Tag: historical immunization schedules

Why Do We Combine Vaccines?

Do you know why they combine multiple vaccines into a single shot?

Have you ever wondered why we combine vaccines? It's not a conspiracy...
It’s not a conspiracy…

Not surprisingly, your answer likely says a lot about what you think about vaccines

Why Do We Combine Vaccines?

Combination vaccines aren’t new.

The DPT vaccine was one of the first vaccines to be combined and that was way back in 1948. Before that, protection against diphtheria, tetanus, and pertussis came from three separate injections.

Want your child to get single antigen vaccines instead of a combo because you think they are getting too much in a combination vaccine? Keep in mind that the original DTP vaccine contained 3,002 antigens in each dose. And now, they get about 650 antigens from all of the vaccines they get during their whole childhood!

Which combination vaccine came next?

No, it wasn’t MMR.

How many antigens did kids get with this old schedule?

When the first polio vaccines came out, kids got three separate vaccines against the three strains of polio. They were later combined into the single polio vaccines.

And to reduce the number of injections even further, from 1959 to 1968, Quadrigen, a DTP/Polio combination was available!

And then came the MMR combination vaccine in 1971, combining protection against measles, mumps, and rubella into one shot.

Are you starting to see why we combine vaccines?

It helps reduce the number of injections that a child receives at one visit.

It has nothing to do with trying to hide any proof of a vaccine injury, after all, most parents still get their kids the same vaccines, whether or not they are combined.

Is it to save money?

In general, combination vaccines are about the same price as individual vaccines. Some are a little more and some are a little less.

It is typically easier to order, store, and administer a combination vaccine than each of the individual vaccines separately though, which can save moey. Using combination vaccines may also help to reduce errors.

Still, combining vaccines has never been about anything more than reducing the number of shots that kids have to get to be protected.

“So, at a doctor’s visit, your child may only get two or three shots to protect him from five diseases, instead of five individual shots. Fewer shots may mean less pain for your child and less stress for you.”

CDC on Combination Vaccines

Combination vaccines allow kids today to get 10 vaccines to protect them against 14 vaccine preventable diseases, but as few as 23 individual shots by age five years.

“Combination vaccines were associated with improved completion and compliance and should be encouraged among children who are undervaccinated or who received single-antigen vaccines only.”

Kurosky et al on Effect of combination vaccines on completion and compliance of childhood vaccinations in the United States

And it helps to keep vaccination rates up!

More on Combination Vaccines

How is the Immunization Schedule Developed?

For some reason, there still seems to be a lot of confusion out there about just how the immunization schedule is developed.

Jay Gordon wonders about the research used to set the current immunization schedule...
ICYMI – Jay Gordon was Jenny McCarthy‘s pediatrician.

Who decides which vaccines we give and get?

How do they make that decision?

History of Immunization Schedule Development

While the current immunization schedule is developed by the CDC based on recommendations of the Advisory Committee on Immunization Practices (ACIP), that’s not how it was always done.

It has just been since 1995 that we have had this single, simple vaccine schedule and format.

The first unified immunization schedule was developed in 1995.
The first unified immunization schedule was developed in 1995.

Before that, we had separate vaccine schedules from the:

Even earlier, we had recommendations and schedules from

  • WHO Expanded Programme on Immunization (EPI)
  • AAP’s Special Committee on Prophylactic Procedures Against Communicable Diseases – from its start in the early 1930s, it evolved into today’s Committee on Control of Infectious Diseases
  • American Public Health Association Subcommittee on Communicable Disease Control

Differences in those schedules, which could lead to confusion, lead experts to create a simpler, unified schedule.

Well, at least in the United States. Of course, other countries still set their own schedules…

The Science Behind Setting the Immunization Schedule

Now that you know who sets the immunization, you are probably wondering how they set the immunization schedule.

To truly understand how the immunization schedule gets set up, it is best to go to an ACIP meeting when they make those decisions.

Can’t make it to Atlanta for one of the ACIP meetings?

You can watch them online!

Thoughtful discussions on setting the immunization schedule at ACIP.
Thoughtful discussions on setting the immunization schedule at ACIP.

Past ACIP meetings, agendas, minutes, slides, and videos, are archived online too.

Reading the minutes from the third meeting of the Advisory Committee on Immunization Practices on November 19-20, 1964 shows how they work, looking at data to make decisions about our vaccines and set the immunization schedule.
Reading the minutes from the third meeting of the Advisory Committee on Immunization Practices on November 19-20, 1964 shows how they work, looking at data to make decisions about our vaccines and set the immunization schedule.

Review them and you will get a very good idea of how the immunization schedule gets set up.

The first flu vaccine was developed in 1945.

