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New Childhood Vaccination Policy and Immunization Schedule in USA


In 2022, the American Academy of Pediatrics (AAP) published a policy statement about the routine immunization schedule for children, which covers the most commonly-administered vaccines. There is an updated section on COVID-19 vaccines, and some other changes compared with those of previous guidelines.

The 2022 immunization schedule has been approved by the Centers for Disease Control and Prevention (CDC) and several medical associations besides AAP, including the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists.

Childhood vaccination policy in the US

Childhood immunization in the United States offers a balance between the rights of the child’s parents or guardians to decide which vaccines are administered to their children and the benefits to public health from having vaccine mandates.

According to the CDC, state laws are responsible for establishing vaccination requirements for all school-aged children. All states in the US require children to be vaccinated against specific communicable diseases as a condition for school attendance.

In most states, the school vaccination laws apply to public schools as well as private schools, with both having the same immunization schedule and exemption provisions. In addition, states may require immunization of healthcare workers and the same for individuals who live in healthcare facilities.

All US states provide medical exemptions and in some states, the laws offer exemptions for religious or philosophical reasons. The CDC works with public health agencies and other partners to monitor the immunization coverage and the safety of vaccines.

State law is responsible for establishing exemptions for school vaccination requirements, and specific requirements related to the exemptions. The graphic below is from the CDC, shows childhood immunization data from 2019. The school vaccination exemption laws are reviewed in the Public Health Law Program Assessment.

d-Immunization-Schedule-in-USA
Source: https://www.cdc.gov/phlp/publications/topic/vaccinationlaws.html?CDC_AA_refVal=https://www.cdc.gov/phlp/publications/topic/vaccinations.html

Highlights of the 2022 immunization schedule in the US

  • The HepB vaccine protects against hepatitis B. There are three doses recommended: at birth, at the age of two months and a third dose between months six and 18.
  • The RV vaccine protects against rotavirus, a virus responsible for watery diarrhea and vomiting in infants and young children. Two rotavirus vaccines are currently used for infants in the US: RotaTeq in three doses at the age of two months, four months, and six months. Rotarix® is given in two doses at the age of two months and four months.
  • Diphtheria, tetanus, and pertussis (DTaP) vaccines. The CDC recommends diphtheria vaccination for all babies, children, preteens, teens, and adults. There are four types of vaccines in the US against diphtheria, all of which also protect against other infections too: DT vaccine (for tetanus and diphtheria), Td (for tetanus and diphtheria), DTaP (for diphtheria, tetanus and pertussis) and Tdap (for tetanus, diphtheria and pertussis). DTaP is recommended for children up to seven years of age and administered at two, four, and six months, between 15 to 18 months and four to six years. Tdap is recommended for teenagers 11 to 12 years old. Td and Tdap are for adults, and administered every 10 years.
  • The Hib vaccine protects against the most common type of Haemophilus influenzae bacteria. Depending on the brand, it is given in three or four doses at two, three, and six months and the last dose between 12 to 18 months.
  • The PCV13 vaccine protects against pneumococcal bacteria, which can cause pneumonia and meningitis. There are four doses for this vaccine given at two, four, and six months and the last dose between 12 and 15 months.
  • The inactivated poliovirus (IPV) vaccine protects against polio and it comes in four doses recommended at two months, four months, between six to18 months and between four and six years of age.
  • The influenza virus vaccine protects against the flu and the shot is recommended yearly, in either one or two doses. The first dose can be given at six months of age and the second dose at least one month apart.
  • The measles, mumps and rubella (MMR) vaccine protects against measles, mumps and rubella (German measles). The first dose is recommended between 12 to 15 months of age, and the second dose between four to six years of age.
  • The varicella vaccine protects against chickenpox. The first dose of this vaccine is scheduled for between 12 to 15 months of age, and the second dose between four to six months of age. It can be given along with the MMR vaccine.
  • The hepatitis A vaccine protects against hepatitis A. The first dose is recommended between 12 and 23 months and the last dose after six months or later.
  • The HPV vaccine protects against diseases caused by human papillomavirus (HPV). This virus can cause a few types of cancer including cervical, anal, penile, head and neck cancer. Children under 15 receive two doses, six to 12 months apart and children older than 15 receive three doses.
  • The meningococcal vaccine protects against meningococcal meningitis. There are two types of meningococcal vaccines in the US: meningococcal conjugate or MenACWY vaccines; and serogroup B meningococcal or MenB vaccines. The CDC recommends MenACWY vaccine to all children age 11 to 12 and a booster at 16 years of age. Young adults aged 16 to 23 can get MenB.
  • The COVID-19 vaccine protects against infection with Sars-Cov-2 virus. The CDC recommends COVID-19 vaccines for children six months and older and boosters for everyone five years and older, if eligible.

A printable version of the vaccine schedule for children is available here. Other vaccines may be recommended by your child’s pediatrician if your child has increased risk for certain infections.

There are also non-routine vaccines available for travelers and specific groups at risk to get certain diseases, for example, vaccines protecting against adenoviruses, cholera, typhoid fever and yellow fever.

Should some children not receive vaccines?

Some children may not be able to get some vaccines, while other children may have to postpone vaccinations. Pediatricians should be notified if the child has an allergic reaction to a previous dose of vaccine, a history of Guillain-Barré Syndrome or has recently had severe illness such as prolonged seizures, or a decreased level of consciousness.

Children with minor ailments such as the common cold may be vaccinated. Children with moderate or severe illnesses may need to wait until they recover from these before getting a vaccine.

Parents and guardians should consult their child’s pediatrician to learn more about the vaccines available to children. While the list above reflects the 2022 immunization schedule in the US, the pediatrician may adjust the vaccine schedule based on your child’s needs.

Resources:

Hendrix, K., Sturm, L., Zimet, G., Meslin, E. (2015). Ethics and Childhood Vaccination Policy in the United States. American Journal of Public Health.

Centers for Disease Control and Prevention. Rotavirus.

Centers for Disease Control and Prevention. Requirements and laws for immunization managers.

Centers for Disease Control and Prevention. State laws for immunization managers.

Centers for Disease Control and Prevention. Vaccines and preventable diseases.

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