Tag: timeline

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

Thimerosal Hype or Hazard

You know the story about vaccines and thimerosal, right?

Unfortunately for the movie Trace Amounts, simple calling something a fact doesn't make it a fact.
Unfortunately for the movie Trace Amounts, simple calling something a fact doesn’t make it a fact. In addition to mischaracterizing how the process started, they seem to think that kids have been getting exposed to even more mercury in vaccines today…

Are you sure?

Thimerosal Timeline

Although it was never actually linked to any significant side effects, as a “precautionary measure,” the AAP recommended that thimerosal (mercury) be removed from childhood vaccines in 1999.

That’s not when the hype over thimerosal started though.

A few years before that, in 1997, an amendment to the Food and Drug Administration (FDA) Modernization Act called on the FDA to compile a list of foods and drugs with added mercury.

“At the time the FDA Modernization Act was passed, it was recommended that infants receive 3 different vaccines that contained thimerosal: diphtheria-tetanus-acellular pertussis (DTaP), hepatitis B, and Haemophilus influenzae type B (Hib). Infants who received all of these vaccines could have been exposed to a cumulative dose of mercury as high as 187.5 μg by 6 months of age. This value exceeded guidelines recommended by the Environmental Protection Agency (EPA) but did not exceed those recommended by the Agency for Toxic Substances Disease Registry (ATSDR) or the FDA.”

Offit et al on Addressing Parents’ Concerns: Do Vaccines Contain Harmful Preservatives, Adjuvants, Additives, or Residuals?

And it was found that in some circumstances, infants could get 187.5 μg of mercury from vaccines by 6 months of age, which exceeded some, but not all regulatory guidelines.

Which regulatory guidelines?

  • EPA – 89 µg
  • ATSDR – 266 µg
  • FDA – 354 µg

That led to the recommendation from the AAP, in July 1999, to remove thimerosal from vaccines, including the hepatitis B, DTaP, and Hib vaccines, the only routinely used, non-flu vaccines that had ever had thimerosal. Specifically, the AAP asked vaccine manufacturers “for a clear commitment and a plan to eliminate or reduce as expeditiously as possible the mercury content of their vaccines.”

“There is a significant safety margin incorporated into all the acceptable mercury exposure limits. Furthermore, there are no data or evidence of any harm caused by the level of exposure that some children may have encountered in following the existing immunization schedule. Infants and children who have received thimerosal-containing vaccines do not need to be tested for mercury exposure.”

Notice to Readers: Thimerosal in Vaccines: A Joint Statement of the American Academy of Pediatrics and the Public Health Service

It is important to note that thimerosal-free versions of the DTaP and Hib were already available at the time though.

So we had:

  • DTP vaccines – contained 25μg thimerosal, but had largely been replaced by DTaP vaccines at this point
  • Infanrix – a DTaP vaccine that never contained thimerosal since it was first approved in 1997 (most folks incorrectly state that Infanrix first contained trace amounts of thimerosal)
  • Tripedia – a DTaP vaccine that was first approved in 1992 and did contain 25μg thimerosal, a thimerosal-free formulation became available in March 2001 – it was discontinued in 2011
  • Acel-Imune – a DTaP vaccine that was approved in 1991 and did contain 25μg thimerosal, it was discontinued in 2001
  • Certiva – a DTaP vaccine that was approved in 1998 and did contain 25μg thimerosal, it was discontinued in 2000
  • TriHIBit – a DTaP/Hib combination vaccine that was approved in 1997 and did contain 25μg thimerosal, it was discontinued in 2011
  • Tetramune – a DTP/Hib combination vaccine that was approved in 19 and did contain 25μg thimerosal, it was later discontinued
  • OmniHib – a Hib vaccine that never contained thimerosal since it was approved in 1993
  • ActHIB – a Hib vaccine that never contained thimerosal since it was approved in 1993
  • ProHIBIT – the first Hib conjugate vaccine licensed in 1987, it contained 25μg thimerosal
  • PedvaxHIB – a Hib vaccine that never contained thimerosal since it was approved in 1989
  • HibTITER – a Hib vaccine that never contained thimerosal since it was approved in 1988, except in multidose vials (25μg thimerosal)
  • Comvax – a Hib/hepatitis B combination vaccine that never contained thimerosal
  • Recombivax HB – a hepatitis B vaccine  with 12.5μg  thimerosal that was approved in September 1983, but a thimerosal-free formulation became available in September 1999
  • Engerix B – a hepatitis B vaccine with 12.5μg  thimerosal that was approved in 1989, but a form with only a trace amount of thimerosal became available in March 2000, followed by a thimerosal-free formulation in January 2007

And of course, the other vaccines that younger kids got at the time never contained thimerosal, including hepatitis A, MMR, Varivax, polio, and Prevnar.

By January 2003, remaining stocks of vaccines with thimerosal expired.

Also in 2003, thimerosal-free flu vaccines became available, including thimerosal-free flu shots and FluMist, the nasal spray flu vaccine.

Thimerosal Hype or Hazard

So what was the big concern about thimerosal?

It wasn’t that infants were getting exposed to thimerosal in vaccines, but rather that they might get exposed to too much thimerosal.

Looking back at the available vaccines at the time, it is fairly obvious that most infants didn’t get that much thimerosal though, as there were already plenty of thimerosal-free versions of all routinely used vaccines. To get to the higher doses that some folks were concerned about, they would have to get the hepatitis B vaccine, plus thimerosal containing versions of both DTaP and Hib, and a flu shot.

Because young, otherwise healthy children are at increased risk for influenza-related hospitalization, influenza vaccination of healthy children aged 6-23 months is recommended.

Also, keep in mind that it wasn’t until 1991 that hepatitis B and Hib vaccines were added to the immunization schedule to be given to all infants.