ACIP basically told folks to go back to the drawing board and make a better flu vaccine at this 1966 meeting.
ACIP basically told folks to go back to the drawing board and make a better flu vaccine at this 1966 meeting.

Did you ever wonder why it took so long to get it on the immunization schedule?

Why was the primary series of polio vaccines made up of three doses?

At the Advisory Committee on Immunization Practices meeting on May 24-26, 1967 they discussed polio vaccine scheduling.
At the Advisory Committee on Immunization Practices meeting on May 24-26, 1967 they discussed polio vaccine scheduling.

Hopefully you are starting to understand how this works…

And no, all of this work doesn’t get done over a couple of days a few times a year. ACIP members belong to workgroups which focus on specific vaccines and they gather, analyze, and prepare information and research about those vaccines throughout the year.

It is at the ACIP meetings where the workgroup findings are presented.

“Development of vaccine schedules is based on a large body of basic sciences and epidemiologic research. There is constant review of evidence, adverse events, and epidemiology by a panel of experts.”

Shetty et al on Rationale for the Immunization Schedule: Why Is It the Way It Is?

And yes, among that body of research are studies of vaccines tested together, vaccines tested with placebos, vaccines tested vs unvaccinated kids, vaccines tested for long periods of time, and studies looking at risk factors to make sure vaccines don’t cause long-term health problems.

It’s a very thorough process!

And that’s why the great majority of folks understand that following the immunization schedule is the best way to keep their kids protected from vaccine-preventable diseases.

Vaccines are safe, with few risks, and are obviously necessary.

What’s not safe? What hasn’t been well studied?

Following a non-standard, parent-selected, delayed protection vaccine schedule.

Thinking that an individualized approach is better doesn't trump the 55 years of ACIP meetings that went into setting the current immunization schedule...
Thinking that an individualized approach is better doesn’t trump the 55 years of ACIP meetings that went into setting the current immunization schedule…

Studies have actually shown that delaying or skipping vaccines offers no benefits and actually puts kids at extra risk.

It puts the rest of us at risk too.

More on Setting the Immunization Schedule

Vaccine Schedules from the 1940s to 2019

To scare parents away from vaccinating and protecting their kids, anti-vaccine folks continue to push the idea the kids get too many vaccines at too early an age.

They don’t.

When did we have a vaccine schedule when we gave just two vaccines?
When did we have a vaccine schedule when we gave just two vaccines?

They try to reinforce the idea by comparing things to the “good ol’ days,” when they think kids only got one dose of one or two vaccines.

Did they?

Vaccine Schedules from the 1940s to 2019

Let’s take a look at how the vaccine schedule has evolved over time to see how many vaccines kids used to get. Looking at the old vaccine schedules can also help you understand how we got to our current schedule.

Although not a formal schedule, the first vaccine recommendations were published in the AAP’s Special Committee on Prophylactic Procedures Against Communicable Diseases 1938 pamphlet, Routine measures for the prophylaxis of communicable diseases.

It included vaccines against diphtheria, pertussis, rabies, tetanus, tuberculosis, typhoid fever, and smallpox.

A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations
A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations

That’s the schedule from 1948!

Surprised?

Many of you were led to believe that kids only got 2 vaccines back in the day. Instead, they got more vaccines and multiple doses of those vaccines.

Multiple doses with formaldehyde inactivated vaccines which contained aluminum. And thimerosal. And far more antigens than kids are exposed to today, even though they now get many more vaccines.

My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.
My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.

By the early 1950s, the DPT vaccine became routine. Other vaccines were also available for special situations, including rabies, typhoid, parathyphoid, and the BCG vaccine.

And of course, we got the polio shot in 1955!

Kids got multiple doses of DPT, DT, polio, and smallpox vaccines in 1960.
Kids got multiple doses of DPT, DT, polio, and smallpox vaccines in 1960.

Although few people remember, the original polio vaccines were monovalent and only included one polio strain in each shot. So you had to get multiple shots to get protected from all three strains!

The polio shot, was used until 1962, when we switched to the oral polio vaccine. Trivalent OPV wasn’t licensed until 1963 though. Before that, kids got multiple doses of monovalent OPV, types 1, 2, and 3.

The ACIP committee came up with four different dosage schedules for measles vaccines in 1964.
The ACIP committee came up with four different dosage schedules for measles vaccines in 1964.

And for a few years, we had both inactivated and live measles vaccines…

The recommended immunization schedule by the AAP in the 1966 Red Book. The first measles vaccine was approved in 1963.

Next came the individual mumps (1967) and rubella (1969) vaccines and the combination MMR vaccine (1971).

And the end of routine vaccination with the smallpox vaccine (1972).

Eleven doses of four vaccines protected kids against seven vaccine-preventable diseases in 1983.
Eleven doses of four vaccines protected kids against seven vaccine-preventable diseases in 1983.

