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New Childhood Vaccine Recommendations for a New Year

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WebMD Health News

Jan. 4, 2000 (Atlanta) -- Childhood vaccine recommendations for the U.S. in the year 2000 bring several major changes, but few surprises. The annual advisory is a joint effort of the American Academy of Pediatrics (AAP), the CDC's Advisory Committee on Immunization Practices (ACIP), and the American Academy of Family Physicians (AAFP).

"People should know that immunization ranks right up there with the greatest achievements of the 20th century," Michael Gerber, MD, FAAP, a member of the AAP committee on infectious diseases, tells WebMD. "We have eliminated smallpox, are on the verge of eliminating polio, and can eliminate measles and other killer diseases. Because of the success of vaccination, people no longer realize how awful whooping cough or Haemophilus influenzaemeningitis can be. People need to remember that the benefits far outweigh the risks of vaccination."

The 2000 immunization schedule has three major changes: it recommends complete replacement of oral poliovirus vaccine (OPV) with inactivated poliovirus vaccine (IPV); it advises routine childhood hepatitis A virus (HAV) vaccination in 11 states; and it advises continued suspension of rotavirus vaccination.

A bigger change may come later in the year when experts anticipate FDA approval of a pneumococcal vaccine capable of preventing a common cause of bacterial meningitis and pneumonia as well as bloodstream infections.

Roger Burr, MD, MPH, a medical epidemiologist at the CDC's National Immunization Program in Atlanta, tells WebMD that the most important difference this year is the change to an all-IPV schedule. The IPV contains an inactivated virus as opposed to a live virus.

ACIP chairman John F. Modlin, MD, agrees. "The change to inactivated vaccine is part of a natural progression of policy that has been taking place over the past several years," he tells WebMD. "We have had two vaccines. The oral vaccine is live, and can cause very rare cases of poliomyelitis. Because the threat of polio is diminishing on a worldwide basis, it is now considered prudent to use the inactivated vaccine."

From 1962 until the mid-1990s, the U.S. relied entirely on the oral poliovirus vaccine. Because this live vaccine replicates just like virulent polio, it could actually spread and extend vaccine coverage in areas where relatively few people actually received the vaccine -- a phenomenon called backdoor immunity.

"In communities where vaccine acceptance rates were very low, it was considered a real advantage," says Modlin, professor of pediatrics at Dartmouth Medical School in Hanover, N.H. "OPV was used for very valid public health reasons. But now the very small risk from IPV outweighs that benefit."

In 1997, the AAP/ACIP/AAFP recommended a change in policy to two doses of IPV followed by two doses of OPV. The Y2K recommendations thus represent further evolution of this change. Modlin says, "IPV confers excellent protection against polio. ... It's a judgement call [over which vaccine to use]; there aren't any strong data to help you one way or the other. But we haven't seen polio in this country for 20 years. I think it's a very good change."

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