And many kids didn’t get flu shots yet.

Remember, it was until the 2004-05 flu season that we started to see strong recommendations to give flu shots to anyone who wasn’t at high risk for complications from the flu. And by that time, thimerosal free flu shots were beginning to appear.

Still, the most important takeaway from all of this is that even though thimerosal was removed from vaccines, it was done as a precautionary measure and not because these kids were harmed. In fact, some kids were harmed in the process, especially as some infants didn’t get their newborn hepatitis B vaccine and at least one went on to get a fatal hepatitis B infection.

What to Know About Vaccines and Thimerosal

Even at the height of the thimerosal scare, most vaccines didn’t contain thimerosal.

More on Vaccines and Thimerosal

Doing the Math on Kennedy, Vaccines and Mercury

Although most anti-vaccine folks have moved on to aluminum by now, some are still sticking by thimerosal as their favorite “toxin” in vaccines to blame for causing so-called vaccine-induced diseases.

“Well, here are the numbers. And the numbers change every year. I think in 2012, there were 185 million doses of flu doses manufactured in this country. And I think fewer than 10 million were thimerosal-free. Over 90 percent had huge, huge doses of mercury.”

An interview with Robert Kennedy Jr. on vaccines

Really?

Huge, huge doses of mercury?

Thimerosal Timeline

Although it was never actually linked to any significant side effects, as a “precautionary measure,” the AAP recommended that thimerosal (mercury) be removed from childhood vaccines in 1999.

Thimerosal was removed from the hepatitis B, DTaP, and Hib vaccines, the only routinely used, non-flu vaccines that ever had thimerosal, in 2001. It is important to note that thimerosal-free versions of the DTaP and Hib vaccines were already available in the late 1990s though.

By January 2003, remaining stocks of vaccines with thimerosal expired.

Also in 2003, thimerosal-free flu vaccines became available, including thimerosal-free flu shots and FluMist, the nasal spray flu vaccine.

Doing the Math on Kennedy, Vaccines and Mercury

Robert F. Kennedy, Jr seems to get a lot of things wrong.

Is he right about the number of thimerosal-free flu vaccines in 2012?

Let’s do the math.

Ever since thimerosal-free flu vaccines became available in 2003, the supply has increased each year.

  • 2007-08: 112 million doses, with 10-12 million doses of thimerosal-free flu vaccine from Sanofi Pasteur, 7 million doses of thimerosal free FluMist, plus Afluria was thimerosal-free, and flu vaccines with trace thimerosal from Novartis and GSK
  • 2008-09: 110 million doses, with 50 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine and only 25% infants and toddlers are fully vaccinated against flu
  • 2009-10: 114 million doses, with 50 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2010-11: 155 million doses, with 74 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2011-12: 132 million doses, with 79 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2012-13: 134 million doses, with 62 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine, including 13 to 14 million doses of FluMist. While 76% of infants and toddlers were vaccinated, only 50% of pregnant women got a flu shot.
  • 2013-14: 134 million doses, with 62 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine. 13 million doses of FluMist.
  • 2014-15: 147 million doses, with 98 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine. 14 to 15 million doses of FluMist.
  • 2015-16: 146 million doses, with 116-118 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2016-17: 145 million doses, with 120 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2017-18: 155 million doses, with 130 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine

So Kennedy was wildly wrong about the number of thimerosal-free flu vaccines that were available in 2012. And he is certainly wrong about the number of thimerosal-free flu vaccines that are available today.

“Over 90 percent had huge, huge doses of mercury. Not trace amounts as the industry likes to claim. Trace amounts means less than 1 microgram. They contain 25 micrograms, which is 25 times trace amount and over 100 times what EPA’s safe exposure levels are. … So today, in the last three or four years, that number has been reduced to 48 million.”
Which number has been reduced to 48 million?
“I believe this year there were 150, around 150 million flu doses manufactured and 48 million of those, or a third, were loaded with mercury.”

An interview with Robert Kennedy Jr. on vaccines

What about his theory about the way the “industry” uses the term trace amounts?

The thimerosal content of flu vaccines has always been clearly labeled, whether it is 25mcg, or less than 1mcg, a trace amount.
The thimerosal content of flu vaccines has always been clearly labeled, whether it is 25mcg, or less than 1mcg, a trace amount.

There has never been a conspiracy to hide the thimerosal content of flu shots or any other vaccines. Those with trace amounts of thimerosal clearly have less than or equal to 1mcg per dose. Others were either thimerosal free or contained a standard amount of thimerosal, 25mcg.

Not surprisingly, this isn’t the first time Kennedy has tried to mislead people about  vaccines.

“There is no question that meningococcal meningitis is a serious disease that can cause death and disability, but we need to ensure that the solution is not worse than the problem. There is every reason to believe that mandatory meningococcal B vaccines for every college student could kill more students than the disease they protect against. Before we relinquish our rights, pay millions and sicken students, we should do the math.”

Robert F. Kennedy, Jr.: Doing the math on meningitis vaccinations

A few years ago, Kennedy responded to a resolution that had been passed by the University of Colorado-Boulder student government about new meningococcal B vaccines.

Students at the University of Colorado Boulder passed a resolution supporting menB vaccines.
Students at the University of Colorado Boulder passed a resolution supporting MenB vaccines.

For some reason, he devoted a good deal of time talking about the “hefty mercury load” that kids could get from Menomune, a vaccine that doesn’t cover the meningococcal B strain and which has largely been replaced by the newer Menactra (2006) and Menveo (2010) vaccines. In fact, Menomune was discontinued last year.

What to Know About Robert F Kennedy, Jr

Kennedy seems to mislead people about thimerosal and vaccines at every opportunity he can.

More on Robert F Kennedy, Jr