The Hib vaccine was added in 1985.

Twelve doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989.
Twelve doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989.

Next came the hepatitis B vaccine and expanded age ranges for the Hib vaccine.

Seventeen doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989 (plus the later Td booster).
Nineteen doses of six vaccines protected kids against nine vaccine-preventable diseases in 1995.

What’s still missing?

Vaccines and protection against rotavirus, hepatitis A, chicken pox, flu, pneumococcal bacteria, meningococcal bacteria, and HPV. And no, they weren’t all added right after the National Childhood Vaccine Injury Act of 1986, another anti-vaccine myth!

Those vaccines were added to the schedule much later:

  • Varivax – a chickenpox vaccine (1995)
  • the polio shot – we began to switch back in 1996
  • VAQTA – the first hepatitis A vaccine was approved for high risk kids in 1996, but wasn’t actually added to the routine vaccine schedule until 2006
This is the immunization we used when I finished residency...
This is the immunization we used when I finished residency…

RotaShield, the first rotavirus vaccine was approved in 1998 but was quickly withdrawn in 1999 because of an increased risk of intussusception

What’s next?

  • Prevnar, with protection against pneumococcal bacteria (2000)
  • FluMist – the nasal spray flu vaccine (2004)
  • new flu shots recommendations for all healthy infants (2004)

Is the vaccine schedule starting to look familiar?

RotaTeq and Gardasil were added to the vaccine schedule the next year, in 2007.
RotaTeq and Gardasil were added to the vaccine schedule the next year, in 2007.

Since then, Prevnar was updated to include protection against 13 strains of pneumococcal bacteria. And we got a new vaccine that covers the B strain of meningococcal disease, but otherwise there haven’t been any major changes to the vaccine schedule in a while.

The 2019 vaccine schedule.
The 2019 vaccine schedule.

Do you see 72 vaccines on the schedule?

Kids today routinely get 13 vaccines that protect them 16 vaccine-preventable diseases.

Do you see 72 doses of vaccines on the schedule?

Guess what? These folks are deliberately misleading you.
Guess what? These folks are deliberately misleading you.

Kids don’t get 72 doses of vaccines today.

That’s an inflated number that’s used to scare parents. That it is a propaganda technique should be obvious, as the folks who use it don’t use the same anti-vaccine math to inflate the number of doses from the historical schedules.

More on Vaccine Schedules from the 1940s to 2019

How Many Vaccines Did Kids Get in the 1950s?

I recently posted an immunization schedule from the 1960s to bust the myth that kids didn’t get many vaccines before the 1970 and 80s, even though they actually got multiple doses of DTP, polio, and smallpox vaccines.

But how about if we go back even earlier than that?

My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.
My uncle got polio around the time this vaccine schedule was released in 1951, but before the first polio vaccines were being routinely used.

In 1951, infants got multiple doses of diphtheria, tetanus, and pertussis vaccines and the smallpox vaccine by the time they were 6 months old, with boosters through age 10 years.

Multiple doses with aluminum. And thimerosal. And far more antigens than kids are exposed to today, even though they now get many more vaccines.

“Tetanus toxoid recall injections should be continued every 3 years throughout life in dosage of 0.1cc to 0.2cc.”

AAP Report of the Committee on the Control of Infectious Diseases 1951

Oh, they also got revaccinated with the smallpox vaccine “every five years.”

And yes, most of the vaccines contained aluminum.

“The Committee recommends that all infants be immunized actively against diphtheria, pertussis, and tetanus with a course of injections of combined alum or aluminum phosphate precipitated, or aluminum hydroxide adsorbed diphtheria and tetanus toxoids containing H. pertussis vaccine. These products are considered preferable to fluid mixtures for the following reasons: (1) more prolonged antitoxic immunity produced by precipitated or adsorbed mixtures, (2) greater effectiveness as immunizers against pertussis in early infancy, and (3) less likelihood of producing systemic reactions because of lower protein content and slower absorption.”

AAP Report of the Committee on the Control of Infectious Diseases 1951

Other vaccines were also available for special situations, including rabies, typhoid, parathyphoid, and the BCG vaccine.

“Acetylsalicylic acid, 65 mg per year of age, should be given within an hour or two of injections and repeated 4 hours thereafter.”

AAP Report of the Committee on the Control of Infectious Diseases 1951

While it is likely a very big surprise to anti-vaccine folks that kids got multiple doses of DPT, tetanus, and smallpox vaccines back then, unfortunately, it means that they were susceptible to many diseases that are now vaccine-preventable.

Diseases that our kids don’t have to get, because they can be vaccinated and protected with vaccines that are safe, with few risks, and still necessary.

How Many Vaccines Did Kids Get in the 1950s?