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    Get an 'A' in Vaccines

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    Never Too Late to Be Up to Date

    Even if you abided by immunization deadlines when your child was younger, you may still have catch-up work because of new vaccines.

    "Early on, when immunizations became available ... (parents) were flocking to clinics to get shots for their kids. But as vaccines have been more and more successful -- and there is less direct memory in parents of how bad these diseases are -- it's dropped a little bit on the priority list," says Dr. David W. Fleming, of the Oregon Health Division in Portland.

    The chickenpox vaccine, for example, has been on the market since May 1995 and recommended by the CDC since '96. Yet varicella has remained the leading cause of vaccine-preventable deaths in this country, according to Dr. Estrada. And immunization rates in some regions are still as low as 25%, according to the CDC.

    Hepatitis B is another case in point. The disease occurs primarily in older children and young adults. Pediatricians have been less enthusiastic in giving those immunizations.

    According to Dr. Fleming, who is also a member of the Advisory Committee on Immunization Practices (ACIP), health-care providers tend to be more jazzed about newer immunizations if they prevent childhood ailments the doctor has treated. "I think we're seeing the same phenomenon with parents," he adds.

    Don't Forget Your Middle-Schooler

    There is slight variation by state, but generally, 11- to 12-year-olds need vaccines against hepatitis B, measles, mumps, rubella and varicella, if previously recommended doses were missed or given earlier than the recommended minimum age.

    In May 1999, the ACIP recommended that all states require varicella vaccination, or evidence of immunity, for children entering child care and elementary school.

    And there is talk of adding chickenpox to the existing measles, mumps and rubella vaccine to pack a quadruple wallop into a single needle stick. But that product won't be developed right away, Dr. Fleming says, and will mainly aid younger children who now face 13 separate injections by age 6.

    A Td shot -- tetanus and diphtheria toxoids -- is recommended at 11 to 12 years of age if more than five years have elapsed since the last dose of DTP, DTaP or DT. Routine Td boosters are recommended every decade.

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