Simultaneous administration of childhood vaccines: an important public health policy that is safe and efficacious

The safety and immunogenicity of simultaneously administered childhood vaccines are important issues as new antigens are introduced and as efforts to vaccinate preschool children at every opportunity intensify. Parents and providers are concerned that side effects may increase and efficacy may decline when different vaccines are given together. In this paper we address these concerns by reviewing the available data which show that giving most routine, childhood vaccines concurrently is a safe and efficacious practice. It is also a policy crucial to achieving the national goal of 90% immunization coverage of 2 year olds by 1996. Multiple vaccines are routinely advised at nearly every age in the vaccination schedules recommended by the Advisory Committee on Immunization Practices (ACIP) super(2) and the American Academy of Pediatrics (AAP) super(3) (Table 1). With the addition of Haemophilus influenzae (Hib) conjugate vaccine for infants in 1990 and hepatitis B vaccine in 1991, current schedules from both the ACIP and the AAP recommend that two to four vaccines be given at each immunization visit during the first year of life. Furthermore the ACIP recommends that three to four vaccines, containing as many as eight antigens, be given at 15 months of age to all children. Both the ACIP and the AAP encourage providers to administer all indicated vaccines at every opportunity in order to complete age-appropriate immunization by the age of 2 years. However, the childhood schedules remain flexible and permit vaccination at separate times to avoid multiple injections at a single visit, particularly for children whose caregivers are considered likely to return for additional immunizations.