Recommendation of the Immunization Practices Advisory Committee
New Recommended Schedule for Active Immunization of
Normal Infants and Children
Until now, the recommended schedule for active immunization of
normal infants and children called for administering combined
measles-mumps-rubella (MMR) vaccine at 15 months and giving the
fourth
dose of Diphtheria and Tetanus Toxoids and Pertussis Vaccine (DTP)
and
the third dose of oral poliovirus vaccine (OPV) at 18 months (1).
Two
visits have been needed to receive these vaccines in the second
year
of life because the safety and efficacy of administering all three
simultaneously had not been proven.* A large, randomized,
double-blind trial has recently been completed (2), and sufficient
data are now available to recommend the simultaneous administration
of
MMR, DTP, and OPV to all children 15 months old or older who are
eligible to receive these vaccines (Table 1).
In this trial, serologic response and clinical reaction rates
following primary immunization with MMR were compared in a test
group
of 405 children given MMR simultaneously with DTP and OPV and a
control group of 410 children given MMR followed by doses of DTP
and
OPV vaccine 2 months later. Seroconversion rates to each MMR
component exceeded 96% in both groups, and the geometric mean
titers
achieved against the other six antigens were also similar in both
groups. Rates of most of the common vaccine-associated clinical
reactions to DTP and MMR were not augmented by simultaneous
administration of these two vaccines. Some minor side effects were
reported more frequently in the simultaneous-administration group;
however, these differences were judged to be related to artifacts
of
the study design rather than to differences in the safety of the
two
vaccine schedules.
Data from CDC's Monitoring System for Adverse Events Following
Immunization (MSAEFI) have been reviewed, particularly the
information
from Idaho, Louisiana, and Tennessee, where policies to administer
MMR, DTP, and OPV simultaneously have been in effect for periods
ranging from several months to years. Although there are
limitations
to the use of the MSAEFI data set for this purpose, the evidence
suggests no increased risk of reactions associated with the
simultaneous administration of these antigens.
Although the overall implications of simultaneous
administration
have not been fully defined, it is anticipated that implementation
of
this new schedule will result in at least three benefits: (1) a
decrease in the number of health-care-provider visits required for
immunization during the second year of life, (2) an accompanying
decrease in costs, and (3) an increase in the percentage of
children
who will be fully or partially immunized by 24 months of age.
Some health-care providers may continue to prefer administering
MMR at 15 months followed by DTP and OPV at 18 months, especially
for
patients who are known to be compliant with health-care
recommendations or if other purposes are served by the additional
visit. Such a schedule remains an acceptable alternative to the
newly
proposed schedule involving simultaneous administration of DTP,
MMR,
and OPV in a single visit.
References
ACIP: General recommendations on immunization. MMWR
1983;32:1-17.
Deforest A, Long FF, Lischner HW, et al. Simultaneous
administration of measles-mumps-rubella (MMR) with booster
doses
of diphtheria-tetanus-pertussis (DTP) and poliovirus (OPV)
vaccines (unpublished data).
*It should be noted that simultaneous administration of MMR, DTP,
and
OPV was previously recommended for children who were behind
schedule
in receiving their immunizations. This recommendation was based on
the demonstrated safety and efficacy of other vaccine combinations
(e.g., DTP and measles, or MMR and OPV).
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