all children "are offered vaccination against nine serious diseases: diphtheria, tetanus, whooping cough, polio, Hib infection (Haemophilius influenzae type B), pneumococcal infection, measles, mumps and rubella. From January 1, 2010, all girls born 1999 or later are also offered vaccination against infection with the human papillomavirus (HPV). Children who are at high risk of infection or serious illness are offered vaccination against hepatitis B, tuberculosis, influenza and pneumococcal infection (if not already vaccinated as infants)."

And according to the Finnish National Vaccination Programme, kids in Finland routinely get the rotavirus vaccine, DTaP, IPV (polio), Hib, MMR, the Pneumococcal conjugate vaccine, and a yearly flu vaccine. Children in high-risk groups are vaccinated against tuberculosis (BCG), hepatitis B, and hepatitis A.

Iceland has added the Streptococcus pneumoniae vaccine to their routine immunization schedule, and others are studying adding it soon.

So the big difference in most European immunization schedules is a lack of a chicken pox vaccine and targeted vaccination against hepatitis A and hepatitis B, while we use universal immunization programs against these vaccine-preventable infections after previous failed attempts at targeted vaccination campaigns.

This makes sense, since:

  • Hepatitis A is not endemic in most countries in Europe
  • Hepatitis B is often found in very well-defined risk groups in many countries in Europe

However, many countries, such as Spain, already give the hepatitis B vaccine, are starting to give the HPV vaccine to teen girls, and even give the chicken pox vaccine to teens if they haven't had chicken pox yet.

Most countries in Europe are still studying the risk versus benefit analysis of routinely using the rotavirus vaccine.

The big takeaway from these other countries is not that they use fewer shots; it is what a good job they do about vaccinating their kids. In Finland, vaccination coverage statistics show that 98 to 99 percent of children are vaccinated.

Also, many countries have immunization schedules that are nearly identical to the CDC immunization schedule. Since 2007, infants in Australia, for example, have gotten five vaccines at two months of age, just like in the United States -- hepB, DTaP, Hib, IPV, Prevnar 7, and a rotavirus vaccine.

Alternative Immunization Schedules

Other alternative immunization schedules that some people continue to promote include the:

  • User-Friendly Vaccination Schedule -- beginning at age two years, one at a time, get individual pertussis (acellular pertussis), diphtheria, tetanus, and then IPV (polio) shots every six months, even though individual pertussis, diphtheria, and tetanus shots aren't available any more

  • Dr. Bob's Alternative Vaccine Schedule -- spaces out vaccines so that infants don't get more than two at a time, but they have to get monthly shots instead, delays hepatitis A and hepatitis B vaccine until kids are older, and recommends individual measles, mumps, and rubella shots instead of the combination MMR vaccine

Parents should understand that whether an alternative schedule can reduce vaccine side effects, or even safely prevent vaccine-preventable infections (the delay in getting shots can leave your child unprotected and risk for getting a vaccine-preventable infection), is untested and unproven.

More Immunization Schedule Statistics

There aren't any statistics on how many parents in the United States are now choosing alternative immunization schedules.

The National Immunization Survey does provide an ongoing survey of immunization coverage of preschoolers, showing that in 2009:

  • Less than 1 percent of children received no vaccinations
  • Coverage levels for poliovirus (92.8%), MMR (90.0%), HepB (92.4%), and the chicken pox vaccine (89.6%) continued to hold at or above 90%
  • About 84% of preschool-age kids get all four of the recommended doses they should have by 19 to 35 months of age
  • Immunization coverage for other vaccines, including rotavirus, heptatis A, and the pneumococcal vaccine, all increased

The problem with these statistics is that they don't reflect the smaller areas with lower immunization rates. In California, for example, up to 40% of kindergartners in some school districts have not received their recommended vaccines.

As vaccine rates dip below 90%, as they obviously are in these pockets with high rates of vaccine refusal and vaccine exemptions, we lose the benefit of herd immunity and it makes it easier for vaccine-preventable infections to spread.

Sources:

Australian Government Department of Health and Ageing. National Immunisation Program Schedule. Accessed February 2011.

Finland National Institute for Health and Welfare. Vaccines in Finland. Accessed February 2011.

Long: Principles and Practice of Pediatric Infectious Diseases Revised Reprint, 3rd ed. - 2009.

MMWR: National, State, and Local Area Vaccination Coverage Among Children Aged 19-35 Months -- United States, 2009. MMWR. September 17, 2010 / 59(36);1171-1177.

Sweden National Board of Health and Welfare. Vaccinations in Sweden. Accessed February 2011.